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26–238 PDF 2006

OCCUPATIONAL AND ENVIRONMENTAL HEALTH

SURVEILLANCE OF DEPLOYED FORCES: TRACKING TOXIC CASUALTIES

HEARING

BEFORE THE

SUBCOMMITTEE ON NATIONAL SECURITY,

EMERGING THREATS, AND INTERNATIONAL

RELATIONS

OF THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED NINTH CONGRESS

FIRST SESSION

JULY 19, 2005

Serial No. 109–120

Printed for the use of the Committee on Government Reform

(

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

CHRISTOPHER SHAYS, Connecticut

DAN BURTON, Indiana

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

GIL GUTKNECHT, Minnesota

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

JOHN J. DUNCAN, JR., Tennessee

CANDICE S. MILLER, Michigan

MICHAEL R. TURNER, Ohio

DARRELL E. ISSA, California

GINNY BROWN-WAITE, Florida

JON C. PORTER, Nevada

KENNY MARCHANT, Texas

LYNN A. WESTMORELAND, Georgia

PATRICK T. MCHENRY, North Carolina

CHARLES W. DENT, Pennsylvania

VIRGINIA FOXX, North Carolina

——— ———

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. DUTCH RUPPERSBERGER, Maryland

BRIAN HIGGINS, New York

ELEANOR HOLMES NORTON, District of

Columbia

———

BERNARD SANDERS, Vermont

(Independent)

MELISSA WOJCIAK, Staff Director

DAVID MARIN, Deputy Staff Director/Communications Director

ROB BORDEN, Parliamentarian

TERESA AUSTIN, Chief Clerk

PHIL BARNETT, Minority Chief of Staff/Chief Counsel

SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING THREATS, AND INTERNATIONAL

RELATIONS

CHRISTOPHER SHAYS, Connecticut, Chairman

KENNY MARCHANT, Texas

DAN BURTON, Indiana

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

STEVEN C. LATOURETTE, Ohio

TODD RUSSELL PLATTS, Pennsylvania

JOHN J. DUNCAN, JR., Tennessee

MICHAEL R. TURNER, Ohio

JON C. PORTER, Nevada

CHARLES W. DENT, Pennsylvania

DENNIS J. KUCINICH, Ohio

TOM LANTOS, California

BERNARD SANDERS, Vermont

CAROLYN B. MALONEY, New York

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. DUTCH RUPPERSBERGER, Maryland

STEPHEN F. LYNCH, Massachusetts

BRIAN HIGGINS, New York

EX OFFICIO

TOM DAVIS, Virginia HENRY A. WAXMAN, California

LAWRENCE J. HALLORAN, Staff Director and Counsel

KRISTINE FIORENTINO, Professional Staff Member

ROBERT A. BRIGGS, Clerk

ANDREW SU, Minority Professional Staff Member

(III)

C O N T E N T S

Page

Hearing held on July 19, 2005 ............................................................................... 1

Statement of:

Kilpatrick, Dr. Michael, Deputy Director of the Deployment Health Support Directorate, Department of Defense, accompanied by Colonel John

Ciesla, Chief of Staff, U.S. Army Center for Health Promotion and

Preventive Medicine [CHPPM]; and Dr. Susan Mather, Chief Officer,

Public Health and Environmental Hazards, Veterans Health Administration, Department of Veterans Affairs, accompanied by Dr. Mark

Brown, Director, Environmental Agents Service, Department of Veterans Affairs ..................................................................................................... 140

Kilpatrick, Dr. Michael ............................................................................. 140

Mather, Dr. Susan ..................................................................................... 161

La Morte, Brian Scott, Company Sergeant Major, B Company, Third

Battalion, 20th Special Forces Group (Airborne), North Carolina Army

National Guard; Raymond Ramos, retired Staff Sergeant, 442nd Military Police Company, New York National Guard; David Chasteen, Operation Iraqi Freedom veteran, associate director of Operation Truth;

and Marcia Crosse, Ph.D., Director, Health Care, Government Accountability Office .................................................................................................. 41

Chasteen, David ........................................................................................ 85

Crosse, Marcia ........................................................................................... 89

La Morte, Brian Scott ............................................................................... 41

Ramos, Raymond ....................................................................................... 55

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

Chasteen, David, Operation Iraqi Freedom veteran, associate director

of Operation Truth, prepared statement of ................................................ 87

Crosse, Marcia, Ph.D., Director, Health Care, Government Accountability

Office:

Information concerning programs ............................................................ 136

Prepared statement of ............................................................................... 91

Kilpatrick, Dr. Michael, Deputy Director of the Deployment Health Support Directorate, Department of Defense, prepared statement of ............ 143

Kucinich, Hon. Dennis J., a Representative in Congress from the State

of Ohio, prepared statement of .................................................................... 121

La Morte, Brian Scott, Company Sergeant Major, B Company, Third

Battalion, 20th Special Forces Group (Airborne), North Carolina Army

National Guard, prepared statement of ...................................................... 45

Mather, Dr. Susan, Chief Officer, Public Health and Environmental Hazards, Veterans Health Administration, Department of Veterans Affairs:

Information pieces ..................................................................................... 163

Prepared statement of ............................................................................... 183

Ramos, Raymond, retired Staff Sergeant, 442nd Military Police Company,

New York National Guard, prepared statement of .................................... 58

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

of Connecticut:

Articles and materials submitted by Susan Zimet, Ulster County

New York legislator, and the Desert Storm Battle Registry .............. 7

Prepared statement of ............................................................................... 3

(1)

OCCUPATIONAL AND ENVIRONMENTAL

HEALTH SURVEILLANCE OF DEPLOYED

FORCES: TRACKING TOXIC CASUALTIES

TUESDAY, JULY 19, 2005

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING

THREATS, AND INTERNATIONAL RELATIONS,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

The subcommittee met, pursuant to notice, at 11 a.m., in room

2154, Rayburn House Office Building, Hon. Christopher Shays

(chairman of the subcommittee) presiding.

Present: Representatives Shays, Duncan, Turner, Dent, and

Kucinich.

Staff present: Lawrence Halloran, staff director and counsel; R.

Nicholas Palarino, Ph.D., senior policy advisor; Robert A. Briggs,

clerk; Kristine Fiorentino, professional staff member; Erick Lynch

and Sam Raymond, interns; Andrew Su, minority professional staff

member; and Earley Green, minority chief clerk.

Mr. SHAYS. A quorum being present, the Subcommittee on National Security, Emerging Threats, and International Relations

hearing entitled, ‘‘Occupational and Environmental Health Surveillance of Deployed Forces, Tracking Toxic Casualties,’’ is called to

order.

Air Force Major Michael W. Donnelly died on June 30th. His testimony before this subcommittee 8 years ago helped persuade a

skeptical Pentagon and Department of Veterans Affairs [VA], that

wartime exposures caused or amplified subsequent illnesses. His

decade-long struggle against the ravaging effects of Amyotrophic

Lateral Sclerosis [ALS], gave heroic witness to the reality of toxic

casualties. Our work on deployment health will continue to be

guided by his indomitable spirit.

After the 1991 war in the Persian Gulf, veterans suffering a variety of unfamiliar syndromes faced daunting official resistance to

evidence linking multiple low-level toxic exposures to subsequent

chronic ill health. Limited environmental sampling, poor troop location data and glaring incomplete medical recordkeeping all blocked

efforts to reach epidemiological or clinical conclusions about wartime exposures.

Since then, the Department of Defense [DOD], has become much

more attuned to the environmental and occupational risks of the

deployment workplace. Lessons learned in the first Gulf war are

being applied to minimize preventable exposures and illness. Air,

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soil and water testing is more prevalent. Baseline routine and incidental driven surveillance reports are being directed to a central

repository. Some information on possible environmental exposures

is finding its way into individual medical records. But as we will

hear this morning, these promising efforts do not yet comprise the

robust, consistent and sustained deployment health program our

forces need and deserve.

Gathering more data on environmental and occupational risk is

only the first and perhaps the easiest step. It will be of limited

value to past, current and future service members unless DOD and

VA can standardize, analyze and use exposure data to better inform research agendas and compensation decisions.

At the subcommittee’s request, the Government Accountability

Office [GAO], examined implementation of DOD’s policies on environmental health surveillance. In a new study released today, GAO

reports finding inconsistencies between the military services and

data collection methods. They found variable levels of training and

expertise among those responsible for environmental monitoring.

While some reports are flowing to a central collection point, the

data integrator, the Army’s Center for Health Promotion and Preventative Medicine, does not know how many reports to expect or

how many might be late or missing at any given time. Troop location data needed to link individuals to individual risks is still unreliable or unavailable. Information on specific sites is often classified, putting critical data behind the reach of most clinicians and

researchers.

These findings frame our discussion of current deployment

health surveillance activities, and we appreciate the work of the

GAO team on these important issues. We also value the time, expertise and dedication of our witnesses from Department of Defense and Veterans Affairs. But we believe, and they agree, the

first voices we need to hear today belong to veterans, those who

lived, worked and faced the risk of toxic harm in Afghanistan and

Iraq.

In this room, in 1997, Major Donnelly described the pain and

frustration caused by official inability or unwillingness to connect

his rare illness with his military service. A once robust fighter pilot

sat before us in a wheelchair. His body racked by the effects of the

disease. His wife and father sat next to him to help interpret. But

when asked if he would go to war against knowing what would befall him, Michael Donnelly did not hesitate 1 second before saying,

in a whisper, yes.

[The prepared statement of Hon. Christopher Shays follows:]

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Mr. SHAYS. The Chair would now recognize Mr. Duncan.

Mr. DUNCAN. Mr. Dent was here before me, if he wants to make

a statement.

Mr. SHAYS. No, with the gavel, I take the senior member. We will

all get our chances.

Mr. DUNCAN. Thank you very much, Mr. Chairman. Once again,

you have called a hearing on a very, very important topic.

Unfortunately, due to previously scheduled meetings, I won’t be

able to stay for much of it. However, my staff did tell my VA representative yesterday of something that I have been wondering

about for several years now, and perhaps some of the witnesses

could help answer some of these questions when they testify, and

of course, we all know that for several years people at the top levels of the Defense Department thought that some or many of the

illnesses that some of the Gulf war, first Gulf war, veterans were

complaining of were psychosomatic or psychological and not related

to their military service. And we all know about the difficult time

that many of these soldiers had in trying to tie their illnesses into

their service.

What raised my curiosity was the fact that we heard almost no

complaints or similarities of symptoms from military personnel

from other countries who had served at the same time and in the

same theaters. And it raised a question in the mind of many, were

these illnesses being claimed primarily because of our VA system

and because there could be a possible compensation, or—and because, in the other countries where there was no similar VA compensation program set up, soldiers were not claiming these same

types of illness? Or could it have been because we were giving our

soldiers some type of vaccinations that had something in them that

was causing problems that weren’t being caused in soldiers from

other countries?

So I think those are some things that we need to look into and

see whether these illnesses, there still is apparently a serious question as to whether some of these illnesses are related to the military or whether there is some other cause, psychological or a vaccination or what the cause might be.

But I thank you for calling this hearing.

Mr. SHAYS. I thank the gentleman.

Mr. Dent.

Mr. DENT. Thank you.

Thank you, Mr. Chairman, for conducting this hearing.

I look forward to receiving your testimony. And having seen a

family member die of ALS, I know that issue is not psychological.

And I just look forward to hearing your testimony about the effects

that our service personnel have experienced while deployed.

So thank you for holding this hearing, Mr. Chairman.

Mr. SHAYS. I thank the gentleman.

And as the former vice chair of the committee, Mr. Turner.

