MR. O’SHEA: Good morning, everyone. We’ll go ahead and get started here, if everybody is ready. On behalf of President Clinton, we want to welcome everybody to this public hearing. And I know we have a full agenda today, so I will cut right to the chase.

First we want to say thanks to the distinguished panel that we have here and for everybody who has been participating thus far, and we’d just like to kick it off with Senator Rudman and the full agenda that we have scheduled for today. So, Senator Rudman, I’ll turn it over to you, sir.

SENATOR RUDMAN: Thank you very much. General Cisneros, who heads a college down in Texas, former president Bush is visiting his college today, so I guess that’s a pretty good excuse for not being here.

As most of you know, one of our very special Oversight Board members, Admiral Bud Zumwalt, a giant of a man, a distinguished American patriot, passed away in early January after a valiant battle against cancer. Admiral Zumwalt was an energetic member of this Board, but more than that, he really lived a life of commitment, of service to our nation and particularly to those in the military. And he handled many complex issues facing active service people and veterans in his whole life. His funeral was held at the U.S. Naval Academy. It truly was a triumphant celebration of a life of a warrior.

President Clinton spoke, as a number of distinguished Americans participated in that ceremony. All of us who worked with him, and I also had the occasion to work with him in the last four years in my capacity of Chairman of the President’s Foreign Intelligence Advisory Board of which he was also a member, will miss him a great deal.

I would ask that we all just observe a moment of silence in memory of our friend and colleague, Admiral Bud Zumwalt.

(Brief pause.)

SENATOR RUDMAN: Thank you very much.

I’d like to propose to the Board a motion that we dedicate the final report of this panel that will be presented to the President for the purpose of better serving our distinguished servicemen and women who served in the Gulf War, that that report be dedicated in memory of Bud Zumwalt. Do I hear a second?

RADM STEINMAN: I second that motion.

SENATOR RUDMAN: All in favor? (Chorus of ayes.)

SENATOR RUDMAN: Any opposed? Motion is adopted and the record will so record it; that is the way we will handle the final report.

Can you all hear me in the back of the room? All right.

This is the seventh public hearing that the Board has held. Our last meeting was conducted at Fort Lewis, Washington, and chaired by our vice chairman, Secretary Brown, who will be joining us this morning. The Board has recently taken several actions that I would like you all to be aware of.

In our special report of November 1999, which is available on our web site, the Board approved a number of OSAGWI recommendations to discontinue certain investigations. Let me note that the Board did not approve two of those recommendations. The Board directed that the investigations in publications concerning the Second Marine RECON Battalion injuries and the SCUD information papers be continued.

In November of 1999, OSAGWI asked the Board for relief from a requirement of the prior Presidential Advisory Committee known as the PAC, that all reports, even if based on hearsay evidence of M256 alarms of fox vehicle detections, be investigated. That was their recommendation.

The Defense Department has done, in our opinion, a commendable job of tracking and investigating the multitude of reports and incidents that occurred during the Gulf War. Our Board granted OSAGWI and the Defense Department relief from a number of reported incidents that did not warrant continued expenditure of valuable time or taxpayer dollars in pursuit of uncorroborated reports that lacked basic documentation such as date, time, place, witnesses, log entries and so forth.

However, in granting relief from those requirements of the PAC, I want to point out several things. First, the Board acted on the initial request of OSAGWI only after we requested and received very detailed supporting documentation and it was very detailed. The Board granted relief to OSAGWI on eleven M256 reports and thirty-two fox vehicle reports. Relief was not granted for seven M256 incidents and two fox incidents.

Today we have a full agenda. Later this morning we will hear from Dr. Rostker on the OSAGWI follow-on organization, which we believe is vital. Before we proceed, however, I would like to recognize Undersecretary of the Army Rostker on his nomination as Undersecretary of Defense for Personnel and Readiness. Congratulations on your nomination, and we certainly think you deserve it.

Our expectation is that the proposal that Dr. Rostker will put forth today has been fully coordinated with a PLD to include OSD health affairs, the Joint Staff, the services and the CINC. Recognizing that there will always be differing views, the Board expects that what we will hear today will represent a unified approach as to how an OSAGWI follow-on organization will advance the overall force health protection effort and two, integrate with parallel efforts of DoD and the other departments.

For our panelists, I encourage you to candidly state your positions; departmental turf is no grounds on which to fail to give our service persons and veterans less than one’s frank opinions and recommendations.

Dr. Mazzuchi, Dr. Claypool, Dr. Brown, Dr. Mazzella, we await your comments.

The Board has invited the veterans service organizations, the Departments of Health and Human Services and Veterans Affairs and the Military and Veterans Health Coordinating Board to give us their ideas as to how they will interact with the follow-on organization. We will also listen with interest as to how remaining Gulf War illness issues will be addressed after OSAGWI ceases as such next January.

One issue in particular deals with outreach and the utility of future town hall meetings. One of OSAGWI’s outreach efforts, the web site GulfLink, is a hallmark of an ongoing full disclosure effort of the government for the public and our veterans community. I would hope to see that effort would be maintained.

On the other hand, the DoD town hall meetings seemed, in our opinion, to have become a forum for our veterans to focus their individual grievances on the VA, its benefits and health care delivery system. The specific subject of Gulf War illnesses does not dominate the public comment at these town halls. Without regard as to the benefit of the forum itself, is there a strong sentiment or justifiable reason to continue these town halls? Dr. Rostker and our other panelists, I will appreciate your thoughts on this issue.

Another issue is completing the phasing out of the OSAGWI retrospective investigations. Over the next eight months, OSAGWI will become a significantly scaled-down follow-on organization. The design of that follow-on organization is solely a planning responsibility of DoD. However, there must be a provision for integration and cooperation with the VA and other organizations on issues of mutual interest. The Board is anxious to learn of plans for that.

Before we hear from our first witness, I will ask our distinguished Board members if they have any comments. First, I will call on Dr. Cam. Do you have any opening remarks, Doctor?

DR. CAM: I am very honored to serve on this Board, and I am very anxious to learn about your concerns on the following organization. Thank you.

SENATOR RUDMAN: Thank you. And Command Sergeant Major Moore?

CSM MOORE: Thank you for being here. I am, too, pleased and honored to serve on this Oversight Board, and I wish that between all the efforts of the participants, that we will have a positive end result.

SENATOR RUDMAN: Thank you very much. And finally I want to call on Admiral Steinman. Let me just say publicly that I want to thank Admiral Steinman for his extraordinary efforts on behalf of the Board. Of course he has a background that none of the rest of us have and that has been extraordinarily valuable to us and he has been -- really given us yeoman service, and I guess for a former public health officer and a Coast Guard Admiral, I guess that’s the least we could expect.

RADM STEINMAN: Well, thank you, sir, for those kind comments. I, too, am honored to serve on the Board and in the interest of saving some time, I think I will reserve my comments to the question and answer sessions for each individual issue.

SENATOR RUDMAN: Thank you, Admiral.

We’re now ready to begin the hearing. We’ll hear from our first witness, Lieutenant Colonel Michelle Ross, Office of the Deputy Assistant of the Secretary of Defense for Chemical Biological Defense. Colonel Ross, I understand you have just released your annual report to Congress on DoD’s chemical and biological defense program.

Please feel free to reference your report as you point out the progress you have made and the areas in which you require assistance. That would include funding shortfalls that the Board should be aware of. Thank you for being here.

LTC ROSS: Good morning gentlemen, ma’am. You have a copy of my briefing slides in front of you, and you also have a copy of the DoD strategy report that I’ll be discussing.

The overview of my presentation is to discuss the Department of Defense’s research plan to investigate low-level chemical exposure to chemical warfare agents. I’ll just give a brief -- very brief introduction of the background that generated this research effort. I’ll discuss the plan and -- the outline and the objectives of the plan and give you a status update of where we are with the research program.

As you know, Congress directed the Department of Defense to develop a five-year research strategy to address low-level exposure to chemical agents that came out of the Strom Thurmond National Defense Authorization Act in 1999 and this -- it was generated from the Presidential Advisory Committee and the Special -- your Special Oversight Board to -- with the recommendations to investigate low-level exposures to chemical agent.

Independent of the Advisory Committee recommendation, the General Accounting Office issued a report on the fact that they identified a gap in the Department of Defense’s research program to look at this research effort.

Next slide, please.

The Office of the Special Assistant for the Gulf War Illness has identified numerous lessons that relate to the chemical and biological warfare issues. These lessons apply to many areas of chemical defense, doctor-in-training, leadership, operations and material and these lessons have been briefed to the services both for training and -- both their training and doctrinal organizations and also have been briefed to disaster preparedness engineers and in public forums.

For example, these recommendations and lessons were briefed at the worldwide chemical conference a few years ago that’s sponsored by the U.S. Army Chemical School.

OSAGWI issued a report in ‘96 looking at the possible effects of organo-phosphorous low-level nerve agent exposure and stated that there was at that time no scientific evidence to support a causal link between low-level exposures and the undiagnosed Gulf War illnesses, and this was briefed to the PAC, the Presidential Advisory Committee.

However, they did recommend that additional research continue to investigate low-level exposures and that was also supported by the military -- next slide, please -- also supported by the military veterans health coordinating board which as you know was established in 98 to ensure coordination among the agencies, the Department of Defense, VA, Health and Human Services, and to address health matters for all the service members, veterans, deployed civilians and their dependents.

Our five-year plan, which I’m going to discuss in a minute, will fully coordinate with the Military [and] Veterans Health Coordinating Board, and our goal is to ensure that there’s minimal duplication of effort and also to leverage departmental resources.

In front of you, you have a copy of the Department’s strategy to address low-level chemical exposures and you can have that for your reference. Yours is bound in – there’s a spiral -- there we go. This is a strategy that was written and published in May of ‘99. This is an unfunded research -- at the time it was an unfunded research plan. And there are two broad objectives to this plan. One is to generate hazard data -- hazard assessment data that will identify low-level exposure concentrations and the associated health effects, and the other general objective is to provide information to develop or potentially modify policy or doctrine related to low-level chemical exposures.

