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87–941PDF 2003

TEN YEARS AFTER: LESSONS FROM THE

GULF WAR

HEARING

BEFORE THE

SUBCOMMITTEE ON HEALTH

OF THE

COMMITTEE ON VETERANS’ AFFAIRS

HOUSE OF REPRESENTATIVES

ONE HUNDRED SEVENTH CONGRESS

SECOND SESSION

JANUARY 24, 2002

Printed for the use of the Committee on Veterans’ Affairs

Serial No. 107–19

(
COMMITTEE ON VETERANS’ AFFAIRS

CHRISTOPHER H. SMITH, New Jersey, Chairman

BOB STUMP, Arizona

MICHAEL BILIRAKIS, Florida

TERRY EVERETT, Alabama

STEVE BUYER, Indiana

JACK QUINN, New York

CLIFF STEARNS, Florida

JERRY MORAN, Kansas

HOWARD P. (BUCK) MCKEON, California

JIM GIBBONS, Nevada

MICHAEL K. SIMPSON, Idaho

RICHARD H. BAKER, Louisiana

ROB SIMMONS, Connecticut

ANDER CRENSHAW, Florida

HENRY E. BROWN, JR., South Carolina

JEFF MILLER, Florida

JOHN BOOZMAN, Arkansas

LANE EVANS, Illinois

BOB FILNER, California

LUIS V. GUTIERREZ, Illinois

CORRINE BROWN, Florida

JULIA CARSON, Indiana

SILVESTRE REYES, Texas

VIC SNYDER, Arkansas

CIRO D. RODRIGUEZ, Texas

RONNIE SHOWS, Mississippi

STEPHEN F. LYNCH, Massachusetts

SHELLEY BERKLEY, Nevada

BARON P. HILL, Indiana

TOM UDALL, New Mexico

SUSAN A. DAVIS, California

PATRICK E. RYAN, Chief Counsel and Staff Director

SUBCOMMITTEE ON HEALTH

JERRY MORAN, Kansas, Chairman

CLIFF STEARNS, Florida,

HOWARD P. (BUCK) MCKEON, California

JIM GIBBONS, Nevada

MICHAEL K. SIMPSON, Idaho

RICHARD H. BAKER, Louisiana

ROB SIMMONS, Connecticut

ANDER CRENSHAW, Florida

HENRY E. BROWN, JR., South Carolina

JEFF MILLER, Florida

JOHN BOOZMAN, Arkansas

BOB FILNER, California

RONNIE SHOWS, Mississippi

SHELLEY BERKLEY, Nevada

CIRO D. RODRIGUEZ, Texas

LUIS V. GUTIERREZ, Illinois

VIC SNYDER, Arkansas

STEPHEN F. LYNCH, Massachusetts

(II)
(III)

C O N T E N T S

January 24, 2002

Page

Ten Years After: Lessons from the Gulf War ........................................................ 1

OPENING STATEMENTS

Chairman Moran ..................................................................................................... 1

Prepared statement of Chairman Moran ............................................................... 61

Hon. Bob Filner ....................................................................................................... 2

Hon. Jeff Miller ........................................................................................................ 4

Hon. John Boozman ................................................................................................. 4

Hon. Stephen F. Lynch ............................................................................................ 15, 24

Hon. Lane Evans, ranking democratic member, Full Committee ....................... 19

Hon. Ciro D. Rodriguez ........................................................................................... 22

Hon. Vic Snyder ....................................................................................................... 24

WITNESSES

Bailey, Hon. Sue, D.O., Former Assistant Secretary of Defense for Health

Affairs, Department of Defense .......................................................................... 40

Prepared statement of Dr. Bailey ................................................................... 114

Eddington, Patrick G., Associate Director of Government Relations, Vietnam

Veterans of America ............................................................................................. 55

Prepared statement of Mr. Eddington, with attachment .............................. 135

Embrey, Ellen P., Deputy Assistant Secretary of Defense for Force Health

Protection and Health Affairs, Department of Defense, accompanied by

Michael E. Kilpatrick, Director of Deployment Health Support ...................... 30

Prepared statement of Ms. Embrey ................................................................ 103

Hayden, Paul, Associate Director of Legislation, Veterans of Foreign Wars ..... 58

Prepared statement of Mr. Hayden ................................................................ 154

Holsinger, Hon. James, M.D., Former Under Secretary for Health, Department of Veterans’ Affairs ..................................................................................... 38

Prepared statement of Dr. Holsinger .............................................................. 111

Mendez, Hon. Enrique, M.D., Former Assistant Secretary of Defense for

Health Affairs, Department of Defense .............................................................. 41

Prepared statement of Dr. Mendez ................................................................. 117

Murphy, Frances, Deputy Under Secretary for Health, Department of Veterans Affairs, accompanied by Susan H. Mather, Chief Public Health and

Environmental Hazards, and Craig K. Hyams, Chief Consultant, Occupational and Environmental Health ....................................................................... 27

Prepared statement of Dr. Murphy ................................................................. 92

Nicolson, Garth, Ph.D., President, Institute of Molecular Medicine ................... 43

Prepared statement of Mr. Nicholson ............................................................. 119

Riegle, The Honorable Donald S., Former U.S. Senator from Michigan and

Former Chairman, Senate Committee on Banking ........................................... 7

Prepared statement of Senator Riegle, with attachment .............................. 68

Robinson, Steve, Executive Director, National Gulf War Resource Center,

Inc. ......................................................................................................................... 53

Prepared statement of Mr. Robinson .............................................................. 130

Rudman, The Honorable Warren B., Former U.S. Senator from New Hampshire and Former Chairman, Presidential Advisory Board on Persian Gulf

War Illnesses ........................................................................................................ 4

Prepared statement of Senator Rudman ........................................................ 64
Page

IV

MATERIAL SUBMITTED FOR THE RECORD

A Senate report of May 25, 1994, prepared by Chairman Donald W. Riegle,

Jr. and Ranking Member Alfonse M. D’Amato of the Committee on Banking, Housing and Urban Affairs, entitled, ‘‘U.S. Chemical and Biological

Warfare-Related Dual Use Exports To Iraq and Their Possible Impact of

the Health Consequences of the Persian Gulf War,’’ submitted by Senator

Riegle ..................................................................................................................... 72

Statements:

General Ronald Blanck, Lieutenant General Retired, U.S. Army ................ 108

Rep. Dan Thimesch, State of Kansas, House of Representatives ................. 62

U.S. General Accounting Office ....................................................................... 159

The American Legion ....................................................................................... 172

AMVETS ........................................................................................................... 176

Disabled American Veterans ........................................................................... 179

Venus-val Hammack, Vietnam and Gulf War Era combat veteran, National Association For Black Veterans ........................................................ 183

National Vietnam and Gulf War Veterans Coalition .................................... 192

Written committee questions and their responses:

Congressman Evans to Warren B. Rudman ................................................... 195

Congressman Evans to Dr. Frances Murphy ................................................. 196

Chairman Moran to Dr. James Holsinger ...................................................... 208

Congressman Evans to Dr. James Holsinger ................................................. 210

Congressman Evans to Dr. Sue Bailey ........................................................... 211

Chairman Moran to Veterans of Foreign Wars ............................................. 214
(1)

TEN YEARS AFTER: LESSONS FROM THE

GULF WAR

THURSDAY, JANUARY 24, 2002

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HEALTH, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC

The subcommittee met, pursuant to call, at 9:07 a.m., in room

334, Cannon House Office Building, Hon. Jerry Moran (chairman

of the subcommittee) presiding.

Present: Representatives Moran, Miller, Boozman, Filner, Shows,

Rodriguez, Snyder and Lynch.