Mr. TURNER. Mr. Chairman, I want to thank you for continuing

your effort to delve into the issue of the health and safety of our

men and women in uniform. Your efforts have produced real results that we want to make certain that, through accountability,

are implemented. The benchmarking or needing to know where our

men and women in uniform begin and then the environmental asVerDate 11-MAY-2000 13:46 Apr 17, 2006 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 D:\DOCS\26238.TXT HGOVREF1 PsN: HGOVREF1
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pects that they are exposed to and the effects upon their health is

incredibly important not only for us to just determine what happened but also to plan so that we can effectively protect people in

the future. And so your work here is very important, and I appreciate it.

Mr. SHAYS. I thank the gentleman.

Before I recognize our witnesses, I ask unanimous consent that

all members of the subcommittee be permitted to place an opening

statement in the record and that the record remain open for 3 days

for that purpose. Without objection, so ordered.

I ask further unanimous consent that all witnesses be able to

submit their written statements in the record. Without objection,

so ordered.

I even ask for unanimous consent to insert into the record articles and other materials submitted by Susan Zimet, Ulster County

New York legislator, and the Desert Storm Battle Registry submitted as well. Without objection, so ordered.

[The information referred to follows:]

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Mr. SHAYS. We have two panels today. Let me thank our Government officials very much for appreciating the need to hear from our

first panel.

We are reversing the order, in other words. Government is going

second. In this case, we are listening to our second panel first and

that is: Mr. Brian Scott La Morte, a company sergeant major, B

Company, Third Battalion, 20th Special Forces Group, North Carolina Army National Guard; Mr. Raymond Ramos, retired staff sergeant, 442nd Military Police Company, New York National Guard;

Mr. David Chasteen, Operation Iraqi Freedom veteran, associate

director of Operation Truth; and Dr. Marcia Crosse, director,

Health Care, Government Accountability Office.

Our second panel will follow. At this time, gentlemen, will you

rise so I can swear you in? And lady.

Raise your right hands.

[Witnesses sworn.]

Mr. SHAYS. For the record, our witnesses have responded in the

affirmative, and now when the other two guests speak, we will

make sure our recorder has their names, and we can identify.

Thank you.

Sergeant Major La Morte, you’re on. What we do is we do 5 minutes. We roll it over a little bit. But we like you to be as close to

the 5 minutes as you can be.

STATEMENTS OF BRIAN SCOTT LA MORTE, COMPANY SERGEANT MAJOR, B COMPANY, THIRD BATTALION, 20TH SPECIAL FORCES GROUP (AIRBORNE), NORTH CAROLINA ARMY

NATIONAL GUARD; RAYMOND RAMOS, RETIRED STAFF SERGEANT, 442ND MILITARY POLICE COMPANY, NEW YORK NATIONAL GUARD; DAVID CHASTEEN, OPERATION IRAQI FREEDOM VETERAN, ASSOCIATE DIRECTOR OF OPERATION

TRUTH; AND MARCIA CROSSE, Ph.D., DIRECTOR, HEALTH

CARE, GOVERNMENT ACCOUNTABILITY OFFICE

STATEMENT OF BRIAN SCOTT LA MORTE

Sergeant Major LA MORTE. I would like to thank the Honorable

Christopher Shays and the fellow members of the subcommittee.

It is an honor for me to testify on behalf of myself and the fellow

service members and the soldiers that I lead. I am Sergeant Major

Brian Scott La Morte, and I am the Company Sergeant Major in

the National Guard Special Forces Unit. I was deployed to

Kandahar Airfield in Afghanistan in April 2002 with the Advance

Party of the Second Battalion, Third Special Forces Group. The

first mission tasked to me was to secure, clean up and improve the

living conditions at the Combined Joint Special Operations Task

Force Afghanistan, CJSOTFA, I was working at the Advanced Operation Base North located in Bagram Afghanistan.

During my initial pre-mission planning trip, I was able to observe living conditions of team safe houses located on the Pakistani

border as well as OAB North.

After that mission, I was living at Kandahar Airfield for most of

my duration in the theater. I witnessed the airfield from April 2002

through October 2002. While there was great improvement made

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during that time in the country, the base still had a long way to

go.

While I was not included in the first contact of the Afghanistan

Campaign, I know the nature of war, and death and destruction

are norms for the daily contact. The amount of vehicles that were

destroyed along with the human carnage was unheard of by so few

of our ground forces. Today’s military is capable of enormous

amounts of destruction with our advanced firepower that is on call

from the Navy and Air Force, from 2,000-pound laser-guided

bombs, 30-millimeter depleted uranium tank-busting rounds to conventional explosives used to destroy tons of recovered Taliban and

Al Qaeda material munitions on a daily basis. The destruction of

cached material and explosives led to many fires that burned for

countless days unattended. As the Taliban moved out of their bases

as fast as they could, they left many tons of captured Soviet and

Afghani equipment hidden or scattered about.

One such example is enclosed in the picture of my report of some

of over 436 1,100-pound aerial drop-off bombs of different types

that the Taliban had tried to bury in the desert to hide from the

advancing Coalition Forces moving into the Kandahar region.

Here is a prime example of the mistakes that we have made in

the past two conflicts, Desert Storm and Operation Enduring Freedom. The next two pictures are from the same cache that showed

buried munitions that were never identified properly. Like the explosion in Desert Storm, the ammunition depot that contained

chemical weapons which were never identified until after the improper destruction, we face a similar chance to do the same again.

I reminded the EOD officer in charge of the necessity of identifying

all the weapons before destroying the cache. He felt it more important to destroy the cache in place as is rather than exposing his

troops to possible booby traps. Remember that EOD personnel had

been killed 6 months beforehand. I, again, protested to him that

there might be chemical or nuclear weapons, and they should be

ID’d first.

In the pictures, I have arrows identifying where the mounds

were buried, where the weapons were buried underneath. And the

picture on the right had no explosives placed on the cache, on that

strip of munitions.

If the mound had contained a chemical weapon, EOD felt it

would burn up in the fire ball following the blast. If it were nuclear, it would be ruined beyond use. My point to the colonel is, it

is a weapon of information for our side. It was a Soviet doctrine

to carry nuclear and chemical weapons to the battlefield front.

I found possible chemical weapons in the barren waste land, and

no one wanted to admit the possibility that chemical weapons were

in Afghanistan. It seemed to me, if they had been found, the

rounds would have caused more complications, and it was better to

be ignorant of the fact than to deal with them.

The conditions of the Kandahar Airfield in April 2002 was showing signs of becoming organized. The Special Forces compound

which housed Forward Operating Base 32 under Lieutenant Colonel Sherwood was located in the middle of the base. Directly behind their motor pool was a trash dump that was pushed out of the

way to make room for more troops. The trash dump contained evVerDate 11-MAY-2000 13:46 Apr 17, 2006 Jkt 000000 PO 00000 Frm 00046 Fmt 6633 Sfmt 6633 D:\DOCS\26238.TXT HGOVREF1 PsN: HGOVREF1
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erything from human bones to armored vehicles to airplanes and

helicopters out of use.

The entire time I was in the area, the dump was on fire. Smoke

from burning rubber, oil and wood drifted across the base. The

smell was incredible, putrid. I could not think of a better way to

describe it. I was conscious of the smoke and wore a rag over my

face when it was really bad. Was there anything that could be

done? Perhaps fighting the fire would have been a start, but it was

not raging out of control, just a smoldering smudge pot that was

more of a nuisance than anything else.

By the time I had left, the 733rd Facility Engineer Team was establishing a good working solution to the HAZMAT environment at

Kandahar. I have an attached article there from the Engineer magazine.

My time at the Advanced Operation Base in Bagram, Afghanistan, May to July 2002, was spent cleaning up after the Taliban,

Fifth Special Forces Group and Third Battalion SFG. The building

we had occupied had been damaged at some point in the war. Possible mortar attacks had left large holes in the roof and no windows in the building. Luckily, it never seemed to rain while I was

there. The dust had free reign and was in everything in the building. The dust was so fine that if you opened plastic wrapping on

a CD container, there was dirt inside the CD container already.

The roof was made of tile shingles, and they were made of material containing asbestos. Tile from the roof was everywhere. We

had moved most of the tiles that were loosened to the ground before finding out we had asbestos in them. The facility improvement

officer came to our compound 1 day to announce that the roof

would be replaced by a local contractor. We had to supply the security detail while they worked. The roof was dismantled and trucked

away to dump outside the front gate. Daily, the contractor dropped

tiles down into the living area and kitchen area of the AOB. We

tried our best to keep them from doing so, but they found ways to

avoid walking to the side of the roof where the truck was parked

if they didn’t have to.

Safe houses in the area ran far and wide, from neat and

efficient——

Mr. SHAYS. Sergeant Major La Morte, I am going to ask you to

kind of summarize.

Sergeant Major LA MORTE. Well, you have my written statement.

In summary, sir, I would like to say that we never, as one of the

first Guard units in theater, when we returned we were never

properly tested for heavy metals or asbestos or nerve agents, which

we identified as being in the area thereof. Taranac Farms came up

hot for nerve agents and blood agents. But that report was classified secret, so I cannot put that in my medical records. Nor do I

have access to that report any longer.

There are 67 people deployed to that theater in my company that

were never tested for any of those. The DMOB station glanced over

records. I was injured. I broke my back and my leg, continued to

fight for 7 months. And when I came home, the doctor there just

glanced through my report and never mentioned that. I had to

bring it to his attention that I had been injured and exposed to

dust and the asbestos and nerve agents. I had a persistent cough

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when I came back. He said it was normal for the people in our

area, not to worry about it. That is easy for him to say. I still have

a persistent cough. And it needs to be identified.

I lost a soldier when we returned to self-inflicted wounds. We are

not sure if it is the drugs that we were on. I was in that group of

SF guys that came home to some violent homecomings.

I haven’t had too many more problems after that. I had a couple

people who are depressed. And I do believe it is due to the drug

mefloquine that we were taking.

[The prepared statement of Sergeant Major La Morte follows:]

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Mr. SHAYS. Thank you very much.

And by the way, your statement was very well organized and

very helpful to the subcommittee. So we have that as well.

Sergeant Major LA MORTE. Thank you.

Mr. SHAYS. Thank you.

Staff Sergeant Ramos.

Staff Sergeant RAMOS. Good morning.

Mr. SHAYS. Good morning, sir.

STATEMENT OF RAYMOND RAMOS

Staff Sergeant RAMOS. I would like to thank the members of the

Committee on Government Reform and Subcommittee on National

Security for the opportunity to speak on my health issues while deployed in Iraq. I come as a voice of many soldiers who will not have

the opportunity to have their statements heard and are still seeking answers, soldiers like Spc. Gerad Mathew, Spc. Anthony Phillip, Sergeant Herbert Reed, Sergeant Agustin Matos, Sergeant

Jerry Ojeda, Sergeant Anthony Yonnone, Sergeant Hector Vega.

There are many more who have made the ultimate sacrifice for this

country and need answers to the questions of poor health after having served in the war on global terrorism.

I served in Iraq from April 3, 2003, to September 6, 2003, with

the 442nd Military Police Company under the direct command

headquarters of the 716th Military Police Battalion. We arrived in

Kuwait and were immediately set out to link up with our battalion.

After a few days of getting acclimated to the weather conditions,

our unit was set to cross the border into Iraq. First of the soldiers

to go forth were myself, an operation sergeant, an admin sergeant

and a gunner who were picked up by two escort vehicles and off

we went.

We linked up with our battalion in Diwanyah. The camp was located within an Iraqi University that had been occupied by the 1/

3 Marine Division who ran the camp. The area in which we were

given to live was in a science and computer section of the University. It was littered with debris, blown out windows, human waste,

books as well as piles of dust, dirt and sand.

We had our work cut out for us because this building had to be

cleaned up before the rest of the unit arrived in a few days. Opposite this building was a lab which had been wired off because we

were told it was used to work on animal and human cadavers. On

the roof of our building, you could see the bones of a camel that

had been left outside. Our unit spent approximately the next 3

weeks there running enemy prisoner of war processing and transport, security checkpoint, front gate duty, Iraqi civilian escort, supply missions and operations tracking.