The research effort started, even though this was not specifically funded and the initial efforts were funded within the research laboratories. They funded within house. My boss, Dr. Anna Johnson-Winegar, who is the deputy assistant to the Secretary of Defense for chemical and biological defense, established a working group to oversee and get a handle, if you will, around all the research efforts that have been ongoing for the last few years and we’ll hear more about those with the next speaker.

So we put together a working group; Dr. Winegar is the chair of this group and there are a number of stakeholders that I’ll outline in the next slide. But before I get to that, could you go back two, please? Back one more. Here we go.

Let me tell you about the objectives of the group. The main objectives are to identify the ongoing research efforts because there are a number of these and to -- as I mentioned before, to minimize or prevent duplication of efforts. Now, I think you can appreciate that the investigation of low-level exposure is a very complicated problem. You have to define an event that has no -- or potentially no immediate clinical signs, perhaps identify clinical signs that are long-term or come out later.

Even the definition of low-level is not well-defined. You can look at -- in terms of safety and health, you can look at short term exposure limits, threshold limits, time weighted averages, if you’re familiar with those terms, permissible exposure limits, there’s all different ways in terms of the safety and health arena of identifying what these levels are.

And the levels for nerve agents -- and this is for other chemicals, organo-phosphorous, compounds and others -- the levels for nerve agents have not been well documented or worked out. So we -- this group decided that we need to start with -- on common ground, if you will, even when it comes to the selection of animal models or the types of exposure, whether we’re going to have inhalation exposure or perineal exposure of these agents.

So the goal is to get everyone started on the same sheet, if you will. There are so many questions, and this is such an enormous task that we felt that if we could start commonly, that we could go from there and address these other related issues as time went on.

The other focus is to direct the investigations to address operational issues because while this is very interesting science, we -- our objective is to answer some specific health and operational questions. There are a number of – there’s basically two levels of effort. One is a medical effort and one is a non-medical effort.

For the medical objective, the surgeons general are interested in establishing medical threshold limits for the deployed personnel, and so they’re looking for numbers and hard data so that they can make some decisions about policy decisions about what’s safe and what’s not and look at risk assessments.

On the non-medical side, this information can generate what level -- for our detector technology, what levels; what are the low-levels that we need to design our detectors to be able to identify and key on? We don’t have good information on that yet so that’s where we’re going right now.

Next slide, please.

The group is inclusive and we have tried – we’re trying to include all the stakeholders that have an interest in this area. We have policy folks, strategy and threat reduction, Health Affairs, Joint Staff, all the services are represented; Navy, Air Force, Marine Corps, the Office of the Specialist Assistant for Gulf War Illness is a mem -- has a representative, the Military and Veterans Health Coordinating Board, SBCCOM--Soldier and Biological Chemical Command, of course the medical research folks, the medical research and material command, the Environmental Center for Health Promotion and Preventive Medicine and it’s not -- and we’re open.

If someone steps up to the plate and says they’d like to -- they are interested, they want to be included, the doors are certainly open.

Next slide, please.

This is a summary of the current funding for the program. It’s -- this is what’s in the President’s budget today, and it is approved by Congress. We also have numbers -- we have projected funding in the POM, in the FY02 to ‘05 which is – isn’t finalized yet, but it’s under discussion right now.

So this effort is a long-term effort. We hope to generate some good information, coordinate the generation of good information within -- certainly within the next year or two and at least have some hard information to start answering some of these questions. But I think you can appreciate the scope of the effort and the fact that it’s going to take a while to get the answers to our complete satisfaction.

Are there any questions from the panel?

RADM STEINMAN: Thank you for that interesting presentation. Just briefly, could you comment for the benefit of the Board members and our audience or summarize the recent finding about the adequacy of the protective clothing that was used in the Gulf and before?

LTC ROSS: I know there are some issues associated with some of the lots that went out on the BDO, the battle dress over garments. The equipment is safe and although there were some problems with certain lots, in general, I mean -- the equipment is rated to be safe and protect against chemical agents.

We have some follow-on suits that are soon to be procured and released. It’s called JS list, and it’s further a follow-on product, if you will, that has -- reduces the seams that are in the current or the original battle dress garment. It’s a lightweight suit. It has – it’s breathable, it causes minimal heat casualties, much unlike the first generation suit.

So the suits are safe but they’re improve – we’re improving on them for a number of operational reasons. I mentioned the heat and the bulkiness and so forth. There are a number of issues that need to be improved on and we’re doing that.

RADM STEINMAN: I guess if I were a veteran I guess the bottom line answer would be I wore the suit in the Gulf; was it sufficient to protect me against potential exposure to chemical agents?

LTC ROSS: Well, of course it depends on when you put it on in terms of exposure. When were you exposed? If you were exposed -- obviously if you were exposed to agents before the alarm went off and you weren’t suited up or you didn’t have your mask on, there’s always potential for that. If you have your protective suit on, your face mask on, absolutely; fully protective if you were adequately protected when the -- when the exposure occurred.

RADM STEINMAN: That was my question. The suits that were used in the Gulf were adequate to protect against potential exposure to chemical weapons?

LTC ROSS: Yes, sir.

RADM STEINMAN: If they were donned correctly.

LTC ROSS: Yes, sir. That’s correct.

SENATOR RUDMAN: Dr. Cam, you have a question?

DR. CAM: I have a couple questions. Thank you for your presentation.

My first question is can you define the difference or is there a relationship between the DoD definition of low-level chemical exposure and what’s commonly called occupational exposure?

LTC ROSS: Well, that’s certainly one of the questions that we’re addressing right away. There is no good definition of -- there is no DoD definition of low-level. Some – what’s been discussed is 100 times or two logs below the occupational safe levels for exposure, specifically the – it’s called the IDLF -- H, excuse me. The immediate danger to life and health.

That’s the level of exposure that will -- where you can observe any effects immediately, like myosis, pinpointing of the pupils or shortness of breath. That’s called -- referred to as the IDLH level. And it’s been discussed that the low-level or the nerve agent low-level DoD definition is 100 times below that. But it’s not well-defined, and that’s certainly something we need to address, and we are. We’re looking at that right away.

So the answer to your question is we don’t yet have a good definition but that’s one of the very important things about standardizing the research so that we can all start looking at the same levels and then working backwards from there.

DR. CAM: My second question is how do your program goals integrate with the Research Working Group pending concerning low-level chemical effects, doctrinal requirements for protection and the most important I feel is lessons learned from prior conflicts.

LTC ROSS: Yes. I touched upon that in my talk and also in the back of your packet are specifically written out paragraphs to those questions. We’re aware of the research that’s been going on, and I think it’s going to be discussed in the next -- with the next speaker, some of the progress in that area.

By including representatives of that group and including the work that’s been done and is ongoing, we’re including them and they’re part of our group and they will have input into not only the status of the research but the direction that it’s going.

As I explained, the Research Working Group will focus the work, understand what’s going on now, focus and direct the ongoing studies so that everyone’s interests and questions can be addressed.

DR. CAM: Thank you.

SENATOR RUDMAN: Thank you very much for bringing us up to date on what you’re doing; appreciate it.

LTC ROSS: If you have any other questions, just let me know.

SENATOR RUDMAN: Thank you. Next witness, Dr. John Feussner from the Research Working Group will update us on low-level chemical exposure on PB.

We welcome the vice chairman. I wonder, before you start if you had any opening remarks at all?

SECRETARY BROWN: No.

SENATOR RUDMAN: All right. Thank you for being with us, Doctor. If you’d bring us up to date on what you’re doing.

DR. FEUSSNER: Good morning, sir. Now that the Secretary has arrived, I am prepared to begin.

SENATOR RUDMAN: All right.

DR. FEUSSNER: I appreciate the opportunity to update you on the research activities ongoing with the Research Working Group. I have chaired the Gulf War Research Working Group since 1996.

May I have the next slide, David?

What I want to do briefly this morning is review for you the goals and functions of the Research Working Group. I have just one or two slides that -- from the 1999 annual report to Congress that demonstrate the scope of the research effort and then focus on the status of low-level chemical agent research, pyridostigmine bromide as you requested.

Next slide, David.

This slide briefly reviews the functions of the Research Working Group, I think fairly typical activities for such a body, to look at the direction of the research, identify gaps that could be filled with additional research, identify potential new research approaches, disseminate these research concepts and then work to continue to develop what we believe is a coherent overall research portfolio.

Next slide, please.

The current Research Working Group portfolio has 145 active research projects. By the end of this calendar year, we will have expended cumulatively in the area of $150 million, and the research effort continues in a very broad and diverse group of areas, 14 specifically.

Next slide, please.

This histogram is taken from the 1999 annual report to Congress. I show it just to demonstrate the diversity of the research effort ranging from central and peripheral nervous system abnormalities through chemical weapons, DU, PB, reproductive health and more recently treatment trials. It’s a diverse and, we believe, comprehensive research effort. Unfortunately, approximately -- only approximately a third of these research projects have actually been completed to date.

Next slide, please.

Some of the conclusions that have been drawn from the initial wave of research projects are listed here. It’s clear that veterans who served in the Gulf report more symptoms. We are in the midst of a -- the Congressionally-mandated phase three survey that involves actually examining veterans spouses and their children and to see what physical concomitance there are on examination to the reported symptoms and to see what the health status of the spouses and the children might be.

The initial epidemiological research which continues, shows that there is no increased mortality, disease-specific mortality from service in the Gulf, no increased use of acute hospitalizations which might be viewed as a marker of illness sufficiently serious to require hospitalization, no increase in birth defects among offspring, and long-term studies to look actually at the veterans’ health status are being planned, although preliminary results from the population-based epidemiological study at Iowa are available.

From that study, approximately 90 percent of veterans report their health status to be good to excellent and approximately 14 percent report their health as deteriorating over the period of observation from ‘96 to ‘99.

SENATOR RUDMAN: Doctor, let me ask you a question while that slide is still up there, just really a statistical question. The bullets following the top one, no increased risk for hospitalization, mortality and so forth and so on, compared to non-deployed veterans compared to the population --

DR. FEUSSNER: Compared to non-deployed veterans there’s no increased risk of mortality. There are two caveats. And -- well, before we get to the caveats, in general, the health status of these soldiers is superior to the health status of the general population, perhaps not unexpected since they are selected for service in the military by being -- for being healthy.