Also Present: Representative Evans.

OPENING STATEMENT OF CHAIRMAN MORAN

Mr. MORAN. Good morning. The subcommittee will come to order.

I welcome all of our witnesses and especially welcome my ranking member Mr. Filner back from California.

As Congress reconvenes in the new session of 2002, we are

pleased to be here this morning to examine preventative procedures in place at the Department of Defense and the Department

of Veterans’ Affairs to protect the health care of our servicemen

and women who have now been deployed in Afghanistan. The question we are here to answer is whether or not lessons learned from

troop deployments during the Persian Gulf War have been integrated into the current deployment procedures of these Departments. We must take steps to ensure that these veterans have a

healthy life when they return home.

Following the unspeakable acts of terror of September 11, the

President admonished the Nation to prepare for a long struggle, a

military and moral struggle against terrorism. On Monday, I witnessed the departure of 25 young men and women of the 388th

U.S. Army Reserve Unit in my hometown of Hays, KS. I watched

the sacrifice of these families who were forced to give up their

loved ones to answer the call of duty. I watched the tears on the

husbands’ and wives’ cheeks and the hugs of children on their father’s pant leg.

Today’s America’s war on terrorism has truly come home. As we

now look at the deployment of thousands—about 70,180 National

Guard and Reservists have been called to duty for combat in Afghanistan and elsewhere, we should remember and learn from

those who have served us in the past. America’s veterans, many of

them who are here today, have put their lives on the line to protect

us during their active military service. I hope today’s hearing will
2

be informative for everyone, will lead us to better solutions for the

concerns that arose as a result of service that arose in Desert

Storm, Somalia, Kosovo, Bosnia, and other recent military

operations.

As the subcommittee with jurisdiction over the VA health care

system and as a member of Congress with an interest, a strong interest in support of our military, we want this hearing to serve as

a public record for our concerns about those being deployed in

harm’s way on foreign shores today.

We have distinguished witnesses with us here today to offer their

views to the subcommittee, and we are privileged to have two

former United States Senators who conducted reviews and investigations of the Gulf War veterans. We have current and former officials of DOD and VA to review the roles they played in the Gulf

War and how policies were formulated to deal with known risks as

well as to discuss some of the problems later uncovered that were

not anticipated with that deployment.

We will review and hear testimony on current deployment. We

will here how we have benefited from the knowledge gained by past

errors. We will also hear from advocates of the Gulf War who will

provide recommendations to ensure the health of our troops. We

look forward to all of those testimonies.

I am closely following the work of the Gulf War. In Kansas, we

have 7,500 Kansas veterans, and a study is ongoing. I look forward

to my home State’s recommendations in regard to what we should

have learned from the Persian Gulf War.

I know that the ranking member, Mr. Filner, has taken a long

and active role in regard to Persian Gulf War veterans and I would

ask my very distinguished colleague, Mr. Filner, for any opening

statement he would like to make.

OPENING STATEMENT OF HON. BOB FILNER

Mr. FILNER. Thank you, Mr. Chairman, and thank you for holding this hearing.

It is not only, of course, absolutely vital that we figure out what

happened in the Persian Gulf War, and treat those who are suffering from illness, but, as we all well know, there is a high probability that our troops will be in the area again and if we haven’t

figured out what happened a dozen years ago, it seems that we are

not adequately prepared for our present day active duty forces. So

it is more than a decade after the 700,000 troops left the Gulf region, and we continue to look for the cause and to try to find a

treatment.

It has been my experience, unfortunately, that both the VA and

the DOD took a stance over the last decade which almost was predictable if you followed the situation with Agent Orange and some

other issues. That is, both agencies said there was no such illness.

It was just isolated problems, and there was nothing to be concerned about. When the cases multiplied, they took the stance,

well, it is all in the person’s head. There is really nothing here. It

is all psychosomatic or psychological and again nothing to worry

about.

Predictably, the testimony we will have today says how many

great things each Department is doing, and I hope that they are,
3

but the testimony that I get on a personal basis and from people

around the country, both those who suffer from illness and those

who are trying to research the cause, finds that there is still a refusal to look at this clearly and fully, that somehow there is a defensive posture. Maybe the VA and the DOD should be the Department of Defensive Reactions, because there seems to be an unwillingness to look and to find the truth. And it seems to me, Mr.

Chairman, that that is what national security demands most today:

the truth.

So we will have some witnesses who will address, as you set up

the hearing, Mr. Chairman, the lessons learned of the Gulf War illness. And of course we cannot forget our responsibility to those

who suffer today and who still need treatment. We want to know

how we applied the knowledge we do have to those veterans who

are suffering, and what are the gaps of our understanding that

might better help us to address the problems. I hope that the witnesses will address some of these issues and lead us to a path for

a more effective response to this grave situation.

The figures that I have seen, Mr. Chairman, show that in the last 6 or 7 years the Federal Government has devoted $155 million

to 192 Persian Gulf War research projects, but none of them have

identified concrete reasons for our Gulf War illness; and while Congress repeatedly has made it clear that we want to give veterans

the benefit of the doubt, we still have limited or suggestive evidence of an association or the notation that additional research is

needed. But the one thing that virtually everyone in both the scientific and political arena agree upon is there are tens of thousands

of Persian Gulf veterans who are sick still with no definitive cause

or clear protocol for their treatment, and we have to do better than

we have been doing.

We have had, as the DOD and VA will suggest today, demonstration projects that have given us helpful leads. We are continuing

to learn from that research, but I wish, in summary, Mr. Chairman, that both departments would take the stance that, ‘‘look, we

don’t know what is going on.’’ It is clear that it is significant. Why

not fund areas of research which for some reason both agencies reject before they even know what the outcome will be? There is a

prejudice there. There is a defensiveness there. There is almost a

roadblock that some researchers will testify to, that we should not

have. We should be reaching out, grabbing hold of anything that

looks like it might help because we don’t know the answer now. So

why not be open to far more risk?

I happen, as you know, Mr. Chairman, to have studied for 30 or

40 years the history of science, and I taught the history of science.

My knowledge tells me that people tend to lock themselves into a

given way of looking at things, a given paradigm, and refuse to

look outside that system until confronted with so much evidence

that their whole previous thought patterns break down.

We need to break down those thought patterns because we have

not had the answer today. So let us look in all kinds of new

directions.

Thank you.

Mr. MORAN. Mr. Filner, thank you very much. I again acknowledge your long-term commitment toward the Persian Gulf syn-
4

drome and your continued dedication to trying to resolve issues on

behalf of those veterans.

Mr. Miller, any opening comments?

Mr. MILLER. Mr. Chairman, thank you.

I just want to say it is an honor to be here as a new member

of this subcommittee, and I look forward to working with you and

the other members.

As I traveled through the district upon returning home in December, visiting with many veterans in my district in northwest

Florida, they seemed to be pleased with my assignment to the full

committee and, most importantly, the subcommittee. I look forward

to working with you and having you in the district. I would say to

the veterans out there that we can do better, we will do better, and

we certainly must do better.

Mr. MORAN. Mr. Miller, I welcome you to Congress and especially

to this subcommittee. You are no longer the most junior member,

however, of this subcommittee; and we welcome our newest colleague, Mr. Boozman. Doctor, welcome to this committee. We are

delighted to have you and your expertise and interest in the welfare of our veterans in this subcommittee. Any opening statement?

Mr. BOOZMAN. Thank you, Mr. Chairman.

I also am very pleased to be here and hopefully with my background as a health care provider can be of some help to the committee. My district, the Third District of Arkansas, has a tremendous amount of veterans and, again, we are anxious to serve them

and just anxious to hear the testimony today.

Mr. MORAN. Thank you very much.