The living areas were shared with ourselves and 716th. There

was no running water, just a water buffalo and one-man shower

that could only be used by the 716th.

Eventually, we built our own showers, got some water cans and

imagined being home. Latrines were as such, tent poles put into

the ground to urinate, two wooden stalls with large cans underneath to move your bowels. And every day, a detail was assigned

to burn the waste which was located outside the living area.

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The unit was then given the task of establishing training curriculum for the new Iraqi police officers academy. Our unit consisted

of many law enforcement officers and this was a task that the battalion wanted us to handle. Approximately 3 weeks passed, and our

unit was given an assignment. We were to be tasked out to the Marines to run in pre-operations, military police operations. So we set

out to link with the 1/7 Marine Division in An Najaf and began an

assignment given us. The living conditions here were a little better

than our last location. But we had to deal with the same set of sanitary conditions, which was fine with us because our unit was very

honored and proud to be serving our country. Well, we spent about

a month there and were given movement orders to As Samawah.

So we set out to join the 2/5 Marine Division. This had to be one

of the hottest days since we had been in country. During the convoy drive, I became dehydrated, which caused me to become a heat

casualty. The medics had given me three IVs and were in fear that

I was having a heat stroke. A fourth was about to be administered,

but then my temperature started to improve, and I was given an

area to lie down. From that point on, my health just began to deteriorate. I became very weak. Headaches began. I was constantly fatigued, no real appetite, and I just did not feel very well.

Then it seemed as though the whole unit began to get ill. My operations sergeant went down and other soldiers started coming

down with high fevers, kidney stone problems, diarrhea, blood in

the urine, and this continued for weeks.

This train repair facility was horrible. It was inhabited by pigeons, rodents, dust, dirt, flies, fleas, oil, trains and daily sand

storms.

I just dealt with my condition trying to exercise, work and be a

productive soldier. These problems didn’t stop. They persisted and

got worse.

Time had passed, and we had been given orders to move. And

this is when the Dutch marines arrived. They had come to replace

us and the 2/5 who were finally going home. I remembered being

so impressed with the Dutch because it seemed as though they

brought all of home with them. They immediately began to not only

get their troops settled in, but began to check the environment and

living conditions. And I didn’t find out until I returned to the

United States that the Dutch found there were too high radiation

and asbestos levels which made living for their troops unsuitable

healthwise. So they moved their camp outside the training facility,

which brings me to this pressing issue.

Why does it seem as though other countries are concerned with

their troops’ health? The time I spent in Iraq, it seems as though

there were more pressing issues. I completed and viewed risk assessments and didn’t see anything about chemical or biological

threats. I read reports on how all U.S. military forces need to be

on one page, have the reports forwarded in a timely manner, receive better training and even the proper way in which the report

is to be completed. But don’t you think that after the first Gulf war

and issues of health from that war, we should have gotten it right

for this one? Or did we already know and choose to ignore it?

Why did it have to take myself and other soldiers getting ill to

find out about the depleted uranium? Why does a soldier have to

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find out by getting his wife pregnant and having his daughter deformed for us to put hearings such as this together? Why did I

have to experience being looked at in a negative way by my immediate chain of command and soldiers in my unit as well as doctors

and staff at Walter Reed when all I did was be concerned for soldiers?

Why, when the injured, when we inquired about DU in Fort Dix,

did they inform us that there was no known testing for DU? Why

did I have to seek outside help to be tested? And why did it take

myself to find out from the deputy director of Deployment Health

Support that soldiers’ illnesses are tracked, and if there are too

many of the same illnesses, an alarm is set off and commanders

are contacted to address the issues?

Why are commanders living as though they are God deciding

who goes for treatment? Why was I told that, when I reported my

findings to the staff at Walter Reed, I was questioned for hours and

told, out of all the troops from Iraq, what made me think I was exposed, that they were the experts and that they know I was not

contaminated?

Why are methods of testing not sophisticated enough to detect

the levels of DU?

Why was Senator Hillary Clinton told at a Joint Arms Committee Meeting that all troops returning from war would be tested and

today still having to bring proof that they may have been contaminated?

I am here because, as a soldier, this has to be corrected by the

soldier. It is the soldier, not the reporter, who has given us freedom

of the press. It is the soldier, not the poet, who has given us freedom of speech. It is the soldier, not the lawyer, who gives us the

right to a fair trial. It is the soldier who serves, defends, who salutes and whose coffin is draped by the flag.

I and the others didn’t go to Iraq ill. And I need to know why

it happened. And with all the resources that this country has, we

need to take responsibility for this and make it right with the soldier.

[The prepared statement of Staff Sergeant Ramos follows:]

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Mr. SHAYS. Thank you. Let me stop you there, and then I will

ask you questions of what you had later so you will be able to cover

the rest of your testimony.

Mr. Chasteen.

STATEMENT OF DAVID CHASTEEN

Mr. CHASTEEN. First, I would like to thank Congressman Shays

and all the members of this subcommittee for organizing this hearing.

I am here today on behalf of Operation Truth, the Nation’s first

and largest Iraq war veterans organization. We represent a number of veterans in all 50 States, Puerto Rico and Guam. Our mission is to amplify the voice of the troops. Along with my fellow veterans, I would like to provide a soldier’s perspective on the issues

addressed in the GAO report.

As a chemical and biological officer stationed in Bagdad with the

Third Infantry Division, I was the guy who had to answer questions like, is this anthrax vaccine going to make me sick? It was

up to me to tell the troops that the things we were doing to them

were keeping them safe and that we were shielding them from as

much risk as possible. But war is a messy, imperfect business and

nothing should be taken for granted.

Were the vaccines and other prophylaxis appropriate? Absolutely.

Did they make some people sick? Yes. Will we know the long-term

health effects of the various exposures if we don’t step up efforts

now to monitor the situation? No.

That is the crux of this issue. An ounce of prevention now will

far outweigh the pound of cure needed if in the future we are left

to guess at the conditions our troops faced.

The bottom line is that, when soldiers come back from war, they

are often sick. Very rarely do we have the opportunity to collect

good data on why that’s the case. Now is the time to rigorously enforce the collection reporting of data on occupational and environmental hazards for our troops in Iraq.

This is an opportunity to do the right thing. It will save money

in the long run, provide better information to our doctors and researchers, and, most importantly, go a long way toward providing

better health care for our soldiers.

Today, many of our troops are not convinced that their health

and well being is a priority for the government, and who can blame

them? There is currently no plan in place for evaluating the longterm health care needs for veterans of the wars in Iraq and Afghanistan, even though organizations like Operation Truth have

been calling on Congress and Department of Defense to come up

with a strategy for over a year now.

And what’s more, the continuing controversy of the funding

shortfalls in the Department of Veterans Affairs demonstrates an

inexcusable level of disregard for the pending health needs of the

more than 1 million uniformed men and women who have served

tours of duty in Iraq and Afghanistan.

There are plenty of great folks working hard at the VA, including

my mother who helps run a VA community-based outreach center

back home in Indiana. These people need to be given the resources

required to do their job, and our troops need to know that, when

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they come back from war, they will return to the best health care

we can offer them.

In today’s edition of the Washington Post, Operation Truth has

placed an ad calling on President Bush and Congress in no uncertain terms to clean up the VA funding mess immediately and to

provide the leadership needed to ensure that our troops and veterans don’t get short changed.

The problems revealed in the GAO report should be addressed

with the same level of urgency. We have had troops on the ground

in Iraq for over 2 years now. And we cannot wait any longer to

make their health needs a top priority. The guidelines for health

hazard surveillance exists, as noted in the report, the results of

previous congressional hearings similar to this one today.

Our Congress must demand that the Department of Defense correct the problems that our commanders in the field face when they

try to follow these guidelines and the hurdles our doctors, nurses

and researchers run up against when they try to put that field research to good use. Reporting must be standardized between the

branches of service, and classification policies must be re-evaluated

to ensure that they don’t needlessly jeopardize the health of our

troops. The Department of Defense must work more closely with

the VA to better anticipate the health needs of our returning

troops.

On behalf of your constituents, you should not tolerate continued

foot dragging when it comes to the well being of our men and

women in uniform. They must know that the full resources of Congress are being brought to bear on their behalf, that they won’t

have to fight a second war for adequate health care when they return home.

Our troops should know that not just our country but also their

government is committed to their well-being. Thank you.

[The prepared statement of Mr. Chasteen follows:]

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Mr. SHAYS. Thank you very much.

Dr. Crosse.

STATEMENT OF MARCIA CROSSE, Ph.D.

Dr. CROSSE. Mr. Chairman, members of the subcommittee, I am

pleased to be here today as you consider DOD’s efforts to collect

and report health surveillance data to address health issues of deployed service members.

These issues have been of particular interest since the end of

1991 Persian Gulf war when many service members subsequently

reported suffering from unexplained illnesses.

Research and investigations into these illnesses were hampered

by a lack of health and deployment data including inadequate occupational and environmental exposure data. In response, DOD developed military-wide occupational and environmental health surveillance policies for use during deployments. These policies call for

the submission of health surveillance reports to a centralized archive within specified timeframes. The military services are responsible for implementing these policies.

My remarks will summarize our findings on how the deployed

military services have implemented these policies for Operation

Iraqi Freedom [OIF], and the efforts underway to use health surveillance reports to address both the immediate and long-term

health issues of the deployed service members.

In reviewing the implementation of these policies, we found that,

although health surveillance data generally have been collected

and reported for OIF, the deployed military services have used

varying data collection standards to conduct their health surveillance. As a result, they have not been collecting comparable information.

In addition, the deployed military services have not submitted all

health surveillance reports for OIF as required by DOD policy for

archiving the information. However, officials don’t know if reports

are not being completed or if they are just not being submitted to

the archive because they do not have information about how many

health surveillance reports have been completed during OIF.

DOD has made progress using health surveillance reports to address immediate in-theater health risks during OIF. OIF is the

first major deployment in which health surveillance reports have

been used routinely as part of operational risk-management activities. These activities have included health risk assessments of the

potential hazards at a site, including soil and water samples; risk

mitigation activities to reduce potential exposure, such as relocating trash burning pits downwind of housing; and risk communication efforts to make service members aware of the possible health

risks, such as reminders to use insect repellent to reduce the likelihood of insect-borne diseases. While these efforts may help to reduce immediate health risks, DOD has not evaluated their effectiveness in OIF.

DOD’s ability to address potential long-term health effects is limited by several factors related to the use of its centralized archive

of health surveillance reports for OIF. These include limited access

to most reports because of security classification, incomplete data

on service members’ deployment locations and the lack of a comVerDate 11-MAY-2000 13:46 Apr 17, 2006 Jkt 000000 PO 00000 Frm 00093 Fmt 6633 Sfmt 6633 D:\DOCS\26238.TXT HGOVREF1 PsN: HGOVREF1
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prehensive Federal research plan incorporating the use of archived

health surveillance reports. Overall, although DOD has made

progress with health surveillance data collection and reporting, the

usefulness of such reports is hampered by DOD’s limited ability to

link reported information to individual service members.

DOD officials have said they are revising an existing policy to

add more specific health surveillance requirements, but unless the

military services take measures to implement this policy, efforts to

collect and report health surveillance data may not improve.

Consequently, we recommended that the Secretary of Defense ensure that cross-service guidance is created to implement DOD’s policy once it has been revised in order to improve both the collection

and reporting of health surveillance data during deployments and

the linking of this information to service members.

While DOD’s risk management efforts during OIF represent a

positive step, the lack of systematic monitoring prevents full knowledge of their effectiveness. Therefore, we recommend that the military services jointly establish and implement procedures to evaluate the effectiveness of risk-management efforts.