The two caveats to these observations are as follows. The first is the period of observation is short, relatively speaking, certainly less than a decade. Many dangerous exposures or for example exposures to chemicals that in the future could cause cancer are related to dose of the exposure, but also there is frequency along latency time.

So these -- why I say these results are preliminary, unfortunately the epidemiological studies will have to continue probably for at least another decade to see if associations occur later reflecting the latency associated with a toxic exposure.

SENATOR RUDMAN: Would you expect, let’s say in the case of some of these exposures that might lead to some form of cancer, what do you expect, 20-year incubation period, 25-year period? I mean, what do we -- does anybody know?

DR. FEUSSNER: Well, I think that you’re in the right ballpark. I think you’re talking about 10- to 20-year latency periods.

SENATOR RUDMAN: The other question I had is kind of a curious statistic there; no increase in the risk for mortality except motor vehicle accidents.

DR. FEUSSNER: Yes.

SENATOR RUDMAN: This is the -- those who were in the Gulf compared to those who were not deployed or again are we talking about the general population?

DR. FEUSSNER: No, we’re talking here about the deployed versus non-deployed. This is not a new observation. In previous deployments, it has been noted that this association with motor vehicle accidents, perhaps risk-taking behavior, results in increased mortality from these causes.

There is additional follow-up on this and my recollection is that this initial observation is decrementing through time.

SENATOR RUDMAN: Okay. But those kinds of statistics were similar in other deployments in which things were checked out where you would find veterans who returned from a conflict who tended to be -- have more accidents, therefore you might assume that probably their driving abilities were the same, you might have to assume they were willing to take more risk, drive faster and so on and so forth.

DR. FEUSSNER: That’s fair.

SECRETARY BROWN: Doctor, just to follow-up on that. Have you noticed the same mortality occurring after other conflicts such as -- I don’t know if you have historical data of World War II, Korea, Vietnam and some of the other lesser conflicts like in Grenada? Did you notice the same thing or do we have data on that?

DR. FEUSSNER: Mr. Secretary, I think we do have data on that. My recollection is -- I don’t know about all the deployments specifically but my recollection is that this issue of an increased risk of accidental death has been reproduced and has been observed after previous deployments. And we do have the data to follow this observation at least with regards to the Gulf War cohort prospectively through time.

SECRETARY BROWN: Now, how do you frame that from a scientific perspective? Exactly what are you saying? Are you saying that there may be something physically happening, increasing hormones or whatever that would modify their normal behavior after having been in a hazardous area or are you saying something that has more to do with misconduct or – I’m trying to get a sense on what does this mean.

DR. FEUSSNER: No. I don’t think that there should be any allusion to any kind of misconduct, nor do we have any evidence that there’s some changed biological state, neurochemical changes in the brain, et cetera. I think our notion is, at the moment at least, that the kind of individuals that participate in war and participate in this deployments have a -- in a pre-existing sense may be more risk-takers and that that would get them into difficulty at all stages in the game.

So I don’t think we’re suggesting -- I don’t believe we have any information suggesting any kind of biological basis and there is no intention to suggest misconduct or inappropriate behaviors.

SENATOR RUDMAN: But what you are saying is the statistics are there.

DR. FEUSSNER: Yes.

SENATOR RUDMAN: And the statistics indicate higher risk from motor vehicle accidents after deployment than before deployment or non-deployment.

DR. FEUSSNER: Yes.

SENATOR RUDMAN: You’re not saying why.

DR. FEUSSNER: Correct.

SENATOR RUDMAN: You don’t have -- you haven’t really looked into the why; you’re simply saying that that’s the fact.

DR. FEUSSNER: Yes; that’s correct.

RADM STEINMAN: One other question, Doctor, before you leave the general conclusions. Do you have any data that looks at the longitudinal changes in the signs and symptoms of Gulf War vets who have been recorded in the CCEP of the VA registry? One of the frustrations is we can’t figure out whether the vets who are originally presented as ill are getting better, is there a change in incidence rate of symptoms. Are there studies looking at these longitudinal changes?

DR. FEUSSNER: At the moment, I don’t think we have very good data. For example, let’s say that we would ask a fairly simple question. Here is the group of veterans who we’re concerned about. Let’s say what their health status is at point A and then take those individual veterans and follow them through time to say this is better, this is worse or this is the same.

I think the data in that regard are not robust. Now, what I would say, however, is that the Iowa study, which is a population-based study, does have some initial data, as I alluded to earlier, suggesting that self-reported health status is rated by veterans as good to excellent overwhelmingly, 90 percent of the time, and that for a minority, 14 percent, there’s the perception that their health status has clearly deteriorated over time.

That particular study made its first observation in 96, has a subsequent one in ‘99 and could be funded to have a third in ‘02 and in that regard, provide us longitudinal data. Unfortunately, the survey -- the national survey, phase one through phase three, are more like snapshots of the population and don’t provide us an opportunity to link say data that is obtained now with health status data that was obtained straight away. My impression when phase one was conducted is the focus was more on exposure history than on health status and while they are improving data on health status later, not so in the early stage.

Now, in the two treatment trials, we will be studying not quite two thousand Gulf War veterans, all of whom have been selected because they are quite ill. And in those trials, there are treatment groups that are more intense and less intense. So within the context of perhaps some of the sickest Gulf War veterans, we’ll have pretty good data, at least over a short period of time, two to three years, whether their health status is deteriorating, staying the same or improving.

You would predict with the overwhelming majority identifying their health status as good to excellent that there would be a ceiling effect and that what would happen is that through time, the natural tendency would be for those patients to get less well as opposed to better.

RADM STEINMAN: But what you’re saying then, as I understand it, there is not a research program currently underway to look at those veterans who registered in the CCEP or the VA registry to track them longitudinally to see whether they’re getting better, worse or staying the same.

DR. FEUSSNER: That’s correct.

SENATOR RUDMAN: Yeah; go ahead.

DR. CAM: Just to go back to the point you made that there was a link, are you planning on studying about this link at all?

DR. FEUSSNER: Well, that’s very problematic. Going back five or ten years and asking what health status was five or ten years ago is very problematic.

DR. CAM: Is it possible to have another study in the future covering that gap?

DR. FEUSSNER: Again, what you really want to know is the longitudinal nature of the health status and the best data that we have again comes from the Iowa study. We will have information 96, 99 and into the future. I think it would be very difficult to say start in ‘00, ‘01 or ‘02 and then ask patients or ask veterans what their health status was ten or so years ago and then know what the health status was. So I think that’s a problem.

One of the issues that we have dealt with as we are moving into the area of post-deployment health is -- one of the lessons learned is that we -- in the Gulf deployment, not having as good a measure as the base state, that is the pre-deployment state, and then not having very good measures immediately post-deployment, which could then serve as base measures down the future, is an issue I think that we’re going to try to address as we move. It’s, if you will, a lesson learned from this particular situation, moving to the future.

SENATOR RUDMAN: I want to keep you on schedule if we can. We know we’re interrupting you a lot, but we’re going to try to keep you on schedule.

DR. FEUSSNER: Where am I?

SENATOR RUDMAN: I think we had finished with that. That’s the new slide.

DR. FEUSSNER: Okay. What I will do now is talk briefly about the low-level chemical warfare agents research and then the research on Pyridostigmine bromide, insecticides, et cetera.

The Research Working Group really had no research plan involving exposure to chemical warfare agents until 1996 when new information about Khamisiyah was raised and introduced concern about chemical weapons exposure. At that time, recommendations were made to look at the long-term health effects, especially of low-level chemical exposures.

In the period immediately around the release of information about Khamisiyah, the Research Working Group in fact had received four excellent research proposals reviewed as scientifically credible but had not funded them because they did not appear to be an appropriate priority for the research funding. The first step was taken to go back, contact those investigators and initiate those for research projects.

Subsequently, in the ensuing years, DoD has had a series of broad agency announcements related to the issue of low-level chemical weapons exposure.

Next slide, please.

Around this same time, the Research Working Group involving VA, DoD, CDC and EPA developed a specific strategic plan for research on the health effects of low-level nerve agent exposures. At that time we, if you will, field tested the initial plan at the International Society of Toxicology meetings in Cincinnati and then published their strategic plan in the 1997 annual report to Congress, and it’s that plan that has guided our actions over the subsequent three years.

Next slide, please.

More nettlesome is the issue of what a low-level exposure is, especially problematic if patients have -- or if the soldiers have no symptoms, no explicit knowledge of exposures.

We within the strategic plan have created an operational definition, minimal reduction in enzymes, biological proteins that could serve as a vial marker for exposure to nerve agent. Of course, acetylcholinesterase levels were not measured systematically during the conflict and that the patient have no or minimal observable clinical signs or symptoms. So from a medical care perspective, these would really be classified as sub clinical exposures.

Next slide, please

Now, much of the research portfolio is actually listed on this slide. Several large-scale epidemiological studies really revolving around the potential exposures due to the Khamisiyah demolition, one of these projects, again looking at hospital utilization, has been published out of the Naval Research Center in San Diego.

The medical follow-up agency, the Institute of Medicine, is helping us with the major epidemiological study, looking at those that might have been exposed in Khamisiyah versus those that are not, and then a third project being developed in Portland.

The second issue here has to do with epidemiological studies of long-term effects of acute exposures. This really reflects the experience of the Aberdeen site in the fifties and the sixties. Again, this is a study that is -- that we have asked the medical follow-up agency at the IOM to help with. We’re looking for neurological and psychological sequelae.

The advantage that this study has is that we have clear knowledge about the dose and duration of exposures that the soldier volunteers had at Aberdeen and so might be able to develop some concrete results from known exposures, even low dose. To develop biomarkers for CW exposures, while the research is proceeding and may succeed in trying to develop biomarkers, we really haven’t any research products yet that could be used in a general way.

And then the fourth category is toxicological studies, looking at long-term effects from CW exposures. Most of these studies actually look at exposures to low doses of sarin.

Next slide, please.

At the moment, there are 19 research projects that the Research Working Group is tracking specifically dealing with low dose CW exposure. The statistics are listed here. The amount of money, the amount of projects completed and the number that we expect to complete this calendar year. Most of these projects should be finishing up before the end of the year.

