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37–476 2008

GULF WAR EXPOSURES 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED TENTH CONGRESS 

FIRST SESSION 

JULY 26, 2007 

Serial No. 110–38 

Printed for the use of the Committee on Veterans’ Affairs 

( 


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COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL H. MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

GINNY BROWN-WAITE, Florida 

MICHAEL R. TURNER, Ohio 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

Malcom A. Shorter, Staff Director 

SUBCOMMITTEE ON HEALTH 

MICHAEL H. MICHAUD, Maine, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

PHIL HARE, Illinois 

MICHAEL F. DOYLE, Pennsylvania 

SHELLEY BERKLEY, Nevada 

JOHN T. SALAZAR, Colorado 

JEFF MILLER, Florida, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

HENRY E. BROWN, JR., South Carolina 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 


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C O N T E N T S 

July 26, 2007 

Page 

Gulf War Exposures ................................................................................................ 1 

OPENING STATEMENTS 

Hon. Phil Hare ......................................................................................................... 1 

Prepared statement of Congressman Hare .................................................... 42 

Hon. Jerry Moran .................................................................................................... 2 

Hon. Henry E. Brown, Jr. ....................................................................................... 2 

Prepared statement of Congressman Brown .................................................. 42 

WITNESSES 

U.S. Department of Veterans Affairs: 

James Binns, Chairman, Research Advisory Committee on Gulf War 

Veterans’ Illnesses ........................................................................................ 20 

Prepared statement of Mr. Binns ............................................................ 57 

Lea Steele, Ph.D., Scientific Director, Research Advisory Committee on 

Gulf War Veterans’ Illnesses, and Associate Professor, Kansas State 

University ...................................................................................................... 21 

Prepared statement of Dr. Steele ............................................................. 59 

Lawrence Deyton, MSPH, M.D., Chief Public Health and Environmental 

Hazards Officer, Veterans Health Administration ..................................... 32 

Prepared statement of Dr. Deyton ........................................................... 61 

Mikolajcik, Brigadier General Thomas R., USAF (Ret.), Mt. Pleasant, SC ........ 4 

Prepared statement of Brigadier General Mikolajcik .................................... 43 

Nass, Meryl, M.D., Internist and Hospitalist, Mount Desert Island Hospital, 

Bar Harbor, ME ................................................................................................... 17 

Prepared statement of Dr. Nass ...................................................................... 51 

National Vietnam and Gulf War Veterans Coalition, Denise Nichols, MSN, 

Vice Chairman ...................................................................................................... 9 

Prepared statement of Ms. Nichols ................................................................. 47 

Veterans of Modern Warfare, Anthony Hardie, Legislative Chair and National 

Treasurer .............................................................................................................. 7 

Prepared statement of Mr. Hardie .................................................................. 46 

SUBMISSIONS FOR THE RECORD 

American Legion, Shannon L. Middleton, Deputy Director, Veterans Affairs 

and Rehabilitation Commission, statement ....................................................... 72 

Brown, Hon. Corrine, a Representative in Congress from the State of Florida, 

statement .............................................................................................................. 76 

Fahey, Dan, San Francisco, CA, statement ........................................................... 76 

Miller, Hon. Jeff, a Representative in Congress from the State of Florida, 

statement .............................................................................................................. 83 

Stearns, Hon. Cliff, a Representative in Congress from the State of Florida, 

statement .............................................................................................................. 84 

MATERIAL SUBMITTED FOR THE RECORD 

Post-Hearing Questions and Responses for the Record: 

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans’ Affairs, to Brigadier General Thomas R. Mikolajcik, 

USAF (Ret.), Mt. Pleasant, SC, letter dated August 2, 2007 .................... 85 


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iv 

Post-Hearing Questions and Responses for the Record—Continued 

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans’ Affairs, to Anthony Hardie, Legislative Chair and 

National Treasurer, Veterans of Modern Warfare, letter dated August 

2, 2007 [NO RESPONSE WAS RECEIVED FROM MR. HARDIE.] .. 86 

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans’ Affairs, to Denise Nichols, MSN, Vice Chairman, 

National Vietnam and Gulf War Veterans Coalition, letter dated August 2, 2007 ................................................................................................... 87 

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans’ Affairs, to Meryl Nass, M.D., Internist and 

Hospitalist, Mount Desert Island Hospital, Bar Harbor, ME, letter 

dated August 2, 2007 .................................................................................... 113 

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans’ Affairs, to James Binns, Chairman, Research Advisory Committee on Gulf War Veterans’ Illnesses, U.S. Department 

of Veterans Affairs, letter dated August 2, 2007 ........................................ 134 

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans’ Affairs, to Lea Steele, Ph.D., Scientific Director, 

Research Advisory Committee on Gulf War Veterans’ Illnesses, U.S. 

Department of Veterans Affairs, and Associate Professor, Kansas State 

University, letter dated August 2, 2007 [NO RESPONSE WAS RECEIVED FROM MR. DR. STEELE.] ....................................................... 136 

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans’ Affairs, to Lawrence Deyton, MSPH, M.D., Chief 

Public Health and Environmental Hazards Officer, Veterans Health 

Administration, U.S. Department of Veterans Affairs, letter dated August 2, 2007 ................................................................................................... 137 


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GULF WAR EXPOSURES 

THURSDAY, JULY 26, 2007 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

SUBCOMMITTEE ON HEALTH, 

Washington, DC. 

The Subcommittee met, pursuant to notice, at 10:00 a.m., in 

Room 334, Cannon House Office Building, Hon. Phil Hare presiding. 

Present: Representatives Hare, Moran, and Brown. 

OPENING STATEMENT OF HON. PHIL HARE 

Mr. HARE. Good morning. The Subcommittee on Health will come 

to order. I would like to thank everyone for coming today. Regrettably, Mr. Michaud, the Subcommittee Chairman, had an emergency and isn’t able to be here today. I’m Congressman Phil Hare 

from Illinois. This is, I think, my first opportunity to Chair a Subcommittee hearing, so I hope you will bear with me. 

During this hearing today, the Subcommittee will examine Gulf 

War exposures of veterans. The incidences of Amyotrophic Lateral 

Sclerosis (ALS) among Gulf War veterans and most importantly 

where is the U.S. Department of Veterans Affairs (VA) in conducting continuing research on Gulf War I exposures and what 

they are finding out about the current exposures in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans. Many of the veterans who served in the Gulf War were exposed to a variety of potentially toxic substances during their deployments. 

According to the Research Advisory Committee on the Gulf War 

veterans, more than 16 years after the end of Operation Desert 

Storm, a substantial proportion of veterans continue to experience 

chronic and often debilitating conditions characterized by persistent headaches, cognitive problems, somatic pain, fatigue, gastrointestinal difficulty, respiratory conditions, and skin abnormalities. 

The Department of Defense (DoD) and the Department of Vet- erans Affairs together has spent $260 million on Gulf War illness 

research. While there have been numerous studies and much research conducted on Gulf War illnesses there are still many unanswered questions. Another aspect of Gulf War I Service is ALS. 

ALS is a progressive and nearly always fatal disease that affects 

a person’s nervous system. According to the Institute of Medicine 

(IOM), Amyotrophic Lateral Sclerosis in veterans review of the sciVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 E:\HR\OC\37476.XXX 37476

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entific literature, there is limited and suggestive evidence of an association between military service and developing ALS. 

Additionally, in a study sponsored by the Department of Veterans Affairs in 2003, researchers identified the incidences of ALS 

in veterans deployed to the Gulf as twice as high as the incidences 

of diseases among those who did not go to the Gulf. 

I look forward to hearing from our panelists on these very important issues. I would now like to yield to my friend, Mr. Brown of 

South Carolina, for any opening statements that he may have. Mr. 

Brown? 

[The prepared statement of Congressman Hare appears on p. 42.] 

Mr. BROWN OF SOUTH CAROLINA. Mr. Chairman, if I might, I 

would like to yield to Mr. Moran for an opening statement. Then 

I have an introduction I would like to give. 

Mr. HARE. Without objection. 

OPENING STATEMENT OF HON. JERRY MORAN 

Mr. MORAN. Mr. Chairman, thank you very much. I only want 

to commend this opportunity for us to once again examine the consequences of various exposures and conditions that our military 

men and women have encountered in service to their country, particularly as it relates to the war in the Gulf. 

Over the last 10 years this Subcommittee, this—actually the full 

Committee has held ten hearings on the topic of Gulf War Syndrome. In the past, I chaired the Subcommittee on Health and this 

was a significant topic of our agenda and continue to believe that 

it is important for us to make certain that we learn everything possible from our previous exposure to conditions in the Gulf and to 

make sure that back in 2002 when we were entering into Afghanistan, we were trying to make certain that our military had learned 

lessons from that previous Gulf War experience. 

Again, I think the consequences of our deployments are significant and real and need to be fully addressed by our Committee, but 

particularly by VA. So these are important hearings on useful topics, and I am glad to see the seriousness with which we are approaching the Gulf War Syndrome today. 

Thank you, Mr. Chairman. Thank you, Mr. Brown. I yield back 

to you. 

OPENING STATEMENT OF HON. HENRY E. BROWN, JR. 

Mr. BROWN OF SOUTH CAROLINA. Thank you very much. And it 

is absolutely a great honor today to be able to be a part of this 

hearing. And I thank the Ranking Member, Mr. Miller, and the 

Chairman, Mr. Michaud for conducting this hearing. And I am glad 

to have you, Mr. Hare, as leading this charge this morning. 

Within my State of South Carolina and the Nation as a whole 

who have served the country during the Gulf War as a Member of 

this distinguished Subcommittee, it is my duty, it is our duty to 

provide our Nation’s veterans with access to the best healthcare 

possible. It is our duty perhaps even a moral responsibility for us 

here today on this Subcommittee to help those brave veterans who 

have helped defend our great Nation. 

Today I have the distinct and dignified honor of introducing 

someone who answered the call of duty by helping his country 


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when it needed him the most. And today he comes before us and 

asks for our help. His name is Brigadier General Thomas 

Mikolajcik. 

For many years my personal friend and great American hero, 

General Mikolajcik, or General Mik as he is known by his closest 

friends, has been a leader in the Charleston Community. First as 

commander of the C–17 Wing Base at the Charleston Air Force 

base and then as an active contributor to the Charleston Chamber 

of Commerce Military Relations Activities following his retirement 

in 1996. 

But General Mik’s dedication to the Charleston Community 

would be noteworthy in any case, it is even more impressive when 

one realized that his focus on the needs of this community comes 

at a time when he is suffering from a debilitating and deadly disease. 

In 2005, General Mik announced that he had been diagnosed 

with ALS. While many individuals would have immediately withdrawn under the pressure and impact of ALS, the General used it 

as an opportunity, and with much resolve and endurance doubled 

his efforts and dedication. In addition to continuing his commitment to the Charleston Community, the General has devoted a 

great deal of attention to raising awareness within the community 

of ALS and improving the quality of life for ALS patients and their 

families. Thanks to his efforts, a new ALS Association Chapter was 

formed in South Carolina and the only ALS clinic in the State was 

founded at Charleston Medical University of South Carolina. 

General Mik is truly an inspiration to many throughout the 

Charleston Community, continually thinking of others despite the 

great challenges he has faced. Numerous studies have shown that 

individuals who have served in the military have a higher propensity toward being diagnosed with ALS. While the Department of 

Veterans Affairs has identified ALS as a Gulf War I related disease, cases abound that show the spread of this disease among veterans is much broader. 

Indeed, a recent study showed the veterans of all conflicts have 

a 60 percent higher chance of being diagnosed with ALS than the 

general population. It has been nearly 70 years since Lou Gehrig 

made his famous speech and retired from baseball after contracting 

this horrific disease. And it has been nearly 17 years since the end 

of Gulf—first Gulf War, and yet little has been done about this disease and even less is known about it’s causes. 

The work of General Mik has also brought to my attention the 

growing number of veterans contracting ALS outside of service during Gulf War I. My office is aware of a number of cases in my district from veterans who have developed ALS where the VA has denied their claims because their service was not within the presumptive timeframe of August the 2, 1990, through July 31, 1991. 

We don’t have a good handle on how many non-Gulf War I veterans have contracted ALS, what military-related risk factors exist 

and what we can do to decrease the chances of ALS among our veterans and military servicemen and women. This issue is of special 

concern as we continue to have troops deployed in OEF and OIF. 

The story of General Mik serves as a testament to the need for 

leadership at the Federal level toward developing the comprehenVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 E:\HR\OC\37476.XXX 37476

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sive ALS research program and declared VA/DoD policy ensuring 

that all veterans with service-connected ALS receive the attention 

they deserve regardless of whether or not they served during Gulf 

War I. We need an agency to step up to the plate and lead Federal 

research into the cause of ALS and how we can better improve it’s 

treatment. 

Most importantly, we need to begin these efforts now before more 

veterans, including General Mik, succumb to ALS. And I thank 

you, Mr. Chairman. And I also would like to identify his wife, Carmen, who is with him and also his son, John, and Jamie Haywood, 

who is founder of the ALS Therapy Development Institution. And 

I thank you all very much for coming. 

[The prepared statement of Congressman Brown appears on p. 

42.] 

Mr. HARE. Thank you, Mr. Brown and welcome General. Our remaining panelists are Anthony Hardie who is a Gulf War veteran. 

Anthony, let me first of all thank you for coming and thank you 

for your service to this country. And Denise Nichols who is Vice 

Chairman of the National Vietnam and Gulf War Veterans Coalition. 

So, General, we will start with you and we welcome your testimony. Good morning. 

STATEMENTS OF BRIGADIER GENERAL THOMAS R. 

MIKOLAJCIK, USAF (RET.), MT. PLEASANT, SC (VETERAN); 

ANTHONY HARDIE, LEGISLATIVE CHAIR AND NATIONAL 

TREASURER, VETERANS OF MODERN WARFARE; AND 

DENISE NICHOLS, MSN, VICE CHAIRMAN, NATIONAL VIETNAM AND GULF WAR VETERANS COALITION 

STATEMENT OF BRIGADIER GENERAL THOMAS R. 

MIKOLAJCIK, USAF (RET.) 

Brigadier General MIKOLAJCIK. Thank you, Congressman Hare, 

Congressman Brown, Congressman Moran. I really appreciate this 

opportunity to testify. 

My name is Tom Mikolajcik. I am neither an M.D. nor a Ph.D. 

I am a PALS. A patient with ALS. I was diagnosed in October 

2003. I was given a death sentence and told to get a second opinion 

while given a prescription for Rilutek which has very limited value. 

Only by the grace of God am I here to speak with you today and 

I have vowed to keep speaking until I no longer can. 

Military veterans like me face a higher risk of this relentless killer. Fifty percent die in one to 3 years. Another 20 percent die in 

5 years. Less than ten percent live to 10 years. 

It was learned in 2001 that Gulf War veterans have two times 

the incident rate of the general population. We discovered in 2005 

that veterans going back to War World II have a one point six 

times higher incident rate then the general population for developing ALS. In other words, any of you in this room that are veterans have a 60 percent higher chance of contacting ALS than nonveterans. 

Four short years ago, the VA opened a voluntary ALS registry. 

It registered thus far 1,993 veterans suffering from ALS. I am sad 

to say and it is unacceptable to me that only 969 are still alive 


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today. That is less than 50 percent. I am one of the blessed ones 

that are still alive. 

And ladies and gentlemen that also means somewhere between 

one and 15 and one out of 30 ALS patients are military veterans. 

The government must step up to the plate on this issue. 

We are currently exposing hundreds of thousands more 

servicemembers to the elevated risk of this disease. There will be 

young men, women and families celebrating a return from Iraq and 

Afghanistan alive, who have no idea that they may soon be facing 

a certain death from ALS. 

We will have to answer those families when they ask what the 

government has been doing to prepare for this onslaught. For this 

reason, the government is compelled to assume a leadership role in 

this issue. If these soldiers were dying in the field rather than 

quietly at home as a consequence of their service, we would leave 

no stone unturned. We would use the best of existing resources and 

programs to make sure they had whatever they needed to survive 

to ensure no man or women is left behind. 

Some say that a lot of ALS research has taken place. My response echoes the famous words of President Lyndon Johnson: ‘‘Research is good, results are better.’’ It has been nearly 70 years since 

Lou Gehrig made his farewell speech and we have basically nothing. One questionable drug in 70 years? What his doctors knew 

then, what my doctors know today, and what therapies we have 

are not much different. 

How many thousands of private farewell speeches must take 

place before we realize we are not doing everything we can? Will 

I have to give mine before an appropriate, large-scale, comprehensive plan to tackle ALS is carried out? ALS is more complicated 

than a Rubik’s cube which is many sided with multiple connections, and various colors like this one. One must consider causes, 

therapies, biomarkers, genomics, existing drugs, patient needs, palliative care, as well as all avenues of research. 

Who is in charge of ALS research today? I have found no one in 

charge! 

[Large rubik’s cube placed on witness table.] 

What is the strategy for solving this ALS Rubik’s cube? I found 

no strategic plan! Who oversees and is accountable for existing 

medical research activities for ALS? No one! So, yes, there may be 

many ongoing efforts into ALS but potential success is thwarted by 

little cooperation, coordination, and sharing of information. From 

my viewpoint and understanding, there is no one entity in charge 

or accountable. 

These blocks or boxes represent the ongoing ALS research. 

[Various sized wooden blocks spilled on witness table.] 

All are separate, none are connected and there is no communication among them. We have underfunded research across the country, each working in their own little box. This approach has been 

unsuccessful thus far. We need to open the doors of labs and encourage collaboration. There should be no more deaths due to protection of ALS related intellectual property and potential profit. 

Some of us are in a hurry. 

Therefore, it is the government’s absolute responsibility to direct 

research into a full understanding of ALS. In other words, my hope 


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would be that we not just think outside the box, but totally redraw 

it; enlarge it to fit the enormity of this horrific disease. Many people come to hearings with problems and needs. I come before you 

with a solution also. I fully understand bureaucracy’s aversion to 

change particularly within an industry as large as medicine and 

with the number of government agencies already dabbling and yes, 

I mean dabbling in ALS research. 

Let’s look back to 1961 when our Nation made a commitment to 

put a man on the moon within a decade. One government agency 

was put in charge and it was supported by other agencies as well 

as private industry and individuals. My proposal is very similar. It 

worked then, it should also work now. 

This is what I propose: Establish a congressionally directed ALS 

Task Force with specific milestones and a time line. Within 30 days 

establish a task force made up of government agencies, ALS researchers, private ALS institutes, patients, and a facilitating team 

not related to ALS or the medical industry. Within 60 days the 

task force should recommend which government agency will be in 

charge and the supporting roles of the other agencies. In other 

words, an executive agency for the government. Within 90 days develop a strategic plan which outlines all avenues of research to be 

included. It must be comprehensive, forward looking, and all inclusive. The strategic plan should also outline agency and researchers 

accountability. An adequate and fair funding stream must accompany this strategic plan. 

The decade of the nineties was the decade of the brain. However, 

we invested too little time and too few researchers on research to 

understand diseases of the brain, especially such a devastating disease as ALS. Over 30 years ago our country launched a war on cancer. Because of that effort we now have many treatments of this 

dreaded disease, even some cures. It is time to launch a war on 

ALS and other neurodegenerative diseases so that we can have effective treatments and cures. 

We designated and designed the Apollo Program to put a man on 

the moon. For ALS we could call it the HOPE Program, Helping 

Other People Endure. From this day forward this new direction can 

be a model program that has one government agency designated by 

Congress which has control and oversight of a lofty objective—solving this ALS Rubik’s Cube. There are many private models of leadership to draw upon. Innovations have sprung up driven by those 

connected to the disease including several which I am involved 

with. The ALS Therapy Development Institute; the ALS Association of America; the Multiple Dystrophy Association; and the Medical University of South Carolina’s ALS Clinic. 

These efforts will succeed with public leadership that amplifies 

their private support into an integrated whole. In the future this 

model could be duplicated as a test bed for research on other diseases. Because of the similarities among neurodegenerative and 

neuro-inflammatory diseases, advances in ALS research will likely 

be relevant to Parkinson’s, Alzheimer’s, Huntington’s and others. 

We must prepare to offer our soldiers, sailors, airmen, and marines an opportunity to fight this disease. We cannot simply fight 

this battle defensively hoping to limit exposure to environmental 

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ical arsenal. Let’s do what it takes to finish off this enemy once and 

for all. Congress can make the commitment, take the initiative, legislate a new way forward and hold agencies accountable. We have 

the intelligence, the resources, and the competencies. It is time to 

apply leadership to the ALS Rubik’s Cube to move the campaign 

in a new and uncharted direction. 

Let us have the answer ready for our veterans and the general 

population suffering from this disease. Let us show them they were 

worth a real investment and a real plan. Let us redraw and enlarge the box to allow for their futures. 

Finally, and probably the easiest task I will ask today, is to immediately establish and fund a national ALS Registry to ensure 

comprehensive patient information, tissue, genes, DNA, etcetera 

are available for investigation. Such a registry will facilitate, even 

stimulate additional research and research collaboration. 

This will provide, ‘‘HOPE’’ for future treatment and increased 

understanding of this disease. But what about veterans like me 

who may not benefit from these future discoveries and treatments? 

We owe our veterans treatment now, however limited. Over 5 years 

ago, the Secretary of Veterans Affairs extended service-connected 

benefits to Gulf War veterans like me based on the research study 

results that they had. Since then,new research has shown an increased incidence of ALS among all veterans, 60 percent higher 

than the general population. 

The Secretary for Veterans’ Affairs should act now with the same 

decisiveness and the same concern for veterans by extending veterans benefits to all veterans suffering from this terrible disease. 

I have attached a copy of the letter I gave to and discussed with 

Secretary Nicholson on 23 March of this year in Charleston. 

Thank you for your attention, for allowing me to speak past my 

time and for giving me this opportunity to represent veterans. God 

Bless our veterans! And God Bless the United States of America! 

[The prepared statement of Brigadier General Mikolajcik appears 

on p. 43.] 

Mr. HARE. Thank you, General, that was an incredible and compelling testimony. I thank you for taking the time out to come this 

morning. You are an incredibly courageous person and we will 

work very hard. 

Our next panelist is Mr. Hardie and Mr. Hardie, welcome. And 

we look forward to your testimony. 

STATEMENT OF ANTHONY HARDIE 

Mr. HARDIE. Thank you, Mr. Chairman. Mr. Chairman and distinguished Members, thank you for holding today’s hearing on Gulf 

War exposures and highlighting and enduring national significance 

of these issues. It is truly an honor and a privilege to be here 

today. And I hope to help voice some of the concerns of the many 

who are not here to share in that this privilege. 

On January 17, 1991 much of America watched Operation Desert 

Storm unfold on their evening news decisively ending the many 

long months of the mass troops watchful waiting under Operation 

Desert Shield. Six weeks and the war was over, but for many of 

the nearly 697,000 troops who served our overarching Gulf War experience had only just begun. 


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For those who may not be familiar, Gulf War troops were exposed to a host of toxic exposures often in combination including 

multiple low-level exposures to chemical warfare agents including 

from bombed munitions factories and detonated munitions bunkers. 

Experimental drugs mandated without informed consent like 

Pyridostigmine Bromide pills intended to help survive nerve agent 

exposure; inhalation of incredibly high levels of micro-fine particulate matter from the Kuwaiti oil well fire plumes; experimental 

vaccines like Anthrax, botulinum, and others; inhaled and ingested 

depleted uranium particulate matter; smoke from the daily burning 

of trash and feces; multiple pesticides; petroleum products and byproducts. 

For some of us who developed lasting health effects from this 

veritable toxic soup of hazardous exposures, it came while still in 

the Gulf. For others it did not come until some time after returning 

home. 

Hearing this list of exposures, most people would find it of no 

surprise that so many thousands of Gulf War veterans became ill, 

or that so many remain ill and injured today. And it should be no 

surprise that so many have developed diagnosable serious conditions like ALS, Multiple Sclerosis (MS), and others. What is stunning is that 16 years later, there are still few tangible results that 

might improve the health of those who became ill and remain ill. 

And we still have little information of any value to provide the Gulf 

War veterans or the healthcare providers that might help to improve Gulf War veterans health. 

Years were squandered disputing whether Gulf War veterans 

were really ill, studying stress, reporting that what was wrong with 

Gulf War veterans was the same as after every war. An incredible 

amount of effort was put into disproving the claims of countless 

veterans testifying before Congress of a chemical and other exposures. Some of that negative effort appears to continue even today. 

It is stunning that after nearly two decades we still have little information to provide the Gulf War veterans who remain ill from 

their service. It is true that VA does still have an open door for 

Gulf War veterans to be seen at VA medical facilities, however, 

being seen is not the same as being treated. 

In terms of informing veterans, the VA’s Office of Public Health 

and Environmental Hazards website also contains little information that might be of use to ill Gulf War veterans and to health 

providers. Much of the information provided is outdated. In July of 

2006, the VA’s Gulf War review included an article entitled, 

‘‘Straight From the Source: VA’s Environmental Agents Service is 

Serious About Communicating With Veterans.’’ That issue, more 

than a year ago, was the last published. 

For Gulf War veterans like me whose ‘‘Kuwaiti Cough’’ has never 

left after having coughed up thick black sputum while still in the 

Gulf and for several weeks after returning home, the report related 

to oil well fire smoke and petroleum from this website which 

seemed to be of particular interest. Perhaps it’s lack of usable content, indicative of the lack of attention being paid to these issues, 

is at least in part related to the fact that it stated principal author 

was not a leading scientist, but instead a community college communications or journalism student summer intern. 


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I have heard from countless other Gulf War veterans that they 

like many before them have stopped going to the VA or have simply given up and have done their best to adapt to the substantial 

lifestyle changes required by their disabilities, which may or may 

not be compensated for these disabling conditions incurred in service. Gulf War veterans have had unique and special challenges and 

in May, a VA report show that only one in four undiagnosed illness 

claims for Gulf War veterans has been approved. 

On a more positive note, I was encouraged during last week’s 

meeting of the Research Advisory Committee, on which I serve, 

from Dr. Robert Haley and his team describing their research goals 

of identifying diagnostic criteria for ill Gulf War veterans. Success 

in achieving these goals should finally help to pave the way for affective treatments. And I remain encouraged by current efforts in 

the U.S. Senate to provide funding for Gulf War health research 

within DoD’s congressionally directed Medical Research Program 

focused on treatments that may aid ill Gulf War veterans. 

The five-point statement of goals that came from Gulf War veterans more than a decade ago still holds true today. Gulf War veterans deserve then and deserve now an insurance, an exhaustive 

investigation has been fulfilled to identify all possible Gulf War exposures. 

Second, that appropriate scientific research is promptly completed to connect known or potential Gulf War exposures with 

health outcomes. Third, that medical treatment is bases on that 

scientific research. Fourth, that compensation is provided to those 

veterans left disabled by their military service if the health conditions cannot be reversed. And finally, that every effort is made to 

ensure that never again what happened to the Gulf War veterans 

be allowed to happen again. For the thousands of living ill Gulf 

War veterans, it is time to make good on our Nation’s enduring 

promise of caring for those who have borne the battle and their 

widows and their orphans. 

Thank you Mr. Chairman and Members of the Subcommittee. 

[The prepared statement of Mr. Hardie appears on p. 46.] 

Mr. HARE. Thank you, Mr. Hardie. Ms. Nichols. 

STATEMENT OF DENISE NICHOLS, MSN 

Ms. NICHOLS. Good morning, Congressman of the VA House 

Health Subcommittee and to all staffers and attendees. It is indeed 

an honor to testify at this hearing for all Operation Desert Storm 

veterans group which reflects only one part of the earlier portion 

of the Iraq war. 

It has been since November 1993 that we have been having hearings on the care and needs of Gulf War veterans. I am a retired 

air force flight nurse that served on the border of Saudi Arabia and 

Iraq to care for those wounded in that war. I have continued that 

duty as a sworn obligation. I am just one of the 697,000 that were 

deployed in 1990 and 1991. My profession, life, and family have 

been directly affected, as has been so many others. 

The symptoms and life changes I have experienced are not 

unique. The war changed our health status and our abilities to perform our duties in our chosen life roles through no fault of our own. 

There are hundreds of thousands of human-case examples both 


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that were deployed and those that received vaccines and exposures 

from secondary sources. In 1994, a total gathering of ill veterans 

and DoD officials and VA officials and university professionals at 

Bethesda attending the conference held on the Health Consequences of the Persian Gulf War that we Gulf War veterans were 

different. We were a force of highly trained, educated, and physically fit men and women who served our country in wartime. And 

even though we were now damaged due to that time in a foreign 

country, we would not give up and we would find answers and 

help. 

Since then, we have battled for compensation, the exposing of the 

full truth and nothing but the truth. We have battled for the best 

care and treatment. Sadly, our war has been facing our own government at times, but as Major Abare an earlier ALS veteran that 

testified said, ‘‘So long ago we did swear to defend against all enemies both foreign and domestic.’’ Sadly this battle seems to be on 

the domestic end of having a lack of faith and sworn duty for by 

our government. 

The Gulf War veterans community has deteriorated health, rising levels. We have lost too many of our own, but we still stand 

pushing, prodding, encouraging to get to the truth and to life saving that has been denied for too long. We were met with denials, 

delays, and resistance, but yet if you had listened and acted many 

of our lives could have been saved and restored. We ask for the 

best diagnostic procedures and treatment, we were denied that by 

lack of truth, at times from our own DoD and government officials. 

Some, but not all the truth has been exposed. We felt that more 

would have been exposed to back up our acknowledgment of the 

multiple exposures that taken alone or in combination would have 

a definite affect on our health. We have pushed for the medical examination and diagnostic treatment that would expose the truth 

held within each of our own bodies. We pushed for the care and 

treatment we earned by putting our lives on the line to serve our 

government. Sadly, we have been delayed by forces within our own 

government. We would win a major fire fight in that battle to face 

a counter attack or a blocking move. We still wonder, what is this? 

Is it financial? Is it a policy? Is it protecting some secret? But that 

answer and the battle our government waged to find the single 

cause of exposure while we lay wounded still continues. 

Those of us with undying spirit and faith would push the wounded each time to raise up and fight for yourselves, your fellow soldier, veteran, your family, and the future soldiers and veterans to 

reach the goal. Within my longer supplied testimony is a recap of 

just a few of the insights or snapshots along the road we have traveled in regards to the VA. I have supplied yet another point paper, 

action plan, or if you want to call it an OP order outlined to fix 

the broken parts, to move forward the goal of appropriate medical 

diagnoses and care. 

The system was not broken by us, but the result of a multitude 

of errors complicated by a government or it’s employees that denied 

us the access to the best medical care for whatever reason. It has 

cost us lives of your fellow Americans, your soldiers, your veterans, 

your family members. In one 3-month period of grievous data reporting from the VA, we lost 1,000 of us to whatever causes. The 


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full count is definitely more. This is morally and ethically wrong. 

In our path we have met many civilian experts that have volunteered to help us out of that morally and ethically wrong situation. 

Sadly, many of their careers have been negatively affected through 

their joining the battle. We have officers and individuals that have 

tried to help from the shadows, well it is time for the all out assault to fix this and have results. 

The veterans have led this battle and we are not done. We hope 

that each of our elected reps will listen to us, join us to fix these 

problems, remove the road blocks, and move for true action. Let us 

move forward together to the best diagnosis care, treatment, and 

compensation before we lose more lives. The veterans have identified something that is critically important and that could affect 

every citizen in this country through the response to critical hazardous substances, weapons of mass destruction, and environmental exposures. Examples are the World Trade Center, the Anthrax exposures, radiation damage and potential terrorist issues in 

our own country. The advances made through us could help save 

lives in the future throughout the U.S. and other countries. 

We need the funding and the commitment from all. Will you do 

your part to correct the errors mismanagement, mis-guidance, obstructions of the past? Will you commitment the funds and the fast 

tracking of corrective legislation? Will you be the active leaders to 

investigate, deliberate, and be part of the solution? But please, if 

you are, you must move quickly and decisively in order to save 

lives. Help us to streamline the process to get the pin pointed research that is needed. Help us get the right diagnostic care and effective treatment. Do not study, investigate, or deny each of us to 

the grave. We need the blim research to actual diagnosis and care 

in a cost and time sensitive manner. We can gain from the clinical 

data that can be obtained for a cost effective means within each VA 

hospital and merge it with research efforts to find better diagnostic 

markers that can be quickly implemented in the clinical area. We 

need to have our VA care organized so that research for treatment 

by way of treatment trials can be moved into the clinical area in 

an expedited manner at true cost effectiveness. 

We need universities to cut their cost of research business so 

that we can use funds provided in the most effective way to implementation. Universities should share their commitments to the 

troops and veterans and not make a profit off the endeavor. We can 

do this in weapon development with tiger teams approaches and 

filled instruments of war in record time. Can we do the same to 

save our troops and veterans? Will you have faith in us that veterans and those civilians as doctors, researchers, and members of 

the Veterans Affairs Research Advisory Committee that have committed to help. Will you put the full weight of this government and 

it’s resources to this task? Our remaining lives and qualities of our 

lives depend upon you. 

Thank you very much for the honor to appear before you today. 

I would be delighted to answer any questions you may have. 

[The prepared statement of Ms. Nichols appears on p. 47.] 

Mr. HARE. Thank you Ms. Nichols. Thank you very much for 

your service to this Nation and for all the work that you are doing 

now. 


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I just want to say one thing before I ask a couple questions of 

the panel. General, one of my closest friends was a retired Catholic 

priest and I can remember to this day he would say, ‘‘Phil, we hear 

about faith, hope, and love, the greatest being love.’’ But he said, 

‘‘If you take hope away from people for them getting up every day 

and to try to do what they can do best.’’ He said, ‘‘While we talk 

so much about love, always remember that hope is, from my perspective, equally important.’’ 

And I just want you to know that it is my sincere desire that the 

HOPE Program that you mentioned, I think it is a wonderful thing. 

And I think we need to look at it and I think we need to work on 

it, and I think we need to do it now. I don’t think—every hour that 

goes by is time wasted. And so, I just wanted you to know that 

your testimony was very compelling and I am just incredibly honored to be Chairing this hearing this morning with such wonderful 

panelist. 

I do want to know, maybe and the whole panel could talk to me, 

the General talked about a congressionally directed ALS task force 

and the timelines, and establishing it in a 30 and 60, 90-day time 

line that you suggested, General. Could you all tell me what, in 

your opinion, would you suggest would be the top three goals of 

that task force. 

Brigadier General MIKOLAJCIK. I’m sorry. The—— 

Mr. HARE. The task force that you were proposing. 

Brigadier General MIKOLAJCIK. The top three goals of the task 

force would be, number one, determine what agency in government 

would take the leadership role. Number two, develop a strategic 

plan to be followed. Number three, provide adequate funding to 

support that strategic plan. 

Mr. HARE. Mr. Hardie. Ms. Nichols? 

Mr. HARDIE. I would certainly concur with those comments. I 

think that is an excellent action plan. 

Mr. HARE. Okay. 

Ms. NICHOLS. Very definitely a definite goal timeline to meet. 

Mr. HARE. Okay. Mr. Hardie, in your testimony you stated that 

being seen is not the same as being treated. And I would like, if 

you could maybe go into it a little bit more regarding that statement. And then you also said that many Gulf War veterans have 

given up going to the VA. Do you know if they are going elsewhere 

or they are just not going anywhere at all? 

Mr. HARDIE. Thank you, Mr. Chairman. In terms of not being 

seen is not the same as being treated. VA continues to have an 

open door and it is always possible to get appointments with general medicine practitioners. In terms of being seen by specialists, 

if it appears that there is some sort of a condition as well, I think 

that Gulf War veterans are able to be referred to specialty care as 

well. But again given the lack of an understanding of the underlying mechanisms causing Gulf War veterans illnesses, my sense is 

that many treatment providers really don’t know what to do with 

Gulf War veterans. 

I had, for myself, I have had significant immune dysfunction 

growing over the last several years. I had an absolutely brilliant 

immunologist tell me, ‘‘I am simply not smart enough to know 

what to do with you. Here are some suggestions for where to go.’’ 


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And so, I continually—my experience has been being seen by, by 

the way that was not a VA practitioner. I did seek outside care 

after having been shuffled around for quite some time. 

In terms of Gulf War veterans going whether they are going elsewhere or simply stopping getting care, my sense is that those are 

some veterans are—some Gulf War veterans are continuing to seek 

care at the VA, but again and elsewhere but after a time it seems 

that many of the people that I am in contact—many of the Gulf 

War veterans that I am in contact with have simply given up on, 

until there is some new breakthrough, there is no point in going 

back and being told, ‘‘We don’t know what to do with you. We see 

your symptoms. We can certainly give you limited prescriptions to 

treat some of the symptoms that you are experiencing. But in 

terms of what is causing these kinds of things, we don’t know.’’ 

And until there is, we simply don’t know. 

I would hope that gives a sense of the answer to those questions. 

Mr. HARE. Yeah. Just real quickly, because I am running out of 

time. Mr. Hardie, outreach can be a great tool and sharing it with 

the veterans from past wars so they are kept informed of any 

changes or developments that may occur. It has been 16 years 

since the Gulf War I ended. Just a couple quick questions. 

Do you think the outreach efforts of the VA have diminished in 

these 16 years? If so, how? My second follow-up would be what 

changes do we need to do to affect that outreach? 

That would be for Ms. Nichols, if I could. 

Ms. NICHOLS. Okay. On the point paper I have provided this 

morning for you, I went step by step, there is 23 steps there. But 

the outreach needs to be very extensive. I think we need to bring 

in outside experts in the anti-aging area that is a board certified 

field medicine that can help from the top down. 

I think a lot of the things that are covered at the VA Research 

Advisory Committee meeting, the updates on research, there is excellent material there. I have encouraged to be videotaped, get out 

there on the web, get out there the physicians in the VA hospital 

and to the patients, the veterans. I have encouraged that from day 

one and it hasn’t been done. That is a simple thing that could be 

put in place to you know further the outreach and education of all 

involved, not only the patients but the physicians that are to care 

for us at the VA. 

But I think we need some other experts put on contract to come 

in and do some education also on other things that are available 

in the civilian world that could help. A lot of it connects with 

chronic fatigue and there is a lot of breaking research in that area. 

Mr. HARE. Thank you, Ms. Nichols. Mr. Brown? 

Mr. BROWN OF SOUTH CAROLINA. Thank you, Mr. Chairman and 

I really thank the other Members of the panel for coming too. I 

know I made my introduction to General Mik, but I am glad to 

have you all here. 

And General Mik, my first question is to you is, how were you 

diagnosed with ALS and how long did it take for you to be granted 

your VA benefits? 

Brigadier General MIKOLAJCIK. Thank you for asking that question. And there is no one test that tells you, you have ALS. I was 

having an annual physical and there were fasciculations that the 


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doctor saw on my shoulders. That is uncontrollable muscle movement. He asked me how long have I had those fasciculations? I 

said, ‘‘What is a fasciculation?’’ He said, ‘‘Look in the mirror.’’ I 

looked in the mirror, I said, ‘‘I have never seen them.’’ Then I was 

sent to a neurologist, who did an EMG; did a CAT scan; did other 

things. And then they said, ‘‘You probably have ALS or some other 

disease.’’ 

So through a process of elimination, it wasn’t Lyme disease, it 

wasn’t Kennedy’s disease, it wasn’t benign fasciculations, even 

though they immediately put me on the one drug, Rilutek, which 

was used for ALS. It is a guessing game until more parts of your 

body start to lose functionality or your speech. It took me 2 years 

before I was granted disability, partial disability by the VA. And 

it took another 6 months before I was granted full disability. 

There is no one scientific test to identify ALS. That is why the 

research is so important to find those biomarkers that may identify 

ALS patients whether it be through DNA or whatever, so that you 

could start treatment sooner. It is not like other diseases, cancer 

or whatever that there is a test that tells you, you have it. ALS 

is not that way. Lou Gehrig gave up his order of batting because 

he couldn’t hold those two bats in his hands to practice swinging. 

After 2,130 consecutive games. He was the iron man of baseball. 

Most ALS patients are very healthy. I was taking an 80 milligram 

a day of aspirin when I was told I had ALS. Most ALS patients are 

very athletic. Why? We got to do the research to find out. 

Why do Italian soccer players have a higher incident rate than 

non-soccer players? We don’t know. Why do pilots have a 2.6 times 

incident rate of ALS compared to non-pilots? We don’t know. And 

the reason, Mr. Chairman, I talked about leadership is I spent 27 

years in the Air Force. There was always a leader. There was always direction. There was always cooperation on whatever you 

were doing. There is no leadership in ALS. Just like these blocks 

on the table. These are blocks from when I was a child over 50 

years ago. Anybody that had ALS then or that has it now is not 

much different than those blocks. It is a sad state. 

So that is why when you ask me what are the three things, number one, has to be leadership. Number two, you have to have a 

strategic plan on how you are going to go do things. And by having 

a plan and by having a leadership, you can also save money in research because you do away with a lot of the duplication that is 

going on. I don’t know how many organizations have tested 

Mynocycline for ALS. We have tested on mice; we have tested on 

patients; we keep on giving grants out to test Mynocycline. Something is wrong in that equation. 

Mr. BROWN OF SOUTH CAROLINA. I notice in your remarks you 

said that one of the easiest tasks would be to establish and fund 

a national ALS Registry to ensure comprehensive patient information. You mean we don’t have one already? 

Brigadier General MIKOLAJCIK. No, there is no national registry. 

There has been a number of organizations, the ALS Association 

that have been trying for a number of years. It was voted upon on 

the House side in one of the conference subcommittee’s and it was 

passed. There is over 50 percent of the Congressmen in this Congress that have signed as sponsors for the bill. I understand that 


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today the full Congressional Committee is voting on the bill. The 

Senate, I don’t remember where the progress stands on that. But 

the ALS registry for veterans is so small, part of it is you got to 

know there is a registry to sign up for the darn thing. If you are 

not computer literate, if somebody didn’t tell you, your name is not 

on that registry. 

So the national registry would put many more people into the 

database. To find out, have you used pesticides? Have done certain 

things? Have you had certain medications? And it doesn’t cost a lot 

for that national registry to be formed. So I would encourage this 

Subcommittee and the Members to support the registry that is 

being voted upon in this Congress. 

Mr. BROWN OF SOUTH CAROLINA. I know my time is expiring, Mr. 

Chairman. If I might just make one statement. I know that there 

is, I hope there is some collaboration between the DoD, National 

Institutes of Health (NIH), and other ALS research funding. I know 

that in the Defense Bill that the Appropriation Bill coming before 

us, we requested $4.8 million for an ALS Therapy Development Institute. And this support would support cutting edge first fast track 

drug discovery and traditional research. We were able to get one 

and a half million dollars, General. And so we hope this will help. 

And but that is a shame if we got to make their marks look like, 

you know, DoD should take this responsibility on their own. But 

we are pleased to announce that. 

Brigadier General MIKOLAJCIK. That sure is. And that is a small 

amount of money for the task ahead. I visited the ALS Therapy Development Institute a little over a year ago in January. I was visiting my mother in Connecticut. I heard about them. I asked if I 

could come visit. I wanted to see the mice that were taking the 

same drugs I was taking. See what they looked liked. What was 

going on? What is the technology there? And I was overwhelmed 

by their discipline and their sole focus on ALS. I am a believer in 

where they are and where they are going as they move forward in 

that direction. 

And there are other laboratories that are doing work. What we 

don’t have is the drug companies are not putting much money into 

ALS research. Why? What is the return on investment? Bottom 

line. What is the return on investment? BioGen a very large drug 

company in the State of Massachusetts about a year or so ago disbanded their whole ALS research center. That is why the government has a responsibility, because private industry won’t step up 

unless you give them some money to do that. 

Mr. BROWN OF SOUTH CAROLINA. Well, look, I thank you for your 

testimony. And I will yield back my time, Mr. Chairman. 

Brigadier General MIKOLAJCIK. I would like to make one more 

comment in relation to that. 

Mr. HARE. Absolutely. 

Brigadier General MIKOLAJCIK. We all know a lot of patients that 

have Multiple Sclerosis. The incident rate of Multiple Sclerosis and 

ALS is not that much different. ALS is somewhere between 5,600 

to 6,000 a year. For MS the incident rate is somewhere around 

8,000, 8,500 a year. Why are there so many MS patients? It is because MS patients live 20, 30 years. We don’t. Our statistics, you 


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know, the doctor told me, ‘‘You have 1 to 3 years to live. Get another opinion. Take Rilutek. Come back and see me in 6 months.’’ 

So the numbers are small because there are not many of us and 

a lot of us can’t speak. Thank you, Mr. Chairman. 

Mr. HARE. Thank you, General. Mr. Moran? 

Mr. MORAN. I thank you, Mr. Chairman. I want to thank you, 

General, for speaking. I only have a few questions, but I suppose 

perhaps more important than questions is that all of your testimony is a reminder of the importance of us providing greater leadership, more emphasis, and support for the efforts that you are outlining. And so, I appreciate the opportunity to be here this morning 

just to remind me that there is a cause that needs champions in 

Congress and across the country. 

So, if, despite the information that you are conveying to me, perhaps more important you are conveying to me the need to go to 

work. I appreciate all of you providing me with that challenge, that 

opportunity, and that—a reminder of my responsibilities. 

Is ALS, is it unique in it’s correlation between military service 

and incidence as compared to any other condition or disease? Is 

this a very unique circumstance? A very rare correlation? 

Brigadier General MIKOLAJCIK. It is a fact. Why? I don’t know. 

Is it unique for military service? 

Mr. MORAN. Is it, compared to any other disease or condition, 

is—— 

Brigadier General MIKOLAJCIK. I know of no other disease—— 

Mr. MORAN [continuing]. Incidence of ALS and its relationship to 

military service is it very unique? 

Brigadier General MIKOLAJCIK. Yes. I know of no cancer that is 

associated just with military service or other things. 

You know I looked through the Defense Bill and there is about 

a billion dollars in earmarks for different research within in the 

DoD Bill. The only disease that I saw that had a direct connection 

to military service was ALS. The rest of them were not. Prostrate 

cancer, breast cancer or other types of things. It is unique. 

Oh, and the Gulf War Syndrome. I am sorry. And the Gulf War 

Syndrome, ALS is the only named disease within that terminology. 

Mr. MORAN. The Gulf War Syndrome is a broader description of 

a variety of conditions, ALS is a subset of that broader description? 

Brigadier General MIKOLAJCIK. Yes. But how do you look at veterans from Somalia, veterans from Haiti, veterans from Bosnia, 

veterans from Korea, World War II and Vietnam. Why do they 

have a 60 percent higher incident rate? 

Mr. MORAN. Is that incident rate, that correlation, is it the similar percentage regardless of location of service? Whether you were 

in Somalia or you were in Iraq or Afghanistan, same statistical relationship? 

Brigadier General MIKOLAJCIK. We don’t know the answer. 

Mr. MORAN. Okay. Again, it goes back perhaps to the registry, 

the facts? 

Brigadier General MIKOLAJCIK. Right. 

Mr. MORAN. Okay. 

Brigadier General MIKOLAJCIK. To gather that data to run the 

test, to do the DNAs, to spend more on specific research for ALS. 

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posure and toxins. Because when you look across the broad spectrum it is not just exposures or toxins that probably trigger the disease in it. We may all have it and something triggers it. What it 

is, we don’t know. But to narrowly focus on exposures and toxins 

to me is delaying the time in which we will find a therapy or a 

cure. 

That is why a multi disciplinary approach with leadership is 

what we need. 

Mr. MORAN. General, thank you for your testimony. Mr. Hardie 

and Ms. Nichols, thank you very much for your advocacy. 

Mr. HARE. Let me again thank the panel for coming this morning 

and thank you for your service to this Nation. I just want to let 

you know that from my perspective I will do everything I can, General, to help on this. I think it is way overdue. 

And, finally, Ms. Nichols you asked a series of questions in your 

testimony and yes to all of the ones you asked. So thank you very 

much for coming this morning. 

Brigadier General MIKOLAJCIK. Mr. Chairman, I would like to 

make one more comment—— 

Mr. HARE. Sure. 

Brigadier General MIKOLAJCIK [continuing]. If I may, please? I 

would like to thank Congressman Brown from the first congressional district of South Carolina, for all that he does for the veterans not only of South Carolina, but also of our country. I personally want to thank him for supporting me over these years as we 

have gone through this struggle to set up an ALS Chapter in our 

State, to make a loan closet, to have an ALS clinic. And I am deeply indebted to you, Congressman Brown, thank you very much. 

Mr. HARE. Thank you, General. And thank the panel. 

This panel is excused. And thank you again, General, for taking 

the time to be with us. 

We welcome our second panel. I would like to introduce at this 

time, Dr. Meryl Nass from Mount Desert Island Hospital who has 

treated Gulf War veterans; James Binns the Chairman of the Research Advisory Committee on Gulf War Veterans’ Illnesses; and 

Dr. Lea Steele, Scientific Director for the Research Advisory Committee on Gulf War Veterans’ Illnesses. I got all that right. Not too 

bad for a rookie here. 

So I thank the second panel and, Dr. Nass, we will begin with 

you. 

STATEMENTS OF MERYL NASS, M.D., INTERNIST AND 

HOSPITALIST, MOUNT DESERT ISLAND HOSPITAL, BAR HARBOR, ME; JAMES BINNS, CHAIRMAN, RESEARCH ADVISORY 

COMMITTEE ON GULF WAR VETERANS’ ILLNESSES, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND LEA STEELE, PH.D., 

SCIENTIFIC DIRECTOR, RESEARCH ADVISORY COMMITTEE 

ON GULF WAR VETERANS’ ILLNESSES, U.S. DEPARTMENT OF 

VETERANS AFFAIRS, AND ASSOCIATE PROFESSOR, KANSAS 

STATE UNIVERSITY 

STATEMENT OF MERYL NASS, M.D. 

Dr. NASS. Thank you very much for holding this hearing. I practice internal medicine in Maine. I have a background in Anthrax 


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and biological warfare and conduct a specialty clinic for patients 

with multi-symptom syndromes, including Gulf War Syndrome, Anthrax vaccine-induced illnesses, fibromyalgia, and chronic fatigue 

syndrome. 

The stories of those with Gulf War or Anthrax vaccine-induced 

illnesses are usually heartrending. Most became disabled in their 

twenties to forties with a combination of physical impairments, cognitive problems, and psychiatric disorders. They carry 10 to 15 diagnoses each on average. Five patients gave me permission to 

share their medical records with this Committee if you wish to see 

them. 

My care for more and more of these individuals has compelled 

me to continue to research and write about their plight, to try to 

prevent further ‘‘friendly fire’’ injuries and to address the barriers 

to good care for the injured. I want to tell you four things today. 

First, Anthrax vaccine can cause a wide range of disorders, but 

most commonly causes a syndrome clinically indistinguishable from 

Gulf War Syndrome. Many studies have shown that it was a contributor, but certainly not the only contributor, to Gulf War illnesses. Data from the military’s Defense Medical Surveillance System have shown that vaccinated servicemembers have significantly 

elevated rates of heart attacks, several cancers, asthma, diabetes, 

Crohn’s disease, psychoses, depression, and blood clots, compared 

to pre-vaccination rates. 

A U.S. government Accountability Office (GAO) report last 

month cited the Centers for Disease Control and Prevention (CDC) 

and Military Vaccine Healthcare Center officials saying that one to 

2 percent of Anthrax vaccine recipients may experience potentially 

disabling side effects or death. The Assistant Secretary of Defense 

for Health Affairs concurred with this report. I would like to refer 

you to my written testimony for the details and sources; I am going 

to talk broadly in this verbal testimony. 

Second item, DoD and Department of Veterans Affairs funded a 

huge portfolio of research that was carefully designed to create a 

smoke screen around both Gulf War illnesses and Anthrax vaccine 

injuries, presumably to deflect culpability from government decisions and actions that led to the massive collateral damage caused 

to Gulf War veterans and Anthrax vaccine recipients. The result is 

confusion in the minds of patients, medical practitioners, and policy 

makers. Last week, a patient of mine and his wife cried in gratitude in my office when I told him he had Gulf War syndrome and 

not a psychiatric illness, even though I said it could not be cured. 

His VA doctor, he said, didn’t believe in Gulf War illnesses. That 

should not be happening today, and it is largely a consequence of 

the failed body of Gulf War research. 

The VA and DoD-funded research has been successful at delaying the provision of pensions and appropriate care for affected veterans, and taking away their self respect. 

Third item. This situation does not need to continue. Both the research, treatment and disability assessment for veterans can be improved and made fair. 

Fourth. Troops would not so easily be placed in harm’s way if the 

Department of Defense bore the long term costs of their injuries. 

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tating exposures, such as aerosolized depleted uranium, illegal levels of toxins on military bases, and known dangerous vaccines for 

which no threat has been demonstrated and for which safer approaches exist. 

Ill soldiers are medically discharged and the cost of their future 

care shifted to the VA. If Congress made sure that some of these 

costs were borne by the Pentagon, it is certain the long-term health 

of soldiers would be taken more seriously. 

What should be done? In terms of research, a total of seven Federal advisory groups and the Committee on government Reform 

have made detailed recommendations for the types of long term 

studies that should be done on Anthrax vaccine. Their recommendations should be carried out. These groups include three 

Institute of Medicine Committees, the Advisory Committee on Immunization Practices of CDC, VA’s Research Advisory Committee, 

the Armed Forces Epidemiology Board, and the GAO. 

The CDC has been conducting a trial of Anthrax vaccine in 1,500 

civilians since 2002. Over 100 adverse event reports have been filed 

with FDA on trial subjects, but no preliminary data have been released to the public and the investigators have decided to focus on 

short-term adverse events. 

Congress could investigate this study and insist that adequate 

long-term safety data are collected. Studies like this have the ability to tell us once and for all the precise side affect profile of this 

vaccine and the rates of adverse reactions. 

What should not be done? History should cease repeating itself. 

In 1997, Phil Shenon of the New York Times reported on Congressman Shays’ investigation of Gulf War illness research. He said, 

‘‘The Pentagon and Department of Veterans Affairs have so mishandled the investigation of the veterans’ health problems that 

Congress should create or designate an agency independent of 

them to coordinate research into the cause of the ailments.’’ 

Now it is 10 years and $260 million later and absolutely nothing 

has changed. 

Failed research does not happen by itself. In the case of Gulf 

War and Anthrax vaccine studies, a number of issues can be identified that led to unusable results: the wrong questions were asked; 

data was withheld; dubious methods were chosen; sample sizes 

were inadequate to answer the questions asked; control groups contained exposed subjects; and exposed groups contained unexposed 

subjects. 

Those government officials who deliberately wasted hundreds of 

millions of dollars on a wild goose chase should be subject to 

charges of research misconduct. Congress can pass a law to establish criteria and penalties for such conduct, similar to existing NIH 

regulations. 

The officials responsible for this research charade could be 

barred from future government grants and contracts and future 

government employment. A new Federal agency should be created 

with a responsibility for only drug and vaccine safety. Currently, 

agencies responsible for promoting drugs and vaccines are also responsible for safety, and this inherent conflict of interest has resulted in repeated failures to regulate appropriately. A bill like this 


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was introduced in the last Congress, I believe by Representatives 

Carolyn Maloney and Dave Weldon. 

Finally, government officials who supported and expanded Anthrax vaccinations while in office are now on the payroll of the vaccine manufacturer or companies with government contracts related 

to Anthrax vaccine. This includes two former U.S. Department of 

Health and Human Services (HHS0 secretaries. Congress should 

pass a law to prevent such egregious conflicts of interest in future. 

In conclusion, we know Anthrax vaccine and other toxic exposures are dangerous to susceptible individuals. Clear steps can be 

taken to reduce future injuries, treat the injuries that exist and 

achieve accountability for the deliberate failures that have occurred. Thank you very much. 

[The prepared statement of Dr. Nass appears on p. 51.] 

Mr. HARE. Thank you. Mr. Binns? 

STATEMENT OF JAMES BINNS 

Mr. BINNS. Mr. Chairman, Members of the Subcommittee, it has 

been my privilege to Chair the Research Advisory Committee on 

Gulf War veterans illnesses. This public body of distinguished scientists and veterans is mandated by Congress and appointed by 

the Secretary of Veterans Affairs. Dr. Steele to my left is a member 

and Scientific Director of the Committee. She will provide highlights of the Committee’s cientific findings, I will address the status 

of Federal research programs. 

Gulf War illnesses remain a major, unmet veterans health problem. According to the Department of Veterans Affairs most recent 

study, 25 percent of Gulf War veterans suffer from chronic multisymptom illness above the rate in other veterans of the same era. 

This confirms five earlier studies showing similar rates. Thus, 16 

years after the war, one in four of those who served 175,000 veterans remain seriously ill. There are currently no effective treatments. 

Gulf War veterans also suffer from ALS, as you have heard, at 

double the rate of other veterans of the same era. That is double 

the rate of people in the military which we have already heard is 

in excess of the normal background level in society. 

The Federal Government has spent over $300 million in Gulf 

War illness research. Much of that money, however, was spent on 

the false theory that these illnesses were caused by psychological 

stress. Part of an overall effort to portray these illnesses as nothing 

unusual, the kind of thing that happens after every war rather 

than the result of toxic exposures. 

Very little money was invested in treatment research. I am 

pleased to report that a major change for the better has recently 

taken place in the direction of VA research. Following our Committee’s 2004, report then Secretary Principi determined that VA 

would no longer fund research based on stress. Secretary Nicholson 

appointed new leadership at the Office of Research and Development and placed most of VA’s research program at the University 

of Texas Southwestern Medical Center, a leading site for Gulf War 

illnesses research. 

I am pleased to see VA Gulf War illness research in the hands 

of scientists committed to solving the problem and funded at the 


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$15 million level recommended by the Research Advisory Committee. I regret that I must also inform you, however, that other 

VA officials continue to minimize these illnesses. For example, a 

fact sheet provided in recent weeks to three U.S. Senators asserted, 

‘‘Gulf War veterans suffer from a wide-range of common illnesses 

which might be expected in any group of veterans their age.’’ 

That is utter hogwash. This fact sheet is the work of the VA Office of Public Health and Environmental Hazards, which is testifying before you today. It is also the office charged with implementing the law requiring VA to contract with the Institute of 

Medicine for reports on the health affects of toxic exposures for use 

and benefits determinations. For 7 years, these reports have been 

structured to restrict the scientific information considered in their 

conclusions in express violation of the statute, misleading the Secretary, Congress, doctors, and medical researchers. 

Dr. Lawrence Deyton who directs this office and will speak to 

you later this morning assumed his position relatively recently and 

did not initiate these practices. I urge this Subcommittee and Dr. 

Deyton to order these misleading and unlawful activities terminated. While VA Gulf War illness research is adequately funded at 

last, two-thirds of Gulf War illnesses research has historically been 

sponsored by the Department of Defense. Over $30 million annually. Since the start of the current war, however, this research program has been eliminated. As a result, the total Federal program 

is at one-third strength. 

Last year Congress initiated an innovative new pilot program at 

DoD focused on studies of treatments already approved for other 

illnesses. It is open to all researchers on a competitive basis. It’s 

initial solicitation last fall attracted 80 proposals compared to only 

two treatments studied in the entire previous history of Gulf War 

illness research. Yet, DoD has again excluded this promising program from it’s proposed fiscal year 2008 budget. It’s future depends 

entirely on Congress. 

Mr. Chairman and Members of the Subcommittee, in recent 

months this country has renewed it’s obligation to care for the 

health of veterans that return home from war. Hundreds of millions of dollars have been appropriated to address the problems of 

currently returning veterans and rightfully so. But it is now time, 

in fact long past time, to address the health problems of 175,000 

ill veterans of the last war. 

Will we follow the example of the current war and address them 

now while there is still hope they can live out their lives in better 

health? Or will we follow the example of Vietnam and agent orange 

and admit the problem only as they are dying? The answer begins 

with you and your colleagues. 

[The prepared statement of Mr. Binns appears on p. 57.] 

Mr. HARE. Thank you, Mr. Binns. Dr. Steele? 

STATEMENT OF LEA STEELE, PH.D. 

Dr. STEELE. Good morning. I am Dr. Lea Steele. I am an epidemiologist and a professor at Kansas State University. And I have 

been involved in research on Gulf War veterans for almost exactly 

10 years when 10 years ago my home State of Kansas stepped up 

to the plate and sponsored a research and service program for Gulf 


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War veterans in Kansas. And we much appreciated the interest 

and support of Congressman Moran for that program over the 

years. 

But now at this time, I am privileged to serve as the scientific 

director for the Research Advisory Committee on Gulf War veterans illnesses. As Mr. Binns said, this is an auspicious group of 

scientists and veterans who are dedicated to addressing these problems. We have now reviewed thousands of scientific studies, government reports, special investigations, special Committee reports, 

all related to what happened during the Gulf War and the health 

consequences for Gulf War veterans. 

My purpose today is to just give you the highlights of some of 

what we have learned in the course of our scientific work. But I 

wanted to let you know that later this year we will be issuing a 

major comprehensive report that contains our scientific findings 

and recommendations based on this extensive information. And I 

think you will find that report to be of great interest. 

Let me just first start by distinguishing a couple of the items 

that have been raised already today. First, most of my comments 

will focus on what we are calling Gulf War illness. This is what 

was previously called Gulf War Syndrome. This is the undiagnosed 

multi-symptom illness that has been described by veterans and 

several of our speakers this morning. I want to distinguish that 

from the diagnosed conditions that also affect Gulf War veterans. 

These include ALS, a very serious condition. And as Mr. Binns has 

said, we know that it affects Gulf War veterans at twice the rate 

of other military veterans. So as new information becomes available saying that all military personnel from whatever era or whether they deployed or not, if all military personnel have higher rate 

of ALS then the general population, the fact that Gulf War veterans have twice as high a rate as other veterans remains a particular concern in relation to Gulf War service. 

There are other diagnosed conditions that have been raised as 

possibly affecting Gulf War veterans. One recent one is brain cancer. I think many of you are familiar with one incident that happened just after the cease fire in the Gulf War in which the Pentagon has estimated that 100,000 Gulf War veterans were potentially exposed to nerve agents, sarin and cyclosarin. We have only 

known since 2005 that those veterans have died from brain cancer 

at twice the rate of veterans who were not in that area. 

So that is another diagnosed condition. But again I want to distinguish these important issues and very serious issues from Gulf 

War illness. And that is because, although these are serious medical conditions, they have affected relatively few veterans of the 

Gulf War in contrast to the alarming numbers of Gulf War veterans who have been affected by Gulf War illness. 

And I think you all have a pretty good idea of what Gulf War 

illness looks like. Multiple symptoms in multiple body systems that 

occur all at the same time and can be quite debilitating; severe 

headaches, memory problems, concentration problems, dizziness, 

fatigue, pain throughout the body, gastrointestinal problems. We 

know many veterans have had diarrhea for 16 years. This is very 

serious and can be quite debilitating for affected veterans. 


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So it is not what we see in the general population and it is not 

what we see in any veterans group of similar age. Luckily, as I 

said, a lot of research has been done on this condition. We now 

have some answers and know some things about Gulf War illness. 

We have a pretty good idea of how many veterans are sick. We 

have a pretty good idea of who is most affected and we also have 

strong evidence regarding what may have caused this condition. 

And again, I will just share with you some of the highlights. 

First, as we have heard earlier today, Gulf War illness is a big 

problem. That is 25 to 30 percent have been shown in study after 

study to be affected by this multi symptom condition. As Mr. Binns 

said that translates to between 175,000 Gulf War veterans and 

200,000 Gulf War veterans. 

Second, I want to be very clear about this. The evidence clearly 

indicates that Gulf War illness was not caused by psychological 

stress. We now have many, many studies that have looked at psychiatric illness and psychological stress in the Gulf War. No comprehensive well-conducted studies have found any connection between combat stress and Gulf War illness. 

In addition, rates of psychiatric conditions like post traumatic 

stress disorder are much lower in Gulf War veterans than in veterans of any other war that we have looked at. And this stands to 

reason. As Mr. Hardie said the war was over in a matter of days, 

the ground fighting, and the whole war was over in 6 weeks. Most 

Gulf War veterans did not engage in combat and were not even in 

areas of theater in which combat took place. So Gulf War illness 

is not a stress condition. 

The next major point is that if stress didn’t cause Gulf War illness, what did? Well we know there are a lot of potential candidates and we have heard about some of them this morning. Burning Kuwaiti oil wells, numerous military vaccines, depleted uranium munitions, low-dose exposure to chemical weapons. What I 

can tell you is that the most consistent evidence and the strongest 

evidence points to a group of chemicals that we know can have 

toxic affects on the brain. This group of chemicals includes a little 

white pill that personnel were given to protect them from the affects of nerve gas. They took this pill around the clock in the event 

of exposure to nerve gas. The second neurotoxin we are concerned 

about relates to the massive and wide spread use of many different 

kinds of pesticides during the war. And the third neurotoxin that 

we are concerned about are the low-level exposures to nerve 

agents. 

