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38–711 CC 1997

GULF WAR SYNDROME: TO EXAMINE NEW STUDIES SUGGESTING LINKS BETWEEN GULF SERVICE AND HIGHER RATES OF ILLNESSES

HEARING

BEFORE THE

COMMITTEE ON

GOVERNMENT REFORM

AND OVERSIGHT

HOUSE OF REPRESENTATIVES

ONE HUNDRED FIFTH CONGRESS

FIRST SESSION

JANUARY 21, 1997

Serial No. 105–1

Printed for the use of the Committee on Government Reform and Oversight

(

(II)

COMMITTEE ON GOVERNMENT REFORM AND OVERSIGHT

DAN BURTON, Indiana, Chairman

BENJAMIN A. GILMAN, New York

J. DENNIS HASTERT, Illinois

CONSTANCE A. MORELLA, Maryland

CHRISTOPHER SHAYS, Connecticut

STEVEN H. SCHIFF, New Mexico

CHRISTOPHER COX, California

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

STEPHEN HORN, California

JOHN L. MICA, Florida

THOMAS M. DAVIS, Virginia

DAVID M. MCINTOSH, Indiana

MARK E. SOUDER, Indiana

JOE SCARBOROUGH, Florida

JOHN SHADEGG, Arizona

STEVEN C. LATOURETTE, Ohio

MARSHALL ‘‘MARK’’ SANFORD, South

Carolina

JOHN E. SUNUNU, New Hampshire

PETE SESSIONS, Texas

MIKE PAPPAS, New Jersey

VINCE SNOWBARGER, Kansas

BOB BARR, Georgia

——— ———

HENRY A. WAXMAN, California

TOM LANTOS, California

ROBERT E. WISE, JR., West Virginia

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

GARY A. CONDIT, California

CAROLYN B. MALONEY, New York

THOMAS M. BARRETT, Wisconsin

ELEANOR HOLMES NORTON, Washington,

DC

CHAKA FATTAH, Pennsylvania

TIM HOLDEN, Pennsylvania

ELIJAH E. CUMMINGS, Maryland

DENNIS KUCINICH, Ohio

ROD R. BLAGOJEVICH, Illinois

DANNY K. DAVIS, Illinois

JOHN F. TIERNEY, Massachusetts

JIM TURNER, Texas

THOMAS H. ALLEN, Maine

———

BERNARD SANDERS, Vermont

(Independent)

KEVIN BINGER, Staff Director

DANIEL R. MOLL, Deputy Staff Director

JUDITH MCCOY, Chief Clerk

PHIL SCHILIRO, Minority Staff Director

(III)

C O N T E N T S

Page

Hearing held on January 21, 1997 ......................................................................... 1

Statement of:

Duffy, Frank, M.D., associate professor of neurology, Harvard Medical

School; Robert Haley, M.D., director of epidemiology, University of

Texas Southwestern Medical Center; and David Schwartz, M.D., professor of internal and preventative medicine, University of Iowa Medical College .................................................................................................... 224

Kizer, Kenneth W., M.D., Under Secretary for Health, Department of

Veterans Affairs, accompanied by Frances Murphy, VA Central Office;

Bernard Rostker, Special Assistant for PGW Illnesses, Department of

Defense; Donald Custis, M.D., Admiral, U.S. Navy (retired), member,

Presidential Advisory Committee on PGW Veterans’ Illnesses, accompanied by Holly L. Gwin, Deputy Director and Counsel ........................... 122

Kornkven, Chris, Persian Gulf war veteran, Watertown, WI; James

Brown, Persian Gulf war veteran, Hannibal, MO; and James Green,

veteran, Fishertown, PA ............................................................................... 268

Letters, statements, etc., submitted for the record by:

Brown, James, Persian Gulf war veteran, Hannibal, MO:

Information concerning Persian Gulf war veterans with Neoplasms

by DX and age group, fiscal years 1991 through 1995 ....................... 308

Prepared statement of ............................................................................... 286

Custis, Donald, M.D., Admiral, U.S. Navy (retired), member, Presidential

Advisory Committee on PGW Veterans’ Illnesses, prepared statement

of ..................................................................................................................... 167

Duffy, Frank, M.D., associate professor of neurology, Harvard Medical

School, prepared statement of ...................................................................... 228

Haley, Robert, M.D., director of epidemiology, University of Texas Southwestern Medical Center, prepared statement of ........................................ 247

Kizer, Kenneth W., M.D., Under Secretary for Health, Department of

Veterans Affairs:

Information concerning VA personnel ..................................................... 198

Prepared statement of ............................................................................... 128

Kornkven, Chris, Persian Gulf war veteran, Watertown, WI, prepared

statement of ................................................................................................... 274

Murphy, Frances, VA Central Office, information concerning the number

of doctors at Birmingham Department of Veterans Affairs Medical Center ................................................................................................................... 192

Pappas, Hon. Mike, a Representative in Congress from the State of

New Jersey, prepared statement of ............................................................. 121

Rostker, Bernard, Special Assistant for PGW Illnesses, Department of

Defense, prepared statement of ................................................................... 155

Sanders, Hon. Bernard, a Representative in Congress from the State

of Vermont, a document entitled, ‘‘A Biopsychosocial Therapeutic Approach for the Treatment of Multiple Chemical Sensitivity Syndrome

in Veterans of Desert Storm’’ ....................................................................... 11

Schwartz, David, M.D., professor of internal and preventative medicine,

University of Iowa Medical College, prepared statement of ..................... 259

Shays, Hon. Christopher, a Representative in Congress from the State

of Connecticut, information concerning holding this hearing prior to

adoption of the committee rules .................................................................. 3

Towns, Hon. Edolphus, a Representative in Congress from the State

of New York, prepared statement of ........................................................... 5

(1)

GULF WAR SYNDROME TO EXAMINE NEW

STUDIES SUGGESTING LINKS BETWEEN

GULF SERVICE AND HIGHER RATES OF ILLNESSES

TUESDAY, JANUARY 21, 1997

HOUSE OF REPRESENTATIVES,

COMMITTEE ON GOVERNMENT REFORM AND OVERSIGHT,

Washington, DC.

The committee met, pursuant to notice, at 10 a.m., in room 2154,

Rayburn House Office Building, Hon. Christopher Shays (chairman

of the Subcommittee on Human Resources and Intergovernmental

Relations) presiding.

Present: Representatives Gilman, Shays, Ros-Lehtinen, Horn,

Sessions, Pappas, Snowbarger, Towns, and Sanders.

Staff present: Lawrence J. Halloran, subcommittee staff director/

counsel; Robert A. Newman, subcommittee professional staff member; Jared Carpenter, subcommittee clerk; Teresa Austin, committee staff assistant; Cherri Branson, minority professional staff;

Phil Barnett, minority chief counsel; and Jean Gosa, minority staff

assistant.

Mr. SHAYS. I would like to call this hearing to order and to welcome our witnesses and our guests. In the last Congress, we convened six hearings to examine the Department of Veterans’ Affairs,

the VA, handling of the health complaints of Gulf war veterans. We

did so because veterans consistently told us their evidence of toxic

exposures was being minimized or ignored.

Over the course of those hearings, the Department of Defense

(DOD) belatedly acknowledged more than 21,000 United States

troops were exposed to some level of chemical weapons agents after

destruction of the ammunition depot at Khamisiyah in Iraq. The

Central Intelligence Agency (CIA) admitted their weather modeling

would never prove their earlier conclusion that no United States

troops had been exposed to toxic vapor plumes after coalition bombing of known Iraqi chemical weapons stores. And the VA conceded

that vital research into the health effect of low-level chemical exposures had been given a low priority out of unwarranted deference

to the Pentagon’s now-discredited conclusions.

So we are making progress.

The DOD has expanded its investigation team in an effort to

make up for the previous, superficial Pentagon inquiries into toxic

exposures. The Presidential Advisory Committee on Gulf War Veterans’ Illnesses will continue to oversee that effort. Both the DOD

2

and VA will undertake more research into the chronic health effects of low levels of toxins.

Recently, the VA reviewed the health records of more than 2,000

of the 21,000 troops stationed within a 50 kilometer radius of the

Khamisiyah bunkers. It appears those closest to the chemical detonations are sicker than other veterans who have sought special

treatment in the VA’s Gulf War Health Registry. We will hear testimony from the VA on this new data.

We will also hear about published results that help distinguish

and clarify the roles of toxic exposures and stress in causing subtle

neurological damage and delayed, chronic health effects.

Our purpose today, and in the months ahead, is thorough, constructive, and fair oversight of the VA and other departments and

agencies charged to find answers for Gulf war veterans. Our mission is to ensure that motion is never mistaken for progress, that

conclusions don’t become evidence, and that military doctrine does

not blind the research agenda or dictate the medical standard of

care.

Thanks to Chairman Dan Burton, and the committee’s ranking

Democrat, Representative Henry Waxman, we are able to convene

this hearing today prior to the formal organization of subcommittees and the adoption of rules for the 105th Congress governing the

subcommittees. Their willingness to go forward today demonstrates

the bipartisan commitment to the accurate diagnosis, effective

treatment, and fair compensation of Gulf war veterans.

[The information referred to follows:]

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Mr. SHAYS. We welcome all our witnesses, particularly the veterans who will testify in our third panel. It is to them we owe continued vigilance in pursuit of the causes and cures of Gulf war veterans’ illnesses.

At this time, I would ask the former ranking member and maybe

the present ranking member, Mr. Towns, if he has a statement to

read.

Mr. TOWNS. Thank you, Mr. Chairman.

Mr. SHAYS. I just want to know, should I take it personally that

you choose not to sit in this seat?

Mr. TOWNS. No, no, it doesn’t have to do with anything, Mr.

Chairman. I guess the only thing was I was looking forward to having your seat. That is the only thing.

Let me also thank you, Mr. Chairman, for holding this hearing.

Since our first hearing on this matter in the 104th Congress, I

have steadfastly maintained several core beliefs. I believe that illnesses of the Persian Gulf war veterans should be examined and

treated. Current research should be continued to determine the existence of a specific illness or syndrome. Compensation should be

provided for those individuals whose Persian Gulf service has rendered them disabled or suffering from chronic illnesses, and research on these causes of potential treatment for those illnesses

should be expanded.

I am encouraged to discover that earlier this month the President asked VA Secretary Brown to examine the possibility of extending benefits to soldiers who suffered from undiagnosed illnesses; that $27 million in funding is available for new research efforts; that the Department of Defense has initiated a 110 member

task force to investigate claims of chemical exposure; and that the

term of the Presidential Advisory Commission on Persian Gulf War

Illnesses has been extended. I am very pleased about that. These

are all encouraging developments in an area that often only carries

bad news.

I hope that these developments mean that all concerned have

reached an agreement to listen to our veterans and share information from Federal agencies with Congress and with the American

public. I believe that the failure to reach such an agreement would

undermine trust and confidence in government, cast doubt upon

any of the few research findings, and waste the investigational and

medical resources of Federal agencies. This Nation cannot afford

such a result.

Again, Mr. Chairman, I would like to thank you for calling this

hearing today and staying with this issue. I agree with you; I think

it is too important not to examine it and make certain that we find

the cause of this illness. It is very clear to me that where there is

smoke, there must be fire. Thank you.

Mr. SHAYS. I thank the gentleman, and while you don’t sit at this

seat, I consider you an equal partner in this effort. And thank you

for your past and present work on this.

[The prepared statement of Hon. Edolphus Towns follows:]

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Mr. SHAYS. In the order of the Members who came here, I am

going to invite a new Member, Mr. Sessions from Texas, if he has

any opening statement.

It is good to have you here.

Mr. SESSIONS. Thank you, sir. My comments are related to the

people who are here before us. It is people who recognize the problem that is evident in America.

Men and women who went across the globe to represent America

have come back with terrible symptoms, and I believe the public

is unsure of the cause. I hope to be an active part of this committee

to listen to expert testimony and witnesses who are in the medical

field who can shed light on this and to offer my background and

experience to get to the bottom of this.

I appreciate you allowing me to be here. Thank you.

Mr. SHAYS. Thank you. We are eager and happy to have you participate, and I would thank and recognize Mr. Sanders, who has

been at these hearings, all six of them, and have appreciated his

contribution.

Mr. SANDERS. Thank you very much, Mr. Chairman, and congratulations on your excellent work and congratulations on the

panels you have assembled today.

Mr. Chairman, to my mind, one of the issues that we have not

gotten into as thoroughly as we might, and I think we are going

to make a major step forward today, is the impact of the synergistic effect of a variety of chemical exposures on the men and

women who served in the Persian Gulf. I think it is important that

we finally have recognized that thousands of our soldiers have been

exposed to chemical war agents, but there were many other chemical exposures there, as you know.

According to the American Medical Association, ‘‘Evidence now

exists linking military service during the Persian Gulf war to a variety of ailments, including neurological injuries potentially caused

by exposure to chemical weapons, government-issued insect repellent, and possibly by a drug taken to prevent poisoning from nerve

gas.’’ But what we must always keep in mind is that the Persian

Gulf theater was a chemical cesspool, and that our soldiers there

were exposed not only to chemical agents, war chemical agents, but

to many, many other chemical agents as well.

Although some doctors have had some success treating sick veterans for chemical exposure, to the best of my knowledge, the VA,

the DOD, and HHS have not offered veterans a treatment specifically geared to overexposure to toxicity. I understand that we are

in a catch-22. Since we do not yet have a clear diagnosis, it is very

hard to treat the problem. I understand that we need to take our

time with some treatment protocol, such as those offered by Drs.

Nicholson and Hyman who treat Gulf war syndrome with antibiotics because there is a risk of negative side effects. I am pleased

that money has apparently been appropriated to take a closer look

at these treatment protocols. That is an important step forward.

In the meantime, there are treatment programs that have no

negative side effects which are making veterans feel better. And we

should implement this no-risk, win-win treatment immediately.

Mr. Chairman, I will later submit to the record a document entitled, ‘‘A Biopsychosocial Therapeutic Approach for the Treatment of

9

Multiple Chemical Sensitivity Syndrome in Veterans of Desert

Storm.’’ It is a treatment protocol. It was written by Dr. Myra

Shayevitz, who was a physician with the Veterans Administration

at the North Hampton, MA, hospital, dated May 5, 1995.

Dr. Shayevitz is of the belief, and treated patients on the basis,

that they were suffering from multiple chemical sensitivity. She

had good success. And in talking with Dr. Shayevitz, who is no

longer at the VA, her concern was that she was—how should we

phrase it?—not getting the kind of support that she wanted from

the medical people on top.

I should tell you, Mr. Chairman, that last week I had a very good

meeting with Secretary Brown and some of the VA physicians, urging them to take a more complete look at treatment protocols involving detoxification of our veterans, and I hope very much that

we will go forward in that area.

In 1993, Dr. Shayevitz treated over 100 Gulf war veterans for

chemical exposure, and improved the health of most of them. So,

in other words, there is a treatment protocol out there.

The problem is as I understand and you understand that when

we talk about multiple chemical sensitivity, we are talking about

a controversial area. Not every physician in America agrees with

this. The chemical industry does not agree with this.

On the other hand, as somebody who has been involved in this

issue for a number of years, I can tell you that there are hundreds

of thousands, if not millions, of Americans in civilian life—forget

the Persian Gulf—who have been affected by overdoses of chemicals.

There are medical organizations now who are treating tens of

thousands of people overdosed with chemicals. And it seems foolhardy to me to be conservative now and not look at all of the medical options that are out there when we have so many people who

are suffering, and, most importantly, when this treatment protocol

is a safe treatment protocol. Detoxification is not a dangerous drug.

It will not have any dangerous side effects.

We have people, for example, Dr. William Rea of the Environmental Health Center in Dallas, TX, who has on his own, mostly

on a pro bono basis, treated over 60 veterans. Dr. Rea is wellknown throughout the country as being one of the pioneers in the

whole area of the multiple chemical sensitivity.

Dr. Charles Ensure in Kansas has also treated patients.

So I would suggest, Mr. Chairman, what this meeting is about

is to open up the door to different treatments. The present diagnosis and treatment from VA and DOD is not working.

I would conclude by simply thanking Dr. Rostker, if I am pronouncing your name right. We met last time informally on a television program. You were on the East Coast and I was here, or

whatever, so it is nice to see you in person. If you allow me to

quote from the letter that you sent me.

Dr. Rostker says he knows that I met with Secretary Brown and

so forth and he says, I understand you met this week with Secretary Brown and his staff at the Department of Energy to discuss

multiple chemical sensitivity research efforts, and that additional

research proposals on chemical sensitivities among Gulf war veterans will be considered for future funding. I support such additional

10

research. And he is shaking his head for the record, up and down

the right way.

Regardless of the current uncertainties and understanding of the

complex issues surrounding MCS and the many other potential

causes of illness, we will continue to try to understand and explain

why so many of those suffer with the Gulf war syndrome. I think

that is a step forward and we will pursue that later.

Thank you, Mr. Chairman.

Mr. SHAYS. I appreciate the gentleman.

[The information referred to follows:]

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Mr. SHAYS. At this time I would call on Mr. Gilman, who is the

chairman of the International Relations Committee of this House,

and appreciate you being here.

Mr. GILMAN. Thank you, Mr. Chairman.

First of all, I want to commend you for providing us the opportunity to further pursue this important issue, and I also want to

recognize the commitment of many of our colleagues on this subcommittee in pursuing the issue.

While I have not benefited from last year’s hearings or actual

participation, I do share our colleagues’ concern for our Nation’s

Persian Gulf war veterans and their families. The issue of the Persian Gulf war syndrome is highly controversial and emotional for

all of those involved, including the families of the veterans involved.

And while we may disagree about the cause of the syndrome or

even if one all-encompassing disease exists, I think we all agree

that the Department of Defense’s record on this subject left much

to be desired. It is simply inexcusable that DOD flatly and categorically denied the presence of chemical weapons in the Persian Gulf

war theater, despite evidence to the contrary. It was only after

being faced with overwhelming evidence that this position was suddenly reversed last summer.

Likewise, the VA’s position of not having given much attention

and priority to the possibility of low-level exposures in their medical research and in our treatment of our veterans, I think was

short-sighted. In essence, it appears that the VA simply followed

the lead by the Department of Defense in not considering the possibility of low-level chemical exposure.

There are numerous serious questions which do remain. In recent studies by the President’s Advisory Committee, and two separate university studies have resulted in widely diverse conclusions,

certainly more research is needed, yet we must guard against

studying this subject to death. There are numerous veterans who

are suffering from something that was related to their service in

the Gulf.

I am concerned that all the studies in the world are not going

to reveal any magic bullet which will answer all of our questions

with regard to the cause of the syndrome, yet the Persian Gulf theater was a highly toxic environment. Whether it was a few chemical agents or a combination of various factors, we are not certain.

But in all probability, stress from combat played a role, but I remain highly skeptical that stress is the sole cause.

One issue which I hope we will be addressing, Mr. Chairman,

during this or any future hearings, is that of the reported birth defects in children born to Gulf war veterans, especially those who

had healthy children born prior to the Gulf war. That issue which

has not received much attention is one that could safely be assumed to be totally unrelated to any combat stress. With this being

said, I again thank Chairman Shays for pursuing this issue. I look

forward to hearing the testimony of our witnesses today.

Mr. SHAYS. Thank you very much, Mr. Gilman, and at this time

I would call on Ms. Ros-Lehtinen.

Ms. ROS-LEHTINEN. Thank you so much, Mr. Chairman.

119

Although I am not fortunate enough to serve on your subcommittee, I wanted to briefly stop by and congratulate you for

holding a hearing on this important issue. As the wife of a Vietnam

veteran, our family knows all too well how long it took our Armed

Forces to recognize the health effects that many of the chemicals

used in that war had on the brave men and women who fought

there and served our country well.

We certainly thought that sad chapter was behind us, yet we find

ourselves in a new decade once again confronting the bureaucracy

and slowness of recognizing the effects of different chemicals used

now in a new combat theater. So I congratulate you for holding the

hearing, and we hope that—and we are optimistic that good things

will come for our veterans as a result of your hearings.

Thank you, Mr. Chairman.

Mr. SHAYS. I thank the gentlelady. At this time I would call on

Mr. Snowbarger, who is a new member of the committee, and is

also designated to be the vice chairman of this subcommittee, and

it is wonderful to have you here.

Mr. SNOWBARGER. Mr. Chairman, thank you, not only for the opportunity to serve on this committee, but to serve as your vice

chairman.

Briefly, I wanted to thank the panelists for their presence here

today and I look forward to their remarks. I realize that the committee has done a lot of work on this issue before, so I am kind

of coming in at the tail end of some of this. But the importance of

the topic was brought home again as late as last Friday when one

of my constituents came to me complaining that he was having

problems with Gulf war syndrome and was anxious to hear what

the committee’s work was going to show on his behalf. I am happy

to be part of the committee, Mr. Chairman, and thank you.

Mr. SHAYS. I thank the gentlemen, and at this time, Mr. Horn,

do you have a statement you would like to make?

Mr. HORN. I don’t have a statement.

Mr. SHAYS. Great to have you here.

Let me say we have three excellent panels, and we are very

eager to hear from all of them. I think, as most of you know, when

we scheduled this hearing we thought it would be a slow day in

the Capitol and obviously it is a very important day with the debate on the ethics of the Speaker. And so this committee will attempt to adjourn at approximately 12 o’clock.

Our intention is we will finish the first panel. We are not going

to keep you here and have you come back. So our intention is to

have the first panel conclude, and at the end of that probably adjourn. It could be as late as—excuse me, not adjourn but to recess.

It could be as late as 1:30 or 2. But I do suspect that the first panel

will take all of our time.

So with that, let me just take care of some House business we

need to take care of first.

First, I will be swearing in the witnesses in a few minutes. I

have been designated by the chairman of the committee since I am

not officially the chairman of the subcommittee, and that is, pursuant to a letter of January 16, I have the authority to swear in witnesses, subject to the approval of Mr. Waxman as well, who has

concurred. We will be doing that shortly.

120

Before we swear in the witnesses, I ask unanimous consent that

all members of the full committee be permitted to place any opening statements in the record, and that the record remain open for

3 days for that purpose. And without objection, so ordered.

[The prepared statement of Hon. Mike Pappas follows:]

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Mr. SHAYS. I also ask unanimous consent that our witnesses be

permitted to include their written statements in the record, and

without objection so ordered.

At this time, I would officially recognize and ask them to stand.

Dr. Kenneth Kizer, Under Secretary for the Health Department of

Veterans Affairs, it is wonderful to have you here; and Bernard

Rostker, Special Assistant for Persian Gulf War Illnesses, Department of Defense; and also Dr. Donald Custis, also a retired Admiral.

I understand that the acoustics here are not too good and if you

have trouble picking up what we are saying, don’t be reluctant to

ask any of us to slow down.

Dr. Custis as well, Admiral, U.S. Navy, retired, member, Presidential Advisory Committee on Persian Gulf War Veterans’ Illnesses.

So we have a wonderful panel, and also we will be swearing in

Ms. Holly Gwin, who was involved in actually writing the final

draft of the report as counsel in charge of the report as well.

And Ms. Gwin, is it your intention to have a statement or will

you be here to respond to questions?

Ms. GWIN. Respond to questions.

Mr. SHAYS. Therefore, we need to swear all of you in. Therefore,

if you would stand—I would say we swear even Members of Congress when they come before the subcommittee.

[Witnesses sworn.]

Mr. SHAYS. For the record, all four witnesses have responded in

the affirmative. We are going to go in the order in which I called

you, from left to right.

Dr. Kizer, it is wonderful to have you here, and I appreciate the

good work you do for the Department of Veterans Affairs.

STATEMENTS OF KENNETH W. KIZER, M.D., UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY FRANCES MURPHY, VA CENTRAL

OFFICE; BERNARD ROSTKER, SPECIAL ASSISTANT FOR PGW

ILLNESSES, DEPARTMENT OF DEFENSE; DONALD CUSTIS,

M.D., ADMIRAL, U.S. NAVY (RETIRED), MEMBER, PRESIDENTIAL ADVISORY COMMITTEE ON PGW VETERANS’ ILLNESSES, ACCOMPANIED BY HOLLY L. GWIN, DEPUTY DIRECTOR AND COUNSEL

Dr. KIZER. Good morning, Mr. Chairman. Having provided rather

lengthy written testimony, I will keep these comments relatively

brief.

I would like to make comments in five specific areas. First, I

would like to note that we believe the VA has a good program to

deal with the illnesses of our Persian Gulf veterans. It is a comprehensive program that includes providing medical care, conducting research, granting disability compensation, and conducting

education and outreach efforts.

Illustrative of the medical care provided are the following statistics that indicate over 63,000 registry exams have been performed

to date; over 187,000 veterans have been seen in our ambulatory

care clinics; over 19,000 veterans have been hospitalized; and more

123

than 74,000 have been seen in our readjustment counseling vet

centers.

Notwithstanding the fact that we believe the VA has a very good

program, we are continually looking for ways to improve it and

make it better, and, therefore, we welcome this opportunity to engage in this ongoing dialog.

The second area I would like to comment on has to do with the

notion of a syndrome per se; perhaps I can put a few things in perspective here.

We believe that Persian Gulf veterans have a diverse array of

symptoms and conditions that cannot be neatly folded into one diagnosis or one syndrome. We also firmly believe that the veterans

who seek care from the VA are suffering from genuine illnesses,

and we are providing treatment for these veterans as illustrated by

the numbers that I just cited. I would also note, perhaps contrary

to one of the comments, I don’t recall exactly who made it before,

many veterans are benefiting from the treatment that is being provided.

Again, I would like to illustrate with some numbers the fact that

our Persian Gulf veterans’ conditions do not cluster in any one system or disease category. Instead, they span a wide range of illnesses and diagnostic categories.

To date, in our registry examination program, over 7 percent of

the diagnoses have been for infectious diseases; over 14 percent for

respiratory disorders; 11 percent for gastrointestinal conditions; 7

percent—7.1 percent—for cardiovascular or circulatory problems;

3.4 percent for genitourinary conditions; 131⁄2 percent for skin disorders; nearly 5 percent for injury for poisoning conditions; 15 percent for psychiatric disorders; over 8 percent for neurologic conditions; and less than half of 1 percent for neoplasms.

These numbers also help to put in perspective the notion of

stress. While the VA does believe that some veterans are suffering

from stress-related conditions, it would certainly be a gross

mischaracterization of the record and the facts to indicate that VA

believes that all of these veterans are suffering from stress-related

conditions. Indeed, just to the contrary. While we believe some are,

we feel that most are not suffering from stress, per se.

The third area I would like to comment on briefly has to do with

a question as to whether the VA listened to the Persian Gulf veterans. I think the facts are there, indeed, and an objective review

of the record, will clearly show that VA has been attentive to the

veterans’ concerns about toxic exposures, including chemical warfare agent exposures.

This data is illustrated by many things, including the questions

and design of the uniform case assessment protocol that is used to

evaluate Persian Gulf veterans, as well as the current registry examination protocol.

Other examples are the research studies that have been funded,

most of which were funded before information about the

Khamisiyah incident was reported by DOD; by the establishment

of the VA Environmental Hazard Centers in 1994; by our collaboration with Japanese scientists investigating the Tokyo subway terrorist incident involving sarin, beginning well over a year before

the data about Khamisiyah was reported by DOD; and, by repeated

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public comments, some of which have been widely reported in the

media. Indeed, I can recall being chastised at a hearing by somebody else for my comments that were reported in USA Today in

early March——

Mr. SHAYS. Just for the record, that was not a hearing before

this committee.

Dr. KIZER. That is correct. As I said, it was before another committee for comments——

Mr. SHAYS. We may chastise you for other reasons.

Dr. KIZER. I am sure you will.

Just to finish that, I think the record clearly shows both in the

public media as well as elsewhere that we have been wide open to

this possibility from the beginning.

The fourth area that I would comment on really has to do with

the illnesses and conditions that our Persian Gulf veterans have,

illustrating both some of the strengths and some of the shortcomings of modern medicine. Indeed, the practice of medicine today

continues to be an art as well as a science. The fact that about

three-fourths of our Persian Gulf veterans have had their conditions diagnosed as quickly as they have been and with the least

amount of invasive testing as possible certainly would not have

been possible 15 or 20 years ago.

However, today’s medical knowledge does not have all the answers, and despite the wonders of modern medicine and the illusion that is often created by television or the movies, many people

have symptoms and conditions for which there is no clear diagnosis

or understanding of the disease, and certainly no ‘‘magic bullet’’ of

treatment.

I can tell you from my firsthand experience as a professor at a

university medical center where many complex patients came with

uncertain diagnoses, uncertain conditions, that that was the norm,

and many people left the university medical center likewise without having firm diagnoses established. Likewise, I can tell you as

a medical toxicologist that medical science certainly does not hold

answers or the science is not as refined in the area of toxicology

as we would like.