Those of us who are not health care providers are rapidly becoming a minority as a group on this subcommittee, Dr. Filner.

It is my pleasure to invite to the table our first panel, Senator

Rudman and Senator Riegle; and we are honored today by their

presence. Senator Riegle was the chairman of the Banking Committee and in the 1990s led efforts to uncover causes of the Gulf

War illness. Senator Rudman is a combat veteran of the Korean

War and served as the chairman of the President’s Advisory Board

on the Persian Gulf War Illness.

We are delighted at the subcommittee that you would take the

time and have the interest to share with us what we should have

learned in the past and how it might apply to the circumstances

we face today. Under the idea that we are going to be fair we were

going to go in alphabetical order, but Mr. Rudman has pled his

schedule so we will allow Senator Rudman to proceed. Thank you,

Senator.

STATEMENT OF THE HONORABLE WARREN B. RUDMAN,

FORMER U.S. SENATOR FROM NEW HAMPSHIRE AND

FORMER CHAIRMAN, PRESIDENTIAL ADVISORY BOARD ON

PERSIAN GULF WAR ILLNESSES

Mr. RUDMAN. I just asked Don if he would like to proceed me,

and he said, no, you go first. I will certainly stay here until the

committee has exhausted—I hope that is not the right word—the

questions.

Mr. Chairman, Congressman Filner, distinguished members of

the subcommittee, I am Warren Rudman, former United States
5

Senator from New Hampshire. I served as the chairman of the Special Oversight Board of the Department of Defense in investigations of Gulf War chemical and biological incidents from February

1998 to December of 2000. I appreciate the opportunity to testify

here today.

Mr. MORAN. Senator, it would be helpful if you would pull the

mike. I never interrupted a senator before. I apologize, but if you

would pull the mike closer.

Mr. RUDMAN. Usually I keep it away for the opposite reason, but

I will bring it up closer. Is that working right now?

Mr. MORAN. Thank you.

Mr. RUDMAN. All right.

The Gulf War revealed with great clarity the many shortcomings

in the military’s force health protection policies of that period. The

undiagnosed symptoms that the ranking member has referred to in

his opening statement, those symptoms that have prompted more

than 12,000 Gulf War veterans to request disability compensation

confronted the two departments with a problem to which they had

no ready solution.

Several inquiries, culminating in the Presidential Advisory Committee on Gulf War Veterans’ Illnesses, known more familiarly as

the PAC, identified doctrinal weaknesses as well as the need for

closer oversight of department investigations of potential exposures

to chemical and biological warfare agents during deployment.

In response, President Clinton issued an Executive Order 13075

in February of 1998. It established the Special Oversight Board for

Department of Defense Investigations of Gulf War Chemical and

Biological Incidents. The President asked me to serve as board

chairman. Former secretary of Veterans Affairs, Jessie Brown,

served as vice chairman.

This independent Blue Ribbon Commission closely examined

DOD investigations as well as the combined research efforts of

DOD, VA, and HHS over a 25-month period beginning in November of 1998. The seven-person board included six veterans, two of

flag rank, five of whom had served in combat. One board member

served as a noncommissioned officer during the Gulf War. Another

was the father of a Gulf War veteran. The board enjoyed the skills

of a medical doctor and a Ph.D. in immunotoxicology.

This board presented two reports to the President describing the

result of our oversight activity and our recommendations for improving force health protection. While I know the subcommittee focuses on lessons learned, please allow me briefly to state our major

findings and conclusions.

We determined that the DOD, VA and HHS had developed by

1998—and we were prospective, not retrospective, by 1998. They

had implemented a comprehensive research program to investigate

the causes and potential treatment for the undiagnosed symptoms

that afflict some Gulf War veterans. I cannot overemphasize the

importance of ensuring the departments fund only meritorious,

peer-reviewed projects. Efforts to fund projects that have not

passed peer review do not serve the best interest of the Nation or

its Gulf War veterans.

Let me depart briefly from my prepared comments to address a

comment to Congressman Filner. I greatly respect your frustration,
6

how you feel; and we all somehow say, whatever comes over the

transom, fund it. The problem is that, if you look very carefully at

the submissions from around the research community in this area,

there are many which obviously have great merit and others which

obviously do not; and, frankly, Mr. Chairman, members of the committee, I don’t know any way to do this fairly other than do it by

a peer review of perfectly neutral, detached scientific experts. I

don’t think Members of Congress can say that is a good one and

this one isn’t, and there has been special funding and earmarking.

You know, as a former Member of the Senate, I understand those

things. If people insist they are going to do them, fine, they have

that right, but I believe it is in the interest of the veterans’ community that a peer review board of extraordinary talent decide where

these research dollars are going. Because, with all due respect,

they are not unlimited, and we certainly didn’t get involved in

those selection processes. We made it clear, however, that we

thought the DOD, VA, and others should do it in a very methodical

way.

Let me state that yesterday the Secretary of Veterans Affairs appointed a special committee and a special scientific advisory board

with some extraordinary people on it to make those selections. Our

board believes that that is the way it should have been done.

Science alone should determine whether a Gulf War syndrome or

illness exists.

The board noted that no study, regardless of funding source or

the nationality of the researcher, has been able to validate a specific cause linking it to a specific undiagnosed symptom that affects

some veterans and members of the general public. That, I think is

the single most frustrating part of our 2 years of work, that when

we got done looking at every major study that was concluded, no

one could point with any certainty to a specific cause linked to a

specific disease. That, of course, is a challenge that this committee

and the executive branch of the government continue to face today.

We confirmed that DOD had worked diligently from 1998 on to

determine the extent and nature of the exposures to nonpersistent

nerve agents released inadvertently during the destruction of

Khamisiyah. The board agreed with the assessment that, with the

exception of some special forces personnel operating covertly in

Iraq, no American forces were exposed to chemical warfare agent

releases resulting from the bombing campaign of the Allied air

forces. DOD made great efforts to provide information to the public

and to obtain firsthand reports from Gulf War veterans.

I do regret that the commitment of resources that we observed

did not begin sooner. One of the problems was that by the time you

got to 1997, 1998 and forward, a lot of the evidence was culled. And

anybody who is a lawyer who has tried a case knows how difficult

it is to deal with evidence which is culled, and we were going back

and looking at events that had taken place 6,7, 8 years before. So

the certainty has a certain doubt cast upon it.

The board also noted the implementation of numerous initiatives

to implement lessons learned from the Gulf War. We believe that

DOD, VA, and HHS established the Military and Veterans Health

Coordinating Board to better harness the three departments’ efforts to enhance force health protection and ensure the well-being
7

of future veterans. We reviewed more than a dozen DOD programs

to improve medical record keeping, collect pertinent health data,

enhance medical intelligence—something that truly had been ignored prior to the Gulf War; we think that was very important— to implement environmental surveillance programs and address a

number of other shortcomings that we noted on our report that existed during the Gulf War.

VA and DOD have begun the Millennium Cohort Study, which

I am sure you are all familiar with, a multi-decade health study

that will eventually involve 140,000 men and women to better understand the long-term effect of military service.

By law, our board terminated 1 year ago after fulfilling its mandated charter. There are two major reports, both on web sites,

which your committee has in my statement. I want to refer you to

the Department of Defense which can respond to the inquiries as

to which of our recommendations, which were numerous, were

acted on. They ought to be able to tell you to the extent they have

implemented this board’s recommendation, which, after all, it was

a presidentially mandated board, and what other initiatives they

have taken beyond those recommendations.

I would say that we noted informally that the exceptional readiness of units returning from deployment to Bosnia, Kosovo, Kuwait, Haiti and Rwanda clearly indicate improvements in force

health protection that they have made since the Gulf War. More

hard work remains, and I know that the subcommittee will assist

in those efforts. I believe that you ought to look at each recommendation that is in our report and mirror that against what

is going on today.

