PRESIDENTIAL SPECIAL OVERSIGHT BOARD
FOR DEPARTMENT OF DEFENSE INVESTIGATIONS
OF GULF WAR CHEMICAL AND BIOLOGICAL INCIDENTS
Thursday, November 19, 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
REMARKS BY BOARD MEMBERS
Hon. Warren B. Rudman, Chairman
ADM (Ret.) Elmo R. Zumwalt, Jr.
RADM (Ret.) Alan M. Steinman
CSM (Ret.) David W. Moore
Dr. Vinh Cam
LTG (Ret.) Marc A. Cisneros
STATEMENTS OF GULF WAR VETERANS
SSG Joe Poe, Jr., U.S. Army (Ret.)
Michael R. Ange
SPC Davis Austin, U.S. Army Reserve
SSG Douglas Waddell, U.S. Army (Ret.)
MAJ Denise Nichols, U.S. Air Force (Ret.)
SSG Robert Bergen, U.S. Air Force (Ret.)
CPO Larry Perry, U.S. Navy (Ret.)
CPT Seth Greene, U.S. Army Reserve
REPORT OF PERSIAN GULF VETERANS COORDINATING BOARD
BG Kevin Kiley, U.S. Army Medical Corps
Dr. Tim Gerrity
Questions and Answers
REPORT OF OFFICE OF THE SPECIAL ASSISTANT FOR GULF WAR ILLNESS
Dr. Bernard Rostker
Dr. Dave Case
Dr. Susan Mather
Dr. Bernard Rostker
Questions and Answers
DEPARTMENT OF DEFENSE RESPONSE TO THE PAC
RADM Michael Cowan
Norma St. Claire
RADM Michael Cowan
Questions and Answers
REPORTS FROM GULF WAR SYNDROME INVESTIGATORS
Dr. William Baumzweiger
Hon. Warren B. Rudman, Chairman
MR. JENNINGS: My name is John Jennings. I am the designated federal officer of this Presidential Special Oversight Boardís public hearing. I hereby call this hearing to order.
It is my honor to welcome all of you here this morning. On behalf of the President of the United States, I would like to thank the board members for their dedicated efforts in ensuring that our Department of Defense investigations into Gulf War chemical and biological incidents are both complete and credible.
By lending your skills and reputations to this effort, you send a clear signal to our Gulf War veterans that the federal government is making an honest and concerted effort to identify a cause or causes for the unexplained illnesses some of them suffer.
The President and our country salute you for the work you are doing on behalf of our veterans. They deserve the very best and you are giving them your very best.
As a transplanted New Englander, it is my honor to introduce Senator Warren Rudman, the chairman of this Special Oversight Board.
SENATOR RUDMAN: Thank you, John, and good morning. The subject of Gulf War illness has been part of our vocabulary now for almost seven years. There are many sick Persian Gulf War veterans. Thereís no shortage of opinion as to why veterans are sick. Many theories and opinions advanced as to why our veterans are sick lack the concrete scientific support they need, yet these unsupported theories alarm our veterans community and our press and influence opinions on the issue.
At the same time that medical science cannot find a single cause that they can agree on for what has become known as Gulf War illness, medical science does recognize it knows that our veterans are sick. Our board knows and recognizes our veterans are sick but we donít know why.
The executive order that establishes this board prohibits the board from conducting scientific research. However, it does not prohibit us from reviewing and examining scientific theories and research. We look forward to the testimony of those veterans and scientists who have come to address this board and will at subsequent hearing.
However, you should not look to this board to produce or endorse a scientific hypothesis as a solution to the mystery of Gulf War illness. The scientific answer to that question, if there is a scientific answer, lies in the future. Our government has allocated over $120 million to the effort, a significant portion of it in the private and university sector.
You can look to this board to be zealous in our scrutiny of the Defense Department and its thoroughness and its efforts in pursuit of information on the circumstances that occurred in the Gulf and their potential importance and relevance to this issue of Gulf War veterans and their illnesses.
Our primary concern is the Defense Departmentís efforts on behalf of the United States Soldier, Airman, Sailor, Marine and Coast Guard service member, the veteran. Our board may consider recommending that the Defense Department discontinue investigations in a particular area. We may also recommend that they begin investigations in another area.
Our board will review, analyze, consider and react to well-researched, well-documented investigative work of the Defense Department in this regard. We anxiously await your support of your input and to your participation in our efforts. We feel the DoD can do a better job; we can all do a better job but we must begin somewhere and we begin today.
Finally, I want to remind you again that this boardís primary focus is the DoDís conduct of ongoing investigations and efforts and implementation of the PAC recommendations. That is our focus.
I want to address just several other issues. Back in July, the press carried comments by some people upset with our ďfirst secret meeting.Ē I want to just say on the record here that that day was the first day that all of us had met. We had been appointed by the President and I decided to convene an organizational meeting, with advice of counsel that it was proper, to get a briefing from the Defense Department generally on their efforts because most of the members of this panel were not personally aware of those efforts.
That meeting was organizational information only and it has been approved and it was proper and I was rather surprised that some people would have found a problem with that. This board, I can assure you, is not part of any effort to cover up anything but you have to start somewhere and thatís where we started.
Secondly, I want to just say that we have had a number of meetings and briefings since that time, not as a full board but individual task forces of this Board. Veterans have participated, invited, including the National Gulf War Resource Center, the AMVETS, the DAV, the VFW, the American Legion. And there is no question that unless there is a classified subject to consider, and that would probably be very unlikely, all of our sessions will be open to anyone who wishes to attend.
Finally, I want to tell you that we will make an interim report to the President within nine months of this meeting and a final report within 18 months. In the back of the room you can find the Executive Order. If youíd like a copy of it, the Charter issued by the White House, the agenda for today and tomorrow and biographical sketches of various board members.
Before I introduce the individual Board members for their comments, I want to recognize Mr. Jennings, who we appreciate your help in getting our business done and I also want to recognize Mr. Robert Bell, special assistant and counselor to the President of the United States and senior director, National Security Council, Defense Policy and Arms Control direr. Mr. Bell, we welcome you, and we appreciate your help.
Finally, yesterday I received a letter from the President which I thought I would read into todayís record, which reads as follows: Dear Senator Rudman, as you prepare to hold the Special Oversight Boardís first public hearing on November 19-20, 1998, I want to thank you and the Board members for your dedication to ensuring that our Department of Defense investigations into Gulf War chemical and biological incidents are both complete and credible.
By lending your skills and reputation to this effort, you send a clear signal to our Gulf War veterans that the federal government is making an honest and concerted effort to identify a cause or causes for the unexplained illnesses some of them suffer.
The Persian Gulf War Veterans Act of 1998 and the Veterans Programs Enhancement Act of 1998 both contain provisions for a non-governmental institution to review and evaluate existing information to determine potential health risks of service during the Persian Gulf War.
The review carried out pursuant to these provisions will not diminish the need for the Office of the Special Assistant for Gulf War Illnesses to continuous research on chemical and biological incidents, nor will it reduce the vital need for ongoing oversight by your Board over the 18-month period established in your charter. I salute you and the Board members for the work you are doing on behalf of our veterans..
I am delighted to be able to now introduce the members of this Board appointed by the President of the United States and I must say that we have the kind of diversity of experience that I think bodes well for the kind of oversight that we want to do here. And I am just so happy to introduce them to you for whatever comments they wish to make.
Secretary Brown I hope will be joining us. He has been unavoidably delayed this morning but Iím sure he will be for most of these hearings. So let me first turn to someone who doesnít need much of an introduction in the veterans community, Admiral Bud Zumwalt who, of course, was chief of Naval Operations in a most distinguished career and in many instances has proven his dedication to the veterans of this country. Admiral?
ADM ZUMWALT: Thank you, Mr. Chairman. For 28 years I have been involved in support of the Vietnam veteransí effort to get proper recognition and compensation for the health effects resulting from exposure to Agent Orange. Until this President came to office, only three diseases had been approved for compensation and those 15 years after the war ended.
President Clinton took ownership of that issue and the government moved and we now have a total of 13 diseases that are compensable as a result of that presidential interest. For that reason, I have been not surprised but pleased that the President has again taken ownership of the issue concerning the exposure of veterans in Desert Storm and Desert Shield.
A far better process for review and oversight has been established than ever came to pass in the early years of Agent Orange. I believe it is a process that gives us every opportunity to get at the objective truth. I have had the pleasure of working with Senator Rudman in another capacity and I can tell you that he is totally objective and fair and will be a great chairman of this oversight effort and I, too, as he, am very pleased at the background of the Board members with whom I will have the opportunity to work.
SENATOR RUDMAN: Thank you, Admiral. Next Iíd like to introduce retired Rear Admiral Alan Steinman, former surgeon general, United States Coast Guard. Admiral?
RADM STEINMAN: Thank you, sir. I just want to say briefly that I am pleased and honored to be part of this committee. My whole professional career is as a physician, a medical officer specializing in occupational medicine, which I think gives me some unique qualifications to look and oversee what efforts the Defense Department is putting into turning over every stone to find out what is going on with our Gulf War injuries and illnesses.
And other to say again that I am pleased and honored, I think Iíll not make any more comments to provide more time for our audience to talk to us rather than us to them. Thank you.
SENATOR RUDMAN: Thank you, Admiral. Next, someone who shared the experience of participating in the Gulf War, retired Command Sergeant Major David Moore.
CSM MOORE:Thank you, Senator. I reserve perhaps comments at this time other than to say that I have held all the positions as a non-commissioned officer over the last 35 years. I have been exposed to the Vietnam era and also served in the Gulf and I share that with you to share my concern and honor to serve on this Board to represent the soldiers in the field who are the ones who are having difficulties with their health.
So having been there, out there in the trenches, if you will, I can understand. And, again, Iím just happy to be carry on my career at this phase to be able to participate in those causes, hoping to find some end result as to the problems that the Persian Gulf veterans are having. Thank you.
SENATOR RUDMAN: Thank you very much. Next Iíd like to introduce Dr. Vinh Cam from Greenwich, Connecticut who is a very eminent immunotoxicologist. Dr. Cam?
DR. CAM:Well, as a member of the Special Oversight Board I want to welcome you all here today to what is an extremely important public hearing. I hope you will take this opportunity to air your concerns and also make recommendations. We are eager to receive your comments. The White House is listening, DoD is listening, the VA is listening.
Iím pleased and very honored to be part of this effort. I want to assure you that our Board is here for you. Weíre not only gathering facts but we also want to ensure that the health concerns of Gulf War veterans are thoroughly addressed. Furthermore, we would like to ensure that lessons learned from the Gulf War be applied to current and future military deployments.
So, once again, I want to thank you all for being here. Weíre looking forward to your testimony.
SENATOR RUDMAN: Finally, currently the president of Texas A&M University at Kingsville, Texas but was the commanding general of the United States Army South Panama during the capture of Manuel Noriega and a very distinguished military career, retired Lieutenant General Marc Cisneros.
LTG CISNEROS: Thank you, Mr. Chairman. Good morning, ladies and gentlemen. Iím very honored to be part of this group. Those of you that know me know I am not a member of any political party. My son served in Desert Storm as a national guardsman from Texas when I was a deputy commanding general of Fort Hood where we deployed over 27,000 soldiers.
I am very honored because I do not consider myself betoken to any man other than God for whatever I have achieved. Those who served under me, the enlisted soldiers, know that I am honestly and genuinely concerned and I am very honored to have been selected in what I thought was a criteria for all of us that we were going to be the honest brokers and we would not have to support any party line.
And so Iím very honored to serve here on behalf of my fellow soldiers.
SENATOR RUDMAN: Thank you, General. From this time until approximately 10:30 to 10:45, depending on how much time each person takes and weíve asked you to take five minutes, we know thatís not a lot of time but unfortunately we have a lot of people to hear in two days, I thought I would ask three of you to come up and take seats, or actually five. You can move the microphones between you.
I will call Staff Sergeant Joe Poe, Jr., United States Army (Ret), Mr. Michael R. Ange, Specialist Linda Davis, United States Army Reserve, Staff Sergeant Douglas Waddell, United States Army (Ret) and Major Denise Nichols, United States Army (Ret) -- United States Air Force (Ret); thank you very much. Canít get that one wrong.
If the people I have called would like to come up and take a seat here. Let me thank all of you here today for offering to come forward and testify. We are anxious to hear your testimony. I think Iím going to call on you in the order in which you are listed on my schedule. That would mean that Staff Sergeant Joe Poe, Jr. would be first.
And Iím going to tell you all, having a lot of experience in this hearing room, that if you can pull that microphone fairly close in each instance, then weíre going to be able to hear you just fine. So if youíd like to proceed, Sgt. Poe, weíre looking forward to hearing from you.
SSG POE:Thank you, sir. Can you hear me? I hope so. First of all, I wanted to have my statement to verify what I am. To all the veterans of the Board and those here in the room today, first of all I want to say welcome home to all of our veterans and to all others who are not here, I will say God bless you on this day.
I will be as quick as I can. First, I respectfully to members of the Board, all present and for the record, I publicly protest the dual role of Mr. Bernard Rostker, recently nominated by the President of the United States and approved by the Senate as the new Undersecretary of the Army, while he simultaneously serves as the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses.
His demonstrated ability to swerve and vacillate regarding verified reports and documents from professional military leaders and published material from medical doctors and researchers has been clearly established since his appointment on 12 November 1996.
Whether by design of appointment or personal desire, Mr. Rostker has clearly ignored professional input from outside his office. Evidence of his ability to spin the facts and effectuate his officeís policy of damage control will be presented by speakers present other than myself.
As a veteran and concerned citizen, I believe this dual role, not individual but the dual role, will present an extreme conflict of interest and serves only to bury data collected by his personnel deeper into the abyss of policy control and making that he is so well adept to, through his vast experience with RAND and other policy predictors and implementers.
Secondly, I am going to skip some. You all do have all of my things and I put in evidence everything so I will skip through to save time for people.
SENATOR RUDMAN: Sgt. Poe, we will incorporate your entire statement into the record as we will with everyone that is here that has a written statement and we appreciate your summarizing if you can.
SSG POE: I will jump around quick for you.
SENATOR RUDMAN: Thatís fine.
SSG POE: On Monday the 26th of May 1998 at 1000 hours, myself and veterans named in the documentation met with two members of Mr. Rostkerís team for almost four hours.
The purpose was to again seek and establish a real working relationship with DoD, VA and the veteran community.
The DoD personnel we met with were Michael Kilpatrick, Captain, Medical Corps, United States Navy, director of medical and health benefits collaboration, and Joe Gordon, Colonel, USMC (Ret). Heís not there anymore. COL Lawhon is now in his place.
Our requests, statements and proposals were received openly. We were asked to assist the office as well in an effort to maintain open and continuing dialogue. This meeting was initiated by veterans seeking answers, treatment to GWI, Gulf War Illness and a hopeful establishment of non-confrontational credibility between DoD, VA and veterans. That transpired approximately six months ago.
We left the table with cautious optimism. This caution has proven itself warranted. We cooperated and subsequently were appeased, ignored and ultimately given conflicting or inaccurate information. We did not request or propose to climb the whole mountain. We strongly sought reciprocal efforts toward jointly breaching the foothills. This has not occurred.
SENATOR RUDMAN: Continue, Sgt. Poe. I know that youíve got a longer statement there but weíll give you some extra time. You go right ahead.
SSG POE: Thank you, sir. Youíve got everything so I will jump ahead fast.
SENATOR RUDMAN: Go ahead.
SSG POE: Our proposal that we (inaudible) into this like Memorial Day. Iím going to paraphrase some so we could get me out of here --
SENATOR RUDMAN: Very well.
SSG POE: We asked and proposed to continue existing protocols, not replace them, but continue existing protocol in VA and other facilities, such as your MRI, Magnetic Resonance Imaging for those presenting with neurological symptoms. However, when neurological difficulties continue, (inaudible) more cost effective to go into SPECT scans, Single Photon Emission Computer Tomography or PET scans to be added to the protocol, not replace MRI but added when it was necessary.
SPECT scans on the average are approximately one and a half times the cost of one MRI. However, when it is indicated that two or more MRIs may be required, the monetary savings justifies the SPECT scan itself. Moreover, SPECT/PET scans highlight areas of brain abnormality resulting from (1) head trauma, (2) stroke or (3) organic brain abnormalities and/or damage. That is what the SPECT scan does do, okay?
This is much more help -- this is very helpful to members of the Board to understand. If a veteran or anyone has not had a brain -- has not had a stroke or has not had a trauma to the head and the areas of the brain are highlight with a SPECT or PET scans, there has to be some form of toxins to go into the brain. Now, whether that be for (inaudible) or whatever but you know when the testing is done, you verify what is into a personís body and you do rule it out.
So I wanted to make that very quick. The doctors, they will say things and some will say (inaudible). This also helps save money to veterans going back and forth, back and forth all over the country. It saves for the doctors and the technicians and the administrators donít want to (inaudible) all over the place. We are concerned on that, too but not my SPECT, very much my SPECT to get to where we are today, still talking.
Iím going to skip on down. This further reduces the stresses incurred upon veterans and families, physicians, clinicians and administrators. Basically DoD and VA created and proliferated PTSD. Veterans get PTSD by sitting at the VA all day long. But I wanted to stress to the Board that it is very important to follow up on -- you have the follow up messages. I have found the Department of Defense team.
We ask for mandatory testing of Gulf War veterans presented with the symptoms or not for mycoplasmas and specifically Mycoplasma Fermentans, incognitus strain. We are not talking now to our current Mycoplasmas. We are talking things developed in laboratories. Whoever used it, I do not care. There is no such thing as friendly fire. What gets you, gets you.
Now, asked at that time that Dr. Nicolson of the Institute for Molecular Medicine, who utilizes exacting testing be a point of contact. Now, Dr. Nicolson is open to working with DoD to assess. One thing I want to know is that early into the year, I think it was in December, that DoD (inaudible) and at the cost of a little over $45,000.
Iíll be quick. We proposed centralized testing of which DoD come back and explained how that would be most difficult for them to do. Iím sorry.
SENATOR RUDMAN: Mr. Poe, we have extra time this morning. We started early so you get through whatever part of your statement you want to get through this morning. We appreciate your coming up here.
SSG POE: All the proposals that we did there, the third one for depleted uranium testing, mandatory depleted uranium testing for all war veterans including U.S. Army also and for the Gulf. At the time that we had the meeting, we asked for the new format for DU testing on all persons. Dr. Kilpatrick at the time said, you know, DU will not show up into the blood or the urinalysis after several weeks or so unless, of course, you got embedded fragments at that time.
We reminded him that we were talking -- we were a little bit incoherent -- we did mention a hair sampling for the DU. We have found out after that that hair sampling is not that accurate either but hair sampling, annual or not, is very inaccurate for internal DU that has penetrated to the bone. Iím not talking onto surface value, depleted uranium exposure.
So, he says, oh, yes, that is right. This is the thing to keep in mind. We asked after that (inaudible) for depleted uranium or (inaudible) MFI testing (inaudible) whenever it shows that it will be most important in neurological testing if the MRIs they were doing in the -- doing more and more MRIs. And we also did ask at that time if it was non-medical, we did ask at that time for them to verify why the only biological detecting capabilities were never deployed into the Gulf, our PACER/PBS units.
Now, at that time, Dr. Kilpatrick just said, oh, yes, that was a problem because we were speaking of a credibility problem. He said yes, that is a problem we are looking into and, as a matter of fact, that is why myself and my team from the Navy did deploy because of our biological capabilities, detection capabilities. I said, oh, where were you at? Oh, I was in Cairo but our teams did go into country. We did go into units that had like dysentery and what would be considered irregular abdominal (inaudible) into the air.
But he did at that time, the first meeting, (inaudible) six months ago almost now, yeah, thatís why we went because the PACERs did not go. This is the thing to keep in the mind. Iím going through very quick now and shut up.
At the National Gulf War Resource Center in Washington, D.C., I was approached by Joe Gordon and a Mr. Prather. And I was told, Joe, you know we have not been able to find a thing onto any PACER/PBS. I go, really? They said, are you sure that you know what youíre talking onto? I said, I do think so. He said, well, we are still looking and it is so very hard. No. Here is the thing, please do remember, members of the Board, I am not accusatory. I try to be respectful and truthful.
The first time that we demand almost six months ago, oh, yes, that is a problem, thatís why we deployed from the Navy. The second time that we did see them at Washington, D.C. a couple months ago, okay, itís no, I just donít know a thing onto it. Cannot find anything about PACER or PBS biological detector.
Now we go to Camp LeJeune, North Carolina approximately a month ago now. At that point in time we have the PACER (inaudible); itís almost seven, eight years. America spends very much money and too much money sometimes, I do believe, on wrong things.
At that board -- I mean at the town hall meeting, I did bring up the PACER again. Oh, yes. That is all ready to go. At this point, sirs, members of the Board, all of you do have a transcribed from the tape where Col. Gerald Schumaker who is heading the PACER/PBS biological detection units did state on film while still serving into the military, you are familiar of Col. Schumaker, sir, I am certain.
I was in Panama as well, sir. Col. Schumaker you do know is reliable, sir. (Inaudible) the DoD team that was there says you cannot find the PACER biological units. Perhaps you can find Col. Schumaker. (Inaudible). I canít find equipment thatís sitting in Dover, Delaware the whole time and never did deploy it, maybe they can find a colonel into the United States Army.
Sir, as members of the Board -- Iím sorry; maíam, too, I present to you this morning a copy of the tape where Col. Schumaker, while still in the military and maintaining his integrity, did state what you have on the written transcript there. I donít know how to get it up there.
SENATOR RUDMAN: We will get it.
SSG POE: There is a tape of him.
SENATOR RUDMAN: And we have the transcript.
SSG POE: You do have everything there that I do have down, okay? Dr. Kilpatrick asked us if we would help them and show our cooperation and willingness. I am not saying this attacking. Iím just saying it factual. Asked us if we could assist in finding American personnel or call particular American personnel who had shown with or had come in contact with SANG units, Saudi Arabia National Guard. We did do our part. We did our part.
We pushed information out, asked soldiers, troops to come forward from information we put out to find. And we did send them into contact. What they did with DoD team after that, I have no idea. Thatís not my responsibility but you have everything we have there and the approval by the DoD team before that we did post anything.
I had better not say anymore because I took on too many other peopleís time, okay? I will stop, only to say, sirs, is that you have who that I am. I do not lie; I do not cheat. What I am saying to you today is the truth. I will tell you anything that is not the truth. You do know that, sir, into the back of the seat over there, okay?
I will not say any more and I apologize for being so long to talk to you but I would like for the record that maybe the members of the Oversight Board will get the answers for the sake of our nation, for the sake of our nation. I am a veteran.
Many people do scream I am a such-and-such war veteran, I am a this kind of veteran. I am an American veteran, no matter where I did go or orders I did follow. And almost all members of this Board are veterans, no matter where that you did do go.
I would like for all the Board members to keep that in mind as they go into how this is being handled and how it is being the policy makers, the policy makers, the economists, maíam, the economists are controlling this operation, not miracle doctors.
I would end on that and I would be quiet and thank you and God bless you and good fortune on the truth, sirs and maíam.
SENATOR RUDMAN: Thank you very much, Sgt. Poe. We appreciate your testimony and we appreciate you coming up here from North Carolina. Mr. Ange -- do I pronounce your name correctly?
MR. ANGE:Itís Ange, sir.
SENATOR RUDMAN: Ange; thank you.
MR. ANGE: Mr. Chairman, members of the Board, I am Michael Ange and although I serve as a national adjunct at the Unified Veterans of America, I am speaking here today as an individual. The views that I will express are my own and are not necessarily representative of the views of my organization.
We are here today at yet another hearing which will likely, and in the opinion of many veterans, end with the same result as the numerous other incessant hearings that have preceded this one. Meanwhile, sick veterans still lack medical care. Families are losing their loved ones to a malady called Gulf War Illness without any adequate explanation. Thousands have died while we sit and talk.
The morale of our active duty forces is affected by the continuing dishonesty and maltreatment of Gulf War veterans and here we are at another meeting. Insomuch as this Board has asked for comments and not evidence, I have decided to approach this hearing differently than the previous ones Iíve been at.
Let me first state that I commend the members of this Board for not attempting to put forth the facade that they are receiving evidence which we can expect to be acted upon. By classifying this input as a period for public comment, this Board has probably done the most honest thing that has been done by any governmental entity with regard to Gulf War Illness.
I will not waste the time of the Board or those present to hear these proceedings by attempting to identify the problem. Only the most ignorant, non-informed could possibly assume that the members of this Board do not yet have a full grasp of the problem.
I will state that in May of this year we met with members of Mr. Rostkerís staff in good faith with the opportunity to demonstrate an honest and forthright response to questions of concern to Gulf War veterans. We posed no question for which we lacked the answers prior to asking.
Our intent was simple: to demonstrate either the integrity that Mr. Rostkerís claims or in the alternative to demonstrate the lack of integrity and lack of honor which we have suspected. Mr. Rostkerís staff was quite cooperative in proving our fears.
In spite of many years of effort, the efforts of Gulf War veterans in the halls of Congress and through various other resources, their concerns still fall on deaf ears. Even the resulting executive orders and legislative facts which have been successfully pursued are ignored and disregarded by both the VA and the DoD.
It is time now that we leave the minutia of numbers and details and statistics, that we deal with facts and reality because statistics in the hand of many governmental bodies frequently serve to cover more than they reveal. At every town hall meeting and press conference perpetrated by DoDís Office for Gulf War Illness Research, we repeatedly hear about the money they are throwing at this problem.
Ladies and gentlemen, if this problem requires the entire national budget, it is irrelevant. This question is not about money; it is about ethics; it is about duty; it is about honor. The American people, each and every one of you, have a contract with Americaís servicemen and women and as we sit in yet another meeting, we are maliciously and indifferently violating our contract with the veterans of the Gulf War.
The truth is that we need no new legislation and we need no executive order providing for the care and treatment of our Gulf War veterans. Everything that we need is and has been contained in the code of federal regulations since before the Gulf War. All that is really required to resolve these problems is a restoration of integrity in the Offices of the Veterans Administration and the Department of Defense.
In each of the hearings and meetings I have attended, there has been much talk about obtaining information in order to decide what has to be done, so we have sat for seven years and analyzed the problem. When I was a young soldier working toward earning my sergeant stripes, a first sergeant gave me a piece of useful information which I will paraphrase here.
He commented that any idiot could find a problem and analyze it. A good NCOís job is to find a solution. This former NCO is going to outline for you today a simple solution to this problem and others that plague our government.
There is only one problem in reality which impacts Gulf War veterans; lack of treatment, lack of information and lack of compensation are merely symptoms which are impacted by that unyielding problem. The problem, ladies and gentlemen, is that there exists a society of bureaucrats and politicians who have set themselves aside as a privileged class that operate and conduct themselves above the law without review and without moral obligation.
Let me give you some specific examples of how we can solve this problem by citing specific examples of misconduct. Before the Senate or congressional hearings, General Norman Schwarzkopf wilfully and demonstrably lied to the United States Congress regarding the exposure of his own troop to chemical agents. He has admitted and he has documented on videotape that he lied though he lacked the courage to use that term.
It is convenient that Gen. Schwarzkopf was not under oath at the time of his pseudo-testimony and therefore cannot be charged with perjury. However, certainly the code of ethics governing an officer of flag rank in the United States Army had been violated.
It is very apparent to most of us who have served and who watched the spectacle of his actions that this would constitute conduct unbecoming an officer, yet no action has been taken because the general considers himself among that elite class that functions above the law.
In the Veterans Administration regional offices throughout the country, there sit adjudication officers. In Winston-Salem, North Carolina, that adjudication officer is Mr. John Matuzak. These adjudicators have been tasked by executive order and legislative act to allow presumptive findings of service connection for Gulf War veterans that have unexplained illnesses, yet in case after case, Mr. Matuzak and his peers refuse to justly apply these directives.
Iíll try to summarize this very quickly, sir.
The only penalty incurred as a result of their violation of law is the penalty incurred by the veteran who must wait for years for these malicious and reprehensible acts to be corrected, if indeed they can be corrected at all.
There is no longer any question that has been documented incontrovertibly that the staff of economist Bernard Rostker have practiced to disseminate falsified information in official forms to Gulf War veterans, the media, members of the government and the American people.
In the 1970s, a famous politician observed that merely misleading the American people was grounds for impeachment of President Richard Nixon. If such proceedings should apply to the president as they are even being applied today a short distance from this chamber, then certainly they should apply to the members of the staff of an Assistant Secretary of Defense. The conduct of this military personnel is clearly conduct unbecoming an officer and they should be prosecuted as such.
What is most disturbing about my comments is that many of you have probably found my comments to be disturbing. Even those sitting in this audience have developed such a sense of apathy that it is nearly incomprehensible to them that bureaucrats, DoD officials and senior military officers shall be held criminally liable for their misconduct.
Iím not sure when this evolution or ethics in morals took place but it concerns me and it should appall each and every one of you if you have the courage to realistically examine this as the way things should be.
I am now ending yet another presentation at yet another hearing to discuss the problem facing Gulf War veterans. There is but one remaining question in my mind and that question is simply what side the members of this neutral Oversight Board will take in this conflict: the side of justice and honor or a position supporting the immoral actions of the Defense Department and the Veterans Administration.
Let me close my comments with a challenge. Even though this is not a legal hearing, it is an official forum and it is within the power of this Board to require anyone presenting evidence or comments to do so under oath. I challenge this Board to close a loophole so frequently used by DoD and the VA and require Assistant Secretary of Defense, Bernard Rostker, and any member of his staff, to testify in this proceeding under oath.
I speak with confidence that no veteran speaking before this Board will object to being held to the same standard. Thank you.
SENATOR RUDMAN: Thank you very much. SPC Davis Austin.
SPC AUSTIN: Thank you for the opportunity to speak here today about an issue that is long overdue to be resolved. I am amazed at having to be here in the first place. The nine years of misinformation, denials and deception cannot be erased, especially from the hearts and minds of family members who could only watch while their loved ones, Gulf War veterans, died needlessly and died with the memory of our government turning its back on them.