This is very clearly borne out by some of the issues and some of

the questions that you have asked, Mr. Chairman, regarding assessing individuals for potential exposure to chemical warfare

agents. There simply is no valid chemical test today to identify

chemical warfare agent exposures that occurred years ago. You just

cannot do that because the science does not exist. That is the sort

of confirmatory testing that both of us would like to be able to do

on our veterans does not exist. And as I think Mr. Sanders commented in his opening comments, that really is no different from

the situation that exists with our agricultural workers or with industrial workers who have been exposed to many of the same

neurotoxins in a variety of other settings in the course of their

work as well as members of the public who may live near

Superfund or who live near various other toxic waste sites and

have developed various symptoms that they believe are related to

chemical exposures, and in many cases multiple chemical exposures.

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We know that many conditions—just to finish this point—we

know that many of the symptoms and conditions that people have

today and have received a diagnosis, especially for those who have

had nonspecific symptoms, may get alternative diagnoses if they

see other practitioners. Indeed, I would hazard to say as I look at

the panel it probably would not be a unique experience that you

may have been to a physician once who told you he wasn’t sure exactly what you were suffering from or likewise you may have seen

more than one physician for the same condition and gotten more

than one diagnosis or impression as to what was causing your

symptoms. This is not at all unique to Persian Gulf veterans, by

any means. Likewise, as medical science advances and more tests

are performed on individuals, we certainly find that diagnoses are

often refined.

Just the last point in this regard, I would also note that the VA

has recognized that forward-looking thinkers usually challenge traditional views. Often the forward-looking thinkers have views that

are at variance with established or conventional thinking. We also

recognize that such researchers have had difficulty getting their

unconventional methods or diagnoses or treatments accepted by the

scientific community.

Recognizing this fact, the VA has kept an open mind and open

door. We will certainly continue to listen to and encourage innovative ideas. The one thing we will require, though, is that investigative methods and techniques have to be consistent with sound

science and ethical principles of experimentation. We simply do not

believe that veterans can be the focus of experiments.

Finally, Mr. Chairman, and recognizing that my time is rapidly

disappearing here, let me comment—— Mr. SHAYS. Dr. Kizer, we value your testimony and realize you

won’t always be coming before the committee so there is no time

restraint on you.

Dr. KIZER. I was watching the lights.

Mr. SHAYS. It helps us get a gauge, so we will put the green on

again.

Dr. KIZER. Thank you, Mr. Chairman.

The last area I want to comment on in this brief opening statement is the one that you asked me to comment upon and that is

the studies by Dr. Haley and Dr. Schwartz that were published in

last week’s issue of the Journal of the American Medical Association.

In brief, just to summarize those studies, the study by Dr.

Schwartz and his colleagues was a population-based telephone survey of a sample of 2,000 Persian Gulf veterans and an equal number of Gulf-era veterans whose home of record was in Iowa. The

participation rates were high in this study, which is good. About

76 percent of the eligible subjects participated.

This study examines self-reported symptoms and their prevalence rates, and used validated algorithms to group symptoms into

five categories of medical conditions. The study group was found to

have a significantly higher self-reported prevalence of medical and

psychiatric conditions, including asthma and bronchitis, post-traumatic stress disorder, depression, cognitive dysfunction, chronic fatigue, and fibromyalgia.

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Among these Persian Gulf veterans, these conditions were more

often reported by those with self-identified exposures to

pyridostigmine bromide, chemical warfare agents, pesticides, solvents, and smoke than those who did not report, or self-report,

such exposures.

I would note that this higher rate of self-reported symptoms is

very similar to the findings of a study that the VA requested CDC

to conduct some time ago of Pennsylvania veterans. That was published in the June 1995 issue of Morbidity and Mortality Weekly

Report.

I would also, Mr. Chairman, if you would indulge me, take this

opportunity to publicly thank Dr. Schwartz. As is typical of VA

physicians, most VA physicians are members of university faculty,

and certainly Dr. Schwartz fits that category. He is one of our staff

physicians at the Iowa City VA Medical Center and a faculty member at the University of Iowa. I would certainly like to thank him

for his work, not only on a day-to-day basis with our patients at

the medical center, but also for his work on this study.

Likewise, Dr. Haley, who is one of the attending physicians at

the VA Medical Center in Dallas. I would also like to acknowledge

and thank him for his efforts on behalf of the patients at the VA

Medical Center in Dallas where he works, as well as recognizing

his position with the university there.

Let me turn specifically to the studies of—several studies, three

studies—that are reported by Dr. Haley and colleagues in the issue

of JAMA that I cited. These studies focus on a single military unit

of Gulf war veterans, the 24th Reserve Naval Construction Battalion and this to characterize the illness of this group of veterans.

Dr. Haley administered a detailed questionnaire on symptoms and

risk factors to 249 of the 606 members of this unit, 41 percent of

the unit, and through a technique called factor analysis, the investigators found six patterns of symptom clusters, indeed six different

syndromes in this relatively small group of persons.

I actually, in the interest of time, will forego all of the details

that were reported, particularly of the studies that focused on the

23 veterans that were most intensively studied with neuropsychological and neurophysiologic testing. I would just note that

when the findings were reported by the authors, and the findings

of the studies were shown to and reviewed by a group of neurologists, no abnormality was found. Using some complicated statistical

methodologies, Dr. Haley was able to identify, in the aggregate, the

patients from the study group who had more symptoms or abnormalities than the others.

I would also, in the interest of time, not go through some of the

specific limitations. We would concur with Dr. Haley in his discussion of the report and what is published in the journal, that the

studies do suffer from a number of shortcomings that make it difficult to extrapolate the findings, particularly the small sample size

and the potential problem of selection bias.

At this point, we are in the process of engaging in further discussion with Dr. Haley to find out some of the details that were not

published. So, we will defer further discussion of these issues until

a later time when we have had the opportunity to go over some of

these details with him.

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I would note, though, that we don’t believe that these studies

provide the definitive answer. They certainly are important. We

view them as very significant findings, but further research is necessary to answer questions both raised by these studies as well as

by others and, likewise, we need to review the findings of these

studies within the context of what else is known about what may

precipitate those findings, accepting the findings themselves. There

is literature that also needs to be reviewed as far as what may

have caused those specific findings, and that is, of course, a process

that will continue.

Let me conclude these comments, Mr. Chairman, by again noting

that we believe the VA has a good program for dealing with the

illnesses of Persian Gulf veterans. No one is being turned away

from care, and while it may take some time for research to provide

answers to some of the problems that some of our veterans have,

we will continue to provide the best care that we can while that

research is being brought to conclusion.

Likewise, I would just repeat—as I said at the outset—that we

welcome the scrutiny of our program. The scrutiny has been provided by the Presidential Advisory Commission, by the many veterans’ service organizations that have been acutely interested in

this subject, by the National Academy of Science and the Institute

of Medicine that has an ongoing review of the program, by the Veterans Affairs Committees of both the House and the Senate, by this

subcommittee, and all of the many other entities that already have

commented upon and will comment in the future or that will review this effort.

Thank you, Mr. Chairman. I would—if I might also just ask one

procedural question, having not testified before you before. One of

the things I have noticed in some other hearings is that sometimes

words may be used differently by different people. You as an attorney may use a word somewhat differently than I as a physician

might, and if that arises, I just wonder if you will allow us to make

sure we are talking about the same thing when words like that

come up.

[The prepared statement of Dr. Kizer follows:]

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Mr. SHAYS. It is essential that we communicate well and I have

no problem with you asking for clarification. And, frankly, I don’t

have any problem if you hear someone ask a question of someone

else and step in if you think we are not communicating. I am not

an attorney, and I am not offended.

Dr. KIZER. I am sorry, I apologize.

Mr. SHAYS. Dr. Rostker.

Mr. ROSTKER. Thank you, Mr. Chairman—— Mr. SHAYS. Excuse me. I am going to have you lower it down just

a little bit. It is the one with the long stem that projects your voice.

The other one is the TV camera.

Mr. ROSTKER. Mr. Chairman, thank you very much for the opportunity to come before the committee today to explain to you and to

the American people the very many changes we made in the Defense Department.

Mr. Chairman, on 12 November 1996, the Deputy Secretary of

Defense, Dr. John White, appointed me Special Assistant for Gulf

War Illnesses. This action was part of a broader set of initiatives

undertaken in September to assess the Department of Defense’s

Gulf war illness program in view of the recent events to include the

report that soldiers may have been exposed to chemical agents during the destruction of storage sites at Khamisiyah.

My mission as the Special Assistant for Gulf War Illnesses is to

serve as the Department of Defense’s coordinator for all issues relating to Gulf war illnesses. Two vital aspects of this mission are

to ensure that we learn everything possible about the suspected

chemical exposure events which occurred during and after the Persian Gulf conflict and to promote improved communications with

Gulf war veterans on the relevant health issues.

This mission is critical not only because we have a moral duty

to our veterans but also because we must understand what is making our people sick so that we can initiate the vital changes required to protect our forces in the future. We must ensure that

DOD puts in place all the required military doctrine, plus personnel and medical policies, procedures, and equipment so as to

prevent future repetitions of the problem.

To quote the President: ‘‘I want to assure all of you that we will

leave no stone unturned in our efforts to investigate Gulf war illnesses, and to provide our Gulf war veterans with the medical care

they need. There are mysteries, still unanswered questions and we

must do more.’’

Mr. Chairman, it is my business to leave no stone unturned. To

carry out this mission, I have expanded by an order of magnitude

the Department of Defense’s investigations organization. The original team of 12 is now more than 110 people strong, and they have

completely revamped the way we do business. We have the investigators and analysts necessary to perform a full review of currently known incidents, and I have the authority to search out and

pursue reports of any new incidences.

My expanded efforts build on earlier work by refocusing and substantially increasing the level of commitment. Much of the increase

is focused on incidents which occurred during the Gulf war, the

hazardous exposures that may have resulted from these incidents,

and the broader implications of such incidents. We are doing this

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with renewed dedication to communicate with all veterans who

served and fought in Southwest Asia in 1991, including those veterans who are still on active duty, serving in the National Guard

and Reserve, and those who have returned to full-time civilian life.

I have expanded into new areas to initiate proactive risk communication strategies with a two-way communication between the

DOD, the VA, and the Gulf war veterans as recommended by the

Presidential Advisory Committee on Gulf War Illnesses, the PAC.

Today, when a veteran calls our telephone hotline to offer information, the veteran receives a followup call and is interviewed by a

trained investigator who ensures that information is incorporated

into our case files.

These call-backs not only provide an in-depth debrief, but for the

future, a single point of contact between my office and the reporting Gulf war veteran. The process involves the veteran in the investigative process in a significant and meaningful way. Our callback teams work on two shifts from 7 a.m. to 11 p.m., Monday

through Friday. Response from the veterans has been extremely

positive.

We also collaborate very closely with veterans’ service organizations. For example, on December 11th, we hosted the VSOs at a

demonstration of the chemical equipment used during the Gulf

war, particularly the M8 alarm, 256 test kits and the FOX chemical reconnaissance vehicle. They appreciated the opportunity to become more familiar with the equipment that has often been written

about in the press and was the subject of debate in Congress.

We have initiated a formal structure for our incident investigations. We are preparing a series of narratives that summarize what

we know about such incidents as Khamisiyah, the Marine breaching operation, operational logs, FOX alarms, for pyridostigmine

bromide tablets, and every other issue under investigation. These

narratives will be a status report to the American people of what

we know, when we knew it, and what actions we plan to take. I

expect that this will be the basis for us to more effectively address

the concerns of Gulf war veterans and their families.

We are building on the major health programs initiated by the

Assistant Secretary of Defense for Health Affairs, Dr. Steve Joseph.

Under his leadership, a comprehensive clinical evaluation program

was established in which more than 38,000 Gulf war veterans registered—and those Gulf war veterans who are in active duty and

in the Reserve components today. The Department of Veterans Affairs has its own registry with 63,000-plus veterans in their registry.

In addition to forming my organization, the Deputy Secretary of

Defense generated a number of other important initiatives. In the

area of research, the DOD has committed to spending $12 million

to study a wide range of medical issues relating to the Gulf war.

Further, we are prepared to spend an additional $15 million to

study the long-term effects of chemical and other hazardous exposures, including low-level chemical exposures.

At this time, therefore, I am withdrawing the DOD staff paper

published on the GulfLINK home page on the Internet which discounts low-level chemical exposures as the cause for Gulf war illnesses. In doing this, I note that the PAC concluded and current

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scientific evidence does not support a causal link between low-level

chemical exposures and undiagnosed Gulf war illnesses. However,

the PAC also recommended that additional research be warranted.

We concur in this assessment and plan to fund the appropriate research. I approach this subject with a completely open mind, and

our research agenda is clear evidence to this.

Dr. White also initiated a review by the Institute of Medicine of

the DOD clinical health examination protocols in light of the possibility of chemical exposures; a review by the Army Inspector General of the military operations at Khamisiyah; and a review by the

Assistant to the Secretary of Defense for Intelligence Oversight of

the circumstances surrounding the handling of intelligence data

concerning Khamisiyah.

Furthermore, Dr. White requested that the National Academy of

Sciences provide a mechanism for oversight to meet the President’s

call for an independent, open, and comprehensive examination of

health-related issues and assessment of the multiple issues relating to the protection of our forces. This is in addition to the PAC’s

oversight of the investigation into low-level chemical exposure

events and monitoring of the governmentwide implementations of

its recommendations.

Mr. Chairman, I would like to take a moment to comment on

issues raised by this committee on 10 December 1996, concerning

its perception that field commanders in the Gulf dismissed what

soldiers and Marines considered to be valid chemical detections.

Marine Corps Gunnery Sergeant George Grass, Major Randy

Hebert, and Army Major Michael Johnson are Americans whose

service we honor and testimony we welcome. We applaud these

men for coming forward to describe events about which we are all

deeply concerned. The clarity and detail of their observations contributed significantly to our investigations, and we are examining

each and every one of the incidents they report. Their close, personal observations, however, must be taken into the context of all

of the information available to us as we go forward in our investigation.

As you see from the illustration provided in the handout before

you, I believe we can, indeed, corroborate one of the initial detections cited by Gunnery Sergeant Grass. However, it is important to

note that the same log that records his initial chemical alert also

records the action taken in response to that alert and the final determination that no chemical warfare agents were present.

Let me be more specific. On 28 February 1991, there is an entry

in the CENTCOM Chemical Log published on GulfLINK, and

therefore available for all to review, that reads, and I quote: CWO

James called: 1st Marine Division has come across an ammo bunker complex with suspected chemical munitions. The FOX has come

up with indications of small concentrations of sulfur mustard after

numerous tests.

The next day, another log entry states, and I quote again: Chief

Warrant Officer James calls back. The suspected bunker was

checked out thoroughly. No chemical munitions was found. In fact,

we have interviewed the members of the team that checked out

that bunker and can confirm that from other sources.

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It is also important to note that the unit commanders did what

was right and responded appropriately by directing their troops to

don chemical protected gear, they cordoned off the area, and waited

for properly trained troops to enter and investigate the bunker.

While in this case the chemical logs help clear up the issue here

of the ammo bunker reported to this committee, in other cases the

same logs identified and confirmed issues we cannot explain. This

includes the Czech records which United States equipment could

not confirm, and I would note that the Czech detectors were more

sensitive than United States equipment, which may help explain

why we cannot confirm their initial reports.

In conclusion, we are wholeheartedly committed to find out everything we can about Gulf war illness. This is necessary not only

because it is right for our veterans but also because it is imperative

for the future safety of our troops. I invite our veterans to assist

by contributing their own observations to our investigation. They

may do so by calling our toll-free number, and if I might, 1–800– 472–6719. We want them to help us become part of our team.

Mr. Chairman, thank you for allowing me to read this statement.

[The prepared statement of Mr. Rostker follows:]

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Mr. SHAYS. Thank you, Dr. Rostker.

Dr. Custis, we will be happy to hear your testimony. Sir, I am

going to ask you if you would line up that mike toward you. It is

a little hard to read because it comes over your paper, but it helps

us hear.

Dr. CUSTIS. Mr. Chairman, members of the committee, we thank

you for this opportunity to appear before you today. We have submitted written testimony for the record. As you requested, I will

now summarize this material.

First, there should be no question that the Presidential Advisory

Committee on Gulf War Veterans’ Illnesses recognizes that many

veterans are experiencing medical problems connected to their

service in the Gulf war. In the near term, the government needs

to fine tune some specific efforts in followup clinical care and risk

communication. Overall, however, we were encouraged, for the

most part, by the Government’s response to the range of health-related problems experienced by Gulf war veterans.

Regarding research, the committee found that the research currently under way places an appropriate emphasis on the epidemiologic studies and stress-related disorders. The broad array of ongoing research will improve our understanding of Gulf war veterans’ illness.

To close gaps in the current knowledge base, however, we recommended additional studies in three specific areas on long-term

health effects of low-level exposures to chemical warfare agents, on

the synergistic effects of pyridostigmine bromide with other Gulf

war risk factors, and on the body’s physical response to stress.

The committee also noted the importance of continuing to ensure

that resources are devoted to mortality studies since some health

effects, such as cancer, would not be expected to appear until a decade or more after the end of the Gulf war.

While all the data are not yet in, the Advisory Committee was

able to reach some conclusions about the nature of Gulf war veterans’ illness. In this regard, we made three findings. First, as I

noted, many veterans have illness likely to be connected to their

service in the government.

Second, current scientific evidence does not support a convincing

causal link between the illness and the symptoms that veterans report today and exposure to any environmental risk factor of the

commonly suspected Gulf war risk hazards that we assess. The

committee conducted a comprehensive review based on results subjected to peer review of the health effects of pesticides, chemical

warfare agents, biological warfare agents, vaccines, pyridostigmine

bromide, infectious diseases, depleted uranium, oil well fire smoke,

and petroleum products, and psychological and physiological stress;

and finally, the fact that stress, which is known to affect the brain,

immune system, cardiovascular system, and various hormonal responses, is likely to be an important contributing factor but that

it is not and cannot be the whole story.

As you know, the Advisory Committee had one significant caveat

about the Government’s response related to Gulf war veterans’

health concerns. We took strong issue with the Department of Defense’s efforts to assess possible exposures of United States troops

to chemical warfare agents in the Gulf. An atmosphere of GovernVerDate 11-MAY-2000 10:15 Jun 28, 2002 Jkt 010199 PO 00000 Frm 00169 Fmt 6633 Sfmt 6602 W:\DISC\38711 pfrm04 PsN: 38711
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ment distrust now surrounds every aspect of Gulf war veterans’ illnesses because of DOD’s mishandling of this matter. This situation

is regrettable, but it is also understandable.

Our investigation of DOD’s efforts in this area led us to conclude

the Department’s early efforts were superficial and lacked credibility. We found substantial evidence of site-specific, low-level exposures to chemical warfare agents. Moreover, we found DOD’s investigations had been superficial and were unlikely to provide credible

answers to veterans’ and the public’s questions.

The Advisory Committee also noted that DOD’s failure to seriously investigate these issues until late last year also adversely affected decisions related to funding research into possible health effects of low-level exposures to chemical warfare agents.

Before concluding my oral remarks, I do want to mention that

during the course of the Advisory Committee’s investigations, we

judged that the government could do a better job in the future of

avoiding post-conflict health concerns. Thus, we made several recommendations to address the need for better communication, better

data, and better services.

Ms. Gwin and I would be happy to discuss committee recommendations in greater detail should you have questions, but I

especially want to note a strong need to improve data collection

and handling. The government has a significant amount of ground

to recover with Gulf war veterans and the American public, because they have come to question whether a lack of data, for example on possible exposures, on the pre- and post-development health

care veterans, or on the location of troops in theatre, indicates a

lack of commitment to veterans’ health.

In conclusion, Mr. Chairman and members of the committee, the

Nation has begun to pay its debt to Gulf war veterans in many important ways. It is essential now to move swiftly toward resolving

their principal remaining concerns: how many U.S. troops were exposed to chemical warfare agents? And to what degree?

Thanks again for this opportunity to review our work with you.

We would be happy to answer any questions. I thank you.

[The prepared statement of Dr. Custis follows:]

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Mr. SHAYS. Thank you, Dr. Custis.

First let me ask a question of all of you. Do you have any disagreement with what the others have said on this panel or any

clarification or response, anything you have heard so far?

Dr. KIZER. I would say none that I can think of at the moment.

Mr. SHAYS. Dr. Kizer, what mistakes has the VA made in the

last 6 years with regard to the Gulf war issue and this whole issue

of the syndrome? Where are the mistakes?

Dr. KIZER. I don’t know that I would characterize them as mistakes. I think as we have commented on a number of times before,

and I have testified before, that we feel the research agenda, as far

as the exposure side, was delayed because of information that was

provided, I think there is an important point—— Mr. SHAYS. Provided where?

Dr. KIZER. Provided by the Department of Defense.

I think an important point to be made there that has, I think,

often been overlooked, is that while the exposure, per se, may not

have been investigated, the effects that such exposure might have

caused have been the focus of research for quite some time, indeed,

antedating this whole discussion about the Khamisiyah incident.

While I can’t speak with any firsthand knowledge about the VA

in the timeframe that you asked, since I have only been with the

Department a little over 2 years, I would also note though that it

would appear that early on, from second- or third-hand impression,

that the communication, the risk communication side, could have

been better than it is today as well.

Mr. SHAYS. So in essence, the only thing you would describe, and

you wouldn’t even describe it as, a mistake, is that you relied on

information from the DOD that said our troops weren’t exposed to

chemicals or there was not an emphasis on the part of the Department to focus in on chemical issues. Is that fair?

Dr. KIZER. I don’t think that quite characterizes what I said accurately, no.

Mr. SHAYS. Well, I don’t want to get into a chess game, but I

want to understand, and we will be here maybe well past 12, just

to tell the panel.

I was hoping you might have answered my questions a little differently. You basically said you wouldn’t characterize any of them

as mistakes, and that is a pretty strong position to take. I mean,

everybody makes mistakes. So why don’t you say it again in shorter terms, and I will try to understand what you are saying.

Dr. KIZER. We may be referring to two different things. Your last

comment that I responded to had to do with chemicals in the aggregate, and what I think you were referring to was chemical warfare agents, per se.

Many of the research studies have focused specifically on the

toxicology of pyridostigmine and other chemicals that have been

the subject of discussion in this whole incident. What I was responding to was, as I said, your comment about chemicals as opposed to chemical warfare agents, per se.

Mr. SHAYS. Frankly, I don’t care whether it was chemicals or

chemical warfare agents. I think our troops were exposed to chemicals, whether defensive or offensive, and the issue I am trying to

understand is whether you characterize any of what has happened

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with the VA as a mistake. And your first answer, I think, is fair,

that you wouldn’t characterize anything that the VA has done as

a mistake. That is what you said. Is that correct?

Dr. KIZER. That is correct. And the latter half, we were responding to two different things.

Mr. SHAYS. All right, let’s go from there. You also said you would

characterize your reliance on the VA as what? The VA’s reliance

on the DOD as regards to chemical exposure, and that was offensive or defensive weapons. How would you characterize your reliance on the DOD on that issue?

Dr. KIZER. I think the Coordinating Board and the various other

entities that looked at this whole question of where in the research

agenda, or what priority in the research agenda should be exposure

to chemical warfare agents, rated that as a lower priority than,

say, the potential toxicity of pyridostigmine or some of the insecticides or other chemicals that folks were exposed to. In assessing

this and in fashioning the research agenda, the potential effects

that these types of neurotoxins would have were addressed.

The issue of exposure to chemical warfare agents, per se, and investigation into that arena, was delayed, and that investigative

focus was given a lower priority because of the information that

had been provided by DOD.

Hopefully, that clarifies what I was saying.

Mr. SHAYS. So the bottom line is, because the DOD denied that

there was any exposure to defensive or offensive chemicals, the VA

made a determination that therefore our troops were not exposed

to defensive or offensive chemicals.

Dr. KIZER. No, I don’t think that at all characterizes what I said,

Mr. Chairman.

Mr. SHAYS. OK. We are going to get at it, and I will just keep

going at it. I want to understand. I don’t want to be in a chess

game with you, I just want to understand. So, bottom line, say it

over again then in a different way. Try to reach this ignorant mind

that I have.

Dr. KIZER. Let me try to rephrase it in a way that may make it

more clear then, Mr. Chairman. The VA has been consistently, and

certainly during my tenure, as evidenced by a variety of things,

some of which I referenced during my opening statement—has

been open to and has been concerned about the exposure of troops

to chemical warfare agents.

As far as the specific research protocols that were funded, the potential exposure was given lower priority than others—— Mr. SHAYS. Because?

Dr. KIZER. Because of the information that was provided by

DOD, although if you look at the nature of the studies that were

funded, the potential effects that those agents might have were the

subject of investigation, although the exposure, per se, may not

have been.

Mr. SHAYS. OK. I find it a little disingenuous, after having six

hearings, to have you suggest that the VA was focused in on exposure to offensive or defensive chemical weapons. You basically said

it is a lower priority. A lower priority implies just what it says; it

wasn’t a higher priority, it was a lower priority, and that was the

case because of information from the DOD.

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To say that you are open or concerned is a meaningless statement, to me. That just means you are open or concerned, it doesn’t

mean you took action. And to imply there were studies, we have

had past witnesses come before us and say basically there were no

studies done. There may have been people out in the field doing

something, but did not look at this issue; is that right? Did the VA

direct any of your people to look at offensive or defensive exposure

to chemicals?

Dr. KIZER. Again, to try to make this clear to you, Mr. Chairman,

the issue where we’re perhaps miscommunicating on are the effects

of exposure and exposure, per se. As I said—— Mr. SHAYS. I asked a question. I just want an answer to that

question. Tell me the list of studies the VA directed to be done on

offensive or defensive exposure to chemicals.

Dr. KIZER. Again, the list of studies is provided—— Mr. SHAYS. No; give me a list of studies related to offensive or

defensive exposures to chemicals.

Dr. KIZER. I guess I am having trouble communicating the difference between exposure and the effects of exposure. As I said, the

effect that such exposure might produce in human beings has been

the subject of investigations.

Mr. SHAYS. What are those studies?

Dr. KIZER. The potential exposure—— Mr. SHAYS. What are those studies?

Dr. KIZER. Again, if one were to look—— Mr. SHAYS. Don’t hold up a book. Again, studies dealing with offensive or defensive chemicals.

Dr. KIZER. I am at a loss. We’ll be happy—— Mr. SHAYS. Don’t be at a loss. You are being evasive.

Dr. KIZER. No, no—— Mr. SHAYS. Doctor, you are being evasive. I am asking a simple

question. You want us to believe the VA is doing all these things,

and I am saying just give me a list. We have had past witnesses

come before us and say: because the DOD said there was no exposure, it did not get the attention from the VA. And now you are

telling me that even though it was a low priority, we still were

studying it.

We know for a fact you didn’t even ask the Registry to ask people

coming before it if they were exposed until 1995. And we asked

people who work for the VA, including Dr. Murphy, why, and she

said because the VA and the DOD had said there was not this exposure, you did not do it. She is shaking her head. She will get a

chance to come before us.

The bottom line is, when did you start to ask the Registry to ask

when our troops were exposed?

Dr. KIZER. I will defer to Dr. Murphy for the exact date. I believe

you are mischaracterizing what I have said.

Mr. SHAYS. OK. It is all a matter of public record. But the bottom

line is, when did the VA decide to ask in the Registry whether our

troops were exposed to chemicals?

Dr. KIZER. The Uniform Case Assessment Protocol, I believe, was

established in 1993, and that was used throughout. As far as the

revised Registry examination, that was formally put in place, I believe, in 1995; and we can get the specific date.

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Mr. SHAYS. Right. So you didn’t even begin to ask our troops if

they felt they were exposed to chemicals until 1995.

Dr. KIZER. Again, I don’t believe that is an accurate statement

insofar as the Uniform Case Assessment did ask that, and, more

importantly—— Mr. SHAYS. Sir, excuse me a second.

Dr. KIZER [continuing]. Asked about the effects of exposure.

Mr. SHAYS. Are you saying before this committee that you asked

before 1995 whether our troops were exposed to chemicals? Is that

your testimony before this committee?

Dr. KIZER. It is my understanding that the Uniform Case Assessment Protocol that existed prior to my joining the Department did

explore those issues before—— Mr. SHAYS. That is not what I asked. I asked specifically. ‘‘Explore’’ is too general a word.

Dr. KIZER. The specific revision of the Registry examination—— Mr. SHAYS. Doctor, let me say this to you. There are a lot of

things that you are going to be right on, but at least establish some

basic point that we can have so we can communicate with each

other. We have had witnesses who have come before you.

This is now the seventh hearing, and it is an established fact

that you were not asking this question early on because the DOD

told you it wasn’t a problem. That is an established fact. So if we

cannot at least agree on a basis, we are just going to be dead in

the water right now.

Is there a comment you want to make?

Dr. KIZER. I think it is a comment I’ve tried to say in several

ways in our short dialog already. The protocol, the specific question

you are referring to, was developed in 1994. It was formally implemented in 1995.

Mr. SHAYS. Why did it take so long to get an answer out of a

basic question? It was not formally asked until 1995; correct? I

mean, it is not a big point.

Dr. KIZER. I know, and I guess I am——

Mr. SHAYS. You don’t have to worry whether it is a big or little

point, you just have to answer the fact, and we will see where it

goes.

1995 is the point at which you began to ask our troops if they

were exposed to chemicals. Is that correct?