Furthermore, although health surveillance reports alone are not

sufficient to identify the causes of potential long-term health effects, they are an important part of research on the long-term

health of deployed service members. To better address potential

health effects of deployment in support of OIF, we recommend that

DOD and VA work together to develop a Federal research plan that

would include the use of archived health surveillance reports.

Mr. Chairman, this completes my prepared statement. I would be

happy to respond to any questions you or other members of the

subcommittee may have at this time. Thank you.

[NOTE.—The GAO report entitled, ‘‘Defense Health Care, Improvements Needed in Occupational and Environmental Health

Surveillance During Deployments to Address Immediate and Longterm Health Issues, GAO–05–632,’’ may be found in subcommittee

files.]

[The prepared statement of Dr. Crosse follows:]

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Mr. SHAYS. Thank you. At this time, the chair would recognize

Mr. Kucinich. I know he is putting his statement in the record. But

I welcome him to make a statement, and he could start out with

questions if likes.

Mr. KUCINICH. I thank the chairman.

And I would like, with the Chair’s indulgence, to have my statement be included in the record and, also with the Chair’s indulgence, to be able to ask a few questions at this time.

[The prepared statement of Hon. Dennis J. Kucinich follows:]

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Mr. SHAYS. Yes. You have the floor.

Mr. KUCINICH. I want to thank the chair. I want to start with

all the witnesses and say thank you for attending and for your concern about protecting the health of those who serve this country.

I would like to begin by asking Staff Sergeant Ramos, uranium

toxicity is not an every day occurrence. And we do not know of all

the effects or how to test for this highly dangerous illness. Could

you tell us a little bit more about your unit’s experience with depleted uranium radiation?

Staff Sergeant RAMOS. I didn’t know anything about DU.

I started getting these symptoms, and as I mentioned in my

statement, when I inquired, our medic had to come back, and he

had mentioned to us that the Dutch had found some radiation levels. I inquired about it at Fort Dix, about depleted uranium. We

met with a lieutenant there. We sat down, and he told us that we

had nothing to worry about. And we said, well, how can we get

tested to make sure? And we were told that there was no known

testing for depleted uranium. I had gone outside of the military to

inquire as to how I could be tested.

Mr. KUCINICH. And when you went outside the military, what information were you able to get on your own that you weren’t given

by——

Staff Sergeant RAMOS. I was put in contact with a Dr. Durakovic,

Asaf Durakovic. And he took the urine samples of myself and some

other soldiers. And the samples were sent out to three different

countries, Germany, Japan and Spain. And then I received a report

from him, which I have a copy of it here on March 24, 2003.

And which it explained the ratio of 238 and 235 is 146.9.

Mr. KUCINICH. Mr. Chairman, is that already in the record?

Mr. SHAYS. No. So without objection, we will put it in the record.

Mr. KUCINICH. So when you received that report, what went on

in your mind about this experience.

Staff Sergeant RAMOS. When I received the report, I was confused. I didn’t know what was going on. And I said, I need to get

answers to this. I had already started my medical board process at

Walter Reed. So when I informed them that I had this document,

I was told to get a copy of it and submit it for review.

When I had it faxed to me—I turned this in at the medical board.

And then I was directed to meet with a Colonel Hack and Lieutenant Colonel Mercer at Walter Reed.

Mr. KUCINICH. In looking over your testimony, I just would like

to go back over something. How did you come into contact with depleted uranium?

Staff Sergeant RAMOS. Sir, I don’t know how I came into contact

with it. I don’t know in whatever part of the country in Iraq I was

in; I was not aware of what was in my surroundings. When I was

at the train station is where I became the most ill.

Mr. KUCINICH. Let me ask you this if I may.

Were you firing any munitions yourself.

Staff Sergeant RAMOS. No. I did not fire any munitions.

Mr. KUCINICH. But you were in places, say, after the fact?

Staff Sergeant RAMOS. Correct.

Mr. KUCINICH. You were in places where it is your belief that you

were exposed?

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Staff Sergeant RAMOS. Yes.

Mr. KUCINICH. To depleted uranium?

Staff Sergeant RAMOS. Yes.

Mr. KUCINICH. Were you exposed on skin, or did you breathe it

in? Do you know? Could that really be ascertained?

Staff Sergeant RAMOS. Sir, the only thing that I can think of is

inhaling. There was a lot of dust blown around the area. And that

is the only way I think I could have gotten it.

Mr. KUCINICH. How are you feeling now?

Staff Sergeant RAMOS. I have daily headaches. I have numbness.

My hands go numb. I have joint pains and fatigue.

Mr. KUCINICH. How old are you?

Staff Sergeant RAMOS. I just turned 43.

Mr. KUCINICH. And other than this encounter with depleted uranium, were you in pretty good health?

Staff Sergeant RAMOS. Prior to me going to Iraq, yes.

Mr. KUCINICH. Have you been in touch with others in your unit

who went there?

Staff Sergeant RAMOS. Yes.

Mr. KUCINICH. And they have experienced some of the same concerns, physical problems?

Staff Sergeant RAMOS. The soldiers that I know of that were tested, yes. Other soldiers in my unit, they haven’t expressed anything—any ill effects to me. Just the soldiers that were in my unit.

Mr. KUCINICH. In your testimony, you alluded to one of your associates whose wife gave birth and the baby was deformed.

Staff Sergeant RAMOS. Yes.

Mr. KUCINICH. Are you in touch with that family still?

Staff Sergeant RAMOS. Yes.

Mr. KUCINICH. Have they had any tests done that would link the

birth deformity to the exposure of your associate?

Staff Sergeant RAMOS. He has not had a test that has linked the

exposure to his child. He has tested himself and has tested positive.

Mr. KUCINICH. Positive for what?

Staff Sergeant RAMOS. Depleted uranium.

Mr. KUCINICH. I would like to ask just one question, if I may, of

Mr. Chasteen. What conclusions have you made about the medical

health system currently in place for soldiers relating to this issue

about depleted uranium?

Mr. CHASTEEN. Actually, it is interesting that you bring that up.

A Gulf war resource center had a conference in Florida a couple

months ago which was a really good opportunity to get soldiers and

VSOs together along with the VHA people who are working on

these issues. I had a long conversation, made a friend with Dr.

Drew Helmer, who is a neurologist working at the War-Related Illness and Injury Study Center at the Department of Veterans’ Affairs in New Jersey. The VA actually has specific resources set up,

kind of cutting edge stuff where they have researchers and practitioners both working for people, such as Sergeant Ramos, who have

illnesses that probably are linked to their service but have been unable to conclusively make a connection to the satisfaction of the

VA.

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The problem that I have found is that the VA centers in general

are unaware of the resources that are available elsewhere in the

VA for these kinds of research and finding these kinds of things

out. So on the one hand, VA is doing real good, cutting-edge work

in trying to connect people with an answer. But the VA system at

large isn’t aware sometimes of even the resources available internally, and also, these are very small centers that have very little

funding. I don’t know if that answers your question.

Mr. KUCINICH. OK, Mr. Chairman, I just want to put this on the

record. You know, my staff had contacted the Department of Defense, maybe it was a couple of years ago when the first discussions

came up about depleted uranium munitions. And maybe there is

some confusion about it. But some of the information we were getting out of the Feds was that there were some people who were actually denying that such munitions were even being used.

I just wanted to mention that to you because I don’t know that

we have had any subsequent hearings where it has truly been established that depleted uranium munitions were used and the level

at which they were used and the attendant health risks to our soldiers or to the civilian population.

Mr. SHAYS. In response to the gentleman’s question, we haven’t

had any hearings specifically about depleted uranium, and frankly,

the case is really still out whether this represents a problem or not.

The tests that is on you is a question of reliability, and everybody

has some radiation in their bodies. So the issue is, is this just abnormal because you were there or would we find that same issue

in people in the United States? So it probably is an area that some

time we should focus on. We just, you know, pick our hearings and

have many to chose from.

Mr. KUCINICH. I want to thank the Chair for having this hearing.

And as always, you are very concerned in general what is happening with the people who serve this country. So I thank you.

Mr. SHAYS. I thank the gentleman.

I love my staff. We get in a dispute whether it is Ramos or

Ramos. You need to tell me how to say your name.

Staff Sergeant RAMOS. Ramos.

Mr. SHAYS. We will chalk one up to the understaff and not to the

counsel here.

Staff Sergeant Ramos, I would like you to, because I cut you

short here, would you just tell me the illnesses you had? You said,

here is a list of what I came back with.

Staff Sergeant RAMOS. Sleep apnea with fatigue, Fibromyalgia.

Mr. SHAYS. What does the percent mean? I don’t understand the

percent. It says zero percent.

Staff Sergeant RAMOS. These are, prior to me being deactivated

from military service, these are percentages I received from Department of Defense. It is not what I have received from the VA.

This is from the Department of Defense.

Mr. SHAYS. So it is a disability rating? It is not the percent of

sleep fatigue?

Staff Sergeant RAMOS. It is a disability rating.

Mr. SHAYS. It is not the percentage of sleep——

Staff Sergeant RAMOS. No. Fibromyalgia was zero percent. The

PSTD, headaches with Punctuate White Matter, Ischemic Changes

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in Parietal Lobes, 30 percent. Cervical myalgia, zero percent. History of single Leishmaniasis lesion on Left Anterior Chest, now

with pigmented scar, zero percent. Bilateral Ulnar Nerve Compression Neuropathy, zero percent. Depleted uranium exposure medically acceptable, zero percent. Skin rashes, zero percent.

Mr. SHAYS. I am going to, at this time, have our counsel ask

some questions to the witnesses.

Mr. HALLORAN. Let me start with Dr. Crosse. Could you describe

for us the impact or the differences you saw in this military service

branch’s approach to these issues and the impact those differences

had on the effectiveness of the surveillance program?

Dr. CROSSE. Yes. Let me see if this microphone will work this

time. The services have teams of preventive medicine units that go

out to do this range of activities that they engage in. The teams

are composed of different types of individuals with different sorts

of expertise. Each service has comprised their teams of different

kinds of specialists. And so, to begin with, you have people with

different sorts of training, levels of expertise going out and doing

this.

It’s not necessary that an Army unit would necessarily have an

Army preventive medicine team coming in there. So you can’t just

assume that the data that are collected for Army bases are comparable. Because some of the data for an Army installation might

be collected by an Army unit, some of it might be collected by a

Navy unit coming in. They have different types of expertise.

They also collect somewhat different information. For example,

the water sampling is done the same across all the services, but

the soil sampling is different. The Army teams collect samples for

20 types of hazards, the Navy teams collect samples for 15 types

of hazards, so it’s highly dependent upon who has done the data

collection at a particular installation at a particular time as to

what kind of information would have been gathered to even be

available for archiving.

Mr. HALLORAN. What explains the consistency of water testing?

Is that a happy accident or did——

Dr. CROSSE. Well, each service has been allowed to develop their

own guidance to implement these broader policies. DOD is now in

the process of trying to modify some of this—the policies to try to

get more comparable kinds of requirements across the services, but

that’s not yet in place.

Mr. HALLORAN. So they all just have to do about same water

standard, is that——

Dr. CROSSE. Perhaps. There is a joint working group that is trying to come together to develop standards. And it may be that

water sampling is more straightforward. I’m not a technical expert

to say why that may be the case. But they’ve implemented them

in different ways with different types of individuals, different levels

of training.

Mr. HALLORAN. DOD points to a low rate of non-battle disease

injuries in this theater in particular, in Iraq, as admittedly indirect

evidence of the effectiveness of these preventative medicine programs. Can you evaluate that claim for us?