History repeating itself over and over again; well, I should say the government repeating itself over and over again. I want each one of you to know that as you look out here today and see our faces and see our pain, you will also see the thousands of faces that are unable to be here because they are dead. Each meeting you hold from this day forward, those thousands of faces will be watching you.
The VA claimed for several years after the Gulf War ended that nothing was wrong with us because the DoD stated repeatedly that the Gulf War veterans were not exposed to anything in the Gulf that would cause health problems. Then DoDís hand was forced to acknowledge that we were in fact exposed to certain agents in the Gulf.
However, DoD stated that the levels were so low that it was impossible to cause long-term health problems. Now, how can the DoD say such a thing? Where is the proof? Where are the studies? And why does the DoD dismiss proof given to them by physicians, scientists and experts that have taken it upon themselves to find the truth of our illness and state that their findings are only theories and that there is no hard evidence to back their claims?
Just because someone is paid by our government does not make that person the one and only expert in their field. I donít have a degree that labels me as an expert in a certain field and, if I did, I have the common sense to know that there are others who have more experience than I do so why would I dismiss their theories, findings and facts?
But that is exactly what the DoD is doing and having someone, an expert in economics, dismiss information pertaining to health problems makes no sense at all. Bernard Rostker is not helping the Gulf War veterans. He is causing more problems and pain to the veterans but he is helping the government in a financial sense by denying information about Gulf War veteransí health which, in turn, lets the VA continue to deny compensation to the sick and dying Gulf War veterans.
I do believe that there is not just one single exposure that can be blamed for the Gulf veteransí illnesses at this time but I do know that you cannot dismiss any of the exposures and state that there can be no serious health effects. As Iíve stated, the DoD repeated themselves saying no exposures, while thousands of Gulf War veterans were sick and dying, losing their families and homes, so the DoD should be held accountable for those lives lost and families torn apart.
Many Gulf War veterans were misdiagnosed and they died while the DoD kept up the denials. But what is so amazing is that this practice is still going on and Gulf War veterans are still dying.
I have written to Bernard Rostkerís office on a few occasions and the responses I received were not as professional and accurate as one would think. I understand that Bernard Rostkerís staff handles the information that is given out but Bernard Rostker is still held accountable for any misinformation that is released because that is the burden he took upon himself when he decided to take the position of special assistant for Gulf War Illnesses.
One case in particular, I asked his office for data on Gulf War veterans who had been diagnosed with cervical cancer and the reply from his office advised me that there were only two cervical cancer cases. And this information was given to me only a little over a month ago. I think asked if I was one of the two and I havenít received a response.
I participated in the CCEP and went as far as phase two. I was told by my VA doctor that the VA in Birmingham, Alabama was participating in the CCEP so I elected to go to Alabama for phase three instead of Washington, D.C. I found out only this year that the VA in Alabama was a referral center and not part of the CCEP. Even though this occurred, my medical records are in the VA, CCEP referral center and the Kuwaiti Registry so therefore I see no way of my medical records not being part of the data from any source.
I also inquired about how long has the DoD been receiving blood and tissue samples from Gulf War veterans. The answer was vague as usual but my medical records show that biopsies and a pap smear that were done by my doctors at the VA in Salisbury, North Carolina, were sent directly to the DoD in 1996.
Having Bernard Rostkerís picture touching a tank that had been destroyed by depleted uranium was not at all impressive and a waste of taxpayersí money. The Gulf news sent out by Bernard Rostkerís office is a waste.
Defending the DoD and being a movie critic should not be in the newsletter; making apologies for the DoDís mishandling of vital information pertaining to our health problems should not be in the newsletter; giving profiles of doctors who just come aboard Bernard Rostkerís team should not be in the newsletter.
Put this information out to the media for all of America to hear. Put facts and truth in the newsletter if DoD wants to use taxpayersí money but DoD needs to stop insulting our intelligence with heartless apologies and profiles of doctors who are not capable of handling this horrible sickness we, the Gulf veterans, are suffering from.
As far as the issue of data and how many veterans are suffering from different symptoms and diseases, why do the DoD and VA claim it is almost impossible to find out how many? If that is an impossible task for our government then I donít see how this country can claim having any intelligence.
While sick and dying Gulf War veterans continue to suffer, DoD still continues to spend money going around the United States to try and convince the veterans, soldiers and the American people that we are not sick due to our service in the Gulf. That is as ignorant as taking a sick Gulf War veteran to a cemetery to try and convince them they are not sick.
Bernard Rostker keeps defending the DoD. I understand now why they call it the Department of Defense. Thank you.
SENATOR RUDMAN: Thank you very much. Sgt. Waddell.
SSG WADDELL:Good morning, Mr. Chairman, members of the Board, Persian Gulf veterans, families and friends. It is with a combination of great pride but also disappointment that I stand before you today.
I am proud to stand in a room full of history where so many great men and women have envisioned and forged our great nation as we know it today, but disappointed in that on this day I stand before you a fallen soldier, hurt by the visible illnesses and manifestations my body has undergone and illnesses that are unknown, unseen or misnamed for whatever reason.I am hurt to know that American fighting men and women across this nation have been ambushed by the very government they have chosen to serve. I am not here on this day to speak on personal issues but hopefully give insight to problems that I have seen with the system.
I was a staff sergeant E-6 electronic intelligence intercepted stationed with the 307th military intelligence battalion out of Stuttgart, Germany. I was tasked every day to collect, correlate, integrate and to disseminate databases for seven corps commanders. In looking at the Gulf War registry database, I find it hard to overlook the oversights of collection, correlation, integration or dissemination of a database that has taken far too much time and money and far too many lives to be such a failure in finding causes of Persian Gulf illness.
In another instance, it can be looked at as a highly successful and efficient tool for covering up Persian Gulf illness and making it economically feasible to take care of sick and dying veterans and their families.
To my knowledge, there are five ways to put your name into the Gulf War registry database. The first is to dial the 1-800-PGW-VETS number. This is a VA 1-800 number to the registry. The second is to make personal contact with your local VAís Persian Gulf representative. This person or persons should be located at your VA hospital.
The third method is to be notified by letter that your unit might have been exposed to chemical fallout. Every day this lists grows because of the indecisive knowledge of precise unit locations. The fourth method is if you have e-mail capabilities, you can fill out a survey at http://www.va.gov/. Note: These are all VA methods of registration.
DoD has four methods of its own depending on the branch of service that you are in. The fifth is that if youíre overseas, you may go to the nearest embassy and ask for the form benefits unit. Each one of the DoDís methods seems to parallel one of the VAís methods.
The problem I see with this is that all of these methods are on a volunteer basis. I think that every unit and soldier in the theater of operation should have been registered. I think that the surveys should be broken down so that each question can be correlated and integrated into the database so that specific data can be queried when needed.
This system would be much like the all-source analysis system used by DoD today. This would allow for immediate studies to be done and also the historical tracking of soldiers due to the long delay between the time of exposure and the time that the illness occurs. The correlation could be made between illnesses and the location of the presumed exposure.
Neither the VA system nor the DoD system should separate the database. This database should include all persons located in the theater of operation at the time of presumed exposure. This would include VA, DoD and all contracted support personnel. This would eliminate some of the statistical misrepresentation that we have noted today. This would also stop the tremendous waste of funds by double testing of phase one and phase two personnel separated by VA and DoD systems.
The database should be a permanent one. Neither a stroke of a pen nor a stroke of a key should eliminate the names and information of the personnel in the database. Left intact and followed, this database could provide an invaluable source of information to scientists and physicians in the present and our future.
In ending, the directors of the agencies, boards or committees should not, under any circumstances, be affiliated with the organization or element of organizations that data is being gathered. The director of this information-gathering and disseminating source should not be a part of DoD and certainly not the Undersecretary of the Army serving as a special assistant to the Deputy Secretary of Defense for Gulf War Illness due to a strong conflict of interest.
I feel that this would prove to be a grave disservice to the men and women in our military and their families and the great country they serve. Thank you.
SENATOR RUDMAN: Thank you very much, Sergeant. MAJ Nichols?
MAJ NICHOLS: Good morning, Chairman and members of the Board. Iím Denise Nichols, served with the 1611 AESP, United States Air Force, activated for the war, flight nurse, had a mobile staging facility between Hopitan and Rafha, flag base Charlie.
As we stand here today at the first public board meeting of the Presidential Oversight Committee, we, the veterans, yet again, ask why this is necessary? Yet again we follow the same path that was set up many years ago, a bureaucracy, it seems, with no ending, a bureaucracy that spends millions of dollars in order to delay justice and care for veterans.
The path we follow is the same as the gas veterans from the World War, as the atomic veterans and as the Agent Orange veterans. Itís truly a disgrace that this country can repeatedly call on its service personnel to go into harmís way and then not expect to provide the care that is needed after a conflict.
Itís an outrage that each group of veterans must return and battle their own government to do the right morally and ethically correct action. This is not an entitlement program but a moral and financial obligation, moral restitution. It was earned.
Weíve been denied our rights as human beings and as citizens that were sworn to protect this country and the Constitution. The common saying with veterans describing this situation is the government will keep denying and the veterans will eventually grow exhausted, give up or die.
Does anyone ever think about that veteran that died of a service-connected illness before the statistical proof finally showed and a presumption of service connection made? What benefits can those survivors get, if any? What has each of those veterans and their family members gone through in the course of their illness? In the end, these veterans, their family members, their extended family and friends will be hesitant to trust their loved ones to military service.
Why do we not finally acknowledge that these denials cost us in things that are more important than dollars? Our belief in our government, in DoD and our leaders are shattered generation by generation. No wonder it gets hard to maintain recruitment retention and the cost associated with recruitment and retention keeps climbing after each war.
Why is our policy slanted against the veteran? Why do we care for one that has a shrapnel wound or loses a leg or a arm but yet deny unseen nuclear biological chemical injuries that occurred in combat? I, for one, would trade a shrapnel wound or a loss of a limb for these illnesses from which we suffer that are chronic, debilitating and definitely life-altering.
How much does it cost? Cost was everyoneís question that I dealt with on the Hill when we were fighting to get our recent legislation. Why is it that the checkbook is open when we go to war and yet closed when we return and need medical care? Is this poor after-action planning on the part of the DoD and the Administration or is it that no one wants to acknowledge and pay the after costs of a war?
This country can do better by considering the cost of medical care that will occur before future conflicts and include it in the figure beforehand. Yes, weíre the superpower that can fund every other issue from refugees that may have just been soldiers firing at our own troops or frozen chicken losses for a corporation or for humanitarian relief throughout the world.
National security starts at home and itís time for DoD, the Administration, all of us to get that straight. We need to come together, sit down at the same table and get the secrets out especially on the health needs of our veterans because history shows that most nations fell when morals and ethics werenít maintained.
So we look to this Oversight Committee that will go into the millennium to set about straightening out these policies with precedents that are rapid and complete. We look to you to get the DoD and the special investigation team to see the light, become proactive, acknowledge responsibility, make policy recommendations to assure the Gulf War veterans do finally get the best medical care and testing available now, and to take definitive action that guarantees future veterans will not face the same pattern of denials.
We need this Oversight Committee to think of cause and effect and to be more proactive and order -- prevent more of the consequences of the denial that we have experienced. The consequences of denial has led to what I term collateral friendly losses and damages. This means lives lost due to Gulf War veterans not being adequately and correctly tested and diagnosed.
It has already been acknowledged that this group of veterans has a higher than normal accidental death rate. We need to look at those veterans that are employed in the transportation industry. We have truck drivers, pilots, doctors, nurses that abilities have been greatly altered. We have memory problems, visual distortions, cognitive dysfunction that have not been given sufficient thought.
Nurses and doctors functioning as handicap that cannot remember drugs or dosages or other key items after they served in the Gulf. What about the active duty or reserve guard people that are still active? Let me talk about a few cases, and Iím shortening my remarks.
We have truck drivers that served in the Gulf that experience blackouts, memory problems, disorientation and visual problems. Iíve caught a few in Colorado that I can document. They have sought medical help, they have filed claims, done everything that theyíre supposed to do.
One of these truck drivers had to resort, yet again, to taking to driving a 18-wheeler cross country when his family fell apart and he had to get money for legal aid.
He knew he was ill and shouldnít but he had no alternative. He ended up getting lost, disoriented and having visual distortions while driving at night, a definite safety hazard for other people on the road.
He ended up in several VA hospitals on the east coast trying to get help on this trip. I was in touch with him. That happened last year, Christmas time. He was calling me long distance to tell me what was going on and I kept pleading with him, please, do not drive at dark; please, park that truck, call the truck company, get them to give you a bus ticket home. I begged him not only to protect him but others on the road.
I have another one out of Colorado that his wife has to go with him because otherwise he gets lost and disoriented. We have been telling you all about these problems since day one. These are just two of the cases that are accidents waiting to happen. Theyíre doing what they can to keep their families together, housed and fed but in the process they put other innocent civilian lives at risk.
We need assurances that Gulf War veterans in transportation provider positions are being accurately tested, monitored closer and assured that the safety of the public is not or has not been jeopardized already.
We should look very hard at our pilots. We call for you to have an independent group reexamine any crash involving a Gulf War veteran pilot that was attributed to pilot error and/or weather factor combinations. We call on you to draw all resources into this, transportation department, FAA, National Safety Board, DoD, flight surgeons and flight safety personnel in these investigations.
I call on you to have any Gulf War veteran pilot involved in a crash be physically evaluated by a special team, a specialist qualified in toxicology, neurology, immunology and to the substance that we were exposed to in the Gulf.
We invite you to ascertain what steps have been taken in regards to assessing the safe functioning of our Gulf War veterans, be it truck driver, pilot or other specialties and report your findings. We invite you to critically examine instants that we will all help identify. One of them was friendly shoot-down of the Iraqi -- over the Iraqi card area, friendly helicopter misidentified. What happened there? Memory? Visual problems? That needs reexamined.
There was a U.S. Air crash. I believe it was in 1994. That was a Gulf War veterans, General Horner was called to testify at that trial. What happened there? Review air crashes and identify if Gulf War veteran pilots were involved and if thereís a higher ratio of accidents in that group as has been shown with the Gulf War veterans accidental death rate.
We have told you of the memory problems and all the symptoms but true insight and preventative action has not occurred to our knowledge. Iíve been in contact with Gulf War veteran pilots. Some grounded themselves because they knew they were not in A-1 shape. Many of these have faced the same obstacles as the other Gulf War veterans.
One pilot clearly told me there is a problem, that they have tried but gotten no help. When offered a flying job in civilian life, these pilots were told just be quiet, donít say anything. Since the government is not acknowledging it anyway and doctors are blinded by denial, these problems just continue.
I have alluded to these problems indirectly in congressional and presidential advisory committee hearings. I have approached congressional staff on the Transportation Committee and individual representatives and senatorial member staff that are assigned to the Transportation Committee.
We had briefings initiated by myself and conducted by members and experts within the Gulf War veterans community here in this senate building and three over on the House side I believe in 1996 and many staffers attended.
When the White House helicopter, Marine Squadron, was taxiing, ran into a utility pole and flipped and burned, I said enough.
I went to a staffer, and Iíll give you his name and who he worked for later. I asked him, find out if that one thatís assigned to the White House Marine Helicopter Squadron is a Gulf War veteran. He had the clearances to get the information. I sat there as he made the calls. When he got through to the person that should be able to tell him, they would neither deny nor confirm that it was a Gulf War veteran.
The pilot lived. Find him. Have him and other pilots examined by Dr. Haley, Dr. Baumzweiger. Reevaluate those crashes that have been written off as pilot error. No one wants to deal with this problem but we must. Denials lead to an adverse snowball effect. That snowball has occurred and itís up to all of us to take corrective remedial action now.
A Gulf War veteran was flying an air ambulance in Denver. He was directed into the scene of the accident away from high power lines. They landed, stabilized the patient, loaded the patient, flight crew on board, took off, he flew right into the power lines that he had been directed in his approach to avoid. Memory? Visual distortion after dusk? I donít know but Iím telling you, we need to look at this and quickly.
Itís up to you to take steps and investigate. When Iíve tried to get information, I havenít been successful. Report back to us and the Congress the findings you uncover. Why is there not a more preventative triage approach available of VA claims and DoD health boards?
Besides rapid action for the veterans at risk of being homeless, we need those that have diagnoses of cancer, ALS, loss of organs, to be pulled and worked at the most rapid case. We need to have a hotline just for those cases and a system that meets the need. Whether they have been service-connected or not, the doubt should go to the veteran.
And those people that have duties that affect the well-being and safety of other innocents that Iíve just alluded to should have a separate triage category in order to save innocent lives and decrease the collateral friendly losses. We need to have emergency assistance similar to a natural disaster on a government level to address the needs for these veterans until their VA claims are settled.
This Oversight Board has the power to make policy recommendations to the Administration. We call on you to do this or to consider it. Let us know the pros and cons. Be proactive, preventative and helpful. In considering the effected of the denial and collateral damage, we also have Dr. Baumzweiger who will be presenting later to you all.
We have veterans that I went with Dr. Baumzweiger once; it broke my heart. It was a very brave Marine thatís done very violent things. His family stood up despite the -- he killed a family member. Despite that, they stood up for their son. Heís in for life. We have more and more of those occurring. We cannot close our eyes to that, either.
The DoD is a branch of the government and thatís where our problem has been. They would rather not look at the after cost. The DoD is there to wage war, not to deal with the after-effect. We just need to -- they need to be involved somehow but theyíve been a real headache for all of us and it doesnít help us.
There was some kind of failure of military leadership. Seymour Hearst mentions it in his book Against All Enemies. But the troops of the Gulf War and their families deserve medical answers now. It is a human right.
Medical testing, theyíve alluded to it already. Iíll just say that weíve been bringing that up and Iíll shorten my remarks there but there is much more testing --
SENATOR RUDMAN: Iím going to let you go a few more minutes but Iíve given you now twice the time so try to wind it up. Thank you.
MAJ NICHOLS: Iím just summarizing. Weíve asked for viral testing, heavy metal screening, been denied. Weíre finding vets with multiple viruses activated in their body. We need that extra effort and we donít need our doctors that have stood up bravely to be criticized, discriminated against, discredited. We need clear help.
We need you to consider making a recommendation to the Administration to enable others that may be affected by Gulf War veterans, whether civilian or veteran, whether in theater or out, whether directly or secondarily exposed, to have their data and health records entered into the database and evaluated.
In summary, we are asking you, show us that the Administration acknowledges the true physical plight of the Gulf War veterans by action, not more bureaucracy, denial, delays, investigations and panels. Broaden the diagnostic testing and the actual care of all Gulf War veterans; release all documentation that may possibly give information on our exposures; assure that Gulf War veterans legislation is instituted quickly and without any delay.
Assure that all data requested is made publicly available and this would include a complete listing of the Gulf War veterans who have died and the diagnosed illnesses that are occurring; review the situation with pilots, truck drivers and other personnel that served for the obvious safety implications; have the Administration set up the hotlines and triage systems for the veterans with catastrophic needs, be it medical or true to professional abilities that may impact on innocent lives; set up a triage method for the claims backlogs.
Do not let this be yet another black mark on Americaís military medical response in history. Restore faith now and rapidly. Our country, its citizens and, most of all, our veterans and their families, are due the truth. Donít waste taxpayer dollars on faulty studies that continue the same. With the truth, Americans can deal with the problems.
SENATOR RUDMAN: Thank you, Major. Thank you all. We had actually five or six people scheduled. Some have been unable to get here today; at least theyíre not here but let me read out the names of the remaining folks and those of you that are here, would you please come up and take your seat?
Ssgt Robert Bergen, United States Air Force (Ret), CPO Larry Perry, United States Navy (Ret). I believe we have SFC McGahee, Mr. James Green, CPT Joyce Von-Kleist and a Mr. Seth Greene. If any of you are in the room, I would like you to come forward. If not, then we will proceed with these two witnesses.
MR. DEES: Senator Rudman, Iíve been added to the list. I believe Iíve been omitted on that list right there. I represent Dr. Nicolson and Iíd like the opportunity to present to the Board.
SENATOR RUDMAN: Just hold on one second here.
(Discussion off the record.)
SENATOR RUDMAN: Sgt. Bergen.
SSGT BERGEN: Thank you. Iíve spent the past two weeks deciding on what I should present to this Board. I thought maybe I should talk about the chemical attack I went through or maybe I should talk about the experimental shot I received or how I got sick from the nerve agent pretreatment tablets.
I could talk about how my beautiful wife and five-year-old daughter are now sick. Then there are the one or two veterans that I see weekly in our support group who die, either succumbing to the illness or committing suicide because they are tired of the fight. But I wonít, because others here have addressed these issues.
I would like to address the issue of Tri-Care and Champus not paying medical bills and the financial burden that veterans and their families are facing due to these unpaid bills. I personally have over $32,000 in medical bills that are not being paid. The indisputable fact that the United States government has drug its feet on helping Gulf War veterans has forced many of us to seek outside medical treatment.
I returned from Desert Storm on July 19, 1991. By September, I was being seen on a regular basis and had to be hospitalized for a severe viral-like infection. Over the next few years I was sent repeatedly to Wilford Hall Medical Center in San Antonio to be evaluated by their specialists. I was seen numerous times by almost every department but they could offer me no treatment.
I was the eighteenth participant in the DoDís CCEP program. After 31 days as an inpatient, they, too, could offer me no treatment. Prior to Desert Storm, the first four years of my medical records were about 20 pages. I was active, played sports and was in great health. The four years following the Gulf War, my medical records grew to over 500 pages. I was constantly sick, some days unable to get out of bed.
In January 1996, I received a combat-related medical retirement. In February of that same year, I began a series of detailed evaluations at the VA Hospital in Oklahoma City. The VA did not know what to do, either. I saw some of the best physicians the government had to offer and none of them could help me. I continued my search for someone who could.
In December 1997 I contacted Dr. William Baumzweiger in Los Angeles, California. Within 10 minutes of talking to him on the phone, I knew this man could help me. My physician submitted a referral to Tri-Care which was immediately denied, stating, quote, unquote, there is no evidence for out-of-network services.
I called Tri-Care and was told again, quote, unquote, they did not think I was sick enough. I submitted a very detailed letter of reconsideration outlining the fact that I was paying for the travel and that the cost of treatment would be the same no matter where it was done. This, too, was denied.
At the same time, Dr. Baumzweigerís office was working with Tri-Care and received an authorization number for treatment. On January 6, 1998, Tarzana Medical Center in Los Angeles also received authorization from Tri-Care to hospitalize me and I was admitted. Three days later, Tri-Care rescinded this authorization number and has since denied payment.
In June of 1998, my physician submitted a referral for both my wife and myself to go to California. Some bills have been paid; most have been denied. We plan to return early next year for a follow-up and to start our daughter on treatment.
This need to travel halfway across the country for medical treatment has cost my family everything. Like many, I am unable to work and so is my wife. We were forced to claim bankruptcy. My parents, grandparents, aunts, uncles and even cousins have helped to support us. They, too, are going broke for they are the ones who have paid our travel expenses to get treatment. They are the ones who help pay for our medications and they are the ones who brought me here today.
Many sick veterans like myself not only lost our health but have lost our future, our ability to earn a living and support our families, our creditworthiness and our homes. For us, the Gulf War continues, not by enemy guns faced in battle but by careless disregard, neglect and inefficiency from a system designed to protect itself from recrimination.
If veterans are ever going to receive the medical treatment necessary to stop this tragic deterioration of health, to stop the spread of illness to family, friends, spouses and children, we must be free to get the medical help from sources outside of the government establishment which has long held the position of playing God for so many of us.
The blatant refusal by Tri-Care and Champus to support these legitimate health care professionals and to pay for treatment that is bringing hope and relief to so many veterans must be addressed immediately. The view that the government is providing all that it can to veterans is flawed. You, the members of this commission, will leave at the end of this day better informed. I will end my day as so many other sick veterans, deeper in debt, more embittered and in poorer health.
Your concern and participation on this commission is very much appreciated but it is your influence and action to right the many wrongs that is so desperately needed and needed now.
SENATOR RUDMAN: Thank you, Sergeant. CPO Perry?
CPO PERRY: Excuse me. Iím trying to get the microphone over here.
Good morning. Iíd like to thank you for inviting me here today to speak. I would like to see this to each of you on the panel member. You have taken upon your shoulders a big responsibility. There have been five panels before you came and the veteran really still needs a lot of help. We have a long way to go and it will be up to you, this panel, to help those veterans.
First of all, Iíd like to say that, believe it or not, I have over 30 diagnosed illnesses. Even though I look healthy on the outside, Iím dying on the inside. I suffer everything from brain damage to nerve damage, just about all the immune problems, vision problems, sleep disturbances. Iíve been living on Prozac; so that gives you an idea of where Iím coming from.
I am the deputy commander of Unified Veterans of North Carolina. I am also the president of Desert Storm Veterans of North Carolina. And you have to bear with me. Iím not real good at this.
I am here today to tell you what happens to those that tell what happened in the Gulf. In other words, those that go public or tells others what experience they had in the Gulf to media or investigation teams and that kind of thing. Iím going to give you a personal story of my own and I know all thatís true.
I was the assistant officer in charge of a detachment Navy -- a Navy CB detachment located in Charlotte, North Carolina. I personally called 51 of my men and told them to pack their bags, that weíre going to the Gulf. This was in November of 1990. Our CBís played a major role in the Gulf War, whether people know that or not. We were tasked with building a 200-mile road through the desert that allowed U.S. and coalition forces to come in behind the Iraqi forces located in Kuwait, Southern Iraq and Hakoi.
The road wound up being 10 lanes wide at the end and was built so fast that the Iraqis was totally surprised when they were caught in a crossfire. We came from the rear and all sides of the Iraqi troops due to the -- they never expected a road to get put through the desert in such a short period of time.
While I was there, I never fired a weapon but I sure as hell was shot at. I was hit -- we were hit with two direct scud missile attacks that Mr. Rostkerís office says is now back to a sonic boom. When fireballs are in the sky, itís not a sonic boom. Our skin was on fire; we took -- we were starting to show immediate signs of flu-like symptoms and the longer we stayed in Saudi Arabia, the worst some of us got.
SENATOR RUDMAN: We welcome Mr. Greene to the table and he will testify when this gentleman is finished.
MR. GREENE: Thank you, sir.
CPO PERRY: When we came home, so many of my men were sick and being the assistant officer in charge, I tried to help them. When I tried to help them, all officers in charge and assistant officers in charge were called to the headquarters in Huntsville, Alabama. We were told that if anyone was dissatisfied with the way things were going, they could just get the hell out.
When I kept helping my men, I was put on report and put on restriction to the chiefís quarters at the reserve center and given a direct order not to talk to my men anymore. This happened two months in a row. I was given a 2(a) evaluation and put out of the Reserves, ending a 22-year career.
I went from a 4-0 Chief Petty Officer, being assistant officer in charge, to a prisoner with a 2(a) evaluation. I have never been so humiliated in all my life and I just couldnít face going back to the Reserves anymore.
I have here before you an appeal for a Navy medical discharge because we were giving a paper discharging in the Gulf in early -- almost a month before we left. I got sick in the Gulf, I came home sick and so did many of my men and DoD had a policy that nobody was to be just throwed out the Navy for a physical reason or administrative reason for evaluation. They just got rid of me because I was making waves. Thatís what happened to a lot of others and they just physically couldnít drill anymore.
When we couldnít get any help, I went public because nobody out there would listen to us. The story I told went nationwide and also it made a lot of high officials in Washington, D.C. very mad because of what I told that we were gassed in the Gulf and I have suffered retribution ever since.
I have had my VA claim turned down eight times. I applied for a Naval medical discharge, be turned down twice and I have wrote the President of the United States, two senators, Secretary William Cohen, Department of the Navy with no results. And guess who was the final person that -- the department that cares so much about our veterans signed the denial? Your future department secretary of the Army, Bernard Rostker, denied my claim.
Your system does not work. It didnít work for me; itís not working for others. I would have a man with that character that cares so much about a veteran and get him the whole United States Army.
Iíll wind it up briefly. I think -- Iím sorry Iím so nervous. Iíve had a rough three days. Mr. Rostkerís job has been to sweep all these case narratives under the rug. He has went to all these places with the MA test alarm, the fox vehicles, he has destroyed the credibility of all those and they say the alarm, sure, they went off but all substance alarms were negative. If it ever went off positive the first time, isnít that a good indication thereís something there? But all substantive tests were negative.
We werenít smart enough to win your war in 45 days. Itís taken us eight years to take and fight our government. These people that are whistle blowers need a safe haven. When we tell our story of what happened in the Gulf, we need some protection and we need some benefits to help us.
Iíve lived through living hell for eight years. Iíve been put in jail because I was not able to pay my child support on two occasions. And you donít think I didnít sit there and think about the VA and the DoD, me sitting in that damn jail and I didnít have the money to support my family? I was mad. Iím still mad.
The DoD absolutely should be removed from this investigation. They got the rule book and they got all the rules and if they donít like them, they can change them. They can produce what they want to and they can cover up what they want to. And my war will be over when our vets get the help they need, the help they deserve and the help theyíve earned.
Thank you, sir.
SENATOR RUDMAN: Thank you. Mr. Greene.
MR. GREENE: Good morning, Senator Rudman and guests, panel. My name is Seth Greene and Iím a military police captain in the District of Columbia Army Reserve National Guard. I was in the headquarters in headquarters detachment 372nd military police battalion when we was notified that we was activated for the Gulf War.
Our mission was to operate a enemy prison of war holding facility which was in Iraq. We also manned military police checkpoints, critical site points and to prevent anyone from going into the clear and unclear bunkers up there in Iraq.
There was a lot of souvenir hawkers after the ground war ceased and this was all throughout Log Base Echo which is in Saudi Arabia and Log Base Nelligan which was in Iraq and we actually manned it both at the same time, operating it at our level as a battalion. We had two national guard MP companies under us and one active component MP company under us. I actually worked in the S-3 operations section.