Next slide, please.

SECRETARY BROWN: Doctor, can you give me a list -- just a few of the 19 projects?

DR. FEUSSNER: Yes. I brought -- I could actually give you the list, but you want some examples. Chronic organophosphate exposure and its effect on memory in the Medical College of Georgia, the toxicokinetics of some of these things, that is, how they are metabolized in the body; this is a rodent study being done in the Netherlands. Long-term effects of sub clinical exposures to sarin out of Albuquerque, butylcholinesterase, which is another enzyme that degrades some of these chemicals and what its genetic variability is, out of the University of Nebraska.

So those are some of the studies and I believe what we’re passing out is the list -- the actual list of the active studies.

SENATOR RUDMAN: Are any of these that are now complete produce any particularly surprising if yet-to-be-corroborated result or are you not in a position to talk about that yet?

DR. FEUSSNER: May I have the next slide, please?

I don’t think there are any particularly surprising results at this point in time. The only epidemiological study to produce results is the one I had mentioned out at San Diego, and it has shown no increased hospitalizations among veterans. Again, that’s a fairly blunt cut of the data.

We have had some success developing biomarkers, so-called adducts to some of the toxins but again those haven’t been field-tested. But other than that, the results to date have not been particularly surprising. We have noted genetic – what’s called genetic polymorphism. That is variability. You may have one capability to destroy or protect yourself from these chemicals, and someone else who is apparently looks just like you might have a dramatically lower ability to do that. That had been suspected before, but basically we’ve confirmed that.

Next slide, please.

What we would say is that the projects that currently are funded in our perspective are addressing the research questions that exist in the strategic plan. These projects are highly variable from very basic biological studies that are looking at what happens in animal models to large-scale epidemiological studies that are trying to tease out differences in exposures and outcomes.

We have not noted any new issues that have come to bear since we created the original strategic plan, so basically we’re still on the original plan and we would deduce, at least at this point in time, that our funding line is probably adequate. But that is conditioned on -- that is -- the caveat there is whether new information would become available or depending on whether the active research projects now ongoing would come up with research observations that require follow-on studies.

I would like to move to the next slide, which talks about issues of pyridostigmine bromide. This is a medication that was used in the Gulf. The Research Working Group did identify PB as a priority for subsequent research in the original working plan for the research group that was published in 1995. A variety of expert panels and presidential commissions have recommended that we look at issues of the pyridostigmine bromide itself, insect repellants that were used in the Gulf, DEET, which is a component in for example Off!, permethrin, and organophosphate pesticides.

Again, DoD has played a prominent role in this line of research and has announced BAA [broad agency announcement] is looking at PB and the interactions with other chemicals from 1995 through 1999.

Now, the research question is on this next slide, and the question is does short term low-level exposures to PB or these other chemicals alone or in combination cause significant harm, specifically specific neurological effects. There are seven specific projects that focus on these issues of interactions between PB and low-level nerve agents.

The research, as we said earlier, is complicated straight away dealing with low-level exposures. Now we’re going to be adding onto that one or more interactions and the research gets even more complicated.

The next slide shows the commitment of resources to date, 27 projects, about $21 million. Several of these projects have been reviewed or have been completed and the results published.

Next slide, please.

SENATOR RUDMAN: I have the same question or maybe you’re going to tell us --

DR. FEUSSNER: Yes, I’m going to get to --

SENATOR RUDMAN: All right.

DR. FEUSSNER: Not this one but the next one.

SENATOR RUDMAN: All right, go ahead. We’ll let you do it your way.

DR. FEUSSNER: Thank you, sir. I appreciate that.

OSAGWI had commissioned an extensive literature view on this issue of PB by Rand. Rand identified these seven areas or hypotheses that should be investigated. We’re pleased that the original Research Working Group, in fact, covered all of these projects.

Issues about penetration of these chemicals into the brain was an important one. The standard scientific information available at the time was that they do not. Differences in susceptibility, we talked about the genetic differences in these proteins and how different people might react to them differently. Issues of interaction. Bromism is a very rare illness associated really with exposure to bromide. In my 25 years I’ve never seen a case of bromism, but I’m just a youngster.

And then other projects relating to the effects of this chemical of the neuromuscular junction, it works where the nerve meets the muscle to tell the muscle how to behave. And then the regulation of this chemical and could exposures in the short run to PB or other drugs actually have unknown and unintended consequences that extend beyond the brief exposure period.

Next slide, please. Oh, that’s the next slide.

Basically, the issue has been concern over whether PB cross a blood brain barrier, can have effects in the central nervous system, that are unanticipated. What we have to say is that on balance, the research suggests that it does not. There was an initial study published by an Israeli group of scientists that showed that PB associated with stress, in this particular case the stress was a swimming stress, allowed the chemical to cross the blood brain barrier of mice and that, of course, was of concern because soldiers taking this medication in the Gulf were exposed to multiple stressors, perhaps chemical but certainly physiological stressors.

That research has not been able to be corroborated but as other scientists have attempted to replicate the research under the same conditions and with the same animal species and have not been able to do that.

Yes, ma’am.

DR. CAM: Do you happen to have any preliminary finding on that study done by Dr. Gary Gilkensen on immunotoxicity due to co exposure to PB and stress? It’s kind of related to what you just said.

DR. FEUSSNER: Actually, I don’t off the top of my head.

DR. BRIX: That’s a very new project that was just very recently ended and there are no results yet. Sorry.

DR. CAM: Okay. And just a minute to ask you the study done by Dr. Abou-Donia at Duke University. The last time I talked to him, I thought he was about getting some interesting findings on long-term effects on sub chronic exposure to sarin alone and was dressed for other chemicals. Do you know anything about that?

DR. FEUSSNER: I don’t think -- actually I was a professor at Duke myself for 23 years and Gary Gilkensen was from Duke before he moved to Charleston so I know these people very well in my previous life. I don’t have any new information, however.

DR. BRIX: No, Dr. Abou-Donia has not published his recent findings from his studies.

DR. FEUSSNER: Yes, sir.

CSM MOORE: Doctor, do you have any data what PB can or has or the effect it has on a normal -- when I say normal, a person that would have the adequate -- all the normal health that they should have versus a person who has a shortfall or lack of a better expression, the health is not as good? So you have one person with good health and one with not-so-good health. What effect would it take on a person that’s normal, and what is medically considered not normal?

DR. FEUSSNER: Research would suggest it would not have any effect. Pyridostigmine bromide is from a family of drugs; physostigmine, which is a similar drug, has actually been used as a treatment for a rare muscle illness called myasthenia gravis for about a half century in the United States and is a very important drug, potentiating the effect of the chemical transmitter allowing those patients to have a more normal muscle actions.

The research suggests -- the volume of research suggests that the PB doesn’t -- it in fact probably does not cause -- cross the blood brain barrier so it would have no effect on the brain. We have other studies that have been recently published, this year, that have looked at the effects of this where it’s supposed to act, where the nerve and the muscle meet.

And what those -- what that research suggests is that the PB in fact can cause damage at the junction where the nerve and the muscle meets. This is an -- again, an animal model experiment. As those observations are extended through time, the conclusion is that the bad effect of the agent at the neuromuscular juncture where the nerve and the muscle meet is very short-lived and that once the chemical is removed, the neuromuscular junction repairs itself and reverts to a normal state.

So the body of research, at least at this point in time, doesn’t impugn PB. Now, we have learned that there are -- as I said earlier, there are differences in different people on how they might metabol -- destroy and -- I don’t know of a better word than metabolize -- these chemicals, and we do know that there is gender differences. That is, for whatever reason, women would be more susceptible to the adverse effect of this drug than men would be.

So we have learned a lot more about this agent than we had in the past but at least at the moment there doesn’t seem to be anything to impugn this as a cause of sustained illness.

CSM MOORE: One other quick question. With the damage in the nerve, how would that affect the person behavior?

DR. FEUSSNER: May I have the next slide, please?

I don’t know that it would. This shows some additional results from the research. The first bullet actually reflects Dr. Abou-Donia’s work with massive doses of PB demonstrating some synergy. These are doses of the drug that actually are extremely harmful to the animals and far exceed any doses that a person would be exposed to.

There are studies that show changes in behavior in animal models when they get pyridostigmine bromide. And the way this is expressed in the animal is, for example, the animal reflexes would be slower so if it were to do a task, it wouldn’t react as quickly as it might.

The animals -- if I challenge the animal such that the animal would be startled, in the presence of the drug, the startle reaction is blunted. So that there are results that show that Pyridostigmine does have behavioral effects in animal models and what’s hard to get to is whether or not those observations kind of carry over to humans.

Most of these results are done using rodent models, and we don’t understand exactly why these behavioral effects are observed. You would think it would be effect on the peripheral nervous system when you see the reflexes being blunted and previous -- the data that I talked to you about in terms of not crossing the blood brain barrier, would suggest not a central effect but we simply don’t know the answer to that yet.

SENATOR RUDMAN: Go ahead.

DR. FEUSSNER: I actually only have two more slides, so I’m almost on time.

This is really a summary of the status of PB as I gave for the CW. A little over two dozen projects, the spectrum of research methods here is variable. Our notion at this point in time is that our funding is probably sufficient but, again, as something new comes up or if these research results produce something that’s positive that we would want to follow on, then that could change.

Last slide -- I believe this is the last slide.

Yeah. This just basically says we’re working on it.

SENATOR RUDMAN: Well, essentially, as you know, PB is an issue, which in some -- in the minds of some veterans is a very serious issue. Many of them are convinced that, in fact, it has produced the problem. I have to assume that you have some time to go yet before these projects are done.

DR. FEUSSNER: Yes, sir.

SENATOR RUDMAN: And you have no idea what they’re going to deduce.

DR. FEUSSNER: That is correct.

SENATOR RUDMAN: And you, I think, have been reluctant to give us any interim reports, which is probably wise, even if you had them, because people tend to jump on them. I would rather see them done. When -- what is the timetable on some of these?

DR. FEUSSNER: Well, the --

SENATOR RUDMAN: On the major PB studies that are going on.

DR. FEUSSNER: Well, I thought that I had that information.

SENATOR RUDMAN: If you don’t have it with you, supply it to us, please.