Dr. CROSSE. I think it does give some reassurance for the kind

of immediate health effects that you would see in theater. They

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have, as we said, made progress I think in going out and trying to

examine the risks on a base, to try to locate trash burning away

from housing, to try to do other kinds of things that would reduce

some of the immediate risk the troops might face. I think it’s way

too soon to know what it has done for longer-term health effects.

Mr. HALLORAN. Sergeant Major La Morte, let me segue to you on

that subject. In your testimony you describe various moves your

unit made to different locations. At each of those locations, could

you describe for the subcommittee the kinds of environmental information you were given before, during, after your stay there in

terms of what hazards might be there, what to avoid, what mitigation steps you might take?

Sergeant Major LA MORTE. The only report we had when I was

at the Forward Operating Base 32 was that the Taranac Farms

trading area that we used as a range came up hot for blood agent

and nerve gas agents; and we assumed, having not taken it with

us, that it was left from the Soviets since they travelled with those

chemical weapons as part of their SOP.

Mr. HALLORAN. And that area is just marked off as hot and you

didn’t go there, or what was done about it?

Sergeant Major LA MORTE. The last report I had, that area has

been bulldozed over and is no longer used.

Mr. HALLORAN. And did you make note of that incident in your

other——

Sergeant Major LA MORTE. I made notes—when I came home, I

put it in my medical records that I had been in the area of contamination, but I have nothing—because that report was secret—

that I can put in my medical records.

Mr. HALLORAN. Staff Sergeant Ramos, could you address the

same question in terms of the locations? If so, what kind of environmental occupational hazards were you told were there? What

information were you told about what to do about them?

Staff Sergeant RAMOS. Right. The information that I was given

afterwards is that there were tanks, vehicles that had been struck

by rounds that were outside the encampment. I worked in an operations cell, so I was pretty much enclosed in the building 24 hours

a day. I wasn’t aware of what was outside the encampment. It

wasn’t until, as I said in my statement, when I got back that I was

told that when the Dutch came in they were taking samples, and

they found it unsuitable for their soldiers to stay in the training

facility, so they built a holding encampment outside of the training

facility in Samawah.

Mr. HALLORAN. Mr. Chasteen, does your organization have any

kind of information or visibility on the pre- and post-deployment

health assessments and their use and effectiveness?

Mr. CHASTEEN. We do actually have some reports on that. I don’t

have it handy. I can have my staff get it to you.

I will say, though, that I agree. I think it’s been a marked improvement from the first Gulf war in terms of actually having those

assessments and doing those assessments. I know that me and my

soldiers got the pre- and post-deployment assessments. I know that

was a little more regular for Active Duty soldiers than it was for

National Guard and Reserve soldiers, which is I think not surprising just in terms of kind of central locations for both where the solVerDate 11-MAY-2000 13:46 Apr 17, 2006 Jkt 000000 PO 00000 Frm 00134 Fmt 6633 Sfmt 6633 D:\DOCS\26238.TXT HGOVREF1 PsN: HGOVREF1
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diers lived and where they were going to return to after they deployed and came back.

Again, with any of these things, you’ve got conflicting motivations. The soldiers, they want to go home. They’re not real interested in a post-deployment examination. They want to get back to

their families. And if those families are off base, it can be harder

for National Guard and Reserve soldiers to have to stick around an

additional week to get those done, as opposed to Active Duty soldiers who can go home tonight, come back in a couple of work days

and get that done.

So those are some of the issues that are at play there.

Mr. HALLORAN. Staff Sergeant Ramos, I think you said you have

sought VA care since you separated from the service; is that right?

Staff Sergeant RAMOS. Yes. When I separated from the service,

I went to the VA to file my paperwork for my health issues, and

since then I’ve received 80 percent from the VA for my health

issues.

Mr. HALLORAN. So you found both the VA disability, the process

and the health care process had access to information they needed

from your military medical records?

Staff Sergeant RAMOS. Well, I had made copies of my military

medical records. I had to make copies. We had a lot of issues in

Fort Dix where things were taken out of your medical records, so

I made copies of everything.

So when I came back I had everything chronologically filed, and

I submitted for each one of my issues documentation, medications

that I was taking, so it made it very easy. Because the VA’s computer system is not on the same with DOD’s, so they don’t have

access to doctors’ notes or addendums.

Mr. HALLORAN. So you did that yourself.

Staff Sergeant RAMOS. I did that myself.

Mr. HALLORAN. And, Dr. Crosse, what kind of information did

GAO find getting into individual medical records?

Dr. CROSSE. Well, there is not a lot of getting individual medical

records generally. For the air bases, the Air Force has created a

summary that can be placed into each service member’s medical

record that explains the sorts of hazards that exist at that air base.

It will talk about exposure to fumes from the fuels and other kinds

of things that would exist in that area, the sorts of insects and diseases that are known, the dust or other kinds of problems that may

exist in that location; and that’s placed into every service member’s

record who is at the air base. That is not done regularly for service

members in other locations, however.

For Port Shuaiba, the Army and the Navy have created a similar

kind of exposure summary document, but it’s up to individual service members to place that into their own medical record if they

want it to be placed there. It’s not routinely done for them.

The other kind of exposure documents that would be placed into

a service member’s record is if there is an incident that is actually

investigated. If, for example, a tank blows up and a lot of people

become ill from the fumes and they go in and try to determine

what kind of chemical was there and who was exposed, then there

could be a report made for all of the service members who were exposed in that specific incident. But, otherwise, there are not routine

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reports being placed into service members’ records for each location

where they’re housed as they’re moved around in Iraq.

Mr. HALLORAN. Sergeant Major La Morte and Staff Sergeant

Ramos and even Mr. Chasteen, were you told—let me try to address Congressman Kucinich’s question. Were you told there were

DU rounds in the vicinity at any time? Were you told about the

hazards of DU before, during or after your deployment?

Sergeant Major LA MORTE. Yes, sir. I’m aware of DU hazards.

It’s in our training for MDC training. There were no reports that

I’m aware of in the military that have indications where those

rounds were used. If there was an overlay for that area, it would

be helpful. Any time that the Air Force is working with an Asian

aircraft, it has depleted uranium rounds. I would assume that

you’re in a depleted uranium area.

Mr. HALLORAN. And, Staff Sergeant Ramos, I think you said

there were some bombed vehicles, or just——

Staff Sergeant RAMOS. Yes, there were vehicles. Especially there

was one outside of the operations area. There was a vehicle that

was left there. But——

Mr. HALLORAN. Was it said or known that it was a DU round,

or just suspected?

Staff Sergeant RAMOS. No. I just saw a vehicle that was blown

or shot up that was left there in front of the building that we ran

our operations out of.

But, as far as training, we didn’t get anything on DU. Most of

our training was on MP operations, patrols, and how to properly

mark unexploded ordinances.

Mr. HALLORAN. And has DOD communicated with you since

you’ve returned, saying you were part of a cohort or a group that

might have been exposed to certain hazards at the training location?

Staff Sergeant RAMOS. No, I have not.

Mr. HALLORAN. VA neither?

Staff Sergeant RAMOS. No.

Mr. CHASTEEN. I was actually the radiation safety officer for my

DIVARTY, and so depleted uranium was my purview as part of my

responsibilities. We did do depleted uranium training for soldiers

who were going to be coming into contact with those kinds of

rounds.

Obviously, the most common use of depleted uranium in the

Army is for cab guys, guys who are operating the M–1A and M–

1A–2 battle tank. Those units do depleted uranium training on a

regular basis because there is an immediate hazard to soldiers who

handle DU rounds and then would eat afterwards without having

washed their hands. Because, obviously, the main risk of DU is

through ingestion, and that can be a serious problem because it is

toxic.

The soldiers who were going to be working with—we have some

artillery soldiers who are Reservists who were attached to the cab

who did actually get depleted uranium training to make sure that

they understood that if they were handling those rounds or near

those rounds, whatever, that they needed to take part in precautions, which mostly involved washing their hands before they

ate.

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Mr. KUCINICH. If I may, Mr. Chairman, to Mr. Chasteen, how

many soldiers received depleted uranium training, to your knowledge?

Mr. CHASTEEN. I would have to say, as part of—there are annual

NBC requirements and there are annual radiation safety requirements. So my specialists, my 54 Bravas, NBC NCOs who were attached to each company or battery and DIVARTY, those guys

would get it as part of their annualized training.

Mr. KUCINICH. Can you extrapolate as to how many that might

be?

Mr. CHASTEEN. Well, I would say it would be approximately 32,

but those would be the specialists who were assigned to each battery. So the specialists who were responsible for knowing those

things got the training on a regular basis, but in terms of then disseminating that information out to the rest of the soldiers, I can’t

say.

Mr. SHAYS. Let me tell you, Dr. Crosse, I have one question that

I want you to think of the answer, so I will just have a conversation with the others for a second. You might want to consult with

your colleagues.

I want you to rank the four branches as to which is further along

in this effort. The bottom line to your report is we’re making

progress on optional safety issues in the environment in the workplace, but which is doing the best at keeping proper records and

trying to keep track of our soldiers in this case and which is doing

the worst? And then I want you to explain to me why.

Staff Sergeant Ramos, your testimony, I thought—what I was

struck most by—and obviously all of your testimony is very helpful—but you said, when you’re talking about the Dutch, they immediately began to not only get their troops settled in but began to

check the environment and living conditions; and I didn’t find out

until I returned to the United States that the Dutch found there

were too high radiation asbestos levels, which made living for their

troops unsuitable healthwise, so they moved their camp outside the

training facility.

I think that speaks volumes. Our folks lived there, and the

troops that replaced them decided to live somewhere else because

they bothered to check.

And I would say to you, Sergeant Major La Morte, I found this

interesting. I and my fellow soldiers were willing to face combat

and the dangers that it brings, but what I find disturbing is the

looking the other way when it’s time to treat or even test the members who are so willing to face bodily harm. The right things need

to be done. Step up the monitoring and the treatment and documentation of the exposure.

What I take from your testimony is you all know that sometimes

you’re going to be in bad workplaces. Now sometimes you don’t

have to live in one place, you can move, but when you’re fighting,

you’re going to have—OSHA inspectors aren’t going to be able to

tell everybody exactly how to conduct themselves. Sometimes they

simply can’t. So you’re going to be exposed to bad things.

I think your point is, when we are, we need to make sure that

we’re aware of it, are tracking it, and following that throughout the

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rest of that individual’s life. That is the obligation that I think exists.

Dr. Crosse, I’m trying to filibuster here. Do you have enough——

Dr. CROSSE. I have an answer.

First, I would say that the archives aren’t tracking which services are submitting reports. As I mentioned before, sometimes the

Navy unit is submitting a report for an Army base. However, we

believe in general that the Army and the Air Force are doing a better job than the Navy and the Marines. The Army has the lead responsibility and the longest history because of CHPPM, their Center for Health Protection—I’m forgetting what it stands for there—

Health Promotion, and they have had the lead in general on these

issues.

The Air Force has an advantage of having fewer fixed facilities,

and they have taken the lead on creating these exposure summaries that they place into the records of every service member.

The Navy and the Marines have lagged both in terms of doing

the pre- and post-deployment health assessments. GAO put out a

report a few months ago on the pre- and post-deployment health

assessments, and the Air Force and the Army were doing a much

better job than the Navy and Marines—particularly than the Marines in doing those kinds of health assessments and getting them

into the individual service member’s records.

Also, the Marines are supported by the Navy, but the Marines

are moving around to many different locations in Iraq, and their

location identification has been a particular problem, we believe.

So, in general, that’s the order in which we would place the services. But, again, we don’t have across-the-board data to measure

different components for each service.

Mr. SHAYS. What type of cooperation did you think you were receiving from the branches when you were doing your study?

Dr. CROSSE. I believe we had good cooperation from them. I think

that the problem is that some of the kinds of information we wanted to obtain just weren’t available.

Mr. SHAYS. Because they were classified or they just weren’t

available?