My health at this time is from fair to poor. My civilian job, Iím a federal police officer. I have joint aches and swelling, pain and pressure in my lower back, periodic rashes on my chest, upper back, behind my knees and lower abdomen, heartburn and I get this reflex, chronic reflex. I guess they call it acid reflex. Thatís one of the things Iím learning now.I get twitching in my right eye causing headaches over the eye and it always feels like thereís something in my eye. Iím taking what he said is like an ibuprofen drops in my eye. Thatís what the doctor is telling me at this time.
I get tingling and numbness in both my arms and legs. Just to tie a tie is something I just couldnít do today; something as simple as that. Diarrhea, the passing of blood in the stool, nervousness, short temper, nightmares, pain and pressure in my chest, shoulders, neck, feeling like -- just canít sleep comfortably in the daytime so Iím now working nights. Iíve become nocturnal. I feel safe as long as itís day because thereís more activity going on and more folks going on.
I was in a area where because weíre National Guard, the Department of Defense is asking about all the people that was up in Iraq during the time of the chemical and biological bomb going off but we were a National Guard unit under an active component MP brigade which was in the seventh corp.
Now, most of the things Iím saying shows the active component combat arms units that were in that area but nothing about the National Guard units. And another issue was that a lot of folks got lost out there in the desert. I donít care if they had the GPS which was the gravitational satellite positioning. When the sandstorms blew, when youíre out there, you had nothing to -- in map reading you find a reference point and you fixate on that and then you intersect from that.
The sand dune that was here on your right-hand side, in a matter of two hours it could be on your left-hand side. So there was -- I donít care how special forces, I donít care who you were, you got lost out in that desert; everybody did. Where you say you may be, you may not have been.
Where our base camp was located at, if a Chinook landed dropping off EPWs, which was enemy prisoners of war, at our location, from their grid instrumentation it would tell us you all are not where you say you are. This is where our instrument tells us youíre located at. Okay; fine. Another one would land and tell us something different.
The communications -- the tactical lines that we had, if we was trying to reach somebody in Saudi Arabia, you would go through different nodes. If they had a sandstorm in that node, you had to wait. You get a whole lot of static. You couldnít get information coming from the rear back to the forward.
No one told us about the explosion that was going on. No one told us when the smoke came and encompassed us to mask or to protect ourselves. It was like an everyday thing, just keep on pushing because the mission drives the train and youíre a soldier and just keep the mission going because itís folks lives out there that depending on everybody being a spoke in the wheel and making this wheel revolve around, rotate.
My deployment has caused a strain on me with my family. Iím one of those now that are separated pending divorce. My coming back and the withdrawal from my family has caused -- because Iím doing a self-assessment of whatís going on with me and has caused them to just, you know, youíre not involved with us. We canít take no more of this. From the time I come back in Ď91 till today, Iím still trying to find out whatís wrong with me.
Itís just been totally a nightmare for me. From a financial standpoint, because I was a captain, that wasnít so bad but my only problem was on the back side was that I had to pay more taxes because the combination of my being on active duty and my civilian job, when you project your withholdings for that year as in my household, we were trying to break even. But because of all the complications or because of what they did from the Department of Defense with my active component, it put me in a position where I had to make a substantial payment to the IRS and that was -- not just myself but there were other folks also.
The deployment on me for my social standpoint, except for family gatherings, I donít have the energy and I donít want to deal with it. Iím nervous sitting here talking to you all but part of me is saying it has to be spoken, someone has to tell the story.
From the time I come back and filed my claim with the VA, Iíve been getting the runaround. Everything is still pending and this is 1998 now, from the time I first put my initial claim in. Iíve been going to my appointments up there. One of my fellow officers, she been told that sheís been denied because all her illness have been diagnosed and the Gulf War is undiagnosed.
In the National Guard, for us to come on active duty, we went through a meticulous exam to come on active duty and Iím prior service enlisted so Iíve already done had that before. But the outprocessing for us National Guard and Reserve personnel when we was telling the folks that, look, these are some symptoms Iím having that I didnít have prior to, donít worry about it; it will go away.
It was more like a stamp, kick, next, stamp, kick, next, that type of a -- and itís just frustrating when you have problems and you yourself figure you got enough sense to do a self-evaluation or to read something and you donít know whatís going on.
No one can tell you or pinpoint, the problem comes, it affects me on my job, I had to file with the merits protection system to keep them off my back because they said I was calling in sick too much. But if I couldnít get out of bed to perform my duties and wear a badge and gun and be able to function properly, I wouldnít know what to do.
At this point Iíd like to say that with the Department of Defense Gulf War health care program, I have to say thank you that that is in existence and please make sure that it stays. And Iíd like to also thank the American Legion for their support and assistance and the information that they gave me in understanding some of the medical problems that I have and some of the other also veterans support organizations.
I think that a lot of the active component military folks are camouflaging their ailments. A lot of us folks who have jobs, weíre camouflaging it because if you see someone else thatís going through the hell that they have to go through, you donít want to go through that so you suck it up and you donít want to get on the registry, you donít want no one else to know that youíre having the same problems. All you want to do is, hey, I got to stay in here for my family.
Another issue, last, is that most of us, if you come off of active duty, no one is going to accept you for any kind of health insurance because of the problems you already have so youíre not going to get no additional treatment in the civilian arena.
Those of us who -- if youíre unemployed as a Desert Storm veteran, and I know plenty that are, the VA is hard to give you -- itís hard to get treatment, health insurance because of the ailments that you have. No one wants to take that risk for you. So without the Department of Defense Gulf War health care plan, itís going to be very hard. Itís going to be very hard, sir.
SENATOR RUDMAN: You all set?
MR. GREENE: Yes, sir. Thank you.
SENATOR RUDMAN: Let me just ask two quick questions, running behind, of the two witnesses. Sgt. Bergen, I was listening to your testimony fairly closely and I thought that you said you received a combat-related discharge; is that correct?
SSGT BERGEN: Yes, sir.
SENATOR RUDMAN: That was not, however, a medical discharge?
SSGT BERGEN: It was medical; yes, sir.
SENATOR RUDMAN: Well, does that not mean that a finding was made by people in the Army at the time of your discharge that you could not serve because of a condition that occurred after you came in the Service?
SSGT BERGEN: I was medically retired due to PTSD and joint degeneration, fibromyalgia.
SENATOR RUDMAN: Something you did not have when you entered the Service.
SSGT BERGEN: Correct; correct. My medical records clearly stated even as far back as September of Ď91 that my illness was due or most likely due to my service in the Gulf War.
SENATOR RUDMAN: But that medical discharge did not have medical compensation attached to it?
SSGT BERGEN: Yes, sir; it did.
SENATOR RUDMAN: It did.
SSGT BERGEN: Yes, sir.
SENATOR RUDMAN: Are you receiving that now?
SSGT BERGEN: Yes, I am.
SENATOR RUDMAN: Oh, you are. Then what is the issue you are addressing that you cannot get medical care?
SSGT BERGEN: They are not wanting to treat it. Itís the same story that I received while I was active duty; more Motrin, weíll take care of your symptoms but we donít know what else to do for you.
SENATOR RUDMAN: Well, is it possible they donít know what else to do for you or you think thereís a place that does know what to do for you?
SSGT BERGEN: I know thereís a place that knows what to do for me.
SENATOR RUDMAN: Okay. All right. Let me ask Chief Perry, you mentioned about you had 30 diagnosed illnesses. I take it that you were -- you did not receive a medically-related discharge when you left; is that correct?
CPO PERRY: No, I didnít, sir. I actually got thrown out of the Navy. I was not recommended for advancement or retention --
SENATOR RUDMAN: But you were honorably discharged from the Navy.
CPO PERRY: You call a 2(a) discharge honorably? It said honorably but it was disgusting.
SENATOR RUDMAN: And youíve since applied for disability and itís been turned down.
CPO PERRY: My VA claim has been turned down eight times, my Navy medical discharge has been turned down three times.
SENATOR RUDMAN: But the 30 problems that you have that you discussed in your statement, these have been diagnosed by physicians?
CPO PERRY: Yes, sir.
SENATOR RUDMAN: I want to -- weíre going to take a quick break here. There are two gentlemen in the room here from the VA, Dr. Murphy and Dr. Wallen. Can you identify yourselves? Well, thereís a lady here and a gentleman. There are people here from the VA in the room. If you want to talk to them at all, theyíre here and would be very happy to have you chat with them if youíd like to. This is not part of what this commission does but they happen to be here and I thought --
CPO PERRY: Sir, excuse me.
SENATOR RUDMAN: Yeah.
CPO PERRY: I was in the Washington VA Medical Center referral center but when I mentioned about chemical and biological warfare I was actually thrown out of the Washington VA Medical Center.
SENATOR RUDMAN: Well, thank you. Weíre going to take a five-minute -- yes.
SSGT BERGEN: Iím sorry, sir. Relating back to the health care and the treatment, within the last month I was approached by a Gulf War veteran in Oklahoma during one of our meetings, showed me documentation that day he had left the VA Hospital in Oklahoma City. He had the same diagnosis that I have. They were not treating him. They told him they did not know what to do. And that was for brain stem damage, demyelinization of the nerve endings.
SENATOR RUDMAN: Well, thank you all very much. Weíre going to take a quick break. Those people scheduled to go on at 10:45 will. Weíll be running a few minutes late.
SENATOR RUDMAN: All right. Weíll come to order and weíll invite to the table Dr. Gerrity, Dr. Roswell and General Kiley, Persian Gulf veterans coordinating board to get an update on research initiatives and findings. We have -- weíre running a little bit late here so I will ask you to move forward as best you can but yours is very important testimony and weíre not going to hurry you in that sense. Any particular order in which youíd like to proceed?
DR. ROSWELL: Iíll begin, Mr. Chairman.
SENATOR RUDMAN: Thank you, Doctor.
DR. ROSWELL: Good morning, Mr. Chairman. Itís a pleasure to be here. Board members, itís our privilege to be here today before you to share with you a little bit of background information about the Persian Gulf Veterans Coordinating Board.
The Coordinating Board was established under authority of Title 31, United States Code Section 1535 on January 21, 1994. The board is co-chaired by the Secretaries of Defense, Health and Human Services and Veterans Affairs and operates with a small support staff in office space in Washington, D.C. provided by the three Departments.
The board basically is committed to jointly resolve, first diligently to pursue an accurate and comprehensive understanding of what factors have contributed to health problems reported by Persian Gulf veterans and their families, second, to ensure that all of the men and women who so honorably served their country in the Persian Gulf have full access to the complete range of health care services necessary for problems they now experience and thirdly, the board is committed to aggressively seek clear and consistent descriptive terminology to document current health problems for the purposes of disability compensation.
In order to facilitate these activities, the board created three working groups dealing with compensation issues, research and clinical issues. Membership on these working groups includes key policy and decision makers from each of the three Departments working collaboratively to achieve greater uniformity in the development and coordination of Gulf War programs.
In addition to assisting with work group activities, the support staff maintains a repository of information about Gulf War programs, activities and research providing this information to clinicians, investigators, veterans and various oversight groups when requested. The staff have also been involved in responding to media requests for information or for interviews, developing and providing educational presentation for both veterans and clinicians and writing scientific articles for publication in peer review medical journal.
During the last four and a half years that the Persian Gulf Veterans Coordinating Board has been in existence, we have learned many things. I would like to just share some personal observations about what I believe we have learned in the last four and a half years as a coordinating board bringing together talent from all three of these very important Departments.
First, we have learned the value of coordination of efforts among various government agencies working on a common problem. Second, we have learned that the illnesses Gulf War veterans are suffering from are very real. Third, we have learned that these illnesses are quite varied in their onset, manifestation and clinical course, making it unlikely that they are the result of a single factor or causative agent.
Fourth, we have learned that similar illnesses have been found in veterans of previous conflicts dating all the way back to the U.S. Civil War, suggesting that these illnesses are indeed related to the combat experience or combat exposures. Fifth, we have learned that Gulf War veterans deserve the best possible care we can provide without questioning what might be causing their illnesses.
Sixth, we have learned that we must make special efforts to educate and sensitize clinicians to the specialized needs of Gulf War veterans. We have learned that veterans should be provided disability compensation when their health cannot be restored and that we must do everything we can to facilitate the rapid provision and adjudication of disability claims.
Eighth, we have learned the importance of communicating potential risk associated with the combat experience before, during and after the battle. Nine, we have learned that our full understanding of future combat-related illnesses will require a more thorough evaluation of military personnel before the threat of deployment becomes a reality.
Ten, we have learned that satisfactory readjustment to civilian life is essential to the health and well-being of those who have served in combat. We have learned that known military occupational exposures are not likely to have caused the majority of unexplained illnesses present in Gulf War veterans. However, we have also learned that we must develop a better understanding of the possible long-term health consequences of military occupational and combat exposures.
We have learned that in our efforts to find a cause for unexplained illnesses, we must not overlook the need to develop effective treatments even though we may not know the cause of the illnesses weíre treating. And finally and most importantly, we have learned that our primary focus must be on sick veterans, not on clinicians, not on investigators nor politicians or journalists, not on activists or government agencies concerned with these issues. Our focus must be on the veterans who now need our help.
Mr. Chairman, itís a pleasure to be here. Iíd like to introduce General Kevin Kiley who chairs the clinical working group who will give you an overview of some of the clinical working group activities.
BG KILEY: Mr. Chairman, distinguished members of the panel, thanks for the opportunity to present a brief overview and update of the activities of the clinical working group of the Persian Gulf Veterans Coordinating Board.
As stated, Iím Brigadier General Kevin Kiley, Medical Corps, United States Army and have succeeded Major General John Parker in May of this year as the chairman of the working group. Iím a Gulf War veteran, a physician and presently serve as the assistant surgeon general for force projection, deputy chief of staff for operations and health policy and services, United States Army Medical Command and chief, United States Army Medical Corps.
Immediately prior to the war in the Gulf I assumed command of the 15th EVAC Hospital at Fort Polk, Louisiana and later deployed that hospital to Saudi Arabia in support of our forces during Desert Shield and Desert Storm.
During my four months of Gulf service, I experienced many of the same exposures that Gulf veterans have concerned with and that youíve heard from today including Anthrax vaccinations, PV pills, chemical detector alarms, smoke from the oil fires and the austere desert environments and having experienced that firsthand, I have a respect for the sacrifice of Gulf War veterans and their families that theyíve made for our nation and am sympathetic, very sympathetic to their health concerns.
One of the three objectives of the Coordinating Board is to ensure that all personnel deployed to the Gulf region with the United States Armed Forces have full and ongoing access to the complete range of health care they need for whatever medical challenges they may face as a consequence of their service in the Gulf. This is perhaps the primary function of the Clinical Working Group.
In an effort to fulfill that objective, the clinical working group provides direction and coordination for DoD and VA clinical efforts aimed at caring for Gulf War veterans. This includes coordination of the DoD and VA clinical examination registries, implementation of uniform assessment questionnaires asking about relevant exposure symptoms, medical and reproductive histories and an individualized relative exhaustive physical and laboratory exam.
The clinical working group provides guidance to DoD and VA designed to ensure that registers are clearly defined as a thorough means for identifying and reporting illness among Gulf War veterans and their families. The work group also manages the development of educational tools and programs regarding Gulf War veteransí health issues and concerns.
In the early Ď90s, both the Department of Veterans Affairs and the Department of Defense developed their clinical exam registries. The Department of Defense program is known as a Comprehensive Clinical Evaluation Program, the CCEP and the VA program is called the Persian Gulfís registry.
Both Departments use a comparable two-phase clinical evaluation program for Gulf War veterans with health concerns related to the war. The phase one exam uses a common VA and DoD clinical exam protocol consisting of a thorough clinical exam and standardized exposure and reproductive health questionnaires.
For those who remain undiagnosed or describe persistent health concerns after phase one exam, a comprehensive multi-specialty leave-no-stone-unturned phase two assessment is done.
In 1995, in response to tasking from Dr. Sue Bailey, now the assistant secretary of defense for health affairs and LtGen Ronald Blank, now the surgeon general of the United States Army, the Department of Defense constructed a unique treatment program for Gulf War veterans who remain undiagnosed after the phase one and phase two CCEP evaluations.
Walter Reed Army Medical Centerís specialized care program remains in operation and is currently the only multi-disciplinary program worldwide that specifically offers treatment for Gulf War veterans with unexplained illnesses.
As we speak, the VA is also constructing several demonstration projects nationally that will offer treatment for Gulf War veterans. These projects are expected to use models of care that are similar to the methods of the specialized care program Walter Reed employs, methods known to successfully treat civilian workers with undiagnosed chronic pain symptoms, for example, such as low back pain.
These DoD and VA clinical care programs for Gulf War veterans have been carefully reviewed by several highly qualified advisory groups from the National Academy of Science, the Institute of Medicine as well as the Presidential Advisory Committee of Gulf War Veterans Illnesses. These groups have given the VA registry and CCEP programs high marks for quality interagency exam compatibility and the appropriateness of clinical diagnoses and treatment.
To date, nearly a hundred thousand symptomatic or concerned veterans have been examined in these two programs. The DoD, CCEP and the military health care systems accommodate the families of Gulf War veterans if they have health concerns they relate to the Gulf War, although the VA registry has very limited congressional authority to examine family members of Gulf War veterans and no authority to treat family members of Gulf War veterans.
The Department of Veterans Affairs Office of Public Health and Environmental Agents has held two national conferences, one in 1996 and the other in Ď97 for VA register and DoD CCEP health care providers. The conferences helped these providers learn the latest clinical and research advances concerning the diagnosis and treatment of Gulf War veteran illness.
In 1998, the Gulf War VA registry and DoD CCEP physicians participated in the 1998 conference on federally sponsored Gulf War Veterans Illness research. Clinical sessions were held daily for the Gulf War care providers.
This meeting allowed clinicians and researchers to learn from each other and to share clinical issues, treatment dilemmas and to familiarize with the latest research efforts to try to find answers for Gulf War veterans. This meeting is an important activity for ensuring that all relevant research is rapidly disseminated and appropriately applied to the care of Gulf War veterans.
In 1998, the VA developed, published and disseminated a guide to Gulf War veteransí health. This continuing medical education guide was developed for all interested Gulf War providers in DoD and VA and is readily accessible from the Internet.
The Presidential Advisory Committee on Gulf War Veterans Illness has recommended that DoD and VA devise a comprehensive health risk communication plan aimed at enhancing the accurate dissemination of new information to Gulf War veterans and improving the avenues through which they make health concerns known to these agencies.
The clinical working group initiated the plan, the Coordinating Board staff developed and refined it and it was delivered to the National Security Council on 30 January 1998. The initial plan is implemented and a revised and updated version is nearing completion.
The Coordinating Board has added a risk communications specialist to its staff who is now overseeing this effort within a subgroup of the clinical working group. This new and revised plan is intended for all concerned federal departmental agencies and will call for the involvement of public, veteran and veteran-support organization advisors.
In addition to the existing examination registries, DoD and VA have worked together to develop a comprehensive program and protocol to evaluate Gulf War veterans who are concerned about depleted Uranium exposure during their Gulf War service. DoD has identified these military personnel and veterans who may have been wounded and still retain DU fragments or those who worked in and around armored vehicles hit by depleted Uranium munitions.
These military personnel and veterans were subsequently contacted and offered entry into the DU medical follow-up program. DoD and VA have issued directives in the DU medical follow-up program as fully active. Many veterans have already been examined including a 24-hour urine sample collected for Uranium analysis. The DU medical follow-up program was instituted to assess each veteranís current state of health and Uranium level.
As more military personnel and veterans complete the protocol, the clinical working group will monitor the results, make recommendations concerning the advisability of extending DU evaluations to an even broader group of Gulf War veterans.
DoD and VA have collaborated together to ensure that all Gulf War veterans selected for participation in the VA national survey have an equal and maximum opportunity to participate in the support study regardless of their military or beneficiary status.
The national survey is an epidemiologic study of the current health status of Gulf War veterans and the clinical working group was one key form in which interagency collaborative efforts were forged occur to maximize the voluntary participation of any active duty Reserve or National Guard member selected for the exam.
DoD is authorized funded transportation and lodging on temporary duty orders for all selected active duty personnel. Reserve and National Guard personnel are activated and similarly paid to travel and receive exams. This is one more example of the way the clinical working group has enhanced cooperative efforts in a wide range of issues pertaining to the health of the men and women who served our country during Operations Desert Shield and Desert Storm.
Mr. Chairman, in conclusion I would like to say although Iím frankly brand new on this committee, Iím already exceptionally impressed with the professionalism and dedication and concern of those committee members that Iím proud to serve with.
Thank you, sir.
DR. ROSWELL: Mr. Chairman, the research activities of the Persian Gulf Coordinating Board will be detailed for the Board by Dr. Tim Gerrity, who is the executive director of the research working group.
DR. GERRITY: Thank you, Dr. Roswell. Mr. Chairman and members of the Special Oversight Board, thank you for this opportunity to discuss the status of the current and projected federal research program on Gulf War veteransí illnesses. I meant that parenthetically. I will provide you with a full written statement for the record.
SENATOR RUDMAN: Weíll incorporate that statement in the record so you can summarize as you wish.
DR. GERRITY: Iím special assistant chief research and development officer in the Department of Veterans Affairs. Iím also the executive director of the research working group of the Persian Gulf Veterans Coordinating Board. I might add parenthetically that my involvement with Persian Gulf War health concerns dates back to March 10, 1991 when I arrived in the Gulf area as a part of an interagency team to assess the potential health consequences of the oil well fires at that time.
In both of my current capacities, I report directly to Dr. John Feussner, VAís chief research and development officer and chairperson of the research working group of the Persian Gulf Veterans Coordinating Board. Dr. Feussner regrets he cannot be here because of a long-term prior commitment. Today, I will focus my presentation on the goals, status and findings, costs and new initiatives in federally funded research on Gulf War veteransí illnesses.
First, I will focus on the goals of research as conceived by the research working group and embodied in its Working Plan for Research on Gulf War Veteransí Illnesses. The appearance of illnesses among Gulf War veterans, especially illnesses that are difficult to diagnose, led to the need for a comprehensive research program with the following goals: (1) establish the nature and prevalence of symptoms, diagnosable diseases and other conditions in Persian Gulf veterans in comparison to appropriate control populations; second, identify possible risk factors or any excess morbidity or mortality among Persian Gulf veterans and thirdly, identify appropriate diagnostic tools, treatment methods and prevention and intervention strategies for conditions found among Persian Gulf veterans.
The research necessary to achieve these goals includes basic research, clinical research and epidemiological research. Where appropriate and feasible, research should address family members of veterans as well as the veterans per se.
I will now move on to a discussion of important research results. The results of a number of new research studies have been published recently which, along with previous research results, are helping to form a body of knowledge that will lead to reliable models of the health problems of Gulf War veterans. In addition, there have been some valuable preliminary findings reported at major scientific meetings. However, until peer-reviewed, these findings must be treated with great caution.
Before reviewing some of these findings, it is important to note that all research studies have strengths and limitations. Among the limitations, epidemiological studies are frequently subject to a variety of biases. For example, studies that rely on self-reported symptoms and exposures are subject to what is called recall bias, and studies that rely on self-selected cohorts, such as registry participants, are subject to what is called selection bias.
Biases can distort the magnitude of differences between cohorts and affect the strength of associations between exposures and outcomes in either direction. Other factors potentially affecting epidemiological outcomes include sample size and response rate.
Research using animal models is also subject to limitations and its applicability to a specific situation for humans. Sources of limitations include extrapolation of biological processes from one animal species to another and extrapolation of experimental dosing regimens, that is, the route of administration, the amount and the duration, in animals to real human exposure conditions.
The presence of limitations in a particular study does not necessarily invalidate its findings or conclusions but must be taken into account in evaluating a studyís overall weight and impact. For this reason, the strengths and limitations of each of the new reports of study findings are cited as a guide.
It is impossible at this time to discuss in detail with you all research advances so I will focus my attention on a few important areas of investigation including the brain and nervous system, health effects of low-level exposure to chemical warfare nerve agents, mortality outcomes, reproductive outcomes and the area of symptoms and general health.
In the area of the brain and nervous system, a number of papers focusing on neuropsychological performance, psychological health and symptoms have been published. These studies suggest that a number of symptoms reported by Gulf War veterans may be explained by psychological distress. However, findings reported in these papers indicate that psychological distress alone may not explain all of the increased symptom reporting.
In addition, new research in post-traumatic stress disorder is shedding new light on the nature, prevention and treatment of the disorder. These findings will assist all veterans of deployments with this disorder, including Gulf War veterans. It will also contribute to the improvement of health outcomes in veterans of future deployments.
In the area of health effects of low-level exposure to chemical warfare nerve agents, follow-up studies of victims of the sarin terrorist attacks in Matsumoto and Tokyo, Japan, two years and six to eight months following exposure, respectively, are enhancing our understanding of the potential for long-term sequelae of exposure to sarin. A VA scientist collaborated in some of this work.
The importance of these studies is the involvement of documented exposure to sarin. Results suggest that exposures causing immediate health responses may lead to persistent chronic effects in a dose-dependent fashion; that is, depending upon how much they were exposed to. These effects may vary from clinically undetectable, except through the use of highly sensitive measurement techniques, to clinically significant with overt signs and symptoms. These effects may not be related to the acutely toxic effects of cholinesterase reductions.
These findings are consistent with a DoD-funded study in laboratory rates that reported that after anticholinesterase treatment when cholinesterase levels returned to pre-treatment control levels, learning deficits persisted in the animals. However, the rats studied were quite symptomatic when exposed.
The fact that these studies report long-term responses following acute exposures at levels sufficient to produce immediate observable effects somewhat diminishes the relevance to Gulf War veterans because there is no documented evidence of any acute health phenomenon during the Gulf War that is consistent with an exposure to a chemical warfare nerve agent.
However, the findings reinforce models of anticholinesterase toxicity that extend beyond the immediate effect and may not be directly related to cholinesterase inhibition. Because of the lack of data on long-term health effects from subclinical exposures to anticholinesterase nerve agents, the research working group worked with DoD to develop solicitations for new research addressing this particular question.
In the area of mortality outcomes, results from a follow-up of the original VA mortality study through 1995 show that disease-specific deaths do not occur at any greater frequency among Gulf War veterans than among their non-deployed counterparts. This result is consistent with the first mortality study published in the New England Journal of Medicine.
However, deaths by accidents, in particular motor vehicle accidents, are more frequent than Gulf War veterans. Preliminary results of a study examining the latter findings suggest that behaviors such as speeding and not wearing a seat belt may be contributing factors to the increased motor vehicle deaths among Gulf War veterans.
In the area of reproductive health, two studies from the Naval Health Research Center in San Diego, California indicate that there is no difference in the rates of birth defects in the offspring of Gulf War veterans compared to their non-deployed counterparts.
A major study of discharge records, over 75,000, from medical military facilities found no difference in birth defects overall in the offspring of Gulf War veterans compared to non-deployed veterans. A substudy examining the rate of a rare birth defect known as Coldenhar Syndrome did not detect a statistically significant difference between the rate of Goldenhar Syndrome in the offspring of Gulf War veterans compared to non-deployed veterans. Additional studies are, however, continuing to pursue the question of adverse reproductive outcomes in Gulf War veterans.
Lastly, in the area of symptoms and general health, researchers find that Gulf War veterans self-report a variety of symptoms and conditions, to a greater extent than non-deployed era veterans, that do not easily fit into a narrowly-defined pattern of disease.
This is demonstrated in both the study of Iowa Gulf War veterans, published in the Journal of the American Medical Association and in a recently published study, also in JAMA, reporting on the health of a group of deployed and non-deployed Pennsylvania Air National Guardsmen. I will discuss this study at a later moment. Consequently, research into the general problems of symptoms and general health status among Gulf War veterans continues to be very, very important.
Researchers are beginning to better understand the reliability of self-reported symptoms and exposures by conducting test-retest reliability studies and exposure validation studies. Iíd like to talk briefly about the aforementioned study on the Pennsylvania Air National Guardsmen.
The Centers for Disease Control and Prevention recently reported the study in JAMA and the results of the study -- reported the results of the study of the Air National Guardsmen. Using a symptom-based case definition, that is, a case definition defined as having one or more chronic symptoms from at two of three categories; fatigue, mood-cognition and musculoskeletal.
Investigators found that 39 percent of deployed Air National Guardsmen satisfied criteria for being mild to moderate cases compared with 14 percent among non-deployed Guardsmen. Although the number of cases was three times as great among the deployed Guardsmen, it is significant to note that cases were also present in the non-deployed Guardsmen.
In addition to these research results, a number of new research projects and initiatives have been started and some significant milestones have been reached. Many of the new projects and initiatives are the direct result of recommendations from a variety of sources including the Presidential Advisory Committee, the Institute of Medicine Panel on the Health Consequences of Service in the Persian Gulf War, Congress, veterans and the research working group.
In collaboration with DoD, VA has initiated two major multi-site, randomized controlled treatment trials for Gulf War veteransí illnesses. One trial, known as the Exercise/Behavioral Therapy or EBT trial, is based on successful application in small single-site trials of aerobic exercise and cognitive behavioral therapy, also known as CBT, in reducing the impact of illness symptoms in persons suffering from a variety of chronic diseases.
These treatments are not meant to cure unexplained illnesses in Gulf War veterans but to help veterans positively cope with their symptoms and thereby increase their ability to function in everyday lift. In addition to the EBT trail, a multi-site treatment trial of long-term antibiotic therapy in ill Gulf War veterans will be implemented.
The Antibiotic Treatment or ABT trial was motivated by two important observations. First, some scientists have promoted the chronic, that is six to twelve monthsí use, of doxycycline in ill Gulf War veterans as treatment for a putative infection with the organism mycoplasma fermentans.
To date, no causal connection has been established between a mycoplasma infection and the types of illnesses being experienced by Gulf War veterans. However, chronic doxycycline therapy is not benign and can be associated with significant side effects. Consequently, VA firmly believes that it owes veterans evidence for efficacy, or the lack thereof, of this treatment approach so they do not unnecessarily take antibiotics for prolonged periods of time.
Second, small single site studies have suggested that mycoplasma organisms may indeed be responsible for some chronic musculoskeletal pain and treatment with appropriate antibiotics has reduced or eliminated this pain.