Dr. KIZER. I don’t believe that is correct, sir, because our physicians were asking the question before that. You asked whether a

standard Registry examination, whether that was developed in

1995——

Mr. SHAYS. I asked whether the Registry required you to ask

that question, and my understanding is—and I am not going to

yield this floor until I get this one point; we will be here in spite

of what happens on the floor, because we are going to get to the

bottom of this. The reason this is going to be so long is, you cannot

even establish basic points.

Now, the question I am asking you is, is it not true that the Registry did not ask this question until 1995?

Dr. KIZER. As I think I have said on several occasions, our physicians were asking the question. As far as the—— Mr. SHAYS. I am asking about the Registry——

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Dr. KIZER. That was developed in 1994 and implemented formally in 1995.

Mr. SHAYS. So I will ask the question again. Is it a fact that the

Registry did not require these questions until 1995?

Dr. KIZER. Again, physicians performing the Registry examinations before that time asked those questions. Did everybody ask it?

I can’t say that they did, no, but it certainly was being asked and

being explored, and, more importantly, the effects of what those

agents would cause was being assessed.

As far as the specific Registry protocol examination, as I have

said already, that was developed in 1994 and formally implemented

in 1995.

Mr. SHAYS. So the Registry did not require those questions until

1995. Is that not correct?

Dr. KIZER. It is not clear how what you are saying and what I

am saying are different.

Mr. SHAYS. You don’t have to worry about it; you don’t; all you

have to do is answer a question that is quite simple.

Dr. KIZER. I stand by my answer.

Mr. SHAYS. So the answer is, the Registry did not have to do it

until 1995. Is that correct?

Dr. KIZER. Again, the Registry protocol we’re talking about was

developed in 1994 and implemented in 1995.

I don’t understand what the problem is.

Mr. SHAYS. Why are you so reluctant to answer that question?

Why is that such a big deal to you?

Dr. KIZER. Because I am trying to answer as completely as possible.

Mr. SHAYS. You are trying to be evasive.

Dr. KIZER. I am not trying to be evasive, Mr. Chairman.

Mr. SHAYS. You are playing a chess game and being evasive.

Dr. KIZER. I beg to differ with you respectfully, sir.

Mr. SANDERS. With the chairman’s kind indulgence, let me pick

up on your general line of questioning.

It is now recognized that some of our soldiers may have been exposed to chemical warfare agents. We agree on that, right?

Dr. KIZER. Yes, it has been our position from the outset.

Mr. SANDERS. All right. In addition to that, it is generally recognized that our soldiers were exposed to heavy use of insecticides

and repellents. They were exposed to leaded fuels used for heating

and dust mitigation. They were exposed, some of them, to radioactivity from depleted uranium shells fired at Iraqi tanks. Many of

them were exposed to very dense smoke from oil well fires when

Saddam Hussein set the Kuwaiti oil wells on fire. They were exposed to parasites that cause a chronic infection, and they may

have been exposed to the side effects of troop inoculations in combination with the taking of experimental antinerve gas drug, PB.

Do you agree with that, all of that?

Dr. KIZER. I agree there was variable exposure to the list of

things that you mentioned. One of the difficulties throughout this

thing is knowing exactly who was exposed—— Mr. SANDERS. I understand that. But you will not disagree, there

was a chemical cesspool and more or less some of our soldiers were

exposed to some or all of those agents. Is that fair?

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Dr. KIZER. Yes. I think, as reflected by our research agenda assessing all of the things that you mentioned, that that is a fact,

that we have tried to assess that further, because we believe that

those exposures were real.

Mr. SANDERS. OK. Mr. Chairman, I am reading from a document;

it is called ‘‘Treatment Protocol: A Biopsychosocial Therapeutic Approach for the Treatment of Multiple Chemical Sensitivity Syndrome in Veterans of Desert Storm,’’ by Dr. Myra Shayevitz, physician at the Veterans Administration, dated May 5, 1995.

First paragraph: ‘‘Experience at North Hampton Veterans Medical Center has led us to believe that the unexplained health problems of some Persian Gulf veterans may relate to the combination

of chemical, physical, and psychological stresses unique to the

Desert Storm operation. Veterans seen at our facility and elsewhere have complained repeatedly of multisymptom symptomatology, including overriding fatigue, memory loss, joint pains, loss

of concentrating ability, depression, headache, rash, cough, and abdominal pain. This symptomatology is remarkably similar to the

syndrome which has been labeled ‘multiple chemical sensitivity.’

MCS is a condition in which multiple symptoms occur in multiple

symptoms of organs of the body as a result of exposure to chemicals.’’

Now, according to Dr. Burton Shayevitz, who is Myra Shayevitz’

husband and also a physician, I believe at the VA, this treatment

protocol was presented to a House subcommittee in 1993, to the

NIH Symposium on Persian Gulf Syndrome in 1994, cleared

through a VA scientific advisory board in 1995, and subsequently

derailed at the VA central office by the newly appointed chief medical director. Would that be you?

Who is the chief medical director?

Dr. KIZER. Well, that is the former title of my position, but I can

tell you, if that is what the testimony was, that is incorrect.

Mr. SANDERS. You have here—this is not important. This is a

protocol done by a physician in North Hampton, MA, employed by

the Veterans Administration. Are you familiar with it at all?

Dr. KIZER. I don’t know that I’ve read that specific document.

Mr. SANDERS. Are you familiar with her work?

Dr. KIZER. I’ve heard of her work, yes.

Mr. SANDERS. I don’t want to see us in an adversarial position.

I mean, let’s be frank. I have enormous respect for Secretary

Brown. He is one of the important and good government officials

we have. I have no doubt everybody up there wants to see us get

to the root of this problem. We are on the same side, so let’s not

be playing games and let’s not get defensive. We are on the same

side here, and I am appreciative of the changes we may be seeing

in the Department of Defense as well.

I have a simple question. Picking up from the chairman’s line of

questioning, given all of this exposure and given the presumption

that some of it may have been synergistic—people are affected with

more than one thing—can you tell us how many diagnoses you

have made, the VA has made: OK, he is sick because of overexposure to a variety of chemicals? Do you have that diagnosis? Are

there any patients who have been diagnosed in that regard?

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Dr. KIZER. I don’t have the specific number you are referring to.

As I stated in my testimony, somewhere around between 4 and 5

percent of patients have been diagnosed with conditions that were

related to toxic exposure or injury. Many of the other conditions

may well have been in part due to that.

Mr. SANDERS. Give me some examples of men and women who

were exposed. How were they exposed? How did you diagnose

them? Five percent is a big number. Give me a couple of examples.

Dr. KIZER. I’m not sure I understand what you are asking.

Mr. SANDERS. OK. You said 5 percent of folks were diagnosed as

being exposed as a result of toxic injury. Is that what you are saying?

Dr. KIZER. That is if you look at the aggregate of the nearly

63,000 Registry examinations. If you look at the breakdown by diagnostic category, you see somewhere between 4 and 5 percent.

Mr. SANDERS. OK. Give me some of the factors that led to toxic

injury. What do you mean?

Dr. KIZER. Again, I think that what we ought to do to make that

more precise is go back, and I can give you that specific diagnosis

by pulling direct records that would more completely answer your

inquiry.

Mr. SANDERS. I am not sure what it means. You said you diagnosed several thousands. I am not being argumentative.

Dr. KIZER. No; I am just saying perhaps Dr. Murphy would like

to comment on some of the specific diagnoses that have been given.

We can provide you more complete information. I don’t have that

information.

Mr. SANDERS. Have you diagnosed anybody who might have been

made ill as a result of exposure to the bad air from the burning

oil wells or the inoculations they may have received?

Dr. KIZER. I am sorry, I missed part of your question.

Mr. SANDERS. Is there any soldier who has been diagnosed as

being made ill as a result of exposure to the bad air from the oil

wells or the inoculations they received?

Dr. KIZER. If one is diagnosed with, say, bronchospasm, tightening of the airways, as what’s seen in asthma that was due to the

chemical-resistant paint, that is the sort of thing we are talking

about, or an example of the sort of thing we are talking about for

example, bronchitis due to oil well smoke, sinusitis from——

Mr. SANDERS. You have diagnosed people as having been made

ill as a result of the smoke of the burning of the oil wells?

Dr. KIZER. That is my understanding, yes, sir.

Mr. SANDERS. OK. My last question, Dr. Kizer, would be, if you

have physicians who are already within the VA system who have

treated people under the diagnosis of multiple chemical sensitivity—and my strong understanding of their therapeutic approach

to the treatment is that it does not have side effects, it is good diet,

trying to get people away from toxicity; it’s not going to make you

worse; it is not like using an experimental drug—why aren’t you—

you made a good point, you don’t want to see veterans being guinea

pigs, but if we have a treatment that is nontoxic, it doesn’t make

people sicker. You have some physicians who have treated tens of

thousands of people that way with good results. We have names of

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people today who are successfully treating people who are over in

the Persian Gulf. Why aren’t we moving faster in that direction?

Dr. KIZER. Well, I think the point you are addressing is whether—with regard to Dr. Shayevitz, whether her study was funded or

whether as part of treatment these things are being done. And her

study was not funded, as I think you know. We have hired a—what

might be called a methodologist, someone to help her design a

study that will provide the most reliable results to help her develop

an investigative protocol—— Mr. SANDERS. She is no longer with the VA; I think she gave up

on that.

Dr. KIZER [continuing]. That could be funded.

The issue of whether patients are being encouraged as far as

changing their diet, stress reduction, or any number of other

things, that is occurring in lots of places throughout the VA as part

of treatment.

Mr. SANDERS. I guess what I am suggesting is, science is a funny

thing; 30 or 40 years ago doctors were on television advertising the

cigarettes they smoked; breast feeding was thought to be a terrible

thing for mothers and babies; and many physicians out there are

treating civilians who are overdosed by toxins in our air, food, and

so forth and so on.

It is a nondangerous form, the treatment. Maybe it is wrong, but

it would seem to me, on behalf of thousands of Gulf war veterans

who are suffering, not to allow them to take advantage of this nondangerous type of treatment is unfortunate. Can you give me some

assurance that we will be looking at that approach?

Dr. KIZER. As I said, those sorts of things are occurring to varying degrees. As far as investigative studies that would look at

whether that should become a standard part of treatment, those

studies need to be looked at as far as methodology that would give

us a good answer.

Mr. SANDERS. See, one of the problems where serious physicians

get discouraged; they bump into walls like that. You can defeat any

proposal you want by saying it is not peer reviewed, and there are

people who have a different approach, and I would hope, on behalf

of thousands of people who are sick, we will overcome that resistance.

Mr. SHAYS. Mr. Horn.

Mr. HORN. Thank you very much, Mr. Chairman. I commend you

and the ranking member for this series of hearings and I have

found the exchange this morning very fascinating.

Just to get this out, I am not going to pursue it, but I have a

tendency to write down conclusions as I listen to testimony, and

Dr. Kizer’s testimony—tell me if I am right or wrong—with some

exceptions, the VA was not as focused as it should have been based

on the DOD history which it received. Is that a fair statement?

Dr. KIZER. I think what you are alluding to is, the priority given

to researching the exposure to chemical warfare agents was not

given as high of a priority as it might have been given if different

information would have been provided.

Mr. HORN. It seemed to be a nonproblem coming out of the Pentagon during the early years after the war. Is that what you have

concluded?

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Dr. KIZER. The answer is yes. They said this is not a problem.

Indeed, referring back to comments I had made and others had

made, when we questioned that, we were very strongly apprised

that that was not the case, and I think as were a number of other

groups that looked at this. And so the research specifically into the

exposure side was given lesser priority, and I think that is what

you are saying.

Mr. HORN. As I listened to this testimony, I wanted to find out,

what is the extent of the VA data base on its patient clientele? Is

there a national data base where all the veterans’ hospitals input

data as to symptoms and the rest?

Dr. KIZER. Yes, that’s correct.

Mr. HORN. There is a national data base.

Dr. KIZER. There is. We also get the data from DOD as well.

Mr. HORN. Now, as I look at the symptoms on page 3 of your testimony, those are pretty general symptoms. As you describe it in

paragraph 2, a diverse array of symptoms including fatigue, skin

rash, headache, muscle and joint pain, memory problems, shortness

of breath, sleep disturbances, gastrointestinal symptoms, and chest

pain. I think everybody feels they have had that going through college almost, one or the other, two or three or four, depending on

how nervous they get before a test.

Dr. KIZER. Certainly you get them before appearing before this

committee.

Mr. HORN. They are pretty general. Yes, the administration witnesses and sometimes Members on the other side of the table.

Were any tests run on your data base as to symptoms of those

that served in the Persian Gulf war, those that were in the affected

area? Because we didn’t know what the affected area was until

more recently, and those in the military or those veterans of the

Second World War, the Korean and Vietnam wars, where your data

base showed these symptoms, one, two, three, four, or more, was

there any analysis like that done? Could there have been any analysis like that done, which would focus in on where you were in the

Persian Gulf war, if they knew where they were in a vast desert?

Dr. KIZER. Well, you raise three questions, if I might address

them. One, the listing that is given to you is a compilation of many

specific diagnoses, and we’ve tried to lump them into categories.

If you went back and looked at that 14.4 percent of this and 15.1

percent, whatever, you would find lots of specific diagnoses. So that

is, I just want to make sure that you understand, as I suspect you

do, that there is much greater specificity within those categories.

The issue about whether these symptoms are the same as might

have been experienced with Vietnam or the Korean Conflict or

World War II veterans, the degree of data and rigor that is available from earlier times is not as good, and we have to rely on that

historical base.

But on comparing the grouping of diagnoses among Persian Gulf

veterans compared to, say, Vietnam veterans, there are differences,

and those have been noted, and things have previously been provided to this committee and other committees as well where there

are some of those differences.

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For example, fatigue is much more commonly expressed among

our Persian Gulf veterans than it was as a symptom in Vietnam

veterans.

The third point—— Mr. HORN. OK. Go ahead.

Dr. KIZER. The third point, and it really is a very important one

that I’ve testified about on numerous occasions before other committees, is the potential of having the specific information you

noted.

If we note that veterans in the aggregate have specific symptoms, what we really need to know is—and it goes back to part of

what Mr. Sanders was asking—where were they at a particular

time? And then we can try to connect the exposure, oil well fire or

depleted uranium, of any of those other things, with their specific

symptomatology and do those sort of comparisons.

Again, this is an area where we have to rely on the Department

of Defense to provide us that data, and, to date, they have not been

able to provide us with the geographic locator study pinpointing exactly where individual veterans and units were at a point in time

so we can do that sort of symptom and site potential exposure assessment that ultimately does need to be done.

Mr. HORN. Well, if you are using a national data base and you

said, OK, let’s search for data where one person has four of these

nine symptoms or seven of these nine symptoms early on in this,

how many people coming into a VA hospital would it take before

it started triggering some real concern that we’ve got a certain

group here that has four of these symptoms, seven of these symptoms, whatever, and then we work backward and know we’ve got

a problem coming through the door? This is a client analysis, if you

will. Was that done before 1995 in any way?

Dr. KIZER. Yes, indeed, it was done. In fact, a Registry examination, designed as a health access vehicle, was designed in 1991 and

implemented in early 1992, and that was the first—I forgot the

word that you used, but it was the first program put in place by

the VA to help our veterans gain access to the system where those

diagnoses could be made, treatment could be rendered, and that

sort of analysis that would be a basis or a platform upon which

more rigorous analysis could be done.

Mr. HORN. What is the earliest the VA knew there was a problem here even if the Pentagon said there wasn’t a problem? What

is the earliest your data says we have got 100, we have got 500,

we have got 1,000? Were there any numbers of that size? I am interested in something in the future, not making the same mistake.

Dr. KIZER. Having not been with the Department at that point

in time, I can’t speak from firsthand experience. It was my understanding that shortly after the Registry started to be done, there

was a recognition there was a problem, albeit ill-defined at that

time.

Mr. HORN. I note that you noted in the committee’s recommendations a computerized central data base is important. Now, are you

referring to the VA or the Pentagon data base? And to what degree

did your committee examine what the data base was in the Pentagon in terms of the medical services? And again, can that flow

in from the various medical facilities of the relevant services?

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Dr. CUSTIS. I will refer to Ms. Gwin, but to my knowledge there

was no data base available to the committee prior to 1995 when all

parties started to become more concerned about having ignored the

possibility of low-level exposure.

Mr. HORN. Well, was the committee referring to the VA when it

said a computerized central data base is important, or were they

referring to the services?

Ms. GWIN. What we hope to see eventually is a centralized data

base that would enable a sort of transparent exchange of records

between the military services and the VA, so that people’s health

records are available throughout their tenure in the Government

health services systems.

Dr. CUSTIS. I am sorry, I misunderstood your question. The computerized data base is now under development and is not a finished

product.

Mr. HORN. In the Department of Defense.

Dr. CUSTIS. A data base that is common to both the Department

of Defense and the VA, so that it is mutually interchangeable.

Mr. HORN. OK. In the committee’s deliberations, did they interview any of the doctors who were in the field, and how close were

M.D.’s to the action that we know that Khamisiyah occurred?

Dr. CUSTIS. In addition to full committee meetings and panel

meetings, there were also site visits to VA hospitals and military

hospitals, and at the time of those site visits, there were numerous

interviews with physicians involved in doing the examinations. It

was the impression of those of us——

Mr. HORN. Well, excuse me; examinations at what point? I mean,

did anybody have these symptoms during the Persian Gulf war?

Realizing it was 100 days and all that, when did they actually first

know in terms of the medical staff of, let’s say, the Army, and how

close were they to people who might have been exposed to this situation while the aftermath of the war, the oil fumes and all the rest,

were being cleaned up?

Dr. CUSTIS. I can only respond to your question in a general way.

As to specifically how many were aware of symptoms during the

Persian Gulf, others might be able to answer that. It’s my impression that few, if any, were sick at that time. This is a delayed onset

illness characterized as veterans’ so-called syndrome.

Mr. HORN. So your committee did interview some of the medical

personnel who were in the area.

Dr. CUSTIS. No; the medical personnel were conducting the examinations of veterans who were registering, who were being admitted to the Registry.

Mr. HORN. See, I am talking about military medical personnel in

field hospital.

Dr. CUSTIS. We also did that. I remember quite vividly Dr.

Dunn’s testimony, who was the physician who recognized——

Mr. HORN. Something is wrong.

Dr. CUSTIS [continuing]. In the soldier who had been exposed to

mustard gas.

There were other physicians who had served in the Gulf who

came before the committee and testified.

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Ms. GWIN. We did both take testimony from and conduct independent interviews with medical personnel who were in the field

during the war.

Mr. HORN. You mentioned in your testimony, Dr. Rostker, about

the Czech masks being better than our masks in terms of detection

and protection.

Mr. ROSTKER. No; what I said—— Mr. HORN. Did I hear you wrong? You said Czech detectors were

more sensitive than United States equipment, which may explain

why we could not confirm—— Mr. ROSTKER. That is correct.

Mr. HORN. And this is not masks, just other equipment in the

field.

Mr. ROSTKER. The Czechs were actually hired by the Saudi

Arabis to provide detection. They had equipment that had been developed for use by the Warsaw Pact. I once called it sophisticated,

and I was corrected. It is much more sensitive but not very sophisticated equipment. And they did make detections which we believe

are valid detections. When we sent FOX vehicles out, the detection

equipment would, and this would occur several hours later. The

equipment we had was not as sensitive as the Czech detectors. So

at the low levels, we may well have missed something that the

Czech detectors had found.

Mr. HORN. Has the Department of Defense remedied their inferior problem and bought Czech equipment?

Mr. ROSTKER. Well, we haven’t bought Czech equipment, but we

have been looking at the equipment we use and improving their

sensitivity.

I think an open question which we are prepared to address is the

issue of low-level chemical monitors on the battlefield, and, in that

regard, I would point out that, as best we know, the Czech detectors went off over a limited number of days in January and then

did not go off again. We’re going to work with the Czechs to make

sure that that statement is correct.

But as a low-level chemical detector, the Czechs certainly had

the most sensitive equipment on the battlefield, that’s correct.

Mr. HORN. I think Members of Congress tell their constituents

and pride themselves that our Army is the best equipped in the

world. Would you say this is a weakness in this area that needs

to be remedied?

Mr. ROSTKER. Yes, I would. The detectors that we had were sensitive to lethal doses. The famous M8 alarm was sensitive to lethal

doses of sarin. The replacement alarm is sensitive to not only sarin

but mustard gas.

So we have a concerted effort which will be expanded through my

efforts to make sure we learn the lessons and we put in place that

equipment that is necessary to protect our troops in the future.

I might add that in general the degree of environmental monitoring that, for example, is going on in Bosnia today is much superior to what went on in the Gulf, and yet we can make further improvements and we are learning lessons even from Bosnia.

Mr. HORN. Mr. Chairman, if I could suggest the staff to followup

with the Department of Defense and make sure the equipment is

being ordered in the current fiscal year, not waiting for the next

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fiscal year, that we program the necessary funds to have the detectors should they be called on to be used somewhere around the

world.

Mr. SHAYS. Thank you.

I now call on the ranking member, Mr. Towns.

Mr. TOWNS. Thank you very much, Mr. Chairman.

Let me begin by saying something I said in the last Congress,

that we view this as a very important issue, and we are not going

to go away, we are going to stay here, we are going to deal with

it.

I made the comment then that I would return and would continue to pursue this issue, and we are going to continue to pursue

it. I would hope that we would recognize that this is a problem we

all must work together to solve, which means that we must be open

and honest with each other. We must share because there might

be some things that we need to do on this side, and we want to

do that to make certain we have the answers.

Let me begin with you, Dr. Rostker. In your testimony you stated

that the Department of Defense has expanded its task force from

12 to 110, which seems to be a lot. Why so many?

No, that is not really my question. Can you tell me what these

additional people would be doing?

Mr. ROSTKER. Sure. Let me first say the team that was in existence, the 12, were completely overwhelmed by the reality of

Khamisiyah. They were bogged down in the administrative details

of writing testimony, of responding to congressional inquiries, and

responding to the press. They were so bogged down, they were unable to examine anything about Khamisiyah, and even Khamisiyah

not as robustly as they should have. I think that is a conclusion

that the PAC will come to, and it is a conclusion we basically

share.

It was in September that Secretary White asked me to assess everything we were doing, because we had come to the uncomfortable

realization that the efforts that were being put forth were clearly

not appropriate, and it took a short while for me to come to him,

in fact well before the PAC issued their interim report, and to say

that the effort we’ve had was understaffed, poorly focused, and inadequate to the job.

If you look at the organization which I’ve put together, it allows

us to truly meet the President’s promise of leaving no stone

unturned. We have much expanded the investigative team. We’ve

provided, as the PAC has so wisely suggested, for a risk communication program with outreach to our veterans, with outreach to

veterans’ service organizations. I make myself available to them

and to the press as well as, of course, to the committee.

It takes people to do that, and we’re prepared, the Defense Department is prepared, to put in place those resources necessary to

get to the bottom of what is causing our people to be sick.

Mr. TOWNS. I am glad to hear you say that.

I note that much of your testimony concerns efforts to expand

communications with the active duty personnel about their Gulf

war experiences. I am concerned that many veterans will not want

to increase communication with the Department of Defense. Why

would you think they would want to increase their communication

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with the Department of Defense? Let’s be open. The perception is

that you are the problem.

Mr. ROSTKER. I understand that, and the only way I can work

that perception is to work hard and tell the truth and open up the

process, and that is what we have done.

It was quite clear, for example, that when a veteran called in and

we took a short statement from him or her, that that was inadequate. It was inadequate for our own purposes, but it was inadequate in terms of just a human response to somebody who was

hurting.

On December 13, we completely changed that procedure. So now

we establish a one-to-one contact; we debrief the veteran and make

sure that that information is incorporated into our inquiry. And I

trust that as we work and demonstrate that type of commitment

to individual veterans, to this committee, to the veterans’ service

organizations, we will be able to repair the unfortunate perceptions

of not caring. We care, but we really did not understand the dimension of the problem and our response was totally inadequate.

Mr. TOWNS. The chairman asked a question at the beginning:

Did you disagree on anything that was said by anyone else? And

I think it was Dr. Custis who said that DOD mishandled this problem. Do you agree?

Mr. ROSTKER. Absolutely. We have said so. I had come to that

conclusion and shared that conclusion with the Deputy Secretary

before the PAC reported, and John White said to me, ‘‘Don’t give

me a recommendation, go fix it,’’ and he gave me the resources to

do just that.

So frankly, the PAC got it right, and I am sorry that I have to

say that, but that is reality, and we have to build from that to repair the damage that may have been done. It was not intentional,

but it was not an adequate job. We understand that, and, as I said,

we’ve put the resources to bear on this issue so that we can get to

the bottom of it.

It is very important we do this for today’s veteran, but I want

to stress how important it is that we learn from this experience so

that we put in place those procedures and equipment and policies

that will allow us to protect our forces in the future. We owe it to

them, and we owe it to today’s veterans.

Mr. TOWNS. Thank you.

There have been some reports in the press concerning missing

operational logs. It would seem that you need these logs to reconstruct events and to compare them with accounts provided by the

soldiers. What can you do or have you done to reconstruct these

missing logs?

Mr. ROSTKER. First of all, let me tell you that most people have

an image of the logs being a series of printed forms that people

wrote in and a book that would be certainly hard to explain why

pages have been removed. But we know, in fact, that the logs were

actually a computer form and a hard drive of a computer that was

in Riyadh.

We have tried through many channels to see if there are, in fact,

pages that we may have lost. But I have also initiated an effort

with two lawyers to trace the accountability of those computer hard

drives and any floppy disks that were produced from Riyadh, all

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the way as far as we can do it. And I’ve done this not just with

interviews but with verbatim testimony from the people who had

access, so you and the PAC and others can see the exact questions

we asked and the exact responses that we got.

I am not at all certain that the pages that are not there were

ever printed out, but I can’t tell you that for sure, and we’re trying

to reconstruct the chain of accountability for whatever floppy disks

existed and the hard drives as they came out of Riyadh and moved

to Tampa and went forward.

If I might, we focus on the missing pages, but the 36 pages which

exist are extremely interesting, and part of what I quoted this

morning were from those pages. We can find the major events,

some of the major events like the Czech detection, like the Marine

breaching operation; we can corroborate Lenny Grass’s testimony;

we can do all of that in the existing logs. So they are, in fact, very

useful and corroborate other reports that we have.

Mr. TOWNS. Thank you very much.

Dr. Custis, what enforcement mechanisms are available to the

committee in the event you found out that an agency is not being

forthcoming?

Dr. CUSTIS. That sounds like a legal question, and I will defer

to my lawyer.

Mr. TOWNS. Sure.

Ms. GWIN. We have found just the opportunity to bring the agencies forward on a regular basis in open meetings to be a fairly effective enforcement tool to make them answer questions about

progress.

Mr. TOWNS. If you feel they are stalling, what other action can

you take as a committee? Eventually, if you find out that the agency is not forthcoming with information that you know exists and

you are convinced it exists, what actions can you take? That is the

question.

Ms. GWIN. Well, we are an advisory committee. We don’t have

particular authority to sanction anybody, but, again, I will say, just

raising the existence or presumed existence of information publicly

has a strong enforcing effect to make that information become public.

Mr. ROSTKER. I think it is only fair to say that the committee

found DOD, VA, HHS, all very cooperative. The problem came in

DOD themselves not recognizing the need to acquire certain data

or pursue certain data. But as far as any lack of cooperation or attempt at hiding, I don’t believe the committee experienced anything

like that.

Mr. TOWNS. Thank you. I am happy to hear that.

Let me just say that, you know, I might as well say this openly.

You know, DOD, I am happy to hear the comments coming forth

at this particular time, because I think that many people feel that

the reason we are in this mess, the reason we haven’t been able

to move a lot faster, is that DOD did not cooperate. And as I listen

to some of the questions that were directed to Dr. Kizer, you know,

I think that the reason some of those questions were directed at

Dr. Kizer is because of the lack of participation on the part of DOD.

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So I think that inasmuch as I understood the questions and felt

that they should be directed, but I think that some of them came

about as a result of DOD not participating.

So I just sort of want to share that, and I am hoping that from

this point on, in terms of your comments, that you will be at the

table and continue to participate, because there is a very serious

problem out there. I am convinced, there is no doubt in my mind,

that it is out there, and it is going to require all of us to come together to be able to solve the problem. People are suffering. They

want to make certain we are working on it. That is what they

want.

So let me thank you, Mr. Chairman, for sticking with this, and

I think you should, and I think we should go on and on and on

until we get to the bottom. So some of these witnesses will need

to come back as we seek additional insight into the issue.

Mr. SHAYS. Thank you, Mr. Towns.

Dr. Curtis, what would you say the major mistakes were made

by the VA? And give me the top two, as relates to any Gulf war

syndrome, both the DOD and VA. What mistakes do you think

each of those Departments made in your extensive research?

Mr. ROSTKER. I think probably the main problem that has complicated the whole process is the inadequacy of medical records. It

is understandable that medical records have never been good in the

environment of acute combat.

Mr. SHAYS. Would that relate to the DOD or both the VA and

DOD?