What you may not know is that this group of chemicals actually 

have similar affects on the brain and many of them affect one specific brain chemical, acetylcholine. This is also compatible with 

what we know about the biology of Gulf War illness. That is we 

now have multiple studies showing brain damage and reduced 

brain function in sick Gulf War veterans. These have been covered 

in the media recently showing that veterans with reduced brain 

function also have reduced volume in specific areas of their brains. 

So, again, we are very concerned about this, but it is useful to 

note that this large body of evidence all sort of converges on the 

central point of neurotoxins. Now my last very important point has 

been raised before by veterans who are ill and by Mr. Binns. And 


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that is there are no effective treatments for Gulf War illness. We 

now have four studies that have followed up the health of Gulf War 

veterans over time and they all tell us the same thing. And that 

is very few Gulf War veterans with Gulf War illness have recovered 

over time and very few have even substantially improved over 

time. So as a result we have many, many veterans with Gulf War 

illness that have been sick for as long as 16 years. 

Our Committee has long considered treatment research to have 

the highest priority of all research related to Gulf War veterans. 

So in short, I will just summarize by saying that Gulf War illness 

is real. It is serious. And it is still widespread among veterans of 

the 1991 Gulf War. It is not the result of psychological stress and 

it is certainly not the same thing that happens after every war. 

We have seen some progress in understanding the big picture 

questions about Gulf War illness and our Committee believes that 

remaining important questions can be answered and must be answered. And this is of course because the government has an obligation to take care of veterans who are chronically ill now as a result of their military service, but it also because we want to be sure 

that by more completely understanding Gulf War illness we can 

prevent anything like this from happening in future deployments. 

Thank you. 

[The prepared statement of Dr. Steele appears on p. 59.] 

Mr. HARE. Thank you all very much for coming and testifying 

this morning. I have a question of the panel and then maybe a couple for you, Dr. Nass. 

The General proposed in his testimony that a Congressionally directed ALS Task Force be established. And I just wanted to know 

from the panels’ perspective your thoughts on creating another 

task force or entity to look into ALS, and if you believe the direction the VA is taking with ALS is the correct way? 

Mr. BINNS. Let me comment on the aspects of the question that 

I can address. First of all, I am not a scientist. My background is 

in business in developing medical equipment. Specifically, if you 

have had an ultrasound scan that is the kind of equipment that the 

companies that I was involved in starting and building developed. 

The General is absolutely on target when he points to the blocks 

and says that this is the kind of disjointed effort that is produced 

by government and university research in general. It is not just 

true in ALS, it has been true with what I have seen in Gulf War 

illness. 

So a comprehensive and coordinated program such as he suggests is an excellent idea. And it is one that only people I would 

say who have been outside of this what I would call government 

academic complex with due apologies to my colleagues here can understand. Unless you have been in the military or you have been 

in the private sector, somehow it is not just answering interesting 

questions that we are about here. It is trying to achieve a goal. And 

the programs as they are conducted, and this is not through any 

malice necessarily at all, but just because of the nature of them 

don’t accomplish that. 

I am not familiar with the details of the Federal—the VA Gulf— 

ALS program, so I can’t comment on that. 

Mr. HARE. Thank you. 


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Dr. NASS. I would just agree with everything Mr. Binns has said. 

Dr. STEELE. I as well. 

Mr. HARE. Thank you. 

One more question for the panel. We have had 16 years that 

have passed and the veterans of the Gulf War are still fighting to 

be recognized and not forgotten. 

What would your recommendations be on how to effectively improve Gulf War illness research, outreach, education, and treatment? 

Dr. STEELE. Well, you have our 2004 report and we gave very 

specific recommendations about the research arm of what you are 

asking about. 

Mr. HARE. Thank you. 

Dr. STEELE. Our next report will also give detailed recommendations. But part of the issue was, as the General and Mr. Binns 

raised, just having a comprehensive and well-planned program to 

actually solve the problem instead of study little pieces of it around 

the periphery. That is a major issue. 

The other issue has to do with funding, of course. We have seen 

so many dollars spent on Gulf War illness research over the years. 

But as you have heard, a lot of it has gone down the wrong alley. 

And now that we are finally beginning to understand Gulf War 

illness, it is really the time to put some more dollars behind it, but 

put it in the right hands and put it into a program that has managed to achieve results. 

Mr. BINNS. Let me take a—— 

Mr. HARE. Sure. 

Mr. BINNS [continuing]. Chapter from the—another chapter from 

the General’s message and offer you an answer and not just a problem. 

We now have, I think, a very good start on a comprehensive Federal program. As I mentioned, VA has $15 million which is what 

the Research Advisory Committee has recommendation committed 

to this effort. And they have placed most of it in the hands of researchers at the University of Texas Southwestern who believe in 

the problem. 

We now need to make sure that they do their job and develop 

a comprehensive program. Their program is oriented toward treatments. But in the long haul, that is the conventional medical approach, scientific approach of understanding the basic science, targeting what the underlying mechanisms are, and ultimately identifying or developing treatments to address that mechanism. 

At the same time, thanks to Congress, not to the Department of 

Defense, in 2006, a pilot program was started at DoD which is 

looking at what you might consider the quick, less likely, but 

quicker approach to developing treatments which is to see if you 

have a treatment already on the books, on the shelf that could 

work for this application. 

And I am not suggesting you try treatments willy nilly, but there 

are logical ways of approaching treatments to detect which ones 

are promising and studying them. 

As I mentioned, with this Congressionally managed proposal put 

out, they received 80 proposals from researchers around the counVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00029 Fmt 6633 Sfmt 6633 E:\HR\OC\37476.XXX 37476

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try and some of them from other countries suggesting treatments 

and diagnostic tests that could be tried. 

So this program unlike many of the programs in the past has a 

strategy that is promising and works. All that is needed now is to 

fund it to balance the program that VA is funding at the University 

of Texas. 

The problem is this is actually the bigger piece. DoD has funded 

two-thirds of research in the past and they are not funding anything as of this minute. 

So if you want to have a comprehensive program, you have the 

makings of it. You just need to fund the $30 million in the DoD 

budget to balance the $15 million in the VA budget and you will 

have a very coordinated program. 

Mr. HARE. Thank you, Mr. Binns. My time is out, but I would 

like to, on my second round, Doctor, ask just a couple brief questions. So, Mr. Brown? 

Mr. BROWN OF SOUTH CAROLINA. Thank you very much for your 

testimony. And if I might address this to Dr. Steele or anybody can 

include in, but apparently one time, you worked with the University of Kansas? 

Dr. STEELE. Kansas State University. 

Mr. BROWN OF SOUTH CAROLINA. Kansas State. Okay. 

Dr. STEELE. I still do. 

Mr. BROWN OF SOUTH CAROLINA. Okay. And, Dr. Binns, you 

mentioned about Texas, a research program there. And I guess 

that was one of the things that the General alluded to, that apparently there is diverse testing around the country and who has the 

umbrella to kind of digest all the results of these tests. 

And I was alarmed to find that in all the research, there is not 

a data bank that monitors, you know, all the folks that are involved with ALS. And I know that you all are addressing other diseases besides ALS. But what can we do to kind of bring some kind 

of oversight to the process so we can have, you know, one path that 

everybody is traveling? 

Dr. STEELE. Are you asking me or Mr. Binns? Actually—— 

Mr. BROWN OF SOUTH CAROLINA. It was directed to you primarily. 

Dr. STEELE. Thank you. 

One of the charges to our Committee is to provide this oversight 

of all the research related specifically to the health of Gulf War 

veterans. The question about ALS, I believe there is no such oversight Committee. 

So we are in the position to monitor all of the research related 

to the health of Gulf War veterans including ALS and Gulf War illness. 

Mr. BROWN OF SOUTH CAROLINA. I did not mean to interrupt, but 

you are focusing—ALS is one of the Gulf War components, right? 

Dr. STEELE. Yes. That is one of the diseases affecting Gulf War 

veterans, correct. 

Mr. BINNS. Let me distinguish, though, between what we are 

charged to do and able to do and with what, I think, you are asking 

about, sir. 


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We are advisors. Dr. Steele has a staff of two other people to look 

at a very large body of research and we can prepare reports suggesting areas to look at. We conduct public hearings and so forth. 

What is necessary to achieve the goal you are speaking about, 

whether it be for Gulf War illness research or for ALS research, is 

a larger body of scientists who are focused on doing that role full 

time and nothing else, who are not conducting necessarily their 

own studies, but who are assimilating and directing the studies of 

others. Nobody does that in medicine today except for a very handful of people in private organizations. And NIH may do this. I can 

say with respect to Gulf War illness, nobody does it. 

Mr. BROWN OF SOUTH CAROLINA. Yes. That would be my leading 

question is, are you all applying for NIH grants to try to further 

your research? Is that one of the money sources or you just go to 

the VA and the DoD? 

Dr. STEELE. We serve on the Advisory Committee and we do not 

do research ourselves in that capacity. I can tell you that other researchers cannot apply to NIH for research funding for Gulf War 

illness research. ALS researchers can apply to NIH in some circumstances. 

Gulf War illness research is handled exclusively by the Department of Veterans Affairs and the Department of Defense. And as 

you just heard, Department of Defense has not funded any this 

year and the Department of Veterans Affairs only funds researchers that are working at the Department of Veterans Affairs. 

So as a result, there are no widely available funds to do research 

on Gulf War-related health problems. 

Mr. BROWN OF SOUTH CAROLINA. I think you were here when I 

made mention that we were able to get a million and a half dollars 

earmarked for ALS, you know, Therapy Development Institute and 

we asked for really four and a half million. 

So we did that through an earmark, not from the DoD recommendations. So I guess we could continue to try to support the 

program through additional earmarks if enough Members, you 

know, were involved in that process. 

But we are looking for some kind of direction that we can move 

forward. I know that ALS has been around predominantly for 70 

years and the Gulf War has been around 17 years. And I know 

there is a lot of fragmented research out there. 

We are just looking for some way that we can get focused, you 

know, just in one war. That is what we keep talking about one war 

force, right? That is what we talk about in the military now, one 

force. 

So this is kind of what we are looking for here. If you all could 

kind of give us some direction, we would appreciate it. 

Dr. STEELE. It is a very important issue. Unfortunately, the two 

realms of ALS research and Gulf War illness research are separate, 

but we do have specific recommendations for providing funding for 

Gulf War illness research programs. 

Mr. HARE. Mr. Moran. 

Mr. MORAN. Chairman Hare, thank you very much. 

First of all, I would comment to Mr. Brown that there is a difference between Kansas University and Kansas State University. 

Dr. STEELE. There certainly is. 


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Mr. MORAN. I will not take sides as to who is the leading institution in Kansas, but they are different. 

Mr. BROWN OF SOUTH CAROLINA. Kansas City. 

Mr. MORAN. Very good. 

Let me say that we heard lots of compelling testimony, but the 

testimony of Mr. Binns, you indicated in your written as well as 

oral testimony, ‘‘this government manipulation of science and violation of law to devalue the health problems of ill veterans is something I would not have believed possible in the United States of 

America until I took this job.’’ 

That is a very strong statement. It is very disturbing to me. I 

have little doubt but that it is true, and I am confused as to why 

that would be the case. Why is not everyone’s motivation here to 

find the right answers, cause and effect, and to pursue a cure or 

treatment of the conditions that our veterans find themselves in. 

What is the systematic circumstances we find ourselves in in 

which you believe that people systematically are trying to avoid accurate information? 

Mr. BINNS. You have asked the $64,000 question, Congressman. 

I do not know the answer. I can speculate, but I think you could 

get better answers under oath perhaps from the people who followed those policies over the last 15 years. 

Obviously you can speculate that it has to do with either—there 

is a whole long list, but I have no facts to back up what they might 

be. 

Mr. MORAN. I always assume in life that people’s motivations are 

honorable and I would certainly think that is the case when it 

comes to the care and treatment for men and women who have 

served this country. 

I can guess what people’s motivation is, spending of money, the 

priorities, budget, but just on balance, I cannot fathom why we 

would ever take the position that we are trying to find a lack of 

cause and effect. I mean, we ought to have scientific research based 

upon science, on a neutral initial position. 

I suppose I would argue that if there is a bias to be had, it would 

be in favor, if there is uncertainty, that we as policy makers, not 

those as scientists, ought to be making decisions based upon the 

bias toward our veterans. Science ought to be providing us with the 

evidence, the accurate evidence so that we can make intelligent decisions. 

Mr. BINNS. If I may just comment further, I think the attitude 

on this goes in waves and I think that in the post Vietnam era, 

there was clearly an attitude on the part of many who were managing Federal policy in this area that was also oriented toward denying and delaying and minimizing this problem. It took over 20 

years for Agent Orange to be acknowledged as a problem. Now we 

know it was a very serious problem. 

I think that part of what happened in the Gulf War is that the 

same philosophy, perhaps some of the same individuals were involved in the government at that time. Just in the last 6 months, 

there has been a renewal of the commitment of the country brought 

about, I think initially, by newspaper reporting, but certainly by 

the attitude of Congress, which I am sure will be reflected in the 

Federal bureaucracy as that message gets delivered to them. 


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But I know that for the last—well, even this Committee has held 

hearings in the past, it has been, I think, more than 5 years because I have been Chairman of this Committee for more than 5 

years and I was delighted to get called here. 

So the interest in veterans’ health begins at Congress. We have 

seen everything that has happened that I described that is good 

has been because Congress is interested. 

Mr. MORAN. The last hearing that either the full Committee or 

this Subcommittee had in regard to Gulf War illnesses was in 

2002. 

Dr. Nass, you seem to want to respond to my comments. 

Dr. NASS. Thank you. Yes. 

I actually made a memorandum written by Mr. Ross Perot available to Chairman Michaud. I cannot tell you where the initial impetus comes to misdirect research and minimize benefits for veterans. 

But what I can tell you is that a small group of people were promoted and were switched around between VA, DoD, CDC, but that 

this same group has managed to push the theory that stress was 

the cause of Gulf War illness and to minimize it. And Perot named 

names and talked about a meeting that was held in which these 

people were given the order that the cause of Gulf War Syndrome 

that you are to promote is going to be stress. 

Mr. MORAN. Dr. Steele indicated that the scientific evidence of 

that conclusion is clear and it is not stress related. I believe that 

is what you are telling us. 

Does the attitude that it is stress related still prevail within DoD 

or the VA? 

Dr. NASS. There is a lot of confusion. As I said, a VA doctor told 

the patient who met the CDC criteria for Gulf War Syndrome that 

she did not believe it existed. 

There continue to be articles published in the literature, repeatedly, by people who have been funded by VA and DoD which minimize, obfuscate. These articles claim we are seeing the same diseases we saw after every war. Yet the fact that 25 percent of Gulf 

War veterans remain chronically ill is unprecedented. Such articles 

are just designed to confuse the issue. 

Mr. MORAN. I guess Mr. Binns has testified as to that attitude 

still prevails. It is just a normal occurrence? 

Mr. Chairman, I know my time is expired. 

Let me ask if there is any different attitude between the VA and 

the DoD? Is this a monolific circumstance or there is a different approach depending upon whether you are at DoD or VA? 

Mr. BINNS. There is a different approach within VA. The VA Office of Research and Development has changed its attitude, but the 

Office of Environmental Hazards has not. 

Dr. STEELE. And it is also not the same top down. Some people 

within DoD understand the science and some have really not 

looked into it and perhaps still minimize these problems. 

Mr. MORAN. Dr. Steele, thank you for joining us today. As a fellow Kansan, I appreciate your efforts in our home State. 

Dr. STEELE. Thank you. 

Mr. MORAN. Thank you, Mr. Chairman. 

Mr. HARE. Thank you, Mr. Moran. 


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Dr. Nass, I just have a couple quick questions for you that I 

wanted to ask before. You acknowledge the symptoms of Gulf War 

are not unique and that they relate closely with other diseases, 

conditions, and syndromes. 

Just a two-part question here. Could you describe the health effects, if there is a typical case—I do not mean to say that every 

case is the same—but a typical case of Gulf War illness and how 

do you treat a patient that is suffering from Gulf War illness? 

Dr. NASS. Yes. The typical case meets the CDC definition which 

is they have a widespread pain syndrome, pain amplification. They 

hurt in odd places. You cannot find tissue damage and if they do 

have tissue damage, you know, if they have an injury, they hurt 

ten times more than a normal person would. 

They have cognitive problems which have been documented in repeated neuropsychological studies. They have problems with memory, focus, attention, concentration. They frequently have psychiatric problems. 

The patients I see tend to have labile affects. They cry easily. 

They are easily upset. They are not able to control themselves in 

public the way most of us can. 

In addition, very frequently, they have chronic diarrhea. They 

frequently have chronic respiratory problems. And then there are 

a range of—they are fatigued. Almost all of them are fatigued. 

They are stiff. 

Some of them have frank musculoskeletal disease so that the 

Vaccine Healthcare Center came up with a case definition of an 

Anthrax vaccine-associated muscle disorder, in which muscle enzymes were elevated and the muscle did not function well and people hurt. 

The Vaccine Healthcare Center doctors worked with CDC, but 

somehow they never published a case definition. And when I asked 

one of the doctors at CDC who is responsible for some of this type 

of research, he tried to tell me that CDC was completely uninvolved with it. So they wanted to bury this. They did not want anyone to know that these exposures actually may cause some new illnesses. 

In addition, as Lea said, I agree with everything Lea said about 

this, you may see a variety of autoimmune and neurological illnesses that are occurring at what appear to be higher rates. So I 

have been in touch with three people who had shrinking of their 

cerebellum, for instance, part of the brain. 

But we do not have good data to look at the rates, and be able 

to define what the rates are of these various individual conditions 

within the Gulf War population, or within military populations. 

And I think there are reasons for that, and that they are related 

to the overall obfuscation of Gulf War illness. 

Congress directed the military to maintain databases of exposures, of troop movements, of illnesses and created a defense medical surveillance system back in the late 19nineties in which all the 

services’ data would be linked. 

However, at least three different people have looked at the accuracy of these records and found that the error rate varies from ten 

to thirty percent and sometimes is greater. 


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Mr. HARE. Doctor, I do not want to interrupt you, but could you 

tell me how do you treat—— 

Dr. NASS. Sure. 

Mr. HARE [continuing]. A patient that is suffering from—— 

Dr. NASS. All I know how to do, and most other people who are 

doing this also, go symptom by symptom—so that if they have 

chemical exposures that they are sensitive to, you teach them 

about that condition and have them avoid the noxious exposures 

which can make them acutely worse for a period of time. 

If they have diarrhea, there may be causes that are treatable. 

Some people have abnormal gut flora that you can treat with antibiotics or anti-yeast medications. There are other medicines that 

will frequently control the diarrhea. They all have sleep disorders. 

You find medication that helps them sleep. 

And it is a combination of piecemeal interventions—trying to 

work on every one of these symptoms and trying to teach the patients how to choose a lifestyle that will allow them to live better, 

teaching their relatives about it, educating them that it is a real 

syndrome and people should not think they are crazy. And you can 

improve their function maybe 30 or 40 percent, but they certainly 

do not get cured. 

Mr. HARE. Thank you, Doctor. 

I want to thank the panel for taking the time to be with us this 

morning and I appreciate your testimony. Thank you very much. 

Dr. NASS. Thank you. 

Mr. HARE. We are going to bring up the third panel. While we 

do, I am going to recess the hearing for about 5 minutes and then 

I will be right back. Thank you. 

[Recess.] 

Mr. HARE. The Committee will now reconvene. 

Our third panel is Dr. Lawrence Deyton, the Chief Public Health 

and Environmental Hazards Officer, Office of Public Health and 

Environmental Hazards, U.S. Department of Veterans Affairs. 

He is accompanied by Dr. Mark Brown, who is the Director of 

Environmental Agents Service, Office of Public Health and Environmental Hazards, U.S. Department of Veterans Affairs. 

And Dr. Timothy O’Leary, who is the Director of Biomedical Laboratory Research and Development Service and the Director, Clinical Science Research and Development, Office of Research and Development, U.S. Department of Veterans Affairs. 

And Dr. Eugene Oddone? 

Dr. ODDONE. Correct. 

Mr. HARE. Dr. Eugene Oddone, who is the Director for the Center for Health Services Research in Primary Care. He is a Principal 

Investigator of the National Registry of Veterans with ALS, U.S. 

Department of Veterans Affairs. 

Let me thank you all for coming this morning. I look forward to 

your testimony. 

And, Dr. Deyton, we will start with you. Thank you. 


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STATEMENT OF LAWRENCE DEYTON, MSPH, M.D., CHIEF PUBLIC HEALTH AND ENVIRONMENTAL HAZARDS OFFICER, 

VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF 

VETERANS AFFAIRS; ACCOMPANIED BY MARK A. BROWN, 

PH.D., DIRECTOR, ENVIRONMENTAL AGENTS SERVICE, OFFICE OF PUBLIC HEALTH AND ENVIRONMENTAL AGENTS 

SERVICE, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; TIMOTHY O’LEARY, DIRECTOR, BIOMEDICAL LABORATORY RESEARCH AND DEVELOPMENT SERVICE, AND DIRECTOR, CLINICAL SCIENCE 

RESEARCH AND DEVELOPMENT, OFFICE OF RESEARCH AND 

DEVELOPMENT, VETERANS HEALTH ADMINISTRATION, U.S. 

DEPARTMENT OF VETERANS AFFAIRS; AND EUGENE 

ODDONE, M.D., MHSC, DIRECTOR, CENTER FOR HEALTH 

SERVICES RESEARCH IN PRIMARY CARE, PRINCIPAL INVESTIGATOR, NATIONAL REGISTRY OF VETERANS WITH ALS, 

VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF 

VETERANS AFFAIRS 

Dr. DEYTON. That is quite all right. Thank you very much, Congressman Hare, Congressman Brown. And I know Congressman 

Moran had to leave. Thank you for the opportunity to be here this 

morning to talk about these very important issues. 

First, I think we all have to and want to express our honor and 

are moved by the experiences and examples of the veterans we 

heard from on our first panel this morning. 

I must, and really want to, respond specifically to General 

Mikolajcik’s moving testimony. I am an active clinician in the VA 

healthcare system. I help care for persons living with ALS and I 

have some appreciation of the struggle such a catastrophic condition brings to a person and to their family. 

We all need to pay attention, very careful attention to the challenges the General has laid down before us today. That the General 

has so selflessly dedicated his energies to educating all of us about 

ALS inspires me and I know inspired Secretary Nicholson when 

they met recently. 

General Mikolajcik’s service makes me all the more proud to 

serve him and all of our veterans, and I thank you, General, for 

being here today. 

My written testimony, Congressman, addresses three major topics. First is VA’s efforts to improve clinical care and our understanding of the illnesses affecting veterans who served in the 1991 

Gulf War. 

Second, how these efforts have helped us respond to the 

healthcare needs of our troops fighting in this same region today. 

And, third, VA’s response to concerns about potential increased 

risk of ALS among military servicemembers. 

As you are well aware, Mr. Chairman, every conflict in which our 

troops take part has the potential of both short-term and long-term 

health effects for those involved. The possible short-term health effects are the obvious risks of the battle. 

The risk of longer term health effects are manifold and sometimes emerge years or even decades later. Those risks may be related to many factors including exposures to toxic substances, some 


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of which are known, others not, but may have their health effects 

emerge years or decades later. 

VA has learned from past conflicts that the sooner we can collect 

health information on our troops and our veterans, the sooner we 

can initiate epidemiologic surveillance and well-designed studies on 

these populations of servicemembers to understand the longer term 

health effects of combat and establish a solid foundation of knowledge upon which we can build a coherent health program for our 

veterans. 

I hasten to add the mission of combat is to accomplish the tasks 

assigned and protect our troops. Thus, the battlefield is a poor 

source of epidemiologic information. So we, the healthcare team 

caring for our veterans years later, are frequently left with less 

than perfect knowledge with which to understand those exposures 

to which these brave men and women have endured during their 

service. 

That less than perfect knowledge may hinder our understanding 

of the cause of some of the health problems, but it does not keep 

us from providing world-class healthcare to our veterans then and 

now. 

In order to better understand the health effects of the 1991 Gulf 

War, in 1992, VA established a Gulf War Veterans Health Examination Registry which offers comprehensive physical examinations 

and collects data from those veterans who participate. 

As of June of this year, over 100,000 Gulf War veterans have enrolled in the Gulf War Registry and it continues to make new enrollments every day. In fact, over 7,000 veterans from the current 

conflict have enrolled. 

Mr. Chairman, while registries help us reach out to the veterans 

and help us better characterize their health status, registries cannot replace well-conducted epidemiologic or biomedical studies of 

the health effects reported by those veterans. Thus, VA has initiated multiple epidemiologic and biomedical research studies to 

allow us to continue to provide knowledge on Gulf War related illnesses both to veterans and their families as well as to educate our 

clinicians. 

Mr. Chairman, as the first Gulf War conflict ended, we all 

learned and worried about veterans returning from that theater 

with hard to diagnose, multi-system complaints. To better understand the causes and identify treatments, VA has funded the epidemiologic and biomedical research I just mentioned and also has 

established war-related illness and injury study centers to provide 

specialized healthcare for those veterans with difficult to diagnose 

or undiagnosed but disabling illnesses. 

These centers have assisted many veterans and have contributed 

significantly to the medical literature on both the diagnosis and 

treatment of these real but vexing clinical situations. 

One of the most important responsibilities we have in VA is to 

assure our veterans and their families are aware of the VA programs and information about how we can assist them with their 

healthcare needs. Thus, for our veterans who served in the first 

Gulf War, VA publishes and mails to over 400,000 veterans the 

Gulf War Review Newsletter and has also distributed over a million copies of a brochure summarizing VA benefits. 


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General Mikolajcik, with his moving testimony and his dedication to improve veterans’ healthcare needs leads me to conclude my 

statement with some comments about VA’s action in relation to 

ALS. 

Mr. Chairman, VA became aware of reports of possible increased 

incidence of ALS among veterans in 2001. In that year, VA implemented a policy for referring Gulf War veterans’ ALS disability 

claims to VA’s central office for review and special consideration. 

Since that time, VA’s continued concern about possible increased 

incidence of ALS among veterans led us to create a VA ALS registry which has enrolled nearly 2,000 veterans. 

In addition, VA has initiated multiple research projects to improve the diagnosis and treatment of ALS. And in 2005, VA asked 

the Institutes of Medicine to conduct an independent review of the 

scientific basis of all the relevant studies on ALS to help us determine the validity of the evidence connecting ALS and military service. 

The results of that report concluded that although there are very 

few relevant studies which have been completed and there are significant limitations in the studies which have been conducted, the 

Institute of Medicine concluded there is limited and suggestive evidence of an association between military service and later development of ALS. 

In response to that IOM report, Secretary Nicholson convened a 

task force to review the IOM’s assessment. That task force has 

completed its review and Secretary Nicholson wants the Committee 

to know that all veterans who have or suspect they may have ALS, 

VA treats veterans with ALS. ALS is a catastrophic disease and 

veterans with significant impairment are eligible for priority category four which will assure they have access to VA healthcare. 

It is the Secretary’s view that the question of whether ALS 

should have presumptive service connection still requires more research. While preliminary studies as cited by the IOM show there 

may be some association, the research is not extensive enough to 

be conclusive. 

The Secretary would like more research to see if a strong correlation exists and he has directed us today to help conduct that research. 

Again, I want to thank you for calling this hearing. There are 

many topics that we have discussed today. And I want to particularly thank General Mik for his continued service to our Nation 

and to our veterans. 

That ends my oral statement. I am happy to take any questions, 

sir. Thank you again very much. 

[The prepared statement of Dr. Deyton appears on p. 61.] 

Mr. HARE. Thank you, Dr. Deyton. Mr. O’Leary? 

Mr. HARE. Just Dr. Deyton. I am sorry. 

Mr. O’LEARY. I did not come with a prepared statement, sir. 

Mr. HARE. Pardon me? 

Mr. O’LEARY. I did not come with a prepared statement. 

Mr. HARE. That is fine. This is my first hearing that I am 

chairing, so you will have to bear with me for my errors. 

Okay. Thank you. 


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I just have a couple questions here. The Gulf War Newsletter 

which is a publication that the VA initiated to help veterans of the 

Gulf War and their families be more aware of VA healthcare and 

other benefits, it is reported that that newsletter has not been 

mailed out for over a year. 

And I was wondering what have you done to ensure that the outreach to Gulf War veterans is being done on a regular basis, that 

that outreach is. 

Dr. DEYTON. The Gulf War Registry is continuing. It is a very 

important publication for us and it is continuing to be released. Dr. 

Brown helps run that—he can provide a specific response. 

Dr. BROWN. Yes. The last publication was July of 2006. We expect to come out with the next edition of that at the end of the 

summer. It is in preparation now. 

Mr. HARE. Thank you. 

Because they suffer from a multitude of illnesses, the treatment 

of Gulf War veterans is by most accounts pretty complex. I think 

we could all agree. 

When you heard Anthony Hardie in his testimony today state 

that the VA’s Office of Public Health and Environmental Hazards’ 

Web site contains little information that might be of any use to 

Gulf War veterans and/or their health providers, could you tell the 

Committee what type of training or continuing medical education 

requirements are in place currently at the VA to ensure healthcare 

professionals have the most current and up-to-date information of 

the Gulf War illness? 

Dr. DEYTON. Yes, sir. As I said, I am a practicing clinician in the 

VA system and I think the theme that we have heard from all the 

panelists today is that there is much more knowledge needed in all 

of these areas, more research needs to be done to better understand. 

So as a practicing physician, I want to know everything I possibly can so I can treat my patient who comes into my clinic complaining of some of those multiple system complaints that Dr. Nass 

so specifically told us about on the last panel. 

And so we have developed multiple education tools for VA clinicians, for veterans and their families as well, to help understand 

that long list of multi-system illnesses and diseases that could compromise a veteran’s health. 

There is a Veterans Health Initiative Program that our office 

runs that has consolidated what knowledge we know and are continually updating that knowledge as more research is revealed 

about both the symptoms, the diagnoses that might be applied to 

those symptoms, and the possible treatments for that long list of 

symptoms. 

And I think Dr. Nass really hit the nail on the head. You really 

have to go through a very long list of clinical possibilities, take 

them one at a time, and examine each one fully and do the right 

diagnostics and try and treat them one at a time. 

Mr. HARE. Let me ask again, Dr. Brown, are there other clinical 

education components that we provide to VA providers and the 

public? 

Dr. BROWN. Yes. It is a good question. I think we see outreach 

to veterans and their families and we see education of our 


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healthcare providers as a top priority about veteran health issues 

in general and about issues surrounding Gulf War veterans, those 

who served in the 1991 Gulf War, and unexplained illness as a specific health issue. 

And it is a long list. I would invite you to take a look at our Web 

site at www.va.gov/environagents and there is also a Web site specifically for Gulf War. And you can see some of these products. 

We have, for example, this issue of unexplained pain and unexplained fatigue that you heard from some of the previous panels is 

a problem with veterans of the 1991 Gulf War. And so we pulled 

together what is called a clinical practice guideline which is essentially a tool kit for our healthcare providers to give them information about how to respond to these illnesses that we developed that 

is up on that Web site. 

Another example you heard somebody mention earlier concerns 

brain cancer among some troops that were around where some 

chemical weapon munitions were blown up at the end of the war, 

when the 1991 cease fire was declared. There is some data now 

showing that some of those exposed may have greater risk for 

brain cancer. As Dr. Steele mentioned, it is a rare disease fortunately. But for those who it affects, it is obviously extremely serious. 

We have information letters talking about the background and 

the medical issues surrounding that that a healthcare provider 

could read and that also a veteran and his or her family could also 

read. 

I think if you look at our Web site, it may be that not everything 

is absolutely up to date as it possibly could be and that is something that we are continuing to work on, but I think we try to cover 

a wide range of health issues that are of interest to veterans and 

their families. 

You received written testimony submitted for the record from 

Mr. Fahey, depleted uranium which is another concern of veterans 

and their families. We have background information on that. We 

also have information on vaccines and so forth. 

I suppose the problem that we face is that there are so many risk 

factors that people have looked at that it is a challenge to keep up 

with it, but I think it has been helpful. 

Mr. HARE. I know I am out of time, but just one question and 

then a comment. 

Dr. Deyton, the General spoke this morning about an ALS task 

force. I think it is a wonderful idea and having the lead agency 

and, the other two items, the money and the other things that are 

necessary. 

I wanted to know what your thoughts might be on that and do 

you believe that VA is taking—what direction you think the VA— 

if you think they are taking the right direction on ALS along the 

way. 

Dr. DEYTON. I think General Mik’s suggestion is very sound. And 

to have cross-agency, public and private communication and coordination to make sure all the bases are being covered and being done 

in a consolidated, organized way is brilliant. 


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And so both officially from a VA point of view, I cannot commit 

for the department, but I can tell you we would be at that table 

and wanting to be a major player in assisting with that task. 

Mr. HARE. Thank you, Doctor. Mr. Brown? 

Mr. BROWN OF SOUTH CAROLINA. Thank you very much and we 

certainly appreciate your testimony. And it has been a real interesting dialog as we had the three panels. 

But my question would be that the Gulf War veterans are considered a disability if they contract ALS. Why would not all veterans 

be qualified with a disability compensation if they have ALS? 

Dr. DEYTON. Certainly any veteran who has the diagnosis of ALS 

or other disabling condition like that can come to VA for 

healthcare. When I spoke with the Secretary’s office this morning 

and my own feeling as a practicing clinician, we want to make sure 

those veterans know they can come and should be coming to VA 

for their care. 

With the disabling conditions, they would likely be categorized in 

priority category four which is a higher priority so that they would 

be sure to get the medical care that they need. 

The issue raised about all veterans and their increased risk of 

ALS is very complicated. I personally agree with the findings in the 

Institute of Medicine’s report that there is an association that has 

been demonstrated by scientific research. 

The Institute of Medicine also went on to say they could not attribute any known factor to that increased risk. And we heard on 

the first panel, particularly, several cogent arguments for what 

those factors might be. 

General Mik’s point is exactly right. We need the research to be 

done to help nail down what the etiology is and, very importantly, 

a parallel path development of effective treatments and effective diagnoses. 

The whole point is to establish a diagnosis before there is serious 

irreparable damage to the nervous system. So how do we find men 

or women who might be developing this and intervene immediately 

to preserve their neurologic function before there is any major deficit? 

I think the ALS registry that VA has started and Dr. Oddone has 

been running is a very important tool. The research that VA has 

been conducting in ALS both in diagnostics as well as in treatments for ALS and other like diseases is very important. 

And, again, back to General Mik’s point of view. Having a consolidated cross-government, public-private communication about 

these issues, I think, would be very important. And, again, VA 

would welcome the opportunity to participate in that. 

Mr. BROWN OF SOUTH CAROLINA. You heard the testimony when 

General Mik said that it was 2 years before, I guess, before he was 

able to get some consideration after basically he was diagnosed. 

The other members of the military that come down with ALS, 

how long before they are eligible to be treated as a class four, do 

you know? 

Dr. DEYTON. That is a good question, sir. I think that that depends upon the diagnostics and the degree of impairment that that 

particular individual would have. So at the point of a diagnosis of 


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ALS, relatively significant impairment would likely have occurred 

and they would be eligible at that point based on that impairment. 

Let me ask Dr. Oddone. Maybe you have some other factors or 

perspective on that. 

Dr. ODDONE. Yeah. I think it is like General Mik said. One of 

the difficulties with ALS is that there is not a single diagnostic test 

that confirms the disease. And so it is time often a second opinion, 

the experience he had where he had a first physician that said this 

looks like it could be this, but I would like you to get a second opinion. 

And so all of those sort of delay in time, unlike you would get 

with a heart attack or something like that where it is pretty clear. 

There is a marker in the blood that tells you what it is. There is 

an EKG that tells you what it is. It is not that clear always in ALS 

and so the process takes time. 

I cannot answer how that might affect policy. 

Mr. BROWN OF SOUTH CAROLINA. I am just concerned. I know 

that one of the things he also requested was some kind of a common data bank and that we do not have one available. 

Dr. ODDONE. Sir, you know, I think one of the reasons that the 

VA funded the registry was to do that, was to try to collect as complete as possible a group of veterans who have developed the disease. That started in 2003, pretty soon on the tail of when we 

found out that there was an increased incidence of the disease in 

veterans who were deployed to Persian Gulf War. 

And so one of the purposes of that was, A, to do several things. 

One, do more in-depth studies about cause and etiology of the disease and several of those are ongoing now. 

Second was to provide a collection for those veterans so that 

when we would find out about treatments, that we would know 

how to let them know about those. 

Mr. BROWN OF SOUTH CAROLINA. And I guess my question is, if 

we have got the data bank and we are actually using it, we ought 

to be able to have some method to be able to determine early detection. Even if you do not have a treatment, we ought to be able to 

at least not have to have someone wait for 2 years before we recognize, you know, in effect, he has been inflicted with that disease. 

Mr. O’LEARY. If I may address that, sir. I think that VA research 

actually has a pretty coordinated and comprehensive approach to 

this problem of ALS, looking at causes, earlier diagnosis, methods 

to retard the progression of the disease, research on the use of 

adult stem cells to perhaps reverse some of the effects of the disease, and, then finally, for those people that are suffering very 

badly, to palliate the effects of the disease and help them to cope 

more effectively. 

I think there is some very promising research that has been done 

on the development of early biomarkers which in combination may 

provide a clue that would allow us to reach a diagnosis much, 

much earlier in the disease. 

Having said that, it is relatively early research. It needs some 

confirmation. It needs some time to prove that it is true because 

not every exciting research finding turns out to be confirmed in 

later studies. 


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But if this does prove to be true, it would be quite useful because 

that earlier diagnosis gives us the possibility then to intervene in 

the disease before so much destruction has occurred. And I think 

that is a really, really critical goal for us to achieve. 

Mr. BROWN OF SOUTH CAROLINA. To the benefit side, what would 

it take to trigger allowing members of the Armed Services that contract ALS to become eligible for disability payments early on rather 

than wait until it is too late? 

Dr. DEYTON. That is a complex question, sir. Let me try and I 

want to answer it in a couple different—— 

Mr. BROWN OF SOUTH CAROLINA. It is not a large number, right? 

Dr. DEYTON. I am sorry. 

Mr. BROWN OF SOUTH CAROLINA. It is not a large number, is it, 

outside of the Gulf War? 

Dr. DEYTON. I do not know what the number would be. Dr. 

Oddone might—— 

Dr. ODDONE. I do not have a census. I know how many patients 

are in the registry. It is nearly 2,000 patients in the registry. At 

the beginning of the registry, we made some estimates about how 

many veterans we would have based on the total U.S. veteran population and we anticipated that it would be between 1,500 and 

2,500 veterans at any given time. 

Mr. BROWN OF SOUTH CAROLINA. So we are not talking about a 

tremendous amount of money, right? 

Dr. DEYTON. I do not know how much money it would be, but it 

is really not the money. It is the right thing to do for the veteran. 

Mr. BROWN OF SOUTH CAROLINA. That is my question and I am 

just trying to justify a good answer from you all. 

Dr. DEYTON. I am sorry. Ask the question again. 

Mr. BROWN OF SOUTH CAROLINA. Okay. My question is, what do 

we have to do to be able to qualify those veterans that are not involved with the Gulf War that come down with ALS? I mean, how 

can we qualify them for immediate benefits? 

Dr. DEYTON. The Secretary has the authority to grant presumptive service connection to any category that he or she wants. Congress could also enact a requirement for us to do that. 

Mr. BROWN OF SOUTH CAROLINA. Well, I do not know if we have 

got a bill that could track with that. Could you all persuade the 

Secretary maybe to do the right thing? 

Dr. DEYTON. And the good news is that the Institute of Medicine 

report that we requested that they do to look at the evidence is in 

the Secretary’s hands. He has read it and his statement today is 

very clear that he wants to invest in the research necessary to understand that connection better and better. And so we will be doing 

that. 

Mr. BROWN OF SOUTH CAROLINA. And maybe he could do that as 

his parting action. That would be great. 

Thank you all very much. 

And I apologize, Mr. Chairman, for overextending my time, but 

this has absolutely been a great dialog. 

And thank you all for participating. 

Mr. HARE. Thank you, Mr. Brown. 


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Mr. Brown, I would not apologize at all. I think your questions 

were wonderful and thank you for hanging in with this rookie this 

morning. 

Let me just close by thanking everybody that came this morning 

and into this afternoon. 

I just want to say a couple things. If you would please convey to 

the Secretary the appreciation that I have in terms of the level four 

for ALS patients. 

I have said on this Committee many times, and I know I am a 

freshman Member, but my opinion is I believe that we have a fundamental responsibility to do everything that we possibly could do 

for our veterans regardless of when they served, where they served, 

what branch they served in. 

I cringe sometimes when I hear how are we going to afford it because to me, the question should be not how are we going to afford 

it. The statement ought to be we cannot afford to not do this. 

I believe for people like General Mik and for other people and for 

the other witnesses that testified, the Gulf War vet that is still 

here with us, I think we have a moral obligation to do everything 

that we possibly can. 

I hope that as we move down the road, and I talked to my friend 

here and colleague, Mr. Brown, about what we can do to try to help 

the General and other patients with ALS and coming up with the 

necessary funding. I always hope that we will err on the side of the 

veteran first and foremost and then worry about how we are going 

to figure it out on the other side because it is the right thing to 

do and, it sends an incredibly poor message, I think, if we make 

the veterans have to go through hoops that they simply cannot go 

through, cannot make it through, or we do not give them the information that they need to be able to get the kind of help that they 

are so desperately in need of. 

So, you know, from this, I guess, very freshman Member of this 

Committee, I would hope that you would convey to the Secretary 

my sincere desire that—you know, I think Mr. Brown brings up a 

good point. Before he leaves, this would be a wonderful way, I 

think, of his leaving and to the new Secretary, whoever he or she 

may be, that we really lead by the presumption on our vets, that 

they are our best and our brightest and that we do have this moral 

obligation. 

And, you know, we will figure out the money. I know we have 

PAYGO, but these are people who have given everything they have. 

And when you see somebody like General Mik—I am sorry. 

Brigadier General MIKOLAJCIK. I wondered, Mr. Chairman, if I 

could I make another statement. 

Mr. HARE. I was a Sergeant. You are the General, so go right 

ahead, sir. 

Brigadier General MIKOLAJCIK. The VA talked about, we help all 

veterans that have ALS. Well, in my support group in Charleston, 

there is a veteran by the name of Tech Sergeant George Jarrell. He 

spent 24 years in the Air Force, served in Vietnam. He was on duty 

during the Gulf War, but not in the Gulf War. Because he is categorized as category eight, he did not even get as much help from 

the VA as the blocks on the table I had, nothing. 


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There is a huge difference between service-connected disability 

and just being a veteran. And we can continue to do more studies. 

This town is great for them. But it is time to make a decision. Secretary Principi had courage when he took the data that he had and 

moved forward and said we are going to grant service-connected 

disability. And I think as the Chairman has just said, we owe that 

to the rest of our veterans. Forget the studies. Make a decision and 

help them. 

George has had to mortgage his house to put a ramp into it. Congressman Brown and his office had gone to the VA in Charleston 

to get him an appointment and he still does not have it. 

I am sorry to be so emotional, but my emotion is honest. Thank 

you, sir. 

Mr. HARE. Thank you, General. Again, thank you for being here 

and your courage is incredible and your voice in terms of standing 

up for veterans is wonderful. And this Nation owes you a tremendous debt of gratitude not just for the service that you had but for 

what you are doing now. And I want to thank you on behalf of the 

Committee and I appreciate your wife coming with you. 

And, you know, I hope I have done a fairly decent job of chairing 

this meeting this morning. And when Congressman Michaud gets 

back, if you would tell him that I did not mess it up too bad, I 

would be honored. 

But I thank you all very much for coming. And with that, the 

hearing is adjourned. Thank you very much. 

[Whereupon, at 12:29 p.m., the Subcommittee was adjourned.] 


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A P P E N D I X 

Prepared Statement of Hon. Phil Hare 

The Subcommittee on Health will come to order. I would like to thank everyone 

for coming today. 

Regrettably, Mr. Michaud, the Subcommittee Chairman had an emergency and is 

unable to be here today. 

During this hearing today, the Subcommittee will examine Gulf War exposures 

of veterans, the incidence of ALS among Gulf War veterans and most importantly, 

where is the VA in conducting continuing research on Gulf War One exposures and 

what are they finding out about the current exposures in OEF/OIF veterans. 

Many of the veterans who served in the Gulf War were exposed to a variety of 

potentially toxic substances during their deployments. 

According the Research Advisory Committee on Gulf War Veterans’ Illnesses more 

than 16 years after the end of Operation Desert Storm, a substantial proportion of 

veterans continue to experience chronic and often debilitating conditions characterized by persistent headaches, cognitive problems, somatic pain, fatigue, gastrointestinal difficulties, respiratory conditions, and skin abnormalities. 

The Department of Defense and VA together have spent $260 million on Gulf War 

illness research. While there have been numerous studies and much research conducted on Gulf War Illness, there are still many unanswered questions. 

Another aspect of Gulf War One service is ALS. ALS is a progressive and nearly 

always fatal disease that affects a person’s nervous system. According to the Institute of Medicine’s Amyotrophic Lateral Sclerosis in Veterans, Review of the Scientific 

Literature, there is limited and suggestive evidence of an association between military service and developing ALS. 

Additionally, in a study sponsored by the Department of Veterans Affairs in 2003, 

researchers identified that the incidence of ALS in veterans deployed to the Gulf 

was twice as high as the incidence of the disease among those who did not go to 

the Gulf. 

I look forward to hearing from our panelists on these very important issues. 

f 

Prepared Statement of Hon. Henry E. Brown, Jr. 

Good morning. Chairman Michaud and Ranking Member Miller I want to thank 

you for holding this hearing to discuss important issues that have impacted many 

veterans, within my state of South Carolina and the Nation as a whole, who have 

served their country during the Gulf War. As a Member of this distinguished Subcommittee, it is my duty—it is our duty to provide our Nations veterans with access 

to the best heath care possible. It is our duty, perhaps even a moral responsibility 

for us here today, on this Committee to help those brave veterans who have helped 

defend our great Nation. 

Today, I have the distinguished and dignified honor of introducing someone who 

answered the call of duty by helping his country when it needed him the most; and 

today he comes before us and asks for our help. His name is Brigadier General 

Thomas Mikolajcik. For many years, my personal friend and great American hero, 

Gen. Mikolajcik, or Gen. Mik as he is known by those closest to him, has been a 

leader in the Charleston community. First, as the commander of the C–17 wing 

based at the Charleston Air Force Base, and then as an active contributor to the 

Charleston Chamber of Commerce’s military relations activities following his retirement in 1996. 

While General Mik’s dedication to the Charleston community would be noteworthy in any case, it is even more impressive when one realizes that his focus on 

the needs of his community come at a time when he is suffering from a debilitating 


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and deadly disease. In 2005, General Mik announced that he had been diagnosed 

with Amyotrophic Lateral Sclerosis (ALS). While many individuals would have immediately withdrawn under the pressure and impact of ALS, the General used it 

as an opportunity, and with much resolve and endurance doubled his efforts and 

dedication. In addition to continuing his commitment to the Charleston community, 

the General has devoted a great deal of attention to raising awareness within the 

community of ALS and improving the quality of life for ALS patients and their families. Thanks to his efforts, a new ALS Association chapter was formed in South 

Carolina, and the only ALS clinic in the state was founded at Charleston’s Medical 

University of South Carolina. General Mik is truly an inspiration to many throughout the Charleston community, continually thinking of others despite the grave 

challenges he faces. 

Numerous studies have shown that individuals who have served in the military 

have a high propensity toward being diagnosed with ALS. While the Department 

of Veterans Affairs has identified ALS as a Gulf War I-related disease, cases abound 

that show the spread of this disease among veterans is much broader. Indeed, a recent study showed that veterans of all conflicts have a 60 percent higher chance of 

being diagnosed with ALS than the general population. It has been nearly 70 years 

since Lou Gehrig made his famous speech and retired from baseball after contracting this horrific disease, and it has been nearly 17 years since the end of the 

first Gulf War; and yet little has been done about this disease and even less is 

known about its causes. The work of General Mik has also brought to my attention 

the growing number of veterans contracting ALS outside of service during Gulf War 

I. My office is aware of a number of cases in my district from veterans who have 

developed ALS where the VA has denied their claims because their service was not 

within the presumptive timeframe of August 2, 1990 through July 31, 1991. We 

don’t have a good handle on how many non-Gulf War I veterans have contracted 

ALS, what military-related risk factors exist, or what we can do to decrease the 

chances of ALS among our veterans and military service men and women. This 

issue is of special concern as we continue to have troops deployed in OEF/OIF. 

The story of General Mik serves as a testament to the need for leadership at the 

Federal level toward developing a comprehensive ALS research program and a clear 

VA/DoD policy ensuring that all veterans with service-connected-ALS receive the attention they deserve, regardless of whether or not they served during Gulf War I. 

We need an agency to step up to the plate and lead Federal research into the causes 

of ALS and how we can better improve its treatment. Most importantly, we need 

to begin these efforts NOW, before more veterans, including General Mik, succumb 

to ALS. 

f 

Prepared Statement of Brigadier General Thomas R. Mikolajcik, 

USAF (Ret.), Mt. Pleasant, SC 

Chairman Michaud, Congressman Brown and Committee Members, thank you for 

this opportunity to testify. 

My name is Tom Mikolajcik. I am neither an MD nor a PhD. I am a P–A–L–S. 

A patient with ALS. 

I was diagnosed in October 2003. I was given a death sentence . . . and told to 

get a second opinion, while given a prescription for Rilutek which has limited value. 

Only by the Grace of God am I here to speak with you today. . . . And I have vowed 

to keep speaking until I no longer can. 

Military veterans, like me, face a higher risk of this relentless killer. Fifty percent 

die in 1 to 3 years, another 20% die within 5 years and only 10% may live to 10 

years. It was learned in 2001 that Gulf War veterans have two times the incident 

rate of the general population. We discovered in 2005 that all veterans dating back 

to World War II have 1.6 times the incident rate of the general population for developing ALS. 

Four short years ago, the VA opened its voluntary ALS Registry. It registered 

1,993 veterans suffering from ALS. I am sad to say, and it is unacceptable to me, 

that only 969 (less than 50%) are still alive today. And, ladies and gentlemen, that 

also means that somewhere between 1 out of 15 and 1 out of 30 ALS patients are 

military veterans. The government must step up to the plate on this issue! 

We are currently exposing 100’s of thousands more service members to the elevated risk of this disease. There will be young men, women, and families celebrating 

a return from Iraq and Afghanistan alive, who have no idea that they may soon be 

facing a certain death from ALS. We will have to answer those families when they 


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ask what the government has been doing to prepare for this onslaught. For this reason, the government is compelled to assume leadership of this issue. 

If these soldiers were dying in the field . . . rather than quietly at home as a consequence of their service, we would leave no stone unturned. We would use the best 

existing resources and programs to make sure they had whatever they needed to 

survive . . . to ensure that no man or woman is left behind. 

Some say that a lot of ALS research has taken place. My response echoes the famous words of President Lyndon Johnson: ‘‘Research is good, results are better!’’ 

It’s been nearly 70 years since Lou Gehrig made his farewell speech—and we have 

basically nothing—one questionable drug in 70 years!? How many thousands of private farewell speeches must take place before we realize we’re not doing everything 

we can? Will I have to give mine before an appropriate, large-scale, comprehensive 

plan to tackle ALS is carried out? 

ALS is more complicated than a Rubik’s cube which is many sided, with multiple 

connections and various colors—like this one. One must consider causes, therapies, 

biomarkers, genomics, existing drugs, patient needs, palliative care as well as all 

avenues of research. Who is in charge of ALS research today? I have found no one 

in charge! What is the strategy for solving this ALS Rubik’s cube? I’ve found no 

strategic plan! Who oversees and is accountable for existing medical research activities for ALS? No one! 

So, yes, there may be many ongoing efforts into ALS, but potential success is 

thwarted by little cooperation, coordination, and sharing of information. From my 

viewpoint and understanding, there is no one entity in charge or accountable. 

These blocks or boxes represent ongoing ALS research. All are separate, 

none are connected and there is no communication among them. We have underfunded researchers across the country; each working in their own little ‘‘box’’. This 

approach has been unsuccessful thus far. 

We need to open the doors of labs and encourage collaboration. There should be 

no more deaths due to protection of ALS related intellectual property or potential 

profit. . . . Some of us are in a hurry. Therefore, it is the government’s absolute 

responsibility to direct research into a full understanding of ALS. 

In other words, my hope would be that we just not think outside the box, but 

totally redraw it; enlarging it to fit the enormity of this horrific disease. Many people come to hearings with problems and needs. I come before you with a solution 

also. I fully understand bureaucracy’s aversion to change particularly within an industry as large as medicine and with the number of government agencies already 

dabbling, yes, dabbling, in ALS research. 

Let’s look back to 1961, when our Nation made a commitment to put a man on 

the moon within the decade. One government agency was put in charge and it was 

supported by other agencies, as well as private industry and individuals. My proposal is very similar. It worked then, it should also work now. 

THIS IS WHAT I PROPOSE: 

Establish a Congressionally directed ALS Task Force with specific milestones and 

a time line. Within 30 days, establish an ALS Task Force made up of government 

agencies, ALS researchers, private ALS Institutes, patients and a facilitating team 

not related to ALS or the medical industry. Within 60 days, the Task Force should 

recommend which government agency will be in charge and the supporting roles of 

other agencies. Within 90 days, develop a strategic plan which outlines all avenues 

of research to be included. It must be comprehensive, forward looking and all inclusive. The strategic plan should also outline agency and researchers’ accountability. 

An adequate and fair funding stream must accompany this strategic plan. 

The decade of the nineties was the decade of the brain. However, we invested too 

little time and too few resources on research to understand diseases of the brain, 

especially such a devastating disease as ALS. Over 30 years ago our country 

launched a war on cancer. Because of that effort, we now have many treatments 

for this dreaded disease, even some cures. Isn’t it time for us to launch a war on 

ALS and other neurodegenerative disease so that we can have effective treatments 

and even cures? 

We designed and designated the Apollo Program to put a man on the moon. For 

ALS, we could call it The Hope Program—Helping Other People Endure. 

From this day forward, this new direction can be a model program that has one 

government agency, designated by Congress, which has control and oversight of a 

lofty objective—solving the ALS Rubik’s cube. There are many private models of 

leadership to draw upon. Innovations have sprung up driven by those connected to 

the disease including several with which I am involved (ALS–Therapy Development 

Institute, ALSA, MDA and MUSC ALS Clinic). These efforts will succeed with public leadership that amplifies their private support into an integrated whole. In the 


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future, this model could be duplicated as a test bed for research on other diseases. 

Because of the similarities among neuro-degenerative and neuro-inflammatory diseases, advances in ALS research will likely be relevant to Parkinson’s, Alzheimer’s’, 

Huntington’s and others. 

We must prepare to offer our soldiers, sailors, airmen and marines an opportunity 

to fight this disease. We can not simply fight this battle defensively, hoping 

to limit exposure to environmental risk. We must fight it offensively as well, 

with an appropriate medical arsenal. Let’s do what it takes to finish this enemy off 

once and for all. 

Congress can make the commitment, take the initiative, legislate a new way forward and hold agencies accountable. We have the intelligence, the resources, and 

the competencies. It’s time to apply leadership to the ALS Rubik’s cube to move 

this campaign in a new and uncharted direction! 

Let’s have the answer ready for our Veterans and the general population suffering 

from ALS. Let’s show them they were worth a real investment and a real plan. Let 

us redraw and enlarge the ‘‘box’’ to allow for their futures. 

Finally, and probably the easiest task, is to immediately establish and fund a national ALS Registry to ensure comprehensive patient information, tissue, genes, 

DNA, etc., are available for investigation. Such a registry will facilitate, even stimulate, additional research and research collaboration. This will provide ‘‘HOPE’’ for 

future treatment and increased understanding of this disease. 

But what about veterans like me who may not benefit from these future discoveries and treatments? We owe our veterans treatment now, however limited. 

Over 5 years ago, the Secretary for Veterans Affairs extended service connected 

benefits to Gulf War veterans like me based on the research study results. Since 

then new research has shown an increased incidence of ALS among all veterans. 

The Secretary for Veterans Affairs should act now with the same decisiveness and 

the same concern for veterans by extending veterans’ benefits to all veterans suffering from this terrible disease. 

I’ve attached a copy of a letter I gave to and discussed with Sec. Nicholson on 

March 23rd of this year. 

Thank you for your attention and for giving me this opportunity to speak. 

God Bless Our Veterans! And God Bless America! 

**Included with my testimony is the letter which I presented and discussed with 

Secretary Nicholson on 23 March 2007. 

Mt. Pleasant, SC. 

March 23, 2007 

Secretary R. James Nicholson 

Department of Veterans Affairs 

Washington, DC 

Dear Secretary Nicholson, 

In 2001, the Veterans’ Administration and Department of Defense rightly recognized the relationship between Gulf War service and Amyotrophic Lateral Sclerosis 

(ALS), commonly referred to as Lou Gerhig’s Disease. At that time the VA duly decided that Gulf War veterans with ALS automatically received a service connected 

disability. It also expedited ALS cases because this relentless disease, which is a 

death sentence, progresses so rapidly. This decision was widely applauded because 

of the compassion it showed to those who have served our country so bravely. 

Since that time, an important study conducted at The Harvard School of Public 

Health has concluded that not just Gulf veterans, but all veterans are a higher risk 

of developing ALS. The 2005 Weisskopf study found that veterans who have served 

at any time in the last century are at a 60% greater risk than the general population. In a recent review of all relevant scientific literature, the National Academies’ Institute of Medicine concluded that ‘‘the implication is that military service 

in general-not confined to exposures specific to the Gulf War-is related to the development of ALS.’’ 

These findings would suggest that the VA is therefore only granting benefits to 

a specific portion of those exposed to whatever trigger is responsible for our veterans’ increased risk. How can we differentiate between all veterans with a 1.6 

higher incident rate and Gulf War veterans with a 2.0 higher incident rate than the 

general population? 

Because of the appropriate precedent set in 2001 and the additional studies subsequent to that, the VA should now grant service connected disability to all veterans! 


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I would be more than happy to discuss this further with you or your staff. You may 

contact me at 843–971–5000. 

Very respectfully, 

Thomas R. Mikolajcik 

f 

Brig. Gen. USAF (Ret.) 

Prepared Statement of Anthony Hardie, Legislative Chair and 

National Treasurer, Veterans of Modern Warfare 

Mr. Chairman and Distinguished Members of the House Subcommittee on Health, 

thank you for holding today’s hearing on Gulf War Exposures and highlighting the 

enduring national significance of these issues. It is truly an honor and a privilege 

to be here today, and I hope to help voice some of the concerns of the many who 

are not here to share in this privilege. 

On January 17, 1991, much of America watched Operation Desert Storm unfold 

on their evening news, decisively ending the many long months of the massed 

troops’ watchful waiting under Operation Desert Shield. Six weeks of aerial bombing—interspersed with cross-border incursions and the Battle of Khafji and followed 

by a 3-day ground war—and the Persian Gulf War 1991 was over. 

But for many of the nearly 697,000 troops who served, our overarching Gulf War 

experience had only just begun. 

For Members of the Committee who may not be familiar, Gulf War troops were 

exposed to a host of toxic exposures experienced, often in combination, including: 

multiple low-level exposures to chemical warfare agents, including from bombed munitions factories and detonated munitions bunkers; experimental drugs mandated 

without informed consent like Pyridostigmine Bromide (PB) pills intended to help 

survive nerve agent exposure; inhalation of the incredibly high levels of micro-fine 

particulate matter from the Kuwaiti oil well fire plumes; experimental vaccines like 

anthrax, botulinum, and others; inhaled and ingested depleted uranium (DU) particulate matter; smoke from the daily burning of trash and feces; multiple pesticides; 

and petroleum products and byproducts. 

For some of us who developed lasting health effects from this veritable toxic soup 

of hazardous exposures, it came while still in the Gulf. For others, it did not come 

until sometime after returning home. 

Hearing this list of exposures, most people would find it of no surprise that so 

many thousands of Gulf War veterans became ill, or that so many remain ill and 

injured today. And it should be no surprise that so many have developed 

diagnosable, serious conditions like ALS, MS, and others. 

What is stunning is that 16 years later, there are still few tangible results that 

might improve the health of those who became ill and remain ill. And we still have 

little information of any value to provide to Gulf War veterans or their health care 

providers that might help to improve Gulf War veterans’ health. 

Years were squandered disputing whether Gulf War veterans were really ill, 

studying stress, reporting that what was wrong with Gulf War veterans was the 

same as after every war. An incredible amount of effort was put into disproving the 

claims of countless veterans testifying before Congress about chemical and other exposures. Some of that negative effort appears to continue even today. 

It is stunning that after nearly two decades, we still have little information to provide to Gulf War veterans who remain ill from their service. 

It is true that VA does still have an open door for Gulf War veterans to be seen 

at VA medical facilities. 

However, being seen is not the same thing as being treated. 

The VA’s Office of Public Health and Environmental Hazards website contains little information that might be of any use to ill Gulf War veterans or their health 

providers. Much of the information provided is dated between 1996 and 2001, years 

before the more recent research discoveries related to ill Gulf War veterans that affirm what Gulf War veterans have been saying all along—that their Gulf War exposures are what made them ill. 

In July 2006, the VA’s ‘‘Gulf War Review’’ included an article entitled, ‘‘Straight 

from the Source: VA’s Environmental Agents Service is Serious About Communicating With Veterans.’’ That issue, a year ago, was the last issue published. 

For Gulf War veterans like me whose ‘‘Kuwaiti Cough’’ has never left after having 

coughed up thick black sputum while still in the Gulf and for several weeks after 

returning home, the report related to oil fire smoke and petroleum notes on the Office of Public Health and Environmental Hazards website would seem to be of parVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00050 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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ticular interest. Perhaps its lack of usable content, indicative of the lack of attention 

being paid to these issues, is at least in part related to the fact that its stated principal author was not a leading scientist, but instead a community college communications/journalism student Summer Intern. 

I have heard from countless other Gulf War veterans that they, like manyVietnam 

veterans before them, have stopped going to the VA, or have simply given up, and 

have done their best to adapt to the substantial lifestyle changes required by their 

disabilities, which may or may not be compensated for these disabling conditions incurred in service. 

In addition to the commonly recognized long wait times and difficulties in the 

claims process, Gulf War veterans have had unique and special challenges due to 

the currently medically undiagnosable nature of many of their health conditions. In 

May, a VA report showed that only one in four undiagnosed illness claims for Gulf 

War veterans has been approved. And, at a Wisconsin Department of Veterans Affairs conference in January on Gulf War veterans’ illnesses, we heard service officers telling their success stories of alternative methods in achieving service-connection for ill Gulf War veterans that bypassed the near impossibilities of undiagnosed 

illness claims. Clearly there remains much to be done to improve the disability 

claims process for ill Gulf War veterans. 

On a more positive note, I was encouraged during last week’s meeting of the Research Advisory Committee on Gulf War Veterans’ Illnesses on which I serve to hear 

Dr. Robert Haley and his team describe their research goals of identifying diagnostic 

criteria for ill Gulf War veterans. Success in achieving these goals should finally 

help to pave the way for effective treatments. 

And I remain encouraged by current efforts in the U.S. Senate to provide funding 

for Gulf War health research within the Department of Defense Congressionally Directed Medical Research Program budget focused on treatments that may aid ill 

Gulf War veterans. 

The five-point statement of goals that came from Gulf War veterans more than 

a decade ago still holds true today: Gulf War veterans deserved then and deserve 

now an assurance that an exhaustive investigation has been fulfilled to identify all 

possible Gulf War exposures; that appropriate scientific research is promptly completed to connect known or potential Gulf War exposures with health outcomes; that 

medical treatment is based on that scientific research; that compensation is provided to those veterans left disabled by their military service if the health conditions 

cannot be reversed; and that every effort is made to ensure that never again can 

what happened to Gulf War veterans be allowed to happen. 

For the thousands of living, ill Gulf War veterans, it is time to make good on our 

Nation’s enduring promise of caring for those who have borne the battle, and their 

widows, and their orphans. 

f 

Prepared Statement of Denise Nichols, MSN, Vice Chairman, 

National Vietnam and Gulf War Veterans Coalition 

Good morning Congressman Michaud and Representatives of the VA House 

Health Subcommittee and the audience in attendance this morning. I am honored 

to be here today representing the National Vietnam and Gulf War Veterans Coalition other Gulf War Veteran’s groups that came forward to our elected representative since shortly after we returned from Operation Desert Storm in 1991. 