Both of these trials that have been initiated have been scientifically peer-reviewed by a federally chartered review committee. They are anticipated to begin in early calendar year 1999 and be completed within approximately two years.
The advantage of large multi-site trials involving thousands of subjects, which these will, is that the outcomes of these trials will be highly definitive. These two trials represent a major shift in the approach of the research working group toward Gulf War veteransí illnesses.
In addition to the treatment trials, there are a number of other important initiatives that are worth noting. DoD has funded new research projects on the health effects of low-level exposures to chemical warfare nerve agent, interactions of multiple chemical stressors, historical war syndromes and other new research.
The Centers for Disease Control funded two major cooperative agreements with Boston University and Robert Wood Johnson Medical Center to study in-depth the characteristics of Gulf War veteransí illnesses and to attempt to develop a valid case definition.
The Iowa Study of Gulf War Veterans that reported over one year ago an excess of self-reported symptoms among deployed Iowa veterans will be extended to include physical examinations with a focus on an outcome of asthma.
The number of new activities can go on. I will leave that for you to read about that in the written testimony. What Iíd like to do now is to turn to the issue of research funding.
The federal research portfolio for Gulf War veteransí illnesses is diverse in scope. Federally funded research covers an array of different exposures and health outcomes using epidemiological, clinical, basic and applied research approaches. In approximate terms, roughly one-third of the research is divided among epidemiological, clinical and basic and applied research, respectively.
Since 1994 and through 1997 the federal government has sponsored 121 research projects and has committed $115 million in resources to these projects. Please note I will focus on funding through FY í97 as we are currently accounting for FY í98 funding and expenditures.
Over half of these projects involve non-government scientists. Through February 1998, 39 of the 121 projects have been completed, 78 projects are ongoing and four have been awarded funds that are pending startup.
As the number of active research projects has increased from 32 in 1994 to as many as 90 in 1998, the patterns of investment have changed. The proportion of research projects funded in epidemiology research has appropriately declined while the number of research projects on chemical weapons, both in relative and absolute terms, has markedly increased as well as, I might note, a focus on treatment.
As noted earlier, beginning in 1999 new research will begin to focus on clinical trials for treatment of Gulf War veterans. VA and DoD have committed approximately $20 million for two large multi-site, randomized, controlled treatment trials.
When we examine all of the areas of research upon which the federal government has focused, we find that the expenditure of funds has been greatest for research on the brain and nervous system, followed by research on symptoms and general health. The reporting by veterans of symptoms that could be tied to the brain and nervous system has largely driven research on this focus area.
The research approaches include psychological, neurobehavioral and neurological outcomes. Research on symptoms and general health have largely been epidemiological in nature designed to better characterize the illnesses of veterans. The third largest investment is in research on diagnosis that is directed toward characterizing Gulf War veteransí illnesses and on specific diagnostic tests such as the research on a serological assay and a skin test for leishmaniasis exposure.
I will close by briefly discussing the accomplishments of the research working group. By drawing the three departments together, the RWG has been able to jointly develop a research strategy, jointly serve as a forum for researchers to present ideas and findings, jointly respond to emerging research issues and problems.
Through the priority setting process carried on within the RWG, each department is able to independently develop approaches to addressing those priorities. These approaches are then returned to the RWG for joint discussion, resolution and recommendations.
The RWG has served as an umbrella under which the federal government has been able to respond to many research issues outside the context of the RWGís regular meetings. When emerging research issues arise within an individual department, the RWG is engaged to ensure that each department participates in discussions on these issues.
The RWG has guided the federal research portfolio using a number of sources of input. These sources include results from ongoing research, various expert panels and oversight committees such as the Institute of Medicine, the Defense Science Board, NIH, Congressional committees including the Human Resources Subcommittee, the Presidential Advisory Committee on Gulf War Veteransí Illnesses, independent scientists and veterans.
The RWG has synthesized the advice and information into a research strategy embodied in a Working Plan for Research on Persian Gulf Veteransí Illnesses first released in August 1995 and revised in November 1996. As a part of the next Annual Report to Congress: Federally Sponsored Research on Gulf War Veteransí Illnesses, this strategy will be revisited and assessed by the RWG for needs to steer new research courses.
This concludes my formal presentation.
SENATOR RUDMAN: Thank you, Dr. Gerrity, Dr. Roswell, General Kiley. Weíve got some time for questions and Iím sure the panel will have some. Two of my colleagues are quite qualified to ask questions of those of you with research backgrounds so Iím going to hope that they both ask questions.
But I just have a really simple question which maybe you can help me out on something that I kind of donít understand. I can understand a veteran who applies for disability and is turned down. I mean, Iíve seen that happen to many people who were veterans of the war that I fought many years ago who were turned down for whatever reason.
What I donít understand is the testimony of Sgt. Bergen, so maybe you can help me out with that. Someone gets a medical discharge from the Armed Services. Last time I checked, that meant that a institutional decision was made by that Service that that person was medically affected in some way during his or her service. Am I correct about that?
DR. ROSWELL: (Nodding.)
SENATOR RUDMAN: Okay. Once receiving that kind of a discharge, I donít understand, if the witnessís testimony is accurate, and I have no reason to think it isnít accurate, that there would be any hesitation, A, to furnish treatment, B, to even try experimental treatment if such was available if the VA itself said, well, we donít have treatment but somebody in the private sector said, well, but we do, unless itís totally, you know, quack medicine. Why wouldnít you allow someone to get treatment?
Now, if I understood the witness, what the witness is saying is that although he has a medical discharge, he is not being allowed to get the treatment other than some pretty cursory stuff. So explain that to us, would you please?
DR. ROSWELL: Weíd be happy to, Mr. Chairman. First, let me say that none of the three of us are familiar with the witnessís testimony --
SENATOR RUDMAN: Well, Iím sure thatís true.
DR. ROSWELL: -- and could not address his particular situation but in general, when someone is retired from one of the uniformed services for a medical reason, they carry into their retirement the same health care benefits that someone retired after 20 or more years in uniformed service. That retirement benefit includes health care provided by the military.
Because of downsizing, because of reduced capacity, much of the militaryís health care beneficiary workload is handled through a third party. That program is Champus, which is Civilian Health And Military Program -- youíre familiar with Champus.
SENATOR RUDMAN: Uh-huh.
DR. ROSWELL: So basically I think in this particular case it sounded like this individual would be eligible for care through a military health care program or through the Veterans Affairs because as a military retiree, he would also be a veteran, though his highest priority would be through the military.
It appears that what we heard was that the Tri-Care provider, which is the Champus contract agent, was declining to cover what they perceived to be potentially experimental services.
SENATOR RUDMAN: Thatís how I read what that testimony was.
DR. ROSWELL: And thatís why the work that Dr. Gerrity spoke of is so important. The multi-center cooperative study that will actually look at antibiotic therapy. It is research. It is experimental. Thatís why we have so painstakingly sought to have an external panel of peer reviewers assure us that this is safe human experimentation because antibiotic treatment for symptoms, fatigue, muscle pains, has scientifically not been a validated effective therapy.
And my guess is that in this particular case the Tri-Care provider wanted or was not willing to cover experimental therapy.
SENATOR RUDMAN: Let me just follow up a little bit. You know, you can educate the panel although I expect some of the members might know the answer to this. I surely donít. I always thought there were kind of two levels of how you look at medical treatment for retired veterans. In this sense, if you have a veteran who serves 20 years, and Iím going to be a little facetious but I know a case similar who served 15 of it as a golf pro at an Army base or I think it was an Air Force base --
DR. ROSWELL: We donít have golf courses in the Army.
SENATOR RUDMAN: -- five years in some other endeavor and left the Service, you know, picture of health. 20 years and out, go and get a job someplace; not a sick day in his life. Thatís case A.
Case B, someone who serves time, including several tours of combat, all kinds of problems, gets a medical discharge, letís say the same period, at the end of 18, 20 years. Isnít there a different track for those two veterans? I mean, sure, I mean, Champus is available primarily and only now to the veteran in my first hypothetical. In the second, isnít there a whole different line of treatment and options available to a veteran who has a service-connected reason for his or her discharge? Am I confused?
DR. ROSWELL: Again, General Kiley may want to comment on the military particularly but military retirees, regardless of what type of retirement occurs, are entitled to full health care. One area of contention is that Champus benefits cease at age 65.
SENATOR RUDMAN: I understand.
DR. ROSWELL: But on a space-available basis, a military retiree, regardless of the type of retirement, would be eligible for care at a military treatment facility or through Champus. I think the medical retirement is usually used in lieu of attainment of the 20-year service period for retirement and that may be why theyíre retired early.
SENATOR RUDMAN: Expressing a personal view, it would seem to me that somebody with a service-connected injury, wound, illness, whatever, might get a slightly different level of attention than someone who retired in good health at the end of 20 years.
And that is really beyond the purview of this group but itís not beyond what I might tell some of my friends who still sit in places like this because I think thatís a weakness. It seems to me that thereís a great deal of difference between -- if you serve 20 years working for General Motors or the United States Army, if you leave in good health, God bless you. Go on and do something else. But if you leave in bad health, I think thereís a different level that has to apply to those people and Iím just wondering whether weíre doing that or not.
DR. ROSWELL: Well, through the Department of Veterans Affairs -- let me quickly point out that I was speaking to military through the Department of Veterans Affairs. Priority health care certainly is available to anyone with service-related disabilities.
SENATOR RUDMAN: General Kiley, you want to comment at all?
BG KILEY: Sir, Iím thinking about your second example, the individual who is medically retired for either combat or non-combat-related condition. Theyíre certainly eligible if medically retired for health care in the military treatment facilities that we have. I do not want to answer as to whether theyíre eligible for Champus, for example, if theyíre medically retired less than at 20 years. Certainly once you hit 20 years youíre eligible for Tri-Care.
In terms of prioritization of care and our MTS, though, itís my impression that a retiree or a medically retired -- let me correct myself -- a medically retired individual would have a high priority based on what his illness or injury is.
SENATOR RUDMAN: But Sgt. Bergen gets caught in the throes of a -- like a lot of people who are in civilian life today who arenít happy with their HMO. He gets in the hands of a private provider who is working on a contract at a certain cost. Thereís an incentive there in my view not to deliver services sometimes. So he ends up medically discharged and maybe not getting treatment.
Well, I donít want to belabor the question but itís a very interesting issue that somebody ought to think about.
ADM. ZUMWALT: I have two or three questions. An individual like Sgt. Bergen retired medically I believe qualifies for a pension, does he not?
DR. ROSWELL: Yes, sir.
ADM. ZUMWALT: Does the current law for veterans discharged short of retirement time and not discharged for medical reasons then permit a man who has symptoms or woman who has symptoms that that person believes is related to service in the Gulf War, does that qualify them for medical treatment?
DR. ROSWELL: Those people are authorized priority medical care through the Department of Veterans Affairs with legislation that was enacted shortly after the Gulf War.
ADM. ZUMWALT: That was my understanding. And does that then permit them to compensation while they have the illness?
DR. ROSWELL: Again, the compensation issue is actually -- itís probably worth, if I may, taking a minute and explain the disability compensation program. Any veteran who serves in the military may file, following their separation from military service, for disability compensation through the Department of Veterans Affairs.
If that individual is able to produce medical or other evidence that shows that during the period of military service a condition either developed or was exacerbated, in other words became more severe, then that condition can be service-connected.
The problem with Gulf War veterans, quite frankly, was that at the end of the Gulf War, many veterans came back, clearly had symptoms, clearly were suffering with fatigue, with joint pains, with sleep disturbances, with gastrointestinal problems, a variety of seemingly unconnected symptoms but there was clear disability there.
VAís disability compensation program required that a diagnosis be made because we canít -- up until recently weíve not been able to service-connect people without a diagnosis. So special legislation that actually Secretary Brown introduced allowed the Department of Veterans Affairs to seek disability compensation for undiagnosed illnesses.
Now, the other factor thatís important with -- the other issue thatís important to Gulf War veterans is that they not only suffer from undiagnosed illnesses. We have solved that with the legislation. The other problem is that often the illnesses have had a significant latent period.
Almost 700,000 troops served in the Gulf War. Many of them, most of them, fortunately, came back healthy. A few had problems. Others have developed problems in the eight years that have elapsed since the end of the Gulf War and now.
Normally if a veteran who was separated from military service developed a condition two, three or more years following separation from the military service, they could not be service-connected for that condition because there would not be evidence to show that that condition developed or was exacerbated during the period of military service.
So, again, legislation has been sought that allows the Department of Veterans Affairs to presumptively service-connect even though thereís a substantial latent period, up to the present time, in fact, in the case of Gulf War veterans, between military service and the onset of undiagnosed symptoms.
Now, if there is a catch-22 so to speak that one of the other witnesses earlier alluded to, it is that except for those undiagnosed illnesses, any other diagnosis must be shown to have occurred during the military period.
So if a veteran with undiagnosed illness in fact received a diagnosis, then VAís disability compensation rules that apply equally to all veterans, combat and non-combat alike, would apply which means that the veteran would have to show that that illness or disability occurred during or within six months of the period of military service. And thatís something thatís of concern to us that weíre working with.
I think in most cases weíre able to show that even though a diagnosis may be made, that there are related undiagnosed symptoms that are also causing disability.
SENATOR RUDMAN: Admiral Steinman.
RADM STEINMAN: Iíve got a couple questions on the research in the clinical arena. The Board is aware of the many research efforts currently in progress to assess the potential factors in Gulf War injuries, DU, PV pills, oil fires, vaccines, chemical, biological weapons, et cetera. And you specifically highlighted the neurobiological studies that are underway in this regard.
The studies are being done by a number of different agencies, the National Defense Institute at the Rand Corporation has been commissioned by OSAGWI to review literature available on related topics, many of which the Persian Gulf Veterans Coordinating Board has already been researching.
My question -- the first part of my question is how does the Rand research differ from research projects currently sponsored by your organization?
DR. GERRITY: Are you specifically referring to the literature reviews that the Rand Corporation has been doing?
RADM STEINMAN: Yes, and others.
DR. GERRITY: That is not -- thatís not research in the sense that the scientific research community would view research. Thatís library research, literature research, assessment of the literature. When we speak of research, we refer to the -- use as a definition one that is in 45 CFR 46 which is the common rule for the protection of human subjects in research and that is research is a systemic process by one to systemically test well-defined hypotheses for the purpose of establishing generalizable information. And so it relates to the acquisition of original data and not assessing.
RADM STEINMAN: I understand. So basically, Rand is doing literature reviews, only collating information thatís already in the medical literature and the primary research projects --
DR. GERRITY: I donít know whether theyíre doing actual meta-analysis which would be a -- which would change that statement if indeed that were being done. But again, if it was not meta-analysis restricted to a subjective interpretation by an expert, I would not consider that research.
RADM STEINMAN: Okay. One other question along the same lines. Are you satisfied that OSAGWI has sufficient resources to explore and publish case scenarios in medically related fields, time, personnel, funding, specialization?
DR. GERRITY: I believe theyíve got the time, personnel and funding with which to do that, engage in that activity; yes.
DR. ROSWELL: And let me point out that the Persian Gulf Coordinating Board doesnít have oversight or jurisdiction over OSAGWI so it would only be our opinion.
RADM STEINMAN: Thank you both.
SENATOR RUDMAN: Dr. Cam?
DR. CAM: Yes. I have a couple questions for Dr. Roswell. The first one is how does the PGVCB coordinate its activities with OSAGWI and my second question is have you found that your efforts have been duplicated by OSAGWI? If so, describe areas of duplication. If not, describe how you determine your projects in light of OSAGWIís work and/or findings of past work.
DR. ROSWELL: Well, as I mentioned in my introductory comments, the creation of the Persian Gulf Coordinating Board predated the OSAGWI activities by quite some time. It was an interdepartmental coordinating effort to look at clinical programs but most importantly the registries, to try to get some standardization and common understanding about disability definitions as well as disability terms and procedures and to begin to focus research.
I think OSAGWI has -- first of all, no direct relationship formally. Thereís a tremendous amount of informal communication between the Coordinating Board staff, Coordinating Board members, working group members and the OSAGWI activities but no formal liaison per se.
Is there duplication? I donít think so. I think until we have more answers that duplication is not something that is a real concern.
DR. CAM: Thank you.
DR. GERRITY: Iíd like to add something to what Dr. Roswell just said. OSAGWI has full representation on the research working group. We invite OSAGWI to, as any other member of the research working group, the health affairs component, the DDR&E component, HHS and so on, that bring to the research working group table ideas, concepts of new research to report on ongoing research and to help provide input to them on the direction in which theyíre going. So I think that the working relationship is there.
DR. CAM: So what youíre saying there is really input from OSAGWI into the research agenda.
DR. GERRITY: Yes.
DR. ROSWELL: Oh, very definitely, as well as the clinical.
DR. CAM: Thank you.
SENATOR RUDMAN: General.
LTG CISNEROS: If I may, sir. Dr. Roswell, in your comments you indicated that the problems of the veterans coming back and you implied that there were real problems in the symptoms they were having but you made a comment like any other previous war we had going back to the Civil War. Were you trying to tell us that you see no difference at all in that, in the Gulf War symptoms and aspects and the other previous wars?
DR. ROSWELL: One of the activities that evolved out of the Coordinating Boardís activities was a manuscript that was actually authored by Capt. Craig Hyams of the United States Navy that looked at a careful review of medical literature dating back all the way to the Civil War.
Dr. Hyams is actually here I believe in the hearing room and may wish to speak himself. But essentially what Dr. Hyams found, and I was a co-author on that paper with him, was that there were striking similarities in the types of symptoms that veterans of the Civil War, World War I, World War II, the Korean Conflict, Vietnam Conflict, striking similarities in physical ailments.
And Iím not talking about PTSD. Iím talking about physical ailments reported by those veterans. Many of the symptoms were the same: fatigue, headaches, joint pain, all consistently found across those, striking similarities.
Were they one and the same? Itís impossible to say with accuracy because the way medical science understood and approached symptoms in the Civil War is quite different from the way theyíre documented and described today but thereís certainly the appearance that in each major U.S. conflict, men and women who served came back and developed physical ailments.
Now, to me, I interpret that to say that these physical ailments experienced by Gulf War veterans are in fact a definite result of the combat experience. Iím convinced of that. These were healthy men and women who mobilized, who served their country, who came back and now suffer. And while we canít pinpoint the cause of their suffering, the suffering is real and I believe that this experience and the history of medicine and the history of the U.S. military confirms that thatís a combat-related experience.
Is it the same illness? I donít know. Are the illnesses of Gulf War veterans somehow tempered or affected or influenced by other exposures that may have been unique to this war? Itís possible; I donít know. But I should point out that many of the exposures that have been scrutinized in connection with the Gulf War were not present in these prior conflicts.
SENATOR RUDMAN: Any other questions at all from the panel? Iím going to allow the gentleman who evidently did not get on the schedule -- I want to thank Gen. Kiley, Dr. Roswell, Dr. Gerrity and Iím sure weíll be calling on you again for information, for your testimony.
The gentleman who represents Dr. Nicolson, I believe; is he here?
MR. DEES: Yes, sir.
SENATOR RUDMAN: You want to come on up? If you would identify yourself, tell us whom you represent and then spend five minutes talking to us, Iíd be appreciative.
MR. DEES: Yes, sir. Unfortunately, Dr. Nicolson has overwhelmed me with such information I donít know that I can do it totally in a five-minute span. Iíll try to abbreviate it as much as I can.
SENATOR RUDMAN: The problem we have is that the reason youíre not on the schedule, with all due respect to Dr. Nicolson, is because we did set deadlines and that request did not come into our office before the deadline. I want you to understand that. That is not to say we donít want to hear from you; we do but we do have a tough schedule so try to stay to five or six minutes and we will certainly incorporate whatever you submit today, other than what you say, into our hearing record.
MR. DEES: I have submitted 20 copies. My name is Tom Dees and I represent Dr. Garth L. Nicolson of the Molecular Institute of Medicine. Gulf War Illness --
SENATOR RUDMAN: For the record, just tell us about Dr. Nicolson and his academic background and so forth.
MR. DEES: His academic background? Dr. Nicolson is currently the chief scientific officer and research professor at the Institute for Molecular Medicine in Huntington Beach, California. He was formerly the David Burton Jr. Chair in Cancer Research and professor at the University of Texas M.D. Anderson Cancer Center in Houston and professor of internal medicine and professor of pathology and laboratory medicine at the University of Texas Medical School at Houston.
He was also the adjunct professor of comparative medicine at Texas A&M University. He is among the most cited scientists in the world, having published over 480 medical and scientific papers, edited 13 books, served on the editorial boards of 12 medical and scientific journals. Currently serving as the editor of two, Clinical and Experimental Metastasis and the Journal of Cellular Biochemistry.
Professor Nicolson has active peer-reviewed research grants from the U.S. Army, National Cancer Institute, the National Institutes of Health, the American Cancer Society and the National Foundation for Cancer Research. In 1998 he received the Stephen Paget Award from the Cancer Research Society and the Albert Schweitzer Award in Lisbon, Portugal.
SENATOR RUDMAN: And he is, as I understand it, a Ph.D. in a scientific field. He is not an M.D. as such.
MR. DEES: No, sir.
SENATOR RUDMAN: He is a scientific researcher with marvelous credentials. Iím not saying that in any way except to point out it would sound like heís was a doctor when you said he was professor of internal medicine but heís a scientist with a Ph.D. with all of that background.
MR. DEES: It is as noted in the 20 copies, sir.
SENATOR RUDMAN: Thank you very much; appreciate it.
MR. DEES: Shall I proceed? Okay. Gulf War Illness has been proposed to be due to accumulated toxic insults that can result in chronic illnesses with apparently nonspecific or not unique signs and symptoms. For the most part, patients do not appear to have some new syndrome; they can be best described as patients with chronic fatigue syndrome, fibromyalgia syndrome or multiple chemical sensitivity syndrome.
The official stance of the Department of Defense appears to be that battlefield stress was a major factor but certainly most nongovernmental researchers doubt that stress alone is a major cause of Gulf War illness and it certainly does not explain how some immediate family members can present with the same signs and symptoms.
Gulf War illness may better be explained as the result of multiple toxic insults to our soldiers, including those from chemical, radiological and biological sources. We have worked exclusively on the biological or infectious sources of patient morbidity. Whether these were obtained as a primary source or secondary opportunistic infections, they have to be identified and treated if patients are to recover from Gulf War illness.
Obtaining an adequate diagnosis and effective treatments for Gulf War illness. Basically in that, many veterans of Operation Desert Storm face tremendous obstacles in trying to obtain an adequate diagnosis for their illnesses and then adequate care for their conditions.
Up until recently, most of the emphasis in diagnosing and treating Gulf War illnesses within the military and VA has been on stress-related somatoform conditions, such as Post Traumatic Stress Disorder. Since many patients do not fit this category, even with the help of military and Veterans Administration psychiatrists, cannot be diagnosed within the existing ICD-9-coded diagnosis categories, they often receive a diagnosis of unknown illness.
This unfortunately results in their receiving reduced disability assessments reduced benefits and essentially little or no effective treatment for Gulf War illness. Itís not that they are any less sick than their compatriots who have ICD-9 diagnoses used by the DoD and the DVA. They just donít fit within the militaryís or the VAís diagnosis systems.
In addition, many active duty members of the Armed Forces are hesitant to admit that they have Gulf War illness. This is because they feel strongly it will hurt their careers or result in their being medically discharged and they have good reason to fear this.
Gulf war illness present as complex, multi-organ chronic signs and symptoms including chronic fatigue, headaches, memory loss, muscle pain, nausea, gastrointestinal problems, joint pain, lymph node pain, memory loss, increased chemical sensitivities and other signs and symptoms. Often included in this complex clinical picture are increased sensitivities to various environmental agents and allergic responses.
Although chronic fatigue, fibromyalgia and now Gulf War illness have been known for years, patients have had few options for obtaining effective treatments. Unfortunately, within the DoD and the VA medical systems treatments are more easily ordered on the basis of laboratory tests than on clinical observations and the lack of clear-cut laboratory results in Gulf War illness cases tends to lend support for psychiatric diagnoses.
Over 100,000 veterans of the Persian Gulf War have been entered into the GWI registry. For the most part, this does not include immediate family members and according to one study, GWI has spread to family members. It is likely to also have spread in the workplace.
Thus diagnoses based on PTSD appear to be a gross over simplification of Gulf War illness and although the official position of DoD is that family members have not contracted GWI, a U.S. Senate report indicates that at least a subset of Gulf War illness patients have a transmittable illness.
In support of the Senate report, we have found similar transmittable infections in Desert Stormís family members. In fact, clinical tests reveal that Gulf War family members have the same chronic infections that have been found in approximately 45 percent of the ill veterans.
Chemical and biological exposures occurred during the Gulf War and many civilian patients have been exposed to chemical and biological substances that could be the underlying cause of their illnesses. The variable incubation times, ranging from months to years after presumed exposure, the cyclic nature of relapsing fevers and other signs and symptoms, and types of signs and symptoms of Gulf War illness are consistent with diseases caused by combinations of biological and/or chemical or radiological agents.
Now, I see my time is up so Iím going to skip to the back of my report and read off five --
SENATOR RUDMAN: How much more time are you going to use, roughly?
MR. DEES: How much time do I have?
SENATOR RUDMAN: I ask the questions. How much time do you need?
MR. DEES: It could take another five minutes.
SENATOR RUDMAN: Weíll give you five more minutes but we will end in five minutes because we have to keep this afternoonís schedule together and we will incorporate that statement in the hearing record.
MR. DEES: Yes, sir. Also, to answer your previous questions about the young sergeant in the back in relation to his benefits, I would like to bring out GAO report on veteransí benefits dated February 5 of 1998. I think youíll find that extremely useful.
SENATOR RUDMAN: Iím familiar with that. Thank you, though, for mentioning it. Go ahead.
MR. DEES: Chemical and biological exposures occurred in the Gulf War and many civilian patients have been exposed to chemical and biological substances that could be the underlying cause of their illnesses. Now, the variable incubation times, as I said, range from months to years after the presumed exposure and the cyclic nature of the relapsing fevers and the other signs and symptoms and the signs and symptoms of Gulf War illness are consistent with diseases caused by combinations of biological and/or chemical or radiological agents.
System wide or systemic chemical insults and/or chronic infections that can penetrate various tissues and organs, including the central and peripheral nervous systems, may be important. When such infections occur, they can cause complex signs and symptoms as seen in chronic fatigue, fibromyalgia and Gulf War illness.
Microorganisms as important agents or cofactors in chronic diseases. Some species of mycoplasmas, such as the fermentans, the penetrans, the pneumoniae, the genitalium, the pirum and the hominis, among others, have been closely associated with human diseases. In addition, chronic infections caused by Brucella or Coxiella can also cause similar signs and symptoms.
Do these agents cause or are they cofactors in chronic fatigue, fibromyalgia and Gulf War illness? They can certainly be important in causing morbidity seen in patients with chronic illnesses. If so, is there any evidence for mycoplasmal infections in chronic fatigue, fibromyalgia and Gulf War patients?
In a majority of these people we examined and others principally by Dr. Daryl See of the University of California College of Medicine in Irvine and a commercial laboratory in Los Angeles and they have documented mycoplasmal blood infections that can explain much of the chronic signs and symptoms that we see in GWI.
In our studies on GWI, we found mycoplasmal infections in the blood of about one-half of the patients and these patients were found to have predominantly one infectious species of mycoplasma fermentans.
And with that, Iím going to go on to the back so that I can meet my time constraints.
SENATOR RUDMAN: All right.
MR. DEES: We have some recommendations. We must stop the denial that immediate family members do not have GWI from the war. Denial that this has occurred has only angered the veterans and their families and created a serious public health problem, including the spread of the illness to the civilian population and contamination of our blood supply.
This is number two. The ICD-9-coded diagnosis system used by the DoD and the DVA to determine illness diagnosis must be overhauled. The categories in this system have not kept pace with new medical discoveries in the diagnosis and treatment of chronic illnesses. This has resulted in a large number of patients from the Gulf War with undiagnosed illnesses who cannot obtain treatments or benefits for their medical conditions.
Three. Denying claims and benefits by assigning partial disabilities due to PTSD should not be continued in patients that have organic medical causes for the illnesses. For example, patients with chronic infections that can take up over to a year to successfully treat -- to be treated, they really should be allowed benefits.
Fourthly, research efforts must be increased in the area of chronic illnesses. Unfortunately, federal funding for such illnesses is often rebudgeted or funds removed. For example, Dr. William Reeves of the CDC in Atlanta recently sought protection under the Federal Whistle Blowerís Act after he exposed such misappropriation of funds at the CDC.
It is estimated that over three percent of the U.S. adult population suffers from chronic illnesses similar to GWI, yet there are few federal dollars available for research on the diagnosis and treatment of these chronic illnesses even though each year Congress allocates such funds.
Fifthly, Senior DoD and DVA personnel must be held accountable for utter mismanagement of the entire GWI problem. This has been especially apparent in the continual denial that chronic infections could play a role in GWI and that the denial that immediately family members could have contracted their illnesses from veterans with GWI.
This has resulted in sick spouses and children being turned away from DoD and DVA facilities without diagnosis or treatments. The responsibility for these civilians must ultimately be borne by the DoD and DVA. I believe that it is now accountability time and the files must be opened so that the American public has a better idea of how many veterans and civilians have died and how many have become sick because of inadequate response to this health crisis.
Thank you for your time.
SENATOR RUDMAN: Thank you. I have one question, if you know the answer. How much funding has Dr. Nicolsonís institute received so far from the United States government in this area?
MR. DEES: Iíd be happy to answer that question. Itís in your report. Itís been a small amount. Iím looking for it and it is in this report. I believe about $40,000. That was -- instead of taking up your time to look for the numbers --
SENATOR RUDMAN: I have a way to check that but I think that number is not correct but I donít know what number is correct. Iíll find out.
MR. DEES: We will have to look that up but itís been remarkably low. Much of it has been to train DoD scientists that have been over to the Institute and he has tried to inform them and to teach and train them in the procedures that he is using.