Dr. ROSTKER. No; I am talking about military records, the

records in the field. I think we were impressed with DOD’s determination at the present time to correct that and to also pursue

how, in the future, any future conflicts, there will be acquired a

base line of information before troops are ever sent to a field, so

that epidemiological studies can be facilitated by such base line

data.

I think probably there are other things in retrospect better pursued. For example, risk communication, making our troops aware

of the risks that they were going to be exposed to, left quite a bit

to be desired. The risk involvement and the lack of data in terms

of——

Mr. SHAYS. I never realized how long it was.

Mr. ROSTKER. I think of a specific example, that the record is

very poor regarding who exactly took pyridostigmine; the lack of

site location of individuals and units.

Mr. SHAYS. Before we get to site: if a soldier was told that taking

the PB tablets would be harmful, if they felt the shots would be

harmful, would they have a right not to take them? If they were

told to go into a tent and, you know, use lindane to spray the

troops all day long without ventilation, would they and should they

be given the right to refuse to follow that order?

Mr. ROSTKER. In my own career I would answer that question,

they had no such right. They could well be guilty of an infraction

that would cause a court-martial. I am at least confused at the

present time. That seems to be the culture of our society seems to

be to challenge that. So I frankly don’t know how to answer your

question as of today.

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As far as pyridostigmine is concerned, there was no real concern

or evidence that anything harmful would result from taking that

medication. It has been used in large doses for many years for individuals with myasthenia gravis, with no appreciable side effects. It

has been known, however, in a very, very small percentage of patients that they are somewhat intolerant of pyridostigmine.

I am mindful of recently, for example—it is not unrelated to your

question—two individuals in the armed forces were court-martialed

for refusing to have serum drawn for a serum bank that DOD is

interested in. They were awarded disciplinary sentences, whereas

it seemed to me that it could have been handled better. But it

seems to me that our society seems to be changing their opinion

about such things.

Mr. SHAYS. The question responding to that, mistakes the DOD

made, you have given me a few. Would you be able to focus in on

mistakes you feel the VA made, or did you focus primarily on the

DOD?

Mr. ROSTKER. One thing that comes to mind as a result of some

of our site visits to VA hospitals: There was some evidence that,

whereas the education of how to handle the veterans reporting for

the Registry and for examinations in the Registry was well done

in terms of those who were dealing with those veterans, doctors

who were not in direct contact and were in many cases ill-informed

about how to proceed in the process, I suspect that early in the

game the VA might have—I think early in the game—that is,

early, right after the war, right after the Gulf conflict—there was

something less than good communication between DOD and VA,

and I would find VA somewhat at fault in not insisting that better

communication be established with DOD. That, however, is more

hearsay than anything else. I am not sure that that can be documented.

Beyond that, I find no fault with what the VA has done in the

way of performance. I think VA is to be complimented, along with

Congress, for having established the legislation for compensation,

even though some of these problems have not found their ultimate

solution. That alone, I think, proved a remarkable advancement in

what the soldiers and sailors have experienced in past conflicts.

Mr. SHAYS. Dr. Kizer, you suggested that Dr. Murphy might be

able to answer some questions, so I think it might be appropriate

to just have her come up and be sworn in so we could assist you.

Mr. SHAYS. If you would stand, Dr. Murphy.

[Witness sworn.]

Mr. SHAYS. I would like to say for the record as we start this

year, it was my hope and aspiration that we would just get a certain level of understanding and from that point we could iron out

our differences.

This Government Reform Committee has 360-degree jurisdiction

on waste, fraud, and abuse. This subcommittee does not have direct

jurisdiction, Dr. Rostker, of the DOD, and we appreciate your being

here. We do have jurisdiction, in the chairman and I think ranking

member as well, that we will have the authority to invite to come

before the committee, and I am sure you will agree.

Mr. ROSTKER. Absolutely.

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Mr. SHAYS I thought I would be able to pursue some questions

with you, and I am not even at that level yet. I just need to get

to the level where I can even ask you a question.

Dr. Murphy, we had two issues at your last hearing, one of them

related to the whole issue of registry and when the field actually

got the message of chemical exposure. And in my own simple mind,

I felt that it was reasonable to make an assumption that the DOD

wasn’t providing you information of exposure. You would have no

reason to think it other than to listen to some of your own troops

and what they were saying.

So I just want to ask you the two areas of questioning: one of

which is the number of doctors in the VA that were exposed. I assume you have expertise in chemical exposure and so on. And the

other issue was of the Registry, and how it related directly to Dr.

Kizer’s point that we just simply never communicated on.

I wanted to know when we started to revise the questionnaire

and the form. And you said the form was published in September

1995, and the instructions were changed in 1993 or 1994. So when

did the protocol begin in earnest? The original protocol began in

1992. That is what you said. It was revised in 1993, then again in

1995. Was the revision in 1993 a revision that was dealing with the

chemical exposure, or was it another exposure?

Dr. MURPHY. In 1993, at the Washington, DC, VA, we developed

the uniform case assessment protocol. The reason people are having so much difficulty telling you exactly when VA changed its

message is that chemical weapons exposure was never taken off

the table. And in the public statements by—— Mr. SHAYS. It was put on the table?

Dr. MURPHY. In public statements by Secretary Brown and when

Dr. Kizer joined us, it was always a consideration.

Mr. SHAYS. Let me just say—— Dr. MURPHY. And, in fact from the beginning, our physicians

were instructed to take complete occupational and military exposure histories.

Mr. SHAYS. It is always on the table, we are always open, we are

all concerned.

I want you to show me. So I don’t deny that you were always

open, you were always concerned, and it was always on the table,

but I am just trying to get at some basic facts. And the next time

I won’t inconvenience our other two witnesses and have them share

in this process. I will just invite the two of you, which I have the

authority to do.

And, Dr. Murphy, I will say, you have been here all the time,

and you have been a very willing witness in terms of being here.

Dr. Kizer, I was hoping I wouldn’t have to keep you before the

committee; once, and that would be it. And you will be coming back

quite often until we get to the bottom of it.

I understand you are open and concerned, and it was always on

the table. I just want some real facts. The fact is that in 1993 you

were not specifically in your Registry asking troops about chemical

exposure. It was not part of the protocol.

Dr. MURPHY. The protocol included instructions to physicians to

take a complete occupational and military exposure history. The information, the data fields that were coded at that point did not inVerDate 11-MAY-2000 10:15 Jun 28, 2002 Jkt 010199 PO 00000 Frm 00194 Fmt 6633 Sfmt 6602 W:\DISC\38711 pfrm04 PsN: 38711
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clude a specific coding of a question that asked about chemical warfare nerve agents and mustard gas.

Mr. SHAYS. I understand, and that is the fact. But in 1995 it

started to have that coding; is that correct?

Dr. MURPHY. That is correct.

Mr. SHAYS. Pardon me?

Dr. MURPHY. That is correct, sir.

Mr. SHAYS. You basically said 1995 is when you started focusing

on chemical exposure and your response—by the way, this is the

hearing dated December 11—was actually the focus began on

chemical exposure much earlier than that. As we have just said,

sir, the questionnaire was not published until then. The instructions to the field about how they should clinically evaluate these

individuals actually began as soon as we had a number of veterans

who came back to us.

Then I said, how would those instructions be disseminated? You

are saying it did not, in fact, happen in 1995, but years ago. I want

to know what document made that known to your doctors in the

field.

Your answer: These were training programs, training videotapes,

training audio conferences.

My response: You can supply a video to this committee that will

say that you expect an exposure, a chemical exposure, and therefore the doctors should proactively seek this out?

Your response: In conjunction with a whole list of other exposures that we still believe are important to ask about.

Then my point: I am not asking you about other things, I am just

focusing on the chemical exposure. And you are before a committee

of Congress who is simply trying to know the truth, and whatever

the truth is is fine. I just suspect that what you are telling me is

not really, frankly, a precise presentation to the committee. I want

to know what document you sent to the field that let them know

that you suspect the chemical weapons might have been used in

the field, and therefore they should check for chemical weapons.

Your response: We will provide you documentation.

Have you done that yet?

Dr. MURPHY. I am not aware that we have.

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Mr. SHAYS. For the record, we don’t have any documentation.

Let me just get to another question. I asked you the number of

doctors who had chemical expertise. Correct me if I am wrong, it

is my understanding that we don’t really have the ability to detect

chemical exposure, and we don’t really have the ability to treat

chemical exposure. This is not a medical science that is particularly

advanced. Is that accurate, or would you want to elaborate?

Dr. KIZER. At risk of appearing to be less than responsive, let me

just ask the question when you say ‘‘chemical,’’ are you referring

to a particular type of chemical? Because there are lots of chemicals that we have very good antidotes and very good treatment for.

Mr. SHAYS. That is fair. Sarin, the nerve gas agents.

Dr. KIZER. And again, the—if one is exposed to this category of

chemicals, organophosphates, carbamates, these types of chemicals,

and there is acute symptomatology, there is a very good antidote,

atropine, that is used when exposure of this occurs in other places,

with agricultural workers, et cetera.

As far as the delayed or long-term effects or effects that might

be caused when there is no clinical manifestation, that is what we

have said here and elsewhere, that there is no diagnostic test for

that particular type of exposure.

Mr. SHAYS. Or treatment?

Dr. KIZER. Or treatment, since one doesn’t know that the exposure caused the symptoms.

And let me, again, try to be as complete and responsive as possible, that for neurologic injury in general, depending on the degree

of insult, there may or may not be any treatment for it. When one

has a stroke because of a blood clot that causes damage to the

brain, there is no recovery of that part of the brain that has been

killed. So that is a general phenomenon that occurs to the central

nervous system regardless of the inciting insult.

Mr. SHAYS. What are the types of skills or specialties that you

have in the VA to deal with chemical exposure? Do you have a

Ph.D. in toxicology?

Dr. KIZER. No, I do not. I think you may be confusing toxicologists with medical toxicologists.

Mr. SHAYS. Elaborate for me. I am confused.

Dr. KIZER. Most toxicologists oversee the care of rats and mice.

That is what Ph.D. toxicologists do. Medical toxicologists, of which

there are 210 board certified medical toxicologists in the United

States, some of whom don’t practice in the United States but in

other countries, are often viewed or often characterized as the consultants’ consultant. They are a very, very small specialty, most of

whom are associated with poison centers or are doing investigations.

The bulk of toxicology care and—of course, hundreds of thousands of people each year are poisoned from either overdoses or industrial settings in lots of situations all the time, and that care is

provided by internists, by occupational medicine physicians, by

family physicians, by neurologists, by pulmonologists, by a host of

other specialists.

Medical toxicologists, which is what I believe you are referring

to, by and large don’t do that much hands-on care. And, of course,

with only 210 in the entire country, you can see why they wouldn’t,

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but most of those serve as consultants to other physicians who are

actually taking care of those patients.

Mr. SHAYS. How many doctors do we have in the VA system?

Dr. KIZER. To clarify, full-time physicians or—— Mr. SHAYS. Yes, let’s take full-time then part-time.

Dr. KIZER. Full-time and part-time, it is around 15,000.

Mr. SHAYS. And of the 15,000—and break down full-time equivalent—if you do it that way, so maybe it is not 15,000 full-time

equivalents, is it 15,000 or 10,000? When you teach at a university

or you work for the government at the State level, you would have

a full-time equivalent. If two people work part time, we call them

one full-time.

Dr. KIZER. I am sorry, I was looking for the exact number, which

I have somewhere in here, and I missed part of your question.

Mr. SHAYS. I understand. You approximately had 15,000, give or

take, and that is acceptable. Some of them are not full-time physicians for the VA.

Dr. KIZER. Probably half of them are not.

Mr. SHAYS. How many of those would have expertise in dealing

with poisons and chemical exposures?

Dr. KIZER. Again, if I can find the sheet, I can tell you. Internists, which are the largest single group of physicians that we

have, receive as part of their training exposure or education in

dealing with overdoses and other chemical exposures. And those

are, of course, the type of physician that provides the bulk of this

care in the country.

The occupational physicians, which, by the way, I do not feel the

VA has as many as they should have, and we are taking steps—— Mr. SHAYS. How many do you have of those?

Mr. KIZER. Of occupational medical physicians? Again, I don’t

have that number at the tip of my tongue, but we certainly can get

that for you.

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Mr. SHAYS. I am not going to hold my breath, and I sound a little

sarcastic because that is the same question we asked of Dr. Murphy last time. I asked her the question, I think it is telling that

you cannot name one person in the whole Department the only

name she gave me was Dr. Spencer, and that was a

neurotoxicologist, so some of them can be by definition. But I fully

expected I would get a response from Dr. Murphy to straighten me

out. She said, we can, of course, provide that for the record if you

are interested. We wanted to know the people involved, and I said

I would definitely like it for the record. And, Dr. Murphy, have you

provided me that information? I am asking the question, have you

provided that information yet?

Dr. MURPHY. We went back and searched our VA data base—— Mr. SHAYS. No, that is not the question I asked. I am allowed

to ask honest questions and get honest answers to the question.

Have you yet provided me that information? I am sorry?

Dr. MURPHY. No, sir, we did not.

Mr. SHAYS. Do you have that information now?

Dr. MURPHY. In searching our data bases, the VA personnel files,

we found that the research Ph.D.’s that we have in VA were not

broken down according to those categories. They are called research chemists, research health science specialists, physiologists,

microbiologists. And I have those numbers here today. We will

need to go out and actually query each of our medical centers

for——

Mr. SHAYS. When do you think you can provide that information?

Dr. MURPHY. We can do that.

Mr. SHAYS. When will we get that information?

Dr. MURPHY. It will take several weeks.

Mr. SHAYS. Dr. Kizer.

Dr. KIZER. I apologize for the delay here, but the numbers I was

looking for a moment ago in response to your question, the VA has

at least, according to the numbers I was given at the end—for the

end of December 31, 1996, we had 7,932 full-time physicians and

7,745 part-time physicians.

Mr. SHAYS. Thank you.

Dr. Kizer, when I went to the West Haven facility, they were

specifically asking questions about chemical exposure, and the reason was that they had physicians from Yale University who had expertise in environmental exposures. And so they had the expertise

to think to put it in their questions. They did it early on.

We have a big disagreement on this issue. My view is that the

soldiers were basically crying in the wilderness, and the one mistake I think the VA made was to listen to the DOD and not our

soldiers. That is my view of the six hearings I have had.

We have tried to document at every hearing by bringing in veterans who will testify to the fact that they feel they were voices in

the wilderness. And one of my theories if, in fact, that ultimately

is found to be true—because we will find the truth to it, because

whether it is true or not, we will know one way or the other eventually—was that they basically felt that the doctors that were

treating them had no background or expertise in chemical exposures, whether they were everyday chemicals or chemicals of war.

And the theory is, and it is one that I think is plausible, is that

214

they basically were constantly being discounted because we didn’t

have doctors who had that expertise.

I would like to ask, Dr. Custis, if you think that is a possibility,

if that ever showed up in your radar screen, or, Ms. Gwin, if that

ever showed up in your radar screen. And that was the issue: Does

the VA have people trained in chemical exposure? Then I will ask

you to respond, Dr. Kizer.

Dr. CUSTIS. Not beyond the internist who has the ability to address problems regarding different chemical exposures. You talk

about speciality, you are talking about a physician who goes beyond that point and goes into great depth on specifically exposure

to chemicals. For example, ophthalmologists have different categories of specialization. There are general ophthalmologists who

are perfectly capable of handling cataracts, for example. There are

also a subspecialty of ophthalmologists who do nothing but cataract

surgery.

I think, to answer your question, I am not aware of the VA having any physician who is beyond the 200 and some who can—as referred to, any one of those being in the VA. I can’t imagine the VA

having any need for that level of subspecialty expertise.

Mr. SHAYS. Let me just say to you in response to that—then I’m

going to call on Mr. Sanders, and, Mr. Rostker, believe it or not I

do have a question for you. And I am happy, Mr. Rostker, to have

you comment on anything you have heard as long as you want— I find your answer really surprising because we have had doctors

from the private sector come and testify that the VA basically

wasn’t listening to our area because they don’t really respect it.

That is their view. It may not be true. We have soldiers who were

continually saying, I was describing symptoms that didn’t seem to

be anything that they could relate to.

And it would strike me that we know that after World War I, the

DOD said, that no one had acute symptoms on the spot; therefore,

chemical exposure was not a problem. We still have General

Schwarzkopf saying that, and others saying if they didn’t die on

the spot, basically chemical exposure wasn’t a serious issue.

It strikes me that we knew after World War I that some soldiers

came home after the war with no acute symptoms, later developed

symptoms and died. We knew after the radiation that we are exposed to it. We know after Agent Orange; it was years later. And

it would seem to me that somebody’s radar screen would say, we

need people with expertise in these areas. This is war, and they

use chemicals. It does strike me as kind of amazing that we

wouldn’t have people with that expertise in the VA, but you basically don’t seem to be surprised by that.

Dr. CUSTIS. At the time that active duty personnel were exposed

to radiation, there was a general ignorance of what long-term exposure would amount to. We know better today.

Mr. SHAYS. I wonder if we know better. I wonder if we do.

Dr. CUSTIS. Medical science is much more informed about the

dosage that will cause a disease in terms of radiation exposure

than they were at the time when so many active duty people were

exposed in the South Pacific.

That same thing will be true, I predict—I think all of us feel that

the problem of low exposure to Sarin and chemical warfare agents

215

tomorrow will be much better understood, and there will be much

more expert knowledge.

I think you have touched upon a very real reason why DOD was

so slow in appreciating that this was a problem, namely that the

literature at that time would indicate that unless there were an

acute manifestation of chemical warfare agent exposure, that there

was no knowledge of any long-term ill effects.

DOD took that information from researching the literature at

face value and didn’t get particularly excited about it until there

was more and more concern about are we wrong? Is there such a

thing as a long-term effective low exposure?

I think it is a matter of how soon science and information catches

up with the medical profession.

To go back to your challenge regarding whether or not the VA

should have chemical experts, I think the need for chemical experts

can be satisfied through consultation, as Ken Kizer has just described.

Mr. SHAYS. Let me call on Mr. Sanders. Dr. Kizer, you will have

a chance to respond to that question.

Mr. SANDERS. Mr. Chairman, I appreciate your line of questioning, and I think this is what the problem may be: I think we

have people up there who are extremely well-intentioned. I do not

have the slightest doubt that they are working night and day trying to resolve this problem.

I think the thrust of your questioning is whether they, in fact,

have the background and understanding and the training, in all

due respect, to approach a new type of problem dealing with chemical sensitivity. I think your line of questioning is, how many physicians do you have; and maybe that you don’t have the proper resources.

Let me give you an example, picking up on the chairman’s questioning. There is a medical association called—I believe I have it

right—the American Academy of Environmental Medicine. To the

best of my knowledge, they have treated mostly civilians, some

25,000 people, over the last 20 years who have been made ill not

by swallowing a toxic—that is where the problem is. We are talking toxicology versus environmental medicine. What is the difference? They have wonderful physicians who, if you overdose on

something, you swallow something, they know how to treat it. And

I am absolutely confident they could diagnosis and treat it well.

Where, I believe, they do not have the background is the overall

area of what we call environmental medicine, the combination of

factors that make people sick. That is not a criticism. That is a contentious and debatable diagnosis in modern medicine today.

I would suggest to you—and this is what gets me a little concerned. And no one is here criticizing. We know you are trying your

best. But instead of saying, gee, we don’t have the background

here, let’s go to those people who may have the background.

If I were to tell you—if, as a common-sense observer out there

saying, gee, we have folks treating 25,000 cases of people, treated,

treated, why aren’t we running to those people and bringing them

in? I could list you names. Have you just—let me do this, picking

up on the chairman’s line of questioning—have you over the years

been in formal contact and asked for the advice of the American

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Academy of Environmental Medicine, have you done that, who

have treated 25,000 people who have been made ill by chemical exposure?

Dr. MURPHY. We actually have two MCS specialists on our VA

Persian Gulf expert committee, which is a federally chartered advisory committee that would give us advice on a routine basis.

Mr. SANDERS. But you didn’t answer my question, Doctor. Have

you brought those people—have you implemented any of the treatments that they are working on? There is treatment out there.

Have you? Yes or no.

Dr. KIZER. I will defer in part to Dr. Murphy, but I would underscore part of what you said or alluded to is that much of the treatment that is advanced is highly controversial as to both its efficacy

and in some cases its safety.

Mr. SANDERS. I beg to differ with you. Give me any evidence that

there is any safety element in this treatment. There has never been

any evidence of that. This is a low-tech type of treatment.

Dr. KIZER. You are referring to part of the treatment that has

been advanced by some of the members of that group. There are

others who have advanced other types of treatment that belong to

that group that does have safety implications, whether it is using

things like ads, which is concentrated bacteria, chelation therapy.

There are coffee enemas, a variety of other things. I think what

you are referring to is a portion of it, so I think you have to make

that distinction. In the aggregate there are concerns both about

safety and efficacy.

As far as the dietary treatment and things like that, that is

something that again we would remain open to. I think part of the

questioning there is that if we are going to fund the treatments,

pay for treatments that are not proven or that haven’t been shown

to be efficacious, then that means that somebody else may not be

treated because of limited funds. We have——

Mr. SANDERS. That is exactly what the problem is here. You are

talking about different approaches to science. I think you don’t

know, in all due respect. I think there is an area of work—let me

give you one example, if I can, Mr. Chairman, and I will explain

how I got involved in this. Be patient with me here.

As Members of Congress, we get a lot of strange calls. I got a

call from a woman in Montpelier, VT. She said to me, ‘‘Mr. Congressman, I installed a new carpet in my house. You are not going

to believe this, but I became very ill, and my kids became very ill.’’

And you know what I said? I said, lady—I didn’t say this, but this

woman is crazy. I never heard of such a thing, getting a carpet in

your house and getting ill. What kind of nutty stuff is this?

We did a little research. You know what we found out? Twentysix attorneys general throughout the United States of America

were pressuring the EPA and the Safety Products Committee here

in Washington to do something about it. This was a problem.

Well, we got into it, and the late Mike Synar of this committee

did a wonderful job, did a big hearing on it. We had the EPA up

here. The EPA said, yes, we know there is a problem. The EPA

itself, you might remember, Mr. Chairman, removed carpet from

their own building, you remember that, and they said, yes, we

217

know there is a problem, but we don’t fully understand the problem.

It turns out there are physicians all over the country who treat

for this and who wrote to us. We got all kinds of letters that say

we are treating kids, adults made sick by chemicals in carpets. We

had the EPA up in a hearing similar to this. Their line of reasoning, not dissimilar to yours is yes, we know there is a problem,

but we don’t know how to treat it and think there may be a problem. I asked them, have you talked to one physician who treated

one patient made ill by a carpet? I never forgot their answer: No,

we haven’t.

Essentially you are saying the same thing. You are saying there

are people out there, there are physicians out there, and while you

may be right that there may be some experimental and potentially

dangerous types of treatment, there are other treatments, as you

well know, that do not have dangers. It is amazing to me that you

are not begging to bring in those people who are providing lowtech, nondangerous treatments and see if they are efficacious or

not.

Dr. KIZER. I think we would welcome that, if I understand your

question, and I want to come back also to respond to a comment

that the chairman made. If those individuals are willing to look at

this, and it doesn’t have to be a long, drawn out study, but to look

at the efficacy of that treatment under accepted protocols or techniques that will give us a reliable answer, we are very willing to

look at that.

Let me put an offer on the table, because I think that in some

ways there is a good parallel example in the issue of silicone breast

implants, and the decision that was made by the judge in Oregon

in this case that—and because this also is an area of some contention—that if you want to name some experts that have nothing to

do with Persian Gulf, and we will name some experts and we will

put them together to agree on what the methodology, what the criteria should be for accepting the data, then we can do that.

And I think that is what was done in the case in Oregon; that

because of the proponents of different schools and different rationales as far as whether the silicone breast implants were causing

the alleged array of diseases, so the judge took noninterested individuals, who said these are the criteria that the evidence the data

should meet, and we have no vested interest in this whatsoever because this it not our area, but that is what sound science, sound

methodology, sound investigative principles would suggest——

Mr. SANDERS. Let me ask you a question. I mentioned to you before that you had a physician. Your own physician in Northampton,

MA was treating people with some success. Have you contacted

those patients? One of the things common sense would dictate if

somebody is treating somebody, is that you might want to ask, hey,

Sergeant, was that treatment successful? How did you feel before

you went in? How did you feel after you went out? If you had 50

people saying, you know what, I don’t know why, but this treatment seemed to have worked, if I were you, I would be on the first

plane to talk to that person and find out what is going on.

Dr. KIZER. We even did more than that. What I suggested in that

case was that we hire a methodologist at VA expense to help the

218

doctor put together the study that would show if, indeed, there

was. And I think, as you well know, in some cases people feel better despite of or because of the treatment they receive. And I think

what we need is, again, the agreement on what are the principles,

how the data should be viewed, and we certainly have made offers

and made the services of methodologists available to them.

Mr. SANDERS. One thing to be in a committee, but in the real

world the end result was you had somebody who was before the

House subcommittee in 1993, went through all of the hoops, did a

lot of work. I think this was in addition to a normal service as a

VA physician. She did this on her own. And it took years before

this thing was dealt with, she apparently felt, for whatever reason.

You are saying one thing, but the end result was she felt, hey, they

are not interested.

And I guess I would hope that we have broad enough egos to understand that none of us know everything, and I hope that we are

open to various forms of treatments. Frankly, I don’t think you

have been, and I hope that you will be. I think it is a very important issue.

Dr. KIZER. I can’t comment on 1993, since I wasn’t associated

with the Department.

Let me respond to something that the chairman proposed. Forgive me, I don’t remember the exact question, but the point that

I wanted to make was that I, as someone who has been a consultant in the area of toxicology and worked with it, I think my index

of suspicion and concern for chemical causation may be higher than

some others. And indeed, coming into the VA, my observations in

this regard is that the VA community is no different than the regular medical community or the rest of the medical community in

having perhaps some lesser sensitivity at times than they may

have. At least they are exploring the potentiality, not necessarily

that there is a cause-and-effect relationship.

That is one of the reasons why we are establishing a number of

new fellowships in the VA; this summer 12 new fellowships in medical toxicology will be supported, as well as funding additional physicians in occupational and environmental medicine. We will have

25 new physicians this summer and hopefully double that the coming year.

One of the concerns that I might just mention, though, in the

area of medical toxicology is that the training programs have had

a shortage of individuals applying for those positions since it is not

something that there is necessarily a demand for in the private sector.

Mr. SHAYS. I appreciate your response to that. I do think that

that will be very helpful.

Dr. Rostker, I don’t know if I am going to be waking you up

or——

Mr. ROSTKER. Here to respond to your questions, sir.

Mr. SHAYS. I was feeling a little uneasy that we invited you, and

you are just having to sit and listen to this dialog, but somehow

maybe there is some good to come from it.

I have been concerned that the DOD, basically given the history

after World War I, given the history basically with radiation and

Agent Orange, that the DOD would have an attitude different

219

than, ‘‘if we don’t see acute symptoms, we don’t think there is a

problem.’’ That is one concern I have, and I would like you to respond to that.

The other concern I have is that—and obviously since I am not

a physician, I could just be totally off base, but someone in Connecticut served in Persian Gulf. His job was to spray the troops

with lindane. He was in a confined area. I am told by occupational

environmentalists here that there are certain chemicals that you

would simply make sure if they were using, there would be ventilation and so on. This individual ended up dying with pancreas cancer, and I remember one doctor saying there can’t be any connection between lindane and pancreas cancer.

But the bottom line is we know how chemicals are stored on

bases. We also know that we are not shutting down some bases because there are such chemical challenges in some of them, because

if we did, the cleanup would be immense. I think you get my drift.

What are you doing to look at the practices of the Department

as it relates to the use of chemicals, not just defensive and offensive, but chemicals in general?

Mr. ROSTKER. First, let me just state for the record I am not a

physician, I am an economist, and after hearing this discussion, I

thank my lucky stars that I went to graduate school in economics

and not medicine.

Mr. SHAYS. Because that is such a pure science, right?

Mr. ROSTKER. Absolutely.

As you know, or may know, the Department of Defense did fund

in the 1970’s some research on low-level chemical exposure. The

subjects were workers at chemical weapons plants who were inadvertently exposed to chemical—low-level chemical exposures. And

that research, unfortunately, was not pursued as far as it could

have gone. You are absolutely right that we had the presumption

that all we had to worry about was acute poisoning from chemical

weapons.

I don’t think it is fair to characterize General Schwarzkopf or the

other leaders as waiting for people to drop dead before we had a

concern for chemicals. That there is——

Mr. SHAYS. It isn’t fair, so let me clarify, since they saw no acute

symptoms, and there was some reference to nobody dying.

Mr. ROSTKER. If I might, the Gulf war is probably the major, the

most significant concern for chemicals that we have had since

World War I because we did know that Saddam Hussein used

chemicals both on his own people and on the Iranians. So the extraordinary precautions that were taken almost bordered on the

hysterical.

The out borders are replete with references to protecting the

troops, to training, to making sure that we had the best chemical

gear that we could have at the time. And, in fact, as you know,

when we went into the offensive part of the war, the troops were

not in their normal utilities, but were in their MOP suits. And the

examples——

Mr. SHAYS. That is the protective gear?