DR. FEUSSNER: Fifteen of the projects are completed now, so about half of them are done now and the other half are not.

SENATOR RUDMAN: And they’ll be done in what? Are these one-year, two-year projects?

DR. FEUSSNER: Only an additional four will be completed this year; another eight will be multiple years out, to ‘01 and ‘02.

SENATOR RUDMAN: Who do you report to?

DR. FEUSSNER: Gee, most everybody in this room, sir.

SENATOR RUDMAN: You can do better than that.

DR. FEUSSNER: Within the Department I report to the Undersecretary for Health. Within VA, I report to the Undersecretary for Health who reports to the Secretary.

SENATOR RUDMAN: Well, the reason I ask is because obviously what happens with these projects is very important, and we’re going to hear about the follow-on organization shortly.

DR. FEUSSNER: Now, we also prepare an annual report to Congress. Unfortunately, our report isn’t ready yet, probably won’t be ready until early summer. And then in addition to that, we are -- Congressman Shays has asked us to put together a summary document separate from the annual report to Congress on each of these fourteen areas and that we hope to have ready by September 30.

SENATOR RUDMAN: But it would be fair to say as of today -- and we have a lot going on.

DR. FEUSSNER: Yes, sir.

SENATOR RUDMAN: But as of today, you do not believe that any of the projects that have been completed in relation to PB and the other issues that you’re looking at have given you any answers that are particularly helpful or surprising.

DR. FEUSSNER: Correct.

SENATOR RUDMAN: I mean, that’s a very important -- it’s very important that people understand that because, you know, I get all kinds of mail from veterans around this country who read something in the newspaper who tell me it’s PB or it’s this or it’s that.

And I can understand when you’re ill, you know, you’re reaching out trying to find something that will tell you, you know, the magic bullet, I found it. But the fact is with all the money that we’ve spent so far and all the research we’ve done, we still have not clearly identified PB as a problem yet, if at all.

DR. FEUSSNER: That’s correct.

SENATOR RUDMAN: Okay. I just want to make sure that testimony is very clear because we get a lot of requests from a lot of people. A lot of people of course are going to disbelieve it because they want to believe what they want to believe but I’ve looked at this list and these aren’t people who are pawns to the United States government.

DR. FEUSSNER: No, sir.

SENATOR RUDMAN: These are independent researchers who have great reputations. I have checked a number of these people out myself in ways that I’m able to do and I am satisfied that you have given money out to people who are seeking the truth and that’s all we can do. If there are those in our society who don’t want to believe that, we can’t deal with that.

DR. FEUSSNER: All of these projects, whether they’re funded by HHS, VA or DoD, go through a very rigorous scientific review process.

SENATOR RUDMAN: I’m aware. I’m aware. In fact, it’s equivalent to what they do over at NIH. It’s the same kind of peer review.

DR. FEUSSNER: That’s correct.

DR. CAM: Can I just follow-up with your comment?

SENATOR RUDMAN: Go ahead.

DR. CAM: Given the exact nature of science and scientific research, can we ever hope that there can one day be established a link or is the answer to this question only in the research, not in speculation? I would like your best estimate on that.

DR. FEUSSNER: Given that there are very few verifiable data on exposures, I think it’s unlikely that we would find the bullet that the Senator referred to that would be the explanation and would, using the scientific dictum of Occam's razor, would provide the simple elegant answer to this problem. No. I think that is unlikely.

Now, having said that, I showed you the diversity and the size of the research enterprise that is looking for those answers. It’s conceivable that one of these projects will find the answer. At the moment, we have not. The President charged us with -- I think his words were leaving no stones unturned and that has been the attitude that we have taken and the departments involved, at least from my perspective, the chairmen of the research committee have been excellent cooperating and collaborating in this common enterprise.

SECRETARY BROWN: Before he’s dismissed I have one more question.

SENATOR RUDMAN: Go ahead.

SECRETARY BROWN: Doctor, can we go back to this here question on the effect on the neuromuscular junction.

DR. FEUSSNER: Yes, sir.

SECRETARY BROWN: Now, kind of help me, see if I understand this here. What we’re basically talking about is the nerve ability to stimulate the muscle.

DR. FEUSSNER: Correct.

SECRETARY BROWN: That is impaired -- and you said that impairment is very mild or --

DR. FEUSSNER: Short-lived.

SECRETARY BROWN: -- short-lived. Okay. Let’s try something like this. If you push that out to the extreme, just push it out to the extreme biologically in the lab, what would the end result look like to the common person or to a scientist?

DR. FEUSSNER: So let’s say that we actually blocked the neuromuscular junction.

SECRETARY BROWN: That’s right.

DR. FEUSSNER: Or damaged it irreversibly. Well, I think the problem -- the spectrum of the problem would be one of muscle weakness that was mild to muscle weakness that was profound to the point where the muscle weakness would be so profound that you might not be able to move or breathe.

SECRETARY BROWN: Would you say that effect could be widespread throughout the body affecting primarily or to include the voluntary muscles?

DR. FEUSSNER: Yeah. I think -- actually there are diseases of the neuromuscular junction where that’s precisely what happens. Patients, fortunately rare, who have myasthenia gravis, for example, have difficulty keeping their eyelids open without the help of medications.

Now, interestingly, the medications used to treat that muscle problem are in a family of drugs like pyridostigmine bromide, physostigmine, et cetera.

SECRETARY BROWN: Now, you mentioned myasthenia gravis twice. What about ALS?

DR. FEUSSNER: Well, ALS is a little more difficult. I think we have a good understanding of myasthenia, although it’s not clear to me what causes it. That may be clear to experts, but it’s not clear to me and we have a treatment for myasthenia.

The problem with ALS doesn’t necessarily appear to be at the neuromuscular junction. It appears to be a serious problem with the nerve so that the nerve deteriorates to the point that it doesn’t tell the muscle to do anything.

Now, the issue -- ALS is a very difficult problem. We don’t know what causes ALS, and we have no treatment, no real effective treatment for ALS. The issue of ALS has come up with regards to possible exposures that may have occurred in the Gulf. I personally looked at these preliminary data starting from March of 1999 through the summer of 1999.

What we found when we looked at the preliminary data with ALS is that the rate appeared to be low and not increased among Gulf War veterans. We looked at the available data we have on the entire Gulf War cohort, and there did not appear to be any increase in death associated with ALS.

Troublesome, however, was that when we looked at these data, there seemed to be a shift among patients developing ALS at a younger age than we would have expected. Now, that raises some uncertainty. Is that important or not? I actually don’t know. You may recall that Lou Gehrig died of ALS at the age of 38 as a young man.

What we have done with help from DoD and also with expert epidemiological help from the CDC is we just announced last week a major national study that is a case finding study trying to find all Gulf War veterans who might have ALS, regardless of whether they were deployed or not, regardless of whether they use VA for medical care, the military or private medical care. That is a project that has literally just been initiated.

This case finding effort will probably go on for about a year. We have solicited and received help from the ALS Association. We are contacting the veterans service groups, and we will contact the professional societies like the American Academy of Neurology who care for these veterans to try to identify all the patients who have it so that we can see what the rates are and then also get some information about possible exposures.

If the rate is not increased and it turns out that the age distribution is not so unusual once we get all the identified patients who have ALS, then we will stop. If anything is remiss or inconclusive, then we will continue with a national study trying to look at cause.

SECRETARY BROWN: Are any of these studies right here, of the 19, do they attempt to determine if any of BP or -- PB could create a disease that mimics ALS or that they are not. I read your announcement, but your announcement also said that you’re not going to get into research, if I remember correctly.

DR. FEUSSNER: Oh, no. The announcement -- I’m sorry, Mr. Secretary. The announcement announced the research effort.

SECRETARY BROWN: No. I’m talking about -- it announced the research effort to identify, not the research effort to determine the etiology or the cause and effect relationship.

DR. FEUSSNER: Well, the -- I regret if the information was not as precise as it might have been.

SENATOR RUDMAN: Well, why don’t you tell us what it is doing? That will be a lot easier.

DR. FEUSSNER: Yes. The goal is to identify the cases, and then there will be specific questions asked about exposures and for all of the patients who are alive, we will invite them to have a comprehensive examination wherever they would like, either at a VA ALS center or a non-VA center.

We wanted to make clear in the announcement that this was not a study looking at treatment. We didn’t want patients with ALS to think that we’re initiating a treatment trial.

SENATOR RUDMAN: Thank you very much.

DR. FEUSSNER: Thank you, sir.

SENATOR RUDMAN: We’re going to take a short break here for about five or ten minutes, and then we’ll proceed with the panel.

(Brief recess.)

SENATOR RUDMAN: If we could all be seated, please. We have Dr. Rostker, Admiral Mayo, Captain Mazzella, Dr. Brown, Dr. Claypool, and Dr. Mazzuchi. And we’re starting a little bit late but we have a little flexibility in the schedule so I’d like you to get through your presentations and Dr. Rostker, we’ll call on you.

DR. ROSTKER: Mr. Chairman, I think we have provided you my testimony, answers to specific questions and then a revised schedule. Let me move through my testimony quickly and then I’ll be pleased to take any questions that you have.

SENATOR RUDMAN: Now, will each of our witnesses this morning be testifying briefly?

DR. ROSTKER: That’s my understanding.

SENATOR RUDMAN: I believe that’s correct.

DR. MAZZUCHI: You did not ask any questions of Health Affairs so we do not have a prepared statement. We’ll be happy to answer any questions.

DR. ROSTKER: The centerpiece of my testimony is the draft charter which we have provided to the Board for a new office which this draft charter has been widely coordinated within DoD, although I note it has not been forwarded to Secretary Cohen for his final approval.

For the past four years, my office has been committed to doing everything possible to understand what happened during the Gulf War and to respond to questions and concerns of veterans. As we move forward, I believe it is imperative that the lessons we have learned are used to address the needs and concerns of the servicemen associated with deployments, not just Gulf War deployments.

While we have taken numerous lessons away from our exhaustive investigations, perhaps the ultimate lesson to be learned is that the Department of Defense is not well structured to deal with non-traditional issues that seem to arise after every deployment. As importantly, we have learned that we must stay connected to service members and veterans less we risk damaging the trust they have in our leadership.