I appreciate the opportunity to testify here today. The one thing

we can all agree on, veterans of this country deserve the very best

from their government and we ought to ensure that we give them

just that.

Mr. MORAN. Senator Rudman, thank you very much.

[The prepared statement of Senator Rudman appears on p. 64.]

Mr. MORAN. Senator Riegle, thank you for joining us. We are

very anxious to hear your testimony.

STATEMENT OF THE HONORABLE DONALD S. RIEGLE,

FORMER U.S. SENATOR FROM MICHIGAN AND FORMER

CHAIRMAN, SENATE COMMITTEE ON BANKING

Mr. RIEGLE. Thank you, Mr. Chairman; and let me say, Chairman Moran, Ranking Member Filner and other members of the

subcommittee, I appreciate the chance to testify here today. Even

more, let me commend and thank you for your leadership, your

concern and your perseverance in investigating the serious health

problems that today face tens of thousands of Gulf War veterans

and their families.

I want to say two things before going into my statement which

you have copies of.

First, let me say I have great respect for my colleague, Warren

Rudman. We served for a long time together. We worked together

on a number of things, occasionally had differences of opinion.

When we have them, we do it in an agreeable fashion. I think, as

you will see from our respective statements today, we have quite
8

a different view of this problem, and I say that respectfully, and

we can both speak from our involvement with it.

I want also to say that it is a great privilege to be back in the

House. Prior to my 18 years of service in the Senate, I spent 10

years here in the House. I love this place. I admire and appreciate

what you do each day. I think the job has gotten tougher over time,

and so I consider it a privilege to be in this committee room and

to be with you today to think about this problem.

I am going to be very frank in what I say. In my view, to this

day our agencies of government have largely stonewalled this problem of sick Gulf War veterans, and I would lay out as a proof point

right at the outset they are still out there and still sick, and we

haven’t done very much about it, about dealing with the sickness

and to try to make them well. They were not sick when they went

to the Gulf War. They got sick there and as they came back, and

the responsibility I think is triggered by that train of events.

I think we have had a decade of very stubborn Defense Department denials on the reality and scale of this problem, and we finally saw just 1 month ago on December 11 a page 1 New York

Times story entitled U.S. Reports Disease Link to Gulf War. I will

read you the first paragraph.

Quote, After years of denying any link between illness and service in the Persian Gulf War, military officials said today that veterans of that conflict were nearly twice as likely as other soldiers to

suffer the fatal neurological disease known as Lou Gehrig’s disease—illness known as Lou Gehrig’s disease. And the article, which

I am sure many of you have seen—if you haven’t, I have it here—

you ought to read. Because if that doesn’t take your blood pressure

up because we have these kinds of things occurring, and the intense difficulty of digging out factual information about what even

happened in the Gulf War that would have laid a foundation for

this kind of pattern of extreme illness is something that needs to

be examined today, and it would have been well if it had been examined right after the war.

Now, one can ask how we have lost a decade of time in the case

of this article that I have just cited. Well, tens of thousands of sick

Gulf War veterans have languished and suffered and are to this

day. All the while our Defense Department has denied any linkage

to the Gulf War and has failed in my view to invest any significant

level of resources necessary to find medical answers that might

make the sick vets whole again, and I will give you an illustration

in a short period here.

I think the question arises, how does one maintain faith—I am

talking about citizens, about mothers and fathers in this country—

in a military command structure that is blind and indifferent to the

persistent suffering and death of its own troops? I have talked to

these veterans, as many of you have. They have been crying out

for help and what they have often been told—and they will come

here to testify and line up down the hall to say it—they have been

told by the VA and others that the problem’s in your head. Take

some pills. In effect, go away. You are an embarrassment. We don’t

need you anymore. That is just as ugly as it has been and, to verify

it, you only need to ask them or talk to their widows.
9

As was noted by the Chairman, nearly 10 years ago in the Senate and Banking Committee at the time when I was a chairman

we did institute a major investigative effort into the probable

causes of Gulf War syndrome and the likely exposure of our Gulf

War military forces to biological and chemical weapons, and I have

brought those documents here. You have them. I would ask that

they, by reference at least, be made part of the record here in the

committee. They were presented in the Congressional Record in full

in 1993 and 1994.

That is part of the history, but it is vitally important today that

Congress move swiftly now, especially since it is a virtual certainty

that many of the biological weapons developed by Saddam Hussein

were made with live disease-producing and poisonous materials

sent to him from the United States to Iraq in the late 1980s under

authority and approval of the U.S. Department of Commerce.

The list is here for you to look at today if you are interested. It

includes anthrax, E. coli, botulism, West Nile virus and a number

of others of the same sort.

What we have discovered then has fresh significance today, both

to the legions of sick Gulf War veterans urgently needing medical

help and support and the present danger of biological weapons exposure now to citizens here at home. Citizens right here in our Nation’s capital have now been killed by weapons grade anthrax. The

Congress itself has been targeted. It is critically important that we

draw upon all the knowledge we have, yes, going all the way back

to the Gulf War so that we can better protect our people both here

at home now and also those in uniform in settings abroad.

While I brought these original reports here for your review today,

I have copied key pages for your direct knowledge and reference

during this hearing and, as you will see, they are attached to my

statement. You will see that they summarize the conclusions of

that earlier investigative work and document by date and type the

shipments of dangerous biological materials from the United States

to Iraq in years past. You may wish to discuss some of these items

today.

(See p. 72.)

I would make four immediate recommendations for your consideration. There is much we can and should do regarding a large

number of Gulf War veterans who are this very day experiencing

severe health problems. You know and I know, we all know that

many are desperately ill, living in poverty. Many others have died

whose lives might have been extended. There is great human urgency to this problem. There would be if there were just one, but

there are tens of thousands in this category.

So, first, I think we should initiate a full, independent medical

review of each—and I mean each and every Gulf War veteran who

is listed on a voluntary medical registry which at one point I know

was up in the range of 130,000. Whatever help they need they

should get it without further delay, and the Federal Government

should pay every penny of the cost.

We spent a long time trying to get the budget balanced. Senator

Rudman worked on that, I did and others, and we got it balanced.

It is out of balance now, but if it is going to be out of balance, then

some of the spending needs to go into this area.
10

Beyond these individual examinations, I think we have to catalogue the pattern of illness. We need to do a careful reconstruction

of where each person was stationed during the Gulf War and do

a systematic construction of patterns of illness tied to events, dates,

places and likely exposures. I think these fellows that are showing

up now and women showing up with Lou Gehrig’s disease are one

element of that, but there are a number of others.

I would say to you many of the veterans with whom I have spoken recall their experiences in the Gulf War very vividly; and,

frankly, they are the best source of our information on exposures.

If you were sick and you were over there and you went through a

set of circumstances, might not your own observations be helpful

for somebody to listen to and pay attention to and catalogue and

put down with somebody else’s? I think so.

We have spent too little time talking to veterans. We have talked

to a lot of other people but not enough time talking to people who

are sick and who have strong reasons to think and theorize why

it is they are sick. I think we should talk to them one by one and

actually listen to them to make a systematic determination of why

they are sick and see if this information can guide us on how these

Gulf War veterans can be best treated medically.

I want to make an analogy. When we have a plane crash in this

country, what we immediately do is we set to work to reconstruct

how the crash worked, and you have seen any number of pictures.