I am Denise Nichols a Gulf War veteran and retired registered nurse with an 

MSN who served along the border of Saudi Arabia and Iraq in 1990–91 with the 

USAFR out of the 32nd Aeromedical Evacuation Group, Kelly Air Force Base, TX. 

When deployed all the Air Force Aeromedical Evacuation resources came under the 

1611 AES(P). Our facilities were deployed throughout the theater with units at 

KKMC, KFMC, and all along the border of Saudi Arabia, Kuwait, and Iraq. 

My particular Mobile Aeromedical Staging Facility (less than 50 people) was located at Log Base Charlie between Rafha and Hafa Al Batin. Our unit was theoretical in the exposure zone from Khamisiyah bunker complex demolition since we 

were assigned to the 44th Medical Group with the Army 7th Corp. Although it appears that the Air Force units were never included in lists provided by the DoD despite all my efforts with DoD during the time of the Office of Special Investigation 

of Gulf War illness and all the other committees and boards during the 1990’s. The 

Army COSCOM unit was down the tapeline Road toward Hafa al Batin and a bit 

further was the Army Engineer Brigade site that was over the 37th Engineers that 

actual did the demolition. In the direction toward Rafha were the Army Hospitals 


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(3) we received patient flow from the closest one being an Alabama Army Guard 

Medical Hospital I believe it was the 115th or the 110th. 

I can tell you now that the symptoms of Gulf War illness began to appear when 

we hit Riyadh and then as we moved forward thru KKMC to our forward location. 

We just were not fully aware of what the symptoms were representing at the time. 

We had rashes, visual sensitive to light, joint aches, urinary urgency, and diarrhea 

occurring. When you are in a desert environment and you are at war your job and 

duty comes first. We also had weird accidents I called them the clumsy/stupidity 

type accidents—falling from stairs of buses is but one example and then the weird 

ones of troops breaking training and handling explosive ordnance they found. We 

also had respiratory problems surfacing but again a lot of these symptoms were 

downplayed. And of course all the tens of thousands of alarms which were going off 

and we were being told that they were false. We had had our first round of anthrax 

shots in Riyadh and being a nurse I insisted that it be documented on my international immunization record (Type A vaccine but no lot number recorded and 

date). Probably not too many got documented because they had us signing a roster, 

which I have been told was lost in transit. We also were order to take the PB tablets. We also had to deal with the sand flies—leichmanasis. We also had pesticide 

spraying occurring at all the locations of troop deployment within Saudi. We also 

had shots on mobilization. Despite having been in charge of our mobilization shot 

scheduling for our whole 32nd Aeromedical Evacuation Group and I believe that our 

unit personnel were at the highest level for compliance for required world wide duty 

we still had additional shots thrown at us in the deployment line to include IGG, 

polio vaccine, and hepatitis and others. I had attempted personally to assure that 

my shot record was current so I was surprised when more shots were thrown at 

us. I had already as a medical person gone to Lowry AFB in Denver to get my hepatitis shots that I knew would be required for medical personnel and that is based 

on building up immunity levels. I had also pushed to have pre-deployment dental 

review done in Denver. I was in Deployable Ready status and didn’t want anything 

to slow us down when we were called to report because we would be busy as officers 

being sure that all our unit personnel and equipment was ready to go. 

The symptom that I believe we all missed was the mental irritability/mental cognitive/neurological functioning changes that began to surface when we hit Riyadh. 

This showed up in weird behavior that I now can attribute to behavior much like 

Brain Concussion cases where you have a change in mental cognitive and behavior 

functioning. This was not PTSD! 

Since our return from the Gulf War in 1991, the Gulf War veterans were directed 

to the DoD/VA Clinical Evaluation Program, these programs have all but died because of VA neglected. Testing that was done in these programs to include EEG’s, 

EMG’s, and neurocognitive functions and many other tests were never compiled and 

released to the veterans or to the researchers that would follow. Many research 

studies listed in the Presidential Advisory Report have never been published. 

In the majority of the VA Hospitals there is no information posted directing the 

Veterans of Operation Desert Storm Veteran Gulf War 90–91 how to access this program i.e. the Registries and what list of tests to anticipate. The Environmental 

Agents names and locations within each VA are not posted and therefore veterans 

seeking help have no information. The Gulf War veteran support groups at the VA 

hospitals were quickly dismantled. Some of our veteran advocates have asked individual VA’s to place posters and information and provide the information desk with 

information that occurs immediately after we bring it to their attention but slowly 

every time the information vanishes. 

The registry was suppose to be an ongoing program and updated but that has not 

occurred. Physicians and health care providers at the VA have not kept up on the 

advancements made and are not well informed. So a sick Gulf War veteran appears 

at their doorstep there is no information and the physicians and staff don’t even 

have knowledge of the latest research findings. The Veterans themselves like Anthony Hardy, myself and many others of us try to bring materials to them and update them. Thank goodness I did this with a VA Emergency room doctor because 

it was shortly thereafter one of our young female veterans presented to that ER 

after being told by staff she called by phone she was just having indigestion. Well 

she was having an MI (myocardial infarction/heart attack). He took her seriously 

and did an EKG and she remembers him being astonished. She was quickly given 

a coronary catherization and taken to surgery. She lived others I know that went 

for help died because of lack of examining our Gulf War veterans. The data on heart 

conditions has not been shared. The data gained from autopsies and cause of death 

is not shared. This is simply not acceptable to have clinical staff that are not knowledgeable and to have valuable data and statistics not available. 


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The expertise on treating a multitude of toxic exposures is not within the VA. 

Very few Gulf War veterans that came to the VA even got a true physical neurological assessment the kind you do at the bedside not with all the brain scans etc. 

Therefore they were never truly assessed, then ordered follow up neurological testing. As a nurse with a master’s degree I was taught the basic physical assessment 

that medical students are taught and I was astounded at the lack of physical neurological assessment. I was also astonished to have Drs like Victor Gordon that had 

done SPEC SCANS on many Gulf War veterans that showed abnormalities to be 

discounted. I had many words over the years with people like Dr Fran Murray that 

were denying the findings by SPEC and PET Scans and saying they were not valid. 

I was also upset that basic blood work to examine our hormones, adrenal, thyroid 

and pituitary functioning were not tested. I was upset when I asked early on for 

heavy metal testing and it was denied. I wondered if they were really wanting to 

find answers and give us competent care and diagnosis. 

They do not even ask physicians in the civilian world involved in environmental 

health or anti aging which is a board certified field to be involved in training their 

physicians. In fact it has been documented that these doctors have approached the 

VA headquarters and different VA’s to offer their expertise and to help train the 

physicians that are seeing Gulf War veterans and they were turned down! There 

are advances in the treatment of these conditions and also in the area of Chronic 

fatigue and Oxidative Stress that could immediately benefit Gulf War veterans who 

are suffering from ill defined or undiagnosed illnesses. We have had many veterans 

go to civilian doctors for help and this is unacceptable when they fought the war 

they were told to fight and have to find money to go to civilian doctors. It is also 

unacceptable for ill patients who look to doctors for relief to have to be bring in 

stacks of research that shows the direction the physicians should be examining and 

then to be ignored. It is unbelievable that patients, our fellow veterans—this country’s veterans—who are ill suffering with neurological cognitive damage and other 

bodily system damage are having to share the expertise and teach doctors what they 

should know and practice and how they should be looking, examining, and testing 

the veterans. 

The VA Newsletters to veterans has not been distributed for years. The VA central office has not responded to our request to update manuals, keep the newsletters 

up, or develop a means of keeping their staff informed of research findings throughout the years since 1990–91. The VA is also dismantling the Environmental Agents 

at each VA hospital or are not replacing them as they leave. 

When veterans bring them research findings that could help the veterans even 

providing reprints and Drs and researchers names and phone numbers I doubt they 

even read the material much less try to make improvements in clinical care of the 

Gulf War veterans at their facilities. 

A case in point at a brainstorming session at the CDC conference in 1999–2000 

with a physician, I pushed the idea of checking the veterans for hypercoagulation 

(meaning thick blood that decreases the ability for the blood to flow to all major organs). This condition is similar to what I saw as a critical care nurse in at Wilford 

Hall USAF Hospital that resulted in Disseminated Intravascular Coagulation. The 

symptoms that we were experiencing that led me to this idea was the bleeding 

gums, the nose bleeds, the uncontrollable menstrual cycles, and the bleeding in 

stools. Sadly our females were not worked up but given hysterectomies early in life 

as a result. This is also a condition that had previously been studied in Chronic Fatigue patients and can be treated. An independent study was done and all Gulf War 

veterans in the study were tested by HEMEX Labs in Phoenix, AZ and all were 

found to be abnormal. The exploratory study and results were published in November 2000 in the Journal of Coagulation and Fibrinolysis, a peer reviewed journal. 

I had my own blood in that sample and the veterans that I contacted throughout 

the country to send in samples had theirs. This was a small sample study but represented a cross section of branches of services, location in theater, duty titles, etc. 

I took the published study in and briefed my primary physician, a hematology specialist, and gave her all the authors names and contact information. I asked her 

treat me for the condition she refused having previously told me her hands were 

tied in regards to Gulf War veterans with Gulf War illness. I asked her to start testing the other veterans of the Gulf War at the VA Denver Hospital. Not getting anywhere I was rightfully upset and at that time she offered me a consult to psychiatry. 

Here we had found a clue to help in our treatment, an independent civilian lab had 

gone in debt testing our blood and yet the VA was going to ignore the clues. I really 

was upset a week later when I found out the Director of the Lab at the VA hospital 

Denver was the EDITOR for the journal that published the study. That was in 2000 

now in 2006 the VA funds a study into hypercoagulation. Now I ask you why not 

just start testing in the clinical area and treat! Why not read the current work on 


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Chronic fatigue that is looking at HPA axis abnormalities and start testing every 

Gulf War veteran at that facility re blood work on adrenal, pituitary, thyroid, and 

hormones. Test and treat! The values on abnormal lab work that would be found 

in Gulf War veterans could then be shared with the researchers. Why is research 

being treated separate and distinct from clinical testing and care? These two areas 

should be interlinked so clinicians feed in the data that researchers need and researchers when they find a treatment by small clinical trials can readily and quickly 

share their findings with clinicians and large scale treatment trials would be integrated more quickly in the clinical area. I offer my observations that this would be 

cheaper and more effective to enhancing the clinical diagnosis and care of Gulf War 

veterans. Much of the research could be done at a savings by integrating the sampling and testing by using clinical abilities and facilities (and cost) that are present 

and available at VA hospitals. We would get answers much more rapidly. This is 

but one example of our continuous saga of Gulf War veterans illness being ignored, 

mishandled, and not addressed in an effective manner! 

The veterans that have developed symptoms of ALS or MS often have to be told 

to go outside the VA to get tested to find out if they have that diagnosis. The first 

veteran I knew with Gulf War illness that developed into ALS was Colonel Don 

Kline a wing commander of the Air Force who served in the Gulf. I met him in 95 

while organizing the Unity Conference for Gulf War Veterans in Dallas, I convinced 

he and his wife to attend the meeting. He was already in a wheelchair with respiratory assistance. He died shortly after that. He had prior to developing the symptoms, luckily had left the military and was hired by Delta and Delta took care of 

his medical needs. The next one I met was Major Mike Donnelly AF F16 pilot—Top 

Gun Bred! . . . and soon after I met Captain Randy Hebert USMC(who had gone 

through the breech into Iraq), I took each of them to Representative Shays government Reform Committee to testify. Mike Donnelly’s family took on the cause and 

advocated for answers for the Gulf War veterans with ALS, they sent their son all 

over the world for medical consults and in there pursuits I believe the number of 

Gulf War veterans we found with ALS was 60 and that is when the VA started 

quietly caring for that group but without a law to cover them as being presumptions 

or service connected. I have found in my travels and in my communications with 

veterans in person, over the phone and Internet others who had suffered and died 

without proper assistance from the VA. Major Mike Donnelly died 2 years ago and 

I am not sure of Major Hebert’s status. This same situation is repeating itself with 

Gulf War veterans with MS. I believe we now have an estimated 500 cases of Gulf 

War veterans with MS. 

We have asked repeatedly that the VA provide data on all known diagnosed illnesses that are being experienced by Gulf War veterans to include all diagnoses including on the top of the list all neurological autoimmune type diagnoses, cancers 

of all types, kidney diseases, thyroid diseases, liver diseases, respiratory diseases, 

the whole picture of all organ diseases. We need a semiannual account of the numbers that are showing up in the diagnosed illness category. This is possible through 

each VA hospital and thru central VA Health Affairs. We are asking that this data 

be mandated to be collected and updated at least semiannually and available for all 

on the VA website. Only in this way can practitioners, patients and researchers be 

aware of the health problems that are developing and then act proactively to screen 

other Gulf War veterans that they see. In this way the Gulf War veterans have a 

chance at early diagnosis and life saving care and treatment. Again we have gotten 

no ACTION on this item. Independently I was given data on the cancers that had 

been diagnosed in Gulf War Veterans from 1991–1995, that was data directly from 

within the VA system. I have copies of the actual data collection sheets. I have presented this data to the VA RAC GWI and to many members of the House and Senate. We also have an earlier listing that was obtained by Congressman Upton. As 

a nurse I was astonished at the numbers and types of cancers. I even consulted by 

phone to an Oncologist specialist in Texas that consults with the military hospitals 

and shared the data with him and he was also very concerned and frankly astonished. Early on I had reports of veterans with multiple cancers in single individuals 

having been diagnosed and one of these individuals even went to the Mt Sinai Hospital in New York for treatment on her own, sadly I feel she has died without any 

help from the VA because contact after she went for help ended. These are just a 

few of the snapshot pictures of the situation that still persists in the VA as far as 

clinical diagnosis, care, and treatment. 

We need to have a law that offers the Service Connection to ALS, MS, Brain Cancer, and any other disease that is found to be above the expect rate of occurrence 

in the general population. These need to be added to our presumptive list by law 

not by arbitrary action of the VA that can change and does not get publicly covered. 

Consideration must be given to giving the veteran the true benefit of the doubt 


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when you are exposed to radiation, chemicals (pesticides and nerve agents, jet fuel 

and other service related exposures), biologicals (including vaccines), endemic diseases in the area of operations. By having the data base public to all we do the right 

thing by shining truth on the subject. WE served our country proudly and the debates must end. This country dishonors its servicemen and women to do no less and 

it sure doesn’t show ‘‘Support the troops’’ to speak the words and not carry through 

in a timely manner. And doing battle with the VA which writes the contracts to 

IOM that is truly not independent is a deception to the troops, the families, and 

to this country’s sworn duty to care for its troops and veterans. The rat’s maze of 

circles of different government entities of denial must be stopped and the broken 

system put aside! 

The Gulf War veterans are also reporting problems with vision and dental problems but unless they are 100% they are not seen and assessment and data on that 

part of the picture is ignored. They are left to fend on their own and the total picture of our rapidly declining multi system failure is not seen. Too many young Gulf 

War veterans have ended up with full dental extractions and dentures with no exploring for the cause or connecting problems. This ties in with oxidative stress theory. 

Jim Binns and the VA RAC GWI have written a letter months ago to the Secretary of the VA recommending other advisory Committees in the area of clinical 

care and benefits to be formed for Gulf War Veterans from Operation Desert Storm 

. . . NO ACTION still after 16 years. Will you consider making that into a law as 

our RAC GWI was brought about. 

In regards to Research we need answers—diagnostic biomarkers and treatments 

now! But do not research us into the GRAVE. Integrate the Research and the clinical testing now so that more veterans can get answers and possibly some treatment 

to help them stop the health decline. WE have all advocated for a targeted response 

in research to Diagnostics, biomarkers, and treatment. WE have asked for defense 

appropriations and defense authorization to be at the level it was prior to 911 for 

the Operation Gulf War Veterans from 1990–91 and it is like we are now the forgotten ones. The MS society has asked for 15 million. The Gulf War illness Advocates 

have asked for 30 million this money will finally be directed and focused in the 

Right direction thanks to the VA RAC GWI. Our money from 1991–2006 was 

misspent on stress/PTSD/ psychologist coordinated research. That time has passed. 

WE got 5 million for Fy06 funding and those reviews were just completed by the 

CDMRP Committees of which I was proud to serve as a Scientific merit reviewer. 

In FY07 we got 0 dollars. It was past due to involve the suffering veterans into the 

review process as oversight directly so we support the CDMRP program. 

So much to inform you of in a short time and I have only hit the highlights and 

a few examples. I thank the Committee for having this hearing it is long overdue 

and we hope that it stimulates not only more hearings and a response to our funding needs but also to real action that fixes the broken system we enter in 1990– 

91. 

Thank you and I would be overjoyed to address any questions you may have. 

f 

Prepared Statement of Meryl Nass, M.D., Internist and Hospitalist, 

Mount Desert Island Hospital, Bar Harbor, ME 

Thank you for inviting me to testify before this Health Subcommittee. My name 

is Meryl Nass, and I practice internal medicine in Bar Harbor, Maine. I have conducted a specialty clinic to treat patients with fibromyalgia, chronic fatigue syndrome and Gulf War illnesses for 8 years. I also have a longstanding interest in the 

scientific evaluation and prevention of bioterrorism, particularly anthrax. Since 

1998, I have spoken and written about the many soldiers and veterans who became 

ill after receiving anthrax vaccinations, usually with illnesses indistinguishable from 

Gulf War Syndrome. I hope to clarify outstanding questions about the vaccine in 

this talk. 

Is There a Gulf War Syndrome? 

How can I possibly ask that question, 16 years after the Gulf War ended? I 

brought it up because many people still deny the reality of this frequently serious 

illness. Last week, a new patient of mine, who presented with a severe, classic case 


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1Fukuda K et al. created the first definition of Gulf War Syndrome in this paper: Chronic 

Multisymptom Illness Affecting Air Force Veterans of the Gulf War. JAMA 1998; 280: 981–988. 2 Brown D. Funding Continues for Illness Scientists Dismiss. Washington Post. December 3, 

2006. A1.http://www.washingtonpost.com/wp-dyn/content/article/2006/12/02/AR2006120201291 

_pf.html 

3 VA RAC 2004 Report: www1.va.gov/rac-gwvi/docs/ReportandRecommendations_2004.pdf ‘‘A 

substantial proportion of veterans of the 1990–1991 Gulf War continue to experience chronic and 

often debilitating conditions characterized by persistent headaches, cognitive problems, somatic 

pain, fatigue, gastrointestinal difficulties, respiratory conditions and skin abnormalities . . . Research studies conducted since the war have consistently indicated that psychiatric illness, combat experience, or other deployment-related stressors do not explain Gulf War veterans’ illnesses 

in the large majority of ill veterans. . . .’’ Progress in understanding Gulf War veterans’ illnesses has been hindered by lack of coordination and availability of data maintained by DoD 

and the Department of Veterans’ Affairs.’’ 4 2005 Annual Report to Congress on Gulf War Veterans’ Illnesses. Page 39 http:// 

www.research.va.gov/resources/pubs/GulfWarRpt05.cfm 5GAO–04–821T. June 1, 2004: ‘‘The modeling assumptions . . . were inaccurate because they 

were uncertain, incomplete and nonvalidated.’’ ‘‘DoD and VA’s conclusions about no association 

between exposure to CW agents and rates of hospitalization and mortality . . . cannot be adequately supported because of study weaknesses.’’ 6GAO–04–767. June 1, 2004: ‘‘Interagency coordination of Gulf War illnesses research has 

waned. In addition, VA has not reassessed the extent to which the collective findings of completed Gulf War illnesses research projects have addressed key research questions. . . . This 

lack of comprehensive analysis leaves VA at greater risk of failing to answer unresolved questions about causes, course of development, and treatments for Gulf War illnesses.’’ 

of Gulf War Syndrome (per the CDC’s case definition,1) and was unable to work, 

informed me that his VA doctor did not believe in Gulf War Syndrome. He had 

never been given a diagnosis, and both he and his wife wondered if his problems 

were ‘all in his head.’ 

Six months ago, the Washington Post ran a front page article on Gulf War Syndrome titled, ‘‘Funding Continues for Illness Scientists Dismiss’’ written by David 

Brown, a physician journalist. Brown misrepresented the findings of the Institute 

of Medicine, claiming it ‘‘reached the same conclusion that half a dozen other expert 

groups had: Gulf War syndrome does not exist.’’ 2 Brown set up a straw man he then 

knocked down: that there is no cluster of symptoms unique to Gulf War veterans. 

He is correct: the symptoms of Gulf War Syndrome are not unique. Instead, they 

overlap closely with those of chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity, and irritable bowel syndrome. 

But why should anyone expect Gulf War Syndrome to be a novel illness? The body 

has only limited ways of responding to environmental insults. Different noxious exposures can cause identical lung or kidney diseases, or cancers. Although Gulf War 

Syndrome may not be absolutely unique in its clinical features, the development of 

this syndrome in 25% of U.S. veterans of one war is unprecedented. 

According to the 2004 Report of the DVA’s Research Advisory Committee on Gulf 

War Veterans’ Illnesses, there are an estimated 200,000 Gulf War 1 veterans with 

chronic, ‘Gulf War’ illnesses related to their deployment.3 According to the Washington Post’s David Brown, 199,000 Gulf War veterans receive compensation for 

such illnesses. 

Why Is This Illness so Often Dismissed? 

DoD and DVA together have spent $260 million on Gulf War illness research.4

But the research findings are often contradictory; a large number of studies focused 

on psychological factors instead of physical illness; and there have been very few 

breakthroughs. According to John Feussner, M.D. (in the aforementioned Washington Post article) who was DVA’s chief research officer from 1996 to 2002, ‘‘After 

hundreds of millions of dollars and a decade or better of research, we really haven’t 

made any significant findings.’’ 

However, the research methods used in these studies have been repeatedly criticized by GAO. For example, models investigating sarin exposure and subsequent illness were inadequate to identify areas of sarin exposure.5 Insufficient coordination 

and analysis of the huge Gulf War research portfolio has persisted.6 Media reports 

have focused more on the lack of a unique syndrome and the negative studies than 

on the clinically relevant, validated research results. 

Gulf War Syndrome does not have an ICD–10 code. It is not described in medical 

textbooks yet, and it is not taught in medical schools. The massive, confusing body 

of published research is extremely difficult for the non-specialist, let alone a journalist, to understand. Veterans have so many symptoms they often appear to have 

psychiatric, rather than physical, illness to uninformed medical practitioners. Therapies recommended by the DVA emphasize the use of psychiatric medications as priVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00056 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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7http://www.oqp.med.va.gov/cpg/cpgn/mus/mus_cpg/frameset.htm 8Senate Committee on Veterans’ Affairs. Is military research hazardous to veterans’ health? 

Lessons spanning half a century. December 8, 1994. S. Prt. 103–97. http://www.gulfweb.org/ 

bigdoc/rockrep.cfm 9Persian Gulf Veterans Coordinating Board. Unexplained illnesses among Desert Storm veterans. A search for causes, treatment, cooperation. Arch Intern Med Feb 13, 1995; 155:262–8. 10 Research Working Group of the Persian Gulf Veterans Coordinating Board. The Annual Report to Congress: federally Sponsored Research on Gulf War Veterans’ Illnesses for 1998, Appendices. Department of Veterans Affairs. June 1999. pp 7–13. 11http://www.research.va.gov/resources/pubs/GulfWarRpt05.cfm. Not one title mentions anthrax vaccine. 12 Institute of Medicine Committee on Health Effects Associated with Exposures During the 

Gulf War. Gulf War and Health. Volume 1: Depleted Uranium, Pyridostigmine Bromide, Sarin, 

Vaccines. National Academy Press, Washington, DC. 2000. 13http://www.lloyd-gwii.com/report.asp 

mary treatment modalities.7 All these factors have conspired to create a smoke screen 

that both the ill veteran, the competent medical practitioner and policymakers have 

trouble penetrating. 

A closely related smokescreen has been created around the safety of anthrax vaccine and its role in Gulf War illnesses. 

Despite the finding by a Senate Committee in 1994 that anthrax vaccine was 

being considered as a possible cause of Gulf War illnesses,8 and the statement by 

the Persian Gulf Veterans Coordinating Board that ‘‘all potential causes [of Gulf 

War illnesses] that have been identified are being investigated,’’ 9 when I first reviewed the portfolio of Federal research on GWS in 1999, I was surprised to find 

that of 166 studies listed, none looked specifically at anthrax vaccine.10 Since 1999, 

a dozen Congressional hearings and seven expert Committees have investigated anthrax vaccine safety and made research recommendations. Yet, since then the DVA 

and DoD have failed to correct the omission of anthrax vaccine-specific Gulf War 

illness research. 

I reviewed the (latest available) 2005 Annual Report to Congress on Gulf War 

Veterans’ Illnesses, which lists a total of 300 separate studies at a cost of $260.6 

million dollars.11

Contrary to the DVA and DoD research funding priorities, anthrax vaccine has 

not been dismissed as a possible cause of Gulf War illnesses by the experts. Since 

2000, three expert panels have reviewed Gulf War illnesses and commented on the 

possible role of anthrax vaccine. Here are some of their findings and recommendations: 

1. Institute of Medicine Committee on Health Effects Associated with Exposures During the Gulf War: 12

• Studies of the anthrax vaccine have not used active surveillance to systematically evaluate long-term health outcomes. 

• The committee recommends a long-term, longitudinal study of participants in 

the Anthrax Vaccine Immunization Program. 

• The committee recommends a careful study of current symptoms, functional status, and disease status in cohorts of Gulf War veterans and Gulf War era veterans for whom vaccination records exist. These cohorts should include nonimmunized, deployed and nondeployed Gulf War veterans; and immunized, deployed and nondeployed Gulf War veterans. 

• Future research should consider issues related to potential long-term adverse 

effects of the combinations of these and other vaccines routinely given to armed 

forces personnel. 

2. 2004 Independent Public Inquiry on Gulf War Veterans’ Illnesses (UK) report:13

• It is of the highest importance to discover the cause or causes of the illnesses 

from which the veterans are suffering, because only if the causes can be discovered is there any prospect of finding effective treatment. 

• A third strong candidate must be the multiple vaccinations, especially the combination of anthrax and pertussis. This would be the best explanation for those 

few [ill veterans] who received the vaccines but were never deployed to the Gulf. 

• On balance, the inquiry concluded that the immunological impact of the multiple vaccinations administered was unusual, possibly unprecedented. The consequences for health of this vaccination programme remain uncertain. 


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14 VA Research Advisory Committee on Gulf War Veterans’ Illnesses. Scientific Progress in 

Understanding Gulf War Veterans’ Illnesses: Report and Recommendations. September 2004. 

www1.va.gov/rac-gwvi/docs/Report and Recommendations_2004.pdf 15http://www.rand.org/multi/gulfwar/publications.html 16 Enserink M. Medicine: Restoring Faith in the Pentagon. Science 2001;291(5505):816. 17 from Chapter 4: ‘‘The Committee did not include various studies that sought to identify risk 

factors for the health problems reported by some Gulf War veterans.’’ Committee to Assess the 

Safety and Efficacy of the Anthrax Vaccine. Medical Follow-Up Agency, Institute of Medicine. 

Anthrax Vaccine: Is it Safe? Does it Work? National Academy Press 2002; Washington, DC. 18 Ibid. Committee to Assess the Safety and Efficacy of the Anthrax Vaccine. Medical Follow 

Agency, Institute of Medicine. Anthrax Vaccine: Is it Safe? Does it Work? National Academy 

Press 2002; Washington, DC. From Chapter 1: ‘‘Several previous IOM Committees evaluating 

possible causal associations between vaccines or other exposures and specific health outcomes 

have chosen to describe their findings with a weight-of-evidence approach (IOM, 1991, 1994, 

2000b). . . . The current committee chose not to use that approach because it was not asked 

to evaluate exposure to AVA as a cause of specific health outcomes. Rather, the Committee was 

asked to provide an overall evaluation of the anthrax vaccine’s safety.’’ 19http://www.fda.gov/OHRMS/DOCKETS/98fr/05n-0040-bkg0001.pdf 

FDA criticized these studies’ methodologies in the vaccine label, stating: ‘‘In addition to the 

VAERS data, adverse events following anthrax vaccination have been assessed in survey studies 

conducted by the Department of Defense in the context of their anthrax vaccination program. 

These survey studies are subject to several methodological limitations, e.g., sample size, the limited ability to detect adverse events, observational bias, loss to follow-up, exemption of vaccine 

recipients with previous adverse events and the absence of unvaccinated control groups.’’ 20The vaccine license was pulled by Federal Judge Emmett Sullivan of the 1st District Court 

in December 2003 and October 2004 for failures in the licensing process. FDA subsequently 

3. VA Research Advisory Commmittee on Gulf War Veterans’ Illnesses: 14

• That VA work with Federal agencies (CDC, NIH, DoD) involved in conducting 

vaccine trials that include administration of AVA [anthrax vaccine adsorbed] to 

ensure that these trials include follow-up assessments of study subjects a minimum of 5 years after inoculation. Such studies should utilize methods and instruments capable of capturing chronic symptoms and cognitive difficulties similar to those experienced by Gulf War veterans. • That VA conduct a retrospective cohort study that compares chronic symptoms 

and diagnosed conditions experienced by veterans who received AVA as part of 

the military’s mandatory anthrax vaccination program to those of a comparable 

group of veterans who did not receive this vaccine. 

The research to determine the extent of anthrax vaccine’s contribution to 

Gulf War illnesses has simply not been done. 

Could the smokescreen be deliberate? The Office of the Secretary of Defense contracted with the RAND Corp. to produce eight volumes on various Gulf War illness 

exposures. Since 2000, only one has remained unavailable: the study of vaccines and 

Gulf War illnesses. Dr. Beatrice Golomb completed this report in 1999, but it was 

not published. At DoD direction she revised the report in 2004–5, and for a time 

the RAND website promised publication in 2005, but it still remains unpublished.15

Neither DoD nor RAND has explained why. 

Even the journal Science commented on the perceived lack of objective science in 

Gulf War illness research: ‘‘Questions about the Pentagon’s ability to objectively study Gulf War illness have 

dogged the department for years and spawned numerous conspiracy theories. Removing those doubts has proven difficult. Just 6 weeks ago, an independent panel reported that the Pentagon had worked ‘‘diligently . . . to leave no stone unturned.’’ 

But that conclusion was spoiled by nasty disputes among panel members and staff, 

some of whom charge that its review was flawed and anything but independent.’’ 16

What do we know about anthrax vaccine and adverse health effects? 

There are two diametrically opposed bodies of work on this subject. Studies performed by the Defense Department since 1998 have uniformly found the anthrax 

vaccine to be safe, as did one Institute of Medicine (IOM) Committee funded by the 

Defense Department. However, that Committee chose to ignore all anthrax vaccinerelated studies of Gulf War illnesses,17 and also failed to use the traditional weightof-evidence approach.18 The DoD studies are filled with methodological errors, as 

outlined by FDA in the vaccine label.19 Yet it was these studies that formed the 

primary basis for the 2002 IOM report used by DoD to validate the vaccine’s safety. 

Because the U.S. Army developed the anthrax vaccine, owns the patent, owns the 

production equipment, owns most of the vaccine stockpile, has indemnified the vaccine manufacturer against all claims regarding lack of safety or efficacy, and chose 

to vaccinate its troops with an insufficiently tested and improperly licensed vaccine 20 on a mandatory basis, it is potentially at risk for large financial losses if the 


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issued a Final Rule and a comment period, reestablishing the license, but new litigation was 

filed in December 2006 challenging the license on the basis of inadequate safety and efficacy 

data. 21Francis v. Maersk Line Limited and United States of America. Case No. C03–2898C. U.S. 

Dist Ct. for the Western District of Washington, ruling by Judge John C. Coughenour, Dec 9, 

2005 to deny Def. motion to deny admissibility of Plaintiff expert witness 22 Unwin C, Blatchley N, Coker W, Ferry S, Hotopf M, Hull L, et al. Health of UK servicemen 

who served in Persian Gulf War. Lancet. 1999 Jan 16; 353(9148):169–78. 23Goss-Gilroy. Study of Canadian Gulf War Veterans: NR–98.050. Study contracted by the 

Canadian Department of National Defense, released June 29, 1998 and published on its website, 

accessed between 1999 and 2001 but no longer at the previous URL: http://www.dnd.ca/menu/ 

press/Reports/Health/health_study_eng_1.htm. 24Sever JL, Brenner AI, Gale AD et al. Safety of anthrax vaccine: an expanded review and 

evaluation of adverse events reported to the Vaccine Adverse Event Reporting System (VAERS). 

Pharmacoepidemiology and Drug Safety 2004; 13: 825–840. 25Schumm WR, Jurich AP, Bollman SR et al. The long term safety of anthrax vaccine, 

pyridostigmine bromide tablets, and other risk factors among Reserve Component Veterans of 

the First Persian Gulf War. Medical Veritas 2005;2:348–362. 26Wolfe J, Proctor SP, Erickson DJ, Hu H. Risk factors for multisymptom illness in U.S. Army 

veterans of the Gulf War. J Occup Environ Med. 2002 Mar; 44(3):271–81. 27 Copies of the serious VAERS reports and all VAERS reports were obtained by FOIA and 

uploaded to my website: http://www.anthraxvaccine.org/serious_VAERS_reports.pdf and http:// 

anthraxvaccine.org/all_VAERS_reports.pdf 28Presented to the Committee to Assess the Safety and Efficacy of the Anthrax Vaccine. Medical Follow-up Agency, Institute of Medicine. Washington, DC. 2001. Can be accessed in the IOM 

reading room. 4 tables are published in Appendix G of the IOM report (cited in footnote 17) 

provide some of this data. I have uploaded some of the raw data tables for public access at the 

following locations: http://merylnass.googlepages.com/AMSAtitlepage.pdf http://merylnass.google 

pages.com/AMSASurveillanceofadverseeffectsofAV.pdf http://merylnass.google pages.com/ 

IOMMentalDisorders.pdf 29http://www.anthrax.osd.mil/resource/qna/qaAll.asp?cID=312 30Wiesen AR, Littell CT. Relationship between pre-pregnancy anthrax vaccination and pregnancy and birth outcomes among U.S. Army women. JAMA 2002; 287 

vaccine is found to be dangerous, its production negligent, or if the vaccine stockpile 

cannot be used. (One case of a disabled civilian Merchant Mariner, vaccinated with 

anthrax and smallpox vaccines, was settled for 2 million dollars.) 21

The non-DoD studies suggest the anthrax vaccine was a contributor to Gulf War 

illnesses, and a cause of multiple chronic medical problems. These studies include 

one by Unwin et al., which found British anthrax vaccinations to have increased the 

risk of chronic Gulf War illnesses by 50% in Gulf War veterans, and by 230% in 

a small cohort of vaccinated Bosnia veterans.22 The Canadian Department of National Defense hired a contractor to investigate Gulf War exposures and subsequent 

illnesses. Anthrax vaccine recipients had a 92% greater chance of developing chronic 

fatigue than unvaccinated veterans.23 A DoD–HHS Anthrax Vaccine Expert Committee found that combinations of symptoms suggestive of Gulf War illnesses reported to the FDA–CDC’s Vaccine Adverse Event Reporting System (VAERS) occurred 2–3 times as often as would have been expected by chance alone.24 Females 

have had higher rates of Gulf War illnesses than male veterans; females also have 

two times the rate of immediate systemic adverse reactions to anthrax vaccine as 

males, and file reports to VAERS at 3 times the rate of males. Schumm 25 and 

Wolfe 26 both determined that anthrax vaccine was a risk factor for Gulf War illness 

in separate cohorts of veterans. 

As of June 26, 2007, the Vaccine Adverse Event Reporting System had received 

a total of 5359 adverse event reports for anthrax vaccine. These included 670 reports that FDA had designated serious, and 44 reports of deaths.27

Raw data from the military’s Defense Medical Surveillance System in 2001 28 re- vealed statistically significant increased rates of hospitalizations after vaccination, 

compared to pre-vaccination, for heart attacks, psychosis, depression, breast cancer, 

thyroid cancer, gallbladder and bile duct cancers, uterine cancer, diabetes, blood 

clots, asthma, multiple sclerosis and abnormal PAP smears in 300,000 soldiers. Yet 

no focused studies of these relationships have been conducted or made public since. 

An unpublished Navy study of active duty women inadvertently vaccinated during 

the first trimester, revealed a 39% greater rate of birth defects in vaccinated mothers, compared to mothers who received anthrax vaccine at any other time.29 An 

Army study found no increased rate of birth defects in vaccinated mothers, but did 

not examine first trimester vaccinations, and was admittedly not adequately powered to examine the issue.30

Easily verifiable, but non-public, DoD and CDC data suggest that anthrax vaccine 

is associated with birth defects and long-term adverse effects. Just last month the 

GAO, citing CDC and Vaccine Healthcare Center officials as sources, reporting that 

1–2% of anthrax-vaccinated individuals ‘‘may experience severe adverse events, 


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31GAO–07–787R. Military Health: DoD’s Vaccine Healthcare Centers Network. June 29, 2007. 

http://www.gao.gov/cgi-bin/getrpt?GAO-07-787R 32LaClair B. Overview of exposures and health conditions reported by countries who served 

in the 1990–1991 Gulf War allied coalition. Presentation to the Department of Veterans’ Affairs 

Research Advisory Committee on Gulf War Veterans’ Illnesses. December 12–13, 2005. Washington, DC. 33Takafuji ET and Russell PK. Military immunizations. Past, present and future prospects. 

Infect Dis Clin North Am 1990; 4(1):143–58. 34Pittman PR, Hack D, Mangiafico J et al. Antibody response to a delayed booster dose of 

anthrax vaccine and botulinum toxoid. Vaccine 2002; 20(16):2107–15. 35 Clifford J (FDA). Statement to the Institute of Medicine Committee on anthrax vaccine safety and efficacy. October 3, 2000. 36 Compilation of expert Committee recommendations: http://www.anthraxvaccine.org/ 

every.htm 

which could result in disability or death.’’ 31 Since the CDC has been conducting a 

trial of anthrax vaccine in 1564 subjects since 2002, and the Vaccine Healthcare 

Centers have performed full evaluations on over 2,400 putative vaccine injuries, 

most following anthrax vaccinations, officials of these agencies should be knowledgeable about the effects of the vaccine. However, no published studies exist to confirm 

that 1–2% of vaccine recipients have serious or life-threatening adverse events, and 

the true number may be more or less than this. The number of deaths that were 

definitely caused by the vaccine is also unknown. 

The evidence is convincing that anthrax vaccine is a contributor, but not the only 

contributor, to Gulf War illnesses. 

How many individuals may be affected? 

It is uncertain how many deployed Gulf War and non-deployed Gulf ‘‘era’’ veterans received this vaccine. The Pentagon estimated that 150,000 deployed 1991 

Gulf War veterans received anthrax vaccine. The VA Research Advisory Committee 

on Gulf War Veterans’ Illnesses staff, using the 40% anthrax vaccination rate in 

self-reports, estimated that 285,000 veterans received anthrax vaccine in the Gulf 

War period.32 Reports exist of experimental anthrax vaccines that were used in addition to the licensed vaccine.33 There are very few available records of who received 

any anthrax vaccines in theater during Operations Desert Shield and Desert Storm. 

(Yet the Pentagon did a study in over 400 Fort Bragg soldiers 2 years after the war, 

in which booster doses of anthrax and botulinum toxoid vaccine were administered. 

The Pentagon was somehow able to identify the number of anthrax and botulinum 

toxoid vaccines administered during the subjects’ Gulf War deployment, and the 

dates, for all soldiers in the study.34) 

Subsequent to the Gulf War, FDA estimated that 475,000 soldiers received anthrax vaccine between 1991 and 1998, yet very few veterans have anthrax vaccine 

listed in their medical records from this period.35 Since 1998, 1.6 million soldiers 

have received anthrax vaccinations, averaging 4 doses each. An unknown number 

of military contractors and merchant mariners have also received anthrax vaccinations. 

Thus over two million American soldiers have been vaccinated since the 1991 Gulf 

War, half of whom have been vaccinated since the start of Operation Iraqi Freedom. 

Consequently, DVA may continue to see large numbers of veterans who have become ill as a result. 

How can DVA improve its research and its care of ill Gulf War veterans? 

1. DVA has the ability to conduct the long-term anthrax vaccine safety studies, 

and should do so, as advised by every expert Committee that has investigated 

the vaccine.36 Matched vaccinated and unvaccinated cohorts could be studied 

longitudinally to finally resolve questions about the types and rates of illness 

associated with the vaccine. 

2. DVA should support the Research Advisory Committee on Gulf War Veterans’ 

Illnesses recommendations regarding areas of research that are likely to bear 

fruit. Clinical research intended to improve the treatment of veterans should 

receive the highest priority. 

3. DVA should improve its ability to provide care to veterans with Gulf War illnesses and vaccine-associated illnesses. DVA designated physicians at each facility to care for Gulf War veterans, but the level of support and training provided to these physicians has not been adequate. Although DVA has convened 

consensus panels and created clinical algorithms for its practitioners, the fact 

remains that to effectively evaluate and treat these patients is extremely difficult. The patients often have idiosyncratic responses to medications, particularly if they are chemically sensitive. They may react adversely to odors in the 

clinic. They usually have cognitive and often emotional problems, and often forVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00060 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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37GAO–02–478T. VA and Defense Health Care. Military Medical Surveillance Policies in 

Place, but Implementation Challenges Remain. February 27, 2002. 

get their doctor’s advice. They require a very patient and understanding clinician, and need detailed written instructions to take home. These patients require care from multiple medical specialists and therapists, and their primary 

provider needs to supervise this process. They have more symptoms, and require much longer visits, than other patients. 

Ideally, DVA will follow the model that DoD and CDC, under Congressional 

directives, pioneered. DoD and CDC jointly created a Vaccine Healthcare Centers Network of four clinics, which perform very detailed and complete evaluations of patients. This provides a solid basis for treating complex patients by 

establishing firm diagnoses, and furthermore allows for a strong bond to develop between the patient and the provider. This bond is particularly important 

for the patients, whose condition is likely to be poorly understood by other providers, and who may have lost trust in the military and DVA systems. 

DoD also created a Deployment Health Center at Walter Reed, where a similar detailed diagnostic process can take place, and patients undergo inpatient 

training about their condition and how best to manage it. This type of center 

might also be beneficial for Gulf War illness and vaccine-injured patients. 

4. Treatment trials for those with Gulf War illnesses are sorely needed. For example, many Gulf War veterans have chronic diarrhea. Empiric trials that included antibiotics, anti-yeast drugs, dietary manipulation, digestive enzymes 

and probiotics such as Lactobacillus rhamnosus could be done in conjunction 

with studies of motility, stool flora, and autonomic nervous system dysfunction. 

Veterans should be screened for hypogonadism, and offered replacement hormone if positive. Those with sleep disorders should undergo formal sleep studies and be given C–PAP trials as indicated. A specialty Gulf War clinic could 

make such evaluations routine. 

5. Accurate, linked medical records between DoD and DVA are a prerequisite for 

optimal care of veterans. According to GAO, ‘‘In 1997, the President, responding to deficiencies in DoD’s and VA’s data capabilities for handling service 

members’ health information, called for the two agencies to start developing a 

comprehensive, lifelong medical record for each service member.’’ 37 Yet the 

databases are still not linked. Congressional attention to this issue might generate more progress than has been made in the 10 years since this policy was 

put in place. 

6. DoD and DVA receive entirely separate funding. Thus, the Defense Department does not have to pay for the long-term care required by soldiers who become ill as a result of DoD’s medical countermeasures. Ill soldiers are medically discharged, and costs are shifted to the DVA. 

If DoD was required to contribute to the long-term care of some ill soldiers, 

it might place a higher priority on the safety of the countermeasures and other 

exposures to which its troops are subjected. Congress should consider instituting a mechanism that would extract a financial penalty from the Pentagon 

when its decisions lead to high rates of (preventable) chronic medical illnesses 

in its soldiers. 

7. A huge amount of effort and money was expended to research Gulf War illnesses for very little return. After arranging for 300 studies, it is striking that 

DVA and DoD have not published quality reviews of this body of work, which 

would make an understanding of the subject so much easier for the public. The 

officials in charge of this failed research project have, for the most part, remained in control for the past 10 years. Congress must assure accountability 

by insuring that future funding of Gulf War illness research is conducted objectively, and is independent of the institutional biases so far demonstrated by 

DoD and DVA. 

f 

Prepared Statement of James Binns, Chairman, 

Research Advisory Committee on Gulf War Veterans’ Illnesses, 

U.S. Department of Veterans Affairs 

Mr. Chairman, Members of the Committee, for the past 5 years, it has been my 

privilege to chair the Research Advisory Committee on Gulf War Veterans Illnesses. 

This public advisory body of distinguished scientists and veterans is mandated by 


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Congress and appointed by the Secretary of Veterans Affairs. Its membership includes leading experts in the field, a former president of the American Academy for 

the Advancement of Science, and the head of the CDC Neurotoxicology Research 

Laboratory. Dr. Steele (to my right) is a member and an epidemiologist who has devoted the past 10 years of her career to the full time study of Gulf War illnesses, 

most recently as scientific director of the Committee. The Committee’s statutory 

mission is to review research studies and plans related to the illnesses suffered by 

veterans of the 1991 Gulf War. 

Dr. Steele will provide highlights of the Committee’s scientific findings. I will address the status of Federal research activities. 

Gulf War illnesses remain a major unmet veterans’ health problem. According to 

the Department of Veterans Affairs most recent study, 25% of Gulf War veterans 

suffer from chronic multisymptom illness over and above the rate in other veterans 

of the same era. This confirms five earlier studies showing similar rates. 

Thus, 16 years after the war, one in four of those who served—175,000 veterans— 

remain seriously ill. And there are currently no effective treatments. 

Gulf War veterans also suffer from amyotrophic lateral sclerosis, ALS, at double 

the rate of other veterans of the same era. 

The veterans whom you have heard today are not exceptional cases. They are representative casualties of the 1991 Gulf War. 

The Federal Government has spent over $300 million on Gulf War illnesses research, roughly one-third by VA and two-thirds by DoD. Some of that research was 

productive, as you will hear from Dr. Steele. Much of that money, however, was 

misspent on the false theory that these illnesses were caused by psychological 

stress. As late as 2003, 57% of new VA Gulf War illnesses research was directed 

at psychological stress. 

This emphasis on stress was part of an overall effort to portray these illnesses 

as nothing unusual, the kind of thing that happens after every war, rather than the 

result of toxic exposures particular to the Gulf War. Very little money was invested 

in treatment research. 

I am pleased to report that a dramatic change for the better has taken place in 

the direction of VA research. Following our Committee’s 2004 report, then VA Secretary Principi announced that VA would no longer fund studies based on stress. 

Secretary Nicholson appointed new leadership at the VA Office of Research and Development, and has placed most of VA’s Gulf War illnesses research program at the 

University of Texas, Southwestern Medical Center, the leading site for Gulf War illnesses research. Congress added $15 million to the VA research budget for this program, which is just getting underway. I am extremely pleased to see VA Gulf War 

illnesses research in the hands of scientists committed to solving the problem and 

fully funded at the level recommended by the Research Advisory Committee. 

At the same time that these positive developments have taken place, however, 

other key VA officials continue to minimize these illnesses at every opportunity. For 

example, a ‘‘fact sheet’’ provided in recent weeks to three U.S. Senators baldly asserted that ‘‘Gulf War veterans suffer from a wide range of common illnesses, which 

might be expected in any group of veterans their age.’’ That is utter hogwash. 

This fact sheet is the work of the VA Office of Public Health and Environmental 

Hazards, which is testifying before you today. It is also the VA office charged with 

implementing Congress’s mandate that VA contract with the National Academy of 

Sciences’ Institute of Medicine to prepare reports on the association between toxic 

exposures in the Gulf War and health effects for use in benefits determinations. For 

7 years, these reports have been structured to restrict the scientific information considered in their conclusions, in express violation of the statute. 

This government manipulation of science and violation of law to devalue the 

health problems of ill veterans is something I would not have believed possible in 

the United States of America until I took this job. Until this practice is stopped, 

the products of Gulf War illnesses research will be distorted, misleading the Secretary, Congress, veterans’ doctors, and the scientific community. 

Dr. Lawrence Deyton, who now directs this office and who will speak to you later 

this morning, assumed his position relatively recently and did not initiate these 

practices. I urge Dr. Deyton to order these misleading activities terminated and previous IOM reports re-done in conformity with the statute. 

The largest sponsor of Federal Gulf War illnesses research is the Department of 

Defense. Historically, DoD has funded approximately two-thirds of Gulf War illnesses research, in excess of $30 million annually. Since the start of the current 

war, however, this program has been eliminated. 

In FY06, Congress initiated a new pilot program for Gulf War illnesses research 

at DoD. This innovative program gives first priority to pilot studies of existing treatments already approved for other illnesses, and so offers the possibility of identiVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00062 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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fying treatments that could be put to immediate use. It complements the VA/University of Texas research program that is focused on understanding the basic science. 

It is open to all researchers, inside or outside of government, through peer-reviewed 

competition, and is administered by the Congressionally Directed Medical Research 

Program. 

Its initial solicitation last fall received eighty proposals—compared to only two 

treatments studied in the entire previous history of Gulf War illnesses research. 

Only a small fraction of these proposals can be funded within the $5 million FY06 

pilot program, but the response demonstrates the interest of the scientific community in finding treatments to improve the health of Gulf War veterans, as well as 

current and future military personnel and civilians at risk of chemical attack. 

Yet DoD has again excluded this promising program from its proposed FY08 

budget. Its future depends on the success of bipartisan efforts in the House and Senate to add it to the DoD budget at the $30 million level consistent with the recommendations of the Research Advisory Committee and historic funding commitments. 

Mr. Chairman and Members of the Committee, in recent months this country has 

renewed its obligation to care for the health of veterans following their return home 

from war. Hundreds of millions of dollars have been appropriated to address the 

health problems of currently returning veterans, and rightfully so. But it is now 

time—in fact, long past time—to address the serious health problems of 175,000 veterans of the last war who remain ill as a result of their service. 

Will we follow the example of the current war and address them now, while there 

is still hope they can live out their lives in better health? Or will we follow the example of Vietnam and Agent Orange, and admit the problem only as they are dying? 

The answer begins with you and your colleagues. 

f 

Prepared Statement of Lea Steele, Ph.D., Scientific Director, Research Advisory Committee on Gulf War Veterans’ Illnesses, U.S. Department of 

Veterans Affairs, and Associate Professor, Kansas State University 

Good morning and thank you for inviting me here today. I’m Dr. Lea Steele, an 

epidemiologist and associate professor at Kansas State University. I first became involved in Gulf War research 10 years ago when I directed a state-sponsored research and service program for Gulf War veterans in Kansas. Our work there provided important insights about Gulf War illness. I am now ‘‘on loan’’ from my university to the Federal Government to serve as Scientific Director of the Federal Research Advisory Committee on Gulf War Veterans’ Illnesses. Our Committee has reviewed and analyzed a vast amount of scientific research and government investigative reports that provide extensive information on the Gulf War and the health of 

Gulf War veterans. We will be issuing our scientific findings and recommendations 

in a major report to be released later in the year. My purpose today is to share with 

you some highlights of what the Committee has learned in the course of our scientific work. 

First, I want to distinguish between the condition known as Gulf War illness and 

other health issues related to the 1991 Gulf War. Gulf War illness is a complex of 

symptoms found at high rates in Gulf War veterans-an illness not explained by 

standard diagnoses and medical tests. This symptom complex affects Gulf War veterans from different units across the U.S. and also from some allied countries. It 

affects more Gulf War veterans, by far, than any other identified health condition. 

There are also other health issues related to Gulf War service. A problem of great 

concern is ALS, as you’ve heard. According to a large VA study, ALS affects twice 

as many Gulf War veterans as other veterans of that period. This neurodegenerative 

disease usually strikes people over age 55, but one study has reported that Gulf War 

veterans may develop ALS at much younger ages. A more recent study has suggested that those who have served in the military, in general, are at increased risk 

for ALS. If true, this could raise even greater concerns, since Gulf War veterans 

have ALS at twice the rate of other military veterans. 

Brain cancer has also been recently identified as a Gulf War health issue. You 

may be familiar with a well-known incident near Khamisiyah, Iraq, in March 1991. 

The Pentagon has estimated that about 100,000 U.S. military personnel were potentially exposed to low-level nerve agents in connection with demolitions at a large 

weapons depot that contained sarin and cyclosarin. A 2005 study found that veterans who were downwind from those demolitions have died from brain cancer at 

twice the rate of veterans in other areas of theater. 


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There might also be problems related to other diagnosed diseases, but studies are 

lacking. The Research Advisory Committee has recommended research to assess 

conditions such as multiple sclerosis, Parkinson’s diseases, and cancer in Gulf War 

veterans. While all of these issues are important, far fewer Gulf War veterans have 

ALS or brain cancer than the very large number affected by Gulf War illness. So 

I will focus my scientific comments today on what we know about Gulf War illness. 

First, let me briefly describe what Gulf War illness looks like, in case you don’t 

have a complete picture from veterans who have testified or whom you know personally. Veterans with Gulf War illness have multiple, persistent symptoms that affect 

different body systems. These include neurological-type problems—severe headaches, memory and concentration problems, dizziness, and mood changes. Persistent 

and widespread pain is also a prominent feature of Gulf War illness, as well as a 

profound fatigue. Other troubling symptoms include gastrointestinal problems—we 

know many veterans have had persistent diarrhea for 15 years. Respiratory symptoms—coughing and wheezing—are also common, as well as unusual skin lesions 

and rashes. Veterans with Gulf War illness experience multiple different types of 

symptoms together, which is why we call it a symptom complex or multisymptom 

illness. We now know quite a lot about Gulf War illness-how many veterans are 

sick, who is most affected, and what may have caused this condition. Here are some 

of the highlights. 

• Gulf War illness is a big problem. 

25–30 percent of veterans who served in the Gulf War are affected by this complex of symptoms as a consequence of their Gulf War service. This has been 

shown by multiple studies, including VA’s most recent large follow-up study. 

That means that Gulf War illness affects between 175,000 and 200,000 of the 

700,000 Americans who served in the Gulf War. • Gulf War illness was not caused by psychological stress. 

Comprehensive studies have found no connection between Gulf War illness and 

combat experiences in the war. In fact, rates of psychiatric conditions like PTSD 

are considerably lower in Gulf War veterans than veterans of other wars. This 

stands to reason since, in contrast to current deployments, severe stress and 

trauma were relatively uncommon in the 1991 Gulf War. A decisive victory was 

achieved after a 4 day ground war; most troops did not see combat and were 

never even in areas where battles occurred. • Research studies consistently identify links between Gulf War illness 

and neurotoxic chemicals. 

Many different Gulf War exposures have been suggested as causes or contributors to Gulf War illness. These include the smoke from over 600 burning Kuwaiti oil wells, receipt of numerous military vaccines, depleted uranium munitions, and low-dose exposure to chemical weapons. 

The most consistent and extensive amount of available evidence implicates a 

group of chemicals to which veterans were exposed that can have toxic effects 

on the brain. These chemicals include pills (NAPP pills or pyridostigmine) given 

to protect troops from the effects of nerve agents, excessive use of pesticides, 

and low levels of nerve gas in theater. Many of these chemicals have a similar 

type of action; they adversely affect the neurotransmitter acetylcholine. Studies 

also show that these chemical toxins can act synergistically, that is, combined 

exposures are worse than any single exposure by itself. 

A link between Gulf War illness and exposure to neurotoxic chemicals is also 

compatible with what we know about biological processes affecting ill veterans. 

Diverse studies have identified abnormalities in the brain and the autonomic 

nervous systems of sick Gulf War veterans. Diverse types of brain scans and 

neurocognitive tests have identified problems that affect different brain processes and areas. For example, in recent months, news stories have widely reported on studies showing that Gulf War veterans have reduced volume in specific brain regions. 

• Effective treatments for Gulf War illness are urgently needed. 

Studies show that few veterans with Gulf War illness have recovered or even 

substantially improved over time. As a result, many Gulf War veterans have 

been sick for as long as 16 years. Effective treatments for Gulf War illness have 

not been identified—very few have even been studied. The Research Advisory 

Committee continues to identify research that can lead to treatments that improve the health of ill Gulf War veterans as the highest priority area of Gulf 

War research. 

In short, Gulf War illness is real, it is serious, and it is still widespread among 

veterans of the 1991 Gulf War. It is not the result of psychological stress and is not 

the same thing that happens after every war. Progress has been made in underVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00064 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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standing ‘‘big picture’’ questions about Gulf War illness and health issues affecting 

Gulf War veterans. The Research Advisory Committee believes that remaining important questions can also be answered and must be addressed. The Federal Government has a continuing obligation to attend to the health problems affecting veterans of the 1990–1991 Gulf War. Further, a more complete understanding of Gulf 

War illness is required to ensure that similar problems do not affect future American troops deployed to war. 

f 

Prepared Statement of Lawrence Deyton, MSPH, M.D., Chief Public Health 

and Environmental Hazards Officer, Veterans Health Administration, 

U.S. Department of Veterans Affairs 

Mr. Chairman and Members of the Subcommittee, thank you for providing the 

Department of Veterans Affairs (VA) this opportunity to discuss VA’s response to 

the health care and other needs of veterans who have served in combat in Southwest Asia. With me today is 

• Mark Brown, PhD, Director, Environmental Agents Service, Office of Public 

Health and Environmental Hazards • Timothy O’Leary, Director, Biomedical Laboratory Research and Development 

Service, Director, Clinical Science Research and Development Service, Office of 

Research and Development and • Eugene Oddone, MD, MHSc, Director, Center for Health Services Research in 

Primary Care and Principal Investigator, National Registry of Veterans with 

ALS 

My testimony today will address three major topics: (1) VA’s efforts toward improving clinical care and our understanding for the illnesses affecting veterans who 

served in the 1991 Gulf War, (2) how these efforts have helped us in responding 

to the health care and other needs of our troops fighting in this same region today; 

and (3) VA’s response to concerns about potential increased risk of Amyotrophic Lateral Sclerosis (ALS, or ‘‘Lou Gehrig’s Disease) among military service members. 

BACKGROUND 

The United States deployed nearly 700,000 military personnel to the Kuwaiti Theater of Operations (KTO) during Operations Desert Shield and Desert Storm (August 2, 1990, through July 31, 1991). Within months of their return, some Gulf War 

veterans reported various symptoms and illnesses that they believed were related 

to their service. Veterans, their families, and VA subsequently became concerned 

about the possible adverse health effects from various environmental exposures during Operations Desert Shield and Desert Storm. 

Of particular concern have been the symptoms and illnesses that, to date, have 

eluded specific diagnosis. More than 130,000 Gulf War veterans have participated 

in the two health registries that VA and the Department of Defense (DoD) maintain. 

In addition, more than 335,000 have been seen at least once as patients by VA. Although the majority of veterans seeking VA health care had readily diagnosable 

health conditions, we remain very concerned about the veterans whose symptoms 

could not be diagnosed. 

I would like to provide a brief description of some of the programs and initiatives 

VA developed in response to health concerns of veterans of the 1991 Gulf War. I 

will also focus on how these new programs have benefited the veterans who are now 

returning from the current conflicts in Southwest Asia, specifically veterans from 

Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) and their 

families. 

VA INITIATIVES FOR SOUTHWEST ASIA COMBAT VETERANS 

The VA Gulf War Veteran Health Registry. Even before the 1991 Gulf War 

cease-fire VA had concerns that returning veterans might have certain unique 

health problems including respiratory effects from exposure to the intense oil fire 

smoke. 

In response, VA quickly established a clinical registry to screen for this possibility. The new voluntary health registry examination also helped encourage new 

combat veterans to take advantage of VA health care programs. VA has long maintained health registries on other at-risk populations, including veterans exposed to 

radiation, and Vietnam veterans exposed to Agent Orange. 

Formally established by law in 1992, VA’s Gulf War Veterans’ Health Examination Registry is still available to all Gulf War veterans, including veterans of the 


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current conflict in Iraq. It offers a comprehensive physical examination, and collects 

data from participating veterans about their symptoms, diagnoses, and self reported 

Gulf War hazardous exposures. As of June 2007, this program evaluated over 

100,000 Gulf War veterans, or about 1 in 7 veterans. 

The program has also seen nearly 7,000 veterans who served in the current conflict in Iraq, who as Gulf War veterans themselves, are eligible for this program. 

After 15 years, the principal finding from VA’s systematic clinical registry examination of about 14 percent 1991 Gulf War veterans is that they are suffering from 

a wide variety of common, recognized illnesses. However, no new or unique syndrome has been identified. Registry data has significant limitations. VA recognizes 

that in the long run, establishing high quality epidemiological research studies is 

the best approach for evaluating the health impacts of service in the 1991 Gulf War 

(or in any deployment). VA has adopted that approach. 

New Compensation for Undiagnosed Illnesses. Many new Gulf War veterans 

encountered problems when they tried to prove that their difficult-to-diagnose or 

undiagnosed illnesses were connected to their military service. This affected their 

access to disability compensation. In response, VA asked Congress for authority, 

granted under Public Law 103–446, to provide compensation benefits to Gulf War 

veterans who are chronically disabled by undiagnosed illnesses when certain conditions are met. This statute as amended authorizes VA to pay compensation for disabilities that cannot be diagnosed as a specific disease or injury, or for certain illnesses with unknown cause including chronic fatigue syndrome, fibromyalgia and 

irritable bowel syndrome. 

Symptoms potentially covered include 1) fatigue; 2) skin signs or symptoms, including hair loss; 3) headache; 4) muscle pain; 5) joint pain; 6) neurologic signs or 

symptoms; 7) neuropsychological signs and symptoms, including memory loss; 8) 

signs or symptoms involving the respiratory system; 9) sleep disturbances; 10) gastrointestinal signs or symptoms; 11) cardiovascular signs and symptoms; 12) abnormal weight loss; and 13) menstrual disorders. This is a unique benefit for Gulf War 

veterans, and more than 3,300 have received service connection for their 

undiagnosed or difficult to diagnose illnesses under this authority. Veterans from 

the current conflict in Iraq are also eligible for this special benefit. 

Epidemiological Research on Gulf War Veterans. Despite the value of VA’s 

Gulf War Health Registry program, additional epidemiological research is required 

to properly characterize any possible long-term health effects of Gulf War 1 service 

to the average Gulf War veteran. This is because the registry participants are selfselected, and therefore do not represent the average veteran. Registry findings demonstrate that Gulf War veterans are not showing up with any unique health problems; however, these findings do not tell us if veterans are suffering from any diagnoses at rates different from expected. That requires population-based epidemiological and related research studies, which VA has carried out. 

VA Gulf War Veteran Mortality Study. VA researchers have been continuously 

monitoring the cause-specific mortality of all Gulf War veterans in comparison to 

their non-deployed peers. In post-war monitoring, Gulf War veteran mortality from 

most causes is not significantly different in comparison to non-deployed peer as controls. Moreover, the mortality for both groups is less than half that of matched civilian controls. This is almost certainly because people who choose to go into the military are healthier to begin with. 

Initially, Gulf War veterans have shown an increased risk of death from accidents, especially motor vehicle accidents. VA’s data shows that this is a temporary 

effect, and by 6 years post-war this difference has disappeared. This overall pattern 

is very consistent with earlier mortality data from Vietnam veterans. 

New Clinical Guidelines for Combat Veteran Health Care. Early on, VA recognized the need to assure training of our health care providers to allow them to 

best respond to the specific health care needs of Gulf War veterans with difficultto-diagnose illnesses. With that in mind, and in collaboration with the Department 

of Defense (DoD), VA developed two Clinical Practice Guidelines on combat veteran 

health issues. This included a general guideline on post combat deployment health, 

and a second dealing with diagnosis of unexplained pain and fatigue. These clinical 

guidelines give VA health care providers access to the best medical evidence for diagnoses and treatment. Developed in response to veterans of the 1991 Gulf War, 

today VA highly recommends these for the evaluation and care of all returning combat veterans, including veterans from OEF and OIF. (also available online at 

www.va.gov/EnvironAgents) 

New VA ‘‘War-Related Illness & Injury Study Centers:’’ Specialized Health 

Care for Combat Veterans. In 2001, as part of VA’s overall health response for 

veterans returning from the 1991 Gulf War, VA established two War Related Illness 

and Injury Study Centers (WRIISCs), at the Washington, DC, and East Orange, NJ 


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VA Medical Centers (VAMCs). Today, these two centers are providing specialized 

health care for combat veterans from all deployments who experience difficult to diagnose or undiagnosed but disabling illnesses. VA now anticipates concerns about 

unexplained illness after virtually all deployments including OEF and OIF, and we 

are building on our understanding of such illnesses. 