In the last few months, I have shared with you and with other members of the Board the need for continued organization that would outreach investigate issues of deployment health. I’ve talked with leaders from the major veterans and military service organizations and asked for their thoughts as we consider the future, and I’ve also provided their input to the Board. I’ve also discussed our vision for the future at a recent meeting of the Gulf War Illness Interagency Working Group.

In your interim and your special reports, you discuss the need for and provided some thoughts on the new organization. The new organization will be a strong voice on behalf of servicemen and will ensure that the lessons learned from past operations are applied to future deployments, redeployments and post-deployment activities.

We will build on and expand the work of OSAGWI, becoming a permanent part of the Department of Defense. Additionally, the new organization will continue to work with veterans and military service organizations and importantly individual Gulf War veterans. We remain as committee as ever to help veterans of the Gulf War and to address the many health issues that unfortunately remain.

Special Assistant for Deployment Matters will operate under the direction of the Secretary of Defense and be responsible for independent reviews of deployment matters as they pertain to the health of the force. Placement as a special assistant to the Secretary of Defense ensures the independence and objectivity of the special assistant.

This relationship also ensures the effectiveness of the special assistant in reviewing the broad range of issues and providing a basis for actions essential to meeting the challenges of today’s defense management and defense environment.

I’d like to share with you some of the comments that we received during the coordination process. One I think highlighted the general consensus and it was, I quote, "we understand the need for and fully support the concept of institutionalizing this organization at the highest levels of the department." The Joint Staff also endorsed the importance of ensuring coordination of OSAGWI’s role in improving relations and developing trust with veterans, helping guide for us health protection policy and doctrine based upon lessons learned.

Within the Department, the Office of the Special assistant for deployment methods, the acronym, interestingly enough, comes out as OSAGWI, will be responsible for accounting to the DoD leadership, Congress, the Executive Branch, veterans and the American people for health issues as they arise during deployments and on the battlefield.

The office roles will be proactive in developing and ensuring the implementation of lessons learned and conducting outreach to the total force, veterans and military, service organizations, individual veterans and the public. OSAGWI will monitor and report on deployment matters and related activities including aspects of doctrine, policy, readiness, medical research, again, as it pertains to the health of the force. This will be done in coordination with other DoD components having deployment policy oversight and execution responsibility.

And I really want to stress this. This is the eyes and ears of the Secretary. We in no way take away from other DoD components, which are charged with actually managing the deployment. We need to be respectful of their roles and their missions and of their responsibilities. At the same time, we need to be in a position to work with them to ensure that we have the full interests and the full ability to view the health of the force as it pertains to the deployments.

In addition to initiating and coordinating actions within the Department to ensure implementation of lessons learned, we will provide a single focal point for actions or for interactions with other government agencies. This will provide the best avenue for the exchange of information between DoD, Department of Veterans Affairs, Department of Health and Human Services and the veterans -- and the military and veterans coordinating board.

We are reminded daily of the challenges faced by our own forces deployed around the globe, protecting our national interest in peacekeeping and humanitarian missions. The Department has a responsibility and an obligation to protect the health and welfare of the men and women we routinely put in harm’s way. It is a commitment we must take seriously. It is not one that we can pass to another agency.

The Office of the Special Assistant for Deployment Matters, building on the lessons learned and the commitments made by OSAGWI, is uniquely positioned to represent veterans and service members. I made a commitment nearly four years ago to our Gulf War veterans and we believe we must continue that legacy to all veterans, past, present and future.

I request your continued support for our efforts and the establishment of the new office for the special Assistant for Deployment Matters and I’d be pleased to respond to any questions that you may have.

SENATOR RUDMAN: Thank you, Dr. Rostker. I may go down the panel but before I do, just one quick question for you. How will this be established? Will it be established within DoD or by the Secretary or will this require legislation?

DR. ROSTKER: No, this would be established within DoD by the Secretary. It’s my understanding it would not require legislation.

SENATOR RUDMAN: Why don’t I ask each member of the panel just to make a few remarks from their particular perspective, whether they have prepared remarks or not? Admiral Mayo.

RADMIRAL MAYO: I agree with the follow-on organization, as does the Joint Staff, as you’ll hear in my prepared statement. We see as important the outreach mainly with the veterans, it’s a very important part and until our force health protection plan that we’re just now embarking on is complete, this serves as a help, if I could say it in those words, or another pair of eyes and hands to assist us in accomplishing our mission.

SENATOR RUDMAN: And you don’t see any conflict here between the traditional people within the CINC staff that do these sorts of things and the Joint Staff?

RADMIRAL MAYO: No, I’ll try to explain that in my statement but we don’t see this. There may be a little bit of overlap, but we don’t see this as a hindrance or any way where folks are impinging on things.

SENATOR RUDMAN: Well, why don’t you go ahead with your statement?

RADMIRAL MAYO: Because part of the concept and the way we see it is not on an ongoing day-to-day basis. It’s part of a -- you can use the word oversight or looking at incidents after they’ve occurred and so forth.

Could I have the first slide, please?

Good morning, Senator Rudman and Secretary Brown and distinguished Board members. I’m pleased to have the opportunity to discuss the force health protection and the Joint Staff position on a follow-on organization to the Office of the Special Assistant for Gulf War Illnesses.

You can go to the next slide.

In our view, OSAGWI has played an integral role in improving relations and developing trust with veterans and helped to guide force health protections policy and doctrine development based upon lessons learned. We want to ensure the continuation of these efforts.

After considering inputs from the combatant commands and services, we concur in the proposed charter for the Office of the Special Assistant for Deployment Matters. We support the concept of a temporary follow-on organization to the OSAGWI. In the following charts, I will briefly present the information you requested as outlined on this chart.

Next slide.

Two primary joint publications outline processes and responsibilities related to deployments. From Joint Pub 3-35, the significant responsibilities of the chairman of the Joint Chiefs of Staff and the Joint Staff responsibilities include preparation and review of joint plans and conform to policy and guidance from the President and the Secretary of Defense, advising the Secretary of Defense on critical deficiencies and strengths in force capabilities including manpower, identified during preparation and review of the operating plans, and assesses the effect of noted deficiencies and strengths on meeting national security objectives, policies and strategic plans and that would also include force health protection as essential to that advice.

In addition, the Joint Staff oversees activities of the combatant commands and reviews the plans and programs of the combatant commanders to determine their adequacy, consistency, acceptability, and feasibility for performance of assigned missions.

Further, the Joint Staff develops, implements, monitors and assesses joint education and training programs to improve deployment and redeployment planning and execution and ensures that deployment and redeployment planning and execution is assessed during all joint force operations as well as chairman of the Joint Chiefs of Staff and the combatant commands sponsored joint exercises.

Relatedly the supported CINCs establish predeployment standards. These predeployment standards outline basic command responsibilities, policies, training and equipment requirements necessary to prepare supporting personnel for the tactical, environmental and/or medical conditions in the field.

Joint Publication 5-0 gives the chairman responsibility to monitor and assess readiness of U.S. military forces to fight and meet demands of the national military strategy. The chairman’s readiness system supports the chairman of the Joint Chiefs of Staff in meeting the responsibility.

Joint operating plans are the foundation for this chairman’s readiness system, providing standards against which readiness is measured. The joint monthly readiness review is a forum available to the CINCs to identify any force health protection shortfalls or deficiencies.

According to the charter for the SADM, responsibility for policy, oversight, execution of deployment activities remains with those DoD components that have responsibility for deployment issues, including the Joint Staff and the CINCs. We see the new organization as complementing what the Joint Staff does.

Next slide.

Many lessons were learned from the Gulf War. In fact, these lessons were key drivers in the development of our force health protection strategy. As you are aware, poor documentation and record keeping were significant issues but not unique to Operation Desert Storm. It had always been there.

There was no comprehensive health surveillance nor environmental assessments. The predeployment and redeployment and garrison cycles were all separate incidents, not connected medically. In fact, health care was episodic care rather than comprehensive longitudinal, which is essential for addressing health maintenance and prevention.

Early improvements examples include the use of our forward laboratories in Somalia in 1994. Comprehensive health surveillance including disease, non-battle injury and environmental surveillance started in Bosnia, in our ongoing efforts in Kosovo. We know more about the soil and the air and the environment in Bosnia than we do about many parts of the United States.

Joint Staff memorandum "Deployment Health Surveillance and Readiness" of December ‘98 float from the 1997 DoD directive and instruction on joint medical surveillance and established standard requirements for all deployments. It became effective in February of 1999. Kosovo was the first major operation requiring compliance with this policy. Pre- and post-deployment health assessments and recording of all healthcare as well as any potential hazardous exposures are ongoing.

I personally visited Kosovo with the Assistant Secretary of Defense for Health Affairs, Dr. Bailey, last August. I was quite impressed with what I saw there. Data was being collected in the composite health care system which is the computer-based system that is in effect now in the Army field hospital, our cache that was there, and they transmitted this data to Germany be included in the database that’s resident here in Washington, D.C.

In addition to establishing standardized procedures, we’re working on improvements in several areas, most notably those listed on this chart. We recognize the value of medical record keeping for both prospective and retrospective uses. These data are obviously essential to any effort to assess health risks or reconstruct reported events.

Having the central repository in the defense medical surveillance system supported by a robust information management applications at all levels will get us where we need to go. Many of these changes in record keeping are still labor-intensive and will be until we have the computerized medical record, worldwide connectivity and database integration, especially with the personnel systems and also a change in our business practices.

Appropriate command emphasis and a culture shift, a major culture shift on everyone’s part are critical to the full success of force health protection.

Next slide.

Deployment oversight occurs through several mechanisms. In addition to plan reviews previously mentioned, compliance with the JCS memorandum includes periodic reporting requirements for data such as disease non-battle injury rates. We have found that having standard language written into all the CJCS directed deployment orders specifying compliance with these requirements has been of great value.

In fact, on the recent deployments, even though they were for less than 30 days, where we sent troops into Mozambique and Venezuela, this was a standard part of the deployment. To collect a predeployment samples; do the predeployment assessment as well as the post-deployment assessment.