We go and get a hangar, and we may tie up the hangar for 2 or

3 years. The plane goes down over the water. We send ships out

and go into the water, retrieve everything we can. We reconstruct

the airplane, where everybody was sitting, what happened. And if

150, 200, 250 people were killed, we try to do everything humanly

possible to reconstruct what happened so we can prevent it from

happening a second time.

We have over a hundred thousand sick Gulf War veterans. Now,

is that any less important? Is it any less important for us to go

back and do that kind of meticulous reconstruction? No, I don’t

think so.

But I can tell you this. The Defense Department has no interest

in doing that. They are looking forward, not backward. And in this

instance looking backward will help us do a better job of looking

forward. So it is not just the obligation to the vets. It is the obligation to the security of the country, the veterans and now on the

home front as well.

I think the Federal Government should welcome the responsibility and willingly pay these costs. The men and women who were

asked to step forward and defend our country, they did, and now

they have got to have from us the full measure of help that they

need to try to save and repair their lives while that is still possible.

Secondly and very important, we need to determine exactly what

biological and chemical weapons Iraq still retains. They had a huge

arsenal. It is all documented. It is all in the formal report in the

Defense Department at the end of the war. Then we need to prepare a strategy that can deal with and eliminate that threat once

and for all. The same is true for other such stockpiles that may

exist in the hands of would-be terrorists in other places.
11

Third, and very importantly, we need new military doctrines and

better protective measures that will not put future U.S. Deployments in areas of biological and chemical weapons risk without

proper safeguards. These safeguards have to include far better detection methods in war zones when these kinds of weapons may

exist. We didn’t even have any detection devices that would trigger

on for biological exposures in the Gulf War. A lot of people don’t

know that. We did for chemical exposures, not for biological, even

though we knew he had enormous capability in that area, and it

was a great risk. That is why we had the chemical suits for people

to put on if they thought they were needed. So we need to have

that kind of capability going forward in the future.

Is the Defense Department developing it? Do they have it today?

Those are questions that ought to be asked, and they ought to be

answered. My guess would be no, but let us let the facts answer

that question.

Another example is that during the Gulf War we had over 14,000

chemical detection warning devices dispersed through the combat

zone. That is a lot of them. We spent a lot of money for those, I

might say. Those alarms went off tens of thousands of times as the

air war took place. They were just going off all the time. There

were recordings that people did in real time. You can hear them.

Some of you probably have. Amazingly, the Defense Department

later claimed that each and every alert that sounded, each one was

a false alarm.

I think, given all the documents that have been assembled, and

we put a lot of it on the table, but there is a lot of other, proves

that that is a patently false assertion, and they shouldn’t be permitted to get away with it. It should not be allowed to stand. If it

does, it is going to do several bad things, but it will continue to prevent the move to a new regime of proper safeguards that can actually offer the protection that our combat forces need today and in

the future and that needs to be ramped up.

It is going to cost money. It is money well spent. We are spending money on a lot of things. We might as well spend it on something we really need.

If the best we can do with Lou Gehrig’s disease that affects Gulf

War veterans 10 years later is to finally say, in effect, well, sorry,

we know it is a bit late, but here is your service-connected disability check. If that is the best we can do, then we really ought to

hang our heads in shame.

Fourth, we also need full public disclosure of military contamination events if and when they occur. I documented some of those

with our investigative team with people who were out there and actually did the tests in the field at the time in the Gulf War, turned

in the records and the records disappeared. Where did they go? I

don’t know where they went, but the fact that the records disappeared does not erase the fact that the event happened.

So we need full public disclosure on these military contamination

events when they occur and the response with the full medical resources of our country to meet the needs of any veteran who returns from a war zone sick from exposures while on duty. That

means to me a full disclosure from the Defense Department when

it comes to sick U.S. veterans. That requires a President, his Com-
12

mander-in-Chief and a Defense Secretary who will hold the officers

at every rank to a standard of absolute truthfulness and transparency on these life-and-death matters. I believe President Bush

and Secretary Rumsfeld are men who would want such a standard.

In the United States today our professional volunteer military

force is trained to accept command orders and be ready to die in

combat if necessary, and we have just seen that happen in Afghanistan. In return, we have got a corresponding obligation on the part

of our government to use every available means to protect these

fighting forces during combat and to enable them to cope with the

aftereffects of combat and to try to return to a normal life.

Chemical and biological weapons risks can produce in veterans

a form of living death. I have seen it, and you can see it and I am

sure have seen it in talking to people who have gone through this

circumstance, of lives broken forever by unseen wounds suffered in

war time.

As we are now finding here on the home front with biological anthrax attacks, we must have new and better methods of protection.

I think we must honor and protect these men and women within

our armed services as they serve our country by equipping them

with everything they need to stay alive and well. They are not so

equipped today, in my view. I think when we fail that test, I think

we dishonor them and we dishonor our Nation. I think we can and

must do better, and hopefully this committee’s work can lead us in

that direction.

Thank you, Mr. Chairman.

[The prepared statement of Senator Riegle, with attachment, appears on p. 68.]

Mr. MORAN. Senator Riegle, Senator Rudman, thank you very

much. I think we can use your testimony as a way to focus our efforts as we talk to the Department of Defense and Department of

Veterans’ Affairs officials, past and present.

I appreciate your remarks, Senator Riegle, about your service in

the House. I notice that every senator reminisces about the good

days in the House, but none of them ever return to join us back

in this body.

Mr. RIEGLE. Well, Dale Kildee, who took my seat, is staying here

forever, so if he decides to leave I may try to come back.

Mr. MORAN. I would like to ask you, the two of you, if you were

on this panel or on the Senate and looking today at the issues that

we are looking at, what would you suggest we ask as questions of

the Department of Defense and Veterans’ Affairs? It seems to me

that our goal has to be—I guess we have to know what the questions are, but they relate to what are we doing today to prevent

what happened in the past from occurring again. And it seems to

me those issues very much are related to medical research, finding

out cause and effect, what are we doing today to resolve the issues

that the two of you—your testimony really points out some unanswered questions.

So how far along are we in medical research? What are we doing

in regard to our vaccination program? Did we learn something 10

years ago in that aspect of service? What equipment safeguards do

we have in place for our personnel? Do we have biological and

chemical detection equipment in place in the regions that our mili-
13

tary men and women are now serving? Are we doing an adequate

job of military screening upon deployment, during service, and

upon return? And do we know specific locations in which our servicemen and women are engaged in combat today? Do we know

where they are and when? Can we track that so that we can develop a potential relationship between contact or events with chemical and biological agents and location of our servicemen and

women? And do we have the intelligence capability of determining

where the stockpiles are, what kinds of agents are there, what the

threat is?

I would just appreciate any response you might have about those

items or others as we try to determine from Department officials

what it is we are doing today and what could we do better.

Mr. RUDMAN. Mr. Chairman, I think in your question you have

laid out a number of markers that have to be answered. A number

of those very items are referred to in our two reports.

Beyond that, I think you owe it to yourself to look into it really

as a stark contrast between what my colleague feels what has been

going on in the research area and what I believe.

In fairness, Don Riegle’s report is dated 1994 and 1995. I have

read it, and it is a first-rate report, and I don’t disagree with a lot

that is in that report. I am going to submit to you I think things

have changed since then. Why did they change? I think that the

total pressure of the Congress, the veterans’ community, by early

1995 that convinced people at the highest levels, whether it be the

outgoing Bush administration or the incoming Clinton administration, that they had to do something different, and I think they

have.

What I would say to all of you is take a look at our report or,

if you wish, records your committee has on the Office of Special Assistant Gulf War Illness, Dr. Rosker at the time, listing every research grant. I think you will find they are done in the finest medical schools by the finest physicians and scientists trying to get the

answer to what Congressman Filner stated in his opening question.