Mr. ROSTKER. The protective gear, exactly.

And invariably where we have even the slightest indication that

chemicals may have been present, there is also a recording in the

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records that are available to you and to the public, the comment

that the troops—— Mr. SHAYS. According to?

Mr. ROSTKER. According to the logs and accounting of operations.

Mr. SHAYS. My understanding is that more than 50 percent of

those logs are not available.

Mr. ROSTKER. The ones that we do have are replete with the

troops moving into MOP 4 and further action being taken.

Mr. SHAYS. I don’t know what you mean by ‘‘further action being

taken.’’ Mr. ROSTKER. A test, confirmational test, doing a 256 kit test.

So I think the record will sustain the fact that, as one of the out

borders said, the safety of the troops were paramount.

But it is true that we did not appreciate the possibility of effects

from low level that might persist over time, might manifest itself

not immediately, but years later. We are prepared to undertake

that research necessary to fill that knowledge gap so in the future

we can be more responsive.

Mr. SHAYS. Do we have any record of Iranian civilians having

health problems as a result, potentially, of chemicals?

Mr. ROSTKER. In the timeframe of the war?

Mr. SHAYS. And since then, and—Iraqi, not Iranian. Let me restate the question over again. I misstated.

Does the DOD have any knowledge, do you have any knowledge,

does the DOD have any knowledge that we would be able to see

of health care challenges that Iraqi civilians have as a result of the

war?

Mr. ROSTKER. There were some accounts near Basra, as the Republican Guard was retreating, of some possible exposures, but

that is the extent that I know of. I believe we have asked the question of the Kuwaitis, and they have indicated that they have none.

But that is the extent of my knowledge.

Mr. SHAYS. Your testimony is you have no knowledge of Iraqi civilians not being exposed, but having serious symptoms? You have

no knowledge of symptoms similar to the U.S. soldiers and the allies?

Mr. ROSTKER. Not that I have.

Mr. SHAYS. Could I ask you to check your records?

Mr. ROSTKER. Of course.

Mr. SHAYS. Since I need to be very definitive here, we have two

requests on the table, Doctor. One of them will be the request you

are going to show me from 1993 to 1995 specific studies that you

asked for dealing with chemical exposure, someone else asked for,

because you were telling me there were studies. I wouldn’t need it

for the committee today since I wouldn’t know what to do with

them, but I will give a few weeks if you would get back to us with

that, in addition to the two previous questions that we asked Dr.

Murphy.

And, Dr. Rostker, if you would check the records to see if there

is any evidence or concern on the part of the U.S. Government that

Iraqi civilians may have some of the same symptoms that our allies

have.

Mr. ROSTKER. We will do that in toto, but let me be clear that

there were reports of civilians possibly exposed to chemical weapVerDate 11-MAY-2000 10:15 Jun 28, 2002 Jkt 010199 PO 00000 Frm 00224 Fmt 6633 Sfmt 6602 W:\DISC\38711 pfrm04 PsN: 38711
221

ons near Basra at the end of the war as the Republican Guards

were retreating and as they were—as action in that city with the

Shiites.

Mr. SHAYS. One of the interests that I have is that the CIA did

projections of what would happen to the plumes when we blew up

some of the depos and some of the chemical plants, and in every

instance they would not come toward our troops. If they would not

come toward our troops, there we have some question mark because they went somewhere.

One of the ironies would be if we could learn basically from our

previous enemy that they are encountering some of these problems,

that we may have a common interest in exchanging information.

Mr. ROSTKER. Absolutely.

Let me, if I might—we are in the process of distributing almost

22,000 questionnaires to servicemen who were near the

Khamisiyah, within 50 kilometers of the Khamisiyah, and we will

have a much better understanding of any anomalies that they saw

or any possible health effects that they suffered around that explosion. And I hope that that analysis will be available in the month

of February.

Mr. SHAYS. I just have basically three more questions here. I

would like to know first off if—from you, Dr. Kizer—if the VA is

sharing its health registry data with the DOD investigative teams.

Dr. KIZER. The DOD shares its data with VA. VA shares data in

the aggregate with DOD. We have not provided individually—or

data that would be linked to an individual largely pursuant to the

feelings that have been expressed by individual veterans as far as

providing that information back to DOD. But we certainly——

Mr. SHAYS. As a privacy issue, that you are not providing the

registry information to the investigative teams; is that right?

Dr. KIZER. The aggregate data, the data that is not linked to individuals, has not been provided to DOD largely in response to the

requests or the feelings that they expressed by the veterans.

Mr. SHAYS. How do we know how they request it? Did they say

they don’t want it provided? Is there a question in the protocol that

asks that?

Dr. MURPHY. No. Our physicians talk to veterans every day.

They call into our offices on the phone, and there is a feeling

among veterans that—whether it is true or not—that if the registry

health information was provided to DOD, it might have an impact

on their career as a reservist or active duty member. So, yes, there

are concerns. It doesn’t impact our ability to deal with aggregate

data. Because DOD sends the data as provided to the VA, we can

do the analysis. It really is not an issue. We do provide aggregate

data back to DOD with no personal identifiers attached. You can

ask the veterans here today if they would like their personal data

sent to DOD.

Mr. SHAYS. It might be wise to have that as part of the protocol,

to ask if you are able to share that information for their own basic

health.

Mr. ROSTKER. I would like to make it perfectly clear that we are

not interested in the name or Social Security number of anybody

who is registered, but if we are going to do the appropriate cluster

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analysis, it would be extremely helpful to have the individual

records at a unit level.

We believe we can safeguard the privacy of the individuals. We

don’t need health identifiers. We don’t need rank. We don’t need

the name or Social Security number. I think we will be trying to

work with the VA to resolve this issue.

Mr. SHAYS. Is that something that, Dr. Kizer, could be resolved

based on that kind of request?

Dr. KIZER. I think we need to look at it and see exactly what that

means. We are certainly open to it, and I would say two things:

One, to date, Dr. Rostker recently has assumed his position and

raised this issue very recently. Prior to that, Dr. Joseph and the

folks from the Health Affairs were satisfied with not getting the individually linked data. I think first and foremost, though, we want

to get some feeling from our Veteran patients as to whether this

would be a problem for them.

Mr. SHAYS. How long ago was that request made?

Mr. ROSTKER. We had this discussion over the last month or so.

I would say that in terms of doing epidemiological studies, Dr.

Joseph had, in fact, reached an accommodation with the Veterans

Administration.

However, in terms of the kind of analysis that we would find

most helpful to at least screen the possibilities of exposure, it

would expedite our research and inquiries if the information were

available with no personal identifiers.

Dr. MURPHY. I can guarantee you that VA will cooperate in all

of those efforts as long as we can maintain the confidentiality of

veterans.

Mr. SHAYS. It would seem to me there would be a way to maintain confidentiality. It seems to me a no-brainer.

Dr. KIZER. I am not sure it is an issue really.

Mr. SHAYS. That would be nice.

Dr. Rostker, is there any comment?

Ms. Gwin, you have been very patient here, and, Dr. Custis, do

you have any closing comment you would like to make before this

committee? I appreciate your patience and participation.

Dr. CUSTIS. No, I think not, Mr. Chairman. I think you have covered it very well.

Mr. SHAYS. I don’t know how much we covered. You are gracious,

but I am disappointed, frankly.

Dr. Rostker.

Mr. ROSTKER. Mr. Chairman, I would like to hear from those

who served with us and those who continue to serve with us in active duty in our reserve components. As I have said in my statement, it is imperative that we get to the bottom of why so many

people are ill. We owe it to them, but most importantly we owe it

to the future soldiers, sailors and Marines and airmen who will be,

I am sure, placed in harm’s way in service to their country. We owe

them no less.

Mr. SHAYS. I think we probably all agree on that.

Dr. Kizer, before I ask if you have any closing comment, and

maybe Dr. Murphy, can you tell me what the analysis of VA registry of Khamisiyah tells us about the health effects of exposure to

223

low levels of chemicals? Have we learned anything from the VA

registry in regards to Khamisiyah?

Dr. MURPHY. We have had long discussions on the usefulness of

VA registry in the past, and I would like to preface my statements

with all of the caveats that we have previously put on it. The registry is health surveillance data and does not give definitive answers, is clearly still true. I think it can be used as a tool to get

a snapshot on a particular issue, and that is what we have done

in searching the registry data base with the names of the 21,000

individuals that DOD tells us were within 50 kilometers.

In looking at the comparison between registry participants overall and Khamisiyah veterans, really there aren’t dramatic differences between the two except in two areas. No. 1, the—both the

individuals within 50 kilometers and those who were identified as

part of the demolition team, are on your charts as being onsite,

have—virtually all have symptoms, and that is different from the

other 52,000 individuals that we looked at in the registry, 12 percent of whom have no symptoms.

The other difference is that those members of the demolition

team have a higher percentage of musculoskeletal symptoms. It is

16 percent versus 28 percent. There doesn’t appear to be a difference between the 50-kilometer group and the other group. The

reasons for those differences are not entirely clear at this point but

could be addressed by the epidemiologic research studies that are

currently being requested. Protocols are being requested through

an announcement that was released by DOD in December and are

due in on February 19th.

Mr. SHAYS. Dr. Kizer, you said today that the Persian Gulf Registry was never intended to or designed to be a scientific research

study. I infer from that that it is basically a helpful document, but

it shouldn’t prove or disprove any conclusions. Would you conclude

with that?

Dr. KIZER. I think that is what the statement says, sir, that the

Registry is first and foremost a health access program. Insofar as

it provides, or can be hypothesis-generating, it may be useful in

that regard, but in and of itself it is not a——

Mr. SHAYS. Do you have any closing comment you’d like to make?

Dr. KIZER. I would perhaps just reaffirm two points that I made

before. One is that while we think the VA approach and program

is a good one and a comprehensive one, we are continually looking

for ways to improve it, and we certainly welcome the oversight and

the scrutiny that this group and many other groups have provided

in an effort to improve the program.

Second, I would just say that I would—I think at times in an effort to be precise in our statements and to ensure that we are communicating it, it may create an incorrect illusion that there is an

attempt not to be responsive, and I certainly hope that is not the

case. And through continued dialog it will be clear that we want

to be as responsive as possible, but we feel the need to also be as

precise in our responses as well.

Mr. SHAYS. Dr. Kizer, I will respond to that point. I think it is

very important, especially your field, that we are being very precise. I just have to say to you that the difficulty I had in getting

a dialog as to what the Registry was at one point was something

224

that I did not expect we would have that challenge in communicating. It tells me that rather than having Dr. Murphy before us,

I think probably you should be conferring so we can iron out those

differences.

I thank all of you for coming, and I thank all of you for your patience. We are going to recess, as there is a vote on the floor. Since

it may be over in 15 minutes, but since I can’t be certain, I am

going to recess until 2 o’clock.

[Whereupon, the subcommittee recessed at 1 p.m., to be reconvened at 2 p.m. this same day.]

Mr. SHAYS. I will call this hearing to order and I apologize to our

witnesses. This has been a momentous day in the history of Congress. Some of you have to be at 3:00—Dr. Haley, where do you

have to be?

Dr. HALEY. Over in the Senate building, Russell Senate Building.

Mr. SHAYS. You have to be at the Pentagon at 3:00?

Dr. HALEY. I have to be there at 3:30.

Dr. DUFFY. I have to be at the Pentagon at 3.

Mr. SHAYS. Can you change it to 3:30? I will tell you what we

will do. We will meet with you first. Since there is only one person

asking questions, you may be able to answer them. We’ll let you

leave before the other panel starts up. I need to swear all of you

in. Dr. Schwartz, I assume you do not have a timeframe.

Dr. SCHWARTZ. No.

Mr. SHAYS. All right. Thank you.

[Witnesses sworn.]

Mr. SHAYS. For the record, all three witnesses have responded in

the affirmative. Our second panel is Dr. Robert Haley from the

University of Texas Southwestern Medical Center; Dr. David

Schwartz, University of Iowa Medical School; and Dr. Frank Duffy,

Harvard Medical School: three distinguished practitioners and

academicians. We are very grateful you are here. Dr. Duffy, since

you have a 3:00 appointment, we’ll let you go first and we’ll get you

out of here, and Dr. Schwartz, and we will get you out of here, by

15 of. Do you have a fast car?

Dr. DUFFY. Taxi.

Mr. SHAYS. OK. Maybe somebody can get a cab and have it waiting for him. So, Dr. Duffy, why don’t you go first.

STATEMENTS OF FRANK DUFFY, M.D., ASSOCIATE PROFESSOR

OF NEUROLOGY, HARVARD MEDICAL SCHOOL; ROBERT

HALEY, M.D., DIRECTOR OF EPIDEMIOLOGY, UNIVERSITY OF

TEXAS SOUTHWESTERN MEDICAL CENTER; AND DAVID

SCHWARTZ, M.D., PROFESSOR OF INTERNAL AND PREVENTATIVE MEDICINE, UNIVERSITY OF IOWA MEDICAL COLLEGE

Dr. DUFFY. Thank you, Mr. Chairman. This presentation will review evidence that’s actually been around a while, that low levels

of exposure to the nerve agent Sarin can produce long-lasting effects. In fact, this began in the 1970’s when the post surgeon at

Rocky Mountain Arsenal noticed a symptom complex amongst

workers there. Rocky Mountain Arsenal, as you know, is the Army

facility charged with maintenance of nerve gas munitions. What he

noticed is they were forgetful, there were problems with concentration, they were irritable and, in particular, they had problems in

225

sleeping, but with the peculiar twist that there was excessive

dreaming. Also there was complaints of decreased libido, diminished sexual performance and, putting all that together, the main

complaint, the presenting complaint was trouble with relationships

and trouble keeping their jobs.

As you might imagine, workers who were demilling nerve gas,

this was not prime employment so there was an overrepresentation

of minority and immigrant workers. And Dr. Gaon initially thought

that this was just a problem that one would associate with lower

socioeconomic classes, but then he recognized that what was really

going on was that these were the people he had actually seen with

histories of exposure, on-the-job industrial exposure. So he took it

to the Department of the Army, and it was at that point I became

involved.

I was what was called an obligatory volunteer back at that time,

and I was involved with the planning and implementation of the

two-part project. The idea was it does seem kind of farfetched that

people would have symptoms a year or so beyond exposure to

organophosphates, so let’s really nail this one, let’s do it on primates, on monkeys.

So we had a project with rhesus monkeys at Edgewood Arsenal,

and the idea was we would expose them to a range of Sarin, from

an exposure that would require treatment to survive and a very

low level where the animals didn’t turn a hair, and look at them

a year later, and not just look at their behavior but to do it objectively. So we put together a team of people to record brain electrical activity, EEG, and analyze it by computer, which was pretty

good back then, a good approach. We still do this.

The results of the study were there were differences in the temporal lobes of the monkeys and they were not seen in the monkeys

who were not exposed. That surprised everybody, but it was sufficient evidence to go ahead and look at the workers at Rocky Mountain Arsenal who had this history. There were some 77 of them.

And we matched them with workers on the post who had never

had an exposure and who their blood checks showed they had

never had an incidental exposure. The workers—this will come to

be important for a moment—had a documented exposure; there

was an accident. They were working with the compound, they had

physical findings, and a 25 percent reduction in their own baseline

cholinesterase levels. So they had exposure.

We took as an outcome point 1 year after their last exposure.

Some had only one exposure, a few had as many as six or seven,

but we looked a year after their last exposure, and we found by

computer analysis of EEG the very same findings we found in the

monkeys. We took it a step further and I—on a double blind basis,

I visually analyzed the EEGs and found out that their overall

EEGs showed a pattern we would now call encephalopathy, that’s

out alpha was reduced and slowing was increased by visual inspection. So another thing we found.

But one of the more interesting things was their all-night sleep

study showed an excess of the phase of sleep now known as REM,

or dreaming sleep. We have a phase of sleep where we just lie kind

of quietly and a phase where, usually occurring toward the mornVerDate 11-MAY-2000 10:15 Jun 28, 2002 Jkt 010199 PO 00000 Frm 00229 Fmt 6633 Sfmt 6602 W:\DISC\38711 pfrm04 PsN: 38711
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ing, where the eyes move. And that’s what you can see, and when

you awaken someone in that period, they are dreaming.

Now, this population had an increase in dreaming sleep, which

fit very well with their complaint of excessive dreaming, but there

are very few compounds that actually increase REM sleep. Most

compounds diminish it. Sleeping medications knock it out. The

compounds that can do it is LSD, mescaline, some of the

psychostimulants, but also the organophosphate anticholinesterase

agents like Sarin will do this acutely.

So there we were with a monkey study and a human study indicating that 1 year after exposure there were differences that could

be objectively measured on a double blind basis by computer and

it seemed inescapable that the human brain responds adversely to

exposures to organophosphate anticholinesterase, and in this case

it’s Sarin. One of the key issues—I might add that 6 months or so

ago, or more, when I was aware of what might have been happening in the Gulf war, a couple of my companions—— Mr. SHAYS. Just so I have a sense of the timeframe, when did

you begin the study on the monkeys?

Dr. DUFFY. This study was published—the dates are on the back

of the handout, but I think the late 1970’s, early 1980’s. So this has

been in the possession of the Department of Defense, paid for and

managed by them and accepted by them completely. And what I

wondered is why, when this all came up, and one of my buddies

who is in the reserve said, Frank, they are going to call you up and

why I never heard anything until the New York Times called me

last December. So I was curious about that.

The other thing I wanted to sort of offer was my impression of

how things worked back then when this incident came up. We were

a group of physicians under the Army Chemicals Corps, the only

physicians in the Army that didn’t report to the Army Surgeon

General. So when this came up and I went out to Rocky Mountain

and looked into this and read the literature, it was perfectly clear

that not only were people after Sarin exposure showing long-term

effects, but it was widely accepted in the pesticide industry that exposure to related compounds like malathion and parrathion or the

chlorinated hydrocarbon insecticides led to long-term consequences,

widely known but not really played up.

Mr. SHAYS. I am just going to interrupt you, and this will help.

Not widely made well-known because the industry didn’t want to

alert OSHA and the others—— Dr. DUFFY. It was not to their economic advantage to have it

known. And I might add, there is extensive anecdotal literature on

long-term exposure to malathion and parrathion, which are well

known in the crop dusting industry and California has done some

studies on this. But I brought it up to the Army and said, hey, this

is bigger than us. There is a big public health issue of exposure to

these compounds and their long-term effects. Don’t you think that

should be taken up to at least the Public Health Service Surgeon

General’s level and we should investigate not just our population,

which was very nicely controlled, but we should include the pesticide facilities that were near? And the response was not only will

we not take it up to the Public Health Service, it would not move

out of the Department of Army and not even get up to the Army

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Surgeon General until we had our ducks in a row. This Army

Chemical Corps was going to take care of themselves.

Then over the years I have always asked myself the question

why was I in charge of this program. I was right out of neurology

residency and they pulled me out of the dream of draftees going

over to Vietnam. Surely there must have been somebody in the

Army better qualified than me to run this study and how did they

know I could do it.

So unless things have changed a lot, my impression of the way

the government, and at least what I know the Department of Army

used to word is they take care of things themselves. And that may

be one of the system problems that could be changed, where—I’ve

heard today that now there is a joint commission between the Veterans’ Administration, the Public Health Service and the DOD, but

what happens if the expertise doesn’t happen to lie there. There

should be the ability to move out into the public sector and find expertise at universities and incorporate this and solve problems this

way, without having someone lose face or someone being terribly

worried that if they spend a little extra money they are going to

be disadvantaged in promotion.

So that’s a strong recollection I have. I mean, they pulled me

kind of by accident rather than search the country for the most

qualified person to do this. They solved this problem internally

rather than call on the resources that they probably should have

because it is a bigger issue than just organophosphates.

My final comment is that I agree with Bernie Sanders’ comments

that we have really got to get together and do something. I do

think, however, that medical treatment is best targeted to disease

that we understand, so that there is not only a treatment component, but there is an investigative component leading to more appropriate treatment. And why, if, say, EEG was so apparently useful in determining the population at Rocky Mountain Arsenal was

exposed, has there not been an EEG project looking to see whether

the same findings or similar findings are present and perhaps targeting those who might respond versus those who might not.

At Rocky, for example, complicating the issue, we discovered that

only about two-thirds of the people who had significant exposure

showed the EEG effects and about a third did not. So there is an

idiosyncratic nature to this, just as you know in multiple chemical

sensitivity issues, you put the rug in the office and 2 out of 12 people will come down with it, but 10 didn’t. So it’s complicated because it’s idiosyncratic, so you need to target and you need to look

for mechanisms, and I know we don’t have time today, but the suspicion is there might be EEG findings in this syndrome akin to

some work we’ve done in chronic fatigue syndrome which has surprised us in terms of its direction it’s pointed us toward therapy.

So there is a lot that can be done here, as well as I think, in a global sense, looking at how the government responds to these—the

freedom the government has to respond to these kinds of crises.

Thank you.

[The prepared statement of Dr. Duffy follows:]

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Mr. SHAYS. Dr. Duffy, I am going to get you out at 20 minutes

of, regardless, but I am going to suggest to Dr. Haley and Dr.

Schwartz if you would like to comment or even ask Dr. Duffy a

question; that would be instructive to us. So I am going to ask you

to make a comment and have Mr. Sanders go, and then I will go.

If you would just make a comment.

Dr. HALEY. Yes, we are very familiar with Dr. Duffy’s studies,

and we strongly agree that this is very important information that

should be on the subject here. It raises the whole issue of how do

you measure subtle neurological damage, subtle brain damage. As

I am going to talk about in a moment, we found that a physician,

in looking and doing all the tests a physician can do, a history, a

physical exam, lab work, a physician cannot make the diagnosis of

this in traditional medicine, and that’s the reason you have so

many people putting in a rug and you go to the doctor and the doctor says there is nothing wrong with you, I can’t find a thing

wrong. You do an objective test like this that’s subtle, sensitive,

and compare it to a control, normal people. In a control study you

can say this group is abnormal compared to the normal, and that’s

right now sort of the state-of-the-art. So I think this is very important information that should be in the record and be the central

part of discussion of this problem.

Mr. SHAYS. Dr. Schwartz, do you want to make a comment?

Dr. SCHWARTZ. Yes, comment first as a clinician and then as an

investigator. My area of specialty is occupational and environmental medicine in terms of the clinical practice of that, so I see—

in practicing medicine in Iowa, I see a fair amount of patients who

have been exposed chronically to pesticides. These problems that

individuals have that Dr. Duffy is describing is not uncommon in

individuals chronically exposed to organophosphates, and they provide an incredible challenge and a lot of difficulty to physicians

who have not seen this type of disease present itself in their normal practice of medicine.

So applying some of these very objective tests to begin to understand why some individuals have chronic complaints following exposures and other individuals might not have chronic complaints

following the same exposures is very important.

I think, as Dr. Duffy had said, it’s also important to look at the

issues of why some individuals are susceptible to that problem and

other individuals appear to be resistant to it. It doesn’t mean that

they shouldn’t prevent those exposures. It’s just scientifically a

very, very important question to answer because it helps us understand the pathogenesis.

In terms of my response as an investigator, I think that some of

the very preliminary epidemiology has been done in this field in

terms of the Persian Gulf activities and health consequences, and

some of that I am going to be able to present. Some of it is still

ongoing and it will come out over the next couple of years, but I

think that the next obvious step, the next very important step in

terms of understanding this disease process is to do very detailed

examinations and very detailed laboratory tests, including tests

like EEG tests, to understand this not as a syndrome or as a group

of diseases that we have never seen before, but to try to underVerDate 11-MAY-2000 10:15 Jun 28, 2002 Jkt 010199 PO 00000 Frm 00236 Fmt 6633 Sfmt 6602 W:\DISC\38711 pfrm04 PsN: 38711
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stand whether this, these processes, these complaints, fall into disease categories that we can treat.

Mr. SHAYS. Let me interrupt you a second because I want Mr.

Sanders to—— Dr. SCHWARTZ. Sure.

Mr. SHAYS. If you could try to finish up.

Dr. SCHWARTZ. Those are my complete comments.

Mr. SHAYS. You are going to be here a little later?

Dr. SCHWARTZ. Yes.

Mr. SANDERS. I apologize for missing the opening part of your

testimony. I am interested in two areas. First, a general question,

we understand that everybody is trying to do their best to get at

the root of this problem. Do you think that from what you heard

today from the DOD and the VA and those people that they have

the expertise to look at it—if you like in environmental medicine,

that they have the background to make the diagnoses that some

other people have been making?

Dr. DUFFY. Since my career doesn’t depend on the answer, my

answer I guess would be no. You graduate from medical school,

most people don’t think of the VA service or the Department of Defense as the top two choices of occupation, but they might go there

if there were medical conditions they were very interested in that

were looked into in either the VA, like rehab medicine, or the Department of Defense in certain areas. But this is universally true.

And what I think is missing is the ability of the VA to candidly

recognize, we don’t have experts, they are out there, let’s facilitate

the ability to bring them in and take a look.

Mr. SANDERS. Let me ask you—we always have a problem because we’re not physicians, but am I correct in understanding the

whole concept, and Dr. Schwartz mentioned environmental medicine, is kind of a different ball game historically than the VA has

been playing, which is not a criticism. They do excellent work in

various areas, but is it fair to say that analyzing, diagnosing and

treating people who may have been exposed to a wide variety of

chemicals is not what they have historically been expert in.

Dr. DUFFY. Or even at every major university medical center will

have a department or someone of interest you can think of, places

in the country. So when you have such a problem, I wouldn’t suggest setting up a branch—unless this becomes a major issue and

we keep fighting in these areas, but I would think there should be

some liaison rather than duplication, and the freedom to move out

rather than causing someone to lose face.

Mr. SANDERS. OK. You used the word ‘‘freedom’’ a couple of

times. What do you mean?

Dr. DUFFY. It’s cheaper to use in-house physicians than to contract. Second, it’s almost an admission of you can’t do it, therefore

you had to ask for help. And that’s unfortunate. It doesn’t need to

be that way, and really shouldn’t be that way.

I might make one final comment. The work was partly made to

sound—our work that I presented—made to sound irrelevant because it might seem as you read it that the workers had more significant exposures than were relevant to the Gulf war.

In fact, what happens is if you are working with this stuff and

you know it’s a lethal agent and an accident happens, the first

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thing that crosses your mind, I have 2 seconds of consciousness and

5 minutes of life, and you panic and do everything you can and run

to be protected as soon as you possibly can. Whether you are exposed or not, you walk in hyperventilating and in panic.

My impression from actually going over all the records and as a

medical officer at Edgewood looking at patients who had been in

these types of accidents, you can have a biologically significant exposure and only maybe it sort of feels like you had a little too much

chili for lunch or you had a fight with your wife or stayed up too

late. That’s the kind of feeling, but that may last. I would put on

as—as well, if you’ve taken a protective agent, you might not experience that. And finally, if it’s over 100 degrees, you’ve got on your

full military garb, you’re worrying about the missiles overhead and

you’re wishing you were back in the United States, the little extra

burden of a whiff of organophosphates you could easily miss and

it still could be significant.

Mr. SHAYS. I would like to understand, when you did this study

with the monkeys, you were first surprised, and I guess I am missing why you were surprised. What was the new revelation that

made you surprised? It seems very logical to me.

Dr. DUFFY. In retrospect it seems logical. The fact that we did

the study means we thought there was a reasonable probability

that the monkeys would show something. But they said you are not

going to be able to look at those people unless the monkeys show

something. And a year later, you are not going to be able to show

it. But they did.

Mr. SHAYS. Now, the second part is given that’s quite a significant finding and has implications to workers, what is your statement as to what happened in the study?

Dr. DUFFY. It was accepted with open arms by the Army at the

time. It keeps surfacing every time the spruce forests of Vermont

are oversprayed by malathion and parrathion and people come out

and go through the literature and see the report and I end up talking on Vermont public radio or something like that. But——

Mr. SHAYS. That’s it, Raiders of the Lost Ark, and in the end it’s

put in a box and they have this warehouse with billions of those

boxes and they are saying we’re taking care of it. Is that the sense

that I should have of what happened to this study?

Dr. DUFFY. What I think happened—this is third and fourth

hand. The Army knew about the study. It was picked up by people

not in a position to—not in—of a rank to make a statement for the

Army. It was—a committee was formed to look into this. It was

maybe or maybe not given to the committee, I am not sure. The

committee, which was composed of civilians, came back with the

recommendation there’s not much to this, and the Army said OK,

and everyone said OK, and the VA said OK, and that was it. That’s

what happened. Then someone really looked at the data more seriously.

Mr. SHAYS. It makes you wonder if there aren’t other pieces of

data like this and other studies that you are not aware of that have

been done by someone else. It’s kind of scary to me. The implication is you’ve determined that some workers were at risk from this

kind of experience and it has long-term implications for a whole

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host of areas, but even just for that plant it has tremendous implications.

Dr. DUFFY. Well, for Denver and their water supply and I don’t

know what happened to all those munitions out there. It used to

be next to Stapleton International Airport. They moved.

Mr. SHAYS. I am going to keep my word to you. You’ve been a

wonderful witness. Thank you for coming.

Dr. DUFFY. My pleasure.