Currently, VA is expanding on this program to better meet the health care needs 

of new combat veterans suffering from mild to moderate traumatic brain injury. To 

that end, VA is establishing a third WRIISC at the Palo Alto VA Health Care System. This will take advantage of their unique assets including a Polytrauma Unit, 

interdisciplinary program on blast injuries which integrates the medical, psychological, rehabilitation, prosthetic needs of injured service members, their programs 

in traumatic brain injury, spinal cord injury, blind rehabilitation post traumatic 

stress disorder, and research into new and emerging areas of combat injuries and 

illnesses. This is a critical development because combat injuries we see today among 

OEF and OIF veterans are much more likely, compared to previous wars, to involve 

some degree of traumatic brain injury. This has been the result of the types of 

weapons commonly used to attack our troops, including improvised explosive devices, blasts from landmines, artillery and mortar attacks, and the resulting shrapnel produced from such devices. Many of the long-term chronic health effects from 

traumatic brain injury appear similar to the difficult-to-diagnose and treat illnesses 

currently being treated by the WRIISC programs today. 

Expanded Education on Combat Health Care for VA Providers. In response to health problems faced by veterans of the 1991 Gulf War, VA developed 

the Veterans Health Initiative (VHI) Independent Study Guides for health care providers titled, ‘‘A Guide to Gulf War Veterans Health.’’ Although originally focusing 

on health care for combat veterans from the 1991 Gulf War, this study guide remains highly relevant for treating OEF and OIF combat veterans, since many of the 

hazardous deployment-related exposures are the same for both conflicts. 

VA also developed several additional VHI Independent Study Guides and other 

materials relevant to veterans returning from Iraq and Afghanistan. These include 

the Under Secretary for Health Information Letter ‘‘Preparing for the Return of 

Women Veterans from Combat Theater,’’ (IL 10–2003–011), which provides guidance 

on the special care needs for women OEF and OIF combat veterans. 

Another VHI independent study guide in this series, ‘‘Endemic Infectious Diseases 

of Southwest Asia,’’ provides guidance to health care providers about the infectious 

disease risks in Southwest Asia, particularly in Afghanistan and Iraq. The emphasis 

is on diseases not typically seen in North America. 

Similarly, ‘‘Health Effects from Chemical, Biological and Radiological Weapons’’ 

was developed to improve recognition of health issues related to chemical, biological, 

and radiological weapons and agents. 

The guideline, ‘‘Military Sexual Trauma,’’ was developed to improve recognition 

and treatment of health problems related to military sexual trauma, including sexual assault and harassment. 

Similarly, ‘‘Post-Traumatic Stress Disorder: Implications for Primary Care’’ is an 

introduction to PTSD diagnosis, treatment, referrals, support and education, as well 

as awareness and understanding of veterans who suffer from this illness. 

‘‘Traumatic Amputation and Prosthetics’’ includes information about patients who 

experience traumatic amputation during military service, their rehabilitation, primary and long-term care, and prosthetic clinical and administrative issues. 

Finally, ‘‘Traumatic Brain Injury’’ presents an overview of TBI issues that primary care practitioners may encounter when providing care to veterans and active 

duty military personnel. All are available in print, CD ROM and on the web at 

www.va.gov/VHI. 

VA National Training on Health Care for New Combat Veterans. Based on 

our experience treating veterans from the 1991 Gulf War, VA recognized the need 

to quickly familiarize all VA health care providers on the unique health concerns 

of new combat veterans returning from Iraq and Afghanistan. VA has sponsored 

multiple regional education conferences and a 3-day National Conference on ‘‘Providing Health Care for a New Generation of Combat Veterans Returning from OEF 

and OIF,’’ in April 2007. 

The conference objective was to sharpen the response of VA providers to new and 

transitioning combat veterans coming to us today, and to the new physical and behavioral health care challenges that these returning veterans bring with them. The 

meeting included plenary sessions featuring VA and DoD leadership, and breakout 

presentations from national and international experts describing their clinical and 

research experiences with new combat veterans. 

Approximately 1,400 people attended this event, from throughout all of VHA. The 

target audience was VA primary care providers from around the country, including 


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social workers, psychologists and mental health professionals, physicians, physician 

assistants, nurses, and others who provide direct care to new combat veterans returning from Iraq and Afghanistan. 

National subject matter experts from VA, DoD, and academia, presented their recent experiences responding to the health care needs of new combat veterans. The 

goal was to give VA healthcare professionals the tools they will need to respond to 

the unique and sometimes complex healthcare needs of returning combat veterans, 

and to develop the necessary competencies to provide optimal care. The deliberately 

multidisciplinary approach also helped providers to focus on more integrated health 

care delivery, foster networking. and share best practices, all of which should enable 

us collectively to improve outcomes for returning wounded service members. 

Breakout session topics covered Polytrauma; Pain Management; Behavioral 

Health; Diversity Issues; Prosthetics; and Special Topics for New Combat Veterans. 

Outreach to Combat Veterans and Their Families. VA has many programs 

designed to help returning combat veterans and their families. To help veterans of 

the 1991 Gulf War and their families be more aware of VA’s health care and other 

benefits that are available for them, and of new research results on Gulf War veterans’ health, VA initiated the ‘‘Gulf War Review’’ newsletter, which is regularly 

mailed out to over 400,000 veterans from that conflict. 

VA has developed many new outreach and information products for new combat 

veterans and their families. The Secretary sends a letter to every newly separated 

OEF and OIF veteran, based on records for these veterans provided to VA by DoD. 

The letter thanks the veteran for their service, welcomes them home, and provides 

basic information about health care and other benefits provided by VA. 

Similarly, in collaboration with DoD, VA published a new short brochure called 

‘‘A Summary of VA Benefits for National Guard and Reservists Personnel.’’ To date, 

over one million copies have been distributed. The new brochure summarizes health 

care and other benefits available to this special population of combat veterans upon 

their return to civilian life (also available online at www.va.gov/EnvironAgents). 

‘‘Health Care and Assistance for U.S. Veterans of Operation Iraqi Freedom’’ is a new 

brochure on basic health issues for that deployment (also available online at 

www.va.gov/EnvironAgents). 

Finally, VA started the ‘‘OEF and OIF Review,’’ which is mailed to all separated 

OEF and OIF veterans (over 700,000 individuals as of July 2007) and their families, 

on VA health care and assistance programs for these newest veterans (also available 

online at www.va.gov/EnvironAgents). 

Combat-Theater Veterans’ Enhanced Access to VA Health Care. VA provides combat veterans enhanced enrollment placement and cost-free health care 

services and nursing home care for conditions possibly related to their service in a 

theater of combat operations after November 11, 1998 for a 2-year period beginning 

on the date of their separation from active military service. These veterans are 

placed into enrollment Priority Group 6 if not otherwise qualified for a higher enrollment Priority Group assignment and have full access to VA’s Medical Benefit 

Package. 

Veterans, including activated Reservists and members of the National Guard, are 

eligible if they served on active duty in a theater of combat operations during a period of war after the Gulf War or; were in combat against a hostile force during a 

period of ‘‘hostilities’’ after November 11, 1998 and, have been discharged under 

other than dishonorable conditions. 

Veterans who enroll with VA under this authority retain enrollment eligibility 

even after their 2-year post discharge period ends under current enrollment policies. 

At the end of this 2-year period VA will reassess the combat veteran’s information 

(including all applicable eligibility factors existing at this time) and make, as appropriate, a new Priority Group assignment. 

Special Depleted Uranium (DU) Surveillance Program. Special armor piercing munitions and tank armor made from depleted uranium (DU) was used with 

great effect by U.S. forces during the 1991 Gulf War, as well as more recently during the initial phases of OEF and OIF. However, some veterans returning from 

these conflicts have had concerns that DU may have affected their health. In response, in 1993, VA established the DU Follow-up Program at the Baltimore VA 

Medical Center to monitor the health of veterans who had retained DU fragments 

in wounds—typically from ‘‘friendly fire’’ incidents in 1991 Gulf War. The program 

provides ongoing and thorough detailed physical examinations for affected veterans, 

including a broad array of testing of the blood, immune, reproductive, and central 

nervous systems, and of kidney and liver function. 

In 1998, in response to increasing concerns among Gulf War veterans, this program was expanded to offer DU screening for any veteran concerned about possible 

DU exposure, and not just those with possible retained DU fragments or with other 


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types of high exposure risks. The program is also open for veterans who served in 

OEF and OIF. 

Researchers with VA’s DU Follow-up Program have not identified any clinically 

significant uranium-related health effects among veterans from exposure from inhalation or from retained DU fragments. There are however some concerns about certain physical changes that have been noted in imbedded DU fragments, and indications for surgical removal of fragments are currently under review by this group. 

VA and DoD will continue to monitor health effects in this population, which includes both 1991 Gulf War veterans and veterans from the current conflict in Iraq. 

New VA Toxic Embedded Fragments Surveillance Center. In response to 

health concerns for new OEF and OIF combat veterans suffering from retained embedded fragments composed of a wide range of metals and other materials as a result of blast injuries from improvised explosive devices, VA is establishing the Toxic 

Embedded Fragments Surveillance Center (TEFSC) at the Baltimore VA Medical 

Center. New studies indicate that some metals, such as certain tungsten alloy fragments, are highly carcinogenic in rats and may pose a health hazard in veterans. 

Some metals are also known or presumed to be human reproductive hazards, including lead, cadmium, nickel, and copper. 

The Baltimore VA DU Surveillance Program has shown us that retained DU fragments and other materials are not necessarily inert in the body, and may change 

over time to produce potential toxic health effects. Such effects may be minimized 

and managed through careful ongoing medical surveillance. 

New Combat Veteran Health Surveillance. The long-term epidemiological 

studies supported by VA assessing the health effects of the 1991 Gulf War on veterans who were deployed to Southwest Asia took a considerable amount of time. 

Today, we appreciate the importance of rapidly monitoring the health status of new 

combat veterans and have initiated surveillance and studies to more rapidly identify 

any health effects that may occur from this current conflict. This has been made 

possible via VA’s electronic inpatient and outpatient medical records, which summarizes every single visit by a combat veteran including all medical diagnoses. For example, according to VA’s July 2007 update ‘‘Analysis of VA Health Care Utilization 

among Southwest Asian War Veterans,’’ since fiscal year (FY) 2002 over 700,000 

OEF and OIF veterans have left active duty and become eligible for VA health care. 

About 35 percent of these new veterans (over 250,000) have received VA health care 

at least once since 2002. 

This simple surveillance shows that new OEF and OIF veterans are coming to VA 

with a wide range of medical and psychological conditions. No special conditions 

stand out, and therefore these new combat veterans are being assessed individually 

to identify all their outstanding health problems. VA will continue to monitor the 

health status of recent OEF and OIF veterans using updated deployment lists provided by DoD to ensure that VA tailors its health care and disability programs to 

meet the needs of this newest generation of war veterans. Also using this new combat veteran roster, VA has developed a new clinical reminder in the electronic 

health record to assist VA primary care clinicians in providing timely and appropriate care to new combat veterans. 

INDEPENDENT REVIEWS ON GULF WAR VETERANS’ HEALTH 

VA has sought advice on the health of combat veterans serving in Southwest Asia 

from a wide range of external advisory groups. For example, VA has long relied 

upon the independent scientific advice of the National Academy of Sciences (NAS) 

Institute of Medicine (IOM) to help evaluate potential associations between environmental hazards encountered during various military deployments and specific 

health effects. This external review process has resulted, for example, in VA recognizing about a dozen diseases as presumed to be connected to exposure to Agent Orange and other herbicides used during the Vietnam War, and to the dioxin impurity 

some contained. 

The National Academy of Sciences was established in 1863 with the signature of 

President Abraham Lincoln, to ‘‘investigate, examine, experiment, and report upon 

any subject of science or art’’ for agencies in the Federal Government. In 1970, the 

NAS created the IOM to provide independent, objective, authoritative, credible and 

timely scientific analyses on medical and health issues. 

The U.S. Congress, through U.S. Government agencies, regularly seeks the IOM’s 

unique scientific advice on a broad range of health-policy issues. Their studies are 

conducted by independent Committees of volunteer scientists composed of leading 

nationally and internationally recognized experts, selected by the IOM based on 

their expertise, good judgment and freedom from conflict of interests. The IOM requires that a Committee’s formal findings and recommendations are evidence-based 

whenever possible and noted as only expert opinion when that is not possible. Each 


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IOM report undergoes extensive formal internal and peer review by external experts 

who are anonymous to the Committee, and whose names are revealed only once the 

study is published. 

Congressionally Mandated NAS/IOM Veterans’ Health Reviews. The NAS/ 

IOM’s highly developed formal review process has proven invaluable to VA for establishing fair, scientifically based disability policies for veterans. Their reputation 

for objectivity, scientific integrity, and independence means that their reports stand 

as authoritative even when their findings fail to please all stakeholders. Since 1991, 

IOM has completed nineteen independent reviews of Gulf War health issues (see attachment). For evaluation of Gulf War-related health effects, Congress directed (in 

Public Laws 105–277 and 105–368) the NAS to ‘‘identify the biological, chemical, or 

other toxic agents, environmental or wartime hazards, or preventive medicines or 

vaccines to which members of the Armed Forces who served in the Southwest Asia 

theater of operations during the Persian Gulf War may have been exposed by reason 

of such service.’’ Public Law 105–277 further required the NAS, for each substance 

or hazard considered, to determine, to the extent feasible, (1) whether a statistical 

association exists between exposure to the substance or hazard and the occurrence 

of illnesses, (2) the increased risk of the illness among exposed human or animal 

populations, and (3) whether a plausible biological mechanism or other evidence of 

a causal relationship between the exposure and illness exists. 

VA RESPONSE TO PREVIOUS NAS COMMITTEE ‘‘GULF WAR & HEALTH’’ 

REPORTS 

The 2000 Report. The initial 2000 NAS Committee report in this series, ‘‘Gulf 

War & Health Volume 1,’’ reviewed health effects from exposure to the four potential hazardous exposures related to the 1991 Gulf War. These included sarin, depleted uranium, vaccinations, and pyridostigmine bromide (‘‘PB,’’ a nerve agent protecting drug used by DoD). The report contained 13 findings, of which four indicated 

a positive association between some health outcome and the reviewed general risk 

factors. Many were obvious, such as an association between a large exposure to the 

military nerve agent sarin and severe health effects including death. Others were 

related to common side effects of drugs and vaccines seen among civilians or military personnel using these agents to protect their health. 

Following review by a VA Task Force, VA determined that establishing new presumptions of service connection for any diseases based on the report findings was 

not necessary. This was primarily because the types and degree of exposures associated with long-term health effects described in the NAS Committee report had either not occurred during the 1991 Gulf War (for example, severe, life-threatening 

and immediate nerve agent poisoning), or that the related health effects were transitory and short-lived (for example, a normal sore arm following a vaccination). 

Those findings were published in the Federal Register, as required by the relevant 

statutes that established this process. 

The 2002 NAS Report. The second 2002 NAS Committee report, ‘‘Gulf War & 

Health Volume 2,’’ reviewed health effects from exposure to pesticides and solvents 

used during the 1991 Gulf War. An important issue was that virtually all the pesticides and solvents used during that conflict were in common approved use 

throughout the civilian and military at that time. The report contained 77 findings, 

of which 21 indicated a positive association between a pesticide or a solvent and 

some general health outcome. These were primarily for various cancers and serious 

hematological disorders (e.g., leukemias, non-Hodgkin’s lymphoma, multiple 

myeloma and aplastic anemia), subtle general neurological effects detected via 

neurobehavioral tests, and other health effects (e.g., reactive airway dysfunction 

syndrome, and allergic contact dermatitis). 

Following review by a VA Task Force, VA determined that it was not necessary 

to establish new presumptions of service connection for any diseases based on the 

report findings. This was in part because the NAS Committee findings were generally limited to long-term, chronic occupational exposures that do not directly correlate to potential hazards of service or exposure scenarios for the 1991 Gulf War. 

Furthermore, individuals who were chronically exposed to relatively high levels of 

these environmental hazards as part of their military occupation, whether or not 

during service in that war, may qualify under existing VA service connection policies for benefits for diseases resulting from such exposures. It should be pointed out 

that VA’s decision to not establish any new presumptions does not alter existing 

claim procedures, nor does it prevent any veteran from establishing service connection for any disease that could be related to their service in the 1991 Gulf War. 

Rather, it merely means that each case must be decided on its facts and merits, as 

is currently the case for veterans from any era. 


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The 2004 NAS Sarin Update Report. In 2004, at the request of the Secretary 

of Veterans Affairs, a new NAS Committee completed a special update on long-term 

health effects from exposure to the nerve agent sarin. The initial 2000 NAS Committee report described above had concluded that available scientific evidence could 

not show an association between trace sarin exposure and subsequent long-term adverse health effects. In response, the Secretary of Veterans Affairs determined that 

there was not an adequate basis to support establishing presumptive service connection for any long-term health problems resulting from low-level sarin exposure. 

After the completion of the 2000 NAS Committee report, several new studies on 

sarin effects in laboratory animals were published that were not available to the 

NAS Committee when they conducted their initial review, and which some saw as 

requiring a new look by the NAS committee. The new NAS Committee reviewed 19 

epidemiological studies of sarin health effects published since the earlier 2000 report, including studies of U.S. and U.K. veterans of the 1991 Gulf War potentially 

exposed at Khamisiyah, Iraq in 1991, of civilians exposed during the Japan sarin 

terrorist attacks in 1994 and 1995, and all the studies used in the earlier 2000 NAS 

Committee report. They also reviewed over 100 animal studies. 

The August 2004 NAS Sarin Update came to the same conclusions as the earlier 

2000 report. In other words, and consistent with their earlier findings, the NAS 

Committee was not able to find a scientific basis to associate any disease with exposure to low levels of sarin, based upon their exhaustive review of the relevant scientific literature. 

The 2004 NAS Report. The third full NAS Committee report, ‘‘Gulf War & 

Health Volume 3: Fuels, Combustion Products, and Propellants,’’ contained nine 

positive findings on long-term health effects related to exposure to the reviewed 

agents. These included associations between exposure to combustion products (e.g., 

smog) and lung cancer, cancers of nasal cavity and nasopharynx, cancers of the oral 

cavity and oropharynx, laryngeal cancer, bladder cancer, low birth weight/intrauterine growth retardation and exposure during pregnancy, preterm birth and exposure during pregnancy, and incident asthma. They also reported an association between exposure to hydrazine rocket fuels and lung cancer. As with previous reports, 

an important point is that most of the agents considered were in common use 

throughout the civilian and military at the time of the 1991 Gulf War. 

The NAS Committee considered over 33,000 potentially relevant references, and 

focused on about 800 epidemiological studies on persistent health outcomes associated with exposure to oil-fire products, diesel-heater fumes, hydrogen sulfide (a specific combustion product), hydrazines and red fuming nitric acid (as rocket propellants), and gasoline and jet fuel. The Committee pointed out that fuels and related 

combustion products are common pollutants with an abundant scientific health literature available for their review. Combustion products included ambient air pollution ‘‘smog,’’ combustion products from motor vehicles, and fumes from stoves and 

heaters using a wide variety of fuels. Fuels included gasoline, kerosene, diesel and 

military fuels including JP–4, JP–5 and JP–8. Finally, to ensure a focus on information that would be the most relevant to veterans of the 1991 Gulf War, the Committee emphasized studies of long-term rather than short-term health effects. A VA 

Task Force reviewing the new NAS Committee report determined that new presumptive service connections were not warranted because none of the specific hazardous agents reviewed, or the exposure levels experienced by most Gulf War service members, were significantly different compared to U.S. civilians or to troops not 

deployed to the Gulf War. 

The 2006 NAS Report ‘‘Volume 4: Health Effects of Serving in the Gulf 

War:’’ The September 2006 fourth full NAS report reviewed peer-reviewed scientific 

literature on the health status of veterans of the 1991 Gulf War. The report was 

intended to inform VA about illnesses and clinical issues including possible relevant 

treatments, which might have been overlooked among this population, regardless of 

the specific underlying cause. It documented increased rates of certain illnesses 

among Gulf War veterans, based on a review of 850 epidemiological and other studies of this group, which they selected from among over 4,000 potentially relevant 

reports. They concluded that ‘‘VA and DoD have expended enormous effort and resources in attempts to address the numerous health issues related to the Gulf War 

veterans. The information obtained from those efforts, however, has not been sufficient to determine conclusively the origins, extent, and potential long-term implications of health problems potentially associated with veterans’ participation in the 

Gulf War.’’ 

The NAS Committee identified numerous serious limitations in existing epidemiological studies of Gulf War veterans, in large part due to the lack of veteran exposure data. However, they did ‘‘not recommend that more such studies be undertaken 

for the Gulf War veterans.’’ Rather, the Committee recommended ‘‘continued surVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00071 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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veillance to determine whether there is actually a higher risk in Gulf War veterans’’ 

for illnesses that current research has identified as possibly appearing at higher 

rates among Gulf War veterans, specifically, brain and testicular cancer, ALS, birth 

defects, and post-deployment psychiatric conditions. 

The NAS Committee also concluded, ‘‘Every study reviewed by this Committee 

found that veterans of the Gulf War report higher rates of nearly all symptoms examined than their nondeployed counterparts.’’ Not surprisingly, they reported that 

symptom-defined ‘‘unexplained illnesses,’’ consistent with Chronic Fatigue Syndrome, Fibromyalgia, Irritable Bowel Syndrome and Multiple Chemical Sensitivity, 

were the most common health problem reported in studies of Gulf War veterans. 

However, they concluded that ‘‘the results of that research indicate that although 

deployed veterans report more symptoms and more severe symptoms than their 

nondeployed counterparts, there is not a unique symptom complex (or syndrome) in 

deployed Gulf War veterans.’’ 

They also found that ‘‘Gulf War veterans consistently have been found to suffer 

from a variety of psychiatric conditions,’’ including PTSD, anxiety, depression and 

substance abuse. Similarly, they found that available studies have ‘‘not demonstrated differences in cognitive and motor measures’’ in deployed versus non-deployed veterans, and show no apparent increase in risk of peripheral neuropathy, 

cardiovascular disease or diabetes. Finally, they reported difficulties in interpreting 

data on birth defects, and found little data supporting objective respiratory illnesses 

among Gulf War veterans. A VA Task Force reviewing the new NAS Committee report determined that new presumptive service connections were not warranted because existing VA policies and procedures for disability compensation effectively 

cover veterans with these health problems. These include, for example, VA policies 

recognizing service connection for PTSD, and for service connection for difficult to 

diagnose or undiagnosed illnesses. 

The 2006 Report ‘‘Infectious Diseases.’’ The October 2006 fifth NAS report in 

this series, ‘‘Gulf War and Health Vol. 5: Infectious Diseases,’’ reviewed published, 

peer-reviewed scientific and medical literature on long-term health effects from infectious diseases associated with Southwest Asia, including those diseases relevant 

to the 1991 Gulf War and to Operations Iraqi Freedom and Enduring Freedom (OIF/ 

OEF). They identified over 20,000 potentially relevant scientific reports, and focused 

on 1,200 that had the necessary scientific quality. 

They focused on nine infectious diseases that were 1) prevalent in Southwest 

Asia, 2) diagnosed among U.S. or other troops serving there, and 3) known to cause 

long-term health problems. They also focused upon those infectious diseases that appeared to be of special concern to veterans who served in Southwest Asia. These 

were Brucella (causing brucellosis); Campylobacter; Salmonella and Shigella (causing diarrheal disease); Coxiella burnetii (causing Q fever); Leishmania (causing 

leishmaniasis); Mycobacterium tuberculosis (causing tuberculosis); Plasmodia (spp) 

(causing malaria) and West Nile Virus (causing West Nile fever). They selected 

these from among about 100 naturally occurring pathogens that potentially could 

have infected U.S. troops in the 1991 Gulf War, or in OIF/OEF. The NAS Committee identified 34 different long-term health effects in their report that might appear weeks to years after initial infection, associated with these nine infectious diseases. Most if not all identified long-term health effects are well-known to be associated with the initial acute infection. A VA Task Force is currently reviewing the 

new NAS Committee report to determine if new presumptive service connections are 

warranted. 

OTHER REVIEWS ON GULF WAR VETERANS’ HEALTH 

The IOM’s reputation for scientific rigor, independence from the political process, 

and freedom from bias has made it an influential source of information on the nature of Gulf War veterans’ health. In addition, since the end of the 1991 Gulf War, 

at least 13 other committees have been established, both in the United States and 

the United Kingdom, to help evaluate Gulf War veteran health issues. Other Committees (and date of publications) include: 

• Armed Forces Epidemiological Board (AFEB). U.S. Department of Defense, 

1996, 1999, 2000, 2000. 

• Goss Gilroy Inc. Canadian Epidemiological Study of Gulf War Veterans. 1998. 

• The Rt Hon The Lord Lloyd of Berwick. Independent Public Inquiry on Gulf 

War Illnesses. 2004. 

• U. S. Department of Veterans Affairs, Research Advisory Committee on Gulf 

War Veterans Illnesses, James Binns, Chair. Scientific Progress in Understanding Gulf War Veterans’ Illnesses: Report and Recommendations, 2004. 


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• U.S. Department of Defense Special Oversight Board for Department of Defense 

Investigations of Gulf War Chemical and Biological Incidents. Final Report, 

2000. • U.S. Department of Defense. Report of the Defense Science Board Task Force 

on Persian Gulf War Health Effects, 1994. • U.S. Department of Health & Human Services, National Institutes of Health 

Technology Assessment Workshop Panel. The Persian Gulf Experience and 

Health. 1994 U.S. government Accountability Office (GAO). Gulf War Illnesses: 

DoD’s Conclusions About U.S. Troops’ Exposure Cannot Be Adequately Supported. 2004 • U.S. Presidential Advisory Committee on Gulf War Veterans’ Illnesses: Interim 

Report. 1996 • U.S. Presidential Advisory Committee on Gulf War Veterans’ Illnesses: Final 

Report. 1996. • U.S. Presidential Advisory Committee on Gulf War Veterans’ Illnesses: Special 

Report, 1997. • United Kingdom Parliamentary Office of Science and Technology. Gulf War illnesses: Dealing with the Uncertainties. 1997. • U.S. Senate, Committee on Veterans’ Affairs, Report of the Special Investigation 

Unit on Gulf War illnesses. 1998. 

Collaboration with the VA Gulf War Veterans Research Advisory Committee. One of the most recent advisory groups on Gulf War veteran health 

issues has been the VA Research Advisory Committee (RAC) on Gulf War Veterans Illnesses, chaired by Mr. James Binns. VA has been pleased with recent efforts with the RAC to lay the groundwork for improved research on Gulf War veterans’ health. VA and the RAC have agreed to several important steps to improve 

the quality of VA’s Gulf War research portfolio. The RAC has recommended scientific experts to serve as research review panel members of a new scientific merit 

review board. In addition, VA consults with the RAC regarding the relevancy of proposals that have been identified as being fundable. VA and the RAC will also work 

together to identify researchers who can partner with VA investigators. 

VA RESEARCH ON GULF WAR VETERANS’ HEALTH 

VA’s Office of Research and Development (ORD) early on recognized that while 

there were few visible casualties associated with the 1991 Gulf War, many individuals returned from this conflict with unexplained medical symptoms and illnesses. 

To date, VA, DoD and the Department of Health and Human Services (HHS) have 

funded a total of 330 projects pertaining to the health consequences of military service in the Gulf War, as described in Annual Reports to Congress on federally Sponsored Research on Gulf War Veterans’ Illnesses. Although the causes and successful 

treatment of GWVI remain illusive VA’s ORD has committed to continued funding 

of relevant research in this area. 

In addition, the Institute of Medicine recently announced (in a report described 

in more detail later) that Gulf War and other combat veterans may be at increased 

risk for amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease) as 

a result of their service. Accordingly, VA’s ORD is supporting a research portfolio 

composed of studies dedicated to understanding chronic multi-symptom illnesses, 

long-term health effects of potentially hazardous substances to which Gulf War veterans may have been exposed to during deployment and conditions and/or symptoms 

that may be occurring with higher prevalence in Gulf War veterans, such as ALS, 

multiple sclerosis and brain cancer. 

While VA, DoD and HHS funds its Gulf War research independently, each closely 

coordinates its efforts with the others to avoid duplication of effort and to foster the 

highest standards of competition and scientific merit review for all research on illnesses in Gulf War veterans. The Research Subcommittee of the Deployment Health 

Work Group, which is a component of the VA/DoD Health Executive Council, currently conducts this coordination. HHS participates in both the Deployment Health 

Work Group and its Research Subcommittee. 

ALS RISK AMONG VETERANS 

ALS is a rare, progressive and nearly always fatal disease of the nervous system. 

About 5 to 10 percent of cases appear to be inherited but the cause of the remaining 

90 to 95 percent of cases is not known. Although certain environmental exposures 

have been considered as potential causes of ALS, none have been clearly tied to this 

disease. 

In December 2001, based on pre-publication announcements from two studies suggesting that Gulf War veterans were at greater risk for ALS, VA announced that 

it would explore options for compensating veterans who served in the Gulf War and 


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who subsequently develop amyotrophic lateral sclerosis (ALS). VA in 2001 implemented a policy of referring all Gulf War ALS claims to VA’s Central Office for special review. 

More recent scientific publications suggest that all veterans may be at greater 

risk of developing ALS. A 2005 study published in the journal Neurology (Weisskopf 

et al.) evaluated ALS risk among veterans from World War 2, and the Korean and 

Vietnam Wars, and reported as a group these veterans were at significantly greater 

risk for ALS compared to civilians. The two studies that supported VA’s ALS policy 

for Gulf War veterans were published in 2003, and also suggested that veterans 

from the 1991 Gulf War were at similarly greater risk for ALS (Horner et al., 

Haley). 

In response to the suggestion that all veterans might be at an increased risk of 

ALS, in May 2005, VA contracted with the NAS/IOM to evaluate the scientific basis 

of all relevant studies. In their November 10, 2006, report the IOM Committee concluded that although there are significant limitations to these studies, there is ‘‘limited and suggestive evidence of an association between military service and later development of ALS.’’ 

What the IOM Found. Following a thorough review of relevant scientific literature, the IOM Committee in their November 2006, report identified one ‘‘highquality cohort study that adequately controlled for confounding factors and reported 

a relationship between serving in the military and later developments of ALS’’ (the 

Weisskopf study). They also found ‘‘three related studies [that] supported the association’’ but which were of variable quality (which included the Gulf War veteran 

studies). 

They concluded, ‘‘On the basis of its evaluation of the literature, the Committee 

concludes that there is limited and suggestive evidence of an association between 

military service and later development of ALS.’’ This is the IOM’s weakest positive 

category of association for a health effect. However, the Committee concluded, 

‘‘[a]lthough the study has some limitations... overall it was a well-designed and well 

conducted study. It adequately controlled for confounding factors (age, cigarette use, 

alcohol consumption, education, self-reported exposure to pesticides and herbicides, 

and several main lifetime occupations).’’ 

A VA Task Force consisting of the Under Secretaries for Health and for Benefits, 

the OGC, and the DAS for Policy and Planning was established to review the new 

IOM report. 

VA Research on ALS. Although presently, there is no effective treatment for 

ALS, ORD currently supports a broad research portfolio dedicated to understanding 

the cause(s) and treatment for this devastating disease. Recent advances in neurological research may allow for the development of strategies to promote the restoration of nerve function. The development of novel strategies and technologies for the 

development and delivery of therapeutics for ALS patients remains an important 

goal in ALS research. ORD-funded projects are directed toward improving our understanding of the continuum of the development, progression, treatment and prevention of ALS.’’ 

Several VA investigators are conducting research on ALS as it relates to military 

service during the first Gulf War. This work includes identification of biological 

markers to identify cases of ALS, examination of the effects of pesticides and insecticides used during the Gulf War on the progression of ALS and examination of the 

prevalence of ALS in Gulf War veterans. One project is examining the overall and 

cause-specific mortality risk of ALS, multiple sclerosis (MS) or brain cancer in a 

group of more than 620,000 Gulf War veterans and assessing the demographic, military and in-theater exposure characteristics associated with the risk of deaths from 

these diseases. 

VA researchers are also studying new ways to selectively increase the ability of 

therapeutic agents to enter the brain and spinal cord without compromising the 

blood brain barrier. While this barrier protects the central nervous system from 

harmful agents, it also limits the ability of many therapeutic agents to enter the 

brain. 

VA investigators have ongoing research projects studying the use of stem cell 

transplants as a means to restore lost function following the loss of neurons associated with ALS, Alzheimer’s disease, Parkinson’s disease, spinal cord injury and 

stroke. Stem cells derived from neurons, as well as from hematopoietic (blood) cells, 

are being studied. It is hoped that these stem cells will mature into adult neurons 

and replace damaged neurons. In addition, VA investigators are examining gene 

therapy to deliver growth factors and other small molecules needed for regeneration 

and/or protection of the brain and spinal cord. 

VA investigators are also examining the use of a neuromotor prosthesis to enhance communication and increase independence for veterans suffering from ALS. 


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A neuromotor prosthesis is a brain-computer interface that uses an electrode that 

picks up brain signals and sends them to a computer for decoding. The brain signals 

are translated into commands to power electronic or robotic devices, or to communicate via word processing, e-mail or the Internet. VA researchers have already 

demonstrated the potential usefulness of this technology in an ALS patient and are 

developing multi-site studies designed to improve this technology and improve the 

lives of individuals suffering from this disease and their families. 

ORD also supports a national registry of veterans with ALS to identify, as completely as possible, all veterans with ALS and to collect data for studies examining 

the causes of ALS. The registry is designed to track the health status, collect DNA 

samples and clinical information and provide a mechanism for VA to inform veterans with ALS about research studies for which they may be eligible to participate. 

The registry will provide VA with a valuable mechanism for involving veterans in 

clinical trials and other studies that may yield improved outcomes for ALS. In addition, data gathered as part of the registry has the potential to benefit not only veterans, but also the larger community of individuals with ALS. 

Other exciting ALS projects supported by ORD include a 15-site clinical trial to 

determine the tolerability and efficacy of sodium phenylbutyrate (NaPB) as a new 

therapy for ALS, and a study examining a compound that has been shown to delay 

the onset of ALS symptoms in animal models of the disease. Finally, ORD supports 

a cooperative effort to collect and store high-quality biological specimens donated by 

veterans diagnosed with ALS for use in biomedical research. 

Anthrax Vaccine Research. ORD supports a study utilizing state of the art 

technology to investigate and characterize the response of human cells to anthrax 

vaccination and other agents. This study represents a novel approach to identifying 

underlying mechanisms operating in specific cell populations which are influenced 

in response to exposure to anthrax vaccination. It is hoped that this study will disclose biological processes that may improve our understanding of the illnesses affecting Gulf War veterans. 

LESSONS LEARNED 

VA developed a wide range of health care and research programs to benefit veterans of the 1991 Gulf War. Lessons learned from this process have provided significant benefits to new combat veterans returning today from Southwest Asia. Both 

groups of combat veterans—those who served in the 1991 Gulf War and those who 

are serving in OEF and OIF, remain a high priority for VA. This issue of a possible 

increased risk for being diagnosed with ALS for all service members remains a large 

concern for VA. In response, VA has initiated new research on this possibility, and 

is considering how to respond to findings of the recent IOM report on this issue. 

Attachment: 19 Studies on Gulf War Veterans’ Health Issues by the National Academy of Sciences Institute of Medicine (IOM) (available on 

line at www.nap.edu). 

Congressionally Mandated ‘‘Gulf War & Health’’ Studies 

(by Public Laws 105–277 and 105–368)

‘‘Gulf War and Health: Volume 1. Depleted Uranium, Pyridostigmine Bromide, Sarin, and Vaccines.’’ 2000 ‘‘Gulf War and Health: 

Volume 3. Fuels, Combustion 

Products, and Propellants.’’ 

2005 

‘‘Gulf War and Health: Volume 2. Insecticides and 

Solvents.’’ 2003 

‘‘Gulf War and HealthVol. 4: 

Health Effects of Serving in 

the Gulf War.’’ 2006 

‘‘Gulf War and Health: Updated Literature Review of Sarin.’’ 2004 ‘‘Gulf War and Health Vol. 5: 

Infectious Diseases.’’ 2006 


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Other Gulf War Veteran’s Health Studies—Clinical and Policy 

Evaluations—continued

‘‘Gulf War Veterans: Treating Symptoms and 

Syndromes.’’ 2001 

‘‘An Assessment of the Safety 

of the Anthrax Vaccine: A 

Letter Report.’’ 2000 

‘‘Protecting Those Who Serve: Strategies to Protect the Health of Deployed U.S. Forces.’’ 2000 ‘‘Strategies to Protect the 

Health of Deployed U.S. 

Forces: Detecting, 

Characterizing, and 

Documenting Exposures.’’ 

2000 

‘‘Measuring the Health of Persian Gulf Veterans: 

Workshop Summary.’’ 1998 

‘‘Gulf War Veterans: 

Measuring Health.’’ 1999 

‘‘Strategies to Protect the Health of Deployed U.S. 

Forces: Medical Surveillance, Record Keeping, 

and Risk Reduction.’’ 1999 

‘‘National Center for Military 

Deployment Health 

Research.’’ 1999 

‘‘Adequacy of the VA Persian Gulf Registry and 

Uniform Case Assessment Protocol.’’ 1998 

‘‘Adequacy of the 

Comprehensive Clinical 

Evaluation Program: A 

Focused Assessment.’’ 1997 

‘‘Adequacy of the Comprehensive Clinical Evaluation Program: Nerve Agents.’’ 1997 ‘‘Health Consequences of 

Service During the Persian 

Gulf War: Recommendations 

for Research and Information 

Systems.’’ 1996 

‘‘Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action.’’ 1995 

f 

Statement of Shannon L. Middleton, Deputy Director, 

Veterans Affairs and Rehabilitation Commission, American Legion 

Mr. Chairman and Members of the Subcommittee: 

The American Legion appreciates the opportunity to offer our views on this very 

important issue. American military forces are currently engaged in combat operations in Iraq and Afghanistan and it is easy to forget that there are still thousands 

of veterans from the 1991 Gulf War still suffering from unexplained multi-symptom 

illnesses related to their service in Southwest Asia. We applaud this Subcommittee 

for not forgetting these veterans and holding this hearing. 

History of Undiagnosed Illness Compensation 

Shortly after the end of the 1991 Gulf War, thousands of Gulf War veterans began 

complaining of unexplained multi-symptom illnesses (headaches, fatigue, muscle 

pain, joint pain, gastrointestinal problems, neurological signs and symptoms, etc.). 

In most cases, doctors were not able to provide definitive diagnoses. As a result, 

compensation claims filed with the Department of Veterans Affairs (VA) were being 

denied outright since VA was prohibited by law from ‘‘service-connecting’’ conditions 

that could not be diagnosed. As result of strong lobbying efforts by the veteran service organization community and others to correct this problem, Public Law 103–446 

(38 USC § 1117) was enacted in 1994, authorizing VA to pay compensation to disabled Gulf War veterans suffering from undiagnosed illnesses. The undiagnosed illness must have become manifest either while the veteran was in the Southwest 

Asia theater of operations or prior to January 1, 2012, if symptoms first developed 

after the veteran left Southwest Asia. Although PL 103–446 was clearly intended 

to compensate ill Gulf War veterans suffering from undiagnosed or medically unexplained conditions, vague wording in the final version of the law allowed VA to publish restrictive implementing regulations, resulting in a very high denial rate under 


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the new law. Conditions such as fibromyalgia, irritable bowel syndrome, and chronic 

fatigue syndrome, although medically unexplained, were considered to be ‘‘diagnosed’’ conditions and were being denied under the new undiagnosed illness law. 

The VSO community again turned to Congress for help. The result was Public 

Law 107–103, signed into law on December 27, 2001. Effective March 1, 2002, provisions of this law clarified and further expanded the definition of undiagnosed illness 

under the law to include medically unexplained chronic multi-symptom illness, such 

as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, that is defined by a cluster of signs or symptoms. Signs or symptoms that may be a manifestation of an undiagnosed or chronic multi-symptom illness include the following: 

fatigue, unexplained rashes or other dermatological signs or symptoms, muscle pain, 

joint pain, neurological signs or symptoms, signs or symptoms involving the upper 

or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, 

cardiovascular signs or symptoms, abnormal weight loss, or menstrual disorders. A 

disability is considered chronic if it has existed for at least 6 months. 

Despite the enactment of PL 107–103, clarifying and expanding the definition of 

undiagnosed illness, the denial rate for these claims remains very high (approximately 75 percent). The restrictive nature of VA’s final rule, published in the Federal Register on June 10, 2003, implementing the Gulf War provisions of PL 107– 

103 has reinforced this pattern. As of May 2007, less than four thousand such 

claims, out of almost 15,000 that have been processed, have been granted service 

connection. 

The American Legion urges the House Veterans’ Affairs Committee to conduct 

oversight of the Gulf War-related provisions of PL 107–103. 

Compensation for Amyotrophic Lateral Sclerosis (ALS) 

Preliminary findings of a joint Department of Veterans Affairs (VA) and Department of Defense (DoD) study, released in December 2001, of nearly 2.5 million veterans indicated that deployed Gulf War veterans (August 2, 1990 to July 31, 1991) 

are twice as likely as their non-deployed counterparts to develop ALS. The Secretary 

of Veterans Affairs immediately announced that he would explore VA’s options for 

compensating Gulf War veterans who have been diagnosed with ALS. VA subsequently directed all VA regional offices to submit all Gulf War ALS cases to VA Central Office for expeditious adjudication. VA service-connected all Gulf War veterans 

(with service in Southwest Asia during the period of August 2, 1990 to July 31, 

1991) identified with ALS at that time (approximately 40) on a direct basis, using 

the preliminary research findings as evidence to link ALS to the veterans Gulf War 

service. 

Despite the Secretary’s announcement and subsequent action, VA did not have 

plans to draft a regulation establishing an ALS presumption under current law 

guaranteeing compensation for Gulf War veterans who develop ALS in the future. 

The joint VA and DoD study was published in the scientific journal ‘‘Neurology’’ in 

September 2003, resulting in the Secretary publicly announcing that this ‘‘final 

study’’ supports his 2001 decision to compensate Gulf War veterans stricken with 

ALS. Despite this public announcement and the Secretary’s initial decision to expeditiously service-connect, on a direct basis, Gulf War veterans diagnosed with ALS, 

VA informed The American Legion that it would be ‘‘premature’’ to create a regulatory presumption of service connection for Gulf War veterans with ALS. Bottomline, although VA expeditiously service-connected a small number of veterans diagnosed with ALS, it has not established ALS as an official Gulf War presumptive disability and it has no plans to do so at this time based on its responses to specific 

American Legion inquiries. Without an actual presumption in place, there is nothing 

to ensure that Gulf War veterans diagnosed with ALS in the future will receive the 

same treatment as those discussed above. Due to the media coverage of VA’s actions 

to expeditiously service-connect Gulf War veterans with ALS in December 2001, 

many people are under the erroneous belief that ALS is a Gulf War presumptive 

disability. 

Additional studies have shown that military veterans in general have a greater 

likelihood than non-veterans of developing ALS. A study published in 2005 in the 

journal ‘‘Neurology’’ titled ‘‘Prospective study of military service and mortality from 

ALS,’’ [M.G. Weisskopf et al., 2005; 64:32–37] evaluated ALS risk for veterans from 

World War 2, and the Korean and Vietnam Wars. This study concluded that these 

veterans were at significantly higher risk for ALS compared to civilians. In November 2006, the Institute of Medicine (IOM) released a report concluding ‘‘there is limited and suggestive evidence of an association between military service and later development of ALS.’’ We understand that VA has finished its evaluation of the November 2006 IOM report in order to determine if any changes in VA health care 

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search is needed and a presumption is not warranted at this time. Although IOM 

also noted that additional research is needed regarding a link between military 

service and ALS, we submit that IOM’s finding of ‘‘limited and suggestive’’ evidence 

between ALS and military service is sufficient, under current law, for VA to move 

forward and establish official ALS service connection presumptions. Even though 

veterans can, in theory, establish service connection without a specific military presumption, it is extremely difficult in most cases for the veteran to meet the burden 

of proof required by VA for establishing direct service connection and many veterans 

will be precluded from establishing entitlement to service connection for ALS without an actual presumption. 

Gulf War Presumptive Disabilities 

Research is inextricably intertwined with an ill Gulf War veteran’s ability to receive VA compensation for specific conditions he/she believes are related to his/her 

Gulf War service. 38 USC § 1118 (PL 105–277), allows the Secretary of Veterans Affairs to establish presumptions of service connection for specific diagnosed conditions/diseases when scientific research supports a positive association with a known 

Gulf War exposure (vaccines, nerve agents, depleted uranium (DU), oil well smoke, 

etc.). The Secretary relies primarily on the IOM literature reviews and subsequent 

reports (Gulf War and Health) to determine whether a positive association exists to 

justify the establishment of a presumption. IOM?s reports to date (Volume 1: Depleted Uranium, Pyridostigmine Bromide, Sarin, Vaccines; Volume 2: Insecticides 

and Solvents; Volume 3: Fuels, Combustion Products, and Propellants; Volume 4: 

Health Effects of Serving in the Gulf War;Volume 5: Infectious Disease), and an August 2004 updated literature review of sarin have not provided the scientific evidence necessary for VA to establish presumptive disabilities for any of the exposures 

looked at by IOM so far. As a result, not one presumptive disability has been established to date under this law. 

Congress directed IOM’s reports to be based on findings from the full range of 

human and animal studies that provide information on the effects of Gulf War-related exposures, as well as both diagnosed and undiagnosed illnesses affecting Gulf 

War veterans. IOM’s ‘‘Gulf War and Health’’ series of reports, as commissioned by 

VA, have not adhered to requirements set forth by Congress in mandating the reports. As a result, they have not comprehensively addressed key questions regarding 

Gulf War-related health conditions in relation to Gulf War exposures. IOM’s reports 

to date have not considered findings from epidemiologic studies of Gulf War veterans (i.e. association of Gulf War veterans’ illnesses with exposures), nor have they 

considered animal studies in drawing its conclusions. A perfect example of this is 

the August 2004 updated literature review of sarin. The Secretary of VA commissioned this review because studies published subsequent to IOM’s September 2000 

report (Volume 1), that addressed sarin, showed that exposure to sarin even at levels too low to cause immediate/acute effects can still have long-term adverse health 

effects (brain damage). Even though these studies were the reason the Secretary 

wanted IOM to look at sarin again, IOM did not even consider this research when 

drawing its conclusions because they were animal-based studies. 

Research 

In the Research Advisory Committee on Gulf War Veterans’ Illness (RACGWI) initial report released in November 2004, it was found that, for a large majority of ill 

Gulf War veterans, their illnesses could not be explained by stress or psychiatric 

illness and concluded that current scientific evidence supports a probable link between neurotoxin exposure and subsequent development of Gulf War veterans’ illnesses. Earlier government panels concluded that deployment-related stress, not the 

numerous environmental and other exposures troops were exposed to during the 

war, was likely responsible for the numerous unexplained symptoms reported by 

thousands of Gulf War veterans. 

Gulf War research is moving away from the previous stress theories and is actually starting to narrow down possible causes. However, research regarding viable 

treatment options is still lacking. The American Legion applauds Congress for having the foresight to provide funding to the Southwestern Medical Center’s Gulf War 

Illness research program. The Center, headed by Dr. Robert Haley at the University 

of Texas Southwestern, was awarded $15 million, renewable for 5 years, to further 

the scientific knowledge on Gulf War Veterans Illnesses research. This research will 

not only impact veterans of the 1991 Gulf War, but may prove beneficial for those 

currently serving in the Southwest Asia Theater and the Middle East during the 

Global War on Terror. The purpose of the research is to fill in the gaps of knowledge 

where there is little, yet suggestive, information. Dr. Haley’s research will further 

this knowledge about Gulf War veterans’ illnesses and hopefully help improve the 


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lives of ill Gulf War veterans, and their families who suffer beside them. We owe 

ill Gulf War veterans our exhaustive efforts in finding treatments for their ailments. 

The American Legion believes that VA should continue to fund research projects 

consistent with the recommendations of the Research Advisory Committee on Gulf 

War Veterans’ Illness (RACGWI). It is important that VA continues to focus its research on finding medical treatments that will alleviate veterans’ suffering as well 

as on figuring out the causes of that suffering. The American Legion also recommends that the Subcommittee thoroughly review the RACGWI’s second report, 

which will be released this fall. 

Health Care 

Public Law 103–210, which authorized the Secretary of Veterans Affairs to provide priority health care to the veterans of the Persian Gulf War who have been 

exposed to toxic substances and environmental hazards, allowed Gulf War Veterans 

to enroll into Priority Group 6. The last sunset date for this authority was December 

31, 2002. Since this date, information provided to veterans and VA hospitals has 

been conflicting. Some hospitals continue to honor Priority Group 6 enrollment for 

ill Gulf War veterans seeking care for their ailments. Other hospitals, well aware 

of the sunset date, deny Priority Group 6 enrollment for these veterans and notify 

them that they qualify for Priority Group 8. To the veterans’ dismay, they are completely denied enrollment because the VA has restricted enrollment for Priority 

Group 8 since January of 2003. Even more confounding is the fact that eligibility 

information disseminated via Internet and printed materials does not consistently 

reflect this change in enrollment eligibility for Priority Group 6. The American Legion has been assured by VA that this issue will be rectified. 

The American Legion believes priority health care should be again extended to 

Gulf War veterans seeking treatment for ailments related to environmental exposures in theater. Although these veterans can file claims for these ailments and possibly gain access to the health care system once a disability percentage rate is 

granted, those whose claims are denied cannot enroll. According to the May 2007 

version of VA’s Gulf War Veterans Information System (GWVIS), there were 14,874 

claims processed for undiagnosed illnesses. Of those undiagnosed illness claims 

processed, 11,136 claims were denied. Because the nature of these illnesses are difficult to understand and information about individual exposures may not be available, many ill veterans are not able to present strong claims. They are then forced 

to seek care from private physicians who may not have enough information about 

Gulf War veterans’ illnesses to provide appropriate care. 

Since VA doctors would be more knowledgeable about the exposures Gulf War veterans experienced in theater, it is important that VA keeps Gulf War Continuing 

Medical Education (CME) updated to reflect current science. It is equally important 

that, once updated, VA makes Gulf War CMEs a requirement, not an option, to better serve this population of ill veterans. Although reputable research Committees 

have shown that Gulf War veterans are sicker than those who did not deploy to the 

Southwest Asia theater, The American Legion is still contacted by veterans complaining that some VA doctors do not know how to treat their Gulf War illnesses. 

In fact, some ill Gulf War veterans are still being told that their illnesses are all 

in their heads. 

Outreach 

It is The American Legion’s understanding that VA has stopped mailing out printed copies of the Gulf War Review and is now only posting it online. We are concerned, not only because not all Gulf War veterans have Internet access, but the 

VA’s Gulf War veterans page is difficult to locate from VA’s main web page. Only 

those who know where it is located, or that it even exists, will have access to the 

information. The American Legion has had several calls from those who inquired 

about the printed newsletter, as well as those who were interested but had no Internet access. We urge VA to resume mailing out printed versions of the Gulf War Review in addition to posting it on the web. 

Again, thank you Mr. Chairman for giving The American Legion this opportunity 

to present its views on such an important issue. We look forward to working with 

the Subcommittee to address this and other issues affecting veterans. 

f 


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Statement of Hon. Corrine Brown, 

a Representative in Congress from the State of Florida 

Thank you, Mr. Chairman for calling this hearing today. 

Gulf War Illnesses have bedeviled the doctors of the Department of Defense and 

the Veterans Administration. 

About 670,000 troops from the United States served in this conflict. They served 

from just after the invasion of Kuwait on August 2, 1990 until June 13, 1991. 

While the troops have long been returned home from this conflict, their suffering 

continues, 16 years later. For years, the VA and DoD rejected the complaints of the 

veterans that they were sick and were told they were imagining things. 

Well, they were not imagining things and the experience of war affects everyone 

differently. We are learning that from the current wars in Iraq and Afghanistan. 

What have we learned from the Persian Gulf War? 

Are we taking these lessons and protecting the soldiers in Iraq and Afghanistan? 

I know the Department of Defense is collecting data from soldiers. Is it the right 

data? 

Is the VA and DoD cooperating in the discussion of symptoms and illnesses soldiers are coming home with? Are they sharing the data. 

Do we have numbers of veterans complaining of unknown illnesses? We have a 

pretty good idea of those suffering from TBI or PTSD. What about what we don’t 

know? 

I look forward to hearing the testimony today. 

f 

Statement of Dan Fahey, San Francisco, CA (Ph.D., Candidate, University 

of California-Berkley) 

Dear Chairman Filner and Honorable Members of the House Veterans Affairs 

Committee: 

I respectfully submit to you this written testimony on the occasion of your hearing 

on Gulf War veterans’ illnesses to call your attention to serious problems with the 

Department of Veterans Affairs (DVA) study of Gulf War veterans exposed to depleted uranium (DU). Since 1993, I have interviewed hundreds of veterans about 

battlefield exposures to dust and debris from armor-piercing DU ammunition and 

presented my research findings to numerous Federal investigations of Gulf War veterans’ illnesses. I am including with this testimony a copy of my most recent presentation at the 28 June 2007 meeting of the Institute of Medicine (IOM) Committee 

that is reviewing scientific and medical literature on the health effects of DU exposure. My IOM presentation provides more detailed information in support of this 

statement. 

The Department of Veterans Affairs study of DU is neither structured nor functioning to provide basic information about the possible health effects of DU exposure 

among Gulf War veterans. There are two major flaws with the study that undermine its integrity and value. First, the DVA study is undersized. From its inception 

in 1993, the study included only a tiny fraction of the number of veterans with 

known or suspected exposures to DU. Consequently, we have no information about 

the possible health effects among the thousands of Gulf War veterans exposed to 

DU in friendly fire incidents; during the recovery, transport, and inspection of contaminated equipment; and as a result of the July 1991 munitions fire at Doha, Kuwait. 

Second, the DVA study has become politicized. In recent years, officials from both 

the Department of Defense (DoD) and DVA have repeatedly presented false and incomplete information about the existence of cancers and tumors among the few 

dozen veterans being studied. The deceitful statements and omissions by DoD and 

DVA officials undermine the integrity of the study and call to question its purpose. 

The DVA study of veterans exposed to DU is located at the Baltimore VA Medical 

Center and directed by Dr. Melissa McDiarmid. When DVA created the study in 

1993, only 33 Gulf War veterans were enrolled. These individuals had been heavily 

exposed to DU as a result of being inside vehicles hit by DU rounds in friendly fire 

incidents; some had been wounded by DU fragments while others inhaled DU dust. 

A 1993 DVA report on the creation of the study noted: ‘‘The small size of the population—[makes it] highly unlikely that definitive conclusions concerning cancer induction will be obtained from the study.’’ By 2000, however, DoD belatedly admitted 

that ‘‘thousands’’ of Gulf War veterans may have been exposed to DU during and 

after the Gulf War, including approximately 900 veterans who are believed to have 


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had heavy exposures to DU during friendly fire incidents, vehicle recovery operations, and the Doha, Kuwait munitions fire. Despite this admission, since 2001 the 

DVA study has examined only 46 individual Gulf War veterans. Since numerous 

laboratory studies have demonstrated that DU may cause cancers, tumors, neurological problems, and other effects, it is imperative to expand and improve the DVA 

study in order to clarify the association between exposure to DU and cancer induction or other illnesses among Gulf War veterans. 

In addition to studying only a few dozen veterans, the DVA study director has 

not honestly and completely presented study findings either publicly or in the medical literature. This fact first emerged in 2001, when DoD and DVA officials responded to European concerns that the use of DU munitions by U.S. jets during the 

Kosovo conflict had affected the health of NATO troops and civilians. At the height 

of the European controversy in January 2001, DVA study director Dr. Melissa 

McDiarmid wrote in the British Medical Journal that no veterans in her study had 

developed ‘‘leukemia, bone cancer or lung cancer,’’ yet she inexplicably failed to mention that in 1999 one veteran in the study had Hodgkin’s lymphoma and a second 

veteran had a bone tumor. Moreover, a 2006 journal article co-authored by Dr. 

McDiarmid supposedly summarized all study findings for the period 1993 to 2005, 

yet this article notably failed to mention the findings of the Hodgkin’s lymphoma 

and bone tumor among the few dozen study participants. During her 28 June 2007 

presentation to the IOM committee assessing the possible link between exposure to 

DU and health effects among veterans, Dr. McDiarmid again neglected to mention 

the findings of the Hodgkin’s lymphoma and bone tumor. 

These deceitful statements and omissions suggest that the DVA study is less a 

scientific study than a political tool used to downplay public concerns about DU and 

to mislead investigations of the connection between DU and health effects—such as 

the current IOM investigation—that could lead to an extension of service-connected 

benefits to Gulf War veterans for cancers or other illnesses. 

I respectfully make the following recommendations to the House Veterans Affairs 

Committee: 

• Initiate a U.S. Government Accountability Office investigation to clarify the 

purpose and findings of the DVA study, and to recommend how the study could 

be restructured to better serve the interests of both veterans and scientific inquiries into the health effects of exposure to depleted uranium; and 

• Summon DVA study director Dr. Melissa McDiarmid to appear before the Committee to testify under oath about the number and type of cancers and tumors 

among study participants, and to explain why she has not honestly and thoroughly reported findings of cancers and tumors in the medical literature or to 

the IOM. 

What is clearly needed at this point—16 years after Operation Desert Storm—is 

a study of all veterans with known or suspected DU exposures to determine rates 

of cancers, tumors, neurological problems, and other health effects potentially related to DU exposure; furthermore, there is an urgent need for a new study director 

who will accurately report study findings. I thank Chairman Filner for his sustained 

interest and action to investigate Gulf War veterans’ illnesses and stand ready to 

assist the House Veterans Affairs Committee in its future work on this subject. 

ADDENDUM TO 

‘‘DEPLETED URANIUM AND VETERANS HEALTH: 

A FLAWED TESTING PROCESS AND AN UNDERSIZED, POLITICIZED 

STUDY LIMIT EVALUATION OF EXPOSURES AND EFFECTS’’ 

Dan Fahey 

Institute of Medicine 

Washington, DC 

28 June 2007 

The following tables and narrative contain additional information about recommended limits on intake, exposure estimates, tumor formation, and Hodgkin’s 

lymphoma. This information supplements my Power Point presentation to the Institute of Medicine, and is excerpted from: 

Fahey, D. In press. ‘‘Depleted Uranium and Its Use in Munitions,’’ and ‘‘Environmental and Health Consequences of Depleted Uranium Munitions,’’ in Avril McDonVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00081 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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ald (ed.) The International Legal Regulation of the Use of Depleted Uranium Weapons: A Cautionary Approach. Den Haag: Asser Press. 

Table 1. Recommended limits on intake 

United States Others 

Members of the Public 0.05 mg/15 minutes 1 0.035 mg/day 3

0.5 mg/day 2 4.5 mg/year 4

Occupational Workers 0.18 mg/15 minutes 5 0.18 mg/15 minutes 9

2 mg/day 6 2mg/day 10

10mg/week 7 130mg/year 11

480mg/year 8

Table compiled by Dan Fahey 

The recommended limits on intake provide a basis from which to assess the significance of theoretical exposure estimates in a range of battlefield scenarios (Table 

2). The Royal Society has generated a series of estimates intended to be generic for 

soldiers and civilians in conflicts where DU munitions are used.12 In 1999, the U.S. 

Army Center for Health Promotion and Preventive Medicine developed a set of exposure estimates that were subsequently criticized as ‘‘incomplete and misleading’’ by 

the Presidential Special Oversight Board on Gulf War Veterans’ Illnesses.13 Consequently, the Army undertook a series of live-fire tests of DU rounds, known as 

the Capstone Project, and released revised estimates in 2004 (figures listed below 

are the Capstone estimates).14 In 2005, Sandia national Laboratories (U.S.) published a study that included exposure estimates. The Royal Society, U.S. Army, and 

Sandia estimates are similar in some cases; in others they vary by orders of magnitude. 


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Table 2. Estimated intakes in exposure scenarios, durations of exposure 

Royal Society ‘‘Central’’ Estimate 15

(Time) 

Royal Society 

‘‘Worst-Case’’ Estimate 16 (Time) 

U.S. Army ‘‘Most 

Likely’’ Estimate 17

(Time) 

U.S. Army ‘‘Upper 

Bound’’ Estimate 18

(Time) 

Sandia ‘‘Nominal 

Exposure’’ 19 (No duration specified) 

Sandia ‘‘Maximum 

Exposure’’ 20 (No duration specified) 

Soldiers in an armored vehicle penetrated by a DU round 250 mg (1 minute) 5000 mg (1 hour) 10–280 mg (1 minute) 43–710 

mg (5 minutes) 

91–970 mg (1 hour) 110–1000 mg (2 hours) 

250 mg inhalation 330 mg fragments 15 mg ingestion 

4000 mg inhalation 1800 mg fragments 500 mg ingestion 

Soldiers who enter vehicles to rescue occupants immediately after a DU impact 250 mg (1 minute) 5000 mg (1 hour) 27–200 mg (10 minutes) No estimate 250 mg inhalation 15 mg ingestion 4000 mg inhalation 500 mg ingestion People who work in and around DU-impacted equipment 1 mg inhalation 0.5 mg ingestion 

(1 hour) 

200 mg inhalation 50 mg ingestion (10 hours) 

0.45 mg inhalation 10.6 mg Ingestion (1 hour) 

14.5 mg inhalation 10.6 mg ingestion (1 hour) 

40 mg inhalation 30 mg ingestion 

600 mg inhalation 300 mg ingestion 

Child at play No estimate No estimate No estimate No estimate 54 mg inhalation 

3000 mg ingestion 

226 mg inhalation 9000 mg ingestion 

People downwind of DU-impacts 0.07 inhalation 

(passage of plume) 

4.9 mg inhalation (passage of plume) 

0.00006 mg inhalation (passage of plume) 

0.04 mg inhalation (passage of plume) 

0.003 mg inhalation 

0.1 mg inhalation 

Inhalation of resuspended DU from soil 0.8 mg 21 (27 

days) 

80 mg 22 (27 

days) 

No estimate No estimate 0.001 mg 

inhalation 

0.003 mg inhalation 

Table compiled by Dan Fahey 


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5.1 Cancer 

Laboratory studies have clearly demonstrated that DU is carcinogenic, but the 

link between DU and cancer in humans remains uncertain. Some of the uncertainties are related to the long latency period for development of cancers related to DU 

and the fact that few exposed humans have been studied. While the use of DU munitions appears unlikely to cause widespread cancers, sufficient evidence exists to 

support concerns that exposure to DU may lead to an elevated risk of cancer in 

heavily exposed populations. 

5.1.1 Laboratory studies 

***** 

[TUMOR FORMATION] 

Research conducted by the U.S. Armed Forces Radiobiology Research Institute 

(AFRRI) found that DU transformed human cells to a pre-cancerous phase; these 

cells then produced tumors when they were injected into mice.23 The transformed 

cells also induced genetic instability and reduced production of a key tumor-suppressor protein.24

Other AFRRI studies found that DU causes DNA damage that might initiate and 

promote the formation of tumors.25 The damage to DNA appears to be caused by 

both alpha radiation and chemical effects,26 with delayed chromosomal damage observed in cells not directly irradiated by DU (the so-called ‘‘bystander effect’’).27

‘‘Considering that conventional understanding of potential DU health effects assumes that chemical effects are of greatest concern, results demonstrating that both 

radiation and chemical effects are involved in DU-induced cellular damage could 

have a significant impact on DU risk assessments.’’ 28

***** 

5.1.3.1 Hodgkin’s Lymphoma 

The one cancer that has repeatedly shown up in surveys of veterans is Hodgkin’s 

lymphoma (also known as Hodgkin’s disease). Hodgkin’s lymphoma develops in the 

lymph nodes, and it is a rare form of cancer (2.58 cases per 100,000 people in more 

developed countries; 0.94 cases per 100,000 in less developed countries 29) with no 

known risk factor.30 According to the Institute of Medicine: 

‘‘The lymphatic system is an important potential target for uranium radiation because inhaled insoluble uranium oxides can remain up to several years in the hilar 

lymph nodes of the lung. Studying the effect of uranium exposure on lymphatic cancer is more difficult than studying lung cancer because lymphatic cancer is much 

less common.’’ 31

In general, Hodgkin’s lymphoma occurs more often among men and in people aged 

15–34 and over 55. 

In the United States, one out of 50 veterans examined in 1999 by the Department 

of Veterans Affairs’’ DU Program had Hodgkin’s lymphoma.32 It is worth noting 

that although this cancer was first reported in 1999 and discussed during an October 1999 meeting between the doctor in charge of the study and several Pentagon 

officials, in January 2001 a Pentagon official publicly denied the existence of this 

or any cancer among U.S. veterans in the DU study.33

In August 2002, the UK Ministry of Defence released a study showing that deaths 

due to lymphatic cancers were nearly twice as high among Gulf War veterans compared to a control group.34 There is no publicly available information about the 

number of cases of Hodgkin’s lymphoma versus the more-common Non-Hodgkin’s 

lymphoma, but of the 3,172 Gulf veterans seen at the UK Gulf Veterans’’ Medical 

Assessment Programme as of 31 January 2003, 11 cases of lymphoma (including 

Hodgkin’s and Non-Hodgkin’s) had been reported.35 The Ministry of Defence denies 

a link between these cancers and DU, but has initiated an additional study to clarify this finding. 