I will submit to you that these people did not engage in an unholy conspiracy to hurt our veterans. They are very good people

from many of your States, if you will look at the medical schools

that were involved in this research. They agree that these illnesses

exist, but the frustrating part is none of them have yet, including

with ALS, come up with a connection. Maybe there is a connection,

but I am simply stating that I think what happened post 1998 is

far different.

So what I think you ought to be doing is to be sure that the ills

that my friend Don Riegle has talked about truly are changed and,

if not, you ought to go in and make sure they are changed. If we

are going to spend $150 million next year on research grants or

$250 million, we ought to make sure it is being spent for the right

people in the right place for the right reasons. So I think there is

a difference in our view there.

Let me also add that you made one interesting point, and it was

an interesting point that my friend Don Riegle made. I was appalled when I first got into this at the lack of knowledge as to

where each infantry, armor and artillery unit was on a particular

day.
14

Having served in the Korean War, having commanded a rifle

company in the Korean War, I had to do a report, which is now

in microfiche in St. Louis, Missouri, which I can pull out and find

out where I was on July 1, 1953, the force structure, where we

were and how many casualties. You couldn’t do that. That has now

changed. I believe you will find that the Army in particular has

made major changes in its deployment protocol so you do know

where people were. That was one of the problems that we had to

deal with. People didn’t know who was where and when in many

occasions.

But I would commend you to the Khamisiyah report, created at

a cost of a lot of money, which has done a pretty good job of answering some of the questions that Senator Riegle’s report had. I

do think all of these things that you mentioned, that he has mentioned, that are in our report, I think those are your marker questions for DOD and VA. That is where they are.

Mr. RIEGLE. I appreciate the questions and the chance to respond, and I will try to be brief in doing so.

The medical research route is part of the response that is needed,

but we have a fairly simple and direct problem to face, and that

is a lot of the veterans who came back sick from the Gulf War, who

are dying before the research is done. And you can say, well, that

is kind of the way it is. It takes a long time to do the research,

and life goes on and so forth. I have known a lot of the veterans,

and I am sure many of you have, who are sick and have since died.

So they haven’t made it to the end of the research.

I am not saying stop the research, but we can’t take that and,

in effect, hide behind the research. And I think there are some people in our government, in the executive branch of our government

over the years that have done that. It is a great way to push the

problem off into the future while people today need help today.

So I will make a very simple suggestion. I am going to make two

that I think ought to be done, and I hope they make some sense

to you. I think any sick veteran that we have from the Gulf War

who went into the Gulf War healthy—and, by definition, people

had to be healthy to get in—but came back and their health was

broken, they deserve, in light of everything we know, in the mysteries and the research going on and the unanswered questions and

now the answered questions on Lou Gehrig’s disease and so forth,

at least part of the answer, we should give them a presumption of

a service-connected problem. We should provide them with serviceconnected compensation, and we should let them hold their lives together, give them a chance to buy some private insurance, if that

is what they are compelled to have to do, but to get some help.

I mean, the reverse side of the coin is to say, look, we wanted

you when you went into the Gulf War. You went over there, and

you were healthy. You came back, and now you are sick. We can’t

prove why you are sick. There is a whole pattern of a lot of sick

people from the Gulf War, but we can’t pin down why you specifically are sick or why you specifically have Lou Gehrig’s disease,

and so we can’t grant you service-connected disability. Now, they

have just done that with respect to the people who have had Lou

Gehrig’s, but it’s a long time later and you have got to eat and feed

your kids every day. And in a budget of the size that this govern-
15

ment has today we are going to plead poverty because we can’t

meet the needs of sick veterans from the Gulf War? Shame on us

if that is our answer.

I don’t need to know precisely what specific cause it may have

been. Whether it was the pretreatment situation, whether it was

the oil fires, whether it was blowing up the chemical and biological

weapons and scattering that stuff all over the place, the alarms

going off. If somebody went over well and they came back sick, they

deserve a presumption of service connection in this instance, especially now because we have got things that are killing people. So

that is pretty straightforward.

Now, you know, we can get caught in the woods and we can get

in a swamp on this thing and not get anywhere and sooner or later

they will all die. I remember when people were trying to get an increase in the pension for World War I veterans, and people kept

stalling and stalling in part because they kept dying off until finally there were hardly any left. So let us not do that here. I think

we are better than that.

What kind of signal do we want to send somebody today to go

into the volunteer military or maybe have to go into Afghanistan

or back into Iraq, which is loaded with these weapons today? What

kind of confident signal do we want to give them and to their parents? What if they come out sick? Are they going to get the same

treatment that the Gulf War veterans got? I hope not. Or the same

treatment that our Vietnam veterans got for so long on Agent

Orange?

This is an old problem. This is a problem of institutional unwillingness to face up to problems that perhaps couldn’t have been anticipated properly when the war was going on. Proper steps weren’t

taken. People got sick, and now some people want to walk away

from it, and we can’t permit that. That is not what America is

about. We are not about walking away from sick veterans. At least

I hope we are not.

Mr. MORAN. Senators, thank you very much. Mr. Filner.

Mr. FILNER. Thank you, Mr. Chairman.

I also would like to welcome to his first meeting Mr. Lynch of

Massachusetts who replaced our beloved Mr. Moakley. We welcome

you to the Veterans’ Committee.

Mr. LYNCH. Very proud to serve on this committee and your remarks are heartwarming. Very good. Thank you.

Mr. FILNER. Thank you, Senators, for your testimony and service

to our country. You don’t know how delighted I feel, as one who

started a Capitol Hill career as a legislative assistant to a senator,

now being able to question you. That is a great feeling.

Mr. Rudman, just briefly, you used the Khamisiyah situation to

show how diligently the DOD worked. I would draw an exact opposite conclusion. That is, at first, DOD denied there was any release

of any of these materials. They just denied it, stonewalled in the

words of Senator Riegle. Then they said, maybe something occurred. Well, maybe it happened at Khamisiyah. Well, but only a

few people were affected, maybe a few hundred. Now it turns out

maybe a hundred thousand were affected by Khamisiyah. So it took

an incredible amount of teeth pulling to even get them to admit

that.
16

By the way, I want to thank Congressman Evans, who is here

with us now. He has been working on Agent Orange issues for so

long and has asked questions that have come out with some of

these answers; and we thank you, Congressman Evans.

You talked about peer review. I come from academia. I believe

in peer review. The problem with peer review is that, as I said earlier, it doesn’t allow any deviation from what is accepted. A peer

review panel in the 17th century wouldn’t have funded any research that presumed the sun and not the earth was the center of

the universe. By definition, peer review only accepts (in a ‘‘neutral,’’ ‘‘unbiased’’ fashion) what people at that moment think is

reasonable.

I don’t want to abolish peer review, but I think there ought to

be an amount of money set aside for wacky ideas, ideas that don’t

conform—— Mr. RUDMAN. How would you write that, sir?

Mr. FILNER (continuing). Ideas that don’t conform to the accepted

paradigm. Because I believe that some scientists from very established and renowned institutions such as you named have been denied research opportunities because they did not fit in with the accepted pattern. I would just say, since we haven’t been successful

so far, let us try something outside of what the peer review system

gives us.

Mr. RUDMAN. Let me respond to the first part and then the second. Well, the second first. I don’t have a problem with that.

If you literally want to write language that says unconventional

research will comprise 10 percent of this appropriation, so be it. I

mean, it might turn something up.

On Khamisiyah, I think we agree. What we are saying is that,

as our board came into being in 1998 and was given a proactive

role in dealing with DOD on a number of things that it had been

doing, we had a major influence I believe in getting these things

reordered and restructured. I don’t disagree that up until that time

there had been a lot of stonewalling.