Now, theyíve come up and said that they havenít been able to reproduce the results but we find a problem in the protocol, basically in the way that the blood, after itís been drawn from the arm, has been stored and shipped.
SENATOR RUDMAN: Well, thereís a good deal of controversy about a lot of the research that has been done, not just Dr. Nicolsonís research but then that is very normal in the scientific community and itís very healthy. I mean, you know, if we accepted certain suppositions early on weíd probably all be pretty sick. So Iím glad the scientists fight with each other until we finally find out what is true.
Weíre going to adjourn until 1:15. We ran late this morning. Weíll come back at 1:15. Thank you.
SENATOR RUDMAN: All right. Weíll come to order. Weíre pleased to welcome Dr. Rostker and his associates here today at this first of the hearings that weíre going to have and it would be good if you introduced your colleagues and then proceed as you would like.
DR. ROSTKER: Thank you, sir. I am joined here by Mrs. Dee Morris. Dee will talk about the investigation program and give you a status report. Dr. Dave Case will talk about depleted uranium and he is joined by Dr. Susan Mather from the Department of Veterans Affairs who will talk about the health aspects of depleted uranium.
Mr. Chairman and members of the Special Oversight Board, thank you for the opportunity to appear before you to discuss the activities of the Office of the Special Assistant for Gulf War Illness which is sometimes called OSAGWI.
You have requested that I report in three general areas; the general operation of my office, specific concerns for the Khamisyah modeling and depleted uranium. With your indulgence, Iíll put off the issue of modeling until tomorrow and cover that topic when we address the Senate Veterans Affairs Committee Special Investigating Unit report since they had a great deal to say about that subject. This afternoon Iíd like to address the general operation of my office, our plans for the future and depleted uranium.
The office of the special assistant was borne out of the realization that the Department of Defense assessment that no American trooper had been exposed to chemical agent was most likely incorrect. In September 1996, the new Deputy Secretary of Defense, Dr. John White, asked me to put together a team to look at everything the Department was doing concerning Gulf War Illnesses.
It became clear that the DoD needed a broader focus, an expanded effort, a strategy for systematically examining the various theories concerning the nature and cause of Gulf War Illness. We also needed a plan to effectively communicate DoDís findings to our veterans and the American people.
On November 12, 1996, Dr. White directed the establishment of the Office of the Special Assistant for Gulf War Illness with broad authority to coordinate all aspects of the Departmentís programs. He asked that we put a special focus on the operational aspects of the war and the issues of future force protection.
He emphasized the need to ensure that we had a communications program to reach out to the veterans and to try to learn from them what went on during the Gulf War. Responsibilities for health-related programs, specifically the clinical programs and the health research programs, remained with the Office of the Assistant Secretary of Defense for Health Affairs.
The Office of the Special Assistant was designed around a three-part mission statement which emphasized our commitment to our service personnel and veterans who served in the Gulf and focused on operational impacts of health and future force protection.
The Assistant Secretary of Defense continues this specific responsibility for care our service men and women still on active duty while the Department of Veterans Affairs is the primary health care provider for those who have left service. We included, however, care for those who served in the Gulf in our mission statement to remind us that the health of our people were our first concern.
Our mission charged us to do everything possible to understand and explain Gulf War illness, to inform the Gulf War veterans the American people of our progress, and then to ensure that DoD makes whatever changes are required in our equipment policy, procedures and doctrine. This is not limited to just the possibility of chemical or biological exposures but includes a broader inquiry into other possible causes of Gulf War illnesses.
Over the past two years, and weíre just about celebrating our second anniversary, our emphasis has expanded from a focus almost entirely on chemical weapons to a more balanced inquiry that includes work on pesticides, oil well fires and depleted uranium.
We have listened to our veterans and initiated a program to assist them in obtaining their inpatient medical records which were filed in such a way that it was almost impossible for an individual to retrieve his or her records. We have recently reorganized to provide more emphasis the lessons that we need to learn and are becoming a proponent for change within the Department of Defense.
All this occurred against the backdrop of an aggressive outreach program that centers around Gulf Link and Gulf News, our case narrative series, our hotline and e-mail program and visits to military bases and town hall meetings.
I can provide some sense of what we have done over the last two years. We have published 17 case narratives and two environmental reports. We have visited five bases and conducted town hall meetings at those bases; an additional 13 town hall meetings throughout the country sponsored by veterans service organizations.
We have answered almost 3,000 hotline calls, almost 5,000 e-mail calls and have had contact through notification or survey actions with almost 150,000 veterans who served in the Gulf. Over the last two years, we have spent almost $66 million and have expended over 340 man-years of effort. These include -- the costs include large-scale simulation, computer simulations and tests of demolition of 122-millimeter chemical rockets at the Armyís Dugway Proving Ground.
Later this afternoon I will return to discuss the issue we raised concerning where we are going in the future. I think this can best be understood after Mrs. Morrisís review of our current and ongoing investigations, which include a discussion of research integration and peer review process.
Before she speaks to you, however, I would like to address one of the issues you specifically asked about and that is the issue of is there a bias in our fact finding and our analysis.
From the very beginning, I understood that public confidence in this office and in the Department of Defense would have to be earned. Moreover, we started our efforts amidst the call for an investigation independent of the Department of Defense. Notwithstanding the work over the past four years that I have described, everything that we do, every report we write, this very testimony, can be a value to you and the American people only if you have absolute confidence in the objectivity and integrity of my office.
In this regard, you have requested I specifically address the comments by the Presidential Advisory Committee, the PAC, on page 18 through 20 of their special report which was issued on October 31, 1997 concerning bias in our investigation and inaccuracies in what we have reported.
Specifically, the PAC level three charges. DoD has a predisposition to downplaying information and contrasts existing views on chemical warfare agent in the Gulf. They further claim the DoD failed to present balance but conflicting statements by its own chemical weapons detection experts, and finally that the Office of the Special Assistant failed to pursue, acknowledge or account for information identified and analyzed by the Mitre Corporation.
I welcome the opportunity to respond to these charges. I do not believe that we have a predisposition to downplay information that contradicts existing views on chemical weapons, agents and the Gulf War. We feel justified in relying on UNSCOM as the primary source of information on Iraqís chemical and biological warfare programs, particularly in light of the lack of any other definitive source and Iíd note that the PAC relied upon them also.
Such reliance does not amount to a predisposition. While each case narrative stands on its own, to date we have not found that Iraqís chemical weapons agents were present in Kuwait. These findings have been confirmed by an independent investigation by the United States Senate and are consistent with the finding of UNSCOM as to the distribution of Iraqi chemical weapons during the Gulf War.
Let me be specific. UNSCOM reported to the PAC during their meeting in Buffalo, New York in August of 1997 that chemical weapons were never released to Iraqi troops and that no chemical weapons were moved further south than Khamisyah.
Specifically, after an extensive briefing on the history of the production, fill and distribution of 155-millimeter mustard shells and 122-millimeter Sarin rockets, the chairperson of the PAC asked UNSCOM, and I quote, do you have any evidence where any chemical weapons were moved from the lower depots, and by this we mean Al Nasiriyah and Khamisyah, actually down to Kuwait, maybe brought back at some time?
The UNSCOM response was we have seen no evidence to that and Iraq has said that no movements took place other than is described here, here being their briefing, which meant no movements further south of Khamisyah.
Furthermore, the Special Investigative Unit of the Senate Committee on Veterans Affairs concluded, and I quote, from analysis of information produced during UNSCOMís inspections, the SIU finds, based on available data, that in addition to Khamisyah, Al Nasiriyah appears to be the only location in the Kuwaiti theater of operations where chemical weapons were fielded during the Gulf War.
Let me now turn to the charge that we failed to present balancing but conflicting statements. At their public hearing in Buffalo, the PAC pointed out, as they did in their special report, that we had failed to report a caveat concerning the reliability of fox detections in the alarm mode of operation.
I agreed with the PACís concern and said so at the hearing but this did not change our assessment that the weight of evidence pointed to false-positives during the Marine breaching operation. There were -- this fact was confirmed by two other independent laboratories.
Now, I would note that we intended from the beginning that readers should use the Internet hyperlink from the footnotes of our case narratives to access the specific source material to check out our report and thatís what the PAC did. In this way, the PAC was free to make their own judgment about our thoroughness and objectivity.
More structured reviews have been undertaken by the General Accounting Office. The GAO is also reviewing our files to check on what material may not have been entered into our case narratives. They have also reinterviewed our people, the people we have interviewed, to make sure we have accurately represented what they have said. And I encourage the Board to review with the GAO their findings.
Finally, the third claim that we failed to pursue, acknowledge or account for information identified and analyzed by the Mitre Corporation. The PAC also accused my office of, and I quote, failure to pursue, acknowledge and account for the Mitre information.
The PAC charged that we would not release the Mitre report. These charges and more were also the subject of a New York Times article on October 31, 1997. The Times reporter noted that the draft special report was, quote, provided by people who had long criticized the Pentagonís handling of this issue.
In the Times article it was charged that the Mitre report concluded that there was, quote, compelling evidence to suggest that the Marines were exposed to poison gases, they crossed the mine field, possibly because of mines containing chemical agents.
These charges are simply without merit. For example, Mitre deals with the Marine breaching operation in less than two pages. We deal with these operations in a case narrative of over 27 pages. Similarly, the ammunition supply point orchard incident is highlighted by Mitre in one page but is the subject of a thorough case narrative before my office.
Probably the most outrageous charge was that we ignored compelling evidence that our troops were exposed to poison gas as they breached the mine field. Mitreís own conclusion was, and I quote, the information available regarding possible chemical releases in the Marine Corps sector during the ground is not sufficiently reliable to be conclusive about release or not release. Hardly compelling evidence.
My position on the Mitre report was spelled out in a letter sent to the chairperson of the PAC and 10 members of Congress when it was declassified on September 3, 1997. So the charge that we failed to release the report is without merit.
In my letter to the PAC chairperson, which I am enclosing -- providing you, I noted that, and I quote, DoD is providing Mitreís chapter 11 as you requested. It is, however, not a complete picture of any of the events it reports on. The material presented is largely uncorroborated accounts of and speculation about possible chemical events. A full investigation beyond Mitreís tasking was left to my office. That full accounting is in the form of the case narratives. These are the case narratives that are reviewed by the General Accounting Office and the American public with full access to all of the source material.
Let me conclude in terms of the issues of bias. As you consider the charge of bias, please consider not only the specific material that I have presented here but the work of the Senate Special Investigative Unit and the close scrutiny provided by the General Accounting Office.
From the start, we set out to provide the most complete accounting of the various incidents we investigated. Each case narrative carries a request for the reader to review it and call us at 1-800-472-6719 with any corrections so that we can make sure the reports are complete and accurate.
To facilitate this, we have hyperlinked all of our source materials so that our readers can fully review all the material that we have used. I do not know of any more open and transparent process to ensure that a full and honest accounting is provided.
At this point, I would like to ask Mrs. Morris to present an update on our investigations but Iíd be happy to take any questions that you might have also at this time.
SENATOR RUDMAN: I believe, Dr. Rostker, that the best way to do this is weíll get through the panel and then weíll have whatever questions any of the members have for various members of the panel. I think it would be more efficient that way and take less time.
MS. MORRIS: Thank you. Senator Rudman, Special Oversight Board members, I, too, thank you for the opportunity to outline why and how we conduct our investigations.
Everything that we now do to investigate individual instants or potential causes for why our Gulf War veterans are ill goes back to why the Office of the Special Assistant was formed two years ago. At that time, the question was how did we get into this mess. The mess was that we werenít listening to our veterans when they told us that they were sick, we werenít providing them with information needed to alleviate their fears and we werenít answering their questions. In short, we had lost credibility.
Since that time, the Office of the Special Assistant and specifically the investigation and analysis directorate has structured our investigative process toward answering veteransí questions and concerns. We determine what happened.
You might wonder, why should we be concerned about events that happened almost eight years ago? We are concerned because over one in seven veterans of the Gulf War report that they are sick. Many believe that their service in the Gulf contributed to their illnesses and we still canít tell them whether it did or it did not.
By studying individual events, we establish the facts. We can then determine whether exposure to something potentially harmful occurred and, if so, when, where and to how much. Taking this information and combining it with unit location data, we identify who might have been affected.
The next step is to compare the exposure information with what is known about how the substance affects people to answer veteransí questions about whether the exposure could explain why they are sick. To date, we have reported on incidents where service members have been potentially exposed to the nerve agent Sarin, the blister agent, Mustard, the riot control agent, CS, red fuming nitric acid, a rocket fuel oxidizer, depleted uranium and smoke from oil well fires.
For the exposures to CS, depleted uranium and the oil well fires, we have a fairly good understanding of the effects, both short and long-term on people at the levels potentially present. However, for Sarin, Mustard and red fuming nitric acid, we have identified potential exposure levels about which we know much less.
While this doesnít yet help us answer veteransí questions, it does help us identify and, through our representative on the research working group of the Persian Gulf Veterans Coordinating Board, target areas for further research.
Finally, studying the past helps us identify things we shouldnít repeat in the future. In the past two years, we have identified a number of areas where the Department can improve how we operate. Therefore, the office has recently formed a directorate for lessons learned implementation. In addition to my duties in the investigation and analysis directorate, I am also the director of lessons learned implementation.
My mission is to identify the lessons that can be learned from our Gulf experience, work with the Services and the joint staff to figure out how best to learn those lessons and monitor the incorporation of that learning into doctrine, training, equipment development and the military culture.
We must have a thorough understanding of what happened in the Gulf before we can begin to identify lessons to be learned. The President charged us to leave no stone unturned to develop that understanding. However, like all military organizations, we have been forced to prioritize how we turn over those stones.
When the office was formed, we focused our effort on those cases which seemed to concern veterans the most and generated the most questions. These centered on potential exposure to chemical warfare agents. The Persian Gulf Illness Investigation Team or the PGIT, our predecessor organization, had reported the potential release of the nerve agent Sarin as a result of demolition activity shortly after the war at the Khamisyah ammunition storage facility. We not only thoroughly investigated the events at Khamisyah, we also tried to determine if there were other Khamisyahs.
There was a lot of information available from the PGIT and other previous DoD inquiries as well as veteran reports to Congress and the Presidential Advisory Committee. These events formed our initial set of investigations.
Over the past year, we have progressed to more complex cases. The most obvious potential chemical warfare agent exposure events have been investigated and reports issued. We have started to investigate potential environmental exposures which are not limited to discrete places and times. These investigations involve more witnesses, more potential exposure scenarios, more modeling and coordination with external agencies and experts.
Despite the complexity of these cases, we can never lose sight of our obligation to address those events and issues which concern our veterans and about which they continue to ask us questions. With that in mind, we have continued to investigate the less obvious potential chemical warfare agent exposure incidents.
At the recommendation of the Presidential Advisory Committee, we are investigating all reports of positive M-256 chemical agent detector kit results and fox vehicle detections. We are analyzing and where possible quantifying potential environmental and occupational hazards in the battle space. We are even looking at field hygiene and sanitation.
We have also conducted thorough reviews of various aspects of Gulf War health care delivery and record keeping. As we continue our work, we will remain in touch with the veterans we serve to ensure that we are still addressing their concerns and answering their questions.
We employ three different methodologies in conducting our investigations. When investigating a potential chemical or biological warfare agent exposure incident, we use the methodology that was derived from the verification protocols of the chemical warfare convention to determine whether the reported exposure occurred. For environmental or occupational exposure cases, we use a methodology derived from the Environmental Protection Agencyís health risk assessment so that we may find out who might have been exposed to what and to how much.
Finally, when reviewing issues involving the medical system, we must determine what happened to cause the many questions and then what has been done to correct any identified problem areas. We have provided you, through previous briefings and documents, with detailed explanations of our methodologies and the factors that we consider in each.
While we have established methodologies for each type of case we investigate, there are a number of challenges, such as incomplete records and passage of time, which require that we flexibly apply our methodologies. We have not, however, used flexibility as an excuse for accepting inadequate information. In fact, we have assisted in recreating information on unit locations and actively solicited veteran input on reported M-256 kit detections.
In spite of our need for flexibility, we understood the need to have a process to ensure the completeness of our investigations and that we have maintained our objectivity throughout the investigative process and therefore we embrace the Presidential Advisory Committeeís recommendation that we establish such a methodology.
Our methodologies help us to ensure that we have reviewed all available documentary evidence, that we have interviewed reporting veterans and other key eye witnesses, have solicited the input of appropriate internal and external experts and have coordinated with the intelligence community.
Through a grueling three-step series of internal and external reviews of our written reports, we ensure that our reports accurately portray the objective supported evidence, that our assessments are clearly stated and flow logically from the evidence and are based on sufficient evidence and that we have consistently applied our methodologies. This process also assists us in rooting out inconsistencies between reports.
The first step in this process is the review of the investigative report by other members of the investigation and analysis directorate, the principal investigatorís peers. Next, the report is reviewed by the directorate leadership and other key individuals within the Office of the Special Assistant. These two reviews ensure the report is clearly written, tells the complete story and makes supportable assessments.
The final review is conducted by external organizations, including the Department of Veterans Affairs, the intelligence community, the National Security Council and the joint staff. In addition, organizations such as the Environmental Protection Agency and the Army Soldier Biological and Chemical Command are asked to review selected reports which deal with their particular areas of expertise.
At each step of the review process, comments are generated which the principal investigator must review and incorporate into the report. In cases where comments conflict or contradict information developed during our investigation, we sit down with all concerned parties and come to a consensus before finalizing the report for publication. This review process takes over four months to complete for each report.
We have published three types of reports. Case narratives are reports of suspected chemical or biological warfare agent incidents. Environmental exposure reports describe investigations into who was exposed to what and how much and information papers address subjects of general interest which do not involve specific instances of exposure.
Each of our published reports is an interim report. At the beginning of each, we explain this and provide the toll free number that Dr. Rostker mentioned for readers to call and provide additional input and comments. We havenít received very many calls to that number on our reports. The GAO has also reinvestigated six of our early cases and tells us that they support our assessments in those investigations.
In the last two years, we have published 13 case narratives, two environmental exposure reports and four information papers. The case narratives fall into two basic categories, the first category dealing with Khamisyah and the question of whether there were other Khamisyahs. We addressed the other Khamisyahs in the Talil Air Base and the Al Nasiriyah case narratives in addition to the Khamisyah case narrative.
The second category dealt with reported chemical detections and injuries and consists of the Camp Monterey Marine breaching, Al Jubayl, scud piece, mustard exposure, ASP orchard, Al Jabar, Kuwaiti Girls School, Czech-French detections and the 11th Marines case narratives.
The two environmental exposure reports are on depleted uranium and oil well fires. The four information papers address veteransí concerns and questions about the fox reconnaissance vehicle, the M-8A1 chemical agent alarm, mission-oriented protective posture and medical surveillance.
We have an additional 15 cases in active investigation and eight information papers in preparation. This next wave of case narratives will also deal with the other Khamisyah question by reporting on Al Muthana, Muhama Diat, Ukhaidar and other suspected chemical weapons sites.
We will continue our investigation of reported chemical detections and injuries in case narratives on the cement factory, Edgewood tapes, injured Marine, possible terrorist attack on Al Jubayl, possible post-war chemical weapons used on civilians, Rafha, M-256 kit incidents and biological warfare.
Upcoming environmental exposure reports will address pesticides, chemical agent resistant coating, retrograde equipment and sand. Future information papers will report on our investigation of the medical system problem areas of record keeping, vaccine administration and medical surveillance as well as address veteransí questions and concerns about the air campaign, the M-256 detector kit, chemical munitions markings, red fuming nitric acid and scuds.
As I stated earlier, each of our reports is an interim report. As such, we are also working on updates of two of our earlier cases, Khamisyah and the Marine mine field breaching. More updates will follow.
Even as the stones we are turning over become smaller, new cases are identified and developed. Veterans still have concerns and ask us to answer their questions. Our preliminary analysis team has 24 cases in the early stages of development and data compilation.
Two of these embryonic cases address the other Khamisyahís question and 11 deal with reported chemical detections and injuries. Early research is ongoing for three potential environmental exposure reports on various aspects of field hygiene and sanitation. We also have at least eight additional areas of veteran concerns or questions to address. All of this will keep us busy at least through the next calendar year.
At the beginning of my presentation, I presented the question we asked ourselves when we started over two years ago: how did we get into this mess? The answer to that question was that the Department of Defense finds it very difficult to deal with battle space casualties that manifest themselves in non-traditional ways. This is what we hope to change.
Over the last two years, we have worked to develop the information that will make it clear to our leadership where change is necessary and how best to achieve it and we welcome your assistance in that process.
SENATOR RUDMAN: Thank you, Ms. Morris. Mr. Case?
DR. CASE: Mr. Chairman, members of the Board, thank you for the opportunity to review the scientific and medical bases for our conclusions about depleted uraniumís role in causing the undiagnosed illnesses. Dr. Susan Mather of the Department of Veterans Affairs will join me in this effort.
On August 4, 1998 the Special Assistant for Gulf War Illnesses issued his first environmental exposure report on depleted uranium. That report, released after intensive effort, addressed the question, could the unexplained illnesses affecting some of those who served in the Gulf War be the result of exposure to depleted uranium?
The report concluded that, based on a comprehensive view of available data and a science-based methodology, exposure to DUís heavy metal toxicity or a low level radiation are not the cause of the undiagnosed illnesses afflicting some Gulf War participants.
This conclusion was based on three things. Testing conducted prior to fielding DU munitions, testing of the environment on the battlefield of Kuwait after the war and medical research and monitoring conducted before and after the Gulf War on human health effects.
The report is an interim report. Injured veterans are continuing to be evaluated. Additional veterans are being identified and offered medical testing. Further scientific efforts are underway or planned, including additional testing of DUís behavior in combat situations. All of these efforts are being conducted to develop as complete a picture of DUís role as possible.
During the course of conducting the investigation into DUís role, important lessons to be learned were evident. We learned that the average combat soldier needed awareness training but did not have it. Consequently, substantial effort has been spent on having the Services develop and conduct this essential training. Mrs. Morris will discuss the details of that training tomorrow.
The DU report carefully studied the circumstances of possible DU exposure in the Gulf War and developed reasonable estimates of the exposures that soldiers might have received. The report accomplished this by preparing estimates of the chemical and radiological doses under scenarios that are far more serious than the actual incidents, a common approach used when assessing health and safety impacts.
These estimates were combined with a detailed review of the scientific and medical knowledge about the known medical effects of depleted uranium. Although we contend that the report represents a sound assessment of DUís role in causing the unexplained illnesses, we recognize that some veterans have concerns about the conclusions reached.
Our presentation today focuses on the scientific and medical basis for the conclusion. We will do this by considering three questions: What medical effects are depleted uranium known to cause, could depleted uranium cause the undiagnosed illnesses and was the likelihood that the Gulf War experience could have produced one or more of the known medical effects of depleted uranium.
Although the report estimates the DU intakes for the worst case are similar to those believed to cause kidney problems, the intake levels are overestimates that were unlikely in Gulf War participants. Similarly, the estimated risks of cancer from the radiation doses corresponding to these intakes are also very low and at levels that are unlikely to be observed.
Our conclusions are based on the currently available yet very convincing evidence. We expect that our future studies are likely to refine the exposure estimates and to provide additional medical observations.
DU was used in the Gulf War in anti-armor munitions and as armor on Abrams tanks. As a low level radioactive material, depleted uranium presents a potential hazard in the form of the metal itself or as one of several oxides of the uranium when it strikes another metal, such as armor, when it is struck by another metal such as a penetrator or when it burns. Furthermore, DUís low level radioactivity may also produce low level ionizing radiation near bulk quantities of the metal such as armor packages or stored and stock-piled munitions.
Primary source of DU exposure to participates in the Gulf War was the friendly fire incidents. However, DU was used throughout the course of the conflict to meet operational needs.
Could I have that first chart, please? The majority of DU expended in the Gulf was fired into uninhabited or sparsely inhabited areas of Kuwait and Iraq as shown on this handout and map. 85 percent of the DU expended in the Gulf was fired from U.S. aircraft which primarily operated in the desert of Kuwait and Southern Iraq as shown on the map in the pink shape.
Some are concerned that U.S. stations are stationed or are conducting training in some of these areas of Southern Iraq. In 1994, the U.S. Army Center for Health Promotion and Preventive Medicine studied depleted uranium in the air, on damaged Iraqi equipment and in the soil and found that air concentrations were well below U.S. regulatory limits for the general public, that DU residues on shot-up Iraqi vehicles were not easily removed and that DU in the soil presented no DU exposure hazard to soldiers operating outside the storage yard.
Further studies in 1998 showed that DU in the soil samples at the locations shown by the triangles were all well below screening levels derived from environmental clean-up criteria published by the Nuclear Regulatory Commission.
During the Gulf War, several Abrams tanks and Bradley fighting vehicles were struck by DU projectiles causing death, injury, equipment damage and release of some DU. Initially, some 33 soldiers were associated with injuries from the friendly fire incidents and were enrolled in the Baltimore VA follow-up program.
About half of these were identified as retaining DU fragments in their bodies from wounds suffered during the friendly fire incidents. The presence of DU in their bodies as well as the potential for exposure to DU dust by inhalation, ingestion or contamination of wounds raised concerns about possible health effects.
In addition to those involved during the friendly fire incidents, other soldiers, DoD civilians and contractor employees assessed battle damage, recovered damaged or destroyed equipment, processed the equipment for disposition, entered destroyed or damaged enemy equipment for a variety of reasons or were present during incidents and accidents involving DU such as the explosion and fire at Camp Doha.
Each of these activities could have placed people in contact with DU in one form or another. Since direct measurement of the exposures was not possible after the fact, we started an effort to perform a detailed assessment of the amount of DU possibly inhaled, ingested or transferred through wounds in Gulf War-specific scenarios.
First, we identified and reviewed the available information about the behavior of DU in combat situations. During the development of DU munitions, some testing for health and safety purposes was done. However, the data were not always obtained under exposure conditions that were similar to the Gulf War situation or the testing experienced other problems.
A review of the possible exposures situations revealed that the various scenarios could be classified into three levels based on the expected chemical and/or radiological dose. In performing the assessments, we considered the amount of material involved, the amount of material that could be inhaled or ingested and the frequency and length of possible exposure events. The three levels of classification of individuals involves increasing numbers of people with decreasing amounts of dose.
After reviewing the available test data on the behavior of DU under conditions similar to the Gulf War and our knowledge of the exposure conditions in the Gulf, we calculated DU uptakes and doses relevant to both chemical and radiation effects. The initial DU report concentrated on the level one participants who occupied vehicles struck by DU but who did not retain fragments. Those who retained fragments are being followed. Their dose is determined and their medical conditions evaluated.
Scenarios were developed that correspond to actual test conditions involving DU penetrators impacting DU armor. These allowed us to use experimental data to approximate the actual conditions. Doses from inhalation and ingestion were estimated for occupants of an Abrams when two depleted uranium rounds penetrated the DU armor package, producing a maximum depleted uranium uptake of 52 milligrams and an average uptake of 24 milligrams. These correspond to radiation doses of about .96 REM and .4 REM.
Doses estimated for occupants of an Abrams whose DU armor was not penetrated produced a DU uptake of .042 milligrams and a corresponding radiation dose of .001 REM. These results represent a best estimate for what is believed to be the highest exposure for Gulf War participants who did not retain fragments.
The DU uptakes and radiation doses considerably overestimate the actual situations because no penetrations of the DU armor package occurred during the Gulf War because many friendly fire incidents involve Bradleys whose soft armor produces much lower amounts of DU residues and because participants in the other levels would be subject only to resuspended depleted uranium which presents a much lower possibility of inhalation uptake.
DU intakes were estimated to be no more than 52 milligrams of DU for a soldier under the maximum conditions. Intakes for participants in levels two and three are expected to be much less. It is now impossible to assess whether temporary kidney disfunction occurred in soldiers immediately following their accidents.
If such dysfunction did occur, however, it could have been related to DU exposure or to traumatic injuries or major surgery. In addition, routine urinalysis tests do not detect the subtle early renal damage that could be associated with DU toxicity. However, no kidney abnormalities have been documented in any of the 33 veterans studied in the Baltimore VA program.
For radiological effects, the current approach to radiation protection applies the linear non-threshold model to managing risks to workers and the public. This approach assumes that there is a risk associated with any dose, no matter how small. The incidents are rated which in effect occurs increases -- with increasing dose.
Furthermore, good practice requires that no one should be exposed to ionizing radiation unless the exposure is justified, that is, there is an expected benefit, that the exposure is kept within established limits and that the dose is kept as far below the established limits as is reasonably achievable.
To provide a sense of health context, the radiation doses for the worst case scenario were compared with a measure that is acceptable. In occupational health regulatory limits levels of natural background radiation and estimated risk of other accepted activities in life or work are used as benchmarks for comparison.
The maximum estimated dose of about one REM from the two penetrations of DU armor into the crew compartment is one-fifth the current annual limit for workers of five REM and equals the recommended limit of one REM per year of a workerís age over a working lifetime. These limits represent acceptable levels of risk according to international and national standard setting groups. The one REM is also about three times the annual background radiation dose for every citizen of the United States.
In the second case, when the crew compartment was not breached by a DU penetrator, the .001 REM estimated dose is 5,000 times below the maximum annual occupational limit and 100 times below the recommended federal limit for members of the public. These limits represent levels of radiation dose that have been judged to represent acceptable although non-zero increases in risk for workers and the public.
As such, we conclude they represent reasonable benchmarks for comparison and support our conclusions that the DU experience in the Gulf War is not likely to produce the medical effects associated with uranium.
This work is interim work. Efforts are continuing to complete those estimates for all 13 categories and the three established levels, to refine the information to use to support the estimates and to continue to study participants and to perform research on animals to fully characterize the behavior of embedded DU.
Research on the effects from embedded fragments from DU alloy used in military applications is limited. Nevertheless, the other routes of exposure, inhalation, ingested, the body of knowledge about uranium is quite relevant and extensive. From that research and experience, we know that DU, like other forms of uranium, exhibits heavy metal toxicity that primarily affects the kidneys.