Mr. SHAYS. Dr. Duffy, thank you very much.

Mr. SANDERS. Thank you very much, Dr. Duffy.

Mr. SHAYS. Dr. Haley, you are next in line. You have to go over

to the Senate, correct?

Dr. HALEY. Right.

Mr. SHAYS. And you have to be there at 3:30, and that’s a 15-

minute walk, so I think we’re doing fine. Why don’t you make your

statement?

Dr. HALEY. OK, we published three articles in last week’s issue

in the Journal of the American Medical Association, and what I

would like to do is list several main conclusions that came from

this study. Basically we studied one group of Seabees, a battalion

of Seabees. So what we’re going to say pertains to this group. To

the extent we can generalize we don’t know yet, although they

seem to have the same type of symptoms that many other groups

have. But what we’re going to say deals with this group.

We started this back in early 1994, and our first activity was to

attend the National Institutes of Health Consensus Conference in

April 1994, and when you are trying to reconstruct what’s done

badly and what’s done well in this scenario over the last several

years, you really need to look at that conference. Had that conference not occurred and the VA central office was primarily involved in establishing that conference; that conference all at one

time summarized everything known, summarized all the information from the VA registries, DOD information, everything about

risk factors, everything about symptoms, and that sped us up by

at least a year.

Mr. SHAYS. What was that conference?

Dr. HALEY. That was at the National Institutes of Health in

April 1994. And all in 2 days we caught up 3 years’ worth of information and we went from that conference and in the following

week we designed a series of three studies that have now been peer

reviewed and published. But it was due to that. And I think that

was a signal event in all of this and really needs to be high on your

priority as you reconstruct what’s happened.

Mr. SHAYS. In other words, it’s very important and your point is

that the bottom line is the VA did something extraordinarily helpful.

Dr. HALEY. Absolutely. See, this is the way science works. A series of small steps, even missteps, information is collected and then

at some point you summarize it and present it to whoever is there,

and there were veterans groups there and scientists, different interest groups, and right there sitting in the audience I had some

insights about how to design a study, and my collaborator, Dr. Tom

Kurt, toxicologist, said I think I know what this is, I think this is

the syndrome of OPIDP. And we went off and started looking into

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chemical combinations and doing epidemiologic studies. And that’s

how science works, and this process was well carried off. It was a

great hour, a great 2 days for the country. So I wanted to start off.

Here’s what was designed then as a result of that process.

Mr. SHAYS. Let me understand one thing. If you want to interrupt at any time, because we’re going to get you out of here, but

I don’t understand the 3-year reference.

Dr. HALEY. That was 3 years from the end of the war. And in

that 3 years, a lot of work was done looking at risk factors, things

that happened in the Gulf war, collecting registries of patients’ symptoms. So we were presented in that 2 days with a complete

inventory of all the things that were possible.

Mr. SHAYS. So you didn’t say you had 3 years, it just took the

3 years of collected data and presented it to you, you didn’t have

to hunt for it, it was just right there.

Dr. HALEY. Yes. It would have taken us a year to find it, but it

put us ahead a year. Now, we designed a study where we did something different. Instead of studying the sick people who were stepping forward. We went out and looked for a battalion of people who

went to the Gulf war to try to study them all, a free-living population and try to study the sick ones and compare them to the well

ones. Because if you look back at Legionnaires’ disease, toxic shock

syndrome, AIDS, hantavirus, that’s how you discover the cause of

the disease. You get the sick ones and the well ones and compare

the two and see how they differ. So we decided to do that.

In this unit, we measured the symptoms in an interview survey,

all 249 of them, studied their symptoms and then did a mathematical analysis to see how the symptoms—if this is a syndrome,

that means there’s a group of guys that will all have the same

symptoms. And there’s another group of guys that have another

group of symptoms. That’s what a syndrome is, and if that’s true,

we should be able to find those groups and that is a mathematical

process. So we applied a mathematical process called factor analysis, but that’s immaterial, and we found three major clusters and

three sort of minor clusters, but the three major clusters looked

like three syndromes.

Now, there was a real ringer here which is important to understand why we have not—why the country has not come up with an

answer until now. This was very complex because when you looked

at each of the individual symptoms, for example, chronic fatigue,

common symptom in this problem, that symptom is ambiguous. It

means one thing to one group of veterans and it means another

thing to another group of veterans, and unless you disentangle

these meanings you get mushy things like post-traumatic stress

disorder, chronic fatigue syndrome, you get diagnoses that are imprecise like this.

We found, for example, with chronic fatigue, one group of soldiers

meant by that that all day I am sleepy, excessively sleepy and

want to go to sleep all day and I go to sleep while I am driving

and so forth. Another group says I am not sleepy at all, but my

muscles feel rung out after I exercise a little while, but I’ve not

sleepy. So these are two different symptoms, but they both go

under the name chronic fatigue, and so unless you differentiate

these, you’re going to come out with these mushy things like chronVerDate 11-MAY-2000 10:15 Jun 28, 2002 Jkt 010199 PO 00000 Frm 00240 Fmt 6633 Sfmt 6602 W:\DISC\38711 pfrm04 PsN: 38711
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ic fatigue syndrome, PTSD, and that’s the language we’ve been

using, and until studies start disentangling these we’re going to

come up with these mushy diagnoses that lump some sick guys

with some well guys and that’s why it all washes out. So if I don’t

get across but one thing—— Mr. SHAYS. What do you mean, it all washes out?

Dr. HALEY. Well, if you include some people with bona fide medical illness along with a larger number who don’t have illness but

are complaining of different types of symptoms, then do you some

tests, the group doesn’t seem sick because the well ones wash out

the sick ones.

Mr. SHAYS. OK. You used the word ‘‘wash out’’ different than I

think.

Dr. HALEY. Yes. It obscures the real effects because it gets lost

in this group of well people you’re using. So that was our first big

breakthrough. Then, in order to prove this is real illness, whether

these clusters are real syndromes or whether it’s just statistical, we

then took a sample, 23, and that sounds like a small number, but

this was 23 selected from already sifted out syndromes. We took

23, brought 20 controls, 10 of whom had gone over to the Gulf in

this unit but remained well, and 10 who didn’t go over but remained well, and matched them for age, sex, and so forth, and

brought them to Dallas and the doctors in Dallas didn’t know who

was in what group. Was a blind study. We didn’t do EEG because

we think there’s some new technology that’s more substantive and

more reproducible, and that is we did tests measuring the velocity

of nerve conduction. How fast the nerve impulse goes up the spinal

cord, measuring reflexes that are mediated by the brain stem. You

have a lower part of the brain where you can stimulate the ear and

the eyes move and so forth, and you can measure the speed of

these reflexes. It’s something the subject cannot, so it’s totally reproducible. And all humans are supposed to have values in a very

narrow range. And also one side is supposed to be exactly the same

as the other side, so we can compare sides and so forth.

In this we found that the ones with the syndromes, the statistical

syndromes, this group were very abnormal and the controls were

normal, but you see, the doctors didn’t know which was which, so

we couldn’t have influenced this. Once it was over we broke the

code and found this group was very abnormal, and that shows this

was due to brain damage, just the way Dr. Duffy’s studies showed

back in the 1970’s.

Mr. SANDERS. Let me jump in one more time. So you are saying

you were able to objectively, scientifically demonstrate brain damage on people who were complaining of symptoms.

Dr. HALEY. That’s correct.

Mr. SANDERS. To your knowledge, has that been replicated within the VA, DOD?

Dr. HALEY. No.

Mr. SANDERS. So this is very significant, is it not?

Dr. HALEY. We believe so. Now, I believe there are studies ongoing, but I don’t know details and perhaps people from VA can talk

about that. I think this is certainly a major area of interest. I think

some at the Portland VA are doing some studies now, but we’re

going to see a movement in this direction soon.

238

Now, the next thing we did, in our survey we asked them standardized questions about the risk factors they were exposed to in the

war. There are no objective records about where people were and

whether they were in chemical attacks, but we developed a series

of objective questions to ask them. The problem is when you ask

people about their exposure at the same time you ask their symptoms, there’s a possibility that recall bias will creep in, that the

people who are sick will have more of a selective memory, be more

concerned about it and more likely to put it, or people might frankly cheat. I am sick so I am going to say I was exposed to these

things.

The ringer here is we asked not only the questions about chemical exposures and combinations which we hypothesized from that

NIH conference to be the most likely cause, we also asked questions about depleted uranium, oil well smoke, multiple immunizations, and so forth. You see, if recall bias was the explanation for

the association, you would expect all of those to be about equally

associated, because back when they did the survey in late 1994, all

of these were being talked about in the press. So you would expect

all of them to be equally associated with the syndromes.

In fact, when we did the analysis, the six chemical exposures

were highly associated with these three syndromes, and I mean

highly. There was not a relative risk of 1.2 or 2.1; relative risks of

4 to 8. Now, this is in a realm that is extremely high association,

and generally the higher the relative risk the more likely it is to

causes not due to bias.

Mr. SANDERS. Please repeat the risk factors that were associated.

Dr. HALEY. OK. First of all, there were risk factors having to do

with the perception that they were involved in a chemical weapons

exposure, that is were they in an area where the chemical weapon

alarms went off and they were concerned about being exposed. Second, we found that a group who was in a certain place on a certain

day had the highest, very high risk. That was not Khamisiyah because none of our soldiers were anywhere near Khamisiyah. This

is the town of Khafji, which is just south of the Kuwaiti border on

the coast, it’s where the incursion was in early February, just on

the border, and it happened that the soldiers who were there in

Khafji, in the Khafji area on January 19 and 20, were the ones who

had the highest risk. Now, the 19th and 20th were the same date

that the Czechoslovakian chemical weapons detected Sarin and a

mustard agent just west of that spot, on that same day. And it was

the same day that in Jim Tuite’s report for the Banking Committee, he obtained eyewitness testimony done way before our

study was even designed and we didn’t know about this until after

we had done the analysis, he found eyewitness testimony that

there was actually chemical weapons alarm, Marines yelling this is

not an alert, people getting into their MOP suit and then symptoms for 24 hours following that.

Mr. SANDERS. You are saying people who were there—— Dr. HALEY. On that day.

Mr. SANDERS. Experienced that, had this objective physical evidence.

Dr. HALEY. That’s right, that’s some of our most severe symptoms. In addition, people who were hyperreactive to

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pyridostigmine, the more side effects they reported to

pyridostigmine, the more likely they were to have our syndromes.

Mr. SANDERS. Now, go through—— Dr. HALEY. The more likely they were to have serious, systemic

side effects after taking pyridostigmine.

Mr. SANDERS. They said we took this and we got sick.

Dr. HALEY. We asked them which side effects they had. The more

side effects, the more advanced side effects, the more likely they

were to have one of our syndromes. OK?

Now, third, those who wore flea collars—now, this was not, as

you know, this was not sanctioned by the military command, but

those who wore flea collars to protect themselves from insects,

those had about a sixfold relative risk over others of having the

syndrome.

Mr. SHAYS. Were these animal—— Dr. HALEY. Yes, these are pet flea and tick collars that you buy

at the hardware store and most of them contain the common pesticide chlorpyrifos, or Dursban, which has been shown in one very

important report of six families that were poisoned by

pyridostigmine by straying in their houses and developed symptoms just like that.

Mr. SHAYS. Definitely not authorized by the military.

Dr. HALEY. No, these were civilian studies.

Mr. SHAYS. No, these soldiers were wearing, literally had these

collars on.

Dr. HALEY. Yes, they were wearing them around their—— Mr. SHAYS. But that was not authorized by the military.

Dr. HALEY. No. But they were wearing them to protect themselves from the insects, which was a valid concern.

Mr. SHAYS. But this was their solution?

Dr. HALEY. Yes, they brought them from home and wore them.

Now, the fourth factor was the highest rates of these syndromes

was in soldiers who used the most insect repellent. So the more insect repellent they used, the greater the risk. Now, it wasn’t all insect repellents, because we asked them which types they used in

the war. Those who used Off, the commercial brand, there was no

excess risk. Those who used Avon Skin-So-Soft, which contains no

DEET, the active ingredient, they had no excess risk. But those

who said they used government-issued insect repellent, which contains 75 percent DEET, an excessive concentration, those, the risk

of our syndrome 3 increased in a step-wise manner with the

amount of the insect repellent they said they used. And there are

reports in the literature showing that using compounds of insect repellent with high concentrations of DEET, 75 to 100 percent DEET,

this causes brain damage and seizures in children and it’s been

banned in New York State, although that ban is undergoing appellate review after appeal by the chemical companies. But we believe

DEET is a toxic agent.

Now, these were the findings, that these four chemical types appear to be related. Now, we found in further testing the epidemiologic findings that those who were exposed to two of these chemicals in combination, they had much higher risk, like fivefold risk,

over those that had exposure to one of them. So there appears to

be an important synergistic effect between different chemicals.

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Mr. SANDERS. I just want to say I am very impressed by what

you are saying, and what you just said, the synergistic effect, it’s

one thing to say exposure to one chemical; mix them all up, inoculate people, God knows what is happening. Is that what you are

saying?

Dr. HALEY. Yes. We have epidemiologic evidence, numerical evidence with P values, statistical testing, that shows that combinations have synergistic, much more higher effect, more higher risk

of the syndromes. Once we had indication this was true, we then

undertook a series of animal studies to try to show the biological

plausibility of what we found, because this might have been only

a statistical finding. It might not be biologically true. So we contracted with a laboratory at Duke, Dr. Abidania, whose studies I

believe you reviewed before, we contracted with him to carry out

some studies that we designed to take these same chemicals that

we found to be synergistic in the troops, to test these in hens. And

he found, as he’s testified before, that if you give any one of these

agents to hens, which is the preferred animal model, you won’t

have a problem. But if you give two of them you get mild nerve and

brain damage, and if you give three of them, you get severe brain

and nerve damage and the type of brain damage is important. It’s

a type of brain damage called OPIDP. Now, this acronym is very

important and has not been introduced into this discussion in a serious way before. It stands for organophosphate induced delayed

polyneuropathy. OPIDP. Now, that’s what we found in the hens. So

we believe the compounds acting synergistically, and

pyridostigmine of course is one of these, in combination produce

OPIDP, and which is mild generalized brain stem, spinal cord and

peripheral nerve damage.

Now, let me make several other points which I think are important for explaining a lot of confusion that’s been going on over the

last several years. First of all, after we have—— Mr. SHAYS. Could I interrupt you for a second? We have been

joined by Michael Pappas who is a new Member from New Jersey,

and it’s wonderful to have you. We’re not following the regular

order, we’re just stepping in sometimes due to the fact that Dr.

Haley will be leaving in 10 or 15 minutes at the most. And I want

to ask you, Dr. Haley, are you in a particular field that is considered kind of orphan in the sense that there aren’t many who are

involved in this, that it’s not a main field of study for practitioners?

Dr. HALEY. No, I don’t think that’s the case. I am an epidemiologist and an internist, and I have working on my team a toxicologist, like Dr. Kizer, very similar credentials, and a

neuropsychologist, because we think it’s a multidisciplinary problem. And we think our insights, we obtained the insights that were

the source of this paper while sitting in that NIH conference.

Mr. SHAYS. I know you give credit to the VA, and I appreciate

that, because that’s important.

Dr. HALEY. There was a whole set of data—— Mr. SHAYS. But I am wondering who is listening to you.

Dr. HALEY. Well, our papers were just published last week, and

we expect there will be conclusion for the next month or 2 months

and then there will be understanding, and these are very complex

issues.

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Mr. SHAYS. Now, in your study, you had 249 people in your

study. One of the areas you’ve been criticized that you didn’t have

a large enough population.

Dr. HALEY. Right, if you look back at the studies that have

solved the great disease mysteries of the last 25 years, Legionnaires’ disease, toxic shock syndrome, AIDS, hantavirus, all of the

studies that have solved these are taken a smaller group of people

and compared the sick and the well, and that’s you solve this—— Mr. SHAYS. We haven’t solved any of those problems, so what do

you mean solved?

Dr. HALEY. No, all of those have been solved. The cause has been

determined and—— Mr. SHAYS. So solve in the sense of—— Dr. HALEY. Understand the nature and the cause, what the disease is and what the causes are so you can then take control measures. All of those—— Mr. SHAYS. Right, you haven’t solved in terms of the control

measures—— Mr. SANDERS. Let me jump in and pick up on the point the chairman made. I think that the testimony you are offering is of enormous consequence, and maybe just paraphrasing the chairman

here, I hope it doesn’t get lost in the intellect. Now, would it be— I would expect that you would be sitting down with the VA and the

DOD to figure out how we build on the work that you’ve done. I

presume you want to continue this very important line of research.

Has that process begun?

Dr. HALEY. Yes. I have an appointment February 4th with the

VA Scientific Advisory Committee with a fairly large chunk of time

to go over this and in the meantime they will have had a chance

to read and study this.

Mr. SHAYS. Is that process open to the public?

Dr. HALEY. Is it?

Mr. SHAYS. Yes. I would just like someone from our committee

to sit in and witness that. I think that would be instructive.

Mr. SANDERS. So you think you are getting a good hearing.

Dr. HALEY. Oh, yes. I think the scientific process has been muddling around and it seems like cover-ups and so forth. This is the

way science works when we’re dealing with an enormously complex

problem. But it builds on itself one step at a time, and the NIH

conference, our work, the work from Iowa, all of this builds and

there will be another round of studies and pretty soon I think we

will have a general consensus of what this is and what to do about

it. I am very confident of that. If I could, let me make a couple of

points—— Mr. SHAYS. I am going to let you make them, but I just want to

make sure you touch the role of stress.

Dr. HALEY. That was my next point. We did very thorough psychological testing on the 249, and then we brought the cases and

controls and we did even more psychological testing. We found no

evidence that the veterans had post-traumatic stress disorder,

none, zero. We found no evidence that combat stress, the ones that

had high levels of combat stress had the same risk of the syndrome

as those with low levels of stress. So we don’t believe stress is a

cause of this unless in a different sense. Stress at the moments of

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chemical weapons attack might have opened up the blood-brain

barrier, as an Israeli study has recently suggested might be true.

However, we have already been following that line and we don’t

think it’s as simple as that study pointed out. We have evidence

we don’t think the blood-brain barrier opened, we think something

else happened.

But in addition, we brought in a group of physicians, neurologists, Dr. Kizer alluded to that this morning. After we already got

all this evidence and we knew what was going on, I brought some

neurologists in to look at these veterans one at a time, all 43 of

the ones we had done the cases and controls, and they didn’t know

who was who and they didn’t know the information, except they

had all the clinical and laboratory information on each veteran.

They looked at them one at a time. They were absolutely unable

to make a diagnosis. Even when they had all that neurologic physiological data, the clinical data, everything, but after they went

over each one and were unable to make a diagnosis of anything in

these people, we then broke the code and I showed them the group

data and they said yes, this group has neurotoxicity compared to

the controls.

Mr. SHAYS. Were they inclined to diagnose stress from that?

Dr. HALEY. No. They said the guys have what look like nonspecific problems, maybe there’s something going on but we can’t

make a medical diagnosis. That is an enormously complex issue. I

don’t think the interpretation was quite right. That doesn’t show

that the neurological tests were invalid. What it shows is there was

a limitation with normal medical diagnosis. You cannot diagnose

these neurotoxic problems that are subtle like this with a history,

physical, routine lab work. Even with complicated neurophysiological tests, when you look at veterans one at a time, and

that’s why I think the CCEP looked at 38,000 veterans and couldn’t

make a diagnosis, because they looked at 38,000 veterans one at

a time and they had no control group.

You see, that doesn’t mean that what they were doing was wrong

and not smart, it’s just, it was a different way of looking at it. They

went to that road which often solves problems, but it just didn’t.

This is a much more complex problem and it gives us great problem right now in what are we going to do. Now that we know

there’s a problem, how do we screen for them. And that’s what

we’re going to in our next study is try to look, and others are looking at this, how to screen so that you can tell an individual veteran

has it.

Mr. SANDERS. Let me ask you this question. How do you treat

it? If what you are saying is right, how do you treat it?

Dr. HALEY. Right, if this is brain damage and we are convinced

at least in this unit that this is brain damage from these chemical

exposures, you can’t fix brain damage. Brain damage is permanent.

Nerves do not regenerate. It will get better over a short period of

time, but once it’s stable it’s there forever. However, we can’t cure

diabetes, we can’t cure coronary heart disease, really. What we can

do, we can look at each of these symptoms, develop medications,

rehab strategies, counseling, whatever, and address each of the

symptoms.

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Now, let me say, this is a tough ball game and for every valid

researcher, this is trying to come up with a treatment that will

work and test it scientifically, there are five charlatans out there

who are putting people in sweatboxes and doing all kind of bizarre

things, I mean bizarre things, with no hint of an idea or desire to

prove any of this works. They are just making money. And I’ve

seen terrible things done to some of the veterans we’ve studied for

$10,000. They were offered a treatment and all it turns out to be

is diet pills, and it’s very disturbing to see the charlatanism going

on out there, and you as the committee, respectfully, let me say,

must be careful not to contribute to the charlatanism out there.

Mr. SANDERS. Let me ask you, something, Doctor. Is this—in

your judgment is multiple chemical sensitivity a reasonable diagnosis?

Dr. HALEY. Absolutely not. Let me say, people with multiple

chemical sensitivities, many of them have similar neurological,

neurotoxicologic syndromes, and they are—as I see it, there are

sort of two groups out there with MCS, working in the MCS area.

There are charlatans, which are most of them, and there’s a small

group of neurologists who are treating these people and finding

some valid neurological things that they are approaching scientifically, but this is a small group and not most of them.

Mr. SANDERS. Give me some evidence about—— Dr. HALEY. I could define a perpetrating—a treatment that has

no scientific rationale and then refusing to do a scientific—double

blind study to prove whether it works or not and even avoiding

doing that. And what is that? Are we that against the veterans?

Mr. SANDERS. There are some people who disagree with your

statement.

Dr. HALEY. The deciding factor is, are they doing a trial as a clinical trial? When the VA offers a chemical methodological expert to

help them design a clinical trial, do they go off and change the subject? That is what is happening.

Mr. SHAYS. Let me ask Dr. Schwartz.

Dr. Schwartz, we are going to have you give your testimony

afterwards, but I would like your response to what Dr. Haley said.

Dr. Haley, you had another point you wanted to make.

Dr. HALEY. One more point.

Mr. SHAYS. I want you to sit here while Dr. Schwartz responds.

Dr. HALEY. Right. The question is, can it leave low-level brain

damage when they don’t produce immediate symptoms? The answer is, definitely yes, and there is information. It is very clear, but

a lot of it has not been introduced.

Mr. SHAYS. What is the question again?

Dr. HALEY. Can it leave low-level brain damage in the absence?

Yes. But the answer is very complex. We had unraveled this in a

paper that I would encourage you to read. We have reference here

that is the way it works. It is a trick, it is a conundrum, that has

not been understood yet.

There are two enzymes in the brain and nervous tissue that are

destroyed by chemicals or nerve gas and pesticides and so forth.

One of them is cholinesterase in the system. Another one is called

neurotoxicesterase, abbreviated NTE. It is another enzyme. Cholinesterase on the battlefield or pesticide in a field, it binds to your

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cholinesterase. You are paralyzed, and you can even have seizures.

You can recover; then you might have brain damage because of the

seizures.

So this can lead to brain damage, but only after you are overcome and have severe brain seizures and damage as a result. That

is what the military has been talking about. Since there were no

seizures, no people overcome, we couldn’t have brain damage by

the cholinesterase system.

However, nobody has talked about NTE. There is a—there are

hundreds of articles of toxicologic literature about NTE since a big

epidemic in the 1930’s, then in the 1970’s. This was understood,

and there is a huge body of literature on it. When these chemicals

get into your nervous system, this can also bind to NTE. That

causes no symptoms immediately, but over the succeeding weeks or

months, the union or the complex between the organophosphate

and the NTE will disintegrate, will decompose into a toxic by-product which, 6 weeks later, will diffuse into the nerves and damage

the axon. That then causes mild, creeping evidence of brain damage which can continue to get worse for months. That is what happened here.

Dr. Duffy pointed out that this type of thing can happen with

low-level chemical nerve agents without acute symptoms.

And let me point out two articles by Hussein, a researcher in

India who in 1993 and 1995 did experiments with mice first, then

hens, in which you treated them daily for 10 days with low-level

doses of Sarin which would not produce acute effects. And he found

that on the 14th day they started developing a progressive neurological injury. And when they sacrificed animals, looked at the

brains, they had OPID. They noticed NTE induced, long term, no

acute symptoms.

Mr. SHAYS. Would you define ‘‘NTE’’ again.

Dr. HALEY. Neuropathy Target Esterase. Neuropathy Target Esterase. We reference these in the third—I have copies of the paper,

and it is referenced in numerous articles too.

Mr. SHAYS. Do you have the ability—why can’t you cure nerve

damage or brain damage? Can you slow the deterioration? And if

you discover it soon enough, can you literally prevent it from getting worse?

Dr. HALEY. No. Once it happens, progresses for a number of

weeks or months, then it levels off. But then as people age, we normally—we who are over 50, we lose neurons normally.

As you lose neurons, you unmask damage, you have less reserve

capacity, so as you age, we expect the symptoms to become exaggerated, and we found in our study the older veterans were more

likely to receive severe damage than the younger brain reserve capacity.

Let me make one other point here.

Mr. SHAYS. Then I am going to ask Dr. Schwartz to comment

while you are still here.

Dr. HALEY. The NTE system that is acute leads this subtle,

creeping brain damage over months, and these are separate; either

one can occur without the other.

Now, pyridostigmine is a class of drugs that is protected from

both cholinesterase damage—and NTE mediated before the expoVerDate 11-MAY-2000 10:15 Jun 28, 2002 Jkt 010199 PO 00000 Frm 00248 Fmt 6633 Sfmt 6602 W:\DISC\38711 pfrm04 PsN: 38711
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sure because it latches, protects them; the bad chemical can’t get

on it.

December 1990, a month before the war actually broke out, a researcher, Kerry Pope and Stephanie Padilla, presented a paper at

a national meeting. Protective agents, after the exposure to it, may

make the brain damage worse. Through the NTE system—not cholinesterase, the NTE system it can make that worse.

What you have got is, if soldiers continue to take it after exposure, this model would suggest it might convert a minimal—it

might take an exposure to a nerve agent that was too low to

produce brain damage by NTE and would amplify into something

that would produce brain damage.

It appears to be through these mechanisms that the

pyridostigmine would protect you, if given first, from dying on the

battlefield. But if you continue taking it by amplifying the effects

through NTE and cause brain damage, unravels all of these riddles

about, can low levels cause it without causing acute symptoms?

Why does pyridostigmine protect you, and how can the Haley

Study say it causes damage? It acted synergistically because you

can’t understand it unless you understand the two different systems. Then this becomes all clear, and that is what we found.

Mr. SHAYS. Dr. Schwartz, why don’t you make a comment on

what you found? I appreciate your patience.

Dr. SCHWARTZ. I have a few comments.

First, I would like to congratulate Dr. Haley. I think Dr. Haley’s

contribution to the group is substantial in advancing the field.

However, I don’t share the degree of definitiveness that Dr. Haley

has regarding these particular findings.

I think you are going to have to bear in mind that this represents a highly selected population; 41 percent of the individuals

within these Guard groups participated in this study, and a very

small percentage of the individuals had these syndromes within

those who were symptomatic.

Another very important item to keep in mind—limitation to keep

in mind, is that the exposures are all self-reported. So in looking

at the relationship between these exposures and the syndromes,

even though the differences were somewhat different from one exposure to the next and they lead to a very nice hypothesis, I think

that hypothesis and that series of observations would be worth

testing in another population to be more certain of the findings.

Another, I think, very important observation in Dr. Haley’s study

is, if I read it correctly, 63 out of 100 or so, there were 21——

Dr. HALEY. 249.

Dr. SCHWARTZ [continuing]. 249 individuals came in for exams;

179 of them were symptomatic. Of the 179 that were symptomatic,

63 were found to have syndromes. So the majority of the individuals who were symptomatic turned out not to have a syndrome.

It is important to recognize that those problems that individuals—that the Persian Gulf veterans have may be related to their

serving in the Persian Gulf; it may be related to certain exposures

but don’t fit into one of the syndromes.

Mr. SHAYS. Is that basically the concept of not everybody is going

to be bothered by the rug?

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Dr. SCHWARTZ. No. Some people may be bothered, but they may

be bothered in ways that are recognized as other diseases. Some

people may be bothered by the rug by developing symptoms of

neurotoxicity. So I think that there are different manifestations potentially of the same exposure.

I guess the third limitation that I just want to address is, the potential issue of other exposures, other occupational exposures, after

the war and other social exposures, like alcohol, were not taken

into account that I actually saw in the study. So those are other

issues, other confounders, other exposures, that may result in some

neurotoxicity that I think need to be addressed in a more definitive

study.

Mr. SHAYS. In just a moment, Dr. Haley, we are going to have

someone walk you through the tunnel.

Dr. HALEY. There is a lot of confusion about this. Some of these

points are excellent, some—let me respond. The selectiveness—I

heard this from a number of groups—that 41 percent of the battalion showed up to participate. However, we didn’t stop there. In

many studies, that is a problem.