My point is I think Dr. Rosker, who is, I am sure, back in California enjoying life after a very tough job for 4 years and he is a

scientist——

Mr. FILNER. Stonewalling is tough for 4 years.

Mr. RUDMAN. He changed a lot of things for the better. I know

a lot of veterans’ groups don’t agree with that, but I believe he was

trying to get to the bottom of it.

Incidentally, if you look at our report, you will find meticulous

review of about 35 reports line by line of what we did. You might

want to look at it.

Mr. FILNER. I thank you for the service you have done in this

regard.

Senator Riegle, as you might guess, I agree with your statement.

I would just add a little bit to your recommendations. I would like

your reaction to this. As you point out, very accurately, we knew

exactly what the Iraqis had in the form of biological and chemical

warfare because we gave it to them. It would be very irresponsible

if we were not also working on potential antidotes to these things

which we knew they had, and it may be that the problem lies with

with those antidotes which were being tested or were given in the
17

vaccination program to our armed forces. When someone asked

DOD for the record of vaccinations, they said ‘‘we didn’t keep

them.’’ That can’t be. It just cannot be.

I believe that it’s possible that something in those inoculations

or vaccinations or injections either were not tested properly or were

coming with the wrong information and may have been responsible

for some of this. There are some theories about that, and I would

just add to your recommendations where you talk about independent medical review and full public disclosure that we ought to add

a complete examination of what went into this vaccination

program.

When the DOD tells me they don’t have those records, that is a

lie, and it leaves me to think they are trying to cover up something.

If friendly fire caused Persian Gulf War illness, that is, something

we did, we need the truth. Because we are sending men and

women into the same situation and, as you know, people have faced

court-martial rather than take the anthrax vaccine because they

had evidence that it may cause problems. I wouldn’t take the anthrax vaccine even if I was in one of the contaminated buildings

today. I don’t trust it. But do you have a comment on that?

Mr. RIEGLE. If I am not mistaken, and correct me if I am, didn’t

I just read or hear that an advisory has gone out to women in the

armed services who may be expecting a child, not to take this? If

you just take that fact, what does that tell you? There has to be

some body of understanding or concern that says, you know, you

could have a bad outcome here; there could be a problem here.

The issue of birth defects and birth issues in the families of returning Gulf War veterans is another huge hidden issue, and if you

want to have a panel that will stand your hair on end, bring in the

spouses, particularly the wives of men who served in the Gulf War,

and let them tell you about the medical problems they have developed and that their children have developed—— Mr. FILNER. And their pets.

Mr. RIEGLE (continuing). Since their husbands have come back

and let us have somebody explain why we have got that burst of

odd pattern and circumstances. The fact is, we haven’t.

But, to your larger question, I would like to refer you to the attachment to my statement that, if you will take a look at it on

what is numbered page 37 on the attachment which comes from

our Senate report of—back in the 1990s, and I want to just cite

this one paragraph because it goes straight to what so much has

been said here today. It is at the top of the page, and it comes from

the Department of Defense’s own report to the Congress on the

conduct of the Persian War.

As Warren Rudman says, the military, when it wants to, can

keep very good records. I think it is also very good at losing records

when it feels it needs to lose records. But, in any event, they wrote

this and signed their name to it. So I think this has to be seen in

that light. It was released in April of 1992, but this has a bearing

on where do we stand today and what threat do we face tomorrow

whether in Washington or in Iraq or some other place.

The quote is this: ‘‘as you will see’’—this is the Department of

Defense talking—’’ by the time of the invasion of Kuwait, Iraq had

developed biological weapons. Its advanced and aggressive biologi-
18

cal warfare program was the most advanced in the Arab world.’’ Some lines missing here. ‘‘The program probably began in the late

1970s and concentrated on the development of two agents, botulism

toxin and anthrax bacteria. Large-scale production of these agents

began in 1989 at four facilities near Baghdad. Delivery means for

biological agents ranged from simple aerial bombs and aerial rockets to surface to surface missiles.’’ Now, as you say, much of this was known before the war, and

that is why some protections were taken, I think grossly inadequate, and that is part of the embarrassment that the Defense Department has today. One of the reasons they don’t want to talk

about this is it is a very untidy part of the war, that that part

wasn’t planned and carried out properly. They didn’t anticipate a

hundred thousand plus sick Gulf War veterans, and nobody wants

to accept responsibility for it. They want to be able to classify it

as a clean and quick war and an efficient war, and if you have got

a hundred thousand sick Gulf War veterans, that is a problem. So

it is a problem that a lot of people don’t want to talk about in the

Defense Department.

But this was what was known at the time, and that threat presumably exists today, and we had better pay attention to it, how

we protect against it in Boston or Washington or anyplace across

America. Or if we find ourselves reengaging in Iraq, are we going

to do it the same way that we did it the last time? I hope not. Because, if we do, we are going to have a lot of sick veterans coming

home from a new Iraq war because of, I think, exposures to biological and chemical residues that get scattered around in the course

of a bombing campaign such as we had before.

So that would be my view.

Mr. MORAN. Senators, thank you. Mr. Boozman.

Mr. BOOZMAN. I would like to ask Senator Rudman, with the

Agent Orange experience it really took a long time to establish

there was a cause and effect there. I think with smoking it took

years for the medical community to actually say there is a cause

and effect here. Yet the public, the doctors that were dealing with

the problem had the gut feeling that there was something here

much sooner than that.

I guess I would ask—you have studied this area extensively and

are a neutral person. Do you have a gut feeling as to some areas—

I think in your statement you said that Congress doesn’t need to

decide what areas are researched, and I agree with that. Sometimes, though, there are other interests involved in research and

that is not always determined in the right venue. I guess, as an

outside observer, do you have a gut feeling in any of the things

that you have come across as to cause and effect?

Mr. RUDMAN. I do and I don’t, and let me tell you why I answer

it that way. I don’t know if any of you are aware of this or not.

I think some are. One of the members of our panel who is, unfortunately, the deceased former Chief of Operations, Bud Zumwalt, Admiral Zumwalt was the one uniformed man in America that fought

for American veterans on Agent Orange. So we had the benefit of

his sitting literally next to us until several months before we completed it and he unfortunately passed away. I talked with him on

this very issue that you just asked me.
19

Here is the difference. We have so many problems in this veterans’ population and with their families referred to as Gulf War illness. The symptoms are all over the place, from birth defects in babies that were born soon after that Gulf War to neurological problems, skin problems, intestinal problems, lung problems. Agent Orange tends to be more defined. Now, my sense is that something

is wrong, but I don’t know what.

Let us address what Don Riegle has said in a very direct way.

I am sitting here with him, so I can do that.

What he is essentially saying to you, and he may be right, what

you as a Congress have to decide is whether we ought to have nofault veterans disability for people coming home sick.

Mr. RIEGLE. From the Gulf War, if I may say.

Mr. RUDMAN. Of course. From the Gulf War. Because it is so

complicated and there is so much dispute about it, if you went and

you are sick, you are covered. That means turning the whole VA

system in this country upside down, but you can do that.

Mr. RIEGLE. Is it upside down or right side up?

Mr. RUDMAN. Whichever way you feel. But the issue is, do you

want to do that? It may be the only way that you can ever satisfy

people who have deep concern about this issue. And I am not going

to sit here and say it is right or it is wrong. A few years ago, I

would have had to take a stand, and right now I don’t, and I don’t

know how I feel about that.

But we are talking about something that, as you say, we are having a terrible time defining. Do we want to say as a Nation, if you

are deployed to the Gulf and you come back here and you got ill

and you progressively get worse that we are just going to say we

take notice of that, you don’t have to prove it? All you have to

prove is that you are sick, and if you have—and you were in the

Gulf, we will give you some sort of disability.