Among Italian soldiers who served in Bosnia and/or Kosovo, ‘‘there is a disproportionately high number, which is statistically significant, of cases of Hodgkin’s 

Lymphoma.’’ 36 Although the Italian Defense Ministry could not identify the causes 

of this increase, it stated: ‘‘The results of sample studies carried out on Italian soldiers on duty in Bosnia and Kosovo have not shown evidence of depleted uranium 

contamination.’’ 37 Overall, the Defense Ministry found a smaller-than-expected 

number of cancer cases among these soldiers.38

Endnotes 

1This limit is for inhalation of insoluble uranium based on a short-term exposure limit of 0.15 

mg/m3 based on a breathing rate of 9.6 m3 per 8-hour working day. U.S. National Institute for 


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Occupational Safety and Health (NIOSH), ‘‘Pocket Guide to Chemical Hazards,’’ 1994; see also 

United Nations Environment Programme, ‘‘Depleted Uranium in Bosnia and Herzegovina.’’ (Geneva: UNEP, 25 March 2003) p. 261. 2This limit is for inhalation of insoluble uranium based on chronic exposure limit of 0.05 mg/ 

m3 based on a breathing rate of 9.6 m3 per 8-hour working day. NIOSH supra n. 107; see also 

United Nations Environment Programme, ‘‘Depleted Uranium in Bosnia and Herzegovina.’’ (Geneva: UNEP, 25 March 2003) p. 261. Another reference states that the limit for inhalation of 

DU for members of the public equates to breathing a mass of 0.2 mg/day; R.L. Fliszar, ‘‘Radiological Contamination from Impacted Abrams Heavy Armor,’’ Technical Report BRL–TR–3068 

(Aberdeen Proving Ground, MD, Ballistic Research Laboratory December 1989) p. 18. 3The International Commission on Radiological Protection and the World Health Organization 

prescribe slightly different limits on intake by inhalation for members of the public, based partly 

on differences in limits based on chemical toxicity and radiation dose. To resolve this discrepancy, a recommendation has been made ‘‘that a unified . . . daily intake of 35 [micrograms] 

would be acceptable in most cases. This value would satisfy the constraints imposed by radiation 

dose and chemical toxicity. However, for protracted exposure to highly insoluble uranium compounds, a further threefold reduction may be considered appropriate.’’ N. Stradling et al, ‘‘Anomalies between radiological and chemical limits for uranium after inhalation by workers and the 

public,’’ 105 Radiation Protection Dosimetry (2003) 178. 4This refers to an inhalation of type S (insoluble) natural uranium and is based on a 1 micron 

activity mean aerodynamic diameter (AMAD). As noted above (see supra n. 8), the majority of 

DU particles created by an impact are insoluble. The limit for intake by inhalation of type M 

(moderately soluble) natural uranium is 13 mg/year; for type F (soluble) it is 75 mg/year. N. 

Stradling et al, ‘‘Anomalies between radiological and chemical limits for uranium after inhalation by workers and the public,’’ 105 Radiation Protection Dosimetry (2003) p. 176. Another reference states ‘‘The Annual Limit of Intake for uranium-238, for a member of the public, as specified by the International Committee for Radiological Protection, equates to breathing in a mass 

of approximately 8 mg of Depleted Uranium.’’ The Lord Gilbert, UK Ministry of Defense, letter 

to The Countess of Mar, 2 March 1998 (in author’s files). 5For brief exposures, the American Conference of governmental Industrial Hygienists 

(ACGIH) set a short-term exposure limit (STEL) of 0.6 mg/m3 over a 15-minute period. At a 

breathing rate of 9.6 m3 per 8-hour working day, this equates to a recommended short-term 

limit on inhalation intake of 0.18 mg. U.S. Agency for Toxic Substances and Disease Registry 

(ATSDR), ‘‘Toxicological Profile for Uranium’’ (Washington, DC: U.S. Public Health Service, September 1999) p. 9 (hereinafter, ATSDR Report). ‘‘The STEL (i.e. less than a 15 minute exposure 

followed by periods of minimal or no exposure) would apply to the shorter term exposures occurring in the Gulf War (e.g., entering damaged equipment).’’ The Office of the Special Assistant 

to the Deputy Secretary of Defense for Gulf War Illnesses, Depleted Uranium in the Gulf (II) 

(Washington, DC, 2000) p. 19. 6 Based on an 8-hour workday, 40-hour workweek maximum air concentration limit of 0.2 mg/ 

m3, with an average breathing rate of 9.6 m3 per 8-hour working day. U.S. Agency for Toxic 

Substances and Disease Registry (ATSDR), ‘‘Toxicological Profile for Uranium.’’ (Washington, 

DC: U.S. Public Health Service, September 1999) pp. 322, 329. The 2 mg figure applies for both 

soluble (type F) and insoluble (type S) compounds; N. Stradling et al, ‘‘Anomalies between radiological and chemical limits for uranium after inhalation by workers and the public,’’ 105 Radiation Protection Dosimetry (2003) p. 177; Dr. Naomi Harley, statement to the Presidential Special Oversight Board for Department of Defense Investigations of Gulf War Chemical and Biological Incidents (Washington, D.C., 19 July 1999); The Office of the Special Assistant to the 

Deputy Secretary of Defense for Gulf War Illnesses, Depleted Uranium in the Gulf (II) (Washington, DC, 2000) p. 18. 7 U.S. Code of Federal Regulations, 10 CFR 20, ‘‘Standards for Protection Against Radiation,’’ 

Subpart C, 20.1201, ‘‘Occupational Dose Limits for Adults, 1 January 2001. 8The annual limit on inhalation intake is based on the volume of air that a worker is assumed 

to breathe in a year (2,400 m3), and the occupational exposure limit of 0.2 mg/m3. U.S. Agency 

for Toxic Substances and Disease Registry (ATSDR), ‘‘Toxicological Profile for Uranium.’’ (Washington, DC: U.S. Public Health Service, September 1999) pp. 321, 329; U.S. Code of Federal Regulations (CFR), 29 CFR 1926.55, Appendix A, ‘‘Threshold Limit Values of Airborne Contaminants for Construction,’’ Uranium, 1 July 2000. 9For brief inhalation exposures, the UK Health and Safety Executive (HSE) set a short-term 

exposure limit (STEL) of 0.6 mg/m3 over a 15-minute period. At a breathing rate of 9.6 m3, this 

equates to a recommended short-term limit on intake of 0.18 mg, based on chemical toxicity. 

UK Health and Safety Executive (HSE), Occupational Health Exposure Limits 2000, EH40/2000 

(Sudbury, Suffolk, HSE Books 2000). 10This is the occupational exposure limit for soluble natural uranium compounds (0.2 mg/m3), 

at a breathing rate of 9.6 m3 per 8-hour working day, based on chemical toxicity. Ibid. 11This refers to an inhalation of type S (insoluble) natural uranium based on a 5 micron activity mean aerodynamic diameter. As noted above (see supra n. 8), the majority of DU particles 

created by an impact are insoluble. The limit for intake by inhalation of type M (moderately 

soluble) natural uranium is 430 mg/year; for type F (soluble) it is 1290 mg/year. N. Stradling 

et al, ‘‘Anomalies between radiological and chemical limits for uranium after inhalation by workers and the public,’’ 105 Radiation Protection Dosimetry (2003) p. 176. 12The Royal Society, ‘‘The health hazards of depleted uranium munitions, Part I.’’ (London: 

Royal Society, 2001) p. 5. 13Presidential Special Oversight Board for Department of Defense Investigations of Gulf War 

Chemical and Biological Incidents, ‘‘Special Oversight Board Analysis (Ver. 2) of OSAGWI’’s DU 

Report,’’ (Washington, DC, 19 February 1999) (in author’s files). 


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14M.A. Parkhurst et al, ‘‘Depleted Uranium Aerosol Doses and Risks: Summary of U.S. Assessments,’’ PNWD–3476 Prepared for the U.S. Army by Battelle (Richland, WA: Battelle, October 2004) http://www.deploymentlink.osd.mil/du_library/du_capstone/index.pdf. 15The Royal Society’’s central estimate ‘‘is intended to be representative of the average individual within the group (or population) of people exposed in that situation.’’ The Royal Society, 

‘‘The health hazards of depleted uranium munitions, Part I.’’ (London: Royal Society, 2001) pp. 

6, 41–43. See also Annexe C of the Royal Society Report online at http://www.royalsoc.ac.uk/policy/du_c.pdf. 16 ‘‘We calculated a ‘‘worst case’’ estimate using values at the upper end of the likely range, 

but not extreme theoretical possibilities. The aim is that it is unlikely that the value for any 

individual would exceed the worst case. . . . If even the worst-case assessment for a scenario 

leads to small exposures, then there is little need to investigate more closely. If, however, the 

worst-case assessment for a scenario leads to significant exposures, it does not necessarily mean 

that such high exposures have occurred, or are likely to occur in a future battlefield, but that 

they might have occurred, or might occur in future conflicts, and further information and assessment are needed.’’ The Royal Society, ‘‘The health hazards of depleted uranium munitions, Part 

I.’’ (London: Royal Society, 2001) pp. 6, 41–43. 17M.A. Parkhurst et al, ‘‘Depleted Uranium Aerosol Doses and Risks: Summary of U.S. Assessments,’’ PNWD–3476 Prepared for the U.S. Army by Battelle (Richland, WA: Battelle, October 2004) Chapters 3, 4. 18M.A. Parkhurst et al, ‘‘Depleted Uranium Aerosol Doses and Risks: Summary of U.S. Assessments,’’ PNWD–3476 Prepared for the U.S. Army by Battelle (Richland, WA: Battelle, October 2004) Chapters 3, 4. 19 A.C. Marshall, ‘‘An Analysis of Uranium Dispersal and Health Effects Using a Gulf War 

Case Study,’’ Sandia Report SAND2005–4331, (Albuquerque, NM: Sandia national Laboratories, 

July 2005) p. 59–60. 20 Ibid, pp 59–60. 21 It is assumed that ‘‘soldiers spend 4 weeks in an area, starting from the time it is contaminated with 1 g m2DU; all the DU is respirable; and the soldiers’’ activities cause enhanced resuspension of the DU owing to normal heavy vehicle movements, but the soldiers are not undertaking digging, ploughing or clearance operations.’’ ‘‘The central estimate is based on UK-like 

conditions. . . .’’ The Royal Society, ‘‘The health hazards of depleted uranium munitions, Part 

I.’’ (London: Royal Society, 2001) p. 43, Annexe C. 22 It is assumed that ‘‘soldiers spend 4 weeks in an area, starting from the time it is contaminated with 1 g m2DU; all the DU is respirable; and the soldiers’’ activities cause enhanced resuspension of the DU owing to normal heavy vehicle movements, but the soldiers are not undertaking digging, ploughing or clearance operations.’’ ‘‘[T]he worst case [estimate] is based on arid, 

dusty conditions.’’ The Royal Society, ‘‘The health hazards of depleted uranium munitions, Part 

I.’’(London: Royal Society, 2001) p. 43, Annexe C. 23 Alexandra Miller et al, ‘‘Transformation of Human Osteoblast Cells to the Tumorigenic Phenotype by Depleted Uranium-Uranyl Chloride,’’ Environmental Health Perspectives (1998) 106: 

469. 24 Ibid., p. 470. 25 A.C. Miller et al, ‘‘Depleted uranium-catalyzed oxidative DNA damage: absence of significant alpha particle decay.’’ 91 Journal of Inorganic Biochemistry (2002) p. 251; A.C. Miller et 

al, ‘‘Genomic instability in human osteoblast cells after exposure to depleted uranium: delayed 

lethality and micronuclei formation.’’ 64 Journal of Environmental Radioactivity (2003) p. 248. 26 A.C. Miller et al, ‘‘Depleted uranium-catalyzed oxidative DNA damage: absence of significant alpha particle decay.’’ 91 Journal of Inorganic Biochemistry (2002) pp. 246, 251 27 A.C. Miller et al, ‘‘Genomic instability in human osteoblast cells after exposure to depleted 

uranium: delayed lethality and micronuclei formation.’’ 64 Journal of Environmental Radioactivity (2003) p. 257. 28 A.C. Miller et al, ‘‘Depleted uranium-catalyzed oxidative DNA damage: absence of significant alpha particle decay.’’ 91 Journal of Inorganic Biochemistry (2002) p. 251. 29 In 1999 the incidence of Hodgkin’s lymphoma among U.S. residents was 2.8 per 100,000 

people (3.0 for men, 2.5 for women). For men and women aged 25–29, the incidence was 5.4 

per 100,000; for ages 30–34 the incidence was 4.1 per 100,000. L.A.G. Ries, M.P. Eisner, C.L. 

Kosary, B.F. Hankey, B.A. Miller, L. Clegg, B.K. Edwards, eds., SEER Cancer Statistics Review, 

1973–1999, National Cancer Institute, Bethesda, MD, http://seer.cancer.gov/csr/1973–1999/, 

2002. Incidence rates in other countries with forces that served in the Gulf War or Balkans are 

similar: Italy—3.62; The Netherlands—2.32; United Kingdom—2.26; Saudi Arabia—2.69; Kuwait—4.33; Iraq—2.10. J. Ferlay, F. Bray, P. Pisani and D.M. Parkin, GLOBOCAN 2000: Cancer 

Incidence, Mortality and Prevalence Worldwide, Version 1.0, IARC CancerBase No. 5, Lyon, 

IARCPress, 2001, Limited version available from: URL: http://www-dep.iarc.fr/globocan/ 

globocan.htm, last updated on 03/02/2001. 30 U.S. National Cancer Institute, ‘‘Information about detection, symptoms, diagnosis, and 

treatment of Hodgkin’s disease,’’ NIH Publication No. 99–1555, 16 September 2002. 31 U.S. Institute of Medicine, Gulf War and Health, Volume 1, ‘‘Depleted Uranium, 

Pyridostigmine Bromide, Sarin, Vaccines.’’ (Washington, D.C., National Academy Press 2000) p. 

142. 32M. McDiarmid, et al, ‘‘Surveillance of Depleted Uranium Exposed Gulf War Veterans: 

Health Effects Observed in an Enlarged ‘‘Friendly Fire’’ Cohort,’’ 43 J Occup Environ Med 

(2001) p. 998. 33See discussion of U.S. DU Program at end of Chapter 2. 34 UK Ministry of Defence, ‘‘UK Gulf Veterans’’ Mortality Figures,’’ August 2002. http:// 

www.mod.uk/issues/gulfwar/info/gen_reports/mortfigs_jun02.htm. 


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35Statement of Lewis Moonie, UK Defence Minister, in response to Dr. Gibson, House of Commons Hansard Written Answers for 11 February 2003, http://www.parliament.the_ stationery_office.co.uk/pa/cm200203/cmhansrd/cm030211/text/30211w04.htm. 36Original in Italian: ‘‘Esiste un eccesso, statisticamente significativo, di casi di Linfoma di 

Hodgkin.’’ Istituita dal Ministro Della Difesa, ‘‘Relazione Finale Della Commissione Istituita dal 

Ministro Della Difesa Sull’’Incidenza di Neoplasie Maligne Tra I Militari Impiegati in Bosnia 

e Kosovo,’’ 11 June 2002, p. 21. 37Original in Italian: ‘‘I risultati dell’’indagine a campione svolta sui militari italiani impiegati 

in Bosnia e Kosovo non hanno evidenziato la presenza di contaminazione da uranio impoverito.’’ 

Istituita dal Ministro Della Difesa, ‘‘Relazione Finale Della Commissione Istituita dal Ministro 

Della Difesa Sull’’Incidenza di Neoplasie Maligne Tra I Militari Impiegati in Bosnia e Kosovo.’’ 

Ibid, p. 21. 38Original in Italian: ‘‘Per le neoplasie maligne (ematologiche e non), considerate globalmente, 

emerge un numero di casiinferiore a quello atteso.’’ Ibid., p. 21. See also C. Nuccatelli et al, ‘‘Depleted uranium: possible health effects and experimental issues,’’ 79 Microchemical Journal 

(2004) 332. 

[The presentation by Mr. Fahey entitled, ‘‘Depleted Uranium and Veterans’ 

Health: A Flawed Testing Process and an Undersized, Politicized Study Limit Evaluation of Exposure and Effects,’’ dated June 28, 2007, is being retained in the Committee files.] 

f 

Statement of Hon. Jeff Miller, Ranking Republican Member, Subcommittee 

on Health, and a Representative in Congress from the State of Florida 

Thank you Mr. Chairman. I believe it is very important for us to be holding this 

hearing on Gulf War exposures. 

We cannot forget the sacrifices of veterans who fought in the first Gulf War and 

must be vigilant in our responsibility to provide for the health care needs of all service men and women who have put their lives on the line to protect our freedom. 

It has been over a decade since the first Gulf War. Unfortunately, to date, neither 

a cause nor a single underlying disease process has been identified for a wide variety of medical problems that thousands of Gulf War veterans have suffered from. 

Yet, the scope of Federal research on Gulf War illnesses is broad, ranging from 

small pilot studies to large-scale epidemiology studies involving large populations 

and major center-based research programs. Between VA, DoD, and HHS, the Federal Government has sponsored over 300 distinct projects related to health problems 

affecting Gulf War veterans and spent nearly $300 million on research relating to 

Gulf War veterans illnesses from FY 1992 through FY 2005, and, the research continues today. 

However, because there was a lack of systematic baseline medical data and reliable exposure data, researchers have faced many difficulties and as a result many 

of the health concerns of Gulf War veterans may never be fully understood or resolved. 

Of particular concern is the rate of ALS in the Gulf War veteran population. The 

relationship between military service and ALS should be aggressively investigated 

and the provision of health benefits for those suffering with this debilitating disease 

should be provided without question. 

At today’s hearing, we will review what is currently being done to address the 

health consequences of the Gulf War. We will also examine if lessons learned have 

led to subsequent improvements in deployment health monitoring and evaluations, 

recordkeeping research and health risk communication. 

I appreciate the participation of all of our witness and look forward to the testimony. We will hear from several veterans of the Gulf War. Their unique perspective 

is extremely valuable to helping us avoid past mistakes and respond to the health 

needs of military personnel currently serving in the Global War on Terror. 

Thank you Mr. Chairman, I yield back the balance of my time. 

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Statement of Hon. Cliff Stearns, a Representative in Congress from the 

State of Florida 

Mr. Chairman, 

Thank you for holding this hearing. I hope to hear from our panel what kinds of 

exposures our servicemen and women are encountering in Iraq and Afghanistan in 

this conflict, the possible connection these exposures may have to debilitating diseases, such as ALS, and the steps the VA has taken to meet this critical health 

problem. 

In the mid-1990s, Gulf War Syndrome became the center of media attention, and 

the focus of fear by Gulf War veterans and their families. Clusters of undiagnosed, 

mysterious illnesses, as well as persistent, debilitating, and unexplainable symptoms began to surface. However, under the Clinton administration, the appointed 

‘‘Presidential Advisory Committee on Gulf War Veterans’ Illnesses,’’ reported on December 31, 1996 that scientific evidence had not produced ‘‘a casual link between 

symptoms and illnesses reported by Gulf War veterans to exposure [to] pesticides, 

chemical warfare agents, biological warfare agents, vaccines, . . . infectious diseases, depleted uranium, oil-well fires and smoke, and petroleum products.’’ This 

Advisory Committee also recommended that VA closely examine the relationship between wartime stress and ‘‘the broad range of physiological and psychological illnesses currently being reported by Gulf War veterans.’’ 

We now know that some of their illnesses were, as the report indicated, were 

often the result of psychological stress. Combat stress, a constant risk of warfare, 

is known to affect the brain, immune system, cardiovascular system, and hormonal 

responses. Therefore the stress could certainly have been a contributing factor to 

some of the symptoms and illnesses reported, although not all. Now it is believed 

by most medical experts that there was no unique Gulf War Syndrome, but rather 

a number of illnesses arising from numerous causes. The list of possible causes includes, but not limited to, the exposure to: Chemical and biological warfare; Depleted uranium dust; Infectious diseases; Medical measures used to protect against 

the threat of chemical and biological warfare; Multiple vaccines; Nerve agents too 

low to cause acute symptoms that can cause chronic adverse effects on nerve and 

immune systems; Pesticides; Toxic hazards, oil fires, smoke, petroleum products; 

and Sarin gas. 

In the years since the war, a number of Gulf War veterans were developing ALS 

(or Lou Gehrig’s disease). Cancers and impairments of the neurological, circulatory, 

respiratory, and reproductive systems have been studied for their links to exposures 

during Desert Shield and Desert Storm. Still, a substantial proportion of veterans’ 

illnesses remain undiagnosed to this day. 

I was here in Congress when we attempted to help these veterans who were suffering under these ailments. In the Veterans Programs Enhancement Act 1998, 

Congress required the National Academy of Sciences to review the available scientific evidence and determine whether there is an association between illnesses experienced by Gulf War veterans. Additionally, this law required VA to submit an 

annual report on the results, status, and priorities of research activities related to 

the health consequences of military service in the Gulf War to the Committees on 

Veterans’ Affairs. The law also established VA authority for priority health care to 

treat illnesses resulting from combat during any period of war after the Gulf War 

or during any other future period of hostilities. 

I look forward to hearing from our panels of witnesses about the progress that 

the VA has made in providing for these veterans, and also what challenges, if any, 

veterans are encountering when seeking medical care for their illnesses. 

Thank you. 

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POST-HEARING QUESTIONS AND RESPONSES FOR THE RECORD 

Committee on Veterans’ Affairs 

Subcommittee on Health 

August 2, 2007 

Brigadier General Thomas R. Mikolajcik, USAF (Retired) 

1751 Omni Blvd. 

Mt. Pleasant, SC 29466 

Dear Tom: 

In reference to our Subcommittee on Health hearing on ‘‘Gulf War Exposures’’ 

held on July 26, 2007, I would appreciate it if you could answer the enclosed hearing questions by the close of business on October 2, 2007. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for materials for all full and Subcommittee hearings. Therefore, we would 

appreciate it if you would provide your answers consecutively and single-spaced. In 

addition, please restate the question in its entirety before the answer. 

Please provide your response to Cathy Wiblemo at the Committee. If you have any 

questions, please call 202–225–9154. 

Sincerely, 

MICHAEL H. MICHAUD 

Chairman 

GULF WAR EXPOSURE—OUTREACH 

Response from Brig. Gen. Thomas R. Mikolajcik, USAF (Ret.) 

2. Outreach—Effective outreach can be a great tool in ensuring that veterans 

from past wars are kept informed of any changes or developments that may occur 

in the years after the conflict. Sixteen years have passed since Gulf War One ended. 

• Have the outreach efforts of VA diminished in the last 16 years and if so, how? 

Answer: I am not familiar with the VA Outreach efforts and do not feel qualified 

to answer this question. My experience with the VA for my condition of ALS was 

very trying at the beginning. It took me over 2 years to be granted a service connected disability of 90% and another 5 months to be categorized with 100% disability. The time between appointments seemed excessive and the amount of paperwork was daunting. Once in the VA system, routine appointments are easy to obtain, however specialty appointments can take several months. It is very apparent 

that the caseload of veterans far exceeds the ability to care for them. Since 2003, 

category 8 veterans have not been seen because of budget limitations and staffing. 

With regard to the care and equipment available, there is no one source which 

can lead you through that maze. The same applies to benefits and compensation. 

The individual veteran needs to research, ask questions and continually follow 

through for everything he needs. The unfortunate thing is that many veterans don’t 

have the energy, skill or ability to research and follow through. Since my correspondence from the VA granting me 100% disability with accompanying documents, I have received no other outreach information updating me on any new programs or benefits. I’ve had a motorized wheelchair for 1.5 years and I just learned 

through a disabled veterans newsletter that I am authorized a small clothing allowance. When I was issued the wheelchair, why didn’t the VA give me the appropriate 

form to fill out for the clothing allowance? 

The VA has a robust website however, one must have a computer and understand 

how to navigate the website system. 

• What would you do to change that? Is this a statement applicable to VA overall, 

suggesting that even with the Vet Center program VA does not have the capacity to treat veterans? 

Answer: When veterans enter the VA system, they should receive a comprehensive briefing on their entitlements along with the pamphlet they now receive. Periodic mailings and group counseling sessions should be used to update veterans on 

changes. Funding by Congress must be increased in order for all veterans to receive 

proper and well deserved care. Our government helps people all over the world, yet 

many veterans at home are ill cared for and do not understand the benefits they 

are entitled to. 

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Committee on Veterans’ Affairs 

Subcommittee on Health 

August 2, 2007 

Anthony Hardie 

National Treasurer 

Veterans of Modern Warfare 

1722 N. Sherman Ave. 

Madison, WI 53704 

Dear Anthony: 

In reference to our Subcommittee on Health hearing on ‘‘Gulf War Exposures’’ 

held on July 26, 2007, I would appreciate it if you could answer the enclosed hearing questions by the close of business on October 2, 2007. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for materials for all full and Subcommittee hearings. Therefore, we would 

appreciate it if you would provide your answers consecutively and single-spaced. In 

addition, please restate the question in its entirety before the answer. 

Please provide your response to Cathy Wiblemo at the Committee. If you have any 

questions, please call 202–225–9154. 

Sincerely, 

MICHAEL H. MICHAUD 

Chairman 

Questions for the Record 

Hon. Michael H. Michaud, Chairman 

Subcommittee on Health 

House Committee on Veterans’ Affairs 

July 26,2007, 10:00 a.m. 

Room 334, Cannon House Office Building 

Follow-Up Questions for Anthony Hardie 

1. ALS—Mr. Mikolajcik proposed in his testimony that a congressionally directed 

ALS Task Force should be established to help provide direction in ALS research and to develop a strategic plan to tackle this illness. The 30- 60- 90- 

day timeline he suggested in his testimony lays out some structural parameters. 

• What are your thoughts on this plan and do you think that it would be effective, 

given the apparent stagnation in Gulf War research and treatment of the Gulf 

War illnesses? 

• What do you suggest should be the top three goals of such a task force? 

2. Outreach—Effective outreach can be a great tool in ensuring that veterans 

from past wars are kept informed of any changes or developments that may 

occur in the years after the conflict. Sixteen years has passed since Gulf War 

One ended. 

• Have the outreach efforts of VA diminished in the last 16 years and if so how? 

• What would you do to change that? Is this a statement applicable to VA overall, 

suggesting that even with the Vet Center program VA does not have the capacity to treat veterans? 

3. Treatment—Mr. Hardie, you state in your testimony that ‘‘being seen is not 

the same as being treated’’. 

• Could you go into more detail regarding that statement? 

• Ms. Nichols and Mr. Hardie—have you found that the medical doctors that 

treat Gulf War veterans are ill informed? 

• Mr. Hardie, you mention that many Gulf War veterans have given up going to 

VA. Do you know if they are going elsewhere or not going anywhere? 

[RESPONSES WERE NOT RECEIVED FROM MR. HARDIE.] 

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Committee on Veterans’ Affairs 

Subcommittee on Health 

August 2, 2007 

Denise Nichols, M.S.N. 

Vice Chairman 

National Vietnam and Gulf War Veterans Coalition 

500 Fifth Street NW 

Washington DC 20001 

Dear Denise: 

In reference to our Subcommittee on Health hearing on ‘‘Gulf War Exposures’’ 

held on July 26, 2007, I would appreciate it if you could answer the enclosed hearing questions by the close of business on October 2, 2007. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for materials for all full and Subcommittee hearings. Therefore, we would 

appreciate it if you would provide your answers consecutively and single-spaced. In 

addition, please restate the question in its entirety before the answer. 

Due to the delay in receiving mail, please provide your response to Cathy 

Wiblemo at cathy.wiblemo@mail.house.gov. If you have any questions, please call 

202–225–9154. 

Please provide your response to Cathy Wiblemo at the Committee. If you have any 

questions, please call 202–225–9154. 

Sincerely, 

MICHAEL H. MICHAUD 

Chairman 

National Vietnam and Gulf War Veterans Coalition 

Washington, DC 

October 2, 2007 

Hon. Michael H. Michaud 

Chairman 

Subcommittee on Health 

Committee on Veterans’ Affairs 

United States House of Representatives 

335 Cannon House Office Building 

Washington, DC 20515 

Dear Congressman Michaud: 

I am honored to respond to your written questions following the July 26 hearing 

on ‘‘Gulf War Exposures.’’ 

1. ALS—What are your thoughts on General Mikolajcik’s thoughts on this 

plan and do you think it would be effective, given the apparent stagnation in Gulf War research and treatment of the Gulf War illnesses? 

The General hit it right on the mark! He clearly and briefly nailed the identification of the problem as a lack of leadership. I would like to say that this is also the 

problem overall with Gulf War illness. Leadership is suppose to identify problems, 

strategize the solution, the solution is then broken down into tasks with clearly defined timetables and project target goals, and then the plan is executed. Each 

project has an assigned individual that is held to accountability and responsibility. 

Leadership also is then held accountable and responsible for the success and failure 

of each component and projects individuals’ actions or nonaction. Leader should be 

named as well as each subsequent project leader. Then Congress has to do their 

part of overseer and true Oversight and they have shared accountability and responsibility to the taxpayer to show results that get transferred to the clinical application of research and results on the large scale. 

There is a lack of focus and direction in all medical research. The end result 

should be measuring the patient veterans’ improvement in the clinical area. There 

are huge disconnects in the VA/DoD health system in this regard. We can effectively 

employ tiger teams to solve a battlefield problem and get research and equipment 

fielded in a somewhat timely and effective manner but we do not have this robust 

system in place for diagnosed or undiagnosed illnesses and chronic life threatening 

medical problems. 

This is what is truly lacking in DoD/VA and the government (Congress and the 

Administration) actions’ to the problem of exposures that occurred in 90–91 with 

Operation Desert Storm and the resultant health effects. The logs and reports that 


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would have given us the whole truth on exposures were destroyed (ordered by General Blanck and confirmed by GAO and the author Cy Hurst) and not one person 

has been held responsible for that destruction of government records that were critical to the health effects after the war. These logs and information would have given 

us the information to lead us quickly to what resulting health problems we would 

have seen in a timelier manner. 

The actions to address Gulf War illness and resulting illnesses both diagnosed 

and undiagnosed show that our system of health care for veterans is broken and 

has been for a long time (example Agent Orange). 

The government responded by funding research studies overwhelming on stress 

for 13 years while the veterans composed of all prior ranks were screaming and trying to get the truth out on exposures and how our health was rapidly deteriorating. 

There were not even annual hearings with the VA Committees with veterans (individuals) to identify to you what was reality! Veterans’ health problems have led to 

broken marriages, inability to maintain their careers, and to the point of veterans 

aging family members (Moms and Dads) having to try to help these adult soldiersveterans. 

ALS thankfully was recognized as occurring in higher numbers in Gulf War veterans than should have occurred in a normal population. The VA is recognizing that 

but congress has yet placed this into a bill to make it legal! MAKE THE BILL/LAW 

happen within 30 days that ALS will be an Immediate Presumption with fast track 

priority and VA ratings accomplished within 30 days. 

WE have asked for that several times. We now are finding Multiple Sclerosis in 

Gulf War veterans at a greater than expected level and no unified leadership or effort is being seen yet again. WE have Cancers and other diagnosed illnesses but no 

one has put the pressure on VA’s Health area to share data to get the whole picture. 

The General spoke clearly identified the problem and spoke to a solution on one 

area—ALS. Mike Donnelly (Major—F16 pilot died 21⁄2 years ago) and Randy Hebert 

(Major, Marine) were brought forward by me to Congressman Shay’s Committee 

years ago to testify. Other Gulf War veterans with ALS from earlier are Randy 

Hebert, Jeff Tack, and Tom Oliver. And we still can’t give them much more than 

get them compensated. Well that is not enough! In addition, I am hearing that the 

benefits that they are entitled to in regards to nursing care and assistance, home 

improvements for their care, specialty equipped vans, and educational benefits for 

their spouse and children is not fully communicated to each and every one of them 

and means to get that assistance in a timely manner is not coordinated. All of this 

information should be readily supplied to them in writing and also easily assessed 

on the VA Web site. I contacted the Donnelly’s because that family turned into true 

advocates. His dad a former marine and state legislator of Connecticut did everything he could for his son and all the others. Tom Donnelly and I talked over the 

general’s testimony and the followup questions his comment to me is very revealing. 

I asked him if I could share it with you. His comment was that he doubted that 

the government would ever do anything useful. He felt that there would never be 

true effective action and that other entities outside the government would have to 

solve the problem. He also compared the Gulf War veterans of 90–91 to the past 

veterans of Agent Orange and the problem with getting any help now with so many 

of our current OIF/OEF casualties needing care. Mike and his wingman are now 

dead as are others. His comrades have formed 2 separate nonprofits in AZ that hold 

annual golf tournaments and awards dinners. Their purpose to look after the children left behind and to fund scholarships for those children. The Donnelly’s still 

reach out to the other ALS veterans and assist them as much as possible. This family and the General need to be recognized by the CONGRESS for their unending 

efforts in supporting and leading the Gulf War Veterans with ALS. 

The General was right with his strategic goals and timetable. Yes I support it 

wholeheartedly. 

I would also recommend highly that the VA ALS registry be more public and include data on how many Gulf War veterans both deployed and non-deployed and 

risk factors with each. We need to know if anthrax or other vaccines may be causing 

this increase. We also need to have data re on where in theater each veteran with 

ALS was located and what was their duty and unit and what other exposures may 

be contributing to the development of this deadly disease. This data without exposing names should be public on a Web site so that researchers and the public can 

join in the battle to tackle the illness with ideas and information. The Gulf War veterans with ALS should be the lead cohort for any ALS study because they were previously healthy and we do have more health data in the military than normal individuals in the population. Also our duty as a nation should be to place the troops 

and veterans health as the priority. We also have the depository at DoD that has 

blood and other specimens on this group of veterans that should be allowed to be 


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used by non DoD/VA researchers to find answers NOW. I include a recent article 

on the depository at DoD that highlights this problem for your review. I also include 

one other article on cancer data not being reported from VA that is altering National Cancer data. 

YES THIS PLAN SHOULD BE DONE AND WITH IT I THINK THE PROGRAM 

ON GULF WAR ILLNESS WOULD BE INVIGORATED BECAUSE IT WOULD 

SERVE AS A ROLE MODEL. I WOULD START RIGHT NOW IN THE SAME DIRECTION WITH AN MS GULF WAR VETERANS PROGRAM. THESE TWO PROGRAMS SHOULD BE OCCURRING CONCURRENTLY BECAUSE THEY ARE 

BOTH RELATED TO NEURO MUSCULAR AND POSSIBLE AUTOIMMUNE OR 

VIRAL SEQUELE TO NEUROTOXIC SUBSTANCES. 

What do you suggest should be the top three goals of such a task force? 

1. Separate ALS Gulf War Veterans from other veterans and civilians to use as 

a specialty Cohort. 

2. Designate THREE VA HOSPITALS as specialty centers—ALS EXCELLENCE 

CENTERS. BE SURE that One is East Coast—One Central—One WEST 

Coast. Leadership overall should be named and each center should have named 

individual. 

3. SET UP COORDINATION WITH CIVILIAN ALS CENTERS OF EXCELLENCE. SET UP UNIVERSITIES/CIVILIAN MEDICAL CENTERS IN EACH 

GEOGRAPHICAL LOCATION EAST—CENTRAL—WEST to be RESEARCH 

CENTERS OF EXCELLENCE WITH NAMED INDIVIDUALS. 

4. Designated by name lead individuals in each government agency that will be 

involved. 

5. Set up VETERANS and their support system for ALS at each regional VA– 

VISN as Task Force. SET up from each of those a national VETERANS ALS 

TASK FORCE. 

The ALS situation is time critical and should go top down and down up along 

with lateral off spouts. The initial setting up is crucial and necessary support and 

communication should be considered as essential. The VA should be in direct communication with each of these veterans and families on a continuing and scheduled 

basis to follow up on their needs proactively. My complements to General Mikolajcik 

for his clear leadership and my prayers and concerns go out to each veteran and 

their family that has encountered ALS that this effort will rapidly succeed for them 

and alleviate their burdens. 

My thanks to you personally Representative Michaud and to the House VA Health 

Subcommittee for highlighting the issue and having this hearing. 

I encourage you to have other hearings on Gulf War illness, one on benefits delivery and one on Clinical Care. I offer my time and ideas and suggestions on these 

efforts. 

2. Outreach—Have the outreach efforts of VA diminished in the last 16 

years and if so how? 

The answer is YES. The congress including VA Committees on both sides Senate 

and House and the Current Government Reform and Oversight Committee of the 

House has been absent. The need is for continual programmed Committee hearings 

to keep a focus on this issue and to provide oversight to corrective action and true 

implementing of the laws by the word of the law and the sense of the Congress. 

There needs to be accountability and responsibility in action and not just words. 

What would you do to change that? 

The VA has failed to update clinical guidelines, to provide training to all VA hospital individuals, and the VA has failed to be sure that progress reports on funded 

all Gulf War illness research projects. There is a need for interim research findings 

at 6 month time periods and a final report of each research project finding and recommendations from each project. WE need this in an organized format that is communicated thoroughly. WE need all research project reports not just the published 

peer reviewed journal result because some of these projects that are funded are 

never published in peer reviewed journals. This extends to DoD research projects 

also. WE need the full 300 plus study white paper. Validate to the veterans and 

the taxpayers what they paid for over the last 16 years. 

The VA has let lapse the newsletter for Gulf War illness and we no longer are 

getting them mailed to the veterans. These newsletters need to be on the VA 

website from each issue to the current in an easy to find format. The DoD has also 

fell down on the job since re-titling the area DEPLOYMENT Medical. The veterans 

nor the medical professionals receive updates on research projects and their findings 

and implications. 


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The VA hospitals have no signs up about the VA Gulf War Registry and information sources and the kiosks in each VA have no information on Gulf War illness. 

The VA has lost focus for one of the largest veteran’s populations that of those 

exposed to Hazardous toxic exposures. A significant effort must be made to rectify 

this situation. I made numerous suggestions during my House and Senate testimonies. I would suggest it is time for the Congress to step in and legislate that 

these actions occur and hold them responsible. 

Mandate training, annual meetings, training and hiring physicians with toxicological, anti-aging, environmental medicine training, set up task forces at each VA 

hospital to include veterans, administration, and medical personnel to address concerns from Gulf War exposures and other eras (Agent Orange, atomic veterans, and 

project shad). Then institute regional and headquarters task forces set up to rectify 

the problems that have been created by the ineffective leadership at the VA in regards to Gulf War illness. Provide materials on hazardous exposures ie newsletters, 

training programs, update VA Web site to include this information, and provide 

video conferencing so that the VA RAC GWI meetings can be shared system wide 

for medical professionals, researchers, and veteran patients. 

Registry exams must be available, and the specialty clinics we had set up early 

in 1994 need to be reestablished, and the WRIISC centers in DC and Orange, New 

Jersey need to be expanded to at least 3 more locations (South, Central, and West 

Coast). These WRIISC centers have a good reputation so far but referrals to them 

are not readily available and health care professionals have not understood their 

availability and funding was not set up for veteran patient travel. 

There has also been concern that Gulf War veterans are being minimized and not 

fully screened on an ongoing basis because of lack of funds and the ability to meet 

the need of younger veteran population from OIF and OEF, Gulf War Veterans, and 

all the other veterans due to staffing shortages. 

There is also a potential problem with veterans not being able to access eye exams 

and dental exams unless they are rated at 100%. These vital body systems are affected by hazardous exposures and those huge factors to health are being totally neglected and no data even available. 

Two new advisory Committees need to be implemented for Gulf War illness one 

on clinical care and one on benefits. The VA GWI identified the need to the Secretary of the VA months ago and no action occurred so therefore Congress must step 

up and legislate these to be formed in somewhat the same as the VA RAC GWI. 

I would suggest more veterans to be at the table and only one VSO at a time to 

serve and at least one family member to also be included. Then specialists on benefits will be needed for the benefit advisory committee. 

Then health care professionals in and out of the VA system for the clinical care 

advisory Committee. This committee must interact with the research advisory Committee in order to be able to take the research findings and implement them 

throughout the VA system. This clinical care Gulf War illnesses advisory Committee 

should include experts in the area of anti-aging, environmental medicine, and toxicology. The key here is to have interaction with each hospitals’ task force locally and 

with regional task forces. So issues can be shared and worked at different levels. 

The chair and co chair must have management business skills and communication 

people skills to set long and short term goals and move toward resolution of problems. There must be commitment from the VA Administration and from both the 

congress and the President to move the VA forward into the new century where consumer client veteran patients feel there is a commitment and is evident through actions. 

I would suggest to initial start with Gulf War illness and Gulf War veterans as 

these prove successful then Agent Orange, Atomic Veterans, and project shad advisory Committees need to be started. 

The VA health division needs to set up databases that collect diagnosis information for Gulf War veterans—cancers, all diseases. This data needs to be reported 

semiannually to the veterans, to congress, to civilian medical organizations and 

needs to be available on a Web site. Registries for MS, cancers, other diseases, birth 

defects should be manned at each VA hospital, each regional VA center, and then 

to the health division. A death registry that contains name, age, cause of death, unit 

assigned in the Gulf War would be invaluable in honoring our veterans but also provide researchers data on deaths of Gulf War veterans. These registries must be public and transparent on the VA Web site. One of the articles I am enclosing talks 

about cancer data from the VA not being shared. This quarantine of information 

must immediately be stopped. 

Bills currently introduced by Representative Pelosi and Senator Clinton, H.R. 

3643 and S.B. 2082 must be reviewed, supported with some changes, and made into 

law before the end of this congressional session. Veteran data needs to be collected 


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from the civilian side of house also because not all veterans can or do utilize the 

VA. Death records in many states do not record Veteran service or war in which 

they served unless they have a VA file number. Birth records need to record parents 

and grandparent service and war time service to be complete in regards to hazardous exposures. Our data on birth defects can not be judged to be total and complete until all states have birth defect registries that also include a means of documenting health issues that arise after birth an example is autism, learning disorders, or health defects found later after birth. There must be some thought to how 

to add current information to existing records. 

The whole process of VA contracting with the IOM for exposure relationships to 

establish presumption of connection must be totally revamped. Due to the IOM process the adversarial position of the veterans begins. I suggest a simplified approach 

of comparison of veteran population with age and the general population data that 

is already available and updated regularly to be utilized. If veterans are showing 

increases with known diseases that are above a random occurrence then that disease needs to be presumed service connected within 60 days. I encourage the government reform Committee and VA Committee hold joint hearings and investigation 

into this area of concern. 

There must be a revamping of the VA benefit claim process now. It is a black 

mark on this nation to treat its veterans as it has over the last 50 years. To have 

sick veterans with cancers and other diagnosed illnesses that are probably connected to their service exposures die without any assistance from their government 

is wrong. To leave their spouses to start the process all over and to continue the 

battle is wrong. This adversarial process impacts the belief of the active duty and 

reserves when they agree to serve. It impacts prior service families from encouraging their offspring to serve their country thru military service. 

Only through going through each of these steps and showing transparency and 

a full commitment will the faith of the veterans, their families, and the public be 

restored. 

Through these efforts and more that faith to trust the government will be healed 

and recruiting for active duty and reserves will benefit because the promises will 

have been restored. 

Only through all of these efforts will our Nation be ready to deal with environmental exposures from WMD and WTC health concerns. The military medicine in 

the past led the way as examples in the implementation of the best care techniques 

for gun shot wounds and rapid air evacuation that has impacted civilian medical 

practice that has saved lives. WE can do this again with changes now in policy 

changes in relation to Gulf War illnesses. 

Is this a statement applicable to VA overall, suggesting that even with the 

Vet Center program VA does not have the capacity to treat veterans? 

I think the Vet Center program is a needed program and needs to be continued. 

I will suggest that you contact others with more expertise in that area to have suggestions for improvement. I do feel that there is newer breaking research in the 

area of PTSD treatment that the Vet Centers specialize in that needs to be brought 

to the Vet Centers and implemented across the country rapidly to meet the needs 

of the returning OIF/OEF veterans. I believe that civilian counseling should also be 

set up for active duty, Reservists, Guard members, and veterans so that this overwhelming need can be met in a timely urgent means. I also feel that advisory group 

on PTSD should be initiated and ongoing until the problem is resolved. I also feel 

the need for local, regional, and central task forces that involve the veteran client, 

family members, and experts would help facilitate the revamping, communication, 

and upgrading in this area as in the clinical area would be beneficial. 

I do not think it is time to dismantle the VA, veterans do have unique needs and 

have the most unusual social, emotional, and physical networks that were formed 

in service to their country. They have unique management, organization, and leadership abilities that need to be tapped and utilized to correct the problems. The ability to blend in civilian experts and facilities exists and we have seen them reaching 

out so help facilitate and make it happen. 

As you can see there are needs for the Committees to have more hearings and 

joint senate and house hearings would be most effective to get the facts and let the 

veterans be heard and be a part of the process that will benefit them and future 

veterans. The need for committees to ask for insightful written and oral testimony 

with suggestions for what can be done on the legislation, administration, clinical 

care, and benefits can not be overstated. The need for good questions both at the 

hearing and as follow up is extremely important. The need to have FULL Committee Hearings outside VA in possibly six locations throughout the country (divide 

the country line from North to south and then intersecting with east-west lines then 


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pick center geographically for 6 locations) would be beneficial to the veterans and 

to you the Committee Members. 

The Committees also should consider assisting financial for veterans in regards 

to airfare and hotels for these hearings. Veterans do not have an excess of funding 

to participate and be witnesses. 

3. Treatment 

Being seen is not the same as being treated and have you found that medical 

doctors that treat Gulf War Veterans are ill informed? Are Gulf War veterans giving up on going to the VA, going elsewhere, or not going anywhere? 

YES DOCTORS ARE ILL INFORMED. They are also restrained by policy whether written or unwritten that began when we returned from the Gulf War in 90–91. 

The doctors are not allowed to have an inquiring mind to find answers. The example 

I gave on the research I provide the doctor at the VA on Hypercoagulation in Gulf 

War Veterans and treatment suggestions is my most graphic example. 

When I found out that the doctor had not followed up on contacting the doctors 

and authors of the paper and refused to retest or provide treatment to me or other 

Gulf War veterans and instead offered me a psychology consult, was the insult that 

pushed me not to return and to seek answers and treatment elsewhere. When the 

doctor, told me her hands were tied even prior to that visit, I knew that what other 

veterans and the doctors that tried to do the right thing within the VA and then 

were told to not see Gulf War Veterans or were cut from the staff at VA hospitals 

were saying was true. When I found out the editor of the journal that published 

the independent research on Gulf War veterans with hypercoagulation worked at 

the VA Hospital Denver Lab it just was over the top. It showed me that they were 

not listening to find clues and help in testing and treating Gulf War veterans. Other 

items I witnessed and experienced are many and I will try to make this as short 

as possible. First of all exams where not to a high standard. I was a nurse with 

a Masters Degree and varied clinical and teaching experience in the military active 

duty, reserve duty, and civilian positions which included teaching nursing. When I 

had been taught Clinical assessment we used the same physical assessment textbooks as medical students and this was in the mid 70’s. The neurological physical 

exams that should have been very thorough and looking for changes when it was 

known we were exposed to neurotoxins and a mixture of exposures was very limited. 

Dr Bill Baumzweiger is an expert to be consulted in regards to his exams and what 

he found. The comments I had at the VA were gee you are complaining of a skin 

rash you need to see a dermatologist and then when I asked to see one they said 

no you will have to go to a civilian this was during the initial CCEP at the VA. 

I had to push for any follow up for the ringing in my ears that continues to this 

day. I was never referred to neurology, infectious disease specialist, endocrinology, 

or immunologist. 

I also participated in the DoD CCEP at Fitzsimmons USAH, Denver. The person 

doing EEGs noted to me he was seeing abnormalities with each of the Gulf War 

veterans I never got my report on my own test results. WE veterans have not seen 

the compilation of all those exams that were done. I did have the hearing tested 

by an audiologist that had been hired back at Fitzsimmons, he did the air percussion testing to the ears and he was puzzled and had me return to be retested at 

that time we got into a discussion I asked him if it was hearing lost from noise since 

I had been a flight nurse on C–130’s and had been exposed to constant generator 

noise during the war. He said no, I said what is it then and he said he saw signs 

indicating ototoxicity. I at that time showed him the full Senator Reigle report at 

which point he got very interested and wanted to keep the copy I had shown him 

which I willingly gave to him. I had taken no chemotherapy, antibiotics, or aspirin 

or any other item that would cause this damage except exposures in the Gulf War. 

At the dermatology clinic I was seen by a female fully qualified dermatologist that 

was very interested in my rash. She documented it but said she had to have me 

released by the chief of service. He came in and blamed it on age and psoriasis. 

After he left, she shut the door and wanted to talk. She was a West Point Graduate 

and her husband had served in the Gulf with us and was experiencing the symptoms we all had. She asked me for any and all information I could share with her. 

Within 2 weeks I returned with copies of everything from hearings on the hill, to 

information on CFS and MCS and presented it to her. Well later I found out from 

a Veteran (first SGT Army) from KS that was there getting tested that this same 

DR had been seen flying into the office of the Dr that was in charge of the CCEP 

at Fitzsimmons right in front of him waiting to see the same Dr. He recounted to 

me how upset she was in her verbal encountered with this chief DR. This was the 

same chief doctor I had heard about from soldiers at Fort Carson that were being 


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seen in the Medical Hold unit. Extensive vision testing was done at Fitzsimmons 

that I never received copies of to include in my record. Again the veterans that participated in these extensive testing have never seen the compilation of all the exam 

results on all of us. EMG’s were also done and again the doctor was curious and 

asked for any information I could share. Again no copies of the results and again 

no compilation of these results on all of us Gulf War veterans has ever been seen. 

When you left the DoD CCEP after cognitive testing and all the other testing you 

felt they knew more than they were telling. I witnessed and spoke to veterans that 

were being told it was all in their minds or that it was because of their age, this 

was despite the fact that these were young soldiers in their 20’s. I witnessed disparities in the testing that was done on some veterans and not others. I confronted 

the chief doctor that he was not being honest as a doctor should be after that I was 

subject to his harassment that was witnessed by the other veterans that were there 

being seen and staying at Fitzsimmons since they came from a number of active 

duty bases. I supplied notebooks of hearing documents and materials related to 

questionnaire for Ross Perot investigation for these soldiers to have in their dayroom. I supplied the copying and the notebooks at my own cost and the troops were 

very interested in reading them. The only problem is they kept vanishing and the 

specialist that was there to schedule the exams finally confided in me that the chief 

doctor kept taking them away. 

The last item of interest is I would see these same military doctors appear at the 

VA in civilian clothes in white lab coats seeing the Gulf War veterans there. 

The veterans that were also Vietnam veterans as well as Gulf War veterans were 

very jaded and told me the system would never change. General Horner who I saw 

at the tenth anniversary of the war hosted by the Kuwaiti Ambassador told me in 

front of another Gulf War veteran they just didn’t realize how bad the system was 

broken. In Pueblo, Colorado we had an Army Reserve doctor who had served with 

us that would see Gulf War veterans in his civilian practice and was trying his best 

to help other veterans accurately documented their cases to the VA. He too eventually ended up to ill and had to retire from practice. The last time I saw him was 

in Phoenix AZ at the Environmental Medicine meeting where he had suck in since 

he didn’t have funds for registration and was trying to gather information. At that 

point I introduced him to Lea Steele and Jim Binns of the VA RAC GWI. I also 

introduced them to Dr. William Rhea and had Dr. Rhea verbally telling them how 

he had approached the Secretary of the VA in 1990–91 to offer assistance and to 

train VA physicians on the care of the environmentally exposed. He was turned 

down. This is interesting since he had served as chief of Thoracic surgery at the 

VA Dallas before he started into environmental medicine. 

Through independent testing with Hemex Labs, AZ and Immunoscience Labs, 

Calif and other labs I have found answers on my own condition. This testing needs 

to be done for all Gulf War veterans and would definitely help us get answers and 

treatment in the right direction started. I also had arterial and venous blood oxygen 

testing done and the results of that simple test was also enlightening but how many 

other Gulf War veterans have had that testing that showed the body was 

oxygenated but the transfer of oxygen to the body was being interfered with resulting in high venous oxygenation. These are the clues in blood testing that the VA 

should have been exploring all along. 

But despite getting some answers I am still not receiving any consistent clinical 

care and most definitely not from the VA. The VA has caused a lot of the PTSD 

since our return from the Gulf War. It is simply exhausting when you are ill to have 

to keep pushing and explaining to doctors and hoping they are listening so most 

Gulf War veterans sit back quietly surviving and looking for supplements from Vitamin Cottage that might help. 

This is a disaster, as a nurse and Gulf War veteran with years of practice and 

training I have focused on identifying the problems, giving voice, collecting data, 

going to hearings, commissions, IOM, and VA RAC GWI, coming to the hill and 

briefing staffers since 1994, working closely with Congressman Shay’s Committee 

staff through the years of hearings he conducted, working to get cosponsors on each 

of our Gulf War veterans legislation efforts, talking and discussing with researchers 

what they are finding and what their thoughts are and sharing with them any information that would help them, and providing information to Gulf War veterans and 

asking the veterans for continuing updates from them. I have tracked research findings, searching for connections and future ideas for researchers. I have compiled 

obits for our own death registry. 

I am upset that pro active screening for cancers and other diagnosed illnesses is 

not happening for Gulf War veterans. 

I decided to deal with the government at the highest level to push for change as 

long as I can. After all we had been called whiners, were not believed, hit the policy 


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from up high not to reveal all the exposures the Gulf War veterans know about, 

and from doctors that told us their hands were tied. Many veterans are not being 

seen at all and have lost faith. 

The question is will the policy and changes be made now or ever? 

Additional Thoughts on Research: 

Research needs to feed into changes in clinical care for Gulf War veterans now 

and continuously. Researchers need to finally be briefed on all the exposures that 

occurred. DO not spend money into research alone or we will all die without having 

received any benefit of this taxpayer spent money. Do put the funds into the DoD 

CDMRP program where consumer advocates serve on the review panels. 

Do find a way to provide chromosome testing ie SKY testing (attachment provided) that will clearly show the highest level of proof of damage to the Gulf War 

veterans. WE veterans all deserve at least that testing so veterans that still wish 

to have children can have tests results that may affect their ability to have healthy 

children. We deserve that test to prove once and for all the damage done. 

I am including the two articles I mentioned in my answers above and my written 

invited testimony to the Senate VA Committee along with my point paper that lists 

problems and solutions that I had done for the VA House Committee hearing for 

you to review. 

I stand ready to assist you, Members of the Committees, and other Members of 

the Congress with help in whatever you may need be it more information, suggestions, suggestions of experts and veterans to bring forward, assistance in organizing, 

etc. 

I apologize for the length of the answers to your questions but I strive to answer 

completely with definitive action ideas. 

Respectfully submitted, 

Denise Nichols, MAJ, USAFR (ret), RN (ret), MSN 

Gulf War Veteran Flight Nurse 

Vice Chair 

Eight attachments follow. 

Attachment 1 

VA Cancer Data Blockade May Imperil Surveillance 

By Michael Smith 

Senior Staff Writer, MedPage Today 

LOS ANGELES—Stonewalling by the Veterans Administration is putting U.S. 

cancer surveillance and research in jeopardy, according to many of the researchers 

involved in those fields. 

After decades of sharing data freely and allowing researchers to get in touch with 

its patients, the agency has been blocking such activity for the past several years, 

according to Dennis Deapen, Dr.PH., of the Los Angeles Cancer Surveillance Program and the University of Southern California. 

The result, Dr. Deapen said, is that California state data on cancer incidence 

rates are being skewed. And that, he said, is likely to have serious effects on national data. 

The California Cancer Surveillance Program has seen a sharp drop in the agency’s reporting of new cases to Californian cancer registries beginning in late 2004— 

from 3,000 cases in 2003 to almost none by the end of 2005, according to an article 

in the September issue of Lancet Oncology. 

But the problem is not restricted to California, according to Holly Howe, Ph.D., 

of the North American Association of Central Cancer Registries (NAACCR) in 

Springfield, Ill. 

‘‘California has been very energetic in evaluating the impact of the loss of VA 

cases on completeness and the ability to produce accurate incidence data,’’ Dr. Howe 

said. 

‘‘But it’s not just California—it’s nearly every state,’’ she said. 

However, California and Florida—where VA reporting of cancer cases has also 

been blocked—have large populations of veterans and large VA medical facilities, 

she said. 

Missing data from those two states has the potential to warp national estimates, 

she said. 


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Lancet Oncology quoted Raye Ann Dorn, the VA’s national coordinator of cancer 

programs, as saying that only California and Florida were withholding data, mainly 

because of privacy concerns. 

Dorn was not immediately available for comment on the eve of the Labor Day 

weekend. 

Lancet Oncology said other VA officials pointed out that of the 130 medical centers that collect cancer data, only 29 withheld cases from state cancer registries in 

2006. 

But the journal also said that, according to CDC data, VA centers in seven states 

are not reporting cancer cases and in six others, at least one VA facility is not reporting. 

All told, ‘‘40 000 to 70 000 cases are potentially missed nationally each year,’’ the 

journal quoted a CDC spokesman. 

Dr. Howe said her organization and others have been trying to persuade the VA 

to resume wholehearted data-sharing, but with little success. ‘‘We’ve been trying to 

solve this for over 5 years,’’ she said. 

Asked if she knows what’s behind the policy, Dr. Howe said flatly: ‘‘No.’’ 

Representatives of a ‘‘whole cadre of associations’’—including NAACCR, the CDC, 

the American Cancer Society, and the National Cancer Institute—met in early August to discuss the issue, Dr. Deapen said. 

He said the VA position has two main effects. 

The skewing of national and state cancer incidence rates, he said, is ‘‘correctable.’’ 

‘‘The VA still has the data,’’ he said. ‘‘They could hand it out and then we could 

correct incidence rate data.’’ 

What is ‘‘incorrectable,’’ he said, is the effect the data blockade could have on research. 

Dr. Deapen said, for example, that researchers investigating the causes of a particular type of cancer might be misled if they were not aware of a cluster of cases 

being treated in VA hospitals. 

‘‘Once that study is done, (the researcher) doesn’t get to go back and do it over,’’ 

Dr. Deapen said. Research during this period ‘‘will forever require an asterisk’’ to 

remind other researchers that it might not be correct. 

But even when states get VA data, some cases may slip through the cracks under 

a related VA policy that forbids interstate data-sharing, he said. 

For instance, he said, it’s common for veterans in some eastern states to seek 

treatment in neighboring states. 

The host state doesn’t count them, because they live next door. And the VA refuses to notify the home state or let the host state do so, so that some cases are 

simply never counted, Dr. Deapen said. 

Several of the cancer registries that are being locked out of VA data take part 

in the Surveillance Epidemiology and End Results (SEER) program, according to 

Brenda Edwards, Ph.D., of the National Cancer Institute, which operates the database, a valued resource for epidemiological research. 

‘‘This will significantly impact reporting in SEER,’’ Dr. Edwards told Lancet Oncology. 

The collection of disease incidence data is a state responsibility, Dr. Deapen said, 

but the VA—as a Federal agency—is under no obligation to comply with state laws. 

Nonetheless, for years the VA voluntarily shared its data and allowed access to 

patients, he said. 

‘‘We had it right and we were doing a good job,’’ Dr. Deapen said. ‘‘Now we need 

to get back on track.’’ 

Primary source: Lancet Oncology 

Source reference: Bryant Furlow. ‘‘Accuracy of U.S. cancer surveillance under 

threat.’’ Lancet Oncology 2007;8:762–63. 

Attachment 2 

A MILITARY MALPRACTICE 

Serum Samples From Service Members Go Unanalyzed. Battlefield Doctors 

Are Unable To Access Records. Who’s Tracking The Troops? 

By REMINGTON NEVIN August 26, 2007 

The Department of Defense is failing to properly monitor the long-term health of 

soldiers, airmen, sailors and Marines more than 15 years after the outbreak of mysterious Persian Gulf War illnesses. 

Following the first Gulf War, the Defense Department began collecting millions 

of serum specimens from service members returning from deployments, and placing 


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them in large freezers for future study. If thawed, this serum—which was bled from 

service members teaspoons at a time—would total thousands of gallons. 

But to help the service members, someone would have to study these specimens, 

and that is rarely done. Although it houses the largest inventory of serum specimens in the world, the Defense Department repository employs only one full-time 

scientist and has never been awarded a permanent budget to test specimens for 

toxic exposures or other health threats. 

The repository also is running out of space—bursting at the seams with more 

than 42 million specimens. More than 5 million of the repository’s oldest specimens—collected before the Gulf War—are now stacked floor to ceiling in teetering 

cardboard boxes, inaccessible to researchers, while the Defense Department’s health 

leaders slowly discuss how and where to build a new repository facility and who 

would run it. 

The inventory continues to grow at more than 2 million specimens annually. Millions more specimens from the Gulf War era will need to be boxed up later this year. 

And while leading civilian repositories now store frozen serum specimens in ultracold minus-80-degree Centigrade storage to minimize degradation, the Defense Department continues to store its newest serum specimens in outdated walk-in freezers at a comparatively balmy minus-30 degrees Centigrade, potentially harming the 

delicate protein and chemical biomarkers that might contain evidence of toxic and 

infectious exposures. 

Urine specimens are another useful tool in monitoring health, as any doctor will 

attest. Yet the Defense Department discards the 2 million-plus urine specimens it 

collects every year during routine drug testing. 

Monitoring health also requires access to modern medical records systems. Military hospitals in Iraq and Afghanistan are forced to use relatively archaic systems 

that don’t communicate in real time with the rest of the electronic medical record. 

These systems don’t even talk among themselves. 

Doctors treating patients transported between facilities on the battlefield often 

can’t access electronic records written by surgeons minutes earlier. Frustration has 

been so intense that doctors treating patients evacuated through Germany have developed a separate Web-based system to work around the problem. Confusion over 

which system the doctors in the field are supposed to be using continues, compromising the quality of the health data. 

One solution, off-the-shelf Web-based technology—such as VPNs (virtual private 

networks), used commonly by corporations to allow remote access to computer networks—has yet to reach the battlefield. Service members stationed in Afghanistan 

on remote snowy mountainsides routinely access their personal e-mail on the Web, 

but medics are not empowered by the Defense Department to use the Web to view 

and interact with vital medical records stored on systems in the United States. 

Instead, medics in the field are instructed to record medical information using 

outdated handheld computers that often break down or run out of power. More often 

than not, medics simply don’t use them, leaving no trace of medical care and giving 

the impression of a falsely low rate of disease and illness among deployed troops. 

Despite these problems, the Defense Department reassures Congress and the 

American public that service members have their health comprehensively monitored, including a lengthy reassessment a few months after they return from deployment. 

These assessments are little more than poorly worded, multi-page forms of little 

use to clinicians and epidemiologists in screening for diseases. The reassessments 

have demonstrated little efficacy in increasing access to military mental or physical 

health care. They often distract doctors, nurses and other health workers from providing therapeutic patient care. 

And now the requirement to complete this lengthy reassessment form is being 

waived for soldiers sent back into the war zone after serving more than a year 

there. Tragically, these overworked service members—the ones who need the most 

careful physical and psychological assessments—are often deploying again after 

completing a token two-page form containing only a single mental health question. 

Often, no one confirms both the accuracy of the information and the suitability of 

the service member for repeated deployment. 

Because of this, large numbers of service members on psychoactive medications 

are still being deployed, including many on anti-psychotic medications and 

anticonvulsants. As many as one in seven deployed service members has a recent 

history of psychoactive medication use. 

But just which of these deploying service members have potentially serious psychiatric disorders is unclear, because the data systems that monitor pharmacy prescriptions are not linked to the Defense Department’s deployment database. 


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Nor are these linked to the larger medical surveillance database that tracks medical diagnoses. The Defense Department would be hard-pressed to quickly identify 

the service members deployed this year with a history of treatment for bipolar disorder or psychosis—in direct violation of its new policy. 

What isn’t monitored can’t be measured or reported. Nor can it improve care to 

service members, or forecast what will be needed to care for the next generation of 

veterans. 

The health data in the Defense Department’s databases and the serum repository 

have shed light on possible causes of multiple sclerosis, schizophrenia and various 

cancers, and contributed to our understanding of the epidemiology of mental and 

physical diseases. But so much more could be done. 

Sadly, many key military health organizations are led by careerists with little experience in this type of work. There is little incentive, and significant risk, for Defense Department health leaders to point out problems, to explore controversial findings or to contradict military leadership when the health of service members is at 

stake. 