Dr. CROSSE. Well, some of both. But we have security clearances

so that we would be able to access the information, so it was really

more of an issue of some of the kinds of information just aren’t

available.

Mr. SHAYS. Before the troops were sent—we had the military

here. They said they would be checked out before they went, and

they would be checked out when they got back.

What I’m troubled with is, first, I’m not quite sure what ‘‘checked

out’’ means now. Second, though, when a soldier is requesting—and

others can speak to this as well—requesting that they verify for

certain exposures and it’s not being done, I particularly find that

unsettling. In other words, if a soldier says I think I was exposed.

But, tell me, what is your sense of how many troops, if you have

a sense, where their health was verified at the beginning and how

many when you came back do you think they went through a decent health check?

Dr. CROSSE. In terms of the pre- and post-deployment health assessments, which is a fairly short assessment that’s done, the Army

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and the Air Force were in excess of 90 percent, the Marines were

somewhere around 70 percent, and the Navy was a little above

that, maybe 80 percent. I don’t have the programs, I could provide

them to your staff.

[The information referred to follows:]

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Mr. SHAYS. When you asked officials there why, frankly, not 100

percent but certainly why just 70 percent, what kind of response

would you have received?

Dr. CROSSE. Well, that wasn’t part of this review. We do have an

entirely separate report on that.

But some of the issues were, just as Mr. Chasteen mentioned,

some of the service members wanted to quickly be demobilized and

get back to their families. It was not necessarily being done within

the first day or two of their arrival back stateside, and so that became a problem, getting people back in or being sure that all of the

steps that were necessary were completed. So it was apparently

more routine and given a higher priority by the Army and the Air

Force.

We also noted in that report that we had previously looked at the

Army and the Air Force for their compliance rates, and they had

improved considerably. We had not previously looked at the Navy

and Marine compliance with those requirements, and they were

still quite low.

Mr. SHAYS. Some of this is like a bad memory for me because

we’ve had so many hearings on this, and there has been a lot of

resistance, not now, on the part of DOD and the VA. But what we

learned from VA was they hardly had anyone, any doctor, who had

any background in occupational hazards. It was as if they could

name only two people out of thousands; and so, you know, the expertise they had just wasn’t in this area.

But literally sitting at that table or one like it, on either side of

Mr. Donnelly was his wife and his father. When we asked him

would he still have gone in the military and served if he knew that

he would get ALS, I thought he would say, what are you, crazy?

But his word was said so softly because he couldn’t speak very

loudly, but he said it quickly, it wasn’t a hesitation.

So I just think it’s important to just put on the record that when

we have military people who come down and complain about their

bad health, I think they have, one, a right to be unhappy if they

were exposed needlessly, but I think they also know that they’re

sometimes going to be exposed. But I think they have a real right

to be angry if they believe that they have been exposed and aren’t

getting the kind of care they need. And that care means that we

need to have the records, we need to know how they went in, we

need to know how they left.

Then there are, frankly, some folks who may not feel well today

but have no sense that it may be connected to their military service

because there may have been a bit of delay. It is unsettling to

think that someone gives birth to a child—and, I mean, there are

children who are born deformed from parents who were not serving

in the military, so you’re not always sure, but the fact that someone could wonder. If I were in the service and I knew that my child

was deformed and I thought it might be because of something I did

or received, it would be something I would be living with the rest

of my life, even though I couldn’t be blamed for it. But it’s just—

so there are just lots of different levels of the need to continue to

make further progress.

What do you think would be the most helpful thing we could be

suggesting to our next panel from the VA and DOD?

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Dr. CROSSE. Well, we believe that——

Mr. SHAYS. And I open that to all the panelists as my last question.

Dr. CROSSE. We believe that they need to be sure that the policies they’re putting in place are implemented consistently, which

would include the collection of this kind of information and the

archiving of that information, including the location data that their

policies already call for but that are not consistently being complied

with.

We also believe that they need to put in place some more specific

plans for evaluating and researching what is going on and the effects on the service members.

Mr. CHASTEEN. I would say that, as with many things in the

military, it’s extremely important that you make sure that the responsibility for making sure the policies get implemented falls with

the person who has the power to make sure that those orders are

actually enforced.

What’s going to be important is, if we’re going to make this a priority, it has to be something that the command is aware of and the

command is going to be evaluated on. If the commanders have on

their OER, you know, did or did not complete with guidance on pre

and post, this, that and the other, the problem is you have a commander deciding whether or not the soldiers can go home early

who doesn’t necessarily have to have the responsibility for whether

or not the surveys get done and get sent up to highers. Does that

make sense?

Mr. SHAYS. Yes.

Mr. CHASTEEN. So you have to make sure that the commanders

are going to be evaluated on whether or not they comply with this,

and that’s the only way it’s going to get done.

Mr. SHAYS. Now, speaking to our two sergeants here, did you feel

that it was the responsibility—why don’t you answer the question

I just asked, and then I’ll ask this last question.

Staff Sergeant RAMOS. Well, I agree with Mr. Chasteen that the

responsibility has to fall on the commanders. The commanders are

given a great deal of responsibility, and one of the responsibilities,

most important, is the welfare of their soldiers.

I also believe that when soldiers DMOB, that DMOB stations do

not offer soldiers a speedy exit: If you sign this waiver you can get

home right away. But then the soldier doesn’t understand that,

once they sign that waiver, if something should happen to them

later on, they can’t come back to the mobilization station and say,

you know, my thumb was hurting me. Uh, uh, uh, you signed this

waiver, so medically you’re cleared.

I think that’s where a lot of problems are happening, especially

with my unit. They returned, and they were immediately given bottles to submit samples for DU. They stood on long lines; and they

were told, oh, it’s going to take a long time. A lot of them just did

not test.

Mr. SHAYS. OK.

Sergeant Major LA MORTE. One of the problems we have is everything is documented as secret, especially in the special operations community.

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Mr. SHAYS. Not everything is documented as secret. Let’s not get

carried away. What do you mean by everything?

Sergeant Major LA MORTE. Where I’ve been, what I’ve done in

country is classified secret. There is no correlation when I have

gone on patrol, where I’ve gone, whether I’ve been exposed to

agents or not. If we have to hastily take over a house, nothing has

been checked.

Mr. SHAYS. Right. But that’s going to happen, you’re going to

take over a house, and it’s not going to be checked, right?

Sergeant Major LA MORTE. I understand that, sir, but if where

I have been is kept secret and later on it is identified as a hot spot,

how am I going to be correlated into that area?

Mr. SHAYS. Good point.

Sergeant Major LA MORTE. A lot of the historical documentation

has been wiped off computers in order to bring it back in the country or left in country. It is as easy to keep the documents there

than it is to transport them. There is a lot of electronic media than

we don’t have access to bring home.

Mr. CHASTEEN. The Sergeant Major and I were discussing this

before this hearing conferred. A lot of times the VA is asking for

information regarding where soldiers were located when they were

serving to try to make correlations between agent exposures and

things like that, and something that you actually run into is there

is a real disincentive to actually even bring that information back

from the deployment.

You know, every battle captain like myself keeps logs of what

takes place during combat operations. Those logs are classified. At

the end mobilization there is this big return home, and almost everything that you have worked with during deployment, all this

staff work and all these other things, they’re classified because it

happened during war. Then when it’s time to go home you have a

safe about this big to take everything home in, and naturally the

intelligence officer is going to say, OK, obviously we’re not going to

take back every scrap of paper. So what happens is a lot of these

records that would show where people were and what happened,

etc., they are, a lot of times, on electronic media, on hard drives

and things like that, and a lot of times it’s easier to just wipe the

hard drive and say that way I can pack it in my suitcase and take

my unclassified stuff with me and not have to put it in the safe,

rather than take back all that classified data.

Soldiers and officers, the lieutenant guy, is going to take the

path of least resistance. If it is easier to wipe a hard drive rather

than take back data that he is not going to be accountable for

maintaining over the long run, he’s going to do it.

Sergeant Major LA MORTE. I think certain reports need to be

made and kept unclassified, and those reports being——

Mr. SHAYS. They may need to be declassified?

Sergeant Major LA MORTE. Yes. And the other thing——

Mr. SHAYS. When you come right down to it, the only people

hurting by having it classified are people who served.

Sergeant Major LA MORTE. Correct.

The other thing we need to look at, especially in Afghanistan, is

we are fighting in a warfront that has been fought as a chemical

war and nothing historically was researched before going in there.

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We don’t know where the hot spots the Soviets had that we’re tripping over. It hasn’t rained in 17 years in some of those locations,

so that environment is still there, and we’re kicking it up every

time we drive through it. Everybody would get sick after they do

a vehicle patrol. So it’s there.

Mr. SHAYS. You all have been very good here, very helpful to us.

Is there any last point you want to put on the record? Anybody?

Dr. Crosse, you all set? I appreciate the work of you and your

colleagues. As always, it is very helpful.

Anyone else?

Thank you. Your testimony was quite helpful to us, and we

thank you for participating.

We go to our second panel: Dr. Michael Kilpatrick, Deputy Director of the Deployment Health Support Directorate, Department of

Defense, accompanied by Colonel John Ciesla, Chief of Staff, U.S.

Army Center for Health Promotion and Preventive Medicine. And

from the VA, Dr. Susan Mather, Veterans Health Administration

Department of the VA, accompanied by Dr. Mark Brown, Director

of Environmental Agents Service, Department of Veteran Affairs.

If you would all stand, please. Thank you.

[Witnesses sworn.]

Mr. SHAYS. Note for our record that the witnesses have responded in the affirmative.

Again, I thank you for being here to listen to the first panel. You

certainly have a privilege to go first, and thank you for waiving

that privilege. It will make our testimony all the more helpful to

us, so I thank you for that.

I think we will hear from two, correct, Dr. Kilpatrick and Dr.

Mather. I’m sorry. We have the name tags. Colonel, I was giving

you a doctor; and, Doctor, I was giving you a colonel here.

Thank you, Dr. Kilpatrick.

STATEMENTS OF DR. MICHAEL KILPATRICK, DEPUTY DIRECTOR OF THE DEPLOYMENT HEALTH SUPPORT DIRECTORATE, DEPARTMENT OF DEFENSE, ACCOMPANIED BY

COLONEL JOHN CIESLA, CHIEF OF STAFF, U.S. ARMY CENTER FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE

(CHPPM); AND DR. SUSAN MATHER, CHIEF OFFICER, PUBLIC

HEALTH AND ENVIRONMENTAL HAZARDS, VETERANS

HEALTH ADMINISTRATION, DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY DR. MARK BROWN, DIRECTOR, ENVIRONMENTAL AGENTS SERVICE, DEPARTMENT OF VETERANS AFFAIRS

STATEMENT OF DR. MICHAEL KILPATRICK

Dr. KILPATRICK. Mr. Chairman, members of the subcommittee,

thank you for the opportunity to appear before you today to discuss

the Department of Defense’s deployment occupational and environmental hazard health surveillance program, a key component of

our force health protection.

My written testimony you have accepted for the record, and I

thank you for that.

I certainly appreciate the opportunity to hear the testimony of

the first panel, particularly the members who have served and

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been in combat. As a former Department of Defense medical officer

and currently working for the Department of Defense in medicine,

we have not done our job well if people still have concerns and

questions about their health. We should be able to answer those

questions, we should be able to give them the right information,

and I have learned some things today I need to go back and work

on how we can fix.

We are, in the Department of Defense, firmly committed to safeguarding the health of our Active and Reserve component service

members before, during and after deployment. Occupational and

environmental health surveillance is a key in both Operation Iraqi

Freedom and Enduring Freedom. We recognize the importance of

sharing these data with the Department of Veteran Affairs, and

we’re working to make that information more available to them.