DU is also known to accumulate in the bone, kidneys and to a certain extent in the liver, brain and other organs. Most chemical toxicity studies of materials such as fluorides, nitrates and others, have shown to produce serious effects in lungs, kidneys and other organs when very high dose levels are involved. Oxides of uranium and metallic uranium that are more prevalent in the Gulf War scenarios are reported to be less toxic.
To fill the information gap on embedded DU fragments, the Armed Forces Radiobiology Research Institute is conducting animal studies with implanted DU. After 18 months of study, uranium is observed in the urine but no adverse renal, reproductive or behavioral effects are observed.
Because DU emits alpha, beta and gamma radiation, it may cause radiological exposure from outside or inside the body. Both cases must be considered in any assessment of the risks from DUís radiological exposure.
Outside the body, DU munitions emit beta and gamma ionizing radiation levels of about two REM per hour on contact and about .001 REM per hour at reasonable distances in bulk storage such as depots. Both of these situations are readily managed to control total doses well within accepted limits.
Inside the body, DU can remain at the site of entry or be distributed to other organs. DU can enter the body by inhalation, ingestion or through the skin where alpha particles are the primary source of radiation dose. By far, the inhalation route generally represents the primary route of concern. Inhaled soluble DU can be taken up into the blood quickly and distributed to other organs.
For soluble DU, the radiological dose is usually less of a concern. Most soluble DU is excreted from the body quickly, usually within days to weeks. Inhaled insoluble DU tends to remain in the lungs and be slowly removed over periods of weeks to years. Interestingly, the participants in the Baltimore VA study who may have inhaled DU but who do not retain DU fragments have shown no abnormal levels of uranium in their urine.
As for all radiation, incidents of cancer may be a concern. However, DU or natural uranium have not been cited as causing cancer in any studies of DU workers or the public. DU simply does not produce the levels of radiation dose that can be realistically associated with cancer. While lung cancer is known in uranium miners, their excess cancers are thought to be linked to their exposure to radon and mine dust.
In July 1998, DoD and VA instituted a new medical program to identify and contact Gulf War veterans who may have had the highest DU exposure. The follow-up program is aimed at ensuring that veterans with higher than normal limits of uranium in their bodies are identified and are appropriately monitored.
The program requires a 24-hour urine collection for uranium level and a detailed DU exposure questionnaire. The follow-up is being implemented in phases. OSAGWI is contacting veterans who were riding in or on a vehicle that was struck by DU munitions or veterans who entered a struck vehicle immediately after it was hit. That is those in level one.
May I have the next chart? Personnel who worked in or on U.S. vehicles contaminated with DU are also included. Veterans who are in lower exposure groups will not be specifically identified by OSAGWI but they may refer themselves to DoD or VA for medical advice if they are concerned.
As of November 17, 1998, 119 level one veterans and 83 level two veterans have been notified. This attached chart shows the current status of our identification and notification program. The identified column represents those people who have been identified by name and social security number and the notified indicate those who have actually been contacted.
Thank you. Now, let me introduce Dr. Susan Mather of the Department of Veterans Affairs who will report their findings related to DU.
DR. MATHER: Thank you. Senator Rudman and members of the Board, I am glad to be here to give you a brief summary of what the Baltimore DU surveillance program has found. That program is directed by Dr. Melissa McDermott who is unable to be here today.
The Baltimore VA Medical Center is the site of the VA surveillance program for Gulf War veterans primarily with retained DU fragments. It began in late 1993. The Department of Defense identified veterans who were on Army vehicles struck by DU-containing munitions. The program at Baltimore is funded by the VA although DoD provides transportation and per diem hospital costs for active duty military personnel who are participating.
There is an interest in expanding the surveillance to all veterans with retained fragments as well as those with DU contaminated wounds or significantly inhaled DU. The status of the program is that 33 veterans were seen in 1994. 29 of the original 33 returned in 1997 for reevaluation. Two are lost to follow-up and two could not travel to Baltimore and Boston for the required tests even when weekend visits were offered. A third evaluation is to begin in the new year and be concluded in 1999.
The program focus is essentially a clinical one. However, there are research and outreach aspects to the program. Controls have been recruited so that exposed and non-exposed Gulf War veterans can be compared. The results have been presented at national and international meetings and are being submitted to national peer review journals for publication.
Staff are available for consultation and technical assistance to clinicians in the field who have veterans who are concerned about depleted uranium. The program officials are also working closely with risk communication specialists in evaluating the information and communication needs of the participants. In other words, how do the participants want to receive information, what information is meaningful to them and what form should it be presented in.
Involvement with the recent OSAGWI outreach to other potentially exposed DU veterans has been a major activity over the past several months. Staff at Baltimore are providing technical assistance to both DoD and VA medical facilities in collecting 24-hour urines for urinary uranium. The DU urinalysis is being performed at the same laboratory used by the Baltimore surveillance program and staff at Baltimore are monitoring results and providing consultations to local clinicians who are seeing these veterans.
I think weíve already discussed the status but I want to point out some interesting things about the people who are coming forward to be tested as a part of this outreach activity. As youíve heard, 202 individuals have been notified by DoD already and 84 of these are veterans who have been referred to the VA and we are in the process of setting up appointments for them with VA physicians.
33 kits for urine testing have been requested and eight have actually returned specimens. However, prior to the OSAGWI outreach activity, we had 48 self-referrals in VA who have come to VA hospitals concerned about DU and who have requested urine testing and this is in the process of happening.
Since the outreach effort, word has evidently gotten out to other veterans who are concerned and 96 additional veterans have come to VA facilities who have not received a call from the Department of Defense but are concerned. Of these, 35 have actually returned specimens.
The urinary uranium results will be coordinated with the survey and demographic data that is being collected on these veterans. Obviously this is important to do because some veterans live in areas where there is elevated uranium in the soil or water or may have been exposed to DU in other scenarios.
The testing has been quite intense that has gone on with the veterans who were referred to Baltimore. We can go into more detail in that if you are interested but I think in summary itís important to note that of the 33 individuals that weíve seen, these individuals do have medical problems some of which are related to their wounds. However, at the present time there is no evidence of kidney disease in these individuals and I think one of their concerns is the risk of birth defects and so far all the children born have been healthy. Thereís also no evidence of cancer in this particular cohort and thatís the summary of the findings at the Baltimore program.
SENATOR RUDMAN: Thank you very much.
DR. ROSTKER: Sir, Iíd like to return to the issue of the long range plans. Mrs. Morris has presented an overview of the current work of the investigation and analysis directorate and Iíd like to build upon her presentation and discuss with you the future of the Office of the Special Assistant.
As she noted, the majority of the work projected to continue remains in the area of chemical incidents. As she has noted, we have already completed 19 papers; of these 13 were chemical case narratives and four were information papers concerning issues relating to the possible use of chemical weapons during the Gulf War. Additionally, we have published two reports on environmental issues.
The cases completed were the ones of the greatest concern to veterans. Additional cases are under investigation because of commitments made to the PAC or inquiries made by individual veterans or veteran groups.
We are prepared to investigate these cases and maintain a level of effort that we have developed over the past two years. Currently this is about $30 million a year and employs upwards of 200 people. To date, however, none of the case narratives that we have published contradicts the conclusions reached by UNSCOM and endorsed by the Senate Special Investigative Unit.
And let me remind you of what the Senate Unit report said, and that was from analysis of information produced during the UNSCOMís inspections, the SIU finds, based on available data, that in addition to Khamisyah, Al Nasiriyah appears to be the only location in the Kuwaiti theater of operations where chemical weapons were fielded during the Gulf War.
Moreover, I can report to you that at this time none of the case narratives that we have under investigation appear to have uncovered any information that would contradict UNSCOMís findings. Frankly, having gotten this wrong before when the Department was incorrect in its conclusion that no American troops were exposed to chemical agents, the Department cannot make the final determination of when the stones are too small to bother to turn over.
I believe that this is a determination that this Board, in concert with the leadership of the Congress and the veteran service organizations, must help us make. We need to continue with the cases that are nearing completion and the revisions to cases that have already been published.
I propose that all interested parties, the Department, the Board, the Congress, the VSOs, jointly review the outstanding future cases to determine if they warrant a full inquiry. If there is a consensus to continue, the Department will provide the resources and under your review we will move forward. If we can agree that further inquiry is not warranted, then we can reallocate resources accordingly.
As you know, we have undertaken a number of other activities that I believe should go forward. We are committed to report on significant environmental exposures. We are supporting the Department of Veterans Affairs with the expanded depleted uranium screening for those exposed to depleted uranium oxides. We are monitoring DU training within the Department of Defense. We have committed to help veterans obtain their inpatient health records. We are sponsoring and leading a review of medical records of the Saudi National Guard. We are continuing our outreach program to include base visits, town hall meetings, Gulf Link and Gulf News.
You should know, however, that almost all of our new contacts with veterans are the result of our initiatives. Contacts made by us during the development of our case narratives or soldiers signed up for interviews during our base visits. Inquiries from our hotlines have fallen off sharply over the last two years.
As we progress, we will work with my colleagues in the Department of Defense to ensure that the lessons from the Gulf War are learned and that the capabilities of this office are made a permanent part of the DoD either by maintaining the Office of the Special Assistant or transferring it to one of the more established offices in DoD.
We need your help to chart the path for the future of the Office of the Special Assistant. I thank you, sir.
SENATOR RUDMAN: Thank you very much, Dr. Rostker and your associates. Iíll just respond to your last comment. As you know, we have our initial report due in August. That will be nine months from the date of inception.
I would very much hope by that time to give you our guidance which you will then of course get guidance Iím sure from the committees in the Congress, but to give you our guidance as to how many more case studies, if any, you ought to do, those that in our view you ought to refine, those that you ought to discontinue.
My own view on this, having looked at it for a year, is Iím not sure with all the debate that still goes on on modeling, you know, itís almost like trying a tort case. You could probably get a hundred experts and all 100 experts would say something different, kind of what you want them to say in some cases. Itís a sad commentary but thatís about the way it is. And I think that the debate probably at some point ought to stop on some of the methodology or else youíre up to meet yourself coming around the other side.
So I would hope that we would give you strong guidance from this group in August and then of course Iíd be interested to hear what other people who you have to pay attention to might say. But weíre going to respond to that.
DR. ROSTKER: And let me make it absolutely clear. This is not an issue for the Department of cost. The resources are there. They will be there as long as necessary. This is an issue of getting it right and doing the best job for veterans and there are certain things that we are thrilled to do in working with the veterans and that -- we want to continue that indefinitely.
SENATOR RUDMAN: I appreciate that, Dr. Rostker. It seems to me that getting it right is very important for -- but on the other hand, if the scientific tools and evidence are not available to ďget it rightĒ, the longer one tries to do that, the longer one may postpone what the veterans really need in the final analysis so I think thatís an important issue also. And we are going to address that.
This commission, I can tell you, is not going to shrink from making very strong recommendations in November. Weíre going to step up to the plate and weíre going to swing at it because frankly itís time for action here for these veterans and thatís the way I feel. I know my fellow commissioners feel the same way.
Let me turn it over to anybody on my panel who wish to ask a question and I will start with Admiral Steinman.
RADM STEINMAN: Thank you, Senator. I just have a comment and a brief question. The comment concerns the DU report. Given that your first DU report was an interim report with a follow-on report presumably to follow that will involve the results of ongoing research on the DU-exposed vets in the Baltimore study and others, I was a little surprised at the definitiveness of your conclusion that DU was not the cause of undiagnosed Gulf War illnesses.
While this may yet prove to be true, I think that conclusion was premature and worse than that, I think making that type of strong statement damaged your credibility. In your report, there was a contradictory statement which I thought was much fairer.
It said based on the ongoing research that we have, Iím paraphrasing now -- based on the ongoing research we have with others to follow, we canít conclude at this time that -- and that was a much more reasonable statement. I assume that your final report will include all the final research as well as some of the data provided in the CHPPM paper.
DR. ROSTKER: Let me explain that and I accept your observation. I think the operable word there is the unexplained illnesses. The work continues in terms of radiation and continues in terms of kidneys but the general identification of unexplained illnesses are not illnesses that, in the medical literature, in any way relate to those kinds of conditions and I think itís in that context that that summary statement was made.
For example, memory loss. Thereís no place that weíre aware of in the medical literature that associates an exposure to depleted uranium with the possibility of memory loss. So it was in that limited sense that that statement was made but I agree with you. In retrospect, it probably was ill-advised to have made such a strong statement and we stand corrected.
SENATOR RUDMAN: General, do you have a question?
LTG CISNEROS: Yes, Mr. Chairman. Dr. Rostker, I have a question on peer review and I think Ms. Morris addressed it so she may want to comment on it. Taking the fact that thereís a lot of mistrust of government and we go into this issue of reviewing the results of what youíre coming up with and trying to put that to bed or at least thinking about it, being smarter than the average bear is how I would describe it, could you please -- and Ms. Morris, you talked about a little about peer review and mentioned the GAO and other interagencies.
What Iíd like to know is did you have any mechanism for peer review by either who you knew were going to be your challengers or some other respectable organizations outside of those that people would consider DoD? Was that done? Was that considered? And if so, what rules did you put out to make that happen?
DR. ROSTKER: The whole process of creating an interim report was that peer review. It was very important to us to provide the best information we had to the American public but we did it in an interim form inviting peer review, inviting the review of the American people and thatís why we provided all of the source material in the form of the hyperlinks to the material.
If we had done that privately, it would have dragged out the process for months and months and months and we would never have presented any facts or any material to the American people. So understanding that this was a process in which there would be many views, we invited the American people to review our work.
In several cases, we presented the material to particular individuals who were cited or quoted in the report. For example, in the Girls School case Maj. Johnson, then Capt. Johnson, was a major figure and we reviewed the report on several occasions with him and in fact he was with us in our prebrief before -- when we released it to the veteran service organizations so he could answer any specific questions they had.
But given that there was congressional testimony on these cases, given that the government had been silent on many of these cases, it was important to put it in perspective giving full consideration that we were open to enter the discussion with anyone who had additional information.
LTG CISNEROS: So in essence you published it and you said weíve invited the American public to serve as a peer review or whoever --
DR. ROSTKER: Yes, sir.
LTG CISNEROS: Has that -- has there been a mechanism to formally get it and then reconsider and re -- see if you had to evaluate? Where do we stand on that?
DR. ROSTKER: The status has been the 800 number. We have solicited comments directly to veterans groups, major people, some of them, who will be testifying later today we have asked to provide us with any input. We have engaged specific individuals who are quoted in the reports to provide additional information. In many cases, weíve gone out and shown the sections that weíre dealing with, for instance in Marine breaching or in some of the Marine cases we have gone back to the individuals who we did not agree with or could place their observations in a broader context and had further discussions with them.
But I must be candid. The best job that has been done has been by the dedicated staff of the General Accounting Office. They will have, based upon their debriefs to us, they will have many things to say and we will take and incorporate their findings since they took the effort to go and reinterview people and really duplicated -- at no loss, duplicated for the better much of our analysis, weíll have a richer product in the future.
LTG CISNEROS: But in the initial process, you indicated you only used internal peer reviews from internal agencies or were there any --
DR. ROSTKER: Well, for example, in the Marine Corps cases we shared the case narrative with the Marine Corps and got their response. I personally delivered a copy to the Commandant and we had his response. We had the response of the Marine Corps senior leadership and they circulated these to members of the Corps. But we did not choose a panel to review this. We got this out to the American people with the full understanding that this was interim and solicited their comments.
MS. MORRIS: General, if I could expand a little bit on what Dr. Rostker has said, peer review is perhaps a misnomer for what we actually do. In the scientific world, peer review has a very specific meaning, has a lot to do with whether or not the results are reproducible.
In our particular case, the peers are the people who are charged with similar investigative responsibilities in different cases and they are there to try and help the investigator make sure that he is clearly and accurately reporting on the information that he has found.
But as I described, weíve got a three-step process. Two of those steps are more or less internal to the Office of the Special Assistant but that third step is an external review where we literally send the report out to a list of ten organizations routinely and then another almost that many, depending upon the contents of the report, and we ask them to look at it and scrutinize it and tear it apart and tell us what we need to do to make it a better product. They do that and we incorporate those comments.
LTG CISNEROS: Itís those 10 that I wanted to -- that I was tying to -- youíre so right. When Iím thinking of peer, Iím thinking about external to your own elements here. Those particular 10 you said you have done it, you have sent it out to them or youíre in the process of doing it?
MS. MORRIS: No; we have done it. When we developed our review process, we have a very formalized process and there is a list and we can -- we briefed that to selected members of the Board last month. But there are approximately 10 organizations, and I listed several in my testimony, National Security Council, Joint Chiefs of Staff, CIA, DIA, VA, Health and Human Services. These are all organizations that we send --
LTG CISNEROS: These are part of the 10 youíre talking about?
DR. ROSTKER: -- we send these reports to those people and to those organizations and we ask them to review them. The responsible organizations.
LTG CISNEROS: But are any of the 10 an agency that your critics could say, yeah, thatís an acceptable one or the 10 that you just unilaterally selected yourself?
DR. ROSTKER: Well, I donít -- since weíre talking -- the 13 papers, weíre talking about military operations. I donít -- Iíd be at a loss to know what outside organizations have the expertise, the knowledge and the material to assess them.
LTG CISNEROS: Iím not talking on the technical aspects of a military operation. Iím talking about drawing a conclusion based on this evidence and somebody who has familiarity with drawing conclusions on --
DR. ROSTKER: Well, the -- 13 of the papers all are military operations because they deal with what happened in the Marine breaching operation or they deal with what happened at the Girls School so that -- and the issue here, the conclusions that are drawn, are conclusions in terms of is it likely, is it indeterminate, is it not likely that there was an exposure to a chemical element -- a chemical agent. So it is very much in the operational chain.
In the one case where we -- the depleted uranium, that went to a broader set of organizations including the Center for Disease Control -- do you have --
MS. MORRIS: Well, the Centers for Disease Control sees an awful lot of our stuff away but we also are selective in a second group of reviewers and that really depends upon the subject matter of the case. And as Dr. Rostker indicated, there have been instances where key witnesses have been involved in the external review process to make sure that we got the story right.
He cited the Kuwaiti Girls School. Not only did we deal with the Army commander who was involved with that particular operation, we sent that report to just about everybody who was named in it and asked them to make sure that they were properly being represented and that the story was correct as they knew it. We donít do that for every case but we have in some instances.
DR. ROSTKER: Let me also point out that through this last year we had two organizations reviewing and overseeing our efforts. One was the Presidentís Advisory Committee. And while they indicated in their special report that they had no intention of reviewing each individual case, they had all of these cases well in advance and from time to time made comments.
The second was the Senate Special Investigative Unit who reviewed many of the cases that we provided and reviewed all of the same material and throughout the whole process, weíve lived with the General Accounting Office who have, again, held us to the highest level to ensure that all of the material presented was correctly interpreted and the like.
But we did not charter a red team, so to speak, to go out and do it. The red team is the American people through reading the cases and providing us input and we providing them all of the material that we use to assess the incident.
SENATOR RUDMAN: Dr. Cam.
DR. CAM: Yes. Your case narratives have been published as interim reports. What criteria you use to make them final reports. A couple other points is how have the PAC recommendation been integrated into OSAGWI investigations? And is there any recommendation that you have chosen not to implement and if thatís the case, provide us the justification.
DR. ROSTKER: The -- we will eventually republish all of our cases and this is a matter of collecting the information that we get in and then determining whether or not it would change a conclusion or description. From time to time we have been explicit in our Gulf Link outreach against soliciting information. We are actively working to republish Khamisyah and we went out with again a notice asking people to come forward.
We have taken the PACís recommendations very seriously. I would tell you, for example, that when we started the case narrative series it was not my intent to draw any conclusions. We felt that we could provide the best -- I felt that we could provide the best service as just laying out the facts.
I did not want to make a judgment of whether something was likely or unlikely because I think it takes away from reading the paper and drawing the conclusion yourself but the PAC insisted that we make that judgment and we were explicit in setting out the scale to which we would do it. The PAC pressed us to be explicit in the presentation of our methodology and we were explicit in the presentation of our methodology.
So if you go to the first set of case narratives and then look at the later case narratives, they very much were in a response to the feedback that we were getting from the PAC. There were things we didnít do that the PAC wanted us to do. They wanted us to notify everyone in 300 miles of Khamisyah that they may have been exposed. We chose to wait and do the analysis on the plume and notify people who we believe may have been under the plume.
The PAC ordered us to notify people who were near the Kuwaiti Girls School that they may have been exposed to mustard. We felt that was way premature, did not do that and the case narrative is generally regarded as probably the best case narrative we have produced and clearly establishes that the agent present was red fuming nitric acid.
So we took what legitimately the PAC in my view could add to the process where there was improvement but frankly, in cases where I disagreed with the PAC, I did not implement the PACís recommendations.
DR. CAM: Thank you.
SENATOR RUDMAN: SGM Moore, you had a question?
CSM MOORE: Thank you, Chairman Rudman. Dr. Rostker, at the beginning you spent a significant amount of your presentation attempting to rebut the Presidential Advisory Committee comments and its special report on biases. However, it appears that when discussing depleted uranium and the 11th Marine Corps, OSAGWI leans towards praising the military service personnel abilities and training when it is evident that at the very least training was suspect.
How do you account for your inability to make the following judgment, either the personnel werenít well trained or the equipment was not any good?
DR. ROSTKER: Well, let me take the first one, depleted uranium. We do not praise the Departmentís training for depleted uranium. We recognize that it was wilfully inadequate, that troopers climbed on and exposed themselves in ways that were -- could easily have been avoided. In the interim report I talked about unnecessary exposures and that judgment continues to stand and thatís why we have been so insistent on improved and thorough training for depleted uranium. So in that paper, I donít think we have made any judgments in terms of the training.
In the 11th Marines, again, I donít think we have been praising the training. Weíve been critical of, for example, the training in the deployment of fox vehicles for all of our cases. The vehicles were made available only six weeks before the war and were used in warning modes that were prone to false alarm and weíve been able to demonstrate that.
Weíve worked with the chemical school. In fact, Mrs. Morris was down there just a few weeks ago to work with them on issues of doctrine to improve our training. So I think thereís no question that our troops were superb in the Gulf but in areas of depleted uranium and in chemical warning, much is yet -- has to be done.
MS. MORRIS: One of the things that has always concerned us is soldier perception about the capabilities of their equipment and one of the things that we constantly hear is that if there were alarms and they kept going off, then there must have been something there.
And as a consequence of that, we started looking at what was actually occurring for many of these events. And what we found was that soldiers were essentially responding as they had been trained and so they did what they thought they were supposed to do. But looking at what probably occurred with some of these items of equipment, our concern shifted to whether or not they were being trained about the right things.
And thatís one of the reasons that I went down to Fort McClellan and I took several other people with me because we were very concerned that soldiers did not adequately understand the capabilities and limitations of their equipment. And we point out some of those capabilities and limitations in the information papers on things like the M-8 alarm and the Fox.
Weíre going to point out similar limitations and capabilities in the 256 kit information paper thatís being prepared now but we wanted to make sure that people knew what these capabilities and limitations were and so we started with the chemical community.
And had we limited ourselves to a paper review of looking what was in the manuals and looking what was in doctrine or published doctrine, POIs, curriculum, lesson plans, even, we would have walked away with the assessment that perhaps this information was not being passed out. We fortunately found that it was.
Itís representative of the fact that when we make changes, it takes a while for us to get the documentation to catch up and thatís what weíre suffering with right now. But we were comforted by the fact that at least chemical soldiers, and we looked at initial entry folks, these are the folks who advise their commanders, and we believe that they are being trained on the capabilities and limitations of their equipment.
I took the opportunity while I was down there to talk to General Wooten who is commandant of the chemical school and chief of chemical and pointed out to him that based on what we were hearing he needed to really seriously consider continuing education and making sure that people know about this afterwards because as doctrine changes, unless somebody goes back to the schoolhouse, they might not get a chance to see it. And so he accepted that as a valid concern and weíll be working with him on that.
DR. ROSTKER: If I might, one of the -- as you well know, I have through all of this worn two hats and Iíve changed my other hat but it is very convenient as Undersecretary of the Army to be in a position to help focus the priorities of the Army on implementing the recommendations from the special assistant for Gulf War illnesses.
So I feel often like the character in the machado who says now as chancellor of the x-checker we do this but as Lord High Executioner I would do that. So I tell my staff that Iím tired of being yelled at by the Special Assistant and as Undersecretary weíre going to fix this problem. But it is very timely, the change that allows me to now push forward on the implementation from this additional vantage point.
CSM MOORE: Would it be justifiable if I ask, knowing what you know now, looking at the 11th Marines and conducting the thorough investigation, would it be adequate to say that if the Marines had been trained properly this wouldnít have happened or, again, if itís the equipment that is not adequately for its intended purpose on the battlefield?
SENATOR RUDMAN: I think that requires a fairly short answer, by the way.
DR. ROSTKER: Weíve made great strides in the equipment, both understanding its limitations and correcting it as well as bringing in new equipment. We have a whole new chemical alarm, the ACADA, the Fox vehicles now require before we declare that thereís a chemical event, a full mask spectrometer reading and then the preservation of the tapes. Those would have been the two best things to occur on the battlefield.
CSM MOORE: Thank you.
SENATOR RUDMAN: Thank you. Admiral?
ADM. ZUMWALT: I have two questions, Dr. Rostker. Most agencies of the government now recognize dioxin as carcinogenic and as having other health effects. Have we looked at the pesticides used in Desert Storm to see whether there are dioxin or other organic phosphate compounds?
DR. ROSTKER: We have. In fact, we brought back from our visit to Saudi Arabia samples of unauthorized pesticides, organic phosphate pesticides, that we know our troops purchased and were used. Given that itís eight years later, weíll never be able to make a cause and effect connection but weíre very interested in understanding how pesticides were used in the Gulf and weíve instituted a survey which will be going out this winter of over 3,000 service members. These will be telephone surveys, not paper and pencil but detailed debriefing interviews to get a better handle on how pesticides were actually employed in the Gulf.
First time through this, we got the standard answer. They were employed according to the way they were supposed to be employed. Thank you for your interest. That didnít sell and we have a number of scenarios that weíre assessing in terms of how pesticides were actually used in the Gulf.
ADM. ZUMWALT: The other question has to do with the fact that several veterans have said to me that they get the impression that the good news is quick to be published and the bad news moves at a rather slow pace. An example thatís cited is that we detailed the depleted uranium radiological hazard but downplay the chem tox issue. Is that a valid criticism?
DR. ROSTKER: No, I donít think so. Things are published as they are ready to be published. For example, we have a paper that Rand has produced on depleted uranium. There is some question of whether they have the facts right in some areas. We havenít published that paper.
Weíre similarly moving a paper forward on pyridostygmine bromide which is, if I may project on that paper, a lot less sanguine than our earlier position. The most important thing is getting the facts straight and thatís why we go through our process.
ADM. ZUMWALT: Thank you.
RADM STEINMAN: I wanted to question on the issue of the mycoplasma. I wonder if you could comment on OSAGWIís follow-up on Dr. Nicolsonís theory that mycoplasma is a cause of undiagnosed illnesses.
DR. ROSTKER: We have tried -- the Department of Defense has tried to engage Dr. Nicolson. He has trained several of our labs. Weíre in the process of trying to get those fully certified so we can draw blood samples and go through a double-blind test but we are absolutely committed to attempt to duplicate his findings.
But equally as important is his claim of treatment and the VA is moving forward on clinical tests of antibiotics to see even if we canít identify mycoplasmas present whether or not the treatment regime will in fact provide a benefit. And I might ask --
DR. MATHER: I think this is one of the research studies underway.
DR. ROSTKER: So as far as Dr. Nicolson is concerned, weíre attacking it at both points, one, move forward with the treatment, not waiting for the normal events and two, engaging with him. And it has been a long process but engaging with him to actually see if we can find the same results that he reports.
SENATOR RUDMAN: Has anyone else duplicated those results?
DR. ROSTKER: No, sir.
SENATOR RUDMAN: Where else have they been tested?
DR. ROSTKER: I shouldnít say that. There are some additional laboratories but -- that report similar findings but it has not been submitted to the peer review literature, it has not been done in a scientific way. What has generally happened is people who are symptomatic in some way show up and have some blood drawn and some results are reported.
What we are trying to do is do common samples in several labs, blind tests, retests, demonstrate the technique and then that would be to the standards of the medical peer review literature. To the best of my knowledge, that has not been done.
SENATOR RUDMAN: I asked Dr. Nicolsonís representative if he knew about how much that effort had been funded by our government and I believe I thought -- the number he gave me, Iím not sure he knew the number. Do you know the number, approximately?
DR. ROSTKER: The number was about $40,000 and that is to train the various laboratories. We have not been able to move forward to complete the set of tests and weíre pressing very hard to do that.
SENATOR RUDMAN: That is the number his representative gave but what is the problem with moving forward?
DR. ROSTKER: Well, we have experts here who deal with it but Dr. Nicolson was out of the country for an extended period of time. There are some discussions about who is going to be present when blood is drawn. And I must be frank with you that Iíve told the Army medical community to get on with this and draw their own blood. If thereís something here, we want to find out.
SENATOR RUDMAN: If there is or there isnít; either way.
DR. ROSTKER: And we have spent way too much time in this process. If you would have told me two years ago when we started this that we would be where we are today, I would have said it was outrageous.
SENATOR RUDMAN: Well, one of the nice things about this Commission, Dr. Rostker, is that weíre all volunteers and nobody is doing this because they enjoy it. Weíre all doing it because we were asked to do it. And this Commission will brook no delay by anybody to do anything important. I mean, we will go wherever we have to go, including the President of the United States, if we think something ought to be done.
Now, this thing ought to be done and it ought to be -- we ought to find out that either this works or it doesnít work. And it doesnít take a rocket scientist to know where that could be done. There are probably 12 great laboratories in this country that are of impeccable reputation that can determine either that works or that doesnít work and it shouldnít take the U.S. Army and half the bureaucracy of the country to find out whether it does or it doesnít.
And I donít know whether it does or it doesnít but Iím not happy to hear itís taken as long as it has.