Oversight does occur at many levels, before and during deployments, including the JTF staff, military components, the CINCs, the Joint Staff and the Office of Secretary of Defense. Established situation reporting, after action reporting and the joint uniform lessons learned system are there to close the loop. Lessons learned and current deployments are both discussed at our semi-annual CINC surgeons’ conferences.

Periodic DoD reviews of deployment activities related to force health protection are conducted by the Joint Preventive Medicine Policy Group and the Joint Environmental Surveillance Working Group formerly chartered by ASD(HA) in 1997 but in existence on an ad hoc basis before that. That group makes policy recommendations to support and improve our force health protection programs.

Notable among these are DoD force immunization policies including immunization documentation and tracking, recommended improvements to the Armed Forces medical intelligence centers, medical environmental disease intelligence countermeasures, it’s called MEDIC, which is widely used throughout the preventive medicine community, development of proposed redeployment clinical guidelines and joint consensus on environmental contaminants of interest and recommended short-term exposure guidelines.

We are excited about the opportunities presented by the standup of the interagency Military and Veterans Health Coordinating Board. I will be very actively involved myself as the designated chair of the deployment health-working group. The SADM will be a key player in Dodd’s efforts in this regard. I am confident that the interchange between DoD, VA, HHS, through this forum will pay great dividends to making our life cycle approach to force health protection a reality.

Finally, our recently-released force health protection vision document has identified several critical success factors including information management and information technology solutions that we will be actively pursuing with the services during the coming year’s budget cycles.

For the future, continued standardization and inter-operability will be the key. Besides other partners within our own government, we are sharing ideas with our NATO allies through alliance medical committees.

Next slide.

As you know, some OSD oversight is already in place by law. USD for Policy, Personnel and Readiness or even Science and Technology, as examples, combined with deployment oversight by the Joint Chiefs or the Joint Staff, the CINCs and the services; we have a fairly comprehensive network established.

The establishment of the SADM represents an interim solution supplementing and complementing other efforts. You might say an extra set of eyes, if you will, to ensure that forced health protection is optimal.

Collaboration with appropriate elements within the Department of Defense, particularly the Joint Staff and combatant commands, the assistant secretary of defense for health affairs, DoD centers for deployment health, and the military and veterans health ordaining board would eliminate unnecessary duplication of effort and allow optimal use of resources to meet these needs. We see the outreach program with the superior veterans advocacy as the most critical function of a follow-on organization.

As our force health protection programs mature and lessons learned that impact force health are institutionalized in future deployment processes, the need for such an organization may be reduced or even eliminated. Formal periodic review of the charter to assess performance, cost and benefits and relevancy of mission and functions would facilitate appropriate resource allocation decision-making.

You can be confident that protecting the health of service members, their families and our veterans remain the highest priority.

I’d be glad to answer any questions.

SENATOR RUDMAN: We’ll go right down the panel; do it that way. Captain Mazzella?

CAPT MAZZELLA: Good morning, Senator Rudman, Secretary Brown, members of the panel, the Board.

HHS has just some brief remarks to make and then we’ll be glad to answer some questions. We had no organized testimony per se. But as an introduction, we’d like to restate our position is one of support for the principally involved Departments of Defense and Veterans Affairs.

Historically, HHS has provided subject matter experts to support the efforts of both the Departments of Defense and VA. For example, at one point the PAC had asked for -- the Presidential Advisory Commission had asked for members from the Agency for Toxic Substances and Disease Registry to participate in the Research Working Group and, of course, we participated in that.

Another example was mentioned to you this morning when the Department of Veterans Affairs had requested our CDC, Centers for Disease Control and Prevention, to provide them with epidemiological experts to help them with their ALS studies.

The Department expects to continue to provide this scientific expertise to its partners and we look forward to the continued collaboration with DoD and VA on these matters pertaining to military service members, veterans and their families.

And that’s all we have for right now.

SENATOR RUDMAN: All right. Thank you very much. Dr. Brown?

DR. BROWN: Thank you. Honorable Chairman, Vice Chairman and members of the Presidential Special Oversight Board, I’m honored by your invitation to appear before you today and tell you about some of Vans activities directed towards improving our understanding and treatment of Gulf War veterans illnesses. As you know, this is the third opportunity I’ve had to appear before this Board.

In your letter of invitation, you asked us four questions, all focusing on how the Department of Veterans Affairs coordinates with other federal agencies with our respective programs directed at military and veterans health. I’d like to be able to tell you today that all the federal agencies do a perfect job in seamlessly coordinating our activities relative to veterans health. You might be skeptical about such a claim.

Nevertheless, I can tell you that the events since the Gulf War in 1991 have led to a new spirit of interagency cooperation, which I believe is to the benefit of all American veterans. Moreover, now that we all see how to do it better, I think that the processes put into place from these efforts will continue to function for the foreseeable future.

Before I address your four specific questions about interagency coordination, I’d like to make some general comments about the broad range of the Department of Veteran Affairs programs that focus on Gulf War veterans health.

As you know, the Department of Veterans Affairs is the lead federal agency for fulfilling this nation’s responsibilities to American veterans. To meet this responsibility, the VA has an integrated program that offers high quality medical care services throughout the nation.

It offers appropriate disability compensation to veterans. It offers outreach and education programs directed at veterans and VA health care providers and it supports scientific research directed at basic and applied medical issues for veterans.

For example, more than 78,000 Gulf War veterans have received our Gulf War health registry examination. About 280,000 Gulf War veterans have been seen at VA outpatient clinics and more than 26,000 Gulf War veterans have received medical care as inpatients at VA health care facilities. I just want to make the point, we don’t need to wait for research to be able to treat veterans, of course.

As of January 15 of this year, the VA has processed approximately 159,000 claims filed by Gulf War veterans for service-connected illnesses, of which approximately 138,000 were granted.

As I have described at previous briefings before this Board, the VA was pleased to be able to implement Public Law 103-446, signed by the President on November 2, 1994, giving VA the authority to compensate any Gulf War veteran suffering from a chronic disability from an undiagnosed illness or combination of undiagnosed illnesses.

The Administration strongly endorsed this legislation and Secretary Jesse Brown had sent letters to all 535 members of Congress urging their support. Based on this law, as of January 2000, VA has granted service connection to about 3,000 Gulf War veterans with undiagnosed medical conditions.

VA also offers substantial outreach and educational activities for Gulf War veterans. For example, in early 1995, VA established the Gulf War Information Center Helpline or 1-800-PGW-VETS. By the beginning of this year, the VA hotline had received over 300,000 calls. This outreach program offers callers the opportunity to obtain information about medical care, about the Gulf War registry, about medical research involving exposure to environmental hazards and about disability compensation benefits that they may be entitled to. It’s available to veterans twenty-four hours a day, seven days a week.

VA also publishes a quarterly Gulf War newsletter on health and compensation issues of interest to veterans and their families with a circulation of about 400,000 copies nationally.

These are just a few examples of Vans initiatives directed at Gulf War veterans. VA takes these responsibilities for Gulf War veterans very seriously. In fact, taking care of veterans is our primary mission.

We also note that the Department of Defense has many similar initiates focusing on active duty and reservist Gulf War veterans service members. Many of these programs mirror some of the programs I’ve just described. We also appreciate that in order to offer the best quality services to American veterans often requires that VA effectively coordinate with other federal agencies, in particular Department of Defense and Department of Health and Human Services.

One example of interagency coordination that you may be familiar with is the effort that took place in May of 1999 in response to problems experienced by certain U.S. service members who had received a medical retirement following a diagnosis of ALS. Some of these service members reported difficulties gaining timely access to veterans benefits from the VA following separation from military service.

As you know, ALS is a very serious disease and given the rapid and debilitating effects of ALS, this was precisely the point of transition -- it was precisely the point when veterans and their families needed benefits the most. Discussions between members of the interagency compensation and pensions working group of the Persian Gulf Coordinating Board led to changes in Vans procedures in order to provide service members access to VA benefits in a timely manner and as appropriate to the care required by these individuals. In this example, coordination was key to quickly providing veterans access to the benefits that they deserved and needed.

I think one of the most outstanding examples recently in -- or the last half decade, since the Gulf War, of interagency coordination on Gulf War veterans health issues is the activities of the Coordinating Board’s Research Working Group. These activities were discussed quite fully by Dr. Feussner at the previous seating.

Dr. Feussner as the chair of this group described their activities in coordinating research, identifying knowledge gaps, and dissemination of research results. Over the last half decade, as Dr. Feussner mentioned, this group has coordinated a federal interagency research effort that today involves more than 145 distinct research projects at a cost of about $151 million.

There are many similar examples that one could point to where veterans and military personnel today receive better services as a result of interagency coordination in such areas as uniform clinical care and basic and applied research on military and veterans health.

My point here is -- in bringing up these examples is that I think each agency has certain clear-cut core responsibilities that are unique to that agency’s mission and the constituents that they must serve. But each agency also has other responsibilities that can be significantly enhanced through interagency coordination.

Over the last decade since the end of the Gulf War, a primary focus for such coordination in research, clinical care and other areas, has been the Persian Gulf Veterans Coordinating Board. As you’ve heard at previous meeting of this Committee, the President established the Persian Gulf Veterans Health Coordinating Board in January 1994 to provide direction and coordination within the Executive Branch of the federal government on health issues related to Gulf War veterans.

Recently the new Military and Veterans Health Coordinating Board was established, based, I believe, largely on the successful model and example established by the earlier coordinating board and their activities. Headed by the secretaries of DoD, HHS and VA, the coordinating board has provided and will undoubtedly continue to provide the institutional framework required for consistent and effective interagency coordination of these types of activities.

Now, I’ll turn to the four specific questions that you asked of us. Your first question was -- you asked how will the Department of Veteran Affairs coordinate Gulf War-related activities with the proposed OSAGWI follow-on organization.

As I mentioned, VA has many Gulf War-related initiatives that address the clinical research and outreach needs of Gulf War veterans. Many of these activities have required significant coordination with other federal agencies, in particular, the Department of Defense, including OSAGWI, and the Department of Health and Human Services. Persian Gulf Veterans Coordinating Board and its successor organization, the Military and Veterans Health Coordinating Board, has provided an invaluable forum for ongoing discussions between the various relevant agencies that participate in these activities.