We then did a background survey on the nonrespondents, the

nonparticipants, and we found that in fact the participants and

nonparticipants were identical on age, sex, race, job title—in the

Gulf war—rank, and so forth. The only thing they differed on was

that the participants were about twice as likely to say that they

had been seriously ill since the war, but only twice as likely. It

wasn’t all the guys who showed up were sick and all the others

weren’t. We believe this shows that the selectivity is a minor issue.

Second, on selectivity, if one were to posit that selectivity were

the cause of these associations with the chemical exposures and the

neurological brain damage, selectivity with relative risks of 4 to 78,

there can’t be enough selectivity to produce that. I have gotten that

comparability in the cases of control. So that doesn’t explain our

findings.

Third, there are self-reported risk factors—a very important consideration. Originally we asked them—all the exposures that were

being equally pointed out in the press—and only chemical ones

were highly associated; the others were not associated. We published all of those findings so people could look to see the chemical

exposure. Selective recall and recall doesn’t work that way. So we

don’t believe that is an explanation. We believe we need to test

these findings.

Mr. SHAYS. I get really the gist. I think the point that Dr.

Schwartz was trying to say is, he saw me get so excited and he

wanted——

Dr. HALEY. Sure it is another scientific——

Mr. SHAYS. I love definitive statements, I love confidence, I love

your energy, and I love the fact that you were here.

Dr. HALEY. Thank you.

[The prepared statement of Dr. Haley follows:]

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Mr. SHAYS. Dr. Schwartz, it has been wonderful to get you here.

We are all done now. We appreciate your accommodating your

other two colleagues.

Dr. SCHWARTZ. Our study was held at the Iowa Public Health

and Centers for Disease Control. The study was primarily focused

on individuals who listed Iowa as their home of record. It involved

initially about 29,000 individuals. We selected our population from

that 29,000 individuals. In the end, 3,700 individuals of the selected individuals in the study participated in the study. This was

a classic epidemiologic study.

The purpose of this epidemiological study was first to try to identify the playing field. In other words, what are the diseases in the

Persian Gulf veterans? What are the Persian Gulf veterans complaining of in relation to the symptoms that non-Persian Gulf veterans are complaining of? Is there a difference, and do those differences fit into categories of disease?

The second item we wanted to address, the objective we wanted

to address in this study, is that we were interested in trying to see

within the Persian Gulf population where those in the regular military had a different expression of disease than those in the National Guard and Reserve, because initially individuals in the National Guard and Reserve were coming forward with increased

rates of disease or complaints, and there was some concern that the

National Guard and Reserve had a higher rate of disease for an unknown reason. So we were very interested in that comparison as

well.

There are several aspects of our study which clearly distinguish

the previous studies and lead to the importance of the findings.

First, this was a population-based study. It involved all four

branches of the military in the Persian Gulf. These individuals

were selected in such a way that they represented the 29,000 individuals in the larger population, and so we could extrapolate back

to that group of veterans.

We also had a control population. Our control population was

identical to our—similar to the exposed population in terms of

background demographics—age, rank, gender, type of military

service, and whether they were enlisted or an officer.

The third very important point is that our study instrument was

developed over a 6 month period of time by 30 different investigators. The reason that we took a great deal of effort in developing

this study instrument is that we wanted to make sure that the

questions that we asked and the disease categories that we put individuals into were valid disease categories.

So what we did is, we went out and used portions of validated

questionnaires and incorporated that into our questionnaire. So it

wasn’t simply, ‘‘Are you forgetful?’’ but it was a series of 10 or 15

questions about memory that had been tried and refined by other

investigators and found to be associated with pathologic evidence

of cognitive dysfunction. Those are the types of disease categories

that we have developed. We developed complex algorithms based

on other investigators’ findings.

The fourth important point of our study is, we used a telephone

interview. A telephone interview is actually a very accurate way of

getting a large number of people to participate. In fact, of the indiVerDate 11-MAY-2000 10:15 Jun 28, 2002 Jkt 010199 PO 00000 Frm 00259 Fmt 6633 Sfmt 6602 W:\DISC\38711 pfrm04 PsN: 38711
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viduals that we contacted by telephone, 91 percent of the individuals participated in this study.

It was hard getting the phone numbers of individuals, so overall,

we had a 76 percent participation rate. But even a 76 percent participation rate is very good and assures you that the study population is representative of all eligible for the study.

Mr. SHAYS. 76 of the 3,700?

Dr. SCHWARTZ. We selected approximately 4,600 eligible study

subjects for this investigation, and 3,700 ended up participating in

the telephone survey.

So our results are really very different than what you have heard

before. We focused on major disease categories like cognitive dysfunction, depression, respiratory diseases. We did that on the basis

of literature that had been presented at the NIH consensus conference and also had developed since the NIH consensus conference.

Our major findings, when you compare the Persian Gulf veterans

to the non-Persian Gulf veterans: 11 percent increase; 6 percent increase in depression; 3 percent increase in anxiety disorder; 2 percent increase in alcohol abuse, bronchitis and asthma; and 1 percent increase in posttraumatic stress disorder and chronic fatigue.

The reason we decided to express this in terms of this particular

disease is—so, in other words, in the population of Persian Gulf

veterans, if chronic fatigue occurs in a background population, a

base line population of about 1 percent, then an excess 1 percent

of Persian Gulf veterans would have chronic fatigue, it tells you

that approximately 7,000 individuals would have chronic fatigue of

those that went over to the Persian Gulf.

If you expressed it in terms of risk ratio, for instance, it could

give very different results for chronic fatigue. We said there was

a 1 percent increase in chronic fatigue, but if you express it in

terms of 4.3-fold excess risk of developing chronic fatigue, that is

a major increase even though it is a small percentage.

Another very important finding from our study is that there were

several things we found not associated with going over to the Persian Gulf and things that were particularly publicized as being related, which addresses this issue, this potential issue of recall bias.

Skin lesions, aplastic injuries, were not related to having been over

in the Persian Gulf.

If we look at the five major disease categories, 64 percent of the

Persian Gulf population was entirely asymptomatic, without any

one of those five diseases; 21 percent only had one of those—symptoms of one of those diseases, and 15 percent had symptoms of two

or more of those diseases.

The reason that I bring those up, of those that are symptomatic,

most of those fall in one disease category classification.

The second important finding from our study was that service in

the Gulf. We looked at measures of functional health: How do people function at home and at work? We found that service in the

Gulf and having one of those diseases that I mentioned—the symptoms of one of those diseases, resulted in decreased self-reported

functioning at home and at work.

So not only were these individuals symptomatic but they didn’t

think they were functioning well at home or at work, which I think

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gets into a major concern of the veterans, how well they are doing

in terms of their daily activities.

A third important finding is that we didn’t find very many

differences—— Mr. SHAYS. Would that also be a factor in how they might have

an inability to articulate their case?

Dr. SCHWARTZ. Absolutely. I think the cognitive dysfunction

would be another problem in terms of them effectively articulating

their case. It does involve that as well as memory.

A third important finding is that, different than previous studies,

we found very little differences between the regular military and

the National Guard and Reserves, suggesting that the type of military service didn’t really affect the development of these symptoms.

So why are our findings important? Our findings, I think, are important because in a very controlled study we clearly document

that Persian Gulf veterans are reporting more medical and more

psychiatric conditions than an appropriate control population.

We also have identified some very well defined medical and psychiatric conditions that are being reported more frequently in this

population. I think an important take-home message for physicians

caring for these individuals is that many of these individuals will

present with diseases that other patients present with that didn’t

go to the Persian Gulf that we have treatment for, like depression,

asthma, bronchitis, fibromyalgia.

I think that is an important take-home message, that not all individuals who are Persian Gulf veterans who have medical problems need necessarily to be referred to specialty centers. Many of

the people are being cared for by their local VA hospital or local

physician.

A second important finding was that the medical and psychiatric

conditions, as I said, appear to have a measurable impact in terms

of their daily functioning. And the third finding was that National

Guard and Reserve didn’t differ from the regular military in terms

of the manifestation of symptomatology.

I think that this study is important because it takes a first fundamental step in establishing what are the medical and psychiatric

concerns among the Persian Gulf veterans. What it does is, it provides a road map for us to begin to look more carefully at these

particular medical and psychiatric conditions with more objective

tests, both clinical tests as well as laboratory tests, directed at

these specific conditions.

A shortcoming of our study is this issue that we relied solely on

self-report. I think self-report is important in identifying what the

problems are, what the potential problems are, but the next step

has to be objectifying those problems.

Another shortcoming of our study and shortcoming of all the Persian Gulf studies that we have seen so far, and something that you

might have influence in, is that minority populations and women

have not been studied specifically to see if those individuals have

different risks than white males who went to the Persian Gulf. I

think this is a very important area of investigation that needs to

be pursued.

If I had to make one other suggestion in terms of future followup

studies, a longitudinal study to look to see what happens to those

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individuals over time is critical, because all we have done is, we

have taken a snapshot of the population. We know what is going

on with them 5 years after the Gulf war. We don’t know how that

is going to change over a period of time and how that is going to

impact on their lives.

Thank you for your attention.

[The prepared statement of Dr. Schwartz follows:]

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Mr. SHAYS. Thank you, Doctor.

What is your reaction when you heard of studies that have been

in the news that have said there is really no difference between

those who served in the Gulf and those who didn’t serve in the

Gulf?

Tell me first off, when did you, again, conduct this study? What

timeframe to what timeframe?

Dr. SCHWARTZ. We started the study in December 1994. The

questionnaire was administered from September 1995 to May 1995.

So fairly recently.

Mr. SHAYS. So you are not using pre-1993 data basically?

Dr. SCHWARTZ. I am sorry, September 1995 to May 1996. I apologize.

Mr. SHAYS. This was basically all telephone conversation interviews?

Dr. SCHWARTZ. This is all telephone conversation interviews in

terms of whether they are currently having a problem. So we didn’t

ask them whether they had a problem immediately after the war

or whether the problem developed and went away. We were interested to find out whether they currently had the problem.

Mr. SHAYS. Now the critics would say you didn’t see these individuals so you don’t know whether they are well or not well.

Dr. SCHWARTZ. Yes, that is absolutely a valid criticism of the

study, that we have self-reported information.

I think a rebut to that criticism is that what we found was that

there wasn’t, as Dr. Haley said, an across-the-board similar percent

increase. That percentage actually differed quite a bit from one disease to the next. So for cognitive dysfunction there was an 11 percent increase, for asthma and bronchitis there was a 2 percent increase, and for injuries and skin lesions there was no increase at

all.

Mr. SHAYS. That is interesting. The 11 percent increase, that is

on a population of those who may have come home from the Persian Gulf feeling totally—and maybe not being exposed to any.

But let me back up a second. Your study basically determines— I am going to ask it differently. I retract that.

Tell me why 11 percent is significant, just in your own words. Is

30 percent significant? Is a 2 percent increase? What other physicians looking at that would say 11 percent is significant? Why?

Dr. SCHWARTZ. Eleven percent is significant because—I am just

pulling out the table here—in the population that didn’t go to the

Persian Gulf, the prevalence or the frequency of cognitive dysfunction was about 9 percent. In the population that went to the Gulf,

the frequency of cognitive dysfunction was 20 percent.

Mr. SHAYS. So it is double.

Dr. SCHWARTZ. It is double. And it is significant because 11 percent of the Persian Gulf veterans are affected by cognitive dysfunction that shouldn’t have been affected by cognitive dysfunction if

they hadn’t gone to the Persian Gulf.

Mr. SHAYS. Eleven percent more?

Dr. SCHWARTZ. Eleven percent total of the Persian Gulf veterans.

Mr. SHAYS. Compared to the population that didn’t go to the Persian Gulf?

Dr. SCHWARTZ. Correct.

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Mr. SHAYS. To my mind, that is double. You add 9, then went

to 20.

Dr. SCHWARTZ. That is right. The reason that we expressed it as

a percentage was that approximately 700,000 individuals went to

the Gulf, so if we say 11 percent of them develop cognitive dysfunction in excess from going to the Gulf, that is 77,000 individuals.

Mr. SHAYS. And your determination as to the cause is not part

of the study?

Dr. SCHWARTZ. No. We did look at the relationship between selfreported exposures and the relevance of specific outcomes, and we

found that many of the exposures were related to many of the outcomes. And I think that one important point related——

Mr. SHAYS. Back up to make sure I understand. In those that

were feeling symptoms, their position was that they had been exposed?

Dr. SCHWARTZ. Yes, yes. And they had been exposed to a variety

of agents. So for depression they had—they said that they were exposed to more smoke from oil fires, more radiation from nonionizing and ionizing forms of radiation, a variety of different exposures that may be related to the outcome, but given the fact that

many of these exposures were related to the outcome, it makes the

exposure response relationship less believable.

But an important point regarding this exposure information is

that we collected it in 1995 to 1996, and we are asking people to

recall exposures that took place between 1990 and 1991. That is

much less reliable than asking them to recall health information

about the last month. So I believe the health information much

more than I do the exposures, and looking at the exposure response

relationship, I think it is difficult.

And one of the points that was made in a recent conference that

I was at was that it may be very difficult for us to identify specifically what is causing this problem in the veterans, or these series

of problems. I think even if we can’t identify what is causing the

problems, we need to take the next step and define what the problems are much more objectively and try to figure out how to treat

these individuals, as Mr. Sanders was saying before.

Mr. SHAYS. How much did stress play into this issue? I asked Dr.

Haley the same thing. You can’t diagnose that, can you?

Dr. SCHWARTZ. We asked questions about stress related to their

experience in the Persian Gulf, and we derived measures of stress

from whether they were in combat, whether they had hand-to-hand

combat, whether they were exposed to gunfire, whether they were

exposed to Scud missile attacks. So we based our index of stress

on those items. We found that stress was related to a number of

the outcomes.

Interestingly, we found that stress was not related to depression.

I don’t know to what extent stress is playing a role here.

Mr. SHAYS. Fair enough. Mr. Pappas would like to ask some

questions, and we would be honored to have you ask questions.

Mr. PAPPAS. Thank you, Mr. Chairman. I apologize for arriving

late.

Mr. SHAYS. You don’t need to apologize. It is great to have you

here. Thank you.

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Mr. PAPPAS. Doctor, maybe this is beyond the scope of your

study, but just last week I had read an article where there was a

gentleman who recently committed suicide that, at least according

to this article, comments from members of his family were prompted by some of the symptoms that I have heard spoken about here

today.

Have you encountered—in your study dealing with these servicemen and women, have you encountered that in other instances that

you might think would be the higher percentage than average population?

Dr. SCHWARTZ. Yes. In terms of suicide risk, we looked at major

depression, and we used a very rigorous approach to looking at

major depression, and I believe that we found that the Persian Gulf

veterans had a 4 percent higher prevalence of major depression

than non-Persian Gulf veterans. I would concur with that.

I would also say that that underscores the importance of therapeutic intervention by physicians that are capable of taking care of

individuals who are depressed.

Mr. PAPPAS. Have you dealt with any other veteran populations

that may not necessarily have been engaged in this conflict but in

other conflicts, or have you read of any other records that would,

in order to compare this particular population with others and

their suicidal rate—— Dr. SCHWARTZ. Yes.

Mr. PAPPAS [continuing]. Or just their ability to cope with the

symptoms that they may have a reaction to either chemical agents

that they may have encountered or just the experience?

Dr. SCHWARTZ. Not in terms of suicide rate. However, Dr.

Hyams, who may have testified before this committee, wrote an excellent article that was published about 6 months ago looking at

symptoms after a number of different wars—the Civil War, World

War I, II, Vietnam war, Korean war—and looked at similarity of

symptoms among the veterans from those wars. And the conclusion

from that article was that stress played a major role in terms of

the development of those similar series of symptoms.

Mr. PAPPAS. Thank you.

Mr. SHAYS. Doctor, we are going to go to the next panel, but if

you would like to make some closing comment, we would love to

hear from you.

Dr. SCHWARTZ. I think the—I would just say that there are two

areas that I want to comment on. First, the lion’s share of the veterans that have symptoms or medical problems related to the Persian Gulf war have very clear, well-defined medical and psychiatric

conditions that are no mystery to any good clinician. And clinicians

need to be encouraged to take care of those individuals and treat

them as they would any other patient.

Another very important next step is not only to look at new

therapies but to begin to very carefully understand how these

symptoms translate into objective evidence of disease, both laboratory and clinical evidence of disease. And we really haven’t taken

that next step yet.

Mr. SHAYS. I appreciate your entire testimony; again, your willingness to be third on the list and to listen to the others testify.

I am grateful that you came.

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I will also say, and then I will yield to my colleague, Mr. Sanders, for some of us who have heard veterans for years tell us that

they are ill and no one is listening, it has been very discouraging

to have official reports come out saying that there is no documentation that our veterans are sicker than anyone else. Then we find

out that the studies have serious flaws in terms of data and conclusions and so on. Then to at least have someone like yourself say,

hey, wait a second; we are coming from a different direction, and

we do see that our veterans haven’t been lying to us, has been very

important.

Mr. SANDERS. I just want to concur in your findings. Thank you

very much.

Mr. SHAYS. We are going to end this hearing, and we usually

have our veterans come first, so I would appreciate our veterans

coming last to accommodate the others who testified.

We have Chris Kornkven a Gulf war veteran who lives in Watertown, WI; we have James Brown, a Gulf war veteran from Hannibal, MO; and James Green, a Gulf war veteran from Fishertown,

PA.

Welcome, all of you. If you would remain standing, I will swear

you in.

We have James Green to my far right; James Brown in the middle; and, Chris Kornkven, you are on my left.

[Witnesses sworn.]

Mr. SHAYS. For the record, all three of our veterans have answered in the affirmative.

We will begin, I think, with Mr. Kornkven. We will go from my

left to my right, and say that you can testify in any way that you

want. I will be happy to have you respond to what you heard earlier, and just let you know that you have time to say what you

need to say.

STATEMENTS OF CHRIS KORNKVEN, PERSIAN GULF WAR VETERAN, WATERTOWN, WI; JAMES BROWN, PERSIAN GULF WAR

VETERAN, HANNIBAL, MO; AND JAMES GREEN, VETERAN,

FISHERTOWN, PA

Mr. KORNKVEN. Thank you, sir. On behalf of my family, Gulf war

veterans, and the National Gulf War Resource Center, I would like

to thank the chairman and the members of this committee for inviting me to provide this testimony today.

My name is Chris Kornkven. I was a Reservist who was activated and served in the Persian Gulf from 8 February 1991, until

5 August 1991, with the 304th Combat Support Company, an Echelon Above Corps unit. My duty, officially, was as a field radio inspector. Unofficially, I was a combat lifesaver in charge of my

unit’s medical requirements. While still in the Gulf, I began experiencing symptoms that continue to this day. After hearing of many

fellow veterans suffering from the same symptoms, I began trying

to recall when I first noticed these problems, and believe they

started in March or April 1991.

In keeping a diary while in the Gulf, I remembered I had difficulty in remembering significant events that happened 2 and 3

days prior. I remembered my knees and shoulders being especially

painful after the slightest exertion, and that fatigue stayed with

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me constantly. I believed these were a result of the conditions I

was in and they would improve with rest.

I began seeking treatment from the Oklahoma City VAMC in

1992 when the symptoms continued and worsened and when I

heard many other Gulf war veterans were having the same problems. I was having intestinal problems; the fatigue was getting

much worse, as was my memory. I still believed the pain in my

joints was from something else and the headaches would eventually

go away. After some initial consultations, I was referred to the

mental health clinic, although I was not told why. Eventually I was

told I may have posttraumatic stress disorder and I would be tested and possibly be followed with counseling. Several weeks passed

with no other medical testing or treatment. I began asking questions in the mental health clinic when any appointment would take

place and was told they were too booked up to get me in any time

soon. It was suggested I go to the Vet Center for any counseling.

At this point, much of the medical testing or treatment had

stopped, with emphasis placed on PTSD and possible treatment in

the mental health clinic.

In May 1994, I became upset with no physical testing or treatment taking place. I waited in the emergency clinic over 6 hours

and finally got to see a nurse. It appeared she would exhibit the

same attitude of indifference and dismissal, so I told her I wouldn’t

leave until each of the medical problems were documented. At one

point she left the room, saying she had to consult with the Persian

Gulf veterans doctor. This was the first I had heard there was one.

When she returned, she said they were referring me to the Houston VA Gulf War Veterans Referral Center because they could not

figure out what was wrong with me.

During this period and after, the testing or treatment improved

somewhat, with the following items having been discovered or reported to the VA: I have reported blinding headaches for more than

a year, with only offers of aspirin. Eventually an MRI was reluctantly performed in which a nasal mass was discovered. There has

been absolutely no treatment to date; I have reported memory loss

since returning from the Gulf. This has been dismissed as a result

of stress, with no other attempts at finding the cause or other

treatment. Many times I have been told it is from PTSD, but when

I try to explain how bad the problem is, it is dismissed. Tests for

memory loss usually consist of being told a few words, then being

asked to repeat them after a few minutes; I have reported skin

problems since returning. After a sample was taken of the many

brown spots that have been appearing, I was told, ‘‘It’s not skin

cancer yet,’’ and I could ‘‘come back as needed.’’ A single examination has been performed of the rashes on my legs so long ago, I

cannot remember the date. There has been no further treatment to

date; I have reported problems breathing and have had instances

of pneumonia and of bronchitis since returning. I have been questioned by VA doctors about whether I have ever had surgery on my

chest, with no explanation. Other than antibiotics for the pneumonia or bronchitis, the only other attempts at treatment have

been frequent chest x-rays; I have reported intestinal problems, to

include diarrhea, for more than a year before a strange type of bacVerDate 11-MAY-2000 10:15 Jun 28, 2002 Jkt 010199 PO 00000 Frm 00273 Fmt 6633 Sfmt 6602 W:\DISC\38711 pfrm04 PsN: 38711
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teria was found. I was given a 2-week course of antibiotics in which

the symptoms receded somewhat.

When the symptoms returned worse than before, I reported this

to the VA for more than another year. During this time, I also reported having rectal bleeding. I was eventually given an appointment, in which the bleeding was dismissed as hemorrhoids, after

no examination. When the doctor found no evidence of hemorrhoids

in my medical records, he continued to dismiss the problem until

I insisted something be done. By the time I left Oklahoma months

later, a followup still had not been performed. This bleeding continues; I have reported joint pain for many months and had been

given a followup to see a rheumatologist in 1994. To date, I have

yet to see a rheumatologist, even after a congressional request, and

the joint pain has been dismissed as being fibromyalgia. No treatment other than Motrin has been given.

I have reported my wife and I having a miscarriage in which the

fetus had to be surgically removed and my semen burning her.

There have been no attempts at finding the cause, other than mysterious questions about sexual diseases asked by some doctor from

the Houston VAMC. At this time I would like to show a picture of

my wife and son.

My wife was always very awake and lively when she woke in the

morning. Now she has as much trouble as I do with fatigue. She

also has been diagnosed by a private physician as having

fibromyalgia. My son, who is 2 years old, has not slept a complete

night through since being born. He appears to have intestinal problems, his stools are very acidic, he is very light sensitive, and has

the exact same rashes on his legs as I do. Other blood and urine

samples have shown glaring abnormalities, with no attempts to

discover the problem. I have been told of these abnormalities

months after the same was taken.

I requested over several months that a urine test for depleted

uranium be performed. After many excuses and attempts to ignore

this, I finally was successful, after requesting congressional help.

After waiting the period needed for the results, I began inquiring

about them from the chief of staff. Three months went by during

which I was told they had called the Baltimore facility performing

the test, left messages, but Baltimore would not return their phone

calls. I called the Baltimore facility, spoke with the doctor overseeing the testing, and had him fax me the results.

During the conversation, I was told I ‘‘had a higher DU count

than those carrying around fragments in them.’’ I was also told it

was nothing for me to worry about and that I probably got it from

the drinking water where I live. I believe the Environmental Protection Agency would be interested in hearing that one.

I understand DU contamination may cause kidney problems. I

have been questioning for many months as to whether this may be

the cause of urine abnormalities, but they have been unanswered.

I also question if this may cause liver problems, and the only response I have ever received is a question of whether I have ever

had an ultrasound of my stomach since it has been painful to the

touch since I have returned.

I have reported chest pains since returning and instances of my

heart racing as high as 160 beats per minute with no activity. After

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going through tests, with results varying from ‘‘no problem’’ to not

being able to start a test due to abnormalities shown, I was given

an appointment with a cardiologist.

After the initial examination in which problems were discovered,

I was given a followup. Unfortunately, this followup was scheduled

for a year after the initial visit. Several attempts to correct this

were ignored, until once again I requested the help of my Congressman. When the appointment was held, after a couple of failed attempts, I was told the heart problem I was having was due to an

abnormal heart valve. After many physicals and no heart problems

prior to the Gulf, I was surprised to hear this. I was also told this

type of problem was hereditary, nicely avoiding the VA’s rating

guidelines.

Many types of treatment at this facility consisted of providing a

quick prescription for whatever the reported problem may be. The

number of prescriptions that I had been given totaled 27 at one

point. I began wondering the interaction of all of these medications

and requested over several months, through the chief of staff, an

appointment with a pharmacist.

During this appointment, I was told two of the medications I was

given interacted, causing heart arrythmias and, ‘‘Some people have

died from it.’’ I would like to note that the FDA is currently considering removing from the market one of these medications. To date, my insurance has been billed more than $42,000 for

these appointments, ranging from a few minutes to half an hour.

Most were with medical students. I have little wonder why claims

are denied once a veteran reports having medical insurance.

Due to problems in obtaining treatment, I have contacted the

Persian Gulf veterans doctor, the patient advocate, the assistant

chief of staff of ambulatory care, the chief of staff, the congressional

liaison, and finally the director, all of the Oklahoma City VAMC.

Since problems continued in obtaining treatment or appointments, I have contacted six different Members of Congress, to include three congressional committees. The problems continued with

obtaining proper and timely medical testing or treatment. During

this time, I was given very good care in the mental health clinic.

I then contacted the VA Inspector General’s Office, which opened

an investigation. This resulted in the Inspector General’s Office requesting a response from the director of the Oklahoma City VA.

The director provided excuses for each of the problems I had identified. After 2 months of waiting for results, I called the Inspector

General’s Office and was told they were satisfied with the director’s

response and refused to investigate further.

I have thought of filing an SF–95 claim for damages with the VA

but have given up, secure in the knowledge that it would end up

in months of red tape.

Throughout this ordeal, an emphasis has been placed on

posttraumatic stress disorder, with the physical aspect of my medical conditions seeming to be ignored, even when clearly indicated

otherwise. I was very surprised, after submitting a claim for service connection for posttraumatic stress disorder, that it was denied

by the VA. It has since been considered 20 percent disabling even

though all of the other conditions have been described as related

to PTSD. I will admit freely that stress from my service in the Gulf

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is a part of my condition, and possibly many other veterans’. I believe the VA has done a very good job in treating PTSD in Gulf war

veterans. I also believe many veterans are subjected to much more

stress by trying to navigate the bureaucracy of the Department of

Veterans Affairs and with worrying how to cope with medical conditions that are ignored, all while being unable to work and wondering how to feed or house a family.

All of the conditions I mentioned earlier, with the exception of fatigue and PTSD, have been denied service connection by the VA.

After 45 days of trying to contact Dr. Frances Murphy of the VA

central office, I finally was able to speak with her. I also left messages to speak with Dr. Susan Mather, and my calls have never

been returned. I wonder if heads of other veterans organizations

have the same problem.

During these conversations, I was told the registry would be updated with any new diagnoses or findings. I sent a FOIA request

to the VA for my information and received it. When I received it

recently, I was horrified to see it only contained medical documentation from a single examination from 1993. If I would have

had my registry examination information to support my claim, it

may have been allowed previously. Since I and many other Gulf

war veterans have found the DOD and VA have been much less

than helpful in outreach to veterans, I have been active in forming

and working with Gulf war veterans organizations in an attempt

to help others through this bureaucracy and to ensure they receive

information that is vital to their medical treatment.

Presently I serve as the president of the National Gulf War Resource Center. In my capacity as the president of the National Gulf

War Resource Center, I have encountered many Gulf war veterans

whose claims have also been denied. Most have fallen outside the

2-year limit that has been imposed by the VA.

I think after 5 years that Gulf war veterans have suffered

enough. Immediate action is needed to provide proper medical testing and treatment of this Nation’s veterans.

I would like to make this next point very clear and understandable to the committee. The complete testimony I just gave is from

me personally, but it could have come from any Gulf war veteran

in America.

With that, I offer the following recommendations: The VA and

DOD should be much more open and willing to communicate with

established Gulf war veterans organizations.

An immediate extension of the arbitrary 2-year limit would help

many thousands of veterans.

Instructing the Department of Veterans Affairs to follow the intentions of Congress in Public Law 103–446, and others, would

help greatly.

Instructing the Department of Veterans Affairs to properly administer and update the Persian Gulf War Veterans Registry will

ensure this becomes a truly useful data base for researchers and

patient care, as was previously reported in the Presidential Advisory Committee’s final report to the President.