RADM STEINMAN: I just had one question for Mr. Dees. In the material that Dr. Nicolson provided to Board members, there was a confusing statement. I believe he intimated that the mycoplasma came from a potential chemical or biological weapon used by Iraq. Is that true or did I misread that?
MR. DEES: Would you like to the patent, sir?
RADM STEINMAN: No, Iíd just like to hear your comment. Is that what Dr. Nicolson is -- is that his thesis that this was the result of a biological weapon?
MR. DEES: Dr. Sky King Lowe, I believe, currently owns the patent which is now owned by DoD and there has been attempts in -- let me say that in the patent it was passed along to American type culture collection and that Saddam Hussein himself had access to what came from American type culture collection. Does that help you?
RADM STEINMAN: It makes it more confusion.
MR. DEES: What I found by reading this is that it states a very wide and broad loop of things that I donít fully understand that there have been players outside --
SENATOR RUDMAN: Weíll follow up on this. Are there any other questions from the panel? Now, weíre moving a little ahead of schedule, which is good. Admiral Cowan is here. I think what weíll do is take a very short break, give people a little chance to stretch a bit, maybe five, six minutes, then weíll go on with you, Admiral. And then we will go on with the panel of Messrs. Tuite, Fahey and Dr. Baumzweiger late in the day. So weíll take a quick break.
SENATOR RUDMAN: If everyone could be seated, please. Weíll come back to order and weíre pleased to have representing the Joint Staff RADM Michael Cowan, Deputy Director for Medical Readiness. And Adm. Cowan is going to give us the DoD response to the PAC. I believe that is the purpose of your testimony today?
RADM COWAN: Yes, sir. Thank you.
SENATOR RUDMAN: I think youíll find that if you pull that microphone a bit closer it will work better.
RADM COWAN: Howís that?
SENATOR RUDMAN: Great. Thank you very much. We have scheduled from -- we have roughly 20 minutes scheduled. If you need more, weíll probably have a little more but weíre moving well but try to do it in 20 if you can. Weíll have some questions.
RADM COWAN: Yes, sir. Iíll confine my remarks to less than 20 minutes and leave some of the time for questions.
SENATOR RUDMAN: Thank you, Admiral. Proceed.
RADM COWAN: Thank you for the opportunity to speak to the Special Oversight Board. My remarks will provide updated information on five specific issues of interest to the Board concerning nuclear, biological, chemical and environmental threats.
To give a little background, the measures and programs that I will talk about all fall under our current concept of operations called Force Health Protection. Youíll see the initials FHP. Itís a cooperative effort among the Services, the office of Assistant Secretary of Defense for Health Affairs and the Joint Staff to protect our forces from the full spectrum of health hazards associated with military service.
It has three components. One, aggressively promoting a healthy and fit force, second, providing full spectrum protection against hazards and that will obviously be the bulk of what Iíll discuss today, and third, continuing to provide the world quality class health care that we do for our soldiers in the field.
This is a multi-faceted program with the ultimate goal of the best possible health outcome for service members. The first issue that Iíll talk about is measures taken to ensure more accurate collection of troop exposure data. We under Force Health Protection realize that we have to have a longitudinal health protection and surveillance program. This includes predeployment briefings, physical exams, immunizations and health assessment.
During deployments, we now do daily and weekly reporting of disease, non-battle injuries, DNBIs, continuous environmental monitoring and weíve established forward medical laboratories in areas where we have high risks from environmental diseases such as Southwest Asia today.
Frequent medical threat updates are conducted and forwarded up through the chain of command and protective measures continue in the post-deployment phase with medical debriefings, health assessment questionnaires and any medical follow-up indicated for individuals whose health status has changed.
We are starting these programs up, learning as we go along. This month the Joint Staff will finish and publish a coordinated document entitled Deployment Health Surveillance and Readiness which will standardize these procedures. Although more work in this area needs to be done, the philosophy and the system are in place. Weíre doing it today and we will continue to continually refine that.
In an effort to move in that direction, we have also recently begun collaboration with Johns Hopkins University who are developing for us an improved and tiered methodology to measure potential environmental hazards that might be encountered by our forces.
At this time I would also like to introduce Mrs. Norma St. Claire, who is the director for joint requirements and integration for the Office of the Undersecretary of Defense for Personnel and Readiness. Her office is responsible for developing the requirements for personnel tracking and location systems and as such Iíve asked her to address those specific issues in the remainder of this part of the presentation.
SENATOR RUDMAN: Thank you.
MS. ST. CLAIRE: Hello; good afternoon. Is this -- can you hear me?
SENATOR RUDMAN: Thatís fine. Thank you very much.
MS. ST. CLAIRE: I wanted to start with a brief introduction to the fact that the tracking problem that we have in theater is one aspect of a lot of tracking issues that we in the department do not do very well. I have some visual aids here.
The top one is the military personnel life cycle. In military personnel, we theoretically track our people through their entire careers as they go back and forth between active and reserve status, as they deploy, what they do in theater, when they come back. Today we donít do a good job on this.
This has impacts not only of the type that you see that after deployments we donít know who was where and we canít make the kinds of post-deployment analysis that we need to make, but it also impacts on the pay and benefits for service members and their families both in real time and in the future when they retire.
One of the reasons that we have these problems is depicted in the chart below. In each of the services, there is today a plethora of legacy systems that support military personnel management. These systems have grown up over the years, independently. They donít talk well to each other. They donít track the things that we want them to track. And one of the things that weíre doing is we are now designing a new capability that will address all of the tracking issues that Iíve mentioned before.
SENATOR RUDMAN: Is that chart essentially a year or two from now going to be gone and something replace it?
MS. ST. CLAIRE: Our expectation is that by the year 2003 that chart will be completely gone; it will be phased out. It is going to take time. We have -- believe it or not, we have been working on this problem for longer than Iíd like you to know. It is not a simple problem; itís extremely complex.
The reason Iím here to talk to you is because my office has been given the responsibility for defining the requirements for this new system and making sure that when itís implemented, it incorporates not only the requirements of the Services but also the requirements of the other federal agencies that addresses the issues that weíve all become so familiar with during just the last few years, the things that were highlighted during the Persian Gulf War but were always there. And we are moving along in that. We have a good portion of the requirements already defined and weíve begun some prototyping for a new capability.
In the meantime, Iíd like to be able to tell you that we have a work-around to solve the problem but we donít have a work-around in place to solve the problem. Weíre looking at different things. Tomorrow you have also asked some questions -- Iíll be giving a lot of the same information tomorrow.
For instance, there had been recommendations for things like global positioning device, a carrier of some kind for improving the manual way that we do accounting going back to the old morning reports, only being sure to put in place rigorous procedures so that theyíre followed every morning, maybe automating the morning reports for a period as a standalone capability.
Weíre also looking at the possibility of an early module of dimers that might be a theater module to support some of these things. The Joint Staff has been developing something called Joint Personnel Asset Visibility Capability which is a very good thing for the CINCCENT theater.
Unfortunately, itís very, very dependent on the personnel systems for their input and then it does not track movements in theater because itís a centrally located capability. And I guess thatís where we are in terms of personnel tracking.
SENATOR RUDMAN: Let me just ask you a question on that point. You know, one can only go by their own experience and when I first got into this issue with Dr. Rostker and his people when I was doing this for Secretary Cohen long before this Commission was established, I was astounded to find out that one of the problems that Dr. Rostkerís group was having is once you could locate where a possible incident had taken place is to find out who was there.
MS. ST. CLAIRE: Thatís correct.
SENATOR RUDMAN: I find that remarkable and I find that hard to understand. And let me tell you why and Iíd like a response from you, possibly from the Colonel. I come out of a rifle company in Korea. There were a lot more people in Korea than there were in the Gulf and the terrain was pretty rugged stuff. I mean, we didnít have GPS but we all could read a map and that was kind of considered pretty good. If you got to be an NCO you had to be able to read a map.
And you made out a morning report every morning. That morning report had four key elements on it that that battalion commander wanted. He wanted to know what we had killed and wounded in the previous 24 hours, what was your strength, how many officers, how many men, how many NCOs. And after action report as to what happened that day in a sentence or two and finally, where were you. And youíd give him coordinates or give him a hill number; either one worked.
Now, I find that with all the technology, you know, weíre getting to the point where a rifle company is going to seven riflemen, five with computers and two with rifles. I donít understand and somebodyís got to explain to me what is the big problem in finding out how a unit is located.
I mean, the Navy does a pretty good job.
MS. ST. CLAIRE: Well, theyíre on ships.
SENATOR RUDMAN: I donít care what theyíre on. They have to find a way to find out where they are. I think the Marine Corps has done a pretty good job. I havenít seen what happened during the Gulf War. What is wrong with the United States Army or all ground forces that we canít know where you are every morning at 8:00 a.m.?
MS. ST. CLAIRE: What it --
SENATOR RUDMAN: I know itís not your fault but youíre the messenger.
MS. ST. CLAIRE: Thank you. I have looked at it because when we discovered that, you know, we sort of were, wait a minute, at least during Vietnam we could retroactively go back and find out. And thatís why I say one of the things is to put those morning reports back in place with the rigor of filling them out.
But apparently what happened, what Iíve been told is that because we had all this automated capability, there was the assumption that the morning report was no longer needed. What in fact happens, and by the way, none of the Services track people around in theater, the problem si the biggest in the Army because the Army has the most troops on the ground and moves around more than the others. Even the Marine Corps who has a much better system does not track movements in theater.
What it is is that we fight TDY wars in the first place and the databases reflect the home base of the unit. We have since tried to figure out ways to at least figure out who has been deployed so we have created what you can think of as artificial unit identification codes so that we can now tell who is deployed but only that theyíre deployed and where they were deployed to, not movements after they hit the ground wherever they are.
So, yes, you are right. We should go back to something that will at least give us that retroactively. We would like to have it in more current time, to tell the truth.
SENATOR RUDMAN: I mean, the remarkable thing is that if we suddenly found out that there was some exposure in Korea in 1951 at a particular location of a certain kind of radioactive material, the Army could go to St. Louis to the archives, pull up the microfiche and find out who was there.
MS. ST. CLAIRE: Thatís right, and in Vietnam.v
SENATOR RUDMAN: 45 years later. And in Vietnam. And so I just have to say that, you know, Iím sure one of the recommendations of this panel, because weíre supposed to look forward as well as make recommendations to the Secretary --
MS. ST. CLAIRE: At least be manual.
SENATOR RUDMAN: -- is even if -- you know, if itís very, very simple with GPS receivers today which you can, you buy for $160 -- weíll probably pay 800 apiece in the government but you can buy them for $160, the bottom line is that we ought to know where people are because, you know, weíre going to have other wars, other health problems and we ought to know where the troops are.
Well, Iím glad that youíre looking at it and it certainly will be something that Iím going to get General Cisnerosís view because he has commanded large numbers of troops and find out just exactly what we ought to be recommended.
Go ahead, Admiral.
RADM COWAN: Sir, that is a good segue into the next part of my presentation because I know that itís been a particular interest of this Board to find out how the PIC, the Personal Identification Carrier, is being developed and what, if any, plans there are at integrating that with global positioning.
We are in the process of developing a PIC, a Personal Identification Carrier. Our goal is to begin fielding that in calendar year 1999. This is a technology that provides an electronic memory chip to be carried by each individual service member which can be updated at individual encounters with a computer. These computers are to be fed into the theater medical information program database which can in turn then be accessed globally through the global command support system.
These are not in place now but they are very close and nearby technologies and we are working very hard to achieve these. Whenever a troop feeds into a computer, at that juncture, his location can be determined but that is not constant determination of his location.
If we are to achieve automatic or continual monitoring of individual member that requires the GPS technology that you mentioned. This is a completely different technology. This can be contained in the same device but not necessarily so. Integrating these two technologies is the responsibility of the defense manpower data center.
Per congressional direction, they have delegated this study to the SMARTCARD technology office who is required to report their recommendations no later than 31 March next year. So we will have a recommendation as to how these technologies will fit together.
SENATOR RUDMAN: Thatís not even so much where the individuals are, Admiral. I mean, Iíve looked at some case studies where they didnít even know where the units were and thatís pretty serious.
RADM COWAN: And it is worse and getting worse because of the way we fight battles today. Weíre far more mobile, fewer individuals going off into various specialized things, covering great distances and so the difficulties of doing it are increasing and our attention needs to be directed there, sir.
SENATOR RUDMAN: Thank you.
RADM COWAN: The next issue describes measures being taken to defend our forces against low level chemical and radiation exposures. Low level generally means those levels at which you would have minimal or no symptomatology.
The ability to detect low levels of chemical warfare -- let me address chemical hazards first -- requires detection technologies with greater sensitivity than the standard units that we use today. Our standard units are called the M8-A-1 and the M-256 A-1 kit.
There is a detector that is available. It is the ACADA, the Automatic Chemical Agent Detector. Itís a commercial off-the-shelf product capable of detecting blister and nerve agents and no others but at low levels. The system is currently being used among the Services and we expect full implementation putting this into all branches by the end of fiscal year 2000.
Additional detectors are under development. There is one called the Joint Service Lightweight Standoff Chemical Agent Detector, JSL CAD. This is a group protection device to look for standoff threats for units.
There is a Joint Chemical Agent Detector, JCAD, which is a point detector for individual application. So thereís group protection for a unit and individual protection for each person. Entry into the inventory is expected in the 2000-2001 time frame. These are technologies under development.
There are some other issues surrounding this. The first and most important is that the setting which will define low level has to be determined. Low level detection poses two problems. One is doctrinal and the other is medical and we have to answer these questions.
For the doctrinal questions, unit and individual responses are problematic for field commanders if alarm goes off but we know that itís at a level that is not an immediate threat to the force but just that itís there, how low do we go? We donít know that and we have to work those sorts of questions out.
From the medical viewpoint, establishing threshold levels at which exposure might be expected to cause delayed health problems have also not been clearly established for many of these agents and we have to do so. Both from the doctrinal and the medical point of view, work is ongoing to answer the questions.
With respect to radiation detection, again speaking of low level detection and protection, several initiatives are in the process of being implemented. First, doctrine is being developed which is being done in concert with NATO and with the assistance and the advice of the National Academy of Sciences.
The point of this is to merge peacetime and wartime standards into one median document and not to say that itís okay to be exposed to a certain level in peacetime but that a different level is okay in war. This is consistent with our concept of total Force Health Protection.
Until that is published, a policy directive has been disseminated by Allied Command Europe and is currently being used in Bosnia and is adaptable to other syncs AOR. So we have a plan in place and a better one on the way.
For detection, we use today a device called the VDR-2 which is a hand held radiation detector. This is sensitive enough to measure low level GAMMA radiation and it can detect depleted uranium contamination on personnel and equipment but itís not sensitive enough to detect depleted uranium at levels that you would expect to find in the environment, such as the soil.
To do that, we have to use specialized remote laboratory testing. Now, thereís another device called the PDR-77. This is a suite, a collection of hand held devices that can measure low level GAMMA and detect alpha contamination. It has the right level of sensitivity to detect depleted uranium and we can enhance its capability until it can detect environmental levels.
But once again, it requires specialized remote laboratory testing to get to those very low levels that we expect from DU in the environment. Again, scientists are studying this, looking for better ways and trying to improve the technology in that regard.
Finally, I would like to try to answer your question regarding the circumstances for deployed forces to conduct bioassay testing so talking about our protective and detection plans for biological attacks.
As you know, the need to conduct biological agent testing relies heavily on intelligence estimates and protective measures depend heavily on the capability and intent of a potential attacker. For each deployment order, the question was what circumstances we would conduct testing and I guess the short answer to the first part of this is it depends on the deployment. It depends on the intent and the capability of our potential enemy.
When we need to do these things, we have for our use today first a device called a hand held immunochrometagraphic assay; itís HHA. This is a disposable antibody mediated assay for identifying biological warfare agents in suspect samples. It can detect agents in liquids, powders or suspensions and in munitions fragments. Anything that can be liquefied in a relatively pure form can be tested. We were using these in Southwest Asia in support of Operation Desert Thunder.
Other technologies are also available and also being used in our deployed forces. These are all based on bioassay strips and these are the most biological detectors. They are used in several configurations.
We use the BIDs, the biological identification detective system in the Army. The Navy uses the IBADs. Itís an interim system. Itís called interim biological agent detector. And theyíre using that until about the end of fiscal year 2000 when we expect to have a joint biological point detection system to come online which is, by all regards, a much better system.
And finally, we have a remote detection system currently being used in several systems called the Portal Shield. Itís an array of devices that again offer unit protection over a fairly large geographical area.
Detection of biological warfare threats is a part of our protective system and it is a system so it uses appropriate levels of detection, protective ensembles, antibiotics as appropriate, vaccination programs such as the anthrax vaccine as we are capable, and forward deployed laboratories.
Newer technologies are being brought to the field as quickly as they are brought online. For example, our joint forward laboratories have the capability of performing whatís called polymerous chain reaction studies. You can take a small amount of biological material which would take days or weeks to culture out and identify, convince that material to spin out its DNA, itís not replicating itself, itís just replicating its DNA thousands and thousands of time until enough material is produced that we can identify the DNA and identify the agent. And this can happen in as little as four hours.
Sir, thatís the end of my remarks. Once again, I appreciate the opportunity to address you and will be happy to try to answer any questions.
SENATOR RUDMAN: Thank you, Adm. Cowan. Questions? General.
LTG CISNEROS: One of our previous testimony talked about an item called PACER and a Col. Schumaker. Have you heard of any of those?
RADM COWAN: Iím sorry; the --
LTG CISNEROS: PACER, that was supposed to be an item of equipment for detecting biological, was not taken to the Persian Gulf?
RADM COWAN: No, sir. That is a new one for me. Iíve not heard it. That was -- you said Col. Schumaker or Gen. Schumaker --
LTG CISNEROS: No, I said Col. Schumaker was mentioned --
MS. MORRIS: Sir, Iíve got some information on that --
SENATOR RUDMAN: Fine. If you could do it briefly for us.
MS. MORRIS: Yes, sir. We have spoken with Col. Schumaker and we have talked to him about the PACER units. As best we can determine, PACER units is another name for the XM-2. The XM-2 was in fact deployed to the Gulf. It was not necessarily used while over there because the unit that had it with them didnít encounter situations where they felt the need to use it.
However, Col. Schumakerís concerns went a little bit further and weíve spoken with him over the last two years approximately three times, as it turns out, most recently this past week. And he was very concerned about biological capability of Saddam Hussein, he was very concerned about the -- our capability to detect real time biological attacks during Desert Shield/Desert Storm, which we didnít have the capability to do and one of the things that he was involved in was other equipment that was being tested prior to Desert Shield/Desert Storm to determine whether or not it could have had value.
He was a reserve officer who was asked by another individual in his reserve unit to if the equipment was sufficiently rugged to make a difference in Desert Shield/Desert Storm, would he form a group of people to take it over.
After tests at Dugway Proving Ground, the equipment was determined not to be sufficiently ready or rugged enough to make a difference, provide information for decision makers and so Col. Shumakerís unit did not deploy. He still had his concerns but we were addressing them as best we could.
SENATOR RUDMAN: Thank you. Question?
DR. CAM: What is DoD plan for comprehensive medical surveillance of deployed troops? I just wonder whether thereís any ongoing efforts to collect, analyze and interpret health data of U.S. troops deployed in Bosnia. I would like also to know whether thereís a medical implementation for the Honduras and the ongoing Middle East deployments.
RADM COWAN: We now are committed to doing life cycle maintenance of our soldier, sailors, airmen and Marines where as they go to deployment, we have standardized ways of getting them ready and make sure theyíre as healthy as possible, have the right vaccinations. This involves several now well-described predeployment screenings and testings and so on.
Automation of the PIC, for example, will also help us mobilize more quickly. In Korea, it could take a unit days to move someplace just to do the paperwork and now we can mobilize whole units who have that PIC technology and do all of their manifesting and readiness in just a few hours.
When we get to an area where there are a variety of hazards, both enemy and environmental, we are now constantly surveying the environment. We know more about the soil, air and water of Bosnia than we know about the soil, air and water at Fort McNair.
In Southwest Asia, when we went back in the winter -- spring of last year, we sent joint medical surveillance teams who were not only taking disease non-battle injury data on the people on the ground but also collecting data, collecting this monitoring and surveillance data, turning the data into information so we had it to use in real time rather than looking back a year later and saying, oh, gee, we had an outbreak of this or that and the soil was dirty and we shouldnít have been there.
So we are constantly working to do exactly what you point at, to make sure this is -- the battleground we think is the workplace of our people and we owe them the responsibility to make it as safe a workplace as we possibly can.
Weíre doing these things very aggressively in Bosnia and Southwest Asia and I wish I could tell you we were doing a great job but these are hard things. These are big body parts and weíre learning as we go along. Thatís why the Joint Staff direction on this is only coming out this month. Weíve been at this about a year but we think weíre beginning to get a handle on it.
Now, weíre putting onesies and twosies into Central America and many of the kind of hazards we have in Bosnia are not there. Theyíre different hazards so we have different plans, different monitoring that weíre doing for those folks.
DR. CAM: Thank you.
SENATOR RUDMAN: Anyone else?
ADM. ZUMWALT: I have one question. I wrote to Gen. Shelton about three weeks ago stressing my thought that we need to be able to know the location of each individual daily. I got a letter back just yesterday which indicated to me that he was -- it may have been prepared in your shop but it indicated to me that they were closing in on the problem and he was hopeful. Is that your understanding, too?
RADM COWAN: Yes, sir. I think -- Iím hopeful that in March when the battle plan for the PIC and the SMARTCARD technologies is determined and reported back, that weíll have the answer to that question.
There are different camps and different feelings about how we will go and how much we can rely on technology and how much goes back to just having commanders know where their people are and having them report in the morning. So those questions have not been answered but Iím hoping weíre coming to that point where we can make a decision and go forward with whatever the right solution is.
SENATOR RUDMAN: Thank you very much; appreciate it.
RADM COWAN: Thank you, sir.
MS. ST. CLAIRE: Can I make one observation?
SENATOR RUDMAN: All right.
MS. ST. CLAIRE: I was just going to make one quick observation that there are some concerns that some people have about what a person carries with them in terms of being captured and what kind of information is then with them when theyíre captured. So he mentioned there were some issues and concerns.
SENATOR RUDMAN: Thank you. You have a question?
DR. CAM: I just read this article Tuesday. I donít know who has seen it. It talks about a smart T-shirt.
MS. ST. CLAIRE: Yes, we saw that.
DR. CAM: Yeah. Iíd like to know more about this.
MS. ST. CLAIRE: I wanted to know more about it, too. One of the problems with that is it sends a signal and I believe that the recommendation from the Persian Gulf troop was for something that would just receive because if youíre sending a signal then thereís always the possibility that the wrong people might be receiving the signal. So that was our quick evaluation.
SENATOR RUDMAN: Thank you. Iím going to depart from the schedule a little bit here because weíre ahead -- you are excused. Thank you very much.
I understand that Dr. Engel from Walter Reed is here and he has been handling -- correct me if Iím wrong, Colonel -- the mycoplasma issue for Walter Reed.
LTC ENGEL: Yes, sir. Thatís right.
SENATOR RUDMAN: Could you just come up here? Would you mind just having a short dialogue with us?
LTC ENGEL: Iíd be glad to do that, sir.
SENATOR RUDMAN: We did not expect to have you here but there was a lot of issue about Dr. Nicolson and what kind of support he had received and I kind of read between the lines that maybe it wasnít easy to get things together and who was going to replicate it. Just kind of give us a five-minute summary or three-minute summary of whatís going on with that.
LTC ENGEL: I will. First, let me introduce myself and a little bit about my credentials as well. I am a physician epidemiologist and a Gulf War veteran. I spent seven months in the Persian Gulf both in Iraq and Saudi Arabia. I experienced, out of the different exposures that the comprehensive clinical evaluation program polls people on, the 20 different exposures, Iíve experienced 12 myself.
I am actively engaged on the order of about 80 to 90 hours a week, as I have been for the last over two years. working hard to provide treatment and to do various research efforts related to the care of Gulf War veterans. I very much want to see answers for Gulf War veterans and Iíd have to say that this has been a difficult experience for me as I have taken pride in and made it my business to really be a part of the solution to the Gulf War illness issue and not a part of the problem. And I think if you poll my colleagues youíll find that to be the case.
I would also like to add that I believe and I know that I have the full support of the leadership within both the Department of the Army and the Department of Defense to press on with this so there certainly is no obstacles organizationally for me in moving this along.
SENATOR RUDMAN: Well, that being the case, then, Colonel, I take you at your word. Whatís the problem?
LTC ENGEL: What the challenge has -- well, let me begin with where the challenge started for me. My understanding is before I first encountered Dr. Nicolson and the mycoplasma hypothesis of Gulf War veteransí illness, that actually the Center for Disease Control and Dr. Bill Reeves there had made efforts to engage Dr. Nicolson in testing Gulf War veterans through blinded sample testing, a scientific design to test them for mycoplasma fermentans and was engaged in attempting to send blood that they had stored to him to have tested.
That was never able to happen for one reason or another --
SENATOR RUDMAN: Do you know why?
LTC ENGEL: I was not a part of it at that time.
SENATOR RUDMAN: Have you been told why that was?
LTC ENGEL: My understanding was that Dr. Nicolson didnít agree to test the blinded samples. For me, the issue started around Christmas of Ď96 when an article was published about Dr. Nicolsonís work in a Seattle newspaper and Congressman Dix brought it to the attention of the commander at Walter Reed Army Medical Center, Maj. Gen. Leslie Berger.
Since I was the chief of the Gulf War Health Center and an epidemiologist, he turned to me and said there is a sense that thereís someone who has the answer to the Gulf War illness issue. Letís figure out whatís going on and respond.
In a period of about three days, I was charged with and did complete a meeting at Walter Reed which involved representatives of the VA, three different university professors in the area of microbiology, the Department of Defense, NIH, actually two NIH investigators in related areas, Dr. Lowe from the Armed Forces Institute of Pathology, as well as Dr. Nicolson.
Dr. Nicolson presented his work at the time. It was decided that there was sparse data to support some of the assertions that he was making but his assertions were scientifically testable and we should get on with this and test it so that we had answers for veterans who are ailing.
Certainly if this boiled down to treating soldiers with an antibiotic, we wanted to be able to bring that antibiotic to them. That would be a very quick answer to what is a fairly complicated problem. I was charged then by Gen. Berger to -- with the assistance of investigators, that I was to organize to write a essentially straw man protocols to begin the research and circulate it among the experts, refine it, with their opinion and so on.
I assembled a seven-member team that involved people from the CDC, Dr. Nicolson, two universities, Armed Forces of Institute of Pathology, NIH. Within three months, I had written essentially a protocol that we as a group of investigators agreed on and a way to proceed. It was a reliability study, fairly simple, looking at the testing procedure that Dr. Nicolson does which is new and, as youíve gathered, controversial.
The idea was that we would have, in addition to Dr. Nicolsonís lab, three other laboratories that bloods would be drawn and blinded and sent to the laboratories and we would compare results in the same individuals across the different labs, the idea being that if different labs doing the same test on the same person couldnít agree, then no matter what the test was measuring, it was not important or not useful.
SENATOR RUDMAN: Who would have held the code? Walter Reed, you?
LTC ENGEL: This is a point that --
SENATOR RUDMAN: Who would know the identities, I guess is what Iím asking you. Who was the neutral and detached magistrate going to be?
LTC ENGEL: Iím getting to that, sir.
SENATOR RUDMAN: Okay.
LTC ENGEL: In the process of setting this up, after we had written the protocol, of course it needed to go through a human use committee and institutional review board and so on. In the meantime -- at the same time, it was going through a contracting procedure which Iím not able to really speak to not being a contracting officer.
We also needed to find laboratories to actually do the work. As we were proceeding through this, Dr. Nicolson was establishing some demands. One was -- the first one that we encountered was that he wanted a conflict of interest statement from each of the investigators in the study, each of the non-federal investigators in the study that they had never done biologic warfare research. That seemed fair enough but we put it to Dr. Nicolson to more or less write this conflict of interest statement which, over the period of several weeks, that was refined and done.
We put that conflict of interest statement to the investigators that we had involved, one of which was a Dr. Joe Tully at NIH who has a long career of doing mycoplasma research and the -- we never got to the point of actually signing the documents because Dr. Nicolson, before Dr. Tully had a chance to sign his document, asserted that Dr. Tully had a track record of doing biologic warfare weapons research.
This was denied by Dr. Tully. However, what proceeded after that was a lengthy process of -- since NIH had offered Dr. Tully as their expert to oversee this process, if there was some question of Dr. Tullyís integrity, we felt we needed to raise that to NIHís attention so they could consider it.
It is my understanding that this went all the way to the desk of Dr. Varmas who is the head of NIH and Dr. Varmas essentially said Dr. Tully is the worldís expert on mycoplasma, he will be the person who represents NIH in this effort. That process actually took at least a couple of months to iron out.
Then the next issue was one that you actually have touched on and that is who does the blinding, who holds the data on the identities of the individuals who are tested. Dr. Nicolson, there again, laid down the gauntlet and said that unless he could personally vouch for the integrity of the person doing the blinding, that he would not agree to go forward.
I remind you, this is a man who claims that 50 percent of Gulf War veterans are suffering from an infectious disease that is rapidly spreading into society at large. It seemed to me that he was making this process fairly difficult.
However, taking into account that being on the outside of the Department of Defense, Department of Army, it could seem like a frightening obstacle trying to do research with us, what I decided to do was to approach this in good faith and what we agreed to do was that we would have a representative who Dr. Nicolson could vouch to their integrity who would be present during the blinding, would not actually do the blinding but would be present to make sure that nobody was doing anything funny.
He chose a woman, Dr. Leisure in Pennsylvania, as his representative. We then approached Dr. Leisure with the idea that we wanted her to play a role in this and she continued to persist in the notion that she would be the one to do the blinding, that she would be the one to do that part of it. She is an infectious disease specialist; however, looking at her CV thereís no evidence that sheís ever been involved with research that involves coding and blinding samples for this kind of study, which is important to do. There are a lot of details that one needs to attend to.