The Services, the Joint Staff and the Combatant Commands have

made substantial progress in addressing deployment health-related

issues with occupational and environmental exposures; and then

we heard from the panel before, commanders bear this responsibility and commanders do what leaders check.

Medical intelligence provided by the Armed Forces Medical Intelligence Center and other sources is used to anticipate environmental health hazards; and we have well-trained Army, Navy and

Air Force medical personnel conducting ongoing in theater environmental surveillance, closely monitoring air, water, soil, food and

disease vectors for health threats. They collect baseline data on air,

water, soil when base camps are established, routine data, following up with air, soil and water in those base camps to detect any

changes. Then they look at incident-related data when we anticipate or expect that perhaps there has happened a chemical spill,

industrial accidents or any illness outbreaks or chemical/biological

agent exposures. That data is certainly systematically identified,

documented and archived.

As you’ve heard before, the U.S. Army’s Center for Health Promotion and Preventive Medicine is our main archive center; and

they have just recently completed a summary report of OIF/OEF

environmental surveillance monitoring data from January 2003, to

April 25. They analyzed nearly 3,900 air, water, soil samples taken

in 274 locations in Iraq, 28 locations in Afghanistan, and several

locations in Kuwait and neighboring countries. We also have over

1,000 environmental reports that were collected in theater and

have been sent to the CHPPM for that archiving. Again, these environmental health assessments give us a very good understanding

of what our troops are being exposed to while they are deployed.

Incident-related data, as you heard from the GAO, is collected

when we believe there is potential contamination with a hazardous

substance; and when we do that, we identify the individuals at

risk, testing is accomplished if indicated, information is entered

into their medical record, and medical debriefings are provided.

One example of this activity is a possible radiation exposure

threat when the Al-Tuwaitha Nuclear Research Center in Iraq was

looted during the early days of OIF. DOD performed extensive environmental assessments and checked personnel radiation levels.

We joined with the International Atomic Agency, Iraq’s Ministry of

Health and Iraq’s Atomic Energy Commission to perform health

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evaluations of some 4,000 people living in five villages surrounding

Al-Tuwaitha. The assessments found no abnormalities related to

radiation.

We also developed fact sheets for the United States and coalition

personnel and briefed our service members in town hall type meetings. Personnel radiation measurements demonstrated that radiation doses to our personnel were within acceptable limits, and so

we would expect no short- or long-term health effects.

During OIF/OEF, we have done extensive environmental and

medical surveillance for possible depleted uranium exposure. The

DOD biomonitoring policy, which was redrafted in 2004, specifies

procedures for identifying personnel possibly exposed to DU, assessing their degree of exposure, and following up with urine bioassays to document exposure level. We also include in that testing

of individuals we express a concern about exposure or possible exposure to depleted uranium.

As of last month, we have completed 1,970 samples from personnel, 24-hour urine samples. Only six of those have been found to

be positive for depleted uranium, and all individuals were involved

in fragment exposure to depleted uranium.

The staff has also looked at some 450,000 post-deployment

health assessment forms where our service members are reporting

their concerns about environmental exposures. The most commonly

reported concerns were sand or dust, vehicle exhaust and loud

noise. The least commonly reported concerns were depleted uranium and the exposure to radiation. DOD is using these results,

along with our health risk communication capability, to make sure

that there is sufficient information available to service members,

their families, military leaders and health care providers to alleviate concerns and anxieties that may be produced because of these

exposures.

The Government Accountability Office has identified a concern

that access to archived environmental surveillance reports is limited by their security classification. Please be assured that the classification of this data does not hinder the Department’s ability to

ensure the appropriate care of our services members for health

issues resulting from deployed occupational and environmental exposures. We remain committed to improving the continuum of care

through our force health protection program and to educating our

military members about environmental factors that could affect

their health and about our preventive measures to safeguard their

health.

Mr. Chairman, I thank you for inviting me here today. I am

pleased to accept your questions.

Mr. SHAYS. Thank you.

[The prepared statement of Dr. Kilpatrick follows:]

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Mr. SHAYS. Dr. Mather, let me just throw out a question I’d like

both of you to think about. I want to get a little bit more about the

depleted uranium. I want to know if it’s more dangerous to breathe

or if it’s particles are on your skin. I’d like to know how much information we have about depleted uranium. But for the site you’re

talking about, I think it was actually a friendly fire attack; is that

accurate?

Dr. KILPATRICK. The individuals who have fragments were in

friendly fire, yes. They were in close—and it was actually more

calling in air support and being very close to where that air support fired.

Mr. SHAYS. Closer than they should have been, or the fire was

a little closer? But, anyway, I will get into it in a bit, but if you

will just know that is an interest there.

And, Dr. Kilpatrick, you’re finished, right?

Dr. KILPATRICK. I’m finished.

STATEMENT OF DR. SUSAN MATHER

Dr. MATHER. Mr. Chairman, thank you for your invitation.

Thank you for the opportunity to come and talk about VA’s initiatives in response to the healthcare needs of OIF/OEF veterans.

I am accompanied by Dr. Mark Brown, as you point out, who is

a VA toxicologist.

VA’s goal is to ensure that every serviceman or woman returning

from combat has access to world-class services and uncomplicated,

seamless passage from soldier to citizen. This is dependent, in part,

upon the seamless transition of a wide range of basic data about

these new veterans from DOD to VA.

I am pleased to say that VA and DOD together are finding better

ways to move this data more efficiently between our two Departments. One example is VA’s successful development, with DOD’s

assistance, of a roster of men and women who have returned from

serving in OIF/OEF and then separated from military service. Our

most recently updated roster of May 17, 2005, contains 360,674

OIF and OEF veterans who have left Active duty, many of whom

have sought VA care. We anticipate serving 103,000 of these veterans in 2005.

Besides use in tracking veterans, this roster is also invaluable for

providing outreach about the benefits they have earned.

I would be remiss, too, if I did not mention that VA’s 207 vet centers also play an important role in outreach. To date, VA vet centers have served 18,000 of these new OIF/OEF veterans in helping

their readjustment in civilian life.

VA has also been working closely with DOD to identify those OIF

and OEF veterans who suffer from serious deployment-related illnesses or injuries, even before their separation. VA and DOD has

signed an MOA that will help give VA access to the DOD Physical

Evaluation Board data base of seriously injured service members.

This effort is being championed by VA’s new seamless transition office established last January, which is charged with identifying

OIF and OEF veterans and insuring their priority to VA health

care.

In your invitation to testify today, you asked about how occupational and environmental health surveillance collected by DOD will

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be used to address health issues of returning service members. We

know from previous experience how important it is to have credible

answers to the questions about possible health problems from exposure to environmental and occupational hazards during military

deployments, so we are pleased to hear from DOD about their activities in this area and their willingness to share this data with

VA in the future.

DOD described the active environmental surveillance program

you’ve heard about today in two briefings to the DOD/VA Deployment Health Working Group. VA will use this data to help evaluate disability claims and conduct research on long-term health effects from military hazardous exposures. It will be useful but less

important for diagnosing and treating health problems.

For example, an OIF veteran suffering from asthma diagnosis

and treatment would not depend on whether he was exposed, for

example, to sulfur dioxide in the sulfur fire at Al Mishraq, which

Dr. Kilpatrick talked about in his testimony, but the treatment

would be the same regardless of the cause. On the other hand, if

that veteran wanted to file a disability claim based on a hazardous

exposure, then data about his or her exposure could be essential to

support the claim.

Similarly, research into whether asthma rates were higher

among all service members exposed to sulfur dioxide in Al Mishraq,

Iraq, would need these environmental data.

I would emphasize that access to what must be an enormous

amount of raw, uncorrelated environmental surveillance data without being able to track it by individual location or other means

would not be very useful to VA or to the veterans. Compiling all

this separate data into a useable electronic format is essential to

making this information useful to the VA.

VA recognizes that making world-class services for veterans is

only the first step. We must also get the word out to veterans and

their families about the services they have earned. As VA adds

names provided by DOD of newly separated OIF and OEF veterans

to our roster, the Secretary of Veterans Affairs mails each a letter

welcoming them home, thanking them for their service to the country and briefly explaining VA programs available. We have significantly expanded our collaboration with DOD to enhance outreach

to Reservists and National Guard, with over 2,000 briefings reaching 135,000 Reserve and Guard members in 2003 and 2004. This

year alone we have provided nearly 1,000 briefings.

Working with DOD, we have developed and distributed over a

million copies of a new brochure summarizing VA benefits for this

group of veterans. The VA has also produced a brochure addressing

major environmental health issues of service members in Iraq and

a similar brochure for veterans in Afghanistan and also for women,

and I ask that these information pieces be inserted in the record.

Mr. SHAYS. Without objection, that will be done.

[The information referred to follows:]

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Dr. MATHER. The VA has developed a range of training materials

and other tools for frontline staff through the Veterans Health Initiation, as well as evidence-based clinical practice guidelines for improving treatment for veterans following deployment. We are also

developing a clinical reminder to providers with specific health

screening requirements to assure that veterans are appropriately

evaluated.

VA and DOD are making progress in systems that will be the

basis for the transfer of occupational and environmental health

surveillance information and enable the transfer of pre- and postdeployment health assessment data to VA physicians and claims

examiners.

I have briefly described how DOD’s data on new OIF and OEF

veterans helps VA provide better services to veterans in many different ways. The roster of separated OIF and OEF veterans is useful for patient tracking, outreach and future research. We clearly

look forward to receiving a complete roster of all deployed personnel, both separated and those remaining on active duty, and the

environmental and occupational surveillance data that DOD is collecting today in Iraq and Afghanistan as soon as it is available in

a usable electronic format.

I want to emphasize that service members separating from military service and seeking health care from VA today will have the

benefit of VA’s decade-long experience with Gulf war health issues,

as well as the President’s commitment to improving collaboration

between VA and DOD.

This concludes my statement. My colleague and I will be happy

to respond to any questions that you have.

[The prepared statement of Dr. Mather follows:]

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Mr. SHAYS. Thank you all very much.

Dr. Kilpatrick, I would like you to read your testimony on page

10 about Al-Samawah and then just then kind of translate it for

me. It seems we’re going to deal with the issue of depleted uranium.

Let me just say that—both Colonel and Dr. Brown, feel free to

be equal participants in the question and answer—if we ask one,

feel free to jump in. I know Dr. Kilpatrick and Dr. Mather will

enjoy your interaction.

So if you would read this, just the whole education session.

Dr. KILPATRICK. Certainly, sir.

Al-Samawah, Iraq. Concern about alleged contamination with depleted uranium and exposure to toxic chemicals among some members of the 442nd Military Police Unit. Extensive environmental

sampling was accomplished. A classified Navy environmental assessment report was written and a follow-on Army environmental

assessment is being finalized for this rail yard, where no combat

occurred. No toxic chemicals, with the exception of some chemicals

contained in a railroad tank car, nor depleted uranium were identified. Nevertheless, 167 were offered laboratory testing for any depleted uranium exposures; 66 of those personnel participated in the

urine DU bioassay testing, and all of them tested in the normal

range for total uranium levels with no detections of depleted uranium in their urine.

Army medical DU experts met with the 442nd soldiers in medical

hold at Fort Dix, NJ, in April 2004, and conducted a similar meeting with the 442nd Family Support Group in Orangeburg, NY,

about 2 weeks later. Another group of subject-matter experts simultaneously met with the main body of the 442nd in Kuwait and

provided information about DU and testing and then briefed them

again at Fort Dix. Fact sheets on DU and DU testing were provided.

Mr. SHAYS. Thank you very much. That, from my laymen’s point

of view, seems to me that you all took this very seriously——

Dr. KILPATRICK. Sir, again, to reflect the total accuracy, the individuals coming back from theater to Fort Dix, several of those individuals expressed concern about depleted uranium, and their urine

samples were taken for testing. It was some 3 months before those

results were given back to those soldiers; and, obviously, in the

meanwhile they began to wonder what was going on. When it really came to light that there was greater concern than just three soldiers, I think the Army stepped up in doing the right thing in addressing the concerns of individuals and trying to get information

to the individuals at the time that they were concerned.