Monitoring the health of service members is a responsibility too important to be 

left to a military leadership distracted by the exigencies of war. Responsibility for 

monitoring health should be consolidated under a new Armed Forces Health Surveillance Center, under the direction of an independent civilian expert in public 

health. Service members cannot wait another 15 years. 

Capt. Remington Nevin is a Johns Hopkins-trained Army public health physician 

currently serving in Afghanistan. His opinions do not reflect those of the Department 

of Defense. 

Attachment 3 

Testimony of Montra Denise Nichols, Major, USAFR (ret) 

Vice Chairman National Vietnam and Gulf War Veterans Coalition 

to the U.S. Senate Veterans Affairs Committee September 25, 2007 

Hearing on Gulf War Veterans Illness Research 

Thank you Senators for having this important hearing today related to Gulf War 

Illness and Research for the Gulf War Veterans of Operation Desert Storm 1990. 

It has been since 2000 since your last hearing on this issue. During the intervening 

7 years, some small progress has finally been made in getting research moving in 

the right direction. It has been too long in coming and a major effort is needed starting now to make up for lost time. No progress has been made in improving the 

health of ill veterans. The majority of us are still waiting for definitive diagnosis 

and any effective treatment for our exposures. There is an overwhelming desperation that has developed year by year. We veterans feel betrayed and abandoned. We 

are angry at the lack of truth, accountability, and responsibility from our government. This is a National Security Issue because the way veterans are treated when 

they return directly has and will reflect on armed services recruitment. Funding for 

a war and the aftermath of exposures in war should be considered as a total. Needs 

of veterans of exposures in war are not to be considered as an afterthought! 

I am not a constitutional lawyer but a citizen, former nurse, and affected Gulf 

War veteran and this is how a majority of Gulf War veterans view what has happened: We have seen this pattern through the years both from the Democratic and 

Republican Party and this has to stop now. Section 8 of the Constitution states 

clearly one of the duties of congress is to ‘‘raise and support Armies and militia.’’ 

There are a lot of appropriations and authorizations that occur that are not called 

for in section 8 and Veterans that have been exposed to hazardous toxins should 

not have to beg and fight their own government for years and decades after exposures in war! Our needs should be addressed as the priority not as an afterthought 

or not to be balanced and compete with items not covered in section 8 of the 

Constititution! 

As of the May GWVIS report from the VA we have 212,867 claims have been 

granted out of 696,842 that served in combat in Operation Desert Storm. This figure 

is getting close to 1⁄3 of the force. We have more than 175,000 with Gulf War illness 

than the VA study picked up. We also have 13,517 veterans that have died according to the GWVIS data. WE the veterans are concerned if this count is accurate because it does not match the statistics in their own report (GWVIS) of the number 

that have served and the number of estimated living veterans. These are not just 

numbers these are human beings that served and put their life on the line. Today 

I am handing in to you the obituaries we have collected, this three ring notebook 

containing 800 pages of 1,473 have been researched over the last 6 months and we 


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have thousands more that we are currently working on using a rigorous process of 

verifying and posting using copyright guidelines. We do not have all of them but 

what is interesting is to review the age of death and one can see clearly something 

is definitely wrong and we needed help from the time of exposure. 

One of the Gulf War Veterans that died this month is Colonel Dr. Gil Ramon. 

Colonel Gil Ramon had five degrees, served in law enforcement in Wichita, KS as 

the youngest person at the time to attain the rank of Sergeant in the Sedwick County Sheriff’s Department, served as the Assistant Vice President for Academic Administration at the University of Northern Colorado from 1975–1977, served as the 

Regional Director of the Denver, Colorado office which covered a six-state region 

served as an undersecretary in the Department of Education, served as Deputy Assistant Secretary of Operations, in Washington, D.C., named Executive Director of 

‘‘The White House Initiative on Educational Excellence for Hispanic Americans,’’ 

served as Deputy Commander of the 311th Evacuation Hospital, Army Medical 

Service Corps, Operation Desert Storm, where he served as Chief of Operations, 

U.S. Army Central Command, the Persian Gulf. Colonel Roman provided administration and operations guidance in the administration of a combat filled hospital 

(400 bed augmented). He was a remarkable person, when he testified before Representative Shays’ Committee he did not let a massive nose hemorrhage that occurred while he was testifying stop him, only Representative Shays could do that 

by ordering a break in the hearing so that he could get it under control, clean up, 

and then continue his testimony. But most of all he and I were a team trying to 

help our fellow veterans of the Gulf War in Colorado by doing whatever we could 

including writing white papers for our Colorado delegation and candidates for office. 

He was my friend and I dedicate my testimony today to him and all of these hundreds of thousands of dead and living but injured veterans. I include his obituary 

as an attachment to represent one of tens of thousands of our lives that are no 

longer with us. His private cardiologist later wrote: ‘‘What is clear is that he [Colonel Roman] served in the Middle East and that he was a cardiomyopathy. I would 

submit that this may well be part of the Gulf War Syndrome.’’ 

Our Special Forces commander in Desert Storm died in July, General Wayne 

Downing, his death is connected because of immune system deterioration from exposures that is happening to all of us. I ask you how long do we wait. How many must 

pay with their lives and their quality of life before full attention and funding to fight 

these deadly exposures. This is the biggest black mark on our country ever! It is 

the largest post war casualty and morbidity ever in the history of this country! It 

has been worse because of policy and delay and denial techniques employed by all 

in the government that started with the atomic veterans and has continued through 

over 50 years. This is the same government that we veterans swore to defend! Everyone from the President to the Congress to the DoD and the VA from the past 

years has not shown the leadership and commitment that we deserved. 

If you are going to fund the continuing war then you must fully fund the needs 

of the veterans, we refuse to be an after thought or disposable GI’s. We also believe 

you should consider this war that started with us in Operation Desert Storm and 

has continued through Operation Iraqi Freedom and Enduring Freedom as one. You 

must address all legislative needs of Operation Desert Storm as you address the 

current troops and veterans. Our voices are united in that point. We also fully believe that Veterans of Agent Orange, Atomic Veterans, Anthrax vaccine veterans 

and Project Shad fall within the same domain of Environmental Exposures. What 

we find thru our push to breaking science in medical research for diagnosis and 

treatment will reach backward as well as forwards. 

It has been 16 years almost 17 years since our health was affected in Operation 

Desert Storm. One of the initiatives that we as veterans and advocates have started 

is the Web site www.honorthenames.com. It is a shame and disgraceful that the VA 

can not provide the basic death data that we have asked for to include Name, Rank, 

Unit assigned, Age, and cause of death to be on a public registry online. At least 

if this data was available patients, doctors, nurses, and researchers could be more 

informed and possibly be more aggressive in follow up for our living veterans whether it be more focused efforts to screen for cancers, cardiac, or renal problems. I recommend this become a legislative effort to make this into a bill and then into law. 

Included in this bill would be a mandate that death certificates list if the deceased 

was a veteran and what war or time period they served. Currently many states’ 

health departments would only know if the deceased was a veteran if a VA file number is indicated we need this uniform across all 50 states. If we can publish the 

names of those killed in Iraq then we should have the same for veterans that served 

at the beginning in Operation Desert Storm. If the VA can not do this, then write 

a bill/law that the Social Security Administration will do it. It is not appropriate 

to wait for periodic death mortality studies when this information can be of clinical 


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significance. If we have a higher rate of automobile accidents then this should be 

investigate and information given to veterans and their family members. The memory problems, cognitive problems and vision problems impact on auto and truckdrivers and also pilots. 

On the same subject of data sharing we need data on all diagnostic codes be it 

ALS, MS, Seizures, all types of cancers, cardiac, renal, liver disorders from the veterans health care data for the Gulf War veterans at a minimal of annually again 

to be on the VA website open to all to review for the purpose of providing data that 

could show trends that need to be monitored for all Gulf War veterans in the clinical 

setting whether by the VA or civilian health care providers. Having been a practicing nurse, patient educator, critical care provider, and educator I know this data 

would be useful not only to health care providers but to the patients. This data 

would be as useful as the patient family history and past medical history in evaluating a patient’s health risks that all health care providers use in educating and 

screening patients for other medical conditions that are likely to emerge. The veterans have already started unofficial registries by online email groups for MS, ALS, 

Parkinson’s, Cancers, Cardiac problems, and for Anthrax vaccine reactions, so we 

ask the VA to do these things (public registries on all of these and more) when they 

don’t we as veterans will lead. We need the diagnostic codes occurring by age group, 

units assigned (if possible), and what it compares to in civilian population data by 

age group. This would also trigger researchers in those areas to pursue potential 

connections whether it is exposures or potential treatment or diagnostic tests that 

need to be evaluated. Please consider this an identified legislative issue to be enacted by a congressional bill/law. 

I include data that we obtained from within the retired/deceased VA physicians 

on Cancers that were occurring in the early years after Operation Desert Storm that 

shows 4 cancers that were occurring at an elevated rate from the normal population 

expected occurrences. In addition to this listing Congressman Upton had gotten a 

listing from the VA in the mid nineties on cancers occurring in the Gulf War veterans. This is critically important data that needs to be shared to all. Knowing that 

these cancers have occurred alerts the patients (our veterans) and doctors (both VA 

and Civilian) to do earlier screening and testing to catch cancers in the earliest 

stage which is needed for fast treatment to save lives! 

By following through on these two efforts we might possibly identify the diagnoses 

that need to be included in Presumption of Service Connected for Operation Desert 

Storm Veterans. In addition the veterans of the Gulf War would appreciate a bill 

that identifies ALS, Brain Cancers, and possibly MS as Presumption of Service Connection be introduced and passed. We don’t want simple VA regulations but we 

want laws that back those up. Therefore all VSO’s, doctors, patients and their family members will know these conditions are recognized! 

If needed GAO (scientists/officials) could be utilized again to collect the data and 

report on the above concerns on deaths (ages, cause of death) and on diagnostic 

codes to the Congress. The Gulf War Veterans believe that GAO reports on the 

whole are more balanced and complete than what we are seeing through the IOM 

studies. The IOM studies have proven to be almost useless and to very little benefit 

to the Gulf War veterans. This procedure/policy of using IOM as an arm of the VA 

to deny help and assistance to veterans needs to be the focus of a full Senate Investigation. 

I propose a change be made for veterans, basically data that is data on diagnosed 

illnesses by Diagnostic code could be compared by data on the same diagnostic codes 

in the general population by age groups. When we experience above the normal population there should be no delays or intermediate steps to connect and compensate 

the veterans for those diagnostic codes and conditions. The intervening 

compounding factor is simply a war exposure that triggered the disease. Finally the 

veterans would receive the benefit of the doubt with no delay that further impacts 

the lives of the veteran, the quality of their lives, and the impact for the families 

of the veterans. 

Congress needs to review the process that is occurring at the IOM in relation to 

Gulf War illness and exposures. This has been testified to before in front of Representative Shays Committee in Nov 2005 and no effective action has occurred. This 

is not what the Gulf War veterans expect of congress, to leave issues that have been 

identified to not be investigated and corrective action taken for over 2 years. This 

is simply unacceptable! 

Since the last Senate Hearing during 2000 on Gulf War illness some hope of 

progress has been made. But hope is not enough! The VA RAC GWI was finally implemented years after the law requiring it was past. This is not acceptable and directly relates to policy of delay and denial that we have seen from all parties since 

1991. 


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The 2004 Report of the VA RAC GWI finally slowed down the misdirecting of research money to Stress Psychological Studies of Gulf War Veterans. That took 12 

years to accomplish, there are still efforts to downplay Gulf War illness as psychosomatic or stress and pushing Gulf War veterans to psychological visits away from 

medical internal medicine, immunology, and other clinics. This is how policy and research impacts actual care and treatment of Gulf War veterans. I believe this is due 

to the physicians at each VA hospital not receiving adequate knowledge of what was 

being done in congressional hearings or information withheld by the DoD on exposures. Training and updates of all the work that has been done is the responsibility 

of the VA Central Headquarters i.e. Environmental Agents i.e. Mark Brown has 

failed in his job. There is still a policy in place at the VA headquarters or higher 

that is interfering with providing what the Gulf War Veterans of Operation Desert 

Storm and those with reactions stemming from anthrax vaccine actually need in regards to diagnosis and treatment. Training of physicians and health care providers 

and sharing of all data is a central leg of our stool to reach better diagnosis and 

treatment of desert storm veterans in the VA health care system or in the civilian 

health care system. This has been and continues to be the most neglected area that 

affects Operation Desert Storm Veterans and potential civilian casualties that may 

still occur in the current War. Some one or several need to be fired! Policy from the 

Top down needs to be changed now not in 50 years when we are dead or when an 

attack occurs on civilians within the U.S. (which has happened already re WTC 

health effects). Truth, Responsibility, Accountability, and the best Training and Resources are what the Active Duty, Guard, and Veterans stand for and give their 

lives for in service to our country. It is a travesty that our Presidents, Congress, 

and all departments do not give that to us. 

We ask that you mandate and call for a change of White House Policy, VA policy, 

and DoD policy now. It is will pass time that roadblock of denial and delay be completely removed publicly. The policy change will benefit our Nation and not only our 

veterans. 

The VA research money is now being sent to the Dallas Collaborative center and 

this is because for years we watched the VA continue to fund research that was not 

focused in the right direction even after 2004. Studies that were on multiple year 

programs needed to be stopped but that was not done. WHY? The answer is because 

there was not a thread of oversight from the Congress or hearings! Money was 

misspent that we needed desperately to make the breaking research that would impact clinical care for us Gulf War veterans. 

We are happy that the UTSW medical will now be a VA Collaborative Center. 

This effort is where the research for the long term effort to a potential cure will 

be placed. This is the long term approach but it needs input and oversight. Besides 

their plans to nail down the best neurological imaging/diagnostic testing more needs 

to be done. They must submit there plans for spending the money and other areas 

they will be investigating. This must be documented in a very public manner on a 

website with a forum for researchers and veteran patients to input their concerns 

and suggestions. 

The other stool leg needs to be addressed re the DoD funding on Gulf War illness 

that disappeared in 2001 except for 5 million in FY06. The DoD Congressional Directed Medical Research Program has proven to us to be a place that can coordinate 

the needs of the Gulf War Illness Research. This program is the really stabilizing 

leg. 

Through using this program Researchers that are in and out of the country that 

can not be funded through the VA funds due to requirement of VA employment time 

can become involved and help us solve the problem. An example of the problem that 

was faced is when Dr Paul Greengard a Nobel Peace Prize nominee in neurology 

was turned down for funding by the VA Research. He had stopped his busy schedule 

to respond to the need of Gulf War illness research. If the DoD CDMRP program 

had been in place then it would have been able to meet the need. The DoD CDMRP 

would be high gain, high risk for breaking science that relates more directly to diagnosis tailored to potential exposures that need DoD collaboration i.e. DU, anthrax 

vaccine, nerve agent exposure, and other hazardous exposures singularly and in 

combination. The treatment modalities that could be developed using the same type 

initiative that we use to fund weapon development from theory to rapid field use 

could be employed to make the rapid short term progress we need. That is why 30 

million annually is needed in that area. Both to fund hypothesis developed/driven 

research and invited research efforts for diagnostic breaking science and treatment 

options. Initially I was skeptical of this program but after participating as part of 

the Scientific Merit Review Committee for studies that were submitted and I am 

now convinced that this is a workable system since it includes consumers of the illness as part of the CDMRP panels. Through this effort we can truly bring in the 


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best minds of this country and other countries to find answers now. As I stated earlier we have large numbers ill and DYING and for 16 years this effort was misdirected and did not serve the needs of a large group of ill combat theater veterans 

exposed to a hazardous environment, questionable medical practices, and a major 

misstep in policy when we returned ill and simply asked for the medical care we 

earned by serving our country. Yes there is a desperation that has been there since 

the start that has built over time as the quality of our lives have been affected to 

the point that many of our careers have been terminated, our ability to live normal 

day to day life has been significantly deteriorating, and too many have died. 

I would like to place in the official record videotapes of the Montel Williams show 

‘‘Dying to Serve’’ and the Discovery channel’s recent program on Gulf War illness 

where they tested 5 veterans using a Chromosome Sky Testing that was developed 

and used at 3–4 medical universities (1998–2000) to show that the veterans are definitely damaged in much more severe ways than has been seen in any condition before (articles submitted as atchm). Dr Urnovitz’s work in the mid 1990’s showed 

RNA problems with the Gulf War veterans. This is the cutting edge diagnostic 

markers that are currently available and are not being utilized. In fact, the University that tested the 5 individuals has already experienced efforts to not make these 

tests available. Similar to what has occurred during the best test on DU in urine 

and squalene antibodies testing in individuals that received the Anthrax vaccine 

during Operation Desert Storm. The policy needs to be changed now. The standard 

that we have to reach i.e. the goal posts keeps changing because of these policies. 

It is time these diagnostic tools are used fully to help the Gulf War veterans seeking 

answers and treatment for 17 years! Interfering with scientist and doctors is an example of implementing bad policy decisions. This practice is detrimental to our very 

lives and to future potential civilian casualties and is against our constitutional 

rights and individual rights and must be stopped. 

Every month we see breaking science news that could be used in Gulf War Veterans ill with Gulf War illness. I am enclosing attachments that review several of 

these new approaches to be considered by the DoD for invited research proposals 

for Gulf War illness. With every research proposal, the DoD should stress that universities should consider their cost factors that range from 40–60% and lower this 

factor if at all possible to encourage that more research can be done to benefit our 

Gulf War veterans with their assistance. The DoD officials should understand that 

we demand a tiger team approach including expert consultants on every research 

proposal in order to streamline the research in regards to time to completion and 

plans for clinical implementation. If we can do this for weapons development and 

troop protection, we should have same approach for Gulf War illness. The DoD and 

the VA Collaborative Research centers must involve clinicians i.e. Doctors, Nurse, 

Pharmacists, Lab experts, etc in the total process in order to have their inputs and 

also to speed the transition of research findings to clinical usage in the most timely 

manner. All proposals should consider ways in which more interactions and sample 

collection can occur from all VA hospitals. Methods making it possible for more veterans across the nation to be directly involved should be considered. 

Other areas that are being neglected in research on impact of Gulf War illness 

are in the areas of vision changes, dental changes, viral evaluations, Cardiac implications, renal implications, and Liver implications. Some of these areas could blend 

clinical input from actual testing in the VA hospitals and then correlating the findings and submitting the final findings as Clinical based research. 

The VA needs to ready the clinical areas to put new diagnostic tests and treatments in place. The VA needs to implement the request by the VA RAC GWI for 

a Clinical Advisory Committee for Gulf War illness. If the VA does not do this within 30 days after a new Secretary of the VA is in place then Congress must come 

forth with a bill and fast track it to a law. The integration of research findings into 

clinical practice at the VA has to be preplanned. The VA should be mandated by 

Congress to produce this plan to the Veterans Affairs Committee of the House and 

Senate within 60 days. Congress must respond by holding a hearing as soon as this 

plan is ready. 

This should start with a new training and research sharing program. An excellent 

way to do this would be to set up teleconferencing the VA RAC GWI presentations 

on Research Reviews and Researcher presentations that occur at the VA RAC GWI. 

The VA headquarters should implement video taping of these quarterly meetings for 

distribution to each VA hospital and mandate the health care professional viewing 

as professional development and training. The plan should also address the need to 

set up a Gulf War Illness task force at each VA hospital to include physicians, directors, health care professionals, and Gulf War veterans. VA should update all their 

training documents on Gulf War Illness. VA Researchers and physicians should be 

offered the opportunity to attend the VA RAC GWI meetings in person. Publications 


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of the VA RAC GWI need to be covered in the VA Newsletters on Research and 

Clinical Areas. Their should be a plan to bring the Gulf War Veterans that registered through the registries to be brought back in for screenings for cancers, new 

diagnostic tests, and sharing of current research findings and research projects materials should be included in these sessions. These updates need to be available to 

Gulf War veterans being seen at the VA at each appointment. By having physicians 

and nurses involved in providing this information all concerned parties will be fully 

involved and aware of what is occurring on the research for diagnostic modalities, 

biomarkers, and treatment trials. The VA needs to reestablish its Gulf War Illness 

Specialty Centers keeping in mind they need to be geographically located in each 

VISN. The two War Related Centers being on the East Coast close to each other 

needs to be reevaluated because referrals are not happening and these centers must 

be strategically located across the U.S. to better serve the Gulf War Veterans with 

Gulf War illness. 

The VA should also consider training at least one physician from each VISN in 

accordance with the Anti-aging board certified program and the American Environmental Training program. Both of these programs have had physicians on the civilian side of the house treating Gulf War veterans. I would be more than willing to 

get the VA in contact with former military doctors that are involved in these two 

specialty areas that have offered their expertise to assist since the early 90’s. 

The research proposals for treatment should also evaluate IV vitamin, COQ10, 

glutathione combinations that some Gulf War veterans have found as relief in dealing with their illnesses. In addition chelating treatment that has been used with nuclear plant workers need to be evaluated for use with Gulf War veterans that are 

testing positive for DU. Also Dr Montoya’s use of Valganciclovir in Chronic fatigue 

patients with viral infections needs to be a treatment trial for Gulf War veterans. 

Many of our Gulf War veterans have never received complete blood work up studies 

that are available from Dr Vjordani’s lab in California or Dr Berg’s Hemex lab in 

AZ. These two labs have found treatable conditions in our Gulf War veterans that 

have gone to the outside civilian world to get answers. It is strange to me that Dr 

Vjordani’s lab was recognized by the VA as outstanding but they have not utilized 

it in any form to get blood work done on repository samples and samples from current Gulf War Veterans seeking answers and care at the VA hospitals nationally. 

Dr Berg’s lab did the initial sample study and paper on hypercoagulation (a treatable condition) and yet the VA has not utilized that lab or the knowledge on a treatable condition in Gulf War Veterans. This is particularly upsetting to me as a Gulf 

War veteran nurse because answers are out there and VA refuses to accept the answers. I am enclosing a number of medical news items that have appeared in the 

last 6 months that need follow up and possible invitations to be part of the researcher invited program of the CDMRP program. A great deal of research in the 

field of MS is available and treatment trials are there that should also include Gulf 

War veterans but this has not happened. 

In addition there are 2 articles that I am including that need to be reviewed by 

Congress. One out of Los Angeles concerns stonewalling by the VA regarding cancer 

surveillance that is affecting the state of California collection of cancer data that 

could effect on the national data on Cancer. The other article concerns the millions 

of serum sample of Gulf War veterans at the DoD Repository and how they are running out of space and are seldom used by researchers to find answers for Gulf War 

veterans. Both of these items need follow up by Congress now. 

I also have a large file on current research abstracts concerning Depleted Uranium that I am making available to the Congress. I include as an attachment my 

written testimony from a previous house hearing to cover my own personal experience as a Gulf War veteran. 

Now I have covered a three legged stool in my testimony but to make that stool 

really solid to stand on we need the fourth leg and that is our elected leaders of 

this country the Congress and the executive branch of government. I have already 

stated the problem we have experienced due to policies of our government and lackluster effective action. Now for my final comments/suggestions to you. 

I have asked the Committee staff to consider other experts to bring forward to 

testify. I believe the most important would be to have the preventive medical team 

sent into theater to finally testify to the Senate VA Committee of what happened 

in theater and since on Gulf War exposures. In fact I would offer a suggestion to 

have joint hearings of the Senate and House Veterans’ Affairs Committees to cover 

Gulf War Exposures and Directions in Research and Clinical Implementations needed for Gulf War Illness. It is past time for this to occur! You have had General Powell and General Stormin Schwarzkopf appear years ago but the team that had the 

designated duty to set up medical care in theater has never been brought forward! 

Before we lose them to death like we lost General Boomer, General Downing, ColoVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00106 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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nel Roman and others please consider this as a priority now. Their information 

could help all of us! They were the ones after the Gulf War that briefed the pentagon why not have them brief the Senate? 

I have also mentioned to the committee other medical experts that need to testify 

before you so that the information on medical treatments that are available can finally have the attention through this Committee to be evaluated fully. We respectfully ask that the Senate VA Committee have more hearings to cover this issue 

fully. There have been too many gaps and time periods that the Gulf War Illness 

issue lost your attention and focus that is so needed. As I said we were sent off to 

the maze of IOM studies just like previous wars i.e. Agent Orange and effective action led from the Congress has been lost! 

We are in a period of amazing medical research that could benefit Gulf War veterans to a better quality of life but leadership is needed from the Hill and the Executive Branch. 

We can make a difference for others to follow and possibly the civilians’ ill from 

the WTC exposures give us that opportunity and the resources needed please. 

I have asked the House Veterans Affairs Committee and now I will ask you the 

following questions: 

Will you have faith in us the veterans and those civilians as doctors and researchers and members of the VARACGWI that have committed to help to listen and hear 

us? Will you commit to putting the full weight of this government and its resources 

to this task finally? Will you listen and implement our requests? Will you follow 

thru with oversight on implementation? We veterans that have been in this struggle 

since after the Gulf War, 17 years ago, have led by ideas, suggestions, actions, and 

continual pleads to you our elected representatives and Senators. Please do not 

abandon us. Please provide us prompt and effective medical care and compensation. 

Attachment 4 

Chromosome testing, Sky Testing 

NIH NEWS ADVISORY 

NATIONAL INSTITUTES OF HEALTH, National Human Genome Research 

Institute 

New Way Of Detecting Human Chromosome Defects Promises Better Diagnosis Of 

Cancer And Other Diseases 

EMBARGOED FOR RELEASE NHGRI Media Contacts: 

Monday, Mar. 31, 1997 Jeff Witherly, (301) 402–8564 

5:00 PM Eastern Time Galen Perry, (301) 402–3035 

Bethesda, Md—Utilizing multi-colored displays, scientists at the National Human 

Genome Research Institute (NHGRI) have developed a new technology for detecting 

defects in human chromosomes that promises to improve significantly the diagnosis 

of certain types of cancer and possibly other diseases as well. 

In the April issue of the journal Nature Genetics, the researchers report that their 

novel approach, called spectral karyotyping or SKY, is far more accurate in diagnosing leukemia-associated chromosome defects than is the standard, Giemsa—or 

G-banding method, today’s most widely used medical test for detecting chromosome 

aberrations. 

‘‘This new advance is a gratifying example of how the Human Genome Project, 

an ambitious effort to map and sequence all of the human DNA by the year 2005, 

is spinning off technologies with almost immediate benefit to clinical medicine,’’ says 

NHGRI director, Dr. Francis Collins. 

Currently, physicians use G-banding to look for abnormalities in any of a patient’s 

46 chromosomes—coiled strands of DNA carried in nearly every cell that contain all 

the genetic information necessary for the body’s proper functioning. By staining 

chromosomes using a substance dye called Giemsa stain, laboratory specialists can 

produce a karyotype, or arrangement of chromosomes, that shows a distinctive 

banding pattern for each chromosome. 

In patients with certain cancers, such as leukemia, and birth defects, such as 

Down syndrome, that banding pattern can reveal various types of chromosomal aberrations. Parts of chromosomes can be translocated, or swapped between one chromosome and another. Other chromosomes can be deleted or duplicated either in 

whole or in part. 

Unfortunately, the limited staining in a G-banding karyotype does not always reveal those aberrations. Subtle translocations in chromosomes, for example, are 


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sometimes undetected in G-banding karyotypes, even by the keen eye of a trained 

specialist because the banding pattern of the ‘‘swapped’’ chromosome ends is identical. 

SKY, on the other hand, produces brightly colored chromosomes that can clearly 

reveal chromosome aberrations that G-banding misses. In a study of 15 patients 

with different forms of leukemia, teams led by Dr. Thomas Ried at NHGRI and by 

Dr. Janet Rowley at the University of Chicago found chromosome aberrations in the 

leukemia cells that went undetected using G-banding in every case. 

‘‘Recently, cytogeneticists have used a technique called fluorescence in situ hybridization, or FISH, which enables the scientist to locate the precise position on the 

chromosome of one or several different DNA probes using different dyes to label 

each probe. SKY has the enormous advantage in that it can simultaneously uniquely identify all of the chromosomes in a single cell.’’ says Dr. Rowley. 

According to Rowley, the question then becomes, are any pieces of chromosomes 

in the wrong place, i.e., has there been a translocation we did not detect? Moreover, 

in cancer cells, there are many so called ‘‘marker’’ chromosomes whose size or shape 

is so unusual that we cannot identify them. SKY can help unravel the composition 

of these marker chromosomes even when they contain pieces of three or more chromosomes joined together. 

SKY is a hybrid technology based on a standard genetics research tool called 

FISH, short for fluorescence in situ hybridization, combined with another technology 

called spectral analysis—a technique commonly used in astronomy to separate out 

the rainbow-like components of light from distant stars. SKY employs molecules 

called probes that attach themselves to parts of chromosomes and glow when exposed to light. The tagged portion of each chromosome appears in a specific color, 

creating a multi-color pattern which vividly distinguishes one chromosome from another. 

Ried and his colleagues are already testing to see whether SKY can be used to 

detect chromosome aberrations in other diseases, such as certain birth defects. If the 

new technology proves successful, the researchers say, it might soon start augmenting or perhaps even replacing the current G-banding method, which is now performed some 500,000 times a year in hospitals and research centers across the 

United States and Canada to diagnose a wide range of diseases. 

Although SKY is still a more expensive technique to carry out compared to Gbanding, Ried believes that SKY’s benefits outweigh its extra costs. First, because 

SKY provides more accurate diagnoses, doctors can better treat patients with appropriate therapies earlier and potentially avoid unnecessary and costly therapies later 

on. And second, because of the well-defined patterns, SKY could be assessed by computers, which would greatly speed up the diagnoses of certain diseases. 

‘‘SKY has the potential to become an important tool in molecular genetics for 

identifying subtle and complex chromosome aberrations without requiring any preconceived notions of the abnormalities involved,’’ says Ried. 

The NHGRI oversees the role of the National Institutes of Health (NIH) in the 

Human Genome Project, an international research effort to develop tools for gene 

discovery. The NHGRI is one of 24 institutes, centers, and divisions that make up 

the NIH, which is part of the U.S. Department of Health and Human Services and 

the Federal Government’s primary agency for the support of biomedical research. 

NCBI National Cancer Institute SKY/M–FISH Database SKY or M–FISH and 

CGH Techniquies 

Spectral Karyotyping (SKY) and Multiplex Fluorescence In Situ 

Hybridization (M–FISH) 

SKY and M–FISH are molecular cytogenetic techniques that permit the simultaneous visualization of all human (or mouse) chromosomes in different colors, 

considerbly facilitating karyotype analysis. Chromosome-specific probe pools (chromosome painting probes) are generated from flow-sorted chromosomes, and then 

amplified and fluorescently labeled by degenerate oligonucleotide-primed polymerase 

chain reaction. Both SKY and M–FISH use a combinatorial labeling scheme with 

spectrally distinguishable fluorochromes, but employ different methods for detecting 

and discriminating the different combinations of fluorescence after in situ hybridization. 

In SKY, image acquistion is based on a combination of epifluorescence microscopy, 

charge-coupled device (CCD) imaging, and Fourier spectroscopy. This makes possible the measurement of the entire emission spectrum with a single exposure at 

all image points. In M–FISH, separate images are captured for each of the five 

fluorochromes using narrow bandpass microscope filters; these images are then comVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00108 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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bined by dedicated software. In both techniques, unique pseudo-colors are assigned 

to the chromosomes based on their specific fluorochrome signatures. 

The applications of SKY and M–FISH for screening genomes for chromosomal aberrations in human disease and animal models of human cancer are manifold. By 

making possible the unambiguous identification of even complex and hidden chromosomal abnormalities, SKY/M–FISH is particularly useful in: 

• Mapping of chromosomal breakpoints 

• Detection of subtle translocations 

• Identification of marker chromosomes, homogeneously staining regions, and 

double minute chromosomes 

• Characterization of complex rearrangements. 

The notoriously difficult analysis of murine chromosomes has now become greatly 

simplified, extending the application of SKY/M–FISH to the visualization of chromosomal aberrations in mouse models of human cancer. 

Visit the Ried Laboratory WebSite for SKY protocols 

Selected SKY/M–FISH References 

• Schro ̈ck E, du Manoir S, Veldman T, Schoell B, Wienberg J, Ferguson-Smith 

MA, Ning Y, Ledbetter DH, Bar-Am I, Soenksen D, Garini Y, Ried T. Multicolor 

spectral karyotyping of human chromosomes. Science 273:494–497, 1996 

• Speicher MR, Gwyn Ballard S, Ward DC. Karyotying human chromosomes by 

combinatorial multi-fluor FISH Nat Genet 12:368–375, 1996 

• Liyanage M, Coleman A, du Manoir S, Veldman T, McCormack S, Dickson RB, 

Barlow C, Wynshaw-Boris A, Janz S, Wienberg J, Ferguson-Smith MA, Schro ̈ck 

E, Ried T. Multicolour spectral karyotyping of mouse chromosomes. Nature 

Genet 14:312–315, 1996 

• Ried T, Liyanage M, du Manoir S, Heselmeyer K, Auer G, Macville M, Schro ̈ck 

E. Tumor cytogenetics revisited: comparative genomic hybridization and spectral karyotyping. J Mol Med 75:801–814, 1997 

• Weaver ZA, McCormack SJ, Liyanage M, du Manoir S, Coleman A, Schro ̈ck E, 

Dickson RB, Ried T.A recurring pattern of chromosomal aberrations in mammary gland tumors of MMTV-cmyc transgenic mice. Genes Chromosomes Cancer 25:251–260, 1999 

• Azofeifa J, Fauth C, Kraus J, Maierhofer C, Langer S, Bolzer A, Reichman J, 

Schuffenhauer S, Speicher MR An optimized probe set for the detection of small 

interchromosomal aberrations by 24-color FISH. Am J Hum Genet 66:1684– 

1688, 2000 

• Knutsen T, Ried T. SKY: A comprehensive diagnostic and research tool.A review of the first 300 published cases. J Asso Genet Technol 26:3–15, 2000 

• Padilla-Nash HM, Heselmeyer-Haddad K, Wangsa D, Zhang H, Ghadimi BM, 

Macville M, Augustus M, Schro ̈ck E, Hilgenfeld E, Ried T. Jumping 

translocations are common in solid tumor cell lines and result in recurrent fusions of whole chromosome arms.Genes Chromosomes Cancer 30:349–363, 2001 

• Phillips JL, Ghadimi BM, Wangsa D, Padilla-Nash H, Worrell R, Hewitt S, 

Walther M, Linehan WM, Klausner RD, Ried T. Molecular cytogenetic characterization of early and late renal cell carcinomas in Von hippel-Lindau (VHL) 

disease.G enes Chromosomes Cancer 31:1–9, 2001 

Comparative Genomic Hybridization (CGH) 

Comparative genomic hybridization (CGH) is a fluorescent molecular cytogenetic 

technique that identifies DNA gains, losses, and amplifications, mapping these variations to normal metaphase chromosomes. It is a powerful tool for screening chromosomal copy number changes in tumor genomes and has the advantage of analyzing entire genomes within a single experiment. It is particularly applicable to the 

study of tumors which do not yield sufficient metaphases for cytogenetic analysis 

and can be applied to fresh or frozen tissues, cell lines, and archival formalin-fixed 

paraffin-embedded samples. 

CGH is based on quantitative two-color fluorescence in situ hybridization. Equal 

amounts of differentially labeled tumor genomic DNA and normal reference DNA 

are mixed together and hybridized under conditions of Cot-1 DNA suppression to 

normal metaphase spreads. The labeled probes are detected with two different 

fluorochromes, e.g., FITC for tumor DNA and TRITC for the normal DNA. The difference in fluorescence intensities along the chromosomes in the reference metaphase spread are a reflection of the copy number changes of corresponding sequences in the tumor DNA. 


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CGH has the advantage of requiring only genomic tumor DNA, making it highly 

useful for cancer cytogenetics, circumventing the need for high quality tumor metaphase spreads. The ability to study archival material allows retrospective analysis 

which can correlate chromosomal aberrations with the clinical course. Since its introduction in 1992, CGH has been applied to a broad variety of tumor types which 

have previously defied comprehensive cytogenetic analysis by traditional methods. 

CGH has, for example: 

• Revealed consistent genetic imbalances and multiple amplification sites in carcinomas of the brain, colon, prostate, cervix, and breast. For instance, it identified chromosome 7 gain and chromosome 10 loss as landmark aberrations in 

glioblastomas, and specific gains of chromosomes 1, 8, 17, and 20 and loss of 

13q and 17p in breast cancer. • Found chromosomal aberrations in human leukemia, lymphoma, and solid tumors has identified non-random tumor and tumor-stage specific genetic 

changes. This information can guide positional cloning efforts. • Become an important initial screening test for chromosomal gains and losses in 

solid tumor progression, and the results derived from these experiments can be 

applied to the development of more specific diagnostics. 

Visit the Ried Laboratory WebSite for CGH protocols 

Selected CGH References 

• Kallioniemi A, Kallioniemi OP, Sudar D, Rutovitz D, Gray JW, Waldman F, 

Pinkel D Comparative genomic hybridization for molecular cytogenetic analysis 

of solid tumors. Science 258:818–821, 1992 • Heselmeyer K, Schro ̈ck E, du Manoir S, Blegen H, Shah K, Steinbeck R, Auer 

G, Ried TGain of chromosome 3q defines the transition from severe dysplasia 

to invasive carcinoma of the uterine cervix. Proc Natl Acad Sci USA 93:479– 

484, 1996 • Ried T, Liyanage M, du Manoir S, Heselmeyer K, Auer G, Macville M, Schro ̈ck 

E Tumor cytogenetics revisited: comparative genomic hybridization and spectral 

karyotyping.J Mol Med 75:801–814, 1997 • Forozan F, Karhu R, Kononen J, Kallioniemi A, Kallioniemi OP. Genome 

screening by comparative genomic hybridization. Trends Genet 1997 

Oct;13(10):405–9, 1997 

ClinicalTrials.gov 

A service to the U.S. National Institutes of Health 

Linking patients to medical research 

Developed by the National Library of Medicine 

Evaluation of Patients With Unresolved Chromosome Abnormalities 

This study has been completed. 

Sponsored by: National Human Genome Research Institute (NHGRI) 

Information provided by: National Institutes of Health Clinical Center (CC) 

ClinicalTrials.gov Identifier: NCT00001639 

Purpose 

The purpose of this research is to study a new way to test for chromosome abnormalities. Chromosomes are strands of DNA (the genetic material in the cell nucleus) 

that are made up of genes-the units of heredity. Chromosome abnormalities are usually investigated by staining the chromosomes with a dye (Giemsa stain) and examining them under a microscope. This method can detect many duplications and deletions of pieces of chromosomes and is very accurate in diagnosing certain abnormalities. It is not useful, however, for identifying very small abnormalities. This study 

will evaluate the accuracy of a test method using 24 different dyes for finding small 

chromosome abnormalities. 

Children and adults with various chromosome abnormalities may be eligible for 

this study, including, for example, people with developmental delay or mental retardation, abnormal growth features or growth retardation, and certain behavioral disorders. Participants will be evaluated in the clinic over a 1- to 3-day period, depending on their symptoms. All participants will be examined by a genetics specialist 

and will have a physical examination and possibly X-rays, computerized tomography 

(CT) scans, magnetic resonance imaging (MRI), ultrasound studies and medical phoVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00110 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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tography. Blood will be drawn for chromosome testing-about 3 tablespoons from 

adults and 1 to 3 teaspoons from children. 

When the test results are available, participants will return to the clinic for follow-up evaluation and review of the test findings. The genetic and medical evaluations, along with their implications, will be discussed. 

Condition 

Abnormalities 

Failure to Thrive 

Mental Retardation 

Microcephaly 

MedlinePlus related topics: Birth Defects; Developmental Disabilities; 

Facial Injuries and Disorders; Growth Disorders; Head and Brain Malformations 

Genetics Home Reference related topics: Developmental Disabilities 

Study Type: Observational 

Study Design: Natural History 

Official Title: Evaluation of Patients With Unresolved Chromosome Aberrations 

Further study details as provided by National Institutes of Health Clinical Center 

(CC): Total Enrollment: 263 

Study start: December 1996; Study completion: October 2000 

There is a range of genomic aberrations from aneuploidy down to single base pair 

deletions or inserts. Present technology uses microscopic cytogenetics for detection 

of large rearrangements (greater than 2 Mb) and molecular techniques for small rearrangements (less than 2 Mb). There is a gap in practical diagnostic technology in 

that microscopic cytogenetics has poor sensitivity for aberrations less than 5 Mb and 

the molecular techniques are cumbersome for clinical use in the megabase range. 

In many cases it is possible to determine that an aberration is present by microscopic cytogenetics but cannot be characterized. We propose to use Spectral 

Karyotyping (SKY) and supplementary FISH and molecular techniques to characterize these aberrations. Subjects will be seen in OP9 for a clinical genetics evaluation and phlebotomy for SKY. Confirmation of SKY results will be performed by 

standard FISH, genomic content mapping, and other standard techniques. 

Eligibility 

Genders Eligible for Study: Both Criteria 

Physical anomalies or developmental anomalies. 

Karyotype showing derivative chromosome abnormality that is not fully characterized. 

No abnormal parental karyotype. 

No prenatal specimens. 

Probands of all ages, genders, and ethnic origin are eligible. 

The proband must have a non-mosaic abnormal G-banded chromosome analysis 

of good quality that shows one or more derivative chromosomes whose foreign component cannot be determined by standard G-banding techniques. 

The parents should also have G-banded chromosome analysis prior to eligibility 

for consent 2. If this has not been done by the referring physician, it may be done 

as part of the protocol. 

The proband with the abnormal karyotype should have one or more of the following features: dysmorphic features; developmental delay or mental retardation; 

growth retardation, microephaly, short stature or failure to thrive; behavioral disorder 

Biological parents must be willing to supply a blood specimen. If they have any 

of the features listed above, they must attend the clinic if the proband is to be eligible. 

The proband must be evaluated by the NCHGR clinical genetics service by the 

PI, a co-investigator, or his associates. 

Mothers will be queried about potential non-paternity. If non-paternity is possible, 

the family will need to undergo clinical paternity evaluation before they are enrolled 

in the study. 

Location Information 

United States, Maryland 

National Human Genome Research Institute (NHGRI), Bethesda, Maryland, 

20892, United States 


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More Information 

Study ID Numbers: 970045; 97–HG–0045 

Last Updated: July 10, 2006 

Record first received: November 3, 1999 

ClinicalTrials.gov Identifier: NCT00001639 

Health Authority: Unspecified 

ClinicalTrials.gov processed this record on October 03, 2007 

University of Pittsburgh Cancer Institute 

A National Cancer Institute (NCI)-designated Comprehensive Cancer Center 

UNIVERSITY OF PITTSBURGH RESEARCHERS USE ‘‘FISH’’ AND ‘‘SKY’’ 

TO STUDY CHROMOSOMES 

PITTSBURGH, Nov 17, 1997—Using two state-of-the-art technologies, scientists 

at the University of Pittsburgh’s Department of Human Genetics are lighting up 

human chromosomes in a colorful display to easily locate errors that give rise to disease. These technologies are FISH (Fluorescence In Situ Hybridization) and SKY 

(Spectral Karyotyping). 

Each person has 23 pairs of chromosomes, large coils of genetic material. Pitt researchers are probing human chromosomes with FISH and SKY to reveal the tapestry of genes that instruct the body to develop and function properly and to yield 

information that could help biomedical researchers develop sensitive tests to detect 

disease and possibly aid in choosing the best treatments for specific disorders. ‘‘With 

our new FISH and SKY instruments, we can visualize specific genes or chromosomal regions to identify the defects at a fundamental level in a variety of disorders, 

such as what chromosomal changes are associated with the development and progression of a variety of cancers,’’ said Susanne Gollin, PhD, associate professor of 

human genetics at the University of Pittsburgh, where she is the director of the Cytogenetics Laboratory. 

‘‘Already, these technologies are allowing us to detect chromosomal alterations in 

otherwise normal looking cells lining the mouth of patients with oral cancer. These 

alterations identify cells that may grow into new cancers. Using such information, 

we may be able to screen individuals at risk for oral cancer, as well as develop and 

apply much better prevention and treatment strategies,’’ noted Dr. Gollin, who also 

directs the University of Pittsburgh Cancer Institute’s Cytogenetics Facility. Pitt’s 

cytogenetics capabilities are unique in the region. SKY is not available elsewhere 

in the tri-state region, including Pennsylvania, Ohio, and West Virginia, according 

to its manufacturer, Applied Spectral Imaging of Carlsbad, CA. Aside from detecting 

the most subtle chromosomal flaws underlying disease, FISH and SKY can be used 

to learn whether a chromosome has received a new gene delivered as part of a gene 

therapy; track the integration of foreign, disease-causing viruses into chromosomes; 

and assess how anti-cancer drugs alter chromosomes before they kill tumor cells. 

Not only are these technologies more informative when studying abnormal cells 

than standard ways of examining chromosomes (called karyotyping), they are also 

quicker because they combine powerful visualization capabilities with rapid, computerized analysis, according to Dr. Gollin. 

With FISH technology, researchers expose a cell’s chromosomes to fluorescent 

probes made of normal human DNA segments. These probes bind (hybridize) tightly 

to a specific region of a cell’s genetic material. Investigators use FISH to count the 

number of chromosomes and/or copies of a particular gene in a cell and to identify 

unusual regions that are amplified, or present in extra copies. Too few or too many 

chromosomes or gene copies indicate a serious genetic defect in that cell. Using a 

different form of FISH, called comparative genomic hybridization, investigators can 

identify chromosomal regions that are gained or lost in abnormal cells, including 

tumor cells. For instance, researchers can expose human cells to a probe made of 

normal DNA (labeled red) and a probe made of tumor DNA (labeled green). This 

technique enables scientists to learn whether chromosomes have lost a section of 

DNA containing a normal gene that suppresses cancer growth (hence the absence 

of any green) or gained too many copies of a DNA section containing a normal gene 

that drives a cancer’s growth (extra green). 

SKY technology, yet another form of FISH, is used to study more complex changes 

in genetic material because some of the probes it employs are labeled with not one 

but several colors. These multicolored probes bind to the chromosomes. This new 

portrait’s panoply of colors, many of which are similar, cannot be differentiated by 

the human eye, but SKY’s spectral imaging hardware and computer software can 

discriminate even the finest variations in the wavelengths of color (spectra) emitted 


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by each dye or combinations of dyes marking a chromosome. After the SKY instrumentation processes this information, the result is a vivid display. Using SKY, researchers can plainly see the chromosome rearrangements in a cell. Normal chromosomes are each one color. Abnormal chromosomes may be composed of two or 

more different colors, signifying their origination by mixing and matching of two or 

more different chromosomes. Recently, Pitt became the first test site in the United 

States for software-driven remote access to classical and molecular cytogenetic results. CytoNet software and the CytoVision System are produced by Applied Imaging, headquartered in Santa Clara, Cal., with its North American sales office located 

in Pittsburgh. 

‘‘The CytoNet provides novel communications capability,’’ said Dr. Gollin. ‘‘The 

CytoNet is envisioned to serve two currently unmet needs: viewing of clinical cytogenetics results by cytogeneticist consultants or laboratory directors who are offsite 

to obtain professional input or second opinions; and viewing of research results and 

discussion between an investigator and the director of a specialized cytogenetics core 

laboratory, such as the UPCI Cytogenetics Facility. Not all institutions have 

cytogeneticists or cytogenetics laboratories for research applications. This software 

facilitates use of these shared resources by investigators at other institutions.’’ The 

Cytogenetics Facility is funded by the UPCI’s cancer center support grant from the 

National Cancer Institute. Funding for the SKY and CytoVision instrumentation 

was provided by the National Center for Research Resources, National Institutes of 

Health. For additional information about the UPMC Health System or the University of Pittsburgh Cancer Institute, please access the web links. 

UPMC News Bureau 

Attachment 5: Point paper Highlight of Actions needed 

POINT PAPER SUMMARY OF TESTIMONY 

ACTION PAPER FOR ADDRESSING ISSUE OF GULF WAR ILLNESSES 

1. The last benefits law(2000) for Gulf War illness had within the original bill 

not only Chronic Fatigue Syndrome and Fibromylagia but also Neurological 

Autoimmune Diseases/Disorders. Unfortunately the Neurological Autoimmune 

diseases/disorders was removed and now in 2007 we are asking that wording 

to be added. We are asking for a bill to be moved quickly that adds Brain 

Cancers, ALS, and MS to the presumption of service connection for Gulf War 

Veterans. The Brain Cancers and ALS should have no problem since the VA 

has agreed by regulation. We need a bill that is fast tracked to be completed 

this session of congress. We want this done by Law not by VA discretionary 

action. 

2. In regards to legislation in the authorization and appropriations area, the 

congress and senate should follow the Lead of the VA Research Advisory 

Committee on Gulf War Illness and Gulf War Veteran’s Organizations. Just 

yesterday the House Appropriations Committee did not do that and has in effect caused potential detrimental action in the needs of the Gulf War veterans 

community. 

3. VA attitude starts at the top and goes down. The hearing today will show the 

detrimental effect that attitude has caused for 16 years. That attitude has to 

be turned on its head. People within the VA system have directly affected 

tens of thousands no hundreds of thousands Gulf War Veterans in regards to 

the VA Benefits, VA Health Care, and VA Research. It is time now that certain people be removed from their positions for their deliberate misguidance, 

mismanagement, and ill regard to Gulf War veterans needs. 

4. All VA Directives/Policies/Guidance/Contracts must be faced with a Stop 

Order and Investigated. They have led to a Direct Breech of Duty to the Gulf 

War Veterans. 

5. New Directives/Policies/Guidance/contracts must be submitted and reviewed 

by the VA RAC GWI and other congressional Committees before they are officially released. 

6. Dental and Eye Exams must be Mandated for ODS Veterans now. Data that 

must be gathered and shared with the VA RAC GWI and House and Senate 

VA Committees and government Reform Committee. Treatment for Dental 

and Eye conditions should be allowed through the VA for these veterans regardless of VA rating. 

7. VA Outreach and all forms of Communication to ODS Veterans must be started in a robust manner expeditiously. This should include the newest research 


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information and exhibit a new VA attitude a true we are here to serve the 

veteran. 

8. VA physicians and medical personnel must be notified to perform expansive 

lab work measurements to cover: 

A. Immune System Function 

B. Viral Panels 

C. Hypercoagulation Lab work 

D. Thyroid system functions 

E. Adrenal Gland Function 

F. Pituitary Gland Function 

G. Hormonal function 

H. Renal Function 

I. Cardiac Function 

J. Liver Function 

K. Screening Cancer workup labs 

9. Data gathered from lab work needs to be collected and analyzed and sent to 

the Research Advisory Committee and reports on same should be issued on 

the VA Website so that physicians, researchers, and patients alike have the 

information. 

10. Treatment of any abnormalities should be started as soon as results are obtained. 

11. Data on all causes of deaths should be assembled and posted as Data Report 

from the VA on its website. 

12. Data on all Diagnosed illnesses for ODS Veterans must be collected and also 

published on the VA Website. 

13. Two additional advisory Committees similar to the VA RAC GWI in the areas 

of Clinical Care and Benefits should be legislated and should be implemented 

ASAP. 

14. New Clinics should be initiated at each VA Hospital specifically for Operation 

Desert Storm Veterans. The staff should be dedicated and then thoroughly 

brought up to current state of knowledge on relevant physiological based research that has occurred. Then the educational process for Medical staff and 

medical personnel should be expanded rapidly. 

The educational process should involve routine scheduled teleconferences 

and videotape reviews. The Videotaping of Jim Binns, Lea Steele, Beatrice 

Golumb, Dr Roberta Hailey, and Dr Roberta White should be produced and 

distributed ASAP. New tapes with other leading researchers and clinicians 

should follow. 

15. The registry program and environmental agent program should be renewed 

and expanded. The individuals that went thru these registries should be 

brought back in for updating of medical progress, expanded lab work, and any 

other diagnostics. 

16. A proactive aggressive Cancers and Neuro Auto Immune Diseases/Disorders 

Screening Program for Operation Desert Storm Veterans should be legislated 

and implemented ASAP. 

17. A directive should be sent out to all VA hospitals that symptoms suggestive 

of ALS or MS need to have through and complete diagnostic workups done 

regardless of VA Rating. 

18. Anti Aging Board Certified Physicians and Environmental physicians should 

be proactively recruited for contracts with the VA headquarters and VA hospitals to provide consultation and physician education programs immediately. 

19. DOD AND ACTIVE MILITARY SERVICE MEDICAL PROFESSIONALS 

NEED UPDATE TRAINING ON ASSESSMENT OF ENVIRONMENTAL EXPOSURES AND REVIEW OF CURRENT RESEARCH. 

20. New DoD and Service Components guidance and regulations on all environmental exposures need to be initiated. Documentation of potential exposures 

and tracking for active duty needs to be reviewed. Any and all potential 

health affects need to be documented. 

21. DoD must review and update exposure lists to include AF, Navy, and Marine 

units and notify the individuals affected. 

22. Assurance needs to be in place by oversight that DoD Military services are 

recording all vaccines appropriately with lot numbers. 

23. Individuals listed in Exposed areas must be notified by DoD and VA by letter 

of the increase risk of Brain Cancers/ALS. 


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Attachment 6 

Ms. Julie Wilson, United States Department of Veterans Affairs, Illiana VA Medical Center, Danville, Illinois. and to The United States Department of Veterans Affairs, The Inspector General, Washington, D.C. 

The latest nonsense comes from the American Legion. I have confirmed that the 

American Legion sent this out with Mr. Bill Johnson (317–630–1239) from the 

American Legion National Headquarters in Indianapolis, Indiana. Please let all Indiana VA staff and all VA National staff and VA facilities staff members nationwide 

know what was done and that the Legion has absolutely no authority to suspend 

or tell veterans that our benefits have lapsed and then to demand payment of $20 

in check or credit card for reinstatement of benefits. 

I REQUEST FORMAL IMMEDIATE WRITTEN CONFIRMATION FROM THE 

DIRECTOR OF THE ILLIANA VA MEDICAL CENTER AND FROM THE UNITED 

STATES OF AMERICA DEPARTMENT OF VETERANS AFFAIRS SECRETARY 

appointed by the President of the United States that my benefits have not lapsed 

as stated by Mr. Robert Spanogole, National Adjutant, The American Legion, in the 

SIGNED letter THAT I received from the HIM AND THE American Legion on October 2, 2007. ALTHOUGH MR, JOHNSON OF THE AMERICAN LEGION TOLD 

ME THIS WAS A ERROR NEEDLESS TO EXPLAIN I DO NOT TRUST ANYONE. 

The specific—relevant information follows: 

I received a letter on October 2, 2007 from Robert Spanogle, National Adjutant, 

American Legion, National Headquarters, P.O. Box 7017, Indianapolis, Indiana that 

quote: ‘‘This letter is to inform you that benefits you are entitled to as a Veteran 

of the United States Armed Forces have lapsed. 

Through a special reinstatement program, you are being given this opportunity 

to reinstate these important benefits, for which you remain eligible in accordance 

with the enclosed publication 57 ‘‘Veterans Guide to additional Benefits. 

To reinstate your benefits you need only return the enclosed Reinstatement Form 

according to the instructions printed on the form. Please note the reinstatement period designated for your last name at the top of the page of this notice. The absolute 

deadline is 3 pm on the last date shown above. 

(from top of the form), Deadline: November 5, 2007, 3:00 pm ET 

Reinstatement period for veterans with last names beginning R–S September 24– 

November 5, 2007 3:00 PM ET’’ end quote 

The implication is that I must renew my membership in American Legion Post 

71; Urbana, Illinois by November 5, 2007 at 3pm ET by sending them a check for 

$20 made payable to ‘‘The American Legion’’ to reinstate my VETERANS benefits. 

I have TWICE called the American Legion National commander Marty Conaster, 

Champaign, Illinois 217–359–4211 and asked him to call me immediately,. NO RESPONSE! I called the Urbana Post 71 at 367–3121. The Urbana American Legion 

Post 71 officer I spoke to did not know this was sent out on their behalf. He agreed 

this was wrong! He called me back today with an apology. 

THIS IS ABSOLUTE NONSENSE AND PURE INTIMIDATION TO OBTAIN $20 

FROM ME. 

I must ask if any Federal laws were broken if so what must be done? 

I BELIEVE that Mr. Spanogles’s treatment of me as a retired and 60% disabled 

veteran who fights for medical care for all of our veterans and myself is simply unacceptable and deserves a Department of Veterans Affairs censure for scaring not 

only me and my wife but thousands of others who probably received this same letter. We did not sleep well last night and today has been a roller coaster. 

MR. SPANOGOLE’S TREATMENT OF OBVIOUSLY THOUSANDS OF VETERANS WHO ARE SEEKING HELP AND WHO RECEIVED THIS SAME LETTER 

IS A TRAVESTY. 

I suspect that I am only one of many who received this letter. 

I believe that I and all others who received this letter deserve a nationwide public 

apology for this action. 

At the bottom of the letter: 

quote: ‘‘Important; There is no mandate to extend the deadline shown or to offer 

additional periods of reinstatement. do not delay in returning your reinstatement 

form.’’ end quote 

I have absolutely confirmed that the American Legion sent the letter. It is directly 

from the American Legion National headquarters. 

The suspect that this organization is just trying to scare me—us into sending 

them $20 for membership. The membership demand in my case is renewal of my 

membership in American Legion Post 71 in Urbana. I belong did belong to this Post 

but have not renewed my membership because they simply refuse to help us when 

we needed and asked for help. 


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The envelope has return address of: ‘‘The American Legion National Headquarters, Department of Veteran Notification, National Adjutant, P. O. Box 7017 Indianapolis, In. 46207–7017’’ 

The envelope has the huge letters ‘‘Deadline Notice for Veterans of the United 

States Armed Forces to Reinstate Benefits’’ 

the enclosed return envelope has the address: Benefit Reinstatement, c/o the 

American Legion National Headquarters, P.O. Box 7017, Indianapolis, In 46207– 

7017 

The letter says I can reinstate my benefits by visiting www.members.legion.org 

It gave me a temporary membership number of 2022422818. The direct telephone 

number of the American Legion National Headquarters in Indianapolis, in. is 317– 

630–1200. 

Thank you, 

Major Doug Rokke, Ph.D. 

U.S. Army, retired 

Attachment 7 

This is a brief of my experiences. My name is Brent Casey, a Gulf War veteran, 

served as a medic with the 82nd Airborne in 90–91. Sept 05’ I received a letter from 

the DoD which was a unit list released by the Pentagon. These units were exposed 

in and around the Kamisiyah demolition pit in Spring 91’ and my unit (3rd/73rd 

Armor) was on this list. 

Scared to death and already suffering terribly from what I now know is 

fibromyalgia, and never having been to a VA hospital in my life, my family convinced me to go see a VA doctor for a check-up. My first visit resulted in medication 

for hypertension, and 19 19 flagged on a PTSD checklist, and obviously a diagnosis. 

After 6–8 months of PTSD counseling (keep in mind I had never heard of PTSD), 

groups and one-on-one, I discovered a Gulf War exam offered at the hospital and 

I signed myself up for the exam. 

By Sept. 06’ I was diagnosed with fibromyalgia, depression, chronic rhinitis, 

paresthesias, erectile dysfunction, fatigue, hypertension and after 2 sleep studies, 

sleep apnea. In Oct. 06’ in my own research, I discovered a PTSD Residential Rehabilitation Program in Lexington, KY (42-day), I completed the program in Dec. 06’. 

While in Lexington, again through my own research, I discovered the WRIISC in 

New Jersey and started working on a referral from a primary care physician. 

I was accepted into WRIISC for a 2-day very intense work-up and history including, exposure assessment, social work evaluation, psychological assessment, neuropsychological assessment, and complete physical, all with special attention to deployment related concerns of mine. Overall recommendations that I just received 

from WRIISC include but are not limited to: Mr. Casey meets the criteria for the 

unexplained condition of Chronic Fatigue Syndrome, and Mr. Casey meets the criteria for Irritable Bowel Syndrome. I was also tested for DU (24-hr. urine) only after 

my own research and request, it was tested in Baltimore in Nov. 06’ and supposedly 

the results are normal and I will not have any adverse consequences. 

Anyhow, it is now exactly 2 years later—and to say the least I am still blown 

away—but I do have a few answers to some of my questions. I have an agent who 

is helping me with my claim, but I’m still not sure if I am coming or going. I had 

5–6 Dr. appt. last month and have about that many so far to keep up with in Oct. 

(Mental health, Rheumatology, PTSD Groups, Primary care and labs an EENT referral, and Physical medicine specialist referral, and an ophthalmology referral, so 

my healthcare is a full-time job. I have had a MRI, CT-scan, EMG, Sperm/fertility 

test, C–PAP machine nightly, CXR, and numerous blood tests of coarse. I hope this 

is appropriate information for your compilation and I would love to help any way 

that I can. Feel free to call me to discuss anything that will help you. 

Sincerely, 

Brent Casey 

Attachment 8 

I am increasingly frustrated. . . . I am asking veterans of Desert Storm to write 

and tell us of your discoveries that could help others re diagnosis findings . . . what 

was found, who tested, how others can get the same. . . . 

Treatment . . . what have you found? Who got you there? Where can other vets 

get it? 

And most of all 


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How is your quality of life . . . what have you managed to do re education, work, 

family HORRIBLE! Everyone is SICK! 

How are your spouses and children? What has been found on their medical condition that could help other veterans? My only child (M–31,has degenerative joint disease and its eating away at him, he has high b/p, and his teeth are just wearing 

away, they aren’t rotting??? Just crumbling?? My wife same thing with her teeth, 

and she hurts all the time and again, they just try and pass it off as diabetic, and 

its FREAKING NOT! 

How has your testing and treatment been at the VA? NO, I have been blown off 

by them for yrs. said it was all in my head! (yah it is I have seizures). 

Have you found civilian help? Where and who should veterans contact . . . which 

doctors? HAH your joking right! NO ONE WANTS TO HELP US, we are just waiting to die. 

How many are having significant dental problems? YES! root canals, and got tired 

of that rout and just having them pulled out now. 

How many have had hearing tests that show ototoxicity? NO TEST, but my hearing isn’t great anymore and my ears hurt a lot. and they just say old age *54 yr 

old. 

How many are experiencing increasing vision problems? Yes and had surgeon to 

correct it, and now find I have cataract forming anyway. 

Are you having thyroid, hormone problems, cardiac, renal conditions? Are they 

being tested for? By who? Are you being treated for these? Again, never tested for 

anything and just tired of being blown off and told its all our own fault for, thinking 

we feel ill. 

Like I said, we are just waiting to die, figure its got to be better than the hell 

we are living in now. 

Tom Daggett 10 yrs U.S. Army 54 and also FED UP 

f 

Committee on Veterans’ Affairs 

Subcommittee on Health 

August 2, 2007 

Meryl Nass, M.D. 

Mount Desert Island Hospital 

Box 8 

Bar Harbor, ME 04609 

Dear Meryl: 

In reference to our Subcommittee on Health hearing on ‘‘Gulf War Exposures’’ 

held on July 26, 2007, I would appreciate it if you could answer the enclosed hearing questions by the close of business on October 2, 2007. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for materials for all full and Subcommittee hearings. Therefore, we would 

appreciate it if you would provide your answers consecutively and single-spaced. In 

addition, please restate the question in its entirety before the answer. 

Please provide your response to Cathy Wiblemo at the Committee. If you have any 

questions, please call 202–225–9154. 

Sincerely, 

MICHAEL H. MICHAUD 

Chairman 

1. Gulf War Illnesses—Everyone on this panel agrees that Gulf War Illnesses 

are real and that more should be done by way of research, outreach and treatment. 

• In your professional estimation, what is the biggest challenge facing VA today 

with regard to Gulf War Illnesses? 

For at least 10 years, the personnel in place to implement Gulf War Illness programs have prevented good research, good diagnostics and good treatments for Gulf 

War veterans. A group of individuals at VA have had control over research, outreach and treatment, and these officials have ensured that the focus of both research and treatment has been primarily psychological. The medical evaluation 

strategies adopted by the VA have specified that investigations of veterans’ sympVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00117 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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1http://www.thenation.com/doc/20071015/kors Joshua Kors. Specialist Town Takes His Case to 

Washington. The Nation. September 27, 2007. 2http://www.gao.gov/new.items/d071256t.pdf DOD and VA: Preliminary Observations on Efforts to Improve Health Care and Disability Evaluations for Returning Servicemembers. GAO– 

07–1256T, September 26, 2007. Pages 19–22 cover the data sharing issue. 3 Hope Yen. GAO Again Slams VA and DoD for Failing to Care for Wounded Iraq War Veterans. AP/Army Times September 27, 2007. ‘‘The report said the Pentagon and VA still remain 

far away from having a comprehensive system for sharing medical records as injured veterans 

move from facility to facility.’’ 

toms be limited, and the recommended treatment strategies have primarily used 

psychiatric drugs. However, I must assume that these individuals have carried out 

VA policy, since there is no evidence they were instructed to do otherwise. Unless 

and until VA policy aligns with the goal of doing our best for GW veterans, things 

cannot change. 