No one is yet certain about the forum of an OSAGWI follow-on organization but regardless of the outcome of ongoing discussions, we expect that the Coordinating Board will continue its past missions in this area.

Your second question was does any overlap in function or responsibility exist between the OSAGWI follow-on organization and other agencies responsible for Gulf War health issues, to include the Department of Veteran Affairs? If so, what should be done to minimize redundancy?

And I think based on our experience dealing with Gulf War veterans health issues over the last decade, I do not see that there is unnecessary redundancy between the various programs that focus on Gulf War veterans health issues offered by the various federal agencies involved.

As you’ve heard, each agency conducts a broad range of programs that reflect our unique constituency and missions. I also believe that it may be misleading to try and identify or eliminate possible redundancies in efforts put forward by the various agencies involved. Again, each agency brings its own unique perspective, expertise, constituent base and a sense of mission to this problem.

The responsibilities for certain issues will clearly fall to a single agency. For example, when it comes to the analysis of after action reports of military activities during the Gulf War, DoD clearly has the lead. VA, on the other hand, has the lead, I think, on issues such as determining what medical treatments and compensation may be appropriate for Gulf War veterans.

Nevertheless, we fully acknowledge the value of interagency cooperation on many federal activities relating to Gulf War veterans health such as in setting our national military and veterans health research agenda and establishing other national policies that affect military and veterans health.

Your third question was what agency should be responsible, if any, for integrating past, current and future medical research to determine the causes of undiagnosed symptoms that are referred to as Gulf War illnesses.

Again, I think that to answer this question about which institution should coordinate Gulf War health issues in the future, we should begin by looking at who has carried out this mission in the past. I believe that the Research Working Group of the Coordinating Board has done an outstanding job in initiating new medical and scientific research and in integrating existing research that focuses on Gulf War illnesses. I think that it’s reasonable to expect that this group will continue to fulfill this mission into the foreseeable future.

And your fourth and last question was is there any value in conducting further town hall meetings on Gulf War issues. If so, what department or agency should sponsor these meetings?

I think each of the federal agencies that have taken an active role in addressing Gulf War veterans health has established its own outreach and educational initiatives that meet its own agenda. The Department of Defense has developed the town hall meeting format, which I understand they consider to be an effective outreach mechanism. In fact, VA has supported this activity by providing VA representatives at nearly all of the town hall meetings to be there to address veterans specific questions about VA benefits and the VA Gulf War veterans health examination registry.

We appreciate this forum as an opportunity for VA representative to speak to Gulf War veterans. VA has a number of outreach initiatives as well, including our hotline and Gulf War veterans newsletter that I mentioned earlier.

I think that my answer to this question is consistent with my earlier points and that is that ultimately the evaluation and review of the DoD town hall meeting as an outreach activity is an issue for DoD itself to determine.

In conclusion, as I mentioned at the beginning of my remarks, we all no recognize the value in coordinating federal activities on military and veterans health. I think that we have made enormous improvements in such coordination since the Gulf War, and I think that the coordinating board has played an important role as a forum for this coordination and I think that the Department of Veteran Affairs looks forward to continuing this collaboration with the coordinating board.

Thank you very much and I’d be happy to answer any questions.

SENATOR RUDMAN: Thank you, Dr. Brown. Dr. Claypool.

DR. CLAYPOOL: Senator Rudman, Secretary Brown, Admiral Steinman, Dr. Cam, CSM Moore, I am Bob Claypool. I am currently dual-headed as the executive director of both the Persian Gulf Veteran Coordinating Board and the Military and Veterans Health Coordinating Board. I will attempt to weave into my prepared testimony or statement answers to the questions that I was asked by the Board and there -- we had three questions which essentially mirror those of the Veterans Affairs office in terms of integrating research, providing Persian Gulf follow-up and for redundancy of application.

SENATOR RUDMAN: Before you get into your prepared statement, Dr. Claypool, you’re dual-hatted now. When will one of those organizations essentially evaporate so you’d only have to wear one hat?

DR. CLAYPOOL: Right.

SENATOR RUDMAN: When is that?

DR. CLAYPOOL: Yes, sir. Let me -- I do address that.

SENATOR RUDMAN: Will you talk about that?

DR. CLAYPOOL: Yes, sir.

SENATOR RUDMAN: All right. Thank you.

DR. CLAYPOOL: The Military and Veterans Health Coordinating Board, which is built upon the successful foundation of the Persian Gulf Veterans Coordinating Board as identified by Dr. Brown, is chartered and chaired by the secretaries of Veteran Affairs, Department of Defense, and Health and Human Services. It’s supported by a small full-time staff of me plus five other individuals, supplied by the three departments.

Furthermore, the charter identifies the top health official in each agency as the principal alternate member of the Board who provides frequent guidance to the director and staff through senior personnel who may have been designated as liaisons of the Board. These top health officials are, as you know, Dr. Tom Garthwaite, the deputy undersecretary of health for Veterans Affairs, Dr. Sue Bailey, assistant secretary of defense, Health Affairs, and Dr. David Satcher, assistant secretary of health for Health and Human Services.

Dr. Mark Brown from the Veterans Affairs, Dr. John Mazzuchi from Defense and Capt Peter Mazzella from Health and Human Services, who are here with me on this panel, are the personnel chosen by their health leaders as the liaison individuals with the Board.

As I mentioned, the Military and Veterans Health Coordinating Board is built upon the foundation of the Persian Gulf Board. It has the same board co-chairs, it is supported by the same full-time staff, but the Military and Veterans Health Coordinating Board has a broader mission, which focuses on the health of the men and women who serve in the U.S. Armed Forces and their families. It also encompasses their total careers beginning with recruitment into the military, throughout their entire length of service, be it active, reserve or guard, and continues through and into their life as a veteran.

Its coordinating effort is supported by three working groups, the deployment of health, health risk communication and research. We are currently in a proposal phase in which we are examining and coordinating with all stakeholders the prospect of continuing the work of the Persian Gulf Veterans Coordinating Board within the construct of the Military and Veterans Health Coordinating Board.

As I mentioned above, the chairs are the same. The offices are co-located and both boards are supported by the same staff. Today --

SENATOR RUDMAN: Well, really it’s the same group, isn’t it, with a different charter?

DR. CLAYPOOL: To that -- yes, sir.

SENATOR RUDMAN: I would think that whoever is doing all this ought to try to, you know, formally establish it as a subcommittee of or whatever, I mean, just to clear up the lines.

DR. CLAYPOOL: To that end, sir, that’s why we have -- that’s what we are in the process of proposing. We have met with veterans service organization, we have met with members of both the Armed Services and veterans committees on the Hill to broach this as a proposal and our follow-on plan is to go ahead and have more detailed discussions with the veteran service organizations to make sure that we capture their trust and confidence in making sure that nothing is dropped in the gap as we make this transition but that is our proposal.

SENATOR RUDMAN: Well, I think that the reason I ask that is as we write our final report, you know, I think we’re going to have a lot to say about the follow-on organization, what we’ve done over the last 18 months -- it seems like longer than that -- but I think we would like to have some comment about what you do because that will be a very important part of the follow-on.

So we would like you to keep us posted on what’s going on, particular with the Hill, to see whether or not people up there are in favor of what you want to -- I would think they would be. They tend to like to streamline organizations rather than duplicate.

DR. CLAYPOOL: The preliminary information that we’ve gotten back from these two groups that we’ve pinged, to use a Navy term, really has been favorable.

SENATOR RUDMAN: All right.

DR. CLAYPOOL: The real shoulder to the wheel work of the Military and Veterans Health Coordinating Board is accomplished by the three working groups I mentioned. The deployment health working group, as Admiral Mayo mentioned, is chaired by him and it focuses on force health protection and medical surveillance.

The charter of the MVHCB calls for the deployment health working group to provide recommendations to the Board to ensure that lessons learned from competent operations and other deployments and research findings are translated into effective preparation for future operations.

It will also take up issues from the Persian Gulf Veterans Coordinating Board with our work group and address coordination matters regarding disability and compensation. So the functionality of the Persian Gulf era in part will be accomplished by the deployment health working group.

The health risk communications working group provides recommendations and coordination for the health risk communication efforts of Department of Veterans Affairs, DoD and HHS for military members, veterans, deployed civilians and their families. It focuses on information before, during and after deployments. It also coordinates interagency activities to provide health care providers with up-to-date guidance on health effects from deployment and battlefield risks.

The third important work group -- and by the way, that health risk communication working group is chaired by Brigadier General Lester Martinez, who is also the commander of the Army’s -- United States Army Center for Health Promotion and Preventive Medicine up in Aberdeen.

The third work group, the military and veterans health Research Working Group is chaired by Dr. Jack Feussner who provided earlier testimony and I was unable to savor this. As was done in the past, the Persian Gulf Veterans Coordinating Board will continue to be responsible for integrating the past, current and future medical research for integrating and examining the cause and examining treatments with the undiagnosed symptoms referred to as Gulf War illnesses.

We’ve formed an executive steering committee that consists of the chairs of these working groups, of Admiral Mayo, Dr. Feussner, General Martinez and myself, to form a steering committee for the working groups to ensure, number one, that any kind of gaps are identified and can be plugged, number two, any duplication or redundancies identified can be addressed.

In this brief sketch, I’ve tried to capture the essence of the board as a true interagency effort, which is based upon three dynamic interactive collaborative work groups. Personnel from the follow-on organization will contribute their considerable expertise as DoD participants on all three of these work groups.

Within each of these agencies, the Military and Veterans Health Coordinating Board staff and the work groups have established and will continue to establish functional links to support specific work group goals. And so the board and the work groups also will work closely with the follow-on organization just as they have done, for example, within HHS, utilizing the CDC, within the Department Veterans Affairs, including research and development expertise, and also within DoD, for instance, as with the Center for Health Promotion and Preventive Medicine.

Just such an interactive collaborative process coordinated through the board is the best assurance to both identify the gaps in the work that is needed to be accomplished and to avoid unnecessary duplicative efforts.

I will provide you a copy of my text and that concludes my statement.

SENATOR RUDMAN: Thank you, Dr. Claypool. Dr. Mazzuchi?

DR. MAZZUCHI: I don’t have any prepared statement, but I