Did that reach every individual? I can’t answer that for sure because, again, it was who was present when they went to give those

briefings.

Mr. SHAYS. Of the 67 that you tested, the range was normal?

Dr. KILPATRICK. Of the 66 who were tested, they were tested

both at the laboratory at the Army Center for Health Promotion

and Preventive Medicine at the Armed Forces Institute of Pathology and at the Centers for Disease Control and Prevention [CDC];

and all of those were within what we considered to be the normal

range of uranium.

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As you earlier said, we all have some uranium in our bodies.

CDC’s national studies says that 95 percent of the population has

50 nanograms or less of natural uranium in their urine per liter,

and that’s what we used as our cutoff to refer people to the DOD/

VA medical followup for completed depleted uranium exposure if

it’s higher than that.

Mr. SHAYS. Dr. Mather, my sense is that the VA is a lot more

capable now of knowing who is going to come in the door. After we

had hearings on the Gulf war, you really didn’t have lists of people

and so on, but that has changed, hasn’t it?

Dr. MATHER. That has changed. Two things that are different in

this war is that when someone comes in who is an OIF or an OEF

veteran we know that and we can track them through the system;

and, also, we have primary care doctors for every patient that registers with us so there is someone who is in charge of that individual’s care through the system. So I think we’re much better prepared now than we were 10 years ago.

One of the things that has happened as a result of the first Gulf

war is setting up the VA/DOD center in Baltimore. I think we already have some numbers that show that DOD has referred 278

OIF/OEF veterans to the Baltimore DU program, and VA providers

have referred 118 OIF/OEF veterans to that program.

We’ve tested a total of 396 veterans and service members. Nine

had urine uranium levels above background. We can now do more

specific testing that shows which of this is naturally occurring uranium, the uranium that is dug out of the soil, or depleted uranium,

which is less radioactive than naturally occurring uranium; and

one of those nine actually had depleted uranium in their urine.

Baltimore’s DU program has identified four OIF/OEF veterans

who have retained DU fragments, and these are the friendly fire

victims that Dr. Kilpatrick talked about.

Mr. SHAYS. Maybe as doctors you can describe to me, what is the

different impact of inhaling something, swallowing something or

having it, you know, pretty much embedded in your body?

Dr. MATHER. Well, there is no doubt that being embedded is the

most dangerous, because you’re constantly getting fall-off from the

depleted uranium. We don’t know a lot about ingestion and inhalation. Of course, you wouldn’t recommend that somebody have a regular diet containing depleted uranium or be in an air space contaminated with that, but very few people are in that situation. I

don’t know of any even in wartime in a tank. It’s a limited time

that you’re exposed to that.

So from the perspective of the specialists in Baltimore, the single

biggest hazard from the heavy metal is in retrained shrapnel. Dr.

Kilpatrick might want to expand on that.

Dr. KILPATRICK. To try to add some more science to it, again, the

Army Center for Health Promotion and Preventive Medicine did

the depleted uranium capstones study where in an enclosed facility

they fired depleted uranium rounds through a depleted uranium

armored tank. They measured the particles of depleted uranium

that were released, both inside and outside the tank. They looked

at the size of those particles, the concentration, and they were then

able to use models to predict inhalation and exposure, both radiological and chemical exposure to people. They found that people

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could be inside a tank that had been penetrated for up to 5 minutes without having enough of a dose inhaled into their lungs to

have any medical concern for their future; and I think that’s a good

news story dated from the Gulf war, is that people were out of

those tanks very quickly when they were hit.

But, you’re right, the inhalation is probably secondary to the

fragment ingestion. There was a very small amount of natural or

depleted uranium that would be absorbed. Most of it would pass

out through the intestine.

Mr. SHAYS. But would your body absorb it more through digestion, or if it’s in your skin does it just permeate through your body?

Dr. KILPATRICK. If it’s in your skin, it is essentially with your

body fluids. It then becomes soluble slowly, and it develops levels.

This is what we have seen in the Gulf war veterans’ medical followup study, is if they continue to excrete high levels of depleted uranium in their urine and their kidneys are functioning perfectly normal, they have adapted to that depleted uranium level in their bodies so that it gets into the body fluid and is excreted through the

kidney. And inhalation, a very small amount or an ingestion of a

small amount, if it does get into the body fluids is excreted very

quickly through the kidney and is essentially gone.

Mr. SHAYS. Colonel, would you like to add anything here?

Colonel CIESLA. Mr. Chairman, I probably couldn’t add much to

what Dr. Kilpatrick said, other than that it depends upon whether

you’re talking about the chemical toxicity of DU, since it’s a metal,

and the radiological exposure, in which case having embedded fragments is the bigger hazard because you keep the radiologic source

with you and so it’s able to continually bombard the surrounding

tissue.

But, once again, as Dr. Kilpatrick indicated, people with fragments will theoretically present the most severe exposure potential,

and we have not seen actual health effects that resulted from that

exposure.

Mr. SHAYS. You see, in the reports and studies that the military

DOD has done on depleted uranium—candidly, we haven’t spent a

lot of time on this—but you have some folks who think it’s extraordinarily dangerous, I guess, because of the word uranium. My

sense is that in a vehicle like a tank this heavy metal is basically

encapsulated—in other words, it’s in the—there is metal on either

side of it?

Colonel CIESLA. Yes, Mr. Chairman. Actually, when you’re talking about the DU penetrator, if I had one here in front of us, it

would look like a big artillery shell.

Mr. SHAYS. No, I’m talking about the armament.

Colonel CIESLA. Oh, the external armor, sir?

Mr. SHAYS. Yes. So it’s low-level radiation, but if it’s hit and penetrated, then there is the dust, correct?

Colonel CIESLA. That is correct, sir.

Mr. SHAYS. Is there anything between the depleted uranium—is

it encapsulated? Is it covered or coated with something?

Colonel CIESLA. Yes, sir. It’s encoated with an epoxy resin, some

of which is the actual paint they use to cover the exterior of the

tank. The actual turret of a Bradley or an M–1, the exterior surfaces that are armored, have depleted uranium literally incorVerDate 11-MAY-2000 13:46 Apr 17, 2006 Jkt 000000 PO 00000 Frm 00198 Fmt 6633 Sfmt 6633 D:\DOCS\26238.TXT HGOVREF1 PsN: HGOVREF1
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porated into the metal that comprise the turret. Inside and outside—there is what we call chemical agent resistant coating on the

outside, which is the colors you see outside of the tank at Bradley,

and then inside there is an epoxy resin paint, usually a light green

or very light color to give it some illumination. So that’s between

it, sir.

Mr. SHAYS. If I was in the military I would want the best protection I could get. But I would—going back to our old hearings, I

mean, we had people who would go into these tanks days later and

describe the dust around. They weren’t told it wasn’t a great idea,

but I’m sure they were told this time.

Let me say that we have votes, but I am not going to hold you

up afterwards. Let me have the professional staff ask a few questions that we need to get on the record.

Ms. FIORENTINO. Dr. Kilpatrick, I wanted to followup with some

more questions about the follow-on Army environmental assessment that’s being finalized. What are the findings of that environmental assessment and why is that not finalized yet?

Dr. KILPATRICK. That assessment is in the final draft. In fact, I

have the report as going through the Army chop chain, so that I

think that all the data are there.

What it does show that was not in any of the testimony that I

had here, because I got a copy of it this morning to take a look at,

is that there was, in fact, an armored vehicle that appeared to have

been penetrated by depleted uranium on a flatbed on a train track

some 150 meters away from the housing area where individuals

were. There was indication of depleted uranium at the penetration

hole on the vehicle itself.

There were some wipes taken at that area that gave an indication of depleted uranium. But other wipes on the vehicle or on the

car, air samples taken around the car were all negative for any indication for depleted uranium, as were all other sampling in that

entire area.

As you heard described, there were a lot of oils and paints and

grease, the pigeon droppings, a lot of other issues were present in

that environment, but as far as a radiological hazard, it was only

on that armed vehicle on that flatbed.

Ms. FIORENTINO. Does DOD routinely test for DU at all military

bases or forward-operating bases?

Dr. KILPATRICK. If you’re asking do we routinely ask people coming back from deployment, that is one of the questions on the postdeployment health assessment that we ask: Do you have a concern

about exposure to depleted uranium?

If an individual answers yes to that question, they should have

a conversation with an expert to say what was your exposure, what

is your concern. If it was, I was loading ammunition and I washed

my hands after loading it, then we say you really don’t need to

worry. If it was, I was nearby where friendly fire came in, then we

would say, yes, you do need; and then we refer them on to have

a 24-hour urine sample collected. That can be collected anywhere

but can only be tested at the CHPPM Center, at the Armed Forces

Institute of Pathology or at CDC, are the three laboratories that we

use that are certified to do tests on human samples.

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Ms. FIORENTINO. When will the OHS data be compiled into a usable data base for VA researchers to use, and who is going to be

responsible for compiling that data?

Dr. KILPATRICK. That is probably a question that I would have

to give you a subjective swag on. The data, as you know, are being

archived at CHPPM. We are working to develop a system or process to analyze that data. Obviously, its location of where it is collected at present, as you heard from Dr. Mather, just getting a

large dump of data is not going to help the VA. They’re going to

have to be able have it location-specific and then ideally located to

where people are.

And if you want to add something to that before I go on—let me

just add part of the answer to your question depends on who is

asking, because I would say it is available now.

With all of the data that we are accumulating, if they ask us for

a unit and location, people and location, there is a classification

that the subcommittee is well aware of; and that is an issue, to be

sure. But if you said to me, can you tell what this individual was

exposed to because they were in this general location and you just

establish the link there, that is an answer we can provide right

now.

In fact, a lot of OEHS surveillance information is available right

now in that form. It is just a matter of asking for it.

Mr. SHAYS. We have a choice of going on afterwards, and I don’t

think we are going to do that. So we are going to cut this hearing

off. There are probably some things that we should have put on the

record that we may need to do by written request.

Dr. Brown, is there any comment that you want to make before

we adjourn this hearing?

Dr. BROWN. One of the things that I think was just hinted at a

little bit here but I think was very important at this hearing that

came out was the aspect of risk communication about some of these

hazards. Dr. Mather described very well our DU program that we

run at Baltimore that we opened up for the 1991 Gulf war to monitor depleted uranium in—for example, do urine samples of veterans who were concerned about how depleted uranium may have affected their health. One of the critical things that they found that

they had to do there was they had to develop risk communication

to be able to talk to the individuals who asked for the tests.

So when you explain when somebody gets a number—we heard

earlier a veteran describe a number he got in the mail from one

of these tests—and the group found that is not adequate. This is

unusual. It is a type of exposure. It is frightening because you’re

talking about radioactivity, you’re talking about heavy metal toxicity, and doing the background work that you need to do to explain

that to a patient is absolutely critical. This is something that the

VA program has done an outstanding job in developing the means

to explain what that number means to somebody’s health.

Mr. SHAYS. Thank you.

Let me say I have 5 minutes until the machine closes.

Given that we have been wrestling with these issues for more

than 12 years, I have seen noticeable improvement in the attitude

of both DOD and the Department of Veterans’ Affairs. I like the

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fact that there is an Office of Deployment Health Support Directorate. That is a good thing.

So I compliment both DOD and the VA on working to just make

improvements. I know you know we have a ways to go. But thank

you for your good work and thank you for the progress that we

have made. Thank you.

With this, the hearing is adjourned.

[Whereupon, at 1:05 p.m., the subcommittee was adjourned.]

[Additional information submitted for the hearing record follows:]

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