We also felt that having -- just as if we had brought in Dr. Rostker to blind the samples, we felt that it was probably not in the best interest of the research to bring in --
SENATOR RUDMAN: I donít think we need to carry that one out, Colonel. I mean, anybody who knows anything about that knows that there would be no validity to the study if it proceeded with the inventor saying Iím going to do the blinding.
LTC ENGEL: Yes, sir.
SENATOR RUDMAN: So, where are we now, because weíre running out of time. I take it weíre nowhere.
LTC ENGEL: Well, what we did at that point is we, with Dr. Nicolson, we agreed to have a safe with two keys, one for Dr. Nicolson and one for a DoD representative in which the data on coding would be represented. In the end, we have not been able to start the reliability study because we have finally decided on our own that we -- if we ever expect to get this done, weíre going to have to recruit our own patients and weíll have an independent lab do the binding but weíre not going to be able to include Dr. Leisure.
I might also add that on at least three occasions I asked Dr. Nicolson, one of which was witnessed in full view of several other scientists involved in this, to please ask Dr. Leisure who we were involving because he wanted an advocate involved in this research to back off and allow us to move ahead, provide an estimate for the work that we wanted her to do and to my knowledge either he never did that or she never responded to it.
SENATOR RUDMAN: Are you able to move ahead and get this done?
LTC ENGEL: Eventually what we had to do in order to get anywhere in this was we had to unlink the training in the test from the actual reliability study. We were hoping to do the two in conjunction under the same budget. We had to create a second budget so that we could at least go out to Dr. Nicolsonís lab and learn about the testing procedure.
We did in January of 1998 go to Dr. Nicolsonís lab. There was Dr. Joel Baseman from the University of Texas, San Antonio, Dr. Lowe from Armed Forces Institute of Pathology and Dr. See from U.C. Irvine in California as well as Dr. Nicolson there. He had, as the contract was laid out, developed manuals in the testing procedures and he taught them visually in his lab to the scientists that we brought.
The next step in the training is to have these scientists go back to their own labs and with some samples, we call it quality control samples, with some samples run those in their own labs and prove to themselves that they could do this thing that they had learned how to do in Dr. Nicolsonís lab.
Dr. Nicolson promised us that he would send us the blood to move ahead with the quality control procedure. Six months later, in July, we essentially had one sample that Dr. Nicolson had sent out. He was still promising that he would be the one to send the bloods out for the quality control samples.
In a meeting of the planning committee for the randomized controlled antibiotic trial which Iím also involved in, we finally got him to agree with some of the other scientists in the room that what we would actually do is have Dr. Tully and Dr. Lowe from NIH and Armed Forces Institute of Pathology together who had used blood bank samples, that they would in a blinded fashion spike these with varying levels of mycoplasma and send it out to the labs, plain and simple.
Essentially since then, which was late July, early August, we have sent out two groups of five blinded bloods and we have just recently completed what I would say is the quality control phase of this. So essentially itís taken nine months to do the training for the test.
We continue to attempt to move ahead with the reliability study. As I mentioned, we decided that weíre going to move ahead without Dr. Leisure. I would also like to say that I, again -- if there are answers to be found here I want to find them.
In August of 1997 I, through my meetings with Dr. Daryl See who was then at U.C. Irvine, he had developed a clinical trial to examine the efficacy of an antibiotic for mycoplasma positive chronic fatigue syndrome patients.
I suggested then to Dr. See that what we needed to do was adapt this clinical trial to a similar trial for Gulf War veterans that probably if we wanted to explore this issue, it was a no-lose proposition to advance to studies of clinical treatment in this population.
I proceeded at that time, in August of 1997, to ask my chain of command if they had any heartburn with me moving -- you know, writing the trial and doing that. They of course said as long as itís good science letís do it and weíre in the process of putting together that trial when it was decided that the VA was going to bring together a planning committee and design a similar sort of clinical trial.
So itís been my intent and full interest and energy to move ahead with this from the very beginning. It has been a source of great frustration to me and since I face these veterans face to face on a daily basis at Walter Reed in the specialized care program, I see those folks who are seeking Doxycycline without knowing whether it will help them.
I see those folks who have tested positively and paid good money to have tested positively in Dr. Nicolsonís lab for mycoplasmas fermentans and I see them look me in the eye and ask for antibiotics and I see the desperation and I know that they want answers and I want answers for them.
SENATOR RUDMAN: I think weíre up to date. That was good information and weíre going to deal with it in some way. I appreciate it very much your willingness to come up on short notice, Doctor, and testify. Thank you.
LTC ENGEL: Thank you, sir.
SENATOR RUDMAN: To conclude today we have Mr. James Tuite, Mr. Dan Fahey and Dr. William Baumzweiger. Anywhere youíd like. Iím going to ask you to -- we are going to leave here at 4:30. Some of the people here do have some time problems, travel problems, so weíre going to proceed. I think I will -- itís up -- I donít care -- I have Mr. Tuite first, Fahey second, and Baumzweiger third so let us do it that way.
MR. TUITE: Mr. Chairman, from the summer of 1993 until the end of the 103rd Congress I was asked to conduct an investigation into the mysterious health ailments being suffered by the veterans of the 1991 Persian Gulf War.
Since that time, Iíve been asked to provide recommendations and advice to Congressmen, congressional committees and investigative and advisory bodies. In addition, for the last three years Iíve been examining some of the scientific issues underlying the illness and I served on the board of directors of the National Gulf War Resource Center.
Now you, the seventh oversight or investigative body established by the executive branch to monitor the governmentís handling of this issue, have again asked for comments. I have had the unique experience of participating in the politics and the science of this issue as well as observing the suffering and despair and disillusionment brought not only by the illnesses themselves but also by the dishonest and dishonorable handling of this issue by the Executive Branch of our government.
When the number of sick veterans were few, the Pentagon accused them of being malingerers, snidely suggesting that the problem was limited to the National Guards and Reserves. As their numbers grew and began to include a large number of active duty soldiers, the Pentagon and VA claimed it was a somatic disorder. Now that they represent a significant portion of the entire force that served in the Gulf War, the Pentagon infers that itís stress.
When the veterans get sick, the Pentagon tells them that these are illnesses we see in the general population. Leukemia, multiple myeloma cancers, non-Hodgkins lymphomas, rashes, central and peripheral nervous system damage, Lou Gehrigís disease, multiple sclerosis, chronic fatigue syndrome, fibromyalgia syndrome and other illnesses often associated with hazardous toxic exposures are seen in the general population. Therefore, by the Pentagonís standards, they could not be from the war.
In 1993, prior to the release of the Senate report, I prepared for the U.S. Senate Banking Committee chairman, Donald Regal, Jr. the Pentagonís -- excuse me -- before submitting that report, the office of the director of the Joint Chiefs of Staff contacted us in an effort to stop the release of the report and assured us that none of the reported information happened.
During the same call, we were told that we cannot release the information because the information was classified. Then the Pentagon in response to that 1993 report publicly claimed that there were neither detections nor any forward deployment of chemical warfare agents.
The subsequent Pentagon investigation performed by the Defense Science Task Force on Gulf War illness agreed, stating there is no scientific or medical evidence that either chemical or biological warfare was deployed against us at any level nor that there were any exposures of U.S. service members to chemical or biological warfare agents in Kuwait or Saudi Arabia.
In the early phases of the investigation, there were event attempts by Pentagon officials to intimidate me and obfuscate our investigation. I was in almost daily contact with a Pentagon office that possessed partial CINCOM logs when we requested them, yet they were not provided. The Pentagonís general counselís office denied their very existence.
The full chemical logs that existed when the Committee requested them subsequently disappeared from two separate secure locations. Pentagon officials in sworn testimony before Congress denied the existence of information regarding the detections and forward deployment of chemical weapons and Pentagon officials withheld pre-war national laboratory reports on the projected fallout from the bombings of the Iraqi chemical warfare agent infrastructure from the U.S. Congress for over five years.
Dr. Joshua Lederberg, director of the 1994 Defense Science Board Task Force investigation into this issue later claimed in press interviews that relevant information regarding chemical warfare agent exposures was withheld from him by the Pentagon. In an interview he said he was not operating under a presumption of malice but after this experience, I want to be a little bit more cautious about that.
Recently, in one office of the Special Assistant for Gulf war illness case narrative by their own admission, inaccurate, misleading information was provided to our committee. Only one possible conclusion can be drawn given the nature of the irreconcilable differences between the two sets of information provided. They were either lying then or theyíre lying now.
The single alternative explanation is that theyíve been incompetent in their efforts. The Pentagonís conduct has been disgraceful. Government officials who were former employees or board members even presided over and continue to preside over millions of dollars in taxpayersí funds being awarded non-competitively to their former companies and organizations.
Pentagon officials have misled, been evasive, and shown tremendous bias and contempt in their dealings with Congress on this issue. Despite all of this, the Pentagon insists that there is no evidence of a coverup.
In a briefing just two weeks ago, a Pentagon official confirmed that key considerations in the Pentagonís ongoing investigation into individual chemical warfare agent exposure incidents are, first, whether acute chemical warfare agent injuries occurred and, second, whether there is direct evidence of Iraqi chemical warfare agent use. This standard seems designed to discount any other possibility of injury or exposure.
What we are trying to understand, however, are the possibility that our doctrine and technologies were inadequate and that our soldiers were exposed to lower levels of these and other compounds that alone or in combination can cause the kinds of illnesses being reported.
Chemical warfare agents attacks against Iraqi rebels which occurred only a few miles from U.S. troop positions, the fallout from the destruction not only of the Iraqi chemical warfare agent infrastructure but also the chemical, pesticide and petrochemical industry infrastructures, the subsequent Czech detections credible by the Pentagonís own admission of airborne nerve and blister agents, the hundreds of thousands of liters of nerve agent precursor materials, some of which is cholinergic and was forward deployed, the thousands of bunkers destroyed but never inventoried whose contents will never be known, the animals dead and dying in the desert and the chemical alarm sounding with the initiation of the air war have all been ignored or minimized by the Pentagon as indicators of potential or actual health hazards to our troops.
An independent presidentially-appointed panel has already concluded that thereís bias in the current Pentagon investigations but that bias was predictable. Ongoing Pentagon investigations into Agent Orange continues to attempt to refute the growing body of scientific evidence regarding the health consequences of that hazardous compound associated with service in the Vietnam conflict.
Yet, most significantly -- yet, some good has come out of the Pentagon investigation. Most significantly for Gulf War veterans was the discovery, albeit after years of denial, that many of our soldiers may have been exposed to low levels of chemical nerve agents and the public release of thousands of classified documents.
More recently, ongoing outreach to veterans and their representatives was initiated in response to both veteran and congressional criticisms. And of importance to future veterans is the initiation of an aggressive Anthrax vaccine tracking program.
These are some of the positive developments but very little involving the Department of Defenseís past or recent handling of the investigation of individual incidents supports any conclusion other than there are continuing severe ingrained institutional professional and personal biases which are reflected in both their methods and conclusions.
This panel has no investigative authority. Without that authority, how do you expect to receive honest, factual answers and have unfettered access to the necessary information given the history of this and other similar issues? Many veterans are concerned that it took over a year between the Presidentís announcement of his intent to create this panel and its first public meeting.
Secretary Brown presided over the VA and signed a letter in 1994 along with Secretaries Perry and Shalala to the Senate Committee on Banking, Housing and Urban Affairs that said there was no classified information that would indicate any exposures or detections of chemical or biological weapons agents, something we now know to be false.
Many veterans believe that the investigations and various panels providing oversight into this issue have merely served as jobs programs for displaced congressional staffers, inept military retirees and out of work politicians so you, too, will have to establish your credibility in this oversight role.
SENATOR RUDMAN: Let me remind you, Mr. Tuite, that most of us are taking no compensation --
MR. TUITE: I understand that, sir.
SENATOR RUDMAN: -- and we are absorbing our own expenses so I think you ought to be a little bit careful with some of your rhetoric. Thank you. Proceed.
MR. TUITE: Yes, sir. Well, this is not just --
SENATOR RUDMAN: Just proceed.
MR. TUITE: In the past, the White House that supported national health care legislation opposed legislation providing military funded health care to those children born to Gulf War veterans with catastrophic birth defects.
Congress only a few weeks ago enacted the Persian Gulf Veterans Act of 1998, a statutory disability and compensation program for these veterans, yet the White House and the congressional authorizing committee opposed this bill in part because they claim it will create an expensive entitlement program costing over 10 years between 450 million, the Congressional Budget Office estimate and 6 billion, the unofficial Office of Management and Budget estimate.
The truth is resolving this matter will cost no more than the veterans who are sick and disabled. Those in Congress who authorize the allocations of funds, the appropriation committees and the full Congress agree and believe we have this obligation to our veterans. With the passage of the Persian Gulf Veterans Act of 1998, the relevance of the Pentagonís investigation has changed.
Mr. Chairman, Congress has already instructed the Secretary of the Department of Veterans Affairs to assume what you are trying to learn because this has gone on for far too long. Congress has also instructed the Secretary of Defense to review and revise chemical warfare defense doctrine and technologies to deal with the complexities of the exposures of the types experienced during the 1991 Gulf War.
These actions directly address two of the key recommendations of the Presidential Advisory Committee on Gulf War Illnesses, the first regarding the inadequacies of our chemical warfare defense doctrine and the second regarding the establishment of a statutory disability and compensation program for these veterans. These actions, along with an aggressive treatment research program, should resolve most of the concern of both veterans and their health care providers.
The Pentagon officials, because of a White House refusal to mandate a truly independent and powered investigation, are free to continue their attacks on the credibility of those who served in the Gulf War and are free to continue to set impractical standards to assess the accuracy of their performance in identifying the presence of chemical warfare agents on the battlefield.
I suspect that these officials sincerely believe that obscuring Department of Defense deficiencies during the war is essential to national security and will help restore some integrity to the Pentagonís wartime conduct but these repeated attacks on the integrity of those who actually served in the Gulf War only further serves to undermine the Pentagonís credibility and guarantees that soldiers on future battlefields will fall prey to these same miscalculations and misjudgments.
SENATOR RUDMAN: Mr. Tuite, you have gone on for 12 minutes. Iíll give you a couple more and weíll wind it up.
MR. TUITE: Scientific peer reviewed research by the Centers of Disease Control and Prevention by independent researchers confirm that extraordinary numbers of our soldiers are sick and that their symptoms are related to known and suspected exposures that occurred on the battlefield. For the Pentagon, for this panel or for any other entity to try to learn which individuals were exposed to which compounds and the amounts that they were exposed to is a time-consuming exercise in futility.
Mr. Chairman, my recommendations to this panel are threefold. First of all, encourage the Department of Defense to apologize to our veterans for the way theyíve been treated. Second, recommend that the investigation by the Office of the Special Assistant for Gulf War Illnesses be terminated and that itís $30 million budget be used to supplement new chemical defense technology development or to expand Department of Defense funding of medical research into these issues and other related issues.
Finally, use your opportunity to look back at the Pentagonís mishandling of this issue not with the goal of criticizing their actions but rather to recommend new policies and institutional adjustments which may assist in preventing future abuses, mistakes and misconducts. I ask that the content of my full statement be entered into the record.
SENATOR RUDMAN: It will be, Mr. Tuite. Mr. Fahey.
MR. FAHEY: Thank you, Senator Rudman. My name is Dan Fahey and I thank you for giving me the opportunity to speak today. I also want to thank the Special Oversight Board for having given me the opportunity to make a presentation about my research on depleted uranium on September 28 during a meeting of the Special Oversight Board.
I got involved in this issue through my work at Swords to Plowshares, which is a non-profit veteran service organization in San Francisco. Initially I was employed as a case manager and a claims representative under the Agent Orange class assistance program working with Vietnam veterans and their families.
Shortly after I started, we were getting contacted by more and more Gulf War veterans so Swords asked me to look into what was going on so we could provide information. Over the next few years, I got more and more involved, both locally and nationally, on this issue. I served on the board of directors of the National Gulf War Resource Center and of the Military Toxics Project.
I would like today to submit to you a copy of a case narrative on depleted uranium exposures that I wrote and this is the third edition. It came out in September and I have it, for the record.
SENATOR RUDMAN: Weíll be glad to accept that and incorporate it in the record.
MR. FAHEY: And I also have a written statement which is too long for me to read so Iím just going to summarize some of it.
SENATOR RUDMAN: Very well. Weíll put that in the record as well.
MR. FAHEY: Thank you. I understand that this Special Oversight Boardís mission or purpose is to ensure that the Department of Defense is objectively investigating what happened during the Gulf War and the relationship with Gulf War veteransí illnesses. And Iím going to narrow my focus down to my interactions with them specific to depleted uranium This is my area of knowledge.
In my opinion, the Office of the Special Assistant has never objectively investigated Gulf War depleted uranium exposures. Itís not even a matter of overseeing it now. They never even started. And I think some of the comments that were made earlier today demonstrated that further.
I want to take you through just a few of the steps of their actions on depleted uranium. Step one, threaten the messenger. My first contact with the Office of the Special Assistant was from Eric Berryman, who at that time was an assistant to Bernard Rostker, called me up in February 1997, asked me about my research, pretended like he didnít know anything on depleted uranium and was questioning me in a way that by the time the phone conversation was over, I was concerned about his motivation and his intentions.
I subsequently found out heís a retired Naval intelligence officer and at that time it made sense to me the way he had questioned me. But I was concerned about this so I wanted to let other veteransí advocates know that, you know, just be careful when youíre dealing with guy.
We sent an e-mail message out warning, saying just use caution if you encounter Berryman. Two days later, he calls up Chris Kornkven, president of the National Gulf War Resource Center and says that Iím a libelist idiot, says that he may file a libel suit against the Resource Center, against myself and against Eric Lundholme who put the message out on e-mail.
He didnít call me. He called Chris Kornkven, president of the National Gulf War Resource Center. I called Berryman. When we finally talked, he immediately threatened to file a libel suit against me. He subsequently told Eric Lundholme that the Department of Defense legal team had reviewed the message and said that he could file a libel suit.
Now, they never filed a libel suit. I donít think they ever intended to. In my opinion, this was an action designed to divide us and also to intimidate us from speaking out. So right from the start, this was my interaction with the Office of the Special Assistant.
Step two, blame the Iraqis. In June of 1997 in the only congressional hearing thatís looked at depleted uranium, was conducted by Christopher Shaysí subcommittee, Bernard Rostker stated that the concerns about depleted uranium are at least partially being influenced by an Iraqi propaganda campaign and I interpret this to have been a statement intended to disparage those, including myself, who have expressed concern about what happened in the Gulf War with relation to depleted uranium.
Step three, lock the doors and pretend youíre listening. It was a year ago tomorrow that Bernard Rostker came to San Francisco for one of the town hall meetings and this meeting, unlike some of the other ones where very few people showed up, we publicized it ahead of time, a lot of veterans showed up.
During the meeting, it didnít go very well. There was, you know, a lot of anger and frustration expressed by the veterans who were there. We later found out that they had locked the doors to the room when the meeting started. Rostker later confirmed this to me in a letter that his staff locked the door to the room. Some people who came werenít able to get into the room. I detail this more in my statement but at some of the other town hall meetings that took place, a lot of them there werenít very many people showed up; there wasnít a lot of publicity done. Generally when there was publicity done, the veterans showed up. People expressed their opinion that the Office of Special Assistant does not have credibility to investigate this issue.
Step four, admit what they already know. January 1998 in the annual report, they admitted that there may have been thousands of veterans exposed to depleted uranium, the first time theyíve admitted this, first and only admission of guilt. They also stated that these exposures may have taken place because information was not given to soldiers about the hazards and ways to avoid exposure.
Step five, shoot the messenger. In March, March 2, 1998 I released the case narrative. My case narrative came out six months after their report was supposed to have been delivered to Congress. When it came out, we brought some veterans here to Washington. We had it at the office of Vietnam Veterans of America, a press conference.
Immediately, the attacks began stating that the report was unscientific. When you look at my report, I put all my footnotes at the bottom of the page so you can see where my documentation came from. Most of it is from the Department of Defense. Further attacks stated that I had a hidden agenda of disarmament. These attacks took place both publicly and privately but I wanted to -- you know, this is, again, examples of things that theyíve done.
Step six, deny everything. About three weeks after the report came out, Rostker gave a speech to the American Legion. In it he stated, and this is a quote, let me be precise. To date, DU exposure has not produced any medically detectable effects. What he was saying there is that no Gulf War vets are sick from DU and it was a very -- also in that speech he pushed the effectiveness of the weapon. And this is one of the things over and over that the Office of the Special Assistant has done is to talk about gee, this is a weapon that works great and they downplay the health effects, they downplay the severity of the exposures and, in my opinion, want to ensure the unrestricted use of this weapon in future conflicts.
Also during that speech, though, he confirmed the key finding of our report which was that there were veterans -- in 1993 the GAO released a report about DU, recommended to the Department of Defense all veterans and vehicles hit by DU rounds should be given medical testing and follow-up. DoD concurred. For reasons that the Department of Defense, the Office of the Special Assistant and the VA have never explained, there are only 35 veterans initially in that program.
I see the light has come on so I better skip ahead. In that speech to the American Legion he confirmed thereís another 80 vets that theyíre now trying to find eight years later who should have been in that program who, according to Army regulations, should have been given medical testing and follow-up continuously since the Gulf War.
Deny everything again is step nine. In their August report, I just have to say that after Mr. Case gave a lengthy presentation today about why their August report -- why the conclusion is justified, Bernard Rostker turns around and says, thanks to the question from RADM Steinman, he basically admitted that it was a premature and unsubstantiated conclusion about the role of depleted uranium in Gulf War veteransí health problems. This does not restore credibility; it further destroys it.
Step 10 is give it up. My recommendation is that, at least with respect to depleted uranium, you terminate the Office of the Special Assistantís investigation of Gulf War depleted uranium exposures. I think based on past experiences and statements given today, itís clear that theyíre incapable of objectively investigating this and we would like to see the General Accounting Office, which is beginning and investigation on DU and also the National Academy of Sciences to have complete access to all classified and unclassified information about Gulf War depleted uranium exposures.
SENATOR RUDMAN: Mr. Fahey, let me ask you a question because you have been following this very closely over the years. Would the new legislation in which there is some delegation of authority from the VA to the National Science Foundation or the National Academy of Sciences, I believe, excuse me, wouldnít that in some ways be supplanting some of the things presently being done?
MR. FAHEY: In theory, yes, sir. What theyíre going to do is review existing literature and research thatís out there. Unfortunately, the research specific to depleted uranium exposures in the Gulf War, thereís three projects underway. Two are on mice, one is on veterans. And there needs to be much expanded. Thereís no research on inhaled or ingested depleted uranium. Theyíre focusing on the fragments that have been put in the veteransí bodies.
And some of the findings that are coming out now about finding DU in veteransí semen, connection with neurocognitive disorders, evidence of chromosomal damage, these are things that are going to take years to study and if the NAS in a year wants to review this literature, I think itís going to be premature and some of the decision-making may be premature.
SENATOR RUDMAN: Okay. Doctor.
DR. BAUMZWEIGER: Good afternoon. Iím Dr. William Baumzweiger. Iíd just like to add to that that while the National Academy of Science is getting the majority of its funding from the DoD and the other military agencies, I think it will be somewhat difficult for them to be objective and it would be preferable for Congress to provide the funding to support these projects independently of the DoD and the VA.
SENATOR RUDMAN: Youíre concerned about the money coming out of the VA or the DoD budget?
DR. BAUMZWEIGER: Yeah; I am.
SENATOR RUDMAN: Somehow that taints it?
DR. BAUMZWEIGER: Yeah. I would think so.
SENATOR RUDMAN: Itís all taxpayer money, you know. It all comes from the same place no matter how you cut it.
DR. BAUMZWEIGER: I understand, but thatís just a concern that I have. I just wanted to follow up on that. I really want to talk about something else. Actually, itís quite related.
First I would like to submit a fax from Dr. Douglas Rokke who was one of our experts over in the Gulf on medical physics and depleted uranium and I very quickly want to read only parts of this because I donít have much time and Iíll just read a few paragraphs.
One of my specific duties, this is Dr. Rokke, was to provide the theater nuclear biological and chemical warfare and preventive medicine threat briefings. Although it has been reported many times that the threats were not known and not disseminated, I can assure you that the threats were known and discussed.
We also specifically discussed the known and expected adverse health effects that would affect individuals who consumed the PB tablets. The probably adverse health effects from the cynergistic reactions between pesticides PB and expected low level chemical and biological agent exposures were also discussed with agreement that we could expect acute and chronic medical problems. This is Dr. Rokke.
Our preventive medical command also expressed serious concern over the endemic disease issues, food, et cetera, CARC painting activities of vehicles and the cynergistic reactions between immunizations that individuals were given and the acute and chronic health effects as a consequence of hazardous material exposures. Iím going to say that again.
They were very concerned about the cynergistic effects of the immunizations individuals were being given and the acute and chronic health effects as a consequence of hazardous materials exposures. The oil well fires presented an expected and serious health threat. We observed acute respiratory and dermatological health effects and suspected chronic health effects will be seen for years.
SENATOR RUDMAN: Doctor, for the record, would you tell me where youíre from?v
DR. BAUMZWEIGER: Oh, Iím from Los Angeles, Tarzana, California.
SENATOR RUDMAN: Are you a practicing physician?
DR. BAUMZWEIGER: I am a neurologist, psychiatrist, child psychiatrist and clinical neurophysiologist.
SENATOR RUDMAN: Okay.
DR. BAUMZWEIGER: And I have been studying Gulf War Syndrome for four years since I did my residency and my fellowship in neurology and clinical neurophysiology at the VA in Los Angeles.
SENATOR RUDMAN: Thank you, Doctor.
DR. BAUMZWEIGER: And Iím going to submit this entire --
SENATOR RUDMAN: We will put that entire statement in the record. Is there anything that --
DR. BAUMZWEIGER: Iím also going to just go on to my portion which is to present very briefly a case presentation of the diagnosis and treatment of Gulf War Syndrome in two individuals, Sgt. Robert Jones and Sgt. Robert Bergen, who youíve already heard from.
These gentlemen both came to me with the typical symptoms of Gulf War Syndrome including sleep difficulty, trouble with bladder and bowel function and multiple what I like to term cranial nerve problems, trouble with vision, with taste, with hearing, with weakness in the neck, with funny feelings in their face, all of which pointed to the brain stem.
Now, the brain stem has always been considered kind of just like the stem of an apple by a neurologist. Itís kind of there, you know, hanging, the brain hangs from it. But itís not really true. For primitive or less evolved animals such as dinosaurs, they were able to do quite well with just the brain stem. Anyone who has seen Jurassic Park would know that. They were very, very effective hunters and killers except they didnít have a social conscience as we of course all in this room hopefully do. Am I not right? Anybody around want to disavow that statement? Okay.
At any rate, many of these symptoms, including Parkinson-like symptoms were found in these gentlemen and I began to look at the brain stem as perhaps the most critical part of what was a myriad of toxic exposures which have now been confirmed by Dr. Rokke.
And I donít want to hear anything about false alarms and gee, the equipment wasnít really good and it was defective. Thatís all baloney as far as Iím concerned. Dr. Rokke is one of the top experts in the world on this. He says the radiation was there, the biological was there, the nerve gas was there, multiple chemicals including dehexane and hydrocarbon in the oil fires potentiating the nerve gas. So thatís no longer a question as far as Iím concerned.
On close examination, the two subjects, Sgts. Jones and Bergen, had a theme that ran through their multiple symptoms all of which are all too familiar to all of us. I came to believe that this inflammation of the brain stem and the cranial nerves, which was the most prominent to me of all their features, not their reflexes or immediate strength, but the gradual weakening, the cranial nerve problems, brain stem problems, gradual onset of peripheral neuropathy and then a kind of a spreading disimmunity, autoimmunity as well as accumulation of multiple viruses and funguses, up to 15 or 20.
Sgt. Jones had 20 viruses and funguses in him, maybe 25. Robert Bergen here had 18, 19 funguses and viruses in him from immunolabs, immunoscience laboratories. And I highly recommend them if we canít get anything out of the testing here in Washington.
They all did very well on a treatment that Iíve concocted with first of all measures to cool down the nerves using calcium channel blockers and something called Gabba agonist and then IV treatments for the viruses and funguses, also IV treatments to stabilize their nervous systems.
They both actually improved remarkably. Youíve heard from Sgt. Bergen here. Sgt. Jones is not quite as well but he is doing better. For both of them, their fevers went away, burning on urination stopped. They stopped having these episodes -- Robert here was kind of confusion for a few seconds over and over. For Jones it was actual blackouts that he wouldnít know where he was when he woke up. Those went away.
So with continued treatments, with oral medication afterwards and with repeat IVís of antifungals, antivirals and IV stabilizers of the immune system, I have demonstrated through laboratory comparisons that their immune systems are far more healthy than they were when they began treatment and I submit that also in my record -- in my presentation which I will give you each a copy of.
I have one for each member of the Committee who is here. Also, I have an article which I published in January about the effect of calcium channel blockers in stabilizing the heart rate when the individual, Gulf War veteran goes from sitting to standing and that was actually where I started this.
SENATOR RUDMAN: Doctor, weíll have the staff pick all that up from you and weíll put that in the record.
DR. BAUMZWEIGER: Okay.
SENATOR RUDMAN: Thank you very much and I want to thank everyone that was here today. I want to make several observations and I understand there are no closing remarks from any of the panel members so I will just say this.
Anyone who wanted to appear today was invited to appear so everyone has been included. That is true tomorrow as well. Tomorrow we will hear from a number of veterans organizations as well as some of the other government agencies will be back to testify again on other issues.
We plan to start at 9:00 a.m.; we hope to be done by 3:30 in the afternoon or 4:00 and keep right on schedule. And I want to thank again all of you for being here and for attempting to keep to the schedule we laid out for you which I know is not easy to say what you want to say in ten minutes.
So we will go and adjourn now until tomorrow at 9:00 a.m.
(The hearing was adjourned at 4:36 p.m.)
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