A true story: in 1999, a Committee on government Reform staffer told me that 

the reason Gulf War veterans were being diagnosed and treated for psychiatric illnesses was because disability pensions could be limited to 2 years more easily than 

if they were acknowledged to have physical illness. I cannot confirm if this is true, 

but it may be relevant to the question of why VA made the choices it did regarding 

GW research and patient care. Recent revelations about the use of ‘‘personality disorder’’ diagnoses 1 by the Army to discharge veterans without a medical board or 

pension suggest that these choices have been deliberate. 

• What would your recommendations be to VA to ensure that what has happened 

to the Gulf War veterans does not happen to the newest generation of veterans 

returning from OEF/OIF? 

At the Senate Veterans Affairs Committee hearing where I testified on Sept. 25, 

2007, DoD’s representative, Michael Kilpatrick, M.D., stated in answer to a question 

that ‘‘15–20% of those who’ve fought in Iraq recently are returning with ‘‘’ill-defined’ 

medical symptoms, Kilpatrick said.’’ (McClatchey-Tribune, Sept 26) Later Kilpatrick 

told a reporter he did not mean to imply they all had GWS. 

It should be a concern to all of us that DoD has already identified a developing 

medical problem in a significant number of returning soldiers. 

In order to provide optimal care to OIF and OEF veterans, VA needs to know the 

types and severity of medical conditions these veterans face, and their frequency. 

An accurate needs assessment cannot be made without reliable information from 

DoD to VA. Media reports suggest VA relies on information from military medical 

boards, but note that many veterans whose status should prompt a medical board 

are not going through the board process. How has this affected VA planning? 

Therefore, since information supplied by DoD on the health of troops has not always been accurate and complete, VA should be performing its own surveillance of 

new veterans, in order to best predict the medical needs of returning soldiers. 

New entrants to the VA system should complete a detailed questionnaire and 

evaluation by practitioners who are knowledgeable about the physical and psychological needs of veterans returning from combat. Creating a database from these assessments could help to prepare further investigations and treatments for returning 

troops, and identify those who have developed chronic medical conditions for specialized care. 

Congressional oversight should address VA’s programs for dealing with the 15– 

20% of troops with ill-defined conditions identified by Dr. Kilpatrick, as these veterans are most at risk of slipping through the cracks in the way that happened to 

veterans with Gulf War Illnesses. 

2. DoD/VA—Getting accurate, up-to-date information on pre-deployment and 

post-deployment health records, where service members were located and other 

pertinent information from DoD, has, in the past, been characterized as difficult. 

• Do you believe that this exchange of information between VA and DoD has improved with current deployments to Afghanistan and Iraq? 

Regarding whether things have improved, I can only refer to the GAO report of 

September 26, 2007: 2,3 DoD and VA: Preliminary Observations on Efforts to Improve Health Care and Disability Evaluations for Returning Servicemembers. See 

pages 19–22. 

http://www.gao.gov/new.items/d071256t.pdf 

Clearly, information exchange is not where it should be. 

My experience has been that DOD jealously guards information on the health of 

troops. Spokespersons have not always reported accurately to media on this issue, 


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4 Christoffer Johansen and Jorgen H. Olsen. Mortality from Amyotrophic Lateral Sclerosis, 

Other Chronic Disorders, and Electric Shocks among Utility Workers. American Journal of Epidemiology Vol. 148, No. 4: 362–368. ‘‘The excess mortality from amyotrophic lateral sclerosis 

seems to be associated with above-average levels of exposure to electromagnetic fields and may 

be due to repeated episodes with electric shocks.’’ http://aje.oxfordjournals.org/cgi/content/abstract/148/4/362 5 ELF Electromagnetic fields and neurodegenerative disease. Report of an advisory group on 

non-ionising radiation. National Radiological Protection Board, 2001. 12(4).http:// 

www.hpa.org.uk/radiation/publications/documents_of_nrpb/pdfs/doc_12_4.pdf 

and military medical studies are frequently at odds with independent research on 

the health of troops. The Congressionally mandated Defense Medical Surveillance 

System database is being maintained, but the data are not shared with independent 

researchers, despite Federal advisory Committee recommendations. The data are 

only 80–90% accurate, according to GAO, CDC and the Navy Environmental Health 

Center in San Diego. Presumably, more effort could be made to improve the accuracy of the database. Congress could require that data be shared. 

Unpublished studies of the database are not shared either. Accompanying this response, I have included two lists, obtained via Freedom of Information Act requests, 

of titles of informal studies performed by the Army Medical Surveillance Activity, 

which used this database for the studies. I have so far been unable to obtain any 

of the actual studies from the Army (using FOIA). Many of these studies, especially 

those on GWS and on anthrax vaccine, should be of interest to the Congress and 

the VA. 

[One list appears at the end of these responses and the other list is being 

retained in the Committee files.] 

• In your professional opinion, would you say the lack of information exchange or 

delayed exchange was a primary factor in hindering research efforts regarding 

Gulf War Illnesses? 

Yes. Procedures for investigating and dealing with toxic exposures could have 

been initiated, appropriate infections sought, etc., had VA been aware of the types 

of exposures that had been experienced by individual veterans when they first arrived in the VA system. The lack of good information from DOD made it very difficult to study most of the Gulf War exposures, since without accurate information 

it was uncertain who was exposed to what, and the magnitude of the exposures. The 

problem is only partly one of information exchange; it is uncertain whether DOD 

monitored and recorded noxious exposures to which its soldiers were exposed. This 

includes exposures to sarin, to unvented tent heaters, to vaccines, pyridostigmine 

bromide (PB) and depleted uranium. Thus the later research had to rely on so-called 

‘‘self-reports’’ of exposures—but the research was also criticized for using these 

unvalidated reports. 

However, the main factor that hindered good Gulf War illness research after the 

immediate post-war period was the lack of will to do so, shared by VA and DOD. 

3. ALS—Mr. Mikolajcik proposed in his testimony that a congressionally directed 

ALS Task Force should be established to help provide direction in ALS research and to develop a strategic plan to tackle this illness. The 30- 60- 90- 

day timeline he suggested in his testimony lays out some structural parameters. 

• What are your thoughts on creating another task force or entity to look into 

ALS? 

A task force is a good way to review the problem and recommend directions to 

pursue. However, the value of a task force is totally dependent on its chairman, 

members and staff. It also needs to be given unfettered access to data, and the 

power to have its recommendations carried out in a meaningful way. 

For example, exposure to electromagnetic fields has been linked to ALS in a number of studies.4 In order to pursue this link most productively, information on the 

electromagnetic fields generated by DOD weapons, communications systems and 

other equipment would need to be known, and the exposures in different groups of 

soldiers identified. It is unlikely that DOD would cooperate in providing these data. 

In order to avoid reinventing the wheel, it should be noted that in 2001, a UK 

(government) expert panel made some research recommendations about ALS and 

electromagnetic fields: 5

‘‘Case-control studies are, however, appropriate for investigating the aetiology of 

amyoptrophic lateral sclerosis and, in view of the rarity of the disease, are generally 

preferred to cohort studies. A large-scale case-control study might, therefore, be 

profitably undertaken in which special enquiries were made about: 


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1. employment in electrical occupations, with special reference to the occurrence 

of severe electric shocks. 

2. medical treatment with electroconvulsive therapy that could be confirmed from 

hospital records. 

3. exposure to transcranial magnetic stimulation (Walsh and Cowey, 1998), a 

technique for magnetic induction of neuronal activity in small brain volumes, 

which is used both experimentally and clinically. 

More work is needed to explore the effects of electromagnetic fields on neurons 

and glial cells. In particular, the effects of both brief explicit shock and prolonged 

exposure to electromagnetic fields on intracellular Ca2+, superoxide dismutase 

(SOD) activity and enzyme function in neurons deserve particular attention.’’ 

• Do you believe that the direction VA is taking with ALS is the right way? 

I cannot comment. ALS has been one disease that has been associated with 1991 

Gulf War service. We do not know how many more diseases may also be associated, 

as the (relatively simple) epidemiological research to study this has not been done 

by VA and DOD. 

4. Where Do We Go From Here—Sixteen years have passed and veterans of the 

Gulf War are still fighting to be recognized and not forgotten. 

• What would your recommendations be on how to effectively move forward with 

Gulf War Illnesses research, outreach, education and treatment? 

As I was preparing my responses to these questions, the Senate Veterans Affairs 

Committee asked me to provide testimony on Gulf War Illnesses. My response is 

included in that document, which I am attaching. 

[The Senate Committee on Veteran’s Affairs testimony appears at the end 

of this document.] 

Accountability for program success is crucial to the effort, and Congress should 

demand regular reports on the Gulf War Illness program. 

5. Gulf War Syndrome—Dr. Nass, you acknowledged that symptoms of Gulf 

War Syndrome are not unique and that they overlap closely with other diseases, conditions and syndromes. 

• Can you please describe the health effects of a typical case of Gulf War Syndrome? 

• How do you treat a patient suffering from Gulf War Syndrome? 

[The response to these questions are contained in the Senate Committee 

on Veteran’s Affairs testimony, which appears at the end of this document.] 

6. Research—Dr. Nass, you said that the research to determine the extent of 

which the anthrax vaccine may have contributed to Gulf War Illnesses has 

simply not been done. 

• Based on my practices and studies, do I believe there is a connection (between 

anthrax vaccine and Gulf War Illnesses)? 

There is no doubt about their connection, which has been identified in at least 

6 different studies. What I was trying (clumsily) to say in my testimony was that 

the magnitude of the anthrax vaccine contribution to Gulf War Illnesses was not 

known. In other words, we do not know what percentage of cases might be due to 

anthrax vaccine alone, though we do know the vaccine alone has caused an illness 

identical to GWS in non-deployed soldiers. (Even the FDA-approved label for anthrax vaccine lists GWS, as defined by CDC, as a reported adverse reaction.) In my 

opinion, anthrax vaccine added to the burden of toxic exposures faced by soldiers 

in the Gulf and increased the number of soldiers who developed chronic illnesses. 

Many soldiers who never received anthrax vaccine became ill, but receiving the vaccine almost certainly increased one’s risk of developing GWS. 

Meryl Nass, M.D. 

September 30, 2007 

LISTS OF TITLES OF INFORMAL STUDIES PERFORMED BY THE ARMY 

MEDICAL SURVEILLANCE ACTIVITY 

21JAN05 BURDEN OF HIV, HEP C, COLORECTAL CA DISEASE IN ALL 

BENEFICIARIES/MTF ONLY (TRICARE MGT ACTIVITY) 


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6DEC99 BOSNIA AND SWA ANTHRAX VACCINATIONS (OSD) 20DEC99 ANTHRAX IMMUNIZATIONS FOLLOW–UP (OTSG) 

4JAN00 SERUM FROM SWA VETS (AFMOA) 

5JAN00 ANTHRAX VACCINE AND THYROID DISEASE (AFMOA) 

5JAN00 ANTHRAX VACCINE AND GUILLAIN BARRE SYNDROME (AFMOA) 

15FEB00 POTENTIAL ANTHRAX OUTCOMES (OTSG) 

1MAR00 ANTHRAX VACCINATIONS BY LOCATION (CDC) 

3MAR00 ACUTE LEUKEMIA AND ANTHRAX VACCINE OTSG TIMING NOTICED LEUK PROB AFTER AVA INITD 

16MAR2000 POSSIBLE ANTHRAX IMMUNIZATION–RELATED NEOPLASMS 

24MAY00 CRUDE RATES OF AMBULATORY VISITS BY ANTHRAX STATUS 

(AFMOA) 

31MAY00 POSSIBLE RISK FACTORS FOR REPORTING ADVERSE REACTIONS TO ANTHRAX VACCINE (OTSG) 

1JUN00 PREGNANCY OUTCOMES FOLLOWING ANTHRAX VACCINATION 

(OTSG) 

13JUN00 SUMMARY OF OTHER VACCINES RECEIVED THE SAME DAY AS 

ANTHRAX (ANTHRAX VACCINE PROGRAM) 

14JUN00 SAME DAY IMMUNIZATIONS (AMSA) 

21JUN00 PREGNANCY OUTCOMES RELATIVE TO ANTHRAX VACCINATION 

(AMSA) 

6SEP00 ANTHRAX RISK FACTORS PART 2 (OTSG) 

16OCT00 BREAST CANCER AND ANTHRAX VACCINATIONS (OTSG) 

6NOV00 ANALYSIS OF SIDR–EIDS DATABASE (AMSA) 

6NOV00 INCIDENCE ANALYSIS OF ANTHRAX VACCINE AND POTENTIAL 

ADVERSE EVENTS (OTSG) 

1DEC00 ANTHRAX QUARTERLY REPORT 

12MAR01 ANTHRAX REPORT FOLLOW–UP QUESTIONS (OTSG) 

19MAR01 VARICELLA RATES, 1995–1999 (OTASG) 

27MAR01 NUMBER OF VACCINATIONS BY YEAR AND SERVICE (OTSG) 

8MAY01 APRIL ANTHRAX REPORT (AMSA) 

5JUL01 JULY ANTHRAX/BIRTHDAY ANALYSIS (AMSA) 

11JUL01 ANTHRAX QUARTERLY REPORT CODE (AMSA) 

30JUL01 JULY ANTHRAX REPORT(AMSA) 

5SEP01 ANTHRAX ANTIBODIES SERUM STUDY (AMSA) 

21SEP01 ANTHRAX REPORT FOR INSTITUTE OF MEDICINE (SPECIAL 

ISSUE) (OTSG) 

26OCT01 POOL OF CASES FOR ANTHRAX SERUM STUDY (AMSA) 

7JAN02 ANTHRAX VACCINATIONS IN DOD BY MONTH (USUHS) 

5FEV02 ANTHRAX VACCINATION DATASET (otsg) 

14FEB02 VARICELLA COUNTS AND RATES IN AD SOLDIERS—RECRUITS 

AND NONRECRUITS (CHPPM) 

22FEB02 FOLLOW–UP TO ANTHRAX SERUM STUDY (WRAIR) 

26FEB02 ANTHRAX IMMUNIZATION DATA REVISITED (OTSG) 

7MAY02 AD ARMY WOMEN WITH ANTHRAX VACCINE (AMSA) 

8MAY02 OHO—DEPLOYMENT HEALTH OUTCOMES ANALYSIS (AMSA) 

8MAY02 QA IMMUNIZATION DATA (AMSA) 

16JUL02 BALANCED SCORECARD C1C ANTHRAX IMMUNIZATIONS COMPLIANCE (USACHPPM, ATTN: MCHB–TS-EDE) 

19JUL02 DESCRIPTIVE STUDY OF CELLULITIS AMONG U.S. ARMED 

FORCES, 

1998–2001 (MSMR) 

29JUL02 DEPLOY FORMS WITH EXPOSURE DATA (USUHS) 

5AUG02 PENTAGON DATASET (WRAMC) 

8AUG02 ANTHRAX IMMUNIZATION SERUM STUDY (WRAIR) 

30AUG02 SLEEP DISORDERS (AMSA) 

23SEP02 RE–RUN VA ANNUAL REQUEST FOR DATA ON BOSNIA/KOSOVA 

VETERANS (VA) 

15APR03 30 DAY SERUM FOR SMALLPOX VACCINEES (EXEC SECRETARY, AFEB)16APR03 SUMMARY OF ANTHRAX TOPICS FOR FDA/CDC 

LIST (CDC) 

16APR03 LIVE BIRTHS AND STILLBORNS IN AD WOMEN (FORSCOM) 

24APR03 SMALLPOX VACCINATION SURVEILLANCE FOR ADVERSE 

EVENTS (AVIP AGENCY) 

1MAY03 GAO DEPLOYMENT INFO (N=277) (GAO) 

6MAY03 AGE DISTRIBUTION OF SMALLPOX VACCINEES WITH SERUM 

SAMPLES BEFORE AND 7–21 POST (EXEC SEC, AFEB) 


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6MAY03 VITAMIN D (ASSOCIATED WITH MS STUDY) (HARVARD SCHOOL 

OF PUBLIC HEALTH) 

27MAY03 FOLLOW–UP OF SUMMARY OF ANTHRAX TOPICS FOR FDA/CDC 

LIST (CDC) 

9JUN03 SMALLPOX VACCINATION SURVEILLANCE FOR ADVERSE 

EVENTS (MSMR) 

10JUN03 UPDATE OF HEART DIAGNOSES FOR SMALLPOX (OTSG) 

18JUN03 PENTAGON SURVEY OF DE–IDENTIFIED DATA (USACHPPM) 

1JUL03 AVAILABLE SERUM AMONG ANTHRAX VACINEES (VACCINE 

HEALTHCARE CENTER) 

15AUG03 VACCINATION FOR ANTHRAX/SMALLPOX AND 3RD PERSCOM 

(OTSG, POPM) 

21AUG03 CONCOMITANT VACCINATIONS RECEIVED WITH SMALLPOX 

VACCINATION (AVIP AGENCY) 

21AUG03 CONGESTIVE HEART FAILURE AMONG SMALLPOX 

VACCINEES—BEFORE AND AFTER (AMSA) 

11MAY04 PEMPHIGUS AUTOANTIBODIES AND ANTHRAX/SMALLPOX VACCINATION (WRAMC) 

23JUN04 PEMPHIGUS/ANTHRAX VACCINE SERUM STUDY—GROUP 3 

(WRAMC) 

23JUN04 PEMPHIGUS/ANTHRAX VACCINE SERUM STUDY—GROUP 1 

(WRAMC) 

20SEP04 ANTHRAX SERCONVERSION IN AD, BY SERIES SCHEDULE COMPLIANCE (WRAIR DIV OF PM) 

19DEC05 PEMPHIGUS/ANTHRAX VACCINE SERUM STUDY—GROUP 2 

(SMALLPOX) (WRAMC) 

29DEC05 AIR FORCE—YELLOW FEVER VACCINE (YFV) ADVERSE EVENTS 

(UPDATED ICD–9 CODES) (USUHS) 

29DEC05 ARMY, NAVY, MARINE YELLOW FEVER VACCINE ADVERSE 

EVENTS (UDPATED ICD–9 CODES) (USUHS) 

4JAN06 MARINE CORPS OIF Q FEVER SEROCONVERSTION STUDY 

(FDPMU–WEST) 

11JAN06 COUNTS OF INFECTIOUS DISEASES FOLLOWING DEPLOYMENT 

(CHPPM PAO) 

17JAN06 MUMPS CASES PRE–AND POST–DX SERUM (MILVAX) 

8MAR06 AIR FORCE DD2796 COMPARISON TO HOGE JAMA PAPER (WRAIR) 

Gulf War Illnesses 

Testimony to the Senate Veterans Affairs Committee 

September 25, 2007 

Meryl Nass, MD 

Mount Desert Island Hospital 

Bar Harbor, Maine 04609 

207 288–5081 ext. 220 

http://anthraxvaccine.blogspot.com 

http://www.anthraxvaccine.org 

Thank you very much for your invitation to discuss Gulf War Illnesses and ideas 

for improved research and treatment of affected veterans. I practice general internal 

medicine, have a background in bioterrorism, anthrax and vaccine injuries, and 

have conducted a clinic for Gulf War (GW) veterans and others with multi-symptom 

syndromes (fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivity) 

since 1999. 

Because so much confusion and controversy has surrounded this illness, I thought 

it would be helpful to discuss persisting issues using a question and answer format, 

while reviewing recent literature on Gulf War Illnesses. I hope to clarify what is 

already known, as well as what needs to be known in order to provide the best 

treatment to affected veterans. I will then discuss my treatment approaches. I use 

the terms Gulf War Illnesses (GWI) and Gulf War Syndrome (GWS) interchangeably. 

1. What is Gulf War Syndrome? 

As early as 1993, Senator Donald Riegle’s staff produced a report that said, ‘‘Over 

4,000 veterans of the Gulf War suffering from a myriad of illnesses collectively labeled ‘‘Gulf War Syndrome’’ are reporting symptoms of muscle and joint pain, memory loss, intestinal and heart problems, fatigue, running noses, urinary urgency, diVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00122 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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1Staff report to Senator Donald Riegle. Gulf War Syndrome: The case for multiple origin 

mixed chemical/biotoxin warfare related disorders. September 9, 1993. 2Donta ST, Clauw DJ, Engel CC Jr et al. Cognitive behavioral therapy and aerobic exercise 

for Gulf War veterans’ illnesses: a randomized controlled trial. JAMA. 2003 Mar 

19;289(11):1396–404. 3Steele L. Prevalence and patterns of Gulf War illness in Kansas veterans: association of 

symptoms with characteristics of person, place, and time of military service. Am J Epidemiol. 

2000 Nov 15;152(10):992–1002. 4Fukuda, K. et al. Chronic Multi-symptom Illness Affecting Air Force Veterans of the Gulf 

War. JAMA 1998; 280: 981–988. ‘‘. . . a case was defined as having 1 or more chronic symptoms 

(more than 6 months) from 2 of the following categories: fatigue; mood and cognition; and musculoskeletal.’’ 5Simmons R, Maconochie N, Doyle P. Self-reported ill health in male UK Gulf War veterans: 

a retrospective cohort study. BMC Public Health. 2004 Jul 13;4:27. 6Toomey r, Kang HK, Karlinsky J et al. Mental health of U.S. Gulf War veterans 10 years 

after the war. Br J Psychiatry 2007; 190: 385–93. 7Gronseth GS. Gulf War syndrome: a toxic exposure? A systematic review. Neurol Clin. 2005 

May;23(2):523–40. 8Thomas HV, Stimpson NJ, Weightman AL et al. Systematic review of multi-symptom conditions in Gulf War veterans. Psychol Med 2006; 36: 735–47. 9 Ibid. 

10 Baraniuk JN, Casado B, Maibach HA. Chronic Fatigue Syndrome—related proteome in 

human cerebrospinal fluid. BMC Neurol. 2005 Dec 1;5:22. 

arrhea, twitching, rashes and sores.’’ 1 In 1998 CDC developed a case definition of 

the illness, which omits some common symptoms, but confirms the illness Riegle’s 

staff identified, and provides clinicians with a reasonable basis for diagnosing veterans and starting treatment. So there is a long, well-documented history of the reality of this illness. 

Yet many physicians are unaware of the CDC case definition, and have been bamboozled by the media into thinking Gulf War Illnesses either do not exist, are psychosomatic or a result of stress. Surprisingly, this includes physicians at VA facilities who care for affected patients. This widespread ignorance is compounded by the 

VA treatment guidelines (posted on the VA website for clinicians), which emphasize 

the use of psychotropic medications and cognitive behavioral therapy, although the 

science to support this is exceedingly weak.2

An estimated 200,000 1991 Gulf War veterans (25–30% of all deployed veterans) 

and some vaccinated, nondeployed Gulf ‘‘era’’ veterans suffer from illnesses related 

to their service,3 and have been awarded partial or full disability benefits by the 

VA. Although the signs, symptoms and severity of illness vary considerably between 

affected veterans, the combination of symptoms known as ‘‘Gulf War Syndrome’’ 

probably affects most of the 200,000 veterans who are ill. 

Their symptoms are not confined to the CDC’s defining triad of musculoskeletal 

pain, fatigue and cognitive and/or emotional disturbance.4 Their medical conditions 

have been variously described in different studies. For example, one UK study found 

that Gulf War veterans were 20 times as likely as other veterans to complain of 

mood swings, 20 times as likely to complain of memory loss and/or lack of concentration, and 5 times as likely to complain of sexual dysfunction.5 It is my opinion that 

the increased mental disorders reported in GW veterans 6 reflect central nervous 

system (brain) dysfunction, manifested in a variety of ways. 

Furthermore, some affected veterans have developed anxiety and/or depression as 

a result of their loss of function, as well as frustration resulting from the lack of 

validation of their illnesses by DOD, VA and civilian health providers, and failure 

to receive beneficial treatment. Many veterans have endured the suspicion of military superiors and colleagues, friends and family that they are malingering, a result 

of the mediocre level of much popular and professional discourse about this illness. 

2. Can we make medical sense of the multiple symptoms that occur in Gulf 

War veterans? 

According to Gronseth, ‘‘Although an objective marker to GWS would be useful 

for studies, the absence of such a marker does not make the syndrome any less legitimate. . . . The real debate surrounding medically unexplained conditions is not 

whether or not they exist, but defining their cause.’’ 7

Many patients with GWS meet criteria for other medically unexplained conditions, also known as multi-symptom syndromes, such as chronic fatigue syndrome,8

fibromyalgia, and multiple chemical sensitivity.9 These conditions are poorly understood, but have a very similar pattern of symptoms and findings as GWS. Some underlying mechanisms have been shown to be the same as well.10

An important VA study in which 1000 deployed 1991 Gulf War and 1000 nondeployed Gulf era veterans were carefully examined 10 years after the Gulf War, 

found that deployed veterans were 2.3 times as likely to have fibromyalgia, and 40.6 


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11 Eisen SA, Kang HK, Murphy FM et al. Gulf War veterans’ health: medical evaluation of 

a U.S. cohort. Ann Intern Med 2005; 142: 122. 12Weisskopf MG, O’Reilly EJ, McCullough ML et al. Prospective study of military service and 

mortality from ALS. Neurology 2005;64(1):32–7. 13 Haley RW. Excess incidence of ALS in young Gulf War veterans. Neurology. 2003 Sep 

23;61(6):750–6. 14http://members.aol.com/vetcenter1/donnelly.htm 15Steele L. Prevalence and patterns of Gulf War illness in Kansas veterans: association of 

symptoms with characteristics of person, place, and time of military service. Am J Epidemiol. 

2000 Nov 15;152(10):992–1002. 16Data DOD shared with the Institute of Medicine in 2001: http://merylnass.googlepages.com/ 

AMSAtitlepage.pdf http://merylnass.googlepages.com/AMSAHeartattackdata.pdf 17Ozakincy G, Hallman WK and Kipen HM. Persistence of symptoms in veterans of the First 

Gulf War: 5-year followup. Environ Health Perspectives 2006; 114: 1553–7. 18 Blanchard MS, Eisen SA, Alpern R et al. Chronic multisymptom illness complex in Gulf 

War 1 veterans 10 years later. Am J Epidemiol 2006; 164: 708–9 

times as likely to have chronic fatigue syndrome as nondeployed era veterans,11 confirming a relationship between these conditions and GWS. 

3. Does the CDC case definition identify all deployment-related illnesses in 

Gulf War veterans? 

No. We know ALS (amyotrophic lateral sclerosis or Lou Gehrig’s disease) occurs 

twice as often in GW vets as in the civilian population, but it also occurs 50% more 

often in soldiers in general.12 The military exposures leading to these increased ALS 

rates are unknown. 

Possible reasons ALS has been studied more carefully in GW veterans than other 

illnesses, are that a) veterans develop the illness at a younger age than the civilian 

population,13 b) Congressional testimony by affected, now deceased Gulf War veteran Michael Donnelly in 1997 gave the illness visibility,14 and c) ALS only affects 

a small number of people. 

Chronic diarrhea is another illness commonly seen in GW veterans, but it is not 

included in the CDC’s case definition. GW veterans have developed a variety of 

other medical illnesses. What we still don’t know is whether there are, for instance, 

more heart attacks in deployed GW veterans than there would have been, had they 

not deployed. The research is contradictory on whether various illnesses occur more 

often in Gulf War veterans, although several studies list a large number of symptoms that are seen more commonly in GW veterans. 

4. Why don’t we know whether deployed veterans have more illnesses (like 

heart attacks) than they would have otherwise? 

The results of research depend on the methods used to investigate the research 

question. Epidemiological research is limited to evaluating a statistical relationship 

between an exposure and an illness. But statistically significant relationships occur 

for many reasons other than cause and effect. Thus, statistics alone cannot prove 

cause and effect. Only when all other factors that can bias the result have been 

taken into account, will the results be reliable. Here is one example of why some 

Gulf War research results may be contradictory: 

As Steele 15 showed, many nondeployed Gulf ‘‘era’’ veterans were given vaccinations in preparation for deployment, and these vaccinated ‘‘era’’ veterans reported 

multi-symptom illness at 3 times the rate of unvaccinated, nondeployed ‘‘era’’ veterans. 

According to the military’s Defense Medical Surveillance System (DMSS) raw 

data, soldiers vaccinated with anthrax vaccine have heart attacks at a greater rate 

than prior to vaccination.16 Thus, if deployed veterans are compared to a nondeployed group, of whom many received deployment vaccines, determining whether 

deployed veterans have more heart attacks than expected is confounded (made unreliable) by the nondeployed group’s vaccinations. 

Military and VA health databases have not been made available to independent 

researchers to study. 

5. Has the health of Gulf War veterans improved over time? 

Veterans who developed this syndrome have, for the most part, remained ill.17

Ten years later, one study found that 29% of deployed veterans had chronic, multisymptom illness.18

6. Do GW veterans die at a higher rate? 

Three studies have demonstrated that GW veterans had an approximately 50% 

greater risk of accidental deaths, particularly from motor vehicle accidents. Although this has been attributed to elevated risk-taking behavior in deployed GW 


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19Levine PH, Young HA, Simmens SJ et al. Is testicular cancer related to Gulf War deployment? Evidence from a pilot population-based study of Gulf War veterans and cancer registries. 

Mil Med 2005: 170: 149–53. 20Steele L. Op. cit. 21GAO–04–821T. June 1, 2004: ‘‘The modeling assumptions . . . were inaccurate because they 

were uncertain, incomplete and nonvalidated.’’ ‘‘DOD and VA’s conclusions about no association 

between exposure to CW agents and rates of hospitalization and mortality . . . cannot be adequately supported because of study weaknesses.’’ 22Mahan CM, Kang HK, Dalager NA Anthrax vaccination and self-reported symptoms, functional status, and medical conditions in the National Health Survey of Gulf War Era Veterans 

and Their Families. Ann Epidemiol. 2004 Feb;14(2):81–8. 23Kelsall HL, Sim MR, Forbes AB et al. Symptoms and medical conditions in Australian veterans of the 1991 Gulf War: relation to immunisations and other Gulf War exposures. Occup 

Environ Med. 2005 Mar;62(3):142–3. ‘‘More than 10 years after the 1991 Gulf War, Australian 

veterans self-report all symptoms and some medical conditions more commonly than the comparison group. Further analysis of the severity of symptoms and likelihood of the diagnosis of 

medical conditions suggested that these findings are not due to over-reporting or to participation 

bias.’’ 24 Barrash J, Denburg NL, Moser DJ et al. Credibility of neuropsychological performances of 

Persian Gulf War veterans and military control subjects participating in clinical epidemiological 

research. Mil Med 2007; 172: 697–707. 

soldiers by some, others (including myself) suspect it is at least partly related to the 

cognitive problems faced by GW veterans, particularly their difficulties with attention and concentration. 

One study found that testicular cancer rates were increased in Persian Gulf War 

veterans.19 This is usually a curable cancer that occurs in young males, so would 

not be expected to increase overall mortality rates significantly. 

Other statistical studies have shown no more deaths and no more birth defects 

in offspring of GW soldiers than in comparable groups. However, was the control 

group truly comparable? Deployed troops are known to be much healthier than a 

group of age and sex-matched civilians, and this is commonly termed the ‘‘Healthy 

Warrior’’ effect. But they may also be healthier than the Gulf ‘‘era’’ troops who were 

not deployed, although ‘‘era’’ troops usually form the comparison group. 

Steele showed that in Kansas veterans, the rate of multi-symptom illness varied 

by deployment location.20 Since different units had very varied exposures during 

their deployments, high rates of birth defects and/or deaths in certain units are possible. Yet the types of large epidemiological studies that have been performed have 

usually obscured possible localized effects of service in the Gulf. 

7. Self reports 

The validity of studies of GW veterans’ health and exposures has been criticized 

on the basis that the exposure and illness data are reported by veterans, and not 

obtained from more reliable sources, such as military or VA databases. Some measures of current health could be obtained from those databases, but the data would 

be incomplete. Exposure data have not been a part of the available record for most 

veterans. Exposure data that have been supplied by DOD have been unreliable (in 

terms of the Khamisiyah plume modeling, according to GAO 21) or the data contradicted the self-reports (as in immunization data supplied by DOD to VA, following 

presentation of a VA study that linked anthrax vaccinations to subsequent ill 

health 22), or the data are missing or classified. The number, names and locations 

of all sites at which chemical warfare agents were exploded remain unknown to the 

public. 

Are self-reports valid? Two recent studies indicate that GW veterans give reliable 

answers to questions.23 A study that compared GW veterans with Gulf era veterans’ 

performance on neuropsychological examinations found that only 1% of GW veterans 

provided ‘‘noncredible’’ exams versus 4% of era veterans.24 Therefore, self-reports by 

GW veterans can safely be judged credible. 

8. Why has the reality of Gulf War Syndrome been so contentious? 

Perhaps remarks by Alabama Congressman Glen Browder in a 1993 House 

Armed Services Oversight and Investigations Subcommittee meeting shed some 

light on this: 

‘‘I have asked a lot of questions about why the Pentagon continues to stonewall these Gulf War veterans, or why are they so resistant to full and open examination of this problem. I don’t have any conclusive answers but I can speculate. 

First, it may be pride. To acknowledge these mystery casualties may blemish 

our Persian Gulf victory. Or, such an acknowledgement may be a terrifying adVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00125 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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25 Use of chemical weapons in Desert Storm. Hearing before the Oversight and Investigations 

Subcommittee of the Committee on Armed Services, House of Representatives. 103d Congress, 

1st session. November 18, 1993. 

26 Identified by Geoffrey Holland, who investigated the provenance of the ATCC anthrax 

strains supplied to Iraq. www.abc.net.au/worldtoday/content/2005/s1434633.htm 27 House Committee on government Reform and Oversight. Gulf War Veterans’ Illnesses: VA, 

DOD continue to resist strong evidence linking toxic causes to chronic health effects. November 

7, 1997. House Report 105–388. 105th Congress, 1st Session. 28Personal communication, September 17, 2007 29 Chaney LA, Rockhold RW, Mozingo JR, Hume AS, Moss JI.Potentiation of pyridostigmine 

bromide toxicity in mice by selected adrenergic agents and caffeine. Vet Hum Toxicol. 1997 

Aug;39(4):214–9. 30Personal communication, September 17, 2007 

mission that the United States did not and perhaps cannot protect our military 

men and women against chemical and biological warfare. 

But I personally suspect that dealing openly and fully with these mystery ailments, and therefore the dirty little secret, will require the Pentagon to make 

budgetary and programmatic adjustments that it does not want to make.’’ 25

Military doctrine calls for continuing use of anthrax and smallpox vaccines, multiple simultaneous vaccinations, pyridostigmine bromide tablets for prophylaxis of 

nerve gas exposure and depleted uranium munitions and armor. Thus military studies that concluded these exposures were safe should come as no surprise. Yet evidence of their adverse effects on health is abundant. 

The American Type Culture Collection (ATCC) supplied various microbial cultures 

to Iraq, in shipments approved by the Department of Commerce, during a period 

in which the United States assisted Iraq in its war with Iran. This may have influenced why infections due to Brucella melitensis, one of the bacteria provided to Iraq, 

were not investigated. Vollum 26 strain anthrax (which had been weaponized by the 

U.S. military before the Biological Weapons Convention came into force in 1975) was 

provided to Iraq by ATCC. Knowing a U.S. corporation provided Iraq virulent anthrax (not a strain used to make vaccines) may have influenced the defense department’s decision to vaccinate troops against anthrax. Similarly, the ATCC provided 

Clostridium botulinum to Iraq; some soldiers were later vaccinated for potential exposure to botulinum toxins. 

Admitting that soldiers became ill as a consequence of what the U.S. gave Iraq 

may be politically unacceptable, undermining the likelihood that credible scientific 

studies of these exposures, funded by the government, would be performed. 

According to the House Committee on government Reform and Oversight in 1997, 

‘‘VA medical policy may have been biased against findings of chemical exposure 

by relying on DOD assertions and unproven theories of toxic causation. VA continues 

today to maintain that chronic symptoms in Gulf War veterans cannot be attributed 

to toxic exposures unless acute symptoms first appear at the time of exposure.’’ 27

Yet the requirement for acute symptoms to occur in order to be harmed by chemical weapons (organophosphates) is scientifically insupportable. 

Investigating certain GW exposures has been a career killer. While some researchers were amply rewarded for finding stress/psychological causes for Gulf War 

Illnesses, other researchers were punished for exploring politically unacceptable 

causes: 

• Jim Moss, PhD on pyridostigmine potentiation research: ‘‘Middle and upper 

level management at USDA promised me I would be blackballed if I did not 

stop the research, or if I ever disclosed my research to anybody (this was before 

I appeared before the Senate VA committee). My biggest regret from my 1994 

Senate VA Committee testimony has been that I did not tell the Committee 

about the threats.’’28,29

• Charles Gutierrez, MS found microorganisms resembling Brucella melitensis in 

stools of dozens of Gulf War veterans in Tennessee, but had his studies halted: 

‘‘In the years following the Persian Gulf War, extensive clinical studies on samples from Persian Gulf War veterans were performed at the James Quillen VA 

in Mountain Home, Tennessee. This work was not adequately pursued by the 

VA, and was instead ordered stopped. The findings in these patients need to 

be addressed, as they may fill in gaps in the existing body of GW illness research.’’30

• Garth Nicolson, PhD on mycoplasma studies: ‘‘I was told by the President of my 

institution (the Univ. of Texas M.D. Anderson Cancer Center) to stop my GWI 

research or face disciplinary action. I refused to stop my research, and my professional career, academic position (and any possible future academic position) 

were destroyed by character assignation and outright lies about my research acVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00126 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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31Personal communication, September 17, 2007 32 Nicolson GL, Nasralla MY, Haier J, Pomfret J. High frequency of systemic mycoplasmal infections in Gulf War veterans and civilians with Amyotrophic Lateral Sclerosis (ALS). J Clin 

Neurosci. 2002 Sep;9(5):525–9. 33 Nicolson GL and Nicolson NL. Diagnosis and treatment of mycoplasmal infections in persian Gulf War llness illness-cfids patients. Journal of Occupational Medicine, Immunology and 

Toxicology 5: 69–78, 1996. 34Smith SW. Sidelining safety-the FDA’s inadequate response to the IOM. NEJM September 

6, 2007. 960–3. 35 Ibid. 36Mathews AW. Report blasts FDA’s system to track drugs. Consultant says mission is hobbled by missteps; agency disputes claims. Wall Street Journal. March 3, 2007. A1. 37http://www.fda.gov/OHRMS/DOCKETS/98fr/05n-0040-bkg0001.pdf 38GAO–07–787R. Military Health: DOD’s Vaccine Healthcare Centers Network. June 29, 

2007. Web address: http://www.gao.gov/cgi-bin/getrpt?GAO-07-787R 39http://usmilitary.about.com/library/milinfo/blferes.htm 

tivities. This occurred even though our work was published in peer-reviewed 

academic journals. This was described in our book Project Day Lily 

(www.projectdaylily.com).’’ 31,32,33

9. How is it that Federal public health ‘‘watchdog’’ agencies and oversight 

mechanisms failed to prevent the public health disaster of GWS? 

Federal agencies that could have weighed in on the safety of drugs and vaccines 

given to soldiers in the Gulf have become politicized, and their decisionmaking processes are opaque. The regulation of toxic substances is fragmented, overseen by a 

variety of agencies. Recent FDA decisions, and the agency’s structure, suggest safety 

has a low priority. 

• FDA permitted use of unlicensed drugs and vaccines, and use of licensed products for unproven purposes, during the Gulf War and later 

• FDA repeatedly approved anthrax vaccine use for bioterrorism preparedness in 

the absence of required human data demonstrating effectiveness, and despite 

ample evidence of safety concerns 

• Astonishingly, FDA drug and vaccine safety experts have no regulatory authority 34

• FDA ‘‘safety experts work largely in isolation, with limited resources and outdated technology.’’ 35

• ‘‘The FDA has bungled its effort to build a new system for detecting the side 

effects of medicines after they go on the market, delaying its implementation 

by at least 4 years, according to a report commissioned by the agency itself . . . 

the FDA has wasted an estimated $25 million on its efforts.’’ 36

• CDC continues to misinform recipients of anthrax vaccine with an official Vaccine Information Statement affirming vaccine safety that is in conflict with the 

vaccine’s FDA-approved package insert,37 and what CDC officials told GAO 

about adverse events following vaccination. The GAO, citing CDC and Vaccine 

Healthcare Center officials as sources, reported that 1–2% of anthrax-vaccinated 

individuals ‘‘may experience severe adverse events, which could result in disability or death,’’ in June 2007.38

• CDC conducted a trial of anthrax vaccine in 1564 people beginning in 2002 and 

provided an interim report on the study to FDA. Yet CDC has released no information to the public about the trial findings, despite filing over 100 adverse 

event reports on trial subjects to the Vaccine Adverse Event Reporting System. 

• These federal agencies know that injured military servicemembers are prevented by the Feres Doctrine 39 from seeking a remedy for their injuries through 

the legal system. 

• There are no viable legal remedies to hold military or government personnel accountable for deliberate cover-ups resulting in denial of healthcare and disability benefits mandated by Federal law. 

10. What Gulf War exposures did soldiers face, and what do we know about 

the injuries they may cause? 

a. Depleted uranium (DU) 

DU is comprised of uranium that has had 40% of its radioactive isotope, uranium235, extracted. However, the DU used by the United States military also contains 


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40http://www.nato.int/du/docu/d010118b.htm 41 Alvarez R. The legacy of depleted uranium in the United States. Institute for Policy Studies 

monograph. June 2003. 42Fitsanakis VA, Erickson KM, Garcia SJ et al. Brain accumulation of depleted uranium in 

rats following 3- or 6-month treatment with implanted depleted uranium pellets. Biol Trace 

Elem Res 2006; 111: 185–97. 43Monleau M, Bussy C, Lestaevel P et al. Bioaccumulation and behavioural effects of depleted 

uranium in rats exposed to repeated inhalations. Neurosci Lett. 2005 Dec 16;390(1):31–6. 44McDiarmid MA, Engelhardt SM, Oliver M et al. Health surveillance of Gulf War 1 veterans 

exposed to depleted uranium: updating the cohort. Health Phys 2007; 93: 60–73. 45McDiarmid MA, Engelhardt SM, Oliver M et al. Biological monitoring and surveillance results of Gulf War 1 veterans exposed to depleted uranium. Int Arch Occup Envir Health 2006; 

79:11–21. 46MacFarlane GJ, Hotopf M, Maconochie N et al. Long-term mortality amongst Gulf War veterans: is there a relationship with experiences during deployment and subsequent morbidity? 

Int J Epidemiol 2005; 34: 1403–8. 47 Raymond-Whish S, Mayer LP, O’Neal T et al. Drinking water with uranium below U.S. 

EPA water standard causes estrogen receptor-dependent responses in female mice. Envir Health 

Perspectives 2007; online September 14, 2007. 48 Alvarez R. Op. cit. 49 Committee on government Reform and Oversight. Gulf War Veterans’ Illnesses: VA, DOD 

continue to resist strong evidence linking toxic causes to chronic health effects. Second Report. 

November 7, 1997. 105th Congress, 1st session. Page 61. 50 Heaton KJ, Palumbo CL, Proctor SP et al. Quantitative magnetic resonance brain imaging 

in U.S. veterans of the 1991 Gulf War potentially exposed to sarin and cyclosarin. 

Neurotoxicology 2007 28:761–9. 

‘‘recycled’’ nuclear reactor waste, including small amounts of highly radioactive plutonium-239, neptunium-237, technicium-99, americium etc.40,41

Both munitions and armor may be made from DU. When a DU munition strikes 

an object, or when DU armor is struck, it ignites and up to 50% of its mass can 

aerosolize into minute particles that may be inhaled and will contaminate the area 

for the foreseeable future. Inhaled DU may have prolonged retention in the lungs, 

accumulates in specific brain regions (in rat experiments) 42 and settles in bone. Inhaled DU led to behavioral effects in animals.43 It is excreted by the kidneys. Its 

toxicity is both chemical and radiological. 

The only veterans who have been studied longitudinally for DU exposure comprise 

a small group with embedded DU shrapnel. They have shown limited findings of 

genotoxicity and are otherwise well,44 but have a ‘‘relatively low uranium burden 

compared to historical uranium-exposed controls.’’ 45 However, other veterans with 

inhalation exposures are probably at greater risk of DU toxicity. One study found 

that reported exposure to DU doubled the risk of dying from disease.46 (Reported 

pesticide exposure in this study doubled the likelihood of accidental death.) 

Consider that the recycled nuclear materials added to DU may not be evenly dispersed. If so, there are likely some veterans with greater exposure to highly radioactive materials, who are at increased risk of cancers, immune and reproductive effects. Recent evidence also points to uranium as an endocrine disruptor.47

If we review the health of workers in uranium processing plants, we can obtain 

clues about what to expect in DU-exposed veterans. Uranium workers have had elevated rates of cancers, especially kidney and respiratory tract cancers. They also 

had elevated levels of chronic kidney disease. 

The Energy Employee Occupational Illness Compensation Program Act of 2000 

(P.L. 106–398) established a ‘‘special cohort’’ of workers employed at three Department of Energy uranium gaseous diffusion plants and Alaska’s nuclear test site: because of the absence of exposure records, and the presence of ultra hazardous workplace exposures, the burden of proof has been shifted to the government for ill workers at these facilities.48 The combination of an ultra hazardous workplace and absent exposure records 49 mirrors the plight of Gulf War veterans, and suggests to 

us that burden of proof requirements could be changed for veterans who suffer from 

illnesses characteristic of their toxic exposures. 

‘‘Personal medical records of veterans, including sick call records, are inadequate or missing. 

Documents which could help verify possible exposures and military unit locations remain in 

DOD files. Most of the military NBC logs, which are records of toxic warfare agent detections, 

are missing or destroyed. . . .’’ 

b. Sarin 

Sarin is an organophosphate ‘‘nerve’’ agent or anticholinesterase, which leads to 

excessive accumulation of the neurotransmitter acetylcholine at nerve synapses. It 

is in the same family as pesticides such as parathion and malathion. A recent study 

found a significant association between levels of estimated sarin/cyclosarin exposure 

and reduced white matter in the brain.50 The same researchers also found that 


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51Proctor SP, Heaton KJ, Heeren T et al. Effects of sarin and cyclosarin exposure during the 

1991 Gulf Waar on neurobehavioral functioning in U.S. Army veterans. Neurotoxicology 2006; 

27: 931–9. 52 Congressional Office of Technology Assessment. Neurotoxicity: Identifying and controlling 

poisons of the nervous system. April 1990. OTA–BA–436. Page 50. 53 Bullman TA, Mahan CM, Kang HK et al. Mortality in U.S. Army Gulf War veterans exposed to 1991 Khamisiyah chemical munitions destruction. Am J Public Health 2005; 95:1382– 

8. 54Klaassen CD. Cassarett and Doull’s Toxicology. 5th edition, 1996. McGraw Hill, N.Y. p.657. 55 Congressional Office of Technology Assessment. Identifying and controlling immunotoxic 

substances. Neurotoxicity: Identifying and controlling poisons of the nervous system. April 1990. 

OTA–BA–436. government Printing Office. 1991. 56Kamel F and Hoppin JA. Association of pesticide exposure with neurologic function and disease. Environ Health Perspect. 2004 Jun;112(9):950–8. 57 Congressional Office of Technology Assessment. 1990. Op. cit. page 30 

‘‘Sarin and cyclosarin exposure was associated with less proficient neurobehavioral 

functioning on tasks involving fine psychomotor dexterity and visuospatial abilities 

4–5 years after exposure.’’ 51

According to the Congressional Office of Technology Assessment (OTA) in 1990: 

‘‘Of particular concern are the delayed neurotoxic effects of some of the 

organophosphorous (organophosphate) insecticides. Some of these compounds cause degeneration of nerve processes in the limbs, leading to 

changes in sensation, muscular weakness and lack of coordination. Because 

of this property, the EPA requires that organophoshorous insecticides undergo special testing for delayed neurotoxicity.’’ 52

Thus despite claims by DOD that lack of acute sarin toxicity precluded later disease, it was common knowledge at the time of the 1991 Gulf War that delayed adverse effects do occur from exposure to this class of compounds. 

Furthermore, a VA study of mortality in 100,000 veterans said to be exposed to 

sarin at Khamisiyah found a statistically significant doubling of deaths from brain 

cancer in the exposed group, compared to unexposed Gulf War veterans, as well as 

a limited dose-response relationship.53

According to a popular toxicology textbook, anticholinesterases may cause ‘‘drowsiness, lethargy, fatigue, mental confusion, inability to concentrate, headache, pressure in head, generalized weakness.’’ 54

c. Other pesticides 

Carbamate pesticides were used in the Gulf and also cause acetylcholine accumulation. They would augment the adverse effects of sarin and organophosphate insecticides. Organochlorine and pyrethrin insecticides have different mechanisms of action, but are also toxic to the peripheral and central nervous system, so their adverse effects might compound those of the anticholinesterases. Some pesticides have 

adverse immunotoxic effects as well.55 A recent review by NIH’s National Institute 

of Environmental Health Sciences researchers discussed the state of knowledge of 

pesticide toxicity, and suggested that general malaise associated with mild cognitive 

dysfunction may be a sensitive marker for pesticide neurotoxicity.56

d. Organic Solvents 

These include jet and vehicle fuels, some cleaning agents and other industrial 

chemicals. According to the Office of Technology Assessment: 

‘‘Acute exposure to organic solvents can affect an individual’s manual dexterity, response speed, coordination and balance. Chronic exposure of workers may lead to reduced function of the peripheral nerves and such adverse neurobehavioral effects as 

fatigue, irritability, loss of memory, sustained changes in personality or mood, and 

decreased ability to learn and concentrate.’’ 57

Therefore, sarin nerve gas, organophosphate and other pesticides, and solvents 

have the potential to induce the neurological and neurobehavioral effects seen in 

Gulf War veterans. This was known prior to the first Gulf War. 

e. Endemic diseases and/or biological weapons exposures 

It remains unknown whether troops faced any biological attacks. Exposure to 

novel microorganisms has never been ruled out. The role of infections endemic to 

the middle east in Gulf War Illnesses is also unknown. The following three microorganisms probably infected some Gulf War veterans, but other microorganisms 

may also contribute to GWI. 

• Leishmaniasis, due to a parasite spread by the sandfly, is endemic in Iraq, but 

the visceral form of the disease is difficult to diagnose. Until better diagnostics 


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58 Nasralla M, Haier J, Nicolson GL. Multiple mycoplasmal infections detected in blood of patients with chronic fatigue syndrome and/or fibromyalgia syndrome. Eur J Clin Microbiol Infect 

Dis. 1999; 18(12):859–65. 59 Baseman JB, Tully JG. Mycoplasmas: sophisticated, reemerging, and burdened by their notoriety. Emerg Infect Dis. 1997 Jan-Mar; 3(1):21–32. 60 Committee on government Reform and Oversight. Gulf War Veterans’ Illnesses: VA, DOD 

continue to resist strong evidence linking toxic causes to chronic health effects. Second Report. 

November 7, 1997. 105th Congress, Ist session. Page 67. 61Schumm, W. R., Reppert, E. J., Jurich AP et al. Pyridostigmine bromide and the long-term 

subjective health status of a sample of over 700 male Reserve Component Gulf War era veterans. Psychological Reports 2002; 90: 707–721. 62 Rettig R. Military use of drugs not yet approved by the FDA for CW/BW defense. RAND 

Monograph on Lessons from the Gulf War. 1999. 63Shulman R. Current drug treatment of sepsis. Hospital Pharmacist 2002; 9: 97–101. 64Quezado ZM, Natanson C, Alling DW et al. A controlled trial of HA–1A in a canine model 

of gram-negative septic shock. JAMA 1993; 269: 2221–7. 65 Chiou HE, Liu CL, Buttrey MJ et al. Adverse effects of ribavirin and outcome in severe 

acute respiratory syndrome in two medical centers. Chest 2005; 128:263–72. 66Muller MP, Dresser L, Raboud J et al. Adverse events associated with high-dose ribavirin: 

evidence from the Toronto outbreak of severe acute respiratory syndrome. Pharmacotherapy 

2007; 27: 494–503. 67Office of Technology Assessment. Identifying and controlling immunotoxic substances. April 

1991. OTA–BP-BA–75. 68http://www.globalsecurity.org/military/systems/munitions/hpm.htm 

are available, it is certain that cases will be missed. It can take months or even 

years to develop symptoms, and leishmaniasis may develop into a chronic, debilitating illness. • Brucella melitensis is both endemic to Iraq and a potential biological warfare 

agent. It can cause a slowly developing, fatiguing illness with a variety of possible signs and symptoms, especially joint pain and fever. It is difficult to diagnose because standard tests usually miss it, so unless it is considered in the 

differential diagnosis and special tests ordered, it will be overlooked. • Mycoplasmas have been linked to chronic multisymptom illnesses.58 They are 

widely distributed, and the known spectrum of clinical illness they cause continues to expand.59 A significant percentage of GW veterans have antibodies to 

mycoplasma. 

f. Contaminated water 

Possible contaminants include endemic or deliberately added microorganisms and 

petroleum products. Soldiers reported that some storage tanks supplying drinking 

water were also used for vehicle fuels, and the water contained fuel residues. 

g. Smoke from oil well fires 

Little reliable data on the contents and concentrations of materials comprising the 

oil well fire smoke is available.60 Toxic inhalants could have been burned deliberately by retreating Iraqi troops. 

h. Pyridostigmine bromide (unlicensed use) a.k.a. PB, NAPPS 

Also increases acetylcholine at nerve synapses; will augment the adverse effects 

of sarin, organophosphate and carbamate insecticides. Multiple studies have linked 

PB use to later illness in GW troops.61

i. Other unlicensed drugs approved for use in the Gulf theater 62

• Centoxin (J5 monoclonal antibody), purchased by the military, prior to licensure of the drug, to treat sepsis in Gulf War veterans. Found later to increase mortality rates in treated patients.63,64 Never licensed. • Ribavirin, purchased by the military for use in unspecified viral illnesses. Yet 

when used later as an experimental treatment for SARS, Ribavirin produced 

anemia, bradycardia and hypomagnesemia, increasing mortality.65 Other researchers later noted, ‘‘Ribavirin should not be used empirically for the treatment of viral syndromes of unknown etiology.’’66 Ribavirin also causes 

immunotoxicity.67 Its adverse reactions include fatigue and depression, which 

may persist after the drug is stopped. 

j. Electromagnetic fields 

Electromagnetic weapons, including high power microwaves,68 were used to disrupt and destroy Iraqi electronic systems. Generation of electromagnetic fields may 

have been used for other effects, and for communication. Whether electromagnetic 

fields contributed to illness is unknown, as are the types and magnitudes of the exposures. However, the European Union’s European Environment Agency has just 

called for immediate action to reduce exposure to microwaves, following an interVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00130 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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69Lean G. EU calls for urgent action on wi-fi radiation. New Zealand Herald. September 16, 

2007. http://www.nzherald.co.nz/section/2/story.cfm?c_id=2&objectid=10463870 70 Unwin C, Blatchley N, Coker W, Ferry S, Hotopf M, Hull L, et al. Health of UK servicemen 

who served in Persian Gulf War. Lancet. 1999 Jan 16; 353(9148):169–78. 71Goss-Gilroy. Study of Canadian Gulf War Veterans: NR–98.050. Study contracted by the 

Canadian Department of National Defense, released June 29, 1998 and published on its website, 

accessed between 1999 and 2001 but no longer at the previous URL: http://www.dnd.ca/menu/ 

press/Reports/Health/health_study_eng_1.htm. 72Schumm WR, Reppert EJ, Jurich AP et al. Self-reported changes in subjective health and 

anthrax vaccination as reported by over 900 Persian Gulf War era veterans. Psychol Rep. 2002 

Apr;90(2):639–53. 73 Boyd KC, Hallman WK, Wartenberg D, Fiedler N, Brewer NT, Kipen HM. Reported exposures, stressors, and life events among Gulf War Registry veterans. J Occup Environ Med. 2003 

Dec;45(12):1247–56. 74Wolfe J, Proctor SP, Erickson DJ, Hu H. Risk factors for multisymptom illness in U.S. Army 

veterans of the Gulf War. J Occup Environ Med. 2002 Mar;44(3):271–81. 75http://merylnass.googlepages.com/writtentestimony7-26-07.doc 76Kelsall HL, Sim MR, Forbes AB et al. Symptoms and medical conditions in Australian veterans of the 1991 Gulf War: relation to immunisations and other Gulf War exposures. Occup 

Environ Med. 2004 Dec;61(12):1006–13. 77 Cherry N, Creed F, Silman A ET AL. Health and exposures of United Kingdom Gulf War 

veterans. Part II: The relation of health to exposure. Occup Environ Med. 2001 May;58(5):299– 

306. 78http://www.bmj.com/cgi/content/full/326/7401/1234-a 

Dyer O. Ministry of Defence accused of contravening inoculation guidelines. BMJ 

2003;326:1234. 79 Ibid 

national scientific review, which concluded that safety limits set for the radiation 

are ‘‘thousands of times too lenient.’’ 69

k. Vaccines 

• Botulinum toxoid vaccine, manufactured by Michigan Department of Public 

Health, meant to immunize against botulinum toxins. The toxins block 

neurotransmission, as does the toxoid. Never licensed. Very little known about 

safety or efficacy. 

• Anthrax vaccine, licensed with inadequate data. Concentration increased 100 

times due to manufacturing changes at the time of the Gulf War. Identified as 

a risk factor for Gulf War illnesses by multiple studies.70,71,72,73,74 The vaccine’s 

package insert lists the CDC definition of Gulf War Syndrome as a reported adverse event following anthrax vaccine. Many of the over 5,000 reports to the 

Vaccine Adverse Event Reporting System of FDA–CDC for anthrax vaccine indicate chronic illnesses whose symptoms resemble GWS. I have treated many soldiers who became ill following anthrax vaccine given since the 1991 Gulf War, 

and the majority experience cognitive impairment, generalized pain and fatigue, 

among other symptoms, meeting the CDC’s case definition for GWS. See my testimony to the House Veterans Affairs Health Subcommittee for additional information.75

• Multiple vaccines given together within a short time period. Are multiple simultaneous vaccinations dangerous? Although the question has been discussed by the Institute of Medicine, the Armed Forces Epidemiology Board and 

the British Ministry of Defense, they provide no conclusive answer. Studies of 

multiple vaccinations associated with Gulf War Illnesses have shown a positive, 

dose-response relationship, suggesting they did contribute to GWI.76,77 Soldiers 

engaged in Operation Iraqi Freedom have also reported Gulf War Illness-like 

disease following multiple vaccinations, with both acute and chronic effects.78

British military policy now separates anthrax and smallpox vaccinations from 

other vaccinations by at least 5 days.79

11. What can we conclude about the exposures? 

a. Several of the exposures can individually produce the symptoms GW veterans 

are experiencing. Injuries from these substances can affect cognition, emotion, 

motor and sensory function. These include sarin, pesticides, solvents, anthrax 

vaccine and some chronic infections, at a minimum. 

b. Combined exposures to certain toxic substances (and simultaneous exercise) 

greatly magnify the potential for adverse reactions: 


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80 Jagannathan R, Husain K and Somani SM. Interaction of pyridostigmine and physical 

stress on antioxidant defense system in skeletal muscle of mice. J App; Toxicol 2001; 21: 341– 

8. 81Del-Rahman A, Dechkovskaia AM, Goldstein LB et al. Neurological deficits induced by malathion, DEET and permethrin, alone or in combination in adult rats. J Toxicology and Environmental Health 2004; 67: 331–356. 82McCain WC, Mark RL, Johnson JS et al. Acute oral toxicity study of pyridostigmine bromide, permethrin, and DEET in the laboratory rat. J Toxicology and Environmental Health 

1997; 50: 113–124. 83Self-reported exposure to neurotoxic chemical combinations in the Gulf War. A cross-sectional epidemiologic study. 84Doug Rokke, PhD. Personal communication September 18, 2007. 85 Clauw D, Groner G, Whalen K. Hypothalamic pituitary adrenal function in veterans with 

unexplained illness, compared to fibromyalgia subjects and controls. Presented at the Conference on Illnesses among Gulf War veterans: A decade of scientific research. January 24–26, 

2001. Alexandria, VA. 86Zhang Q, Zhou XD, Denny T et al. Changes in immune parameters seen in Gulf War veterans but not in civilians with chronic fatigue syndrome. Clin Diagn Lab Immunol. 1999 

Jan;6(1):6–13. 87 Haley RW, Billecke S, La Du BN. Association of low PON1 type Q (type A) arylesterase 

activity with neurologic symptom complexes in Gulf War veterans. Toxicol Appl Pharmacol. 1999 

Jun 15;157(3):227–33. 88Kelsall HL, Sim MR, Forbes AB et al. Symptoms and medical conditions in Australian veterans of the 1991 Gulf War: relation to immunisations and other Gulf War exposures. Occup 

Environ Med. 2005 Mar;62(3):142–3. ‘‘Increased symptom reporting was associated with several 

exposures, including having more than 10 immunisations, pyridostigmine bromide tablets, antibiological warfare tablets, pesticides, insect repellents, reportedly being in a chemical weapons 

area, and stressful military service experiences in a strong dose-response relation.’’ 89 Rose MR, Sharief MK, Priddin J et al. Evaluation of neuromuscular symptoms in UK Gulf 

War veterans: a controlled study. Neurology. 2004 Nov 9;63(9):1681–7. 90Wong R, Lopaschuk G, Zhu G et al. Skeletal muscle metabolism in the chronic fatigue syndrome. In vivo assessment by 31P nuclear magnetic resonance spectroscopy. Chest. 1992 

Dec;102(6):1716–22. 

• Somani et al. Exercise plus Pyridostigmine Bromide amplified oxidative injury 

in skeletal muscle of mice.80

• Abou-Donia et al. ‘‘These results suggest that exposure to real-life doses of malathion, DEET and permethrin, alone or in combination, produce no overt signs 

of toxicity but induce significant neurobehavioral deficits and neuronal degeneration in brain.’’ 81

• McCain et al. ‘‘A significant increase in lethality occurred when PB, permethrin 

and DEET were given concurrently, when compared to expected additive values.’’ 82

• Haley RW et al. ‘‘Some Gulf War veterans may have delayed, chronic neurotoxic 

syndromes from wartime exposure to combinations of chemicals that inhibit 

butyrylcholinesterase and neuropathy target esterase.’’ 83

Haley RW, Kurt TL. JAMA. 1997 Jan 15;277(3):231–7. 

c. Multiple simultaneous vaccinations increased the risk of GWS. 

d. For some other exposures, there is very little available information on toxicity. 

e. Depleted uranium likely contributed to chronic illnesses (and deaths in soldiers 

tasked to clean up DU.) 84

f. Illnesses resulting from infections, electromagnetic fields, smoke, drugs and 

possibly other exposures have not been ruled out in GW veterans. 

12. What is known about underlying pathology in GWS? 

a. Autonomic nervous system function has been shown to be altered in Gulf War 

veterans in multiple studies, as has hypothalamic pituitary adrenal function.85

b. Altered immune function reflects another aspect of this disorder for many vet- erans.86

c. One’s genes affect the speed of processing of toxic substances and later manifestation of toxic effects.87

d. Gulf War soldiers encountered an unprecedented mix of noxious substances, 

which are known to cause neurological, immunologic and other adverse effects. 

Gulf War Illness research even suggests a dose-response relationship between 

some exposures and symptoms.88

* A very reasonable hypothesis is that those who became ill reached a tipping point, where their body’s ability to safely process the toxic materials 

they took in was exceeded. Chronic illness may have resulted from tissue 

damage (such as permanent loss of neurons) and/or persisting metabolic 

abnormalities, which have yet to be defined, but are suspected to include 

impaired oxidative phosphorylation89,90 and/or other fundamental changes 

in body chemistry that can affect multiple organ systems. 


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91Donta ST, Clauw DJ, Engel CC Jr et al. Cognitive behavioral therapy and aerobic exercise 

for Gulf War veterans’ illnesses: a randomized controlled trial. JAMA. 2003 Mar 

19;289(11):1396–404. 92Donta ST, Engel CC Jr, Collins JF et al. Benefits and harms of doxycycline treatment for 

Gulf War veterans’ illnesses: a randomized, double-blind, placebo-controlled trial. Ann Intern 

Med. 2004 Jul 20;141(2):85–94. 93Personal communication with Sam Donta, MD, the Principal Investigator. 

13. Why have we no effective treatment strategies 16 years after the end of 

the war? 

VA Treatment Trials 91,92

• The original two VA treatment trials were exorbitantly expensive, particularly 

given the number of subjects and cost of the interventions. Failure to conduct 

additional treatment studies was rationalized by these trials’ high cost. 