Instructing the Department of Veterans Affairs to improve communications with medical care personnel throughout their facilities

on issues relating to Gulf war veterans.

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An independent oversight commission to oversee the review of

the 12,000 previously denied claims would ensure the process is

fair to veterans. The current practice of adjudicating these claims

at area processing offices removes the veteran, their service officer,

and possibly their Congressman from the claims process. A 96 percent rejection rate is unacceptable.

Encourage the Department of Defense to seek out and interview

medical care professionals who were in the Gulf in order to receive

their insight on what medical conditions they witnessed during

their service in the Gulf.

Request a plan of action and oversight from the DOD on ensuring medical boards are conducted properly and by regulation.

Request the DOD immediately communicate down to unit commanders that veterans will not be retaliated against in any way for

seeking health care related to service in the Gulf.

[The prepared statement of Mr. Kornkven follows:]

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Mr. SHAYS. Mr. Kornkven, that is powerful testimony. Thank

you.

James Brown. Mr. Brown, I am going to ask you—basically I let

Mr. Kornkven go about 10 minutes, a little beyond. That is the

outer limit.

Mr. BROWN. No problem.

First I wish to give a statement of appreciation to the members

of this committee for having this hearing and for inviting me to testify today. It is through events like this that the truth can be told

and changes can be made. Due to recent statements and news releases made by the Department of Defense, Central Intelligence

Agency, and Veterans Affairs, finally some actions may be forthcoming that will help to save lives, which is the highest calling of

them all.

In my testimony I will refer to many events, some recent, some

historical, but all having a bearing on the state of mind of the institutions I have just mentioned. This mentality is one of denial, ignorance, and abuse of power given not as a right but as a gift.

The need to defend one’s home and family is a basic one. However, when the responsibility of that defense is given over to another, there is a basic trust passed on which, once broken, may

never mend. This broken trust is the real, basic reason we are here

today.

My name is Jim Brown, and I am 32 years old. I was a U.S.

Army soldier, rank of specialist E–4, assigned to the 514th Maintenance Company, 548th S&S Battalion, 10th Mountain Division,

Fort Drum, NY, from 9 June 1989 to 10 April 1991. I served proudly. My primary job was to fix generators and to run the computer

system for the shop office and the first sergeant. As such, I had an

appropriate clearance for sensitive materials as well as training.

The health hazards and exposures that I was—the health hazards that I was exposed to are the shots that I received before leaving the United States, which were the immune gamma globulin,

IGG; meningococcal, MGC; typhoid II; botulinum toxoid; and anthrax, prior to deployment in the United States at the same time.

The environmental exposures in Saudi Arabia were leaded diesel,

in vehicles and poured on roads to reduce dust; microscopic dust;

lack of acclimation from cold to hot extreme; drinking highly

chlorinated water from a local source; drinking chlorinated water

from a local source; pesticide-laden living environment/compound,

cement city; infrequent showers, with oil-contaminated local water;

sand fleas; sand flies; basic unsanitary conditions; leaded fuels

used in improperly vented interior heaters for tents; work environment, vehicles, parts, saturating clothing with oil, et cetera; lack of

bottled water to remain hydrated; rodents; smoke from waste disposal descending over camp; smoke from first oil well fires, started

12 February 1991.

Other hazards were fallout from bombed chemical storage/production facilities; fallout from bombed biological storage/production

facilities; Scud attacks that resulted in chemical alarms sounding;

DU on task worked on/around and used by returning A–10’s flying

overhead after firing rounds in Iraq, trailing dust.

After my return to the United States, I became increasingly more

ill. I finally went to the hospital in Fort Jackson, SC, on 27 March

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1991, and complained of fatigue, sleeplessness, inability to concentrate, headaches, rashes, dizziness, abdominal pain, blood in my

stool and urine, and short-term memory loss. Soon after, my wife

began having the same illnesses.

The doctors examined me thoroughly and agreed that my symptoms were real and that I did have blood in my stool and urine.

They then told me they could do nothing for me, and even though

they found physical signs of what could have been internal bleeding, I was sent away with no idea what was wrong with me, no

treatment, and no followup in the near future. This was a potentially life-threatening situation. To this day, I still occasionally

have the same blood in my stool and urine and have no idea why.

After a few months, I received a compassionate reassignment to

Fort Gordon, GA. During my time there, I progressively became

worse and tried to be evaluated by the doctors there. I had a series

of tests done on 2 September 1992, by the doctors at Eisenhower

Medical Center, and the results showed that I had a tendency toward anemia and abnormally high glucose levels. The doctors dismissed the findings and told me to go back to duty, with, again,

no idea what was causing the fainting and nausea I constantly experienced.

On 4 November 1993, I ended up in the Army post’s emergency

room after having passed out standing up while outside doing common task training. Nothing strenuous was involved to induce this

reaction.

I was taken to the hospital and put in an area far from any other

patients and left to sit on a curtained-off bed. Soon, several doctors

pushed into the cramped space and began talking excitedly among

themselves about toxicology, poisoning, and the effects usually seen

in victims of it. This was said directly about me and my problem.

They talked about me as if I would not understand the jargon,

yet I understood all too well that these people were connecting an

exposure to a toxin to my condition. I sat up to look at them and

began asking questions that left no doubt that I did understand

them. The conversations stopped, and all eyes turned to me.

With ‘‘hand in the jar’’ looks, the doctors, who now numbered

about 10, looked suddenly about for somewhere else to be. I asked

if there was some kind of a problem with intelligent patients coming in this hospital and was told to lie down and be quiet and wait

for another doctor. I asked why the change and was again told to

be quiet. So I waited. I stayed in the hospital for 2 days hooked

up to an IV of fluids mixed with antibiotics of a type I had not

heard of. Since I am not a doctor, no surprise there. The surprise

came when the doctors told me I could leave and I was not to tell

anyone that I had been given antibiotics at all. Again I asked why.

I was again told to be quiet.

When I asked what was wrong with me, I was told it was pharyngitis. I asked how they knew so fast, since cultures take a little

while to be really sure of the microorganism responsible. As expected, I was told to leave well enough alone, and it seemed to

anger the doctor a lot to be put on the spot. It seemed to be the

trend in the hospital when dealing with normal questions about abnormal situations. The nurse that had attended most of the ‘‘be

quiet’’ sessions let me know some of what had happened to me. She

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pointed out that a lot of the returning Saudi vets were coming in

sick, same symptoms, and especially right after the flu shots had

been given out on the post. She also said that I had gotten mine

2 days before I showed up sick. In other words, she was trying to

connect the flu shot and my seeming reaction to it. The timeframe

didn’t seem very consistent considering—but oh, well.

After all of this, I was forced out of the military because I wanted

medical treatment. They sent me home. The assessment and diagnosis they gave me was ‘‘benign physical examination; stress syndrome.’’ In other words, a PTSD.

The doctors were all worried that I had a toxic shock reaction to

the shot and that it ‘‘was to be expected in the Saudi vets as opposed to healthy folks.’’ It seemed that there was a lot more to this

than I had first thought, especially if it was treated as if it were

a common thing by the doctors and that the doctors were making

a connection where they were publicly saying there was not one.

No surprise there either.

After looking at the test results from this hospital stay, I was

seeing a trend of values that were high or low rather than normal

that the doctors were dismissing yet were cropping up in every lab

report I had. A pattern was forming.

After all of this, I was forced out of the military because I wanted

medical treatment.

Repeatedly I was denied it and got worse as time went by.

Eventually I finished my time allowed and transferred to the Reserves to finish my 8-year obligation.

On September 1, 1994, I went to the VA hospital in Augusta, GA,

for my registry exam. I was already aware of the CCEP protocol

and the three phases involved since I had access to the documentation concerning that. I and other veterans had met in support

groups we had formed and were sharing information we had gathered.

Prior to coming to the VA, I had done several TV interviews with

stations in the area. I was known to be outspoken. Since there was

a large amount of veterans close to the hospital at Fort Gordon—

two full battalions had been deployed from there to Saudi Arabia,

and I knew many of the vets who were sick there—I thought this

would be a good idea to invite a member of the media to interview

me as I went through the program, to let the vets know they had

somewhere to go for testing and possibly treatment.

I asked the press representative at the VA if this was OK with

them. The reaction was not a good one. He felt it was best for me

to leave it to the professionals and called the reporter to tell him

what had happened. He informed me that when I tried to talk to

the press officer, he was told that, ‘‘He and I would be forcibly

ejected from the hospital grounds,’’ if any reporter showed up. So

we crossed the street and did the interview with the hospital in the

background.

When I went back to the hospital after the interview, everything

seemed to have changed in a very weird way. All of the people who

would not even look at me before were asking me if they could get

me things like coffee, and since I was accompanied there by my

mother, who drove me there since I had traveled all night to attend

the testing, and assumed they would draw a lot of blood, making

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me unfit to drive home, as well as another vet, they also got royal

treatment.

It seemed like things might be turning for the better when the

other vet noted that he had been followed when going to the bathroom. Looking around, my mother noted the same thing happening

when one of us moved around. We began to test this just to knock

the paranoia theory down, and, sure enough, every time we would

move, whenever we moved, the people at the front desk would send

someone to see where we went.

I finally surprised one of them and asked what was going on. I

was told it was for security reasons, to keep the reporters out of

the hospital. I said that was odd since neither I, my mother, or the

vet were reporters and the interview was already over. She said it

was the administrator’s decision, not hers, and went back to her

desk, which means they had coordinated with someone in the

upper hierarchy, told them what was going on, and received instruction.

After all this happened, I was finally seen by the environmental

physicians, and which I have to ask this committee, does anybody

know the actual definition that the VA is giving these people as

‘‘environmental physician’’? The doctors that are seeing the veterans are calling themselves this, but from my understanding, this

is a discipline that these people have absolutely no training in.

They are putting a name to themselves that they haven’t earned,

they have no diploma, and no right to say. And I wish this committee would investigate that fully.

As I saw the doctor, I filled out the paperwork with care, attending to all the formalities I knew of, in order to test the system for

other vets that may not be as well informed as I. I let the physician

see the large package of medical files I was carrying and asked

where he wanted them. He answered, ‘‘Outside the office.’’ I said

they would help establish a pattern of illness for him. He said that

was what he was for. I began to see an old pattern forming again

I had seen in the DOD, which again supports the idea that if DOD

says it’s supposed to be done a certain way, the VA is going to follow and tow the line.

DOD basically has subcontracted the VA to take care of the

health care for its employees, which are the veterans, and that’s a

conflict of interest all the way around. The VA has an innate sense

of survivability. It’s not going to treat us and get rid of its only people that keep it in business. It’s going to keep us around to make

sure that we keep coming back.

I held on to my copy of the protocol phases and asked him to describe the testing he was going to do today. He said it would be

real extensive, a lot of stuff, and he rattled off the basic tests listed

on the phase 1 protocol, very simple things. I mentioned this and

was told it was the very best they have to offer and this would be

all the VA could do for me, period, ever. He said this as I had the

protocol papers rolled in my hand. I knew better and had proof.

So after he said this, I asked him again if he would not like to

increase the testing scope since the tests I had from other physicians told a real pattern story. He said no. We proceeded through

these tests he outlined.

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When he was done with what any first-day medical student

would have passed over as useless, I showed him the protocol

sheets with the three phases on them. He turned a very interesting

shade of white and asked me where exactly did I get those from,

I was not supposed to have those, and so on. He got rather irate

then. I showed the three phrases to him and asked him what we

were going to do now. He stammered something about having to

go get more papers so he could do tests I requested since he only

had 25 patients in the office at the time. Phase 1 consists of only

five tests if you include the x-ray. It seemed that a little pressure

had worked.

Afterwards I had talked to the doctor in finding out what tests

he had done, and they took approximately eight tubes of blood during that time, at one time. It made me woozy, it made me dizzy,

but I figured we would actually get somewhere with this. When I

received the statement from the VA telling me exactly what had

come of this, this very extensive training, very extensive testing,

they sent me this letter on September 23rd, which was 22 days

after I had had my examination: ‘‘The results of your physical examination indicate no problems with your labs or x-rays. However,

you should keep all your appointments to Mental Health.’’ That put it into a very interesting frame. When I compared the

documentation that the VA actually had put forward on me, the

tests they had run, and I compared them to other documentation

I had gotten from medical doctors outside the VA and DOD system,

the results were almost identical. Highs were in the same place,

and lows were in the same place, and these other doctors had said

that I had a severe case of anemia and I had a severe infection of

the Epstein-Barr virus, which at that time didn’t mean very much

to me, but considering what I had been exposed to in my environment and the chronic fatigue I was experiencing at that time, it

seemed rather odd that the VA did not pick this up with their own

testing. The people interpreting the test results are falling flat on

their face. The test results were the same.

[The prepared statement of Mr. Brown follows:]

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Mr. SHAYS. Let me figure out how we proceed. This has been 10

minutes now. I’d like Jim Green——

Mr. GREEN. Mine is not very long.

Mr. SHAYS. Yes, we might come back to you, but I would like—

you have eight more pages left in your testimony, and you are also

doing some ad-libbing as well. So why don’t you make your statement.

Mr. GREEN. OK. How are you doing, Mr. Chairman.

My name is James B. Green, formerly of the U.S. Air Force. On

or near October 1990, I was placed on an antiterrorist team. We

were told that——

Mr. SHAYS. Let me do this. While he is giving his testimony, if

you could get your eight pages down to four and just kind of go

through what you think would be good.

Yes, Mr. Green.

Mr. GREEN. Sorry about that.

We were told that we were going to Germany and then possibly

the Gulf. I was told to get my shots updated for mobility, so I went

and was given a shot and a series of little white pills. We went to

Germany and stayed at a hotel, waiting to be assigned. It turned

out that another group had come before us and we were sent home.

About a week later, I was assigned to Dover, DE. There I guarded planes and work gates to monitor the coming in and out of the

base.

When I first got sick, I broke out in rashes that looked like bull’seyes, and later they turned into pimples what split open whenever

I moved. I now have AIDS-like lesions that come and go on my

body, and he saw—Mr. Brown here saw—some of them last night.

I got out of the military—excuse my speech. My speech gets slurred

sometimes.

Mr. SHAYS. You know, your statement is a little shorter, so you

can speak slowly. You have a statement, so why don’t you take

your time.

Mr. GREEN. OK. Excuse my speech; it does get slurred.

Mr. SHAYS. Take your time.

Mr. GREEN. At one point in time, my entire body was covered

with this rash. I got out of the military and immediately went to

the doctors. After four visits to the VA, I was given some type of

medication that helped with the rash, but it kept coming back in

different forms. The health care I received in the military was inadequate.

After receiving the shots and the PB pills, I suffered many symptoms. These included severe headaches, muscle soreness, joint pain,

stiffness, memory loss, severe mood swings, loss of appetite, loss of

mental capability.

My wife and children have been forced to live a life of hell. They

don’t know how I am going to act from one day to the next or even

hour to hour.

I signed up for the VA Health Registry in 1994. I filled out the

paperwork. They sent me to the VA hospital for a Desert Storm

exam. I received a better exam from my family doctor. The doctor

asked what was wrong and asked me to describe the symptoms. I

was then sent for a series of blood work and referred to the mental

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health clinic for stress-related problems. Seems awful funny to me

that my illness is stress related and I was not even in the theatre.

I am scared to go to the VA hospital for treatment. The government thought it was OK to give us poison once. Why wouldn’t they

do it again? I am referring to the shots and the PB bills. That is

what I believe is making me sick with this illness and probably exposure to things coming from overseas.

I’ve lost excessive amounts of weight. I’ve lost about 80 pounds.

I was 222 when I got out of the military; I am down to 167 pounds

now. My life and my family’s lives have been complete hell. I have

to drink a six-pack of Ensure almost daily to keep at this weight.

I feel that the government should take responsibility for what it

has done to us. This disease is obviously not stress related, as they

would like us to believe. I am a perfect example. My jobs weren’t

stress related, and I am experiencing the same symptoms as others.

My theory rests on the inoculations and the PB pills. As everybody knows, the French troops were not given the experimental

pills, and not many of them are sick.

In conclusion, I believe that it is the government’s duty to help

those that are sick, especially those who were also exposed to the

chemicals in the Persian Gulf. They are twice as sick. Let them not

fight anymore just to find a way to live day to day. Take responsibility. We weren’t sick before, and now we are very sick. We’re not

asking for much, just a chance to live as normal a life as possible

under the circumstances.

Thank you, Mr. Chairman.

Mr. SHAYS. Thank you, Mr. Green. Your testimony is interesting

in that you never served in the theatre but you basically took the

pills, and you didn’t take the PB tablets, did you?

Mr. GREEN. Yes, sir, I took the tablets.

Mr. SHAYS. As well as the shots.

Mr. GREEN. And the shots; yes, sir.

Mr. SHAYS. And you learned that you weren’t going in about

when?

Mr. GREEN. Well, we went to Germany, and they said go to this

hotel and wait and you will be assigned where you are going, and

we were—like I said, we were there a week, and then they sent us

home, and then they sent me to Dover, DE.

Mr. SHAYS. I just want to come back to Mr. Brown in a moment

to finish up his four pages, but your health before you went in the

service was——

Mr. GREEN. Excellent.

Mr. SHAYS. Mr. Green.

Mr. GREEN. I was in excellent health. I went through 6 weeks

of basic training, 6 weeks of tech school, and 6 weeks of combat

training.

Before I went in the military, I was in excellent health. Now I

am 100 percent disabled. I am just trying to help these Desert

Storm—I am 100 percent disabled for my back, neurologic problems

in my back.

Mr. SANDERS. Mr. Green, were any of your comrades who also

took these pills affected in any kind of negative way?

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Mr. GREEN. A lot of people complained about just like being sick,

but nobody ever broke out with the skin rashes and stuff like that.

I was the only one, for some reason.

Mr. SHAYS. Mr. Brown, let me just say all of your testimony is

just very valuable to this committee and tells us a story totally in

conflict with the so-called party line of the VA. I mean, all three

of you experienced—now you are on total disability.

Mr. GREEN. Yes, sir. It took 5 years to get that, almost 6 years

of fighting the VA to get that, and my back was hurting immediately after I got out of the military. So it took 6 years of fighting

to get my 100 percent.

Mr. SHAYS. Mr. Brown.

Mr. PAPPAS. Mr. Chairman.

Mr. SHAYS. Yes.

Mr. PAPPAS. I would just ask Mr. Green a question about the

pills and shots that you were administered. How soon from the

time you were given these pills or shots did you begin—— Mr. GREEN. To tell you the truth, sir, I really can’t recall. I

mean, if you asked me what happened last Tuesday, I couldn’t really tell you. That’s how bad my memory is anymore, just disintegrating.

Mr. SHAYS. Would somebody in your family be able to answer

that question?

Mr. GREEN. Yes, my wife would, but she’s getting—like he said

about his wife, my wife is starting to get the same symptoms. My

child has swollen lymph nodes on her neck, the skin rash.

Mr. SHAYS. If you are able to get us that answer—— Mr. GREEN. I can definitely have my wife—— Mr. SHAYS. Write down the question. Do you have a pencil there?

Mr. GREEN. Sure.

Mr. SHAYS. The question is, how soon—you took the pills, the

shots and the pills—did you become ill, OK?

Mr. GREEN. Yes, sir, I’ll get that to you.

[The information referred to was not available at the time of

press.]

Mr. SHAYS. Mr. Brown, why don’t you finish up. Again, your testimony is very valuable to us, so thank you for condensing what

is left.

Mr. BROWN. Yes, sir. As far as my experiences with the VA, the

main problem I had with them all the way around is, I got the

exact same treatment from them that I did from the Department

of Defense: Basically, there’s nothing wrong with you, go about

your business, and if there is, don’t worry about it, we know better.

When I finished up at the VA and had to end up spending my

own money, which I didn’t happen to have that much of, because

I had been put out of the military for speaking out about this, I

ended up spending my own money on this, and ended up finding

out some answers that I should have gotten from the VA to begin

with.

And when I went back and started comparing notes with Medicare papers—and a half, I submitted those to Mr. Newman for the

record, my medical records. You can look through these. And compared from 1991, 1992, 1993, 1994, all the way through there,

every one of the tests comes out the same.

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The only one out of the entire gamut that I got any answers from

was a private physician I ended paying money to. There wasn’t any

treatment they had. They told us, ‘‘We can’t treat that, you have

to go back to the government because they are the ones that

messed you up to begin with.’’

When you look through these papers, there’s no way you can reconcile that going back there is going to get me treatment, for him,

for him, any of us, unless pressure is put on the VA and DOD. Unless accountability is put on these individuals, I don’t see any kind

of change coming about.

Like Dr. Murphy and Mr. Kizer here, if they make a

misstatement or perjure themselves before the committee, that’s

something they can have put back on them. There are consequences for these people, as you well know. That’s the only way

I can see we’re going to get any.

DOD is the same way. They know the fat’s in the fire and they

are about to burn. That’s why they came forward with the facts

about Khamisiyah. It wasn’t somebody in the CIA that was listening to the radio and washing dishes. That wasn’t it. A video came

forward, the documentation came forward, they were advised of it

by the President’s Advisory Committee’s counsel, Jim Turner, and

as of that time when they were advised of the fact that this video

and this document fit together, they knew the gig was up. They

had to come forward and make their statement first. And that is

when June 21st came forward.

Until and unless that gets out of the way, the VA is going to follow in DOD’s footsteps. As DOD goes, so do they. Where VA

messed me over, there is a contract between DOD, VA, and the veteran. ‘‘Honor the contract’’ is the bottom line. We fulfilled our side

of the contract. We’re not asking for money. We’re not asking for

anything but our health back. I had a job to begin with.

Mr. SHAYS. You may not be asking for money, but there is one

question, properly diagnose, properly treat, and properly compensate.

Mr. BROWN. Right.

Mr. SHAYS. If you are not able to support your family because of

your illness, you might need compensation.

Mr. BROWN. It comes down to that. If I had the option between

being treated and put back in the work force, more or less, and

being able to be put back to my job, that’s it for me, I am done;

let me earn my own way. I did before all this other junk started.

That’s one of the things I’ve been after from the get-go. I want

these people to put us back where we were, if that’s at all possible.

The documentation I’ve seen points in the direction that there is

some form, if not a cure, a treatment, that at least can keep us

where we are, if not backtrack us some. As Dr. Haley talked about,

there is a way. So for VA and DOD to wait until we all die off and

there’s 20 left and then talk about compensation and treatment,

that’s not it.

One of things I wanted to submit for testimony also is this list

of cancers. There are 2,045 cancers listed on this. This is from the

VA data base in Hines, IL, the VMAG there. This lists in fiscal

year 1991 through 1995 the amount of cancers that were in the VA

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system. We’ve been told there’s only a couple of hundred. This is

a couple of thousand.

Mr. SHAYS. Is that of Gulf war veterans?

Mr. BROWN. Yes. It reads at the top, ‘‘Persian Gulf War Veterans

with neoplasms by diagnosis and age group, fiscal year 1991.’’ It

has the diagnostic codes which they have in their system and no

one else does, the IDC9ZM codes, ‘‘malignant neoplasms of,’’ and

then they fill in the blanks. For 1991, there was 51; for 1992, there

was 250. Now, this is not in addition, with the 51 incorporated in

it. These are 250 that occurred in the fiscal year of 1992.

Mr. SHAYS. I will be happy to have you submit that, and we

would ask the VA to respond to it.

Mr. BROWN. Yes, sir. Thank you very much for that. There is no

way for VA to say there is no pattern to this illness. There’s nothing that makes us stand out from the background of everybody

else. We’re no different from anyone else. That’s ridiculous, and it’s

got to stop, because people are dying from this.

[The information referred to follows:]

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Mr. SHAYS. Mr. Kornkven, are there any points you would like

to make in addition before we adjourn?

Mr. KORNKVEN. I believe my testimony and the recommendation

are an initial starting point. Tomorrow I will be meeting with Dr.

Rostker and Mr. Gober at the VA, and we’re encouraged that finally they are opening up a dialog with us. We will see over the

next few months how everything will be improving on this issue.

Mr. SHAYS. And you will stay in touch with us to let us know

how you think that is going.

Mr. KORNKVEN. Yes, sir, and I do hope that things will start to

change now.

Mr. SHAYS. Mr. Green, do you have any other comment you

would like to make to the committee?

Mr. GREEN. No, sir. My main worry is the children and my wife,

as he was saying, with whatever it is that we have going over to

them, and that’s my main worry. And my—I care about my life, but

they are my life, you know.

Mr. SHAYS. I wish I had the three of you go first, and that way

I could make reference to your testimony, which has been the practice we wanted. We may just decide that if they can’t wait, we will

just tell them to come later. But I wish I had asked all the witnesses before the issue of what type of exposure a spouse has to

chemical disorders, if that is the case.

Mr. KORNKVEN. Sir, if I may.

Mr. SHAYS. Sure.

Mr. KORNKVEN. I have provided some information to Mr. Newman concerning the questions we’ll have for Dr. Rostker and Mr.

Gober, and some of the questions are rather pointed, and you may

want to followup those questions in the future.

One last comment, I guess, is if the VA can do something about

the registry. For this data base to be a truly useful tool, it needs

to be updated. This is my paperwork, sir, since 1992. This is what

is in the Registry concerning that paperwork: two pages. It needs

to be updated.

Thank you.

Mr. PAPPAS. Mr. Chairman.

Mr. SHAYS. Yes. The gentleman may ask any questions he wants.

It has been nice to have you there.

Mr. PAPPAS. Thank you.

For Mr. Kornkven, is that how you pronounce your name?

Mr. KORNKVEN. Yes, sir.

Mr. PAPPAS. In your testimony you mentioned something about

an arbitrary 2-year limit, and I am not familiar with what you

were speaking about.

Mr. KORNKVEN. Public Law 103–446 was passed, I believe, 2 or

4 November 1994 to specifically address Gulf war veterans’ health

problems.

There are 13 prevalent symptoms that Gulf war veterans have

been reporting that are considered undiagnosed by the VA. With

that legislation, it calls for a Gulf war veteran to have reported

their health problems within 2 years of leaving the Persian Gulf.

That is the 2-year timeframe. That 2-year timeframe must be extended, because many Gulf war veterans are falling just outside of

that 2-year timeframe. We did not know of some of the programs

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that were going on in inside the VA until well after this 2-year

timeframe.

I’d like to note as well with that statement that the VA be instructed to follow that law. I say follow that law. The 2-year timeframe, with myself personally, I returned in August 1991, which

means symptoms should have been reported by August 1993. This

registry paperwork is January 1993, yet every one of the problems

that I had requested service connection for were denied. The law

was ignored.

Mr. SHAYS. Was not what, I am sorry?

Mr. KORNKVEN. The symptoms or the diagnoses or the health

problems that I had reported to the VA and requested service connection for were denied, even though they were reported within

this 2-year timeframe. And I’d like to note as well, on that 2-year

timeframe, it appeared many veterans that just after that law was

passed were suddenly diagnosed with any kind of frivolous title diagnosis.

Mr. GREEN. It seems they wanted to pin—I am sorry, I didn’t

mean—it seemed like they were trying to put PTSD on all of us.

That’s their magic, you know: This is what you have, PTSD, all

three of us. They all say we have PTSD. It’s not PTSD; it’s not in

our heads. I have rashes and lesions I can show you. I don’t think

y’all want to—but I mean, it’s not in our heads.

Mr. SHAYS. Mr. Green, we know it is not in your head. I think

the second panel can point us in a direction where they didn’t, in

their studies, see PTSD as a likely diagnosis. So I know this has

been extraordinarily frustrating and life threatening, and as someone who sent you all there, I feel, as do other Members, a tremendous responsibility to make it right.

If there’s no other comment, I am going to call this hearing—yes,

sir, Mr. Brown.

Mr. BROWN. Sir, one more thing that I would like to add for the

record. If you would, please ask the VA and DOD exactly what are

the ICDM codes for chemical and biological injuries. They don’t

have them in their data base at all. They don’t exist. They have

to take a lot of different symptoms that look like they fit into that

category and then throw them at the problem. That is why you

have somebody walking in with one problem or three or four problems.

I’ve asked the doctors at the VA if they have them, and there’s

no way—it is like going to a Burger King and asking one of the

kids behind the counter to give you a burger with extra onions but

there isn’t a picture they can push. It is the same mentality; they

give you a blank stare, like, ‘‘Excuse me.’’ That is what we have

at the VA right now. DOD is doing the same thing.

Yet what is chemical warfare? What is biological warfare? This

isn’t something you run into working at the local grocery store.

This is military-based. So is DOD; so is VA. By that, they should

have the code in there first for this type of warfare. They should.

They don’t.

Mr. SHAYS. That is an excellent point I am happy you made, and

I am glad you felt compelled to make it.

Any other points?

Mr. BROWN. Thank you.

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Mr. GREEN. Thank you for having us.

Mr. KORNKVEN. Yes, thank you, sir.

Mr. SHAYS. Sure.

Mr. PAPPAS. My statement—— Mr. SHAYS. Yes, your statement will be submitted for the record,

and it has been great having you.

Mr. PAPPAS. Thank you.

Mr. SHAYS. Thank you, gentlemen. This hearing is adjourned.

[Whereupon, at 4:37 p.m., the committee was adjourned.]

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