• The mycoplasma/doxycycline trial was a ‘‘failed study’’ in that positive results 

seen at 3 and 6 months did not carryover to 9- and 12-month followup, possibly 

due to a high dropout rate.93 Yet it was not repeated with a larger number of 

veterans to reach a definitive conclusion regarding the benefit of antibiotic 

treatment. 

• The cognitive behavioral therapy/exercise trial showed extremely modest gains 

and a high dropout rate; these treatments are known to be of little value in patients with chronic fatigue syndrome, and exercise can make them worse; yet 

cognitive behavioral therapy and exercise are primary treatments recommended 

for GW veterans, who have a high rate of chronic fatigue syndrome. 

* We do not need to continue to examine whether the noxious exposures 

already studied can cause GWI. They can, and they did. And we should 

have expected it. Some people were genetically more susceptible; some people received more or larger exposures. The result is that many veterans became chronically ill. 

The manner in which DOD and VA pursued GW research was flawed for a variety 

of reasons. 

• A significant amount of research focused on stress or psychiatric causes of illness. 

• Certain exposures were studiously avoided as objects of study. 

• Methodologies chosen were sometimes inadequate to answer the questions 

posed. 

• Exposure data provided by DOD to researchers was not necessarily accurate. 

• Funded studies were not selected on the basis of whether they would lead to 

a treatment, or to a policy change to protect future soldiers. Instead, some 

might suspect the research was designed to avoid uncovering negative information regarding use of DU, pyridostigmine bromide and anthrax vaccine. 

This review of some GWI research shows that completed research projects have: 

• confirmed the symptoms of the illnesses 

• identified specific neurological deficits in affected veterans and some of their 

anatomic/physiologic correlates, 

• provided partial information on rates of different GW-associated illnesses, and 

• furthered our knowledge of the adverse effects caused by some noxious GW exposures, alone and in combination. 

14. Where should the research go from here? How can we meld our research 

goals with the need to develop effective treatment strategies? 

Infections (where a treatment payoff could be very large) 

• Perform conclusive research to determine if GW veterans have untreated chronic infections. Utilize all modalities including microscopy, specialized cultures, serology, PCR, etc. Develop new diagnostics when needed, such as for visceral 

leishmaniasis. 

• Also seek novel infections (biological agents), using above techniques, genetic 

techniques, monoclonal antibodies, etc. 

• Perform empiric antibiotic trials in veterans who test positive, including a repeat trial of antibiotics for veterans with positive mycoplasma forensic PCR (the 

test used to screen veterans for the earlier trial). 


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94Steele L. Prevalence and patterns of Gulf War illness in Kansas veterans: association of 

symptoms with characteristics of person, place, and time of military service. Am J Epidemiol. 

2000 Nov 15;152(10):992–1002. 95 Cameron B, Galbraith S, Zhang Y, Davenport T, Vollmer-Conna U, Wakefield D, Hickie I, 

Dunsmuir W, Whistler T, Vernon S, Reeves WC, Lloyd AR; Dubbo Infection Outcomes Study. 

Gene expression correlates of postinfective fatigue syndrome after infectious mononucleosis. J 

Infect Dis. 2007 Jul 1;196(1):56–66. 96Fang H, Xie Q, Boneva R, Fostel J, Perkins R, Tong W. Gene expression profile exploration 

of a large dataset on chronic fatigue syndrome. Pharmacogenomics 2006 Apr;7(3):429–40. 97Whistler T, Jones JF, Unger ER et al. Exercise responsive genes measured in peripheral 

blood of women with chronic fatigue syndrome and matched control subjects. BMC Physiol. 2005 

Mar 24;5(1):5. 98 Baraniuk JN, Casado B, Maibach H et al. A chronic fatigue syndrome-related proteome in 

human cerebrospinal fluid. BMC Neurol 2005; December 1: 5:22. 99 Vladutiu GD and Natelson BH. Association of medically unexplained fatigue with ACE insertion/deletion polymorphisms in Gulf War veterans. Muscle Nerve 2004; 30: 38–43. 100Kuwabara S, Misawa S. Axonal ionic pathophysiology in human peripheral neuropathy and 

motor neuron disease. Curr Neurovasc Res. 2004 Oct;1(4):373–9. 101 Chaudhuri A, Watson WS, Pearn J, Behan PO. The symptoms of chronic fatigue syndrome 

are related to abnormal ion channel function. Med Hypotheses. 2000 Jan;54(1):59–63. 

Value for money 

• A large number of small, inexpensive pilot studies should be funded instead of 

a few large, mainly epidemiologic studies; later give larger grants to those 

projects that show the most promise in terms of treatment strategies. 

• Make the grant application process inclusive. Encourage clinicians who have 

been caring for GW veterans to participate. Reduce the complexity, time and 

cost needed to complete grant applications. Don’t restrict VA research grants to 

VA employees, as has been the case: open the process to the best scientists and 

proposals. 

• Note the low cost, excellent methodology, analysis and results of Lea Steele’s 

Kansas veterans study,94 compared to numerous Federally funded studies that 

cost at least ten times more and yielded much less information. Use her strategies as a model for other studies: passion for the subject, careful use of funds, 

thoughtful design and analysis. 

• The selection process for grants must be transparent, which has not previously 

been the case. 

Promising areas-basic research 

The underlying causes of all the multi-symptom syndromes remain unknown. It 

is very probable that the molecular and cellular origin of these syndromes will be 

the same, although they are likely triggered by a variety of noxious exposures combined with genetic susceptibility. Because together these syndromes affect an estimated 6 million Americans, research identifying their underlying causes will pay 

enormous dividends, and should point the way to more effective treatment and prevention strategies. 

• Gene expression studies have the potential to identify fundamental physiological processes that have been altered.95,96,97 Genetic and proteomic studies 

of both predisposing gene patterns and protein differences between affected and 

unaffected veterans have already shown promise in pilot studies,98,99 and 

should be continued. 

• Abnormal ion channel function may provide a conceptual and physiologic bridge 

between fatigue, neuropathies and motor neuron disorders like ALS, providing 

clues to why different disorders develop after similar exposures.100,101 It may 

also help explain episodic alterations in mental status, arrhythmias and epileptic seizures in veterans. Maintaining ion gradients across membranes requires 

a lot of cellular energy. This can potentially be improved with supplements that 

improve intracellular adenosine triphosphate (ATP) production and oral electrolytes. 

Specific studies that could reap valuable rewards 

• Detailed study of individual families, in which family members have developed 

illnesses similar to the ill veteran. An exhaustive search for microorganisms 

should be undertaken. Search for DU that may have been present on items that 

returned home with the veteran. Seek other toxics in the home as appropriate 

to illnesses. Investigate gene expression in these families. 

• Study illnesses and mortality in selected units that have reported high death 

rates; try to recapture their locations, job descriptions and exposures when deployed. 


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102http://merylnass.googlepages.com/Selectedfindings.doc 103http://www.haaretz.com/hasen/spages/863699.html 104Michael Ravnitzky 105 IOM Committee to Review the CDC Anthrax Vaccine Safety and Efficacy Program. An Assessment of the CDC Anthrax Vaccine Safety and Efficacy Research Program. 2003. 

• Collect several hundred very ill GW veterans and perform exhaustive investigations on them, followed by treatment trials. 

• Investigate those hypotheses for which researchers were threatened or forced to 

end their studies. Investigate the electromagnetic field strengths and frequencies of all weapons, communications devices and other equipment that may 

have been used in the war, and try to determine which areas or units were exposed and estimate the magnitude of exposure. 

• The choice of control groups in research is critical to a meaningful outcome: 

compare GW veterans with controls who did not receive deployment vaccines 

and had demonstrated equivalent health status. Review all research projects 

with independent experts prior to funding, to minimize confounding and bias. 

• Eight expert Committees have made recommendations on the research studies 

needed for anthrax vaccine since 1999.102 Their recommendations are excellent, 

and should be followed. 

• Eight hundred Israeli soldiers received U.S. anthrax vaccine or a similar Israeli 

anthrax vaccine several years ago, and dozens have reported chronic illnesses 

they believe are related to their vaccinations.103 Information from this trial 

should be obtained, along with follow-up examinations to document what illnesses, if any, have developed and rates of illnesses. 

• A clinical trial of various strategies to remove toxic substances would be extremely useful. Do antioxidants, vitamins, saunas, or other strategies safely remove toxins after an exposure and lead to better health? 

Obtain relevant information from existing government databases 

• The Army Medical Surveillance Activity has performed many analyses of its 

raw data (the Defense Medical Surveillance System) on the health status of soldiers and GW veterans. These studies were not published, nor are they easily 

available. A researcher 104 who filed Freedom of Information Act requests to 

learn what was studied, shared 66 pages with approximately 40 study titles 

listed per page with me. I have filed a Freedom of Information Act Request for 

the contents of 60 of these studies that pertain to the health of Gulf War veterans; my request is pending. Any serious study of Gulf War veteran health 

needs to make use of this material and the available military and VA databases. The Institute of Medicine noted that, ‘‘Analysis of DMSS data should be 

the primary approach for investigation of possible AVA (anthrax vaccine adsorbed)-related health effects of medical significance.’’ 105 This should be true of 

other potential health impacts, in addition to anthrax vaccine. 

• VA and military databases, used correctly, can tell us which other illnesses can 

be linked to the Gulf deployment, and the strength of the association, so that 

appropriate presumptions can be made about the illnesses’ cause; disability decisions can then be made based on presumption. 

• Independent researchers who gain access to this data to study GWI, and determine what other illnesses may be linked with the 1991 Gulf War deployment, 

should not be subject to the military chain of command nor be VA employees. 

• We can learn more about the health risks of toxic GW exposures by gaining access to data held by Federal agencies. This includes obtaining information about 

anthrax vaccine adverse effects from FDA. What in-house studies or reviews 

have been done of anthrax vaccine? How has FDA evaluated the 5600 adverse 

event reports, particularly the 670 it judged serious? What assessment was 

done of the 44 reported deaths associated with anthrax vaccine? How is the vaccine tested for safety? (I filed several FOIAs with FDA for this information since 

2001. So far, 99% of what I requested was redacted, and much has never been 

provided in any form. Yet the material should not have been withheld according 

to FDA guidelines (21 CFR20.61 and 21CFR601.51.) 

• EPA and NIEHS have information about pesticide, heavy metal and solvent 

health risks. DOE has information on the makeup and production of depleted 

uranium. These sources of information should be explored for their potential to 

shed more light on the specifics of the illnesses causes by these materials. 

• Anthrax vaccine trials: NIH has data on human trials of failed anthrax vaccines 

and CDC has data on its own clinical trial of 1564 subjects who received anthrax vaccine since 2002. What adverse events occurred in these carefully studVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00135 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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106Krop J. Chemical sensitivity after intoxication at work with solvents: response to sauna 

therapy. J Altern Complement Med. 1998 Spring;4(1):77–86. 107Kilburn KH, Warsaw RH, Shields MG. Neurobehavioral dysfunction in firemen exposed to 

polycholorinated biphenyls (PCBs): possible improvement after detoxification. Arch Environ 

Health. 1989 Nov-Dec;44(6):345–50. 

ied groups? What is the current health of the subjects? Late follow-up could be 

done on these subjects to evaluate for longer term adverse events. • Multiple vaccines: Currently deploying soldiers are receiving multiple simultaneous vaccinations and should be studied. • The military vaccine healthcare centers have data on over 2,000 soldiers who 

have become ill after anthrax vaccines. As well as documenting the illnesses in 

great detail, the centers have tried a variety of treatment regimens. Information 

on the illnesses and the effectiveness of the treatments is extremely relevant 

to GW veterans. 

15. My medical approach to treatment 

GWS is one of medicine’s poor stepchildren for many reasons. Patients with memory and concentration problems require a lot more time and understanding from 

both physicians and clinic staff, compared to other patients. They miss appointments, lose prescriptions, forget the instructions you gave them. They have an average of eight different problems to address at each visit. They often have emotional 

issues. They are at high risk of family breakdown and economic collapse. Standard 

medications don’t alleviate their symptoms. Providers may not understand their illnesses nor the context in which they seek care. They may be suspected as having 

secondary gain (desiring a disability pension) as the driver for medical visits. Yet 

sometimes almost the only thing the physician can do for the GWI patient is to aid 

the disability process by keeping detailed notes. 

This syndrome is not described in textbooks. Journal articles may list the symptoms, but fail to guide clinicians with information on effective treatments. If the clinician reads the GWI literature, she may come away confused as to whether there 

really is a medical illness, and whether she should transfer the patient to the psychiatric clinic. 

There are no standard medical treatments for the chronic effects of exposure to 

pesticides, solvents, toxic materials in inhaled smoke, etc. A few doctors have experimented with various detoxification strategies,106,107 and some alternative doctors 

use these treatments frequently, but they are not proven to be effective and are not 

eligible for third party reimbursement. 

Medicine is a business. Third party payers use similar visit codes to reimburse 

physicians. Treating four patients in an hour pays much better than treating one. 

The maximal visit code pays for a 40 minute visit. Additional time spent with the 

patient will not be reimbursed. Extra time spent by office staff is not reimbursed. 

I am fortunate that as a salaried physician, my employer, Mount Desert Island Hospital, allows me to conduct a specialty clinic as a community service, even though 

I could bring in considerably more fees treating patients with standard illnesses 

during brief visits. Patients often travel long distances to see these doctors, who are 

few and far between. Thus they need long visits. Few GW veterans can afford to 

pay out of pocket for medical care, which is how most doctors who treat multi-symptom syndromes expect payment, because of the limitations placed on reimbursement 

by insurers. 

Frankly, until the financial disincentive is changed, I doubt that treatment of GW 

veterans will improve greatly. 

What do I actually do with patients? First, patients complete detailed questionnaires prior to their visit to help me determine which aspects of the illnesses are 

present in their case. Because I am familiar with the features of the multisymptom 

syndromes, I know what to look for, ask about, and can direct treatment to these 

aspects of the illness. For example: 

• Are they sensitive to odors (especially diesel exhaust), fluorescent lights or 

foods? • What happens when exposed to these things? • Do they have intermittent episodes of confusion? • Do they balance their own checkbook? • How is their driving? 

• How is their GI tract function? 

• How do they sleep? Has their partner noticed pauses in breathing? 

• Do they have chronic pain? Where? What exacerbates or relieves it? 

• What kind of activity can they perform? For how long? What makes them stop? 

• Do they have rashes? 


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• How is their breathing? 

• How is their libido and sexual function? 

• Is there mold, or are there other substances at home or elsewhere that increase 

symptoms? 

If they have developed multiple chemical sensitivity (which seems to be present 

in about 40% of GWS patients), I help them identify the odors that provoke symptoms so they can avoid them. I prescribe elimination diets to identify foods that trigger symptoms. I order tests to rule out other causes of symptoms, such as muscle 

diseases, standard autoimmune conditions, thyroid disease, anemia, etc. I may order 

sleep studies. Some patients may get a muscle biopsy or other specialized tests. 

Stools are cultured and endoscopy performed when indicated. 

I then address treatment for each symptom individually, since we cannot currently address underlying causes. However, I additionally try to optimize patients’ 

overall metabolic function with diet, vitamins and supplements designed to increase 

cellular energy and provide substrates for important intracellular molecules such as 

NADH, glutathione, ATP. Antioxidants may also be helpful. Most veterans cannot 

afford this treatment, however. Vitamins and supplements are not covered by insurance, although they are usually much cheaper than prescription medications. 

Hopefully, clinical trials will demonstrate whether these approaches improve 

health, and if so, perhaps the VA will make vitamins and supplements available to 

GW veterans. 

I treat the sleep disorder, diarrhea, pain, low hormone levels, or whatever other 

symptoms are present. I try one treatment after another, since there are many adverse reactions to medications, and it is often difficult to predict which medicines 

are likely to be effective. Usually, you can improve sleep considerably, but energy 

only a little. You can improve pain. The diarrhea can resolve, though it may return 

later. Sometimes sex hormones improve sexual function, but often they do not. Thyroid hormone may provide a modest energy boost. Autonomic dysfunction may be 

treated with increased salt and water intake, drugs and/or hormones to raise blood 

pressure, and electrolytes. If you are very lucky, cognition may improve. 

The doctor-patient relationship, and lifestyle coaching, may be equally as important as medications. Patients need to know you are their partner, not a representative of a system they fear is pitted against them. I warn them that marital difficulties should be expected. I prefer their partners to attend visits, and am happy to 

answer partners’ questions. Treating psychological problems may be helpful, but 

veterans are sensitive that such treatment is a denial they have physical illness. 

I explain that they have real medical illness, and may give them an article or book 

on GWS that describes the resulting psychological and physical symptoms, to help 

them understand their disorder. I may refer to other therapists. I suggest that people with limited mental and physical energy reserve their most challenging tasks 

for when they feel most rested. I may advise them not to drive alone. 

With this treatment, I estimate a veterans’ overall function can improve 30–40% 

and sometimes more. But it is a piecemeal, palliative, symptom-based approach that 

does not provide a cure. It also requires highly intensive care. A list of many of the 

treatments I employ was provided to the VA Research Advisory Committee and listed on my website at: http://www.anthraxvaccine.org/gulfwartreatment.htm. 

I greatly appreciate this opportunity to share my knowledge and opinions with the 

Committee. 

I would also like to express my appreciation to Walter Schumm, PhD, Garth 

Nicolson, PhD, and affected Gulf War veterans Doug Rokke, PhD, Joyce Riley, RN 

and Kirt Love for sharing materials on GWS that were used in this presentation. 

My deepest thanks also to Lt. Col. John Richardson, retired Air Force GW veteran 

(still healthy), who has worked tirelessly to improve the condition of his fellow GW 

veterans and anthrax vaccine-injured soldiers. 

f 


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Committee on Veterans’ Affairs 

Subcommittee on Health 

August 2, 2007 

James Binns 

Chairman 

Research Advisory Committee on Gulf War Veterans’ Illnesses 

U.S. Department of Veterans Affairs 

2398 East Camelback Road, Suite 280 

Phoenix, AZ 85016 

Dear Jim: 

In reference to our Subcommittee on Health hearing on ‘‘Gulf War Exposures’’ 

held on July 26, 2007, I would appreciate it if you could answer the enclosed hearing questions by the close of business on October 2, 2007. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for materials for all full and Subcommittee hearings. Therefore, we would 

appreciate it if you would provide your answers consecutively and single-spaced. In 

addition, please restate the question in its entirety before the answer. 

Please provide your response to Cathy Wiblemo at the Committee. If you have any 

questions, please call 202–225–9154. 

Sincerely, 

MICHAEL H. MICHAUD 

Chairman 

Research Advisory Committee on Gulf War Veterans’ Illnesses 

U.S. Department of Veterans Affairs 

Phoenix, AZ 

October 2, 2007 

Hon. Michael H. Michaud 

Chairman 

Subcommittee on Health 

Committee on Veterans’ Affairs 

United States House of Representatives 

335 Cannon House Office Building 

Washington, DC 20515 

Dear Congressman Michaud: 

I am pleased to respond to your written questions following the July 26 hearing 

on ‘‘Gulf War Exposures.’’ 

1. Gulf War Illnesses—Everyone on this panel agrees that Gulf War Illnesses 

are real and that more should be done by way of research, outreach and treatment. 

• In your professional estimation, what is the biggest challenge facing VA today 

with regard to Gulf War Illnesses? 

In recent years, I have observed VA’s Office of Research and Development change 

course to embrace the reality of these illnesses and redirect VA research to address 

the problem, thanks to the active leadership of Secretary Principi and Secretary 

Nicholson. Indeed VA research is responsible for much of the progress that has been 

made in understanding that these are widespread, serious health problems, neurological in nature, rather than the result of battlefield stress. Even since the July 

26 hearing, Dr. Kupersmith, the head of research and development, has continued 

this advance by announcing new studies to investigate the prevalence of MS and 

brain cancer in Gulf War veterans. 

Other parts of VA, however, notably the Office of Environmental Hazards, continue to push the old message that minimizes these illnesses and associates them 

with psychological causes, whether in ‘‘fact sheets’’ provided to Congress or outdated 

clinical training guidelines given to VA doctors. This activity misleads the scientific 

community that might be engaged in helping these veterans and denies VA the 

credit it should be receiving for addressing the problem head-on. In my estimation, 

the biggest challenge facing VA today with regard to Gulf War Illnesses is to project 

throughout the department the perspective of VA leadership and the Office of Research and Development. 


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Dr. Deyton, who was appointed the new head of the Office of Public Health and 

Environmental Hazards relatively recently, has a reputation as a straightforward 

and dedicated senior official. am hopeful that he will address this challenge. 

• What would your recommendations be to VA to ensure that what has happened 

to Gulf War Veterans does not happen to the newest generation of veterans returning from OEF/OIF? 

Our Committee submitted a list of recommendations to Deputy Secretary McKay 

before the start of the war in Iraq, a copy of which is attached, and which formed 

the basis of a letter from VA leadership to the Department of Defense. 

2. DoD/VA—Getting accurate, up-to-date information on pre-deployment and 

post-deployment health records, where service members were located and other pertinent information from DoD, has, in the past, been characterized as difficult. 

• Do you believe that this exchange of information between VA and DoD has improved with the current deployments to Afghanistan and Iraq? 

As the current war is outside the charter of the Research Advisory Committee, 

I regret that I have no personal knowledge to offer. 

• In your professional opinion, would you say that the lack of information exchange or delayed exchange was a primary factor in hindering research efforts 

regarding Gulf War Illnesses? 

It has been a factor that has hindered research. 

3. ALS—Mr. Mikolajcik proposed in his testimony that a congressionally directed 

ALS Task Force should be established to help provide direction in ALS research and 

to develop a strategic plan to tackle this illness. The 30- 60- 90-day timeline he suggested in his testimony lays out some structural parameters. 

• What are your thoughts on creating another task force or entity to look into 

ALS? 

• Do you believe that the direction VA is taking with ALS is the right way? 

Other than the research studies specifically directed at Gulf War veterans with 

ALS, our Committee is not charged with reviewing ALS research and has not reviewed the VA ALS portfolio. Thus I regret that I am unable to comment knowledgeably on this question. Coming from private industry, my general impression of 

government and academic research programs is that many would benefit from a 

more comprehensive, integrated approach. In my opinion, a task force would need 

to consider the full scope of ALS research, not only VA, to be effective, and I would 

want to know if some entity (such as at NIH?) already has that responsibility and 

if they were executing it effectively. 

4. Where Do We Go From Here—Sixteen years have passed and veterans of the 

Gulf War are still fighting to be recognized and not forgotten. 

• What would your recommendations be on how to effectively move forward with 

Gulf War illnesses research, outreach, education and treatment? 

The Research Advisory Committee is currently preparing a comprehensive report 

that will address these topics in detail. I look forward to providing it to you as soon 

as it is available, early in the new year. Certain of these topics that have already 

been addressed by the Committee are available now at the Committee website: 

http://www1.va.gov/racgwvi/docs/Letter_Recommendations_Feb012007.pdf 

Respectfully submitted, 

James Binns 

Chairman 

Research Advisory Committee on Gulf War Veterans’ Illnesses 

U.S. Department of Veterans Affairs 

Phoenix, AZ 

December 16, 2002 

Hon. Leo S. Mackay, Jr., PhD 

Deputy Secretary of Veterans Affairs 

Department of Veterans Affairs 

Washington, DC 

RE: ‘‘Lessons Learned’’ 


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Dear Mr. Deputy Secretary, 

At the recent meeting of the Research Advisory Committee on Gulf War Veterans 

Illnesses, you asked if the Committee had recommendations regarding the prospective conflict with Iraq based on lessons learned from the Gulf War Illnesses experience. Because the request came at the end of our meeting, these observations did not 

in all cases go through the formal process for recommendations of a public advisory 

committee and they are not comprehensive. However, we appreciate your interest, 

and offer these observations for consideration as time is of the essence. 

1. DoD should retain health and locational records for future conflicts. Even if security considerations require classification of personnel records, they should be 

retained for health reasons. 

2. Predeployment physicals should be standardized. 

3. Military exit physical examinations should be conducted in accordance with 

procedures that meet VA standards. 

4. There should be a single comprehensive DoD/VA patient record. 

5. Good immunization records should be maintained. 

6. [The following recommendation was formally deliberated and adopted by the 

Committee.] 

‘‘Substantial questions remain about the possible contribution of vaccines, including the anthrax vaccine, to chronic ill health experienced by veterans of the 

1991 Gulf War. Evaluation of the contribution of vaccines in the 1991 conflict 

would have been aided by proper and extant vaccination records including specifics of vaccine lots received and dosage schedules. Should such health problems recur after future deployments or after civilian vaccination programs, 

VA’s ability to evaluate and treat affected veterans would require access to 

comprehensive vaccination records. To fill this gap of knowledge we recommend 

that stringent efforts be made to generate and keep such records and to perform active surveillance of both short term and long term adverse health effects 

of all biodefense vaccines, including the anthrax vaccine. We therefore recommend to the Secretary of Veterans Affairs that he initiate discussions with 

the Secretary of Defense to ensure that this is achieved.’’ 

7. Several members of the Committee pointed out that most of these recommendations were enacted into law in the Force Health Protection statute, 

PL 105–85. They report, however, that a recent GAO study and Congressional 

hearings indicate that compliance with this law is weak at the operational unit 

level. Thus, a core recommendation would be to encourage you and Secretary 

Principi to work with your counterparts at the Department of Defense to ensure that these laws are implemented. 

Respectfully submitted, 

James H. Binns 

Chair 

cc: Hon. Anthony J. Principi, 

Secretary of Veterans Affairs 

f 

Committee on Veterans’ Affairs 

Subcommittee on Health 

August 2, 2007 

Lea Steele, Ph.D. 

Scientific Director 

Research Advisory Committee on Gulf War Veterans’ Illnesses 

Eastern Kansas VA Healthcare System (T–GW) 

2200 S.W. Gage Blvd. 

Topeka, KS 66622 

Dear Lea: 

In reference to our Subcommittee on Health hearing on ‘‘Gulf War Exposures’’ 

held on July 26, 2007, I would appreciate it if you could answer the enclosed hearing questions by the close of business on October 2, 2007. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for materials for all full and Subcommittee hearings. Therefore, we would 

appreciate it if you would provide your answers consecutively and single-spaced. In 

addition, please restate the question in its entirety before the answer. 


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Please provide your response to Cathy Wiblemo at the Committee. If you have any 

questions, please call 202–225–9154. 

Sincerely, 

MICHAEL H. MICHAUD 

Chairman 

Questions for the Record 

Hon. Michael H. Michaud, Chairman 

Subcommittee on Health 

House Committee on Veterans’ Affairs 

July 26, 2007, 10:00 a.m. 

Room 334, Cannon House Office Building 

Follow-Up Questions for Lea Steele, Ph.D. 

1. Gulf War Illnesses—Everyone on this panel agrees that Gulf War Illnesses 

are real and that more should be done by way of research, outreach and treatment. 

• In your professional estimations, what is the biggest challenge facing VA today 

with regard to Gulf War Illnesses? 

• What would your recommendations be to VA to ensure that what has happened 

to the Gulf War Veterans does not happen to the newest generation of veterans 

returning from OEF/OIF? 

2. DoD/VA—Getting accurate, up-to-date information on pre-deployment and 

post-deployment health records, where service members were located and other pertinent information from DoD, has, in the past, been characterized as difficult. 

• Do you believe that this exchange of information between VA and DoD has improved with the current deployments to Afghanistan and Iraq? 

• In your professional opinions, would you say the lack of information exchange 

or delayed exchange was a primary factor in hindering research efforts regarding Gulf War Illnesses? 

3. ALS—Mr. Mikolajcik proposed in his testimony that a congressionally directed 

ALS Task Force should be established to help provide direction in ALS research and 

to develop a strategic plan to tackle this illness. The 30- 60- 90-day timeline he suggested in his testimony lays out some structural parameters. 

• What are your thoughts on creating another task force or entity to look into 

ALS? 

• Do you believe that the direction VA is taking with ALS is the right way? 

4. Where Do We Go From Here—Sixteen years have passed and veterans of the 

Gulf War are still fighting to be recognized and not forgotten. 

• What would your recommendations be on how to effectively move forward with 

Gulf War Illnesses research, outreach, education and treatment? 

[RESPONSES WERE NOT RECEIVED FROM DR. STEELE.] 

f 

Committee on Veterans’ Affairs 

Subcommittee on Health 

August 2, 2007 

Lawrence Deyton, MSPH, M.D. 

Chief Public Health and Environmental Hazards Officer 

Office of Public Health and Environmental Hazards 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington DC 20420 

Dear Lawrence: 

In reference to our Subcommittee on Health hearing on ‘‘Gulf War Exposures’’ 

held on July 26, 2007, I would appreciate it if you could answer the enclosed hearing questions by the close of business on October 2, 2007. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 


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1 (Note: In the responses the 1990–1991 Gulf War is sometimes referred to as Gulf War 1.) 

changes for materials for all full and Subcommittee hearings. Therefore, we would 

appreciate it if you would provide your answers consecutively and single-spaced. In 

addition, please restate the question in its entirety before the answer. 

Please provide your response to Cathy Wiblemo at the Committee. If you have any 

questions, please call 202–225–9154. 

Sincerely, 

MICHAEL H. MICHAUD 

Chairman 

Questions for the Record 

Hon. Michael H. Michaud, Chairman 

Subcommittee on Health 

House Committee on Veterans’ Affairs 

July 26, 2007 

Gulf War Exposures 

Question 1: Outreach—The Gulf War Review newsletter, which is the publication VA initiated to help veterans of the Gulf War and their families be more aware 

of VA’s health care and other benefits has reportedly not been mailed out in over 

a year. 

• What has the VA done to ensure that outreach to Gulf War veterans is being 

done on a regular basis? 

Response: The Department of Veterans Affairs (VA) places a very high priority 

on ensuring broad and wide-ranging outreach to all veterans, including veterans of 

the Gulf War. 

To achieve this, VA has a great deal of material made available to Gulf War veterans and their families, including information newsletters, brochures, wallet cards, 

posters, and other materials, both in print, online and as ‘‘pod casts,’’ to ensure that 

veterans and their families are kept up to date on the VA health care and other 

benefits that may affect them. 

Some VA outreach materials specifically targeting veterans of the 1991 Gulf War1

and their families available online at www.va.gov/GulfWar and www.va.gov/ 

EnvironAgents (see summary of this outreach information, Attachment 1). 

Since 1992, VA has published 38 editions of the ‘‘Gulf War Review’’ newsletter. 

The next edition will appear in the Fall of 2007. That edition will highlight a number of new authoritative reports from the independent National Academy of Sciences 

Institute of Medicine (IOM) which will be completed by then, and should be of significant interest to Gulf War veterans and their families. 

Question 2: Treatment—Because they suffer from a multitude of illnesses, the 

treatment of Gulf War veterans is by most counts, pretty complex. Additionally, Anthony Hardie, in his testimony states that the VA’s Office of Public Health and Environmental Hazards website contains little information that might be of any use 

to ill Gulf War veterans or their health providers. 

• Could you tell us what type of training or continuing medical education requirements are currently in place to ensure that VA health care professionals have 

the most current research findings and up-to-date information on the Gulf War 

Illnesses? 

Response: VA has a wide range of training and educational materials on Gulf 

War veteran health issues, aimed at VA health care providers as well as for veterans and their families. 

Attached is a brief description of some VHA initiatives from the Office of Public 

Health’ and Environmental Hazards (OPHEH), developed for training and education 

purposes for VA health care providers seeing Gulf War 1 veteran patients (Attachment 2). 

Many of these programs have now also been expanded to prepare for veterans 

from Operations Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) and for 

their families. All of these programs represent ‘‘lessons learned’’ from VA’s experiences responding to the health care and other benefits needs of veterans returning 

from the 1991 Gulf War, and from the Vietnam War before that. 


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The most authoritative sources of health information for veterans of the 1991 Gulf 

War is the series of congressionally mandated ‘‘Gulf War and Health’’ reports conducted by the IOM. These reports have reviewed a wide range of Gulf War risk factors, including health effects from exposure to oil well fire smoke. Summaries of 

these reports are available online at www.va.gov/EnvironAgents for the benefit of 

both veterans and VA health care providers. 

In addition, VA’s Office of Research and Development (ORD) disseminates an annual report, written jointly with the Departments of Defense (DoD) and Health and 

Human Services (HHS), which summarizes Federally supported research on Gulf 

War veterans’ health available online at http://www.research.va.gov/resources/pubs/ 

pubs_individual.cfm?Category=Gulf War Reports. 

Question 3: Epidemiological Research—On page 3 of your testimony you say 

‘‘additional epidemiological research is required to properly characterize any possible long-term health effects of Gulf War One service to the average Gulf War veterans. 

• Has VA initiated the needed research and if not, why not? 

Response: An enormous amount of epidemiological research has been carried out 

focusing on the health of veterans of the 1991 Gulf War. Some of this research has 

been supported or conducted by VA researchers, but most of it has been conducted 

by a wide range of academic and government researchers around the world. 

The quoted reference in VA’s testimony was making the point that VA’s Gulf War 

Health Registry program was not intended for definitive evaluation of specific 

health effects for the average Gulf War veteran. To do that thoroughly requires epidemiological research to fully characterize any possible long-term health effects of 

Gulf War 1 service. Gulf War Health Registry participants are self-selected, and 

therefore do not represent the average veteran. Registry findings do show that no 

unique health problems are emerging among those Gulf War veterans who have 

participated in the special registry program. However, these findings do not tell us 

if Gulf War veterans are suffering from any diagnoses at rates different from that 

expected among this group, based on their age and demographic characteristics. 

To gain an overview about how this enormous effort has improved our understanding of Gulf War veteran health issues, in 2004, VA requested an in depth review by the National Academies of Sciences IOM, of all epidemiological studies of 

Gulf War veterans. This was the fourth in a series of statutorily required (in Public 

Laws 105–277 and 105–368) studies by the IOM on the scientific and medical literature on the long-term health effects from exposure to a wide range of environmental hazards potentially related to service in the 1991 Gulf War. The 2004 IOM 

Committee was charged with reviewing all epidemiological studies of health outcomes among Gulf War veterans to determine their health status in comparison 

with other populations. 

The resulting 2006 IOM Committee report documented increased rates of certain 

illnesses among Gulf War veterans, based on a review of 850 epidemiological and 

other studies of this group, which they selected from among over 4,DoD potentially 

relevant reports. The IOM Committee concluded: 

‘‘VA and DoD have expended enormous effort and resources in attempts to address the numerous health issues related to the Gulf War veterans. The information 

obtained from those efforts, however, has not been sufficient to determine conclusively the origins, extent, and potential long-term implications of health problems 

potentially associated with veterans’ participation in the Gulf War.’’ 

The IOM Committee identified numerous serious limitations in existing epidemiological studies of Gulf War veterans, in large part due to the lack of data on veterans’ exposure to putative toxic agents. However, they did ‘‘not recommend that 

more such studies be undertaken for the Gulf War veterans.’’ Rather, the Committee 

recommended ‘‘continued surveillance to determine whether there is actually a higher risk in Gulf War veterans’’ for illnesses that current research has identified as 

possibly appearing at higher rates among Gulf War veterans, specifically, brain and 

testicular cancer, amyotrophic lateral sclerosis (ALS), birth defects, and post deployment psychiatric conditions. 

The IOM Committee concluded that ‘‘every study reviewed by this Committee 

found that veterans of the Gulf War report higher rates of nearly all symptoms examined than their non-deployed counterparts.’’ 

Of note, they reported that symptom-defined ‘‘unexplained illnesses,’’ consistent 

with chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome and multiple 

chemical sensitivity, were the most common health problem reported in studies of 

Gulf War veterans. However, they concluded that ‘‘the results of research indicate 

that although deployed veterans report more symptoms and more severe symptoms 


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than their non-deployed counterparts, there is not a unique symptom complex (or 

syndrome) in deployed Gulf War veterans.’’ They also found that ‘‘Gulf War veterans 

consistently have.been found to suffer from a variety of psychiatric conditions,’’ including post traumatic stress disorder (PTSD), anxiety, depression and substance 

abuse. 

They also reported that studies have ‘‘not demonstrated differences in cognitive 

and motor measures’’ in deployed versus non-deployed veterans, and show no apparent increase in risk of peripheral neuropathy, cardiovascular disease or diabetes. 

Finally, they reported difficulties in interpreting data on birth defects, and found 

little data to support an objective finding of increased respiratory illnesses among 

Gulf War veterans. 

VA’s Office of Research and Development also prepares an annual report on Federally sponsored research on Gulf War veterans’ illnesses (their latest report is 

dated May 2007). Research topics have included large population-based epidemiological studies 1991 Gulf War veterans, including on symptoms and general health status, brain and nervous system function, diagnoses of infectious diseases, health effects of depleted uranium (DU), chemical weapons, and pyridostigmine bromide, and 

multiple exposure effects. 

It is important to note that the U.S. government has provided significant support 

for research on the health of Gulf War veterans. From fiscal year (FY) 1992 through 

FY 2006, VA, DoD and HHS funded 330 distinct projects related to health problems 

affecting Gulf War veterans. These projects are broad in scope, from small pilot 

studies to large-scale epidemiology studies involving large populations and major 

center-based research programs. Federal funding for research on Gulf War veterans 

totaled $274.0 million over FY 1997 to FY 2006, and as of September 2006, 223 

projects (68 percent) were completed, while 107 (34 percent) were new or ongoing. 

VA’s own research activities focusing on veterans of the 1991 Gulf War include: 

1. A comprehensive mortality study, which continues even today; 

2. An interagency study on veteran hospitalization rates; 

3. VA’s National Health Survey of Gulf War veterans and their families; and, 

4. Surveillance on long-term health effects from exposure to DU among Gulf War 

veterans. 

One example of VA research is a study of mortality and causes of mortality among 

all Gulf War veterans. For this effort, VA researchers have been continuously monitoring the cause-specific mortality of all Gulf War veterans in comparison to their 

non-deployed peers. In post-war monitoring, Gulf War veteran mortality from most 

causes is not significantly different in comparison to non-deployed peer as controls. 

Moreover, the mortality for both groups is less than half that of matched civilian 

controls. This is almost certainly because people who choose to go into the military 

are healthier to begin with. 

Initially, Gulf War veterans have shown an increased risk of death from accidents, especially motor vehicle accidents. VA’s data shows that this is a temporary 

effect, and by 6 years post-war this difference has disappeared. This overall pattern 

is very consistent with earlier mortality data from Vietnam veterans. 

The Washington DC VA War-Related Illness and Injury Study Center (WRIISC) 

has also initiated significant research on the possible long-term health effects of the 

1991 Gulf War service. These include: 

1. Post War Mortality from Neurologic Diseases in Gulf War Veterans 

The concept behind this study is that Gulf War veterans may be at increased risk 

for neurological disorders, amyotrophic lateral sclerosis (ALS), multiple sclerosis 

(MS), Parkinson’s disease, or brain cancer, as a result of their Gulf War service. 

These risks are related to potentially hazardous environmental exposures during the 

war, such as oil well fire smoke, chemical and biological warfare (CBW) agents, prophylactic agents against CBW, multiple vaccinations, depleted uranium, pesticides, 

and endemic infectious diseases. Therefore, the Washington, DC-based WRIISC is 

investigating post-war mortality from neurological disease in Gulf War veterans. 

This study compares risks of mortality due to ALS, MS, Parkinson’s, or brain cancer 

between 620,DoD Gulf War veterans and 750,DoD non-Gulf War veterans. The 

study is scheduled to be completed by the end of 2007. 

2. Estimates of Cancer Prevalence in Gulf Veterans Using State Registries 

For this study, WRIISC researchers are evaluating the hypothesis that 1990–1991 

Gulf War veterans are at an increased risk of developing specific cancers compared 

to nonGulf War veterans. The objectives of the study are (a) to assess and compare 

the prevalence, distribution, and characteristics of cancer among 621,902 Gulf War 

veterans to 746,248 non-Gulf War veterans; and (b) to assess demographic, military, 


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and in-theater exposure characteristics associated with the cancer. They are identifying Gulf War and non-Gulf War veterans with a diagnosis of cancer from 1991 

to 2005 through record linkage of the veterans’ database with files supplied by state 

cancer registries. This study will produce information with adequate statistical 

power to address the question on whether or not there is an excess cancer risk associated with the 1990–1991 Gulf War. The study is scheduled to be completed by the 

end of 2008. 

3. Autonomic Functions of Gulf War Veterans with Unexplained Illnesses 

This population-based, clinical pilot study is designed to measure and compare 

functions of the autonomic nervous system in Gulf War 1 veterans who have a cluster of neurological symptoms to Gulf War 1 veterans without these symptoms. Researchers will explore two questions: first, is autonomic nervous system function impaired in Gulf War veterans with a cluster of neurological symptoms (e.g., dizziness, 

blurred vision, tremor, and excessive fatigue) compared to those without; second, are 

these symptoms associated with abnormal testing for specific functions of the autonomic nervous system. The study is scheduled to be completed in 2 years. 

4. Motor Neuron Function of Gulf War Veterans with Excessive Fatigue 

This pilot study is designed to explore whether the number of motor neurons is 

significantly reduced in ill Gulf War 1 veterans compared to controls; and if 

mitochondrial (energy producing cells) function is impaired in ill Gulf War One veterans compared to controls. III veterans will have at least one of the following selfreported neuromuscular symptoms: muscle weakness, muscle pain or cramp, excessive fatigue, recurring fatigue lasting more than 24 hours after exertion, or having 

chronic fatigue syndrome. The study is scheduled to be completed in 2 years. 

Question 4: WRIISCs—In 2001, VA established the War Related Illness and Injury Study Centers (WRIISCs), at the Washington, D.C, and East Orange, NJ VA 

Medical Centers. The centers were established initially for returning 1991 Gulf War 

veterans however the centers see combat veterans from all deployments. It is good 

to see that VA is expanding on this program and establishing a third WRIISC at 

the Palo Alto VA Health Care System. 

Response: In 2001, as part of VA’s overall health response for veterans returning 

from the 1991 Gulf War, VA established the two WRIISCs at Washington, DC, and 

East Orange, NJ. Today, they are providing specialized health care for combat veterans from all deployments who experience difficult to diagnose.or undiagnosed but 

disabling illnesses. 

Currently, VA is expanding this program to better meet the health care needs of 

new combat veterans suffering from mild to moderate traumatic brain injury. To 

that end, VA is establishing a third WRIISC at the Palo Alto VA Health Care System, in Palo Alto, CA. 

Question 4(a): How many Gulf War One veterans are seen at the two centers? 

Response: The two existing WRIISCs, established in 2001, have evaluated 344 

Gulf War veteran patients from across the nation. 

Question 4(b): Have there been any significant findings or recommendations that 

have emanated from the study centers since opening in 2001? 

Response: The two WRIISCs were charged with developing new approaches for 

responding to all veterans with disabling but difficult or impossible to diagnose illnesses. They were required to focus on 1) specialized clinical care; 2) research on 

improved diagnoses and treatments; 3) relevant education for health care providers; 

and 4) risk communication and outreach for veterans and their families with deployment-related health concerns. 

The two WRIISCs have achieved a great deal in each of these four core areas, 

and we have attached their latest annual reports to provide more complete information about their accomplishments. (Attachment 3) 

Question 4(c): Do you know how many OEF/OIF veterans have been seen at the 

centers? 

Response: The WRIISC program has evaluated 577 OEF/OIF veterans, beginning in 2005. 

Question 4(d): What types of unexplained disabling illnesses or difficult to diagnose illnesses are OEF/OIF veterans experiencing? 

Response: OEF/OIF veterans present to the two WRIISCs with musculoskeletal 

injuries and related pain, dental conditions, PTSD, mood disorders, and traumatic 

brain injury (TBI). WRIISCs report that they generally consider mild TBI as difficult to diagnose among returning OEF/OIF veterans, especially when, as is commonly the case, their symptoms are complicated with overlapping PTSD and other 


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mental health conditions. Clearly, mild TBI was not a significant concern as a consequence of the 1991 Gulf War, but certainly is one for the current conflict in Southwest Asia. We are expecting these clinical findings to appear in future publications 

from the two WRIISCs. 

Many of the long-term chronic health effects from TBI appear similar to the difficult-to-diagnose and treat illnesses currently being treated by the WRIISC programs today. To improve our ability to respond to the health care needs of combat 

veterans suffering from mild to moderate TBI, VA is establishing a third WRIISC 

at the Palo Alto VA Health Care System. The new WRIISC will take advantage of 

the unique assets available there, including a poly trauma unit, interdisciplinary 

program on blast injuries which integrates the medical, psychological, rehabilitation, 

prosthetic needs of injured service members, their programs in TBI, spinal cord injury, blind rehabilitation, PTSD, and research into new and emerging areas of combat injuries and illnesses. 

Finally, WRIISC have reported that sleep disturbances are rather common finding 

among new OEF/OIF veterans. This is a difficult symptom because it is sometimes 

hard to pinpoint their underlying cause. Commonly, OEF/OIF veterans’ circadian 

rhythm appears to be disrupted as a result of irregular sleeping patterns in theater, 

but often this issue is compounded by PTSD. 

Question 4(e): Are the OEF/OIF veterans experiencing different maladies than 

those presented by the Gulf War One veterans? 

Response: The WRIISCs report that based on recent clinical experience with 

these new veterans that in general, health issues among OEF/OIF veterans have 

many similarities as well as certain differences compared to veterans of the 1991 

Gulf War. They report that there appear to be more exposure-related illness concerns among Gulf War 1 veterans, for example, related to oil well fires, chemical 

weapons potential, and vaccinations. OEF/OIF veterans also have some concerns 

about these deployment-related concerns, including relative to vaccinations, depleted 

uranium, and air quality issues. Symptoms and illnesses vary depending on the conflict in which the veteran served. However, symptoms related to depression, PTSD, 

pain, memory difficulties, respiratory, and skin conditions are common among new 

combat veterans. 

Significant post-deployment health concerns of Gulf War 1 veterans are medically 

unexplained symptoms, including headaches, fatigue, gastrointestinal disturbances, 

chronic pain, memory difficulties, and mood disorders. Gulf War 1 veterans also see 

Gulf War environmental exposures as the etiology for their health symptoms. The 

deployment health concerns of OEF/OIF veterans include musculoskeletal injuries 

and related pain, dental conditions, PTSO, mood disorders and TBI. 

Question 5: ALS Research—You mention in your testimony that there is ongoing research being done by VA regarding ALS. 

Do you know when the results of some of this research will be complete or are 

these studies that will take years to come to fruition? 

Response: Most of the research studies on ALS funded by ORD are long-term 

research projects that will take some years to come to fruition. Projects aimed at 

identifying genetic markers for ALS are closer to providing useful tools for clinicians 

to diagnose ALS and potentially to follow disease progression, however, there is no 

definitive timeframe for completion of these studies. The ORD-sponsored VA National ALS Registry is currently being used by investigators funded by a broad spectrum of agencies, including VA and DoD. 

Question 6: ALS Registry—There is a national registry of veterans with ALS 

to identify, as completely as possible, all veterans with ALS and to collect data for 

studies examining the causes of ALS. 

Question 6(a): How many veterans are currently on the registry? 

Response: Since 2003, VA has enrolled a total 2027 veterans. Currently, 965 of 

these veterans are alive and engaged in biannual follow-up. 

Question 6(b): Do you have any veterans from the current conflict on the registry? 

Response: There are 10 veterans from OEF and 3 from OIF enrolled. 

Question 6(c): How do you reach out to veterans to make them aware that the 

registry exists? 

Response: VA makes veterans aware that the registry exists through a variety 

of mechanisms including: 

• The ALS Registry website (http://www.durham.hsrd.research.va.gov/ 

alsreqistrv.asp) 


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• Letters and brochures sent to all neurologists (VA and non-VA) 

• Announcements on ALS and veteran-specific websites 

Brochures sent to national and state ALS Associations 

Periodic data-pulls from VA Inpatient/Outpatient databases followed by a contact 

letter to veterans and a call 1 week later to determine eligibility 

Question 6(d): Have you tried to specifically target veterans from the first Gulf 

War given that they are twice as likely to contract ALS? 

Response: All veterans in the VA funded study, ‘‘An Investigation into the Occurrence of ALS Among Gulf War Veterans’’ were contacted and enrolled in the ALS 

Registry. In addition, VA contacted the Persian Gulf War Veterans Association and 

requested that it notify veterans about the registry. 

Attachment 1 

Partial list of Outreach Materials for Gulf War veterans and their families available online at www.va.gov/GulfWar. www.va.gov/EnvironAgents and other sources. 

At the www.va.gov/GulfWar Web site, Gulf War veterans and their families have 

access to: 

• VA’s Gulf War Veterans Information Helpline (1–800–PGW-VETS) 

• The most recent VA Gulf War Newsletter (July 2006) 

• VA’s Gulf War (OIF) Registry Program Handbook (June 2007) 

• The Annual Report to Congress on Gulf War Veterans’ Illnesses from VA/DoD 

Research Working Group 

• Veterans Health Initiative (VHI) Independent Study Guide for Providers on 

Gulf War Health Issues 

• VA’s Depleted Uranium Handbook for Gulf War Veterans (February 2004) 

• VA’s Evaluation Protocol for Gulf War OIF Veterans with Potential Exposure 

to Depleted Uranium (DU) Handbook 

• VA’s Southwest Asia Poster (May 2004) (distributed to all VA medical centers, 

regional offices and vet centers) 

Brochures and Information Bulletins: 

• Health Care and Assistance for U.S. Veterans of OIF 

• Q&A Brochure—Gulf War Illnesses, August 2003 (English and Spanish) 

• Information Bulletin on Gulf War veteran health issues 10–41 and—42, March 

2004 (in Spanish) 

• Gulf War Fact Sheet April 2 DoD 

• Depleted Uranium Frequently Asked Questions (FAQs) 

• VA Gulf War Registry Examination Handbook 2005 

Research Reports and Summaries: 

• Combined Analysis of VA/DoD Gulf War Clinical Evaluation Programs (Study 

of Clinical Findings from Systematic Medical Examinations of 100,339 U.S. Gulf 

War Veterans)—September 2002 

• Gulf War Research: A Report to Veterans October 2003 (English and Spanish) 

• Journal Article Summaries on Gulf War veteran health issues 

• Gulf LINK Medical Information (Gulf LINK is DoD’s site on Gulf War veteran 

health issues containing Gulf-War research-related information. It is a collaborative effort of DoD, VA, and HHS. 

Gulf War Risk Factor Report Reprints (from VA’s ‘‘Gulf War Review’’ Newsletter): 

• Introduction 

• Deplete Uranium 

• Pesticides 

• Pyridostigmine Bromide 

• Infectious Diseases 

• Chemical & Biological Warfare Agents 

• Vaccinations including Anthrax & Botulinum 

• Oil Well Fire Smoke and Petroleum 

At the www.va.gov/EnvironAgents Web site, Gulf War veterans and their families 

have access to a wide range of information on health and other information that 

may affect them, including: 

Brochures: 

• Depleted Uranium & Health Pocket Guide For Clinicians (May 2007) 


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• Special Health Registry Examination Programs (including the Gulf War Health 

Examination Registry Program) (June 2006) 

• Your Story: Tell Your Military History (November 2005) 

Fact Sheets: 

• OIF Veterans: Information For Veterans Who Served In Iraq In 2003–04 and 

Beyond and Their Families (IB 10–166) December 2004 

• OEF Veterans: Information For Veterans Who Served In Afghanistan and Their 

Families (IB 10–71) December 2004 

• Ionizing Radiation Brief: Fact Sheets For Those Concerned About Possible 

Long-Term Health Consequences of Ionizing Radiation Exposure (December 

2004) 

Newsletters: 

• OEF/OIF Review: Information for Veterans Who Served In Afghanistan and 

Iraq and Their Families (July 2007) 

• OEF/OIF Review: Information for Veterans Who Served In Afghanistan and 

Iraq and Their Families (April 2007) 

Pod Casts (downloadable audio files for veterans): 

• Polytrauma Centers (April 2007) 

• Blast Injuries (April 2007) 

• Transition Assistance Advisors (April 2007) 

• New Brochure Explains Registry Programs (April 2007) 

• Newsletter Editor Rosenblum Retires (April 2007) 

• Readjustment After Deployment (April 2007) 

• How To Apply For Disability Compensation From VA (April 2007) 

• En Espan ̃ ol: Co ́mo aplicar para la compensacio ́n de incapacidad en el VA (Abril 

2007) 

• Special Compensation (April 2007) 

• Quick Guide To Traumatic Brain Injury (April 2007) 

• WRIISC: National Referral Program (April 2007) 

• WRIISC: Transition and Orientation Class (April 2007) 

Under Secretary for Health Information Letters (IL): 

• Under Secretary for Health’s IL 10–2006–010: Potential Health Effects Among 

Veterans Involved In Military Chemical Warfare Agent Experiments Conducted 

From 1955 to 1975 (August 14, 2006) 

• Chemical Warfare Agent Experiments among U.S. Service Members (Updated 

August 2006) 

• VBA Letter and DoD Fact Sheet and FAQs For Veterans Involved in Military 

Experiments at Edgewood/Aberdeen with Chemical Warfare Agents from 1955 

to 1975 (June 30, 2006) 

• Under Secretary for Health’s Information Letter (IL 10–2006–004): Screening 

and Clinical Management of Traumatic Brain Injury (January 25, 2006) 

• Under Secretary For Health’s Information Letter (IL 10–2005–020): New Study 

Reporting Increased Risk Of Brain Cancer Deaths Among 1991 Gulf War Veterans Possibly Exposed To Sarin Chemical Warfare Agent At Khamisiyah, Iraq 

(September 15, 2005) 

• DoD Letter, Fact Sheet and FAQs for Gulf War Veterans Who Served Near 

Khamisiyah, Iraq (September 27, 2005) 

• Under Secretary for Health’s Information Letter (IL 10–2005–004): Health Effects among Veterans Exposed To Mustard Gas And Lewisite Chemical Warfare 

Agents (March 14,2005) 

• Under Secretary for Health’s Information Letter (IL 10–2004–013): Guidance 

For The Diagnosis And Treatment Of Leishmania Infection (October 6,2004) 

• Under Secretary for Health’s Information Letter (IL 10–2004–007): Possible 

Long-Term Health Effects from The Malarial Prophylaxis Mefloquine (Lariam) 

June 23, 2004 

• Undersecretary for Health’s Information Letter (IL 10–2003–014): Long-Term 

Effects of Heat-Related Illnesses (November 20, 2003) 

Veterans Health Administration Directives: 

• VHA Directive (2005–020)—Determining Combat Veteran Eligibility (June 2, 

2005) 


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Veterans Health Administration Handbook—VA Health Care, Benefits and 

Eligibility Information for Veterans: 

• VHA Handbook 1303.2, Gulf War (Including Operation Iraqi Freedom) Registry 

Program (March 2005) 

• ‘‘VA Health Care and Benefits Information for Veterans’’ is a new wallet card 

that nicely summarizes all VA health and other benefits for veterans, along 

with contact information, in a single, wallet-sized card for easy reference (available online at www.va.gov/EnvironAgents) 

• In collaboration with DoD, VA published and distributed one million copies of 

a new short brochure called ‘‘A Summary of VA Benefits for National Guard 

and Reservists Personnel.’’ The new brochure does a tremendous job of summarizing health’ care and other benefits available to this special population of combat veterans upon their return to civilian life (available online at www.va.gov/ 

EnvironAgents) 

• VA Health Care Benefits Eligibility (Link to VA Health Eligibility Home Page) 

• Special VA Health Care Eligibility for Veterans Who Served In Combat Theaters Fact Sheet, IB10–162 (December 2003) 

Improvements in Health Care Eligibility 

• Based on VA’s experience providing health care to veterans of the 1991 Gulf 

War, VA supported legislation that provides enhanced enrollment (Priority 

Group 6) placement for veterans who served in a theater of combat operations 

after November 11, 1998. This authority provides a 2 year post-discharge period 

of cost-free care or services for conditions potentially related to this service. 

• Provides full access to VA’s Medical Benefits Package for recently separated 

combat veterans. 

• Summarized in the brochure and poster distributed to all VA facilities called 

‘‘Special VA Healthcare Eligibility for Combat Veterans,’’ (available online at 

www.va.gov/EnvironAgents). 

Poster: 

Two Years Free VA Medical Care-New Combat Veterans (Sept 2006) 

Special Reports on Gulf War Veteran Health Issues from the National Academy of Sciences Institute of Medicine (The full reports are available online at: www.nas.edu) 

• Health Risk Factors by the National Academy of Sciences Institute of Medicine 

• Gulf War & Health Volume 1 (2DoD): Depleted Uranium, Pyridostigmine Bromide 

• Sarin, Vaccines 

• Gulf War & Health Volume 2 (2002): Insecticides and Solvents 

• Gulf War & Health (2004): Updated Literature Review of Sarin 

• Gulf War & Health Volume 3 (2004): Fuels, Combustion Products, and Propellants 

• Gulf War & Health Volume 4 (2006): Health Effects of Serving in the Gulf War 

• Gulf War & Health Volume 5 (2007): Infectious Diseases 

Attachment 2—Partial list of Training and Educational Materials on Gulf 

War veteran Health Issues for Health Care Providers, and Veterans and 

their Families 

1. New Clinical Guidelines for Combat Veteran Health Care: In collaboration with DoD, VA developed two Clinical Practice Guidelines on combat veteran health issues specifically in response to health concerns of veterans of the 

1991 Gulf War. These include a general guideline to post-deployment health, 

and a second dealing with unexplained pain and fatigue. 

• The new clinical guidelines give our health care providers the best medical 

evidence for diagnoses and treatment of illnesses that are a particular concern among veterans of the 1991 Gulf War. 

• VA highly recommends these for the evaluation and care of all returning 

combat veterans, including veterans from OEF/OIF. 

• Available online at www.va.gov/EnvironAgents under the heading, ‘‘Environmental Health Clinicians.’’ 

2. New VA ‘‘War-Related Illness & Injury Study Centers’’ Specialize in 

Health Care for Combat Veterans with Difficult to Diagnose Illnesses: 

In 2001, VA established two new War Related Illness and Injury Study CenVerDate Aug 31 2005 02:41 Jul 12, 2008 Jkt 037476 PO 00000 Frm 00149 Fmt 6604 Sfmt 6621 E:\HR\OC\37476.XXX 37476

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ters, or ‘‘WRIISCs’’ as they have become to be known, at the Washington, DC, 

and East Orange, NJ VAMCs. 

• Today providing specialized health care for combat veterans from the 1991 

Gulf War and other combat deployments who experience difficult to diagnose 

but disabling illnesses. 

• Concerns about unexplained illness are seen after all deployments including 

OEF/OIF, but we are building on our understanding of these illnesses. More 

information available online at www.va.gov/EnvironAgents under the heading 

‘‘WRIISC Referral Eligibility Information.’’ 

3. Expanded Education on Combat Health Care for VA Providers: In addition to the programs already described, VA has developed several Veterans Health 

Initiative (VHI) Independent Study Guides and other materials relevant to veterans 

returning from Iraq and Afghanistan: 

• ‘‘Preparing for the Return of Women Veterans from Combat Theater,’’ Under 

Secretary for Health Information Letter IL 10–2003–011, provides guidance 

to VA health care providers in planning and projecting special care needs for 

women veterans who have served in combat, including the 1991 Gulf War 

and from OEF/OIF. 

• ‘‘A Guide to Gulf War Veterans Health’’ on healthcare for combat veterans 

from the 1991 Gulf War. The product, written for clinicians, veterans and 

their families, also remains very relevant for OEF/OIF combat veterans because many of the hazardous exposures are the same. Although still current, 

this clinical practice guideline is scheduled for updating in 2008. 

• ‘‘Endemic Infectious Diseases of Southwest Asia’’ provides information for 

health care providers about the infectious disease risks in Southwest Asia, 

particularly in Afghanistan and Iraq, including for veterans who served in 

the 1991 Gulf War and OEF/OIF. The emphasis is on diseases not typically 

seen in North America. 

• ‘‘Health Effects from Chemical, Biological and Radiological Weapons’’ was developed to improve recognition of health issues related to chemical, biological 

and radiological weapons and agents, in particular, in relation to service in 

the 1991 Gulf War and more recently in OEF/OIF. 

• ‘‘Military Sexual Trauma’’ was developed to improve recognitions and treatment of health problems related to military sexual trauma, including sexual 

assault and harassment, in any deployment. 

• ‘‘Post-Traumatic Stress Disorder: Implications for Primary Care’’ is an introduction to PTSD diagnosis, treatment, referrals, support and education, as 

well as awareness and understanding of veterans who suffer from this illness. 

• ‘‘Traumatic Amputation and Prosthetics’’ includes information about patients 

who experience traumatic amputation during military service, their rehabilitation, primary and long-term care, prosthetic, clinical and administrative 

issues. 

• ‘‘Traumatic Brain Injury’’ presents an overview of TBI issues that primary 

care practitioners may encounter when providing care to veterans and active 

duty military personnel. 

• All are available in print, CD ROM and online at www.va.gov/NHI. 

4. New VA ‘‘War-Related Illness & Injury Study Center’’ focusing on Combat Veterans with Mild and Moderate Traumatic Brain Injury: Based upon 

the success of the existing WRIISC program, established in response to health care 

needs of veterans returning from the 1991 Gulf War, VA recently established a new 

War-Related Illness & Injury Study Center (WRIISC) to respond the health care 

needs of new combat veterans suffering from mild to moderate traumatic brain injury. This third WRIISC will be located at the Palo Alto VA Health Care System. 

• Improvised Explosive Devices, blasts, landmines and shrapnel account for a 

significant proportion of combat injuries seen from the conflict in Iraq and 

Afghanistan today—many of these result in some degree for traumatic brain 

injury. 

• Many of the long-term chronic health effects reported for traumatic brain injury look like the sort of difficult to diagnose and treat illnesses currently 

being treated by the WRIISC programs today. 

• The recently announced new WRIISC at the Palo Alto VA Health Care System (HCS) will take advantage of their unique assets including their Poly 

trauma Unit, interdisciplinary program on blast injuries that integrate the 

medical, psychological, rehabilitation, prosthetic needs of injured service 

Members, traumatic brain injury, spinal cord injury, blind rehabilitation post 


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traumatic stress disorder, and research into new and emerging areas of combat injuries and illnesses. 

• The specialized clinical programs of the Palo Alto HCS will be enhanced and 

complemented via collaborations with the specialized clinical programs of a 

new Palo Alto WRIISC, and offer enhanced access to these clinical services 

to younger and new combat veterans across the country. 

5. Special DU program: Gulf War veterans (as well as OEF/OIF veterans) concerned about possible exposure to depleted uranium can be evaluated using a special DU exposure protocol that VA began after the 1991 Gulf War. 

• This program offers free DU urine screening tests by referral from VA primary care physicians to veterans who have concerns about their possible exposure to this agent. 

• Gulf War and OIF veterans are eligible to participate in the VA DU evaluation protocol/screening program for Gulf War and OIF veterans. 

• OEF veterans are eligible to participate in the VA DU evaluation protocol/ 

screening program for non-Gulf War veterans. 

• In response to health concerns about new combat veterans with retained embedded fragments from combat injuries in Iraq and Afghanistan, including 

blast injuries from improvised explosive devices, VHA is establishing the 

Toxic Embedded Fragments Surveillance Center (TEFSC) at the Baltimore 

VA Medical Center. Lessons learned from the Baltimore VA Depleted Uranium program show that retained metal fragments are not inert in the body 

and may change over time to produce potential toxic health effects. Such effects maybe minimized and managed through careful ongoing medical surveillance. 

6. VA Gulf War Registry Examination Program: 

• VA’s Gulf War Health Examination Registry is one way VA tracks the special 

health concerns of veterans. 

• Open to any veteran who served on active military duty in Southwest Asia 

during the Gulf War which began in 1990, and continues to the present including Operation Iraqi Freedom. 

• Quarterly teleconferences with VA Gulf War Registry Health Clinicians and 

Coordinators. 

• Eligible veterans receive a free specialized and comprehensive health examination with blood work, urinalysis (EKG and chest x-ray where medically indicated) and answers to questions relating to any environmental exposures. 

• Every VA medical center has an Environmental Health Clinician and a Coordinator assigned to assist veterans in obtaining health registry examinations. 

• VA Environmental Health Clinicians and Coordinators receive special training in Gulf War veteran (and other) health issues, including quarterly conference calls with the Office of Public Health and Environmental Hazards. 

• As of August 2007, 101,057 veterans from the 1991 Gulf War have taken advantage of this free examination, as well as 7,325 veterans from OIF. 

Attachment 3 

Recent Annual Reports from the Washington, DC and East Orange, NJ VA WarRelated Illness & Injury Study Centers (WRIISCs) 

[This above report is being retained in the Committee files.] 

Æ 


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