Maybe that is what this Congress will end up doing. I don’t

know. But it seems to me here are the two ends of this debate. And

you ran for this office. You decide.

Mr. MORAN. Mr. Evans—we have the ranking member of our full

committee with us, and I am delighted that you are here and again

acknowledge, as Mr. Filner did, your active interest and commitment to this topic, and we would welcome any questions you have

of the witnesses.

Mr. EVANS. Thank you, Mr. Chairman. I thank you for the opportunity to speak.

Not to date yourself, Senator Riegle, but I read your book in college and enjoyed it.

Mr. RIEGLE. Thank you. I am glad it didn’t scare you away from

running for Congress.

Mr. EVANS. I think that the veterans of this country owe you a

great degree of gratitude for initiating your investigation. We followed it closely here, and we appreciate your work when no one

else was willing to take this on.

And of course we thank you, Senator Rudman, for your continued

help to us.

I agree more with Senator Riegle about what I think happened

there, but the one thing that bothered me the most was, you know,

I am a former Marine. What would be the motive for the Federal
20

Government to basically get rid of this problem by sweeping it

under the mat? I didn’t think that the—obviously, it could not have

been a nationwide program to deny people of their benefits, but do

you have any idea of why our government would want to hide either the Agent Orange problems or the problems of the Persian

Gulf veterans? Do you have a theory about that at least?

Mr. RIEGLE. I do, and if I may answer first.

First, let me thank you for your leadership on this over a long

period of time. This is not an issue that has necessarily attracted

a lot of attention, and it needs a lot of attention, and I appreciate

the effort you have made and others to get the bright light on this

to see if we can’t help people.

I think there are some other reasons. You have to theorize a bit.

I have seen a pattern of this in our government over a great length

of time.

You have mentioned not facing up to the problem of Agent Orange in the Vietnam War. That is quite apparent. But we also did

atomic testing in civilian areas, and people were contaminated, and

they got sick and many died and got cancers and so forth. The data

was in the government, and the government suppressed it for years

and years and years. So there are other powerful examples in this

past century where our government has done things, presumably

inadvertently, that have killed people or caused great medical

harm, and I think there is always a reluctance of those bureaucracies to necessarily want to come back in and dramatize that or

fess up or put the light on it.

If it hadn’t happened repeatedly, you might say, what is the

basis for you to offer that theory? But we have got enough powerful

examples that we know there tends to be an institutional response

not to do that; namely not to tell the truth, when the facts are

ugly.

Why would it even be greater in the case of the Gulf War? This

is just my own personal thinking, but I have thought about it a lot,

and you have asked the question. We all have our own opinions on

it.

I think in the professional military in the Defense Department

after the experience in Vietnam, which was an unhappy one by almost every way one might describe it, that in the minds of some

the Gulf War, when it happened, if it could be executed quickly, efficiently, few deaths, achieve the objectives and so forth, this would

be a very powerful validation of the fact that if we got it wrong in

Vietnam, we got it right in Iraq, and everyone would feel good

about that, and we all salute the work that was done by people

who went and fought that war in Iraq.

But this problem of a hundred thousand plus sick veterans coming home was not part of the plan, wasn’t part of the adequacy of

the planning going in to prevent this kind of thing from happening,

despite the fact that we knew he was loaded with these chemical

and biological weapons, and we also knew that we were going to

go in there with massive air strikes and blow these places up and

wherever this stuff would go, it would go. But the point is we knew

it was highly dangerous. That is why we had I think a very insufficient but nevertheless some level of protection for our troops. That
21

is why the alarms were going off all the time once the bombing

started.

So now we execute the war. We brought it to an end. Saddam

Hussein is still there, and we did not cancel out this threat by any

means. I think the threat is bigger today than it was then, but that

is another point.

But as we are sort of praising ourselves for the efficiency and the

perfection of the Gulf War, lo and behold, we start to have all these

veterans, some still on active duty, some who have mustered out,

reservists and so forth, who get sick and start dying, and it is a

very untidy fact and not a small fact. We are not talking about a

platoon or 5 or 10, dozen people or 200 or 300 people. We are talking about—I don’t know the final total on the voluntary registry of

Gulf War veterans, but I know it reached 130,000 at one point.

Now, here is 130,000 out of something like just over 500,000 or

so who served, who came back and who were sick to some degree

and felt there was some connection to that problem and went

ahead and registered on the registry. Now, that raises huge questions. Should we have bought the alarm system? Are we still using

it? Is it adequate? Did we get the people in the mop suits fast

enough? Do we need biological weapons detection devices out in the

field?

Should we have a different approach when we go in and attack

a madman like Saddam Hussein who has got all this stuff which

we helped him build in the first place? Which is another untidy

fact that goes back a little bit earlier. A lot of people don’t want

to talk about that. Because you say how did this lunatic end up

with all of this stuff, when we sent it to him. We sent all the live

viruses over there. That is how he built this capacity, and that is

an untidy fact. Nobody wants to talk about that.

So the parades and the hooray, as justified as they are, also have

the effect of sort of taking the attention away from these very unpleasant facts.

But the biggest fact of all is you have got a very large number

of sick veterans from that war right now who need help. Now, I

think that is a fact that we should be prepared and honored to step

up to, not find ways not to do something about it or to postpone

action or to have a perfect answer. I mean, when you are sick and

you can’t get out of bed and you can’t feed your kids or get a job

and you can’t get insurance and you got sick in the Gulf and you

were well when you went, you were sick when you came back, why

isn’t that sufficient grounds to help that person?

I don’t think you have to have a Ph.D. and be a scientist to be

able to figure that out. That is pretty basic. And I don’t think we

should ask anybody to go and serve and run these risks and come

back sick and get anything less than that. Otherwise, why are we

here, any of us in this town?

So I think it is sort of upholding the honor of the country. When

you ask in somebody to put the uniform on and go out and risk

their life and they get sick and they come back and are in desperate shape, do you do something about it or do you walk away

from the problem? And I don’t mean not doing the research. I am

talking about getting them the help they need to survive. That is
22

the issue, and it is pretty simple I think and something we can do

something about.

And, yes, we ought to have legislation to do it, and I bet we get

a lot of co-sponsors. I think George Bush would sign it. Yes, we

tack a little bit more money on the budget, but it is money well

spent. But it is a bill that has come due, and we ought to pay it.

OPENING STATEMENT OF HON. CIRO D. RODRIGUEZ

Mr. RODRIGUEZ. Thank you, Mr. Chairman.

Senators Rudman and Riegle, let me thank you for your

testimony.

Senator Riegle, I agree with what you have indicated. I know

that the military for good reason tends to be a very closed system

and for that I gather it makes it very difficult for them to disclose.

It bothers me when I heard about Marines and their families who

were drinking that dirty water for so long and nobody ever mentioned that until years later, and it bothers me that it took so

many years for Agent Orange, and it bothers me—— I recall I was still a State rep right after the Gulf War, still a

representative, and I had been invited to talk about another issue

to some of the people who had just returned, and at that point they

were already beginning to complain about what they felt, the fact

that they didn’t have any energy and those kind of things, and it

has taken so long for us to respond.

One of the things that I wanted to ask you and maybe for you

to make some comments is I also had the distinction of having the

community that has probably the most bases than anyone else, and

I just had a base that was closed, Kelley Air Force Base. I have

over 128 diagnosed Lou Gehrig’s disease patients, and the Department of Defense has yet to want to do research and want to be

able—they haven’t been able to make the designation. Yet it is a

very disproportional number in the population, over 128 diagnosed,

and they were all working at Kelley Air Force Base. So somehow

we need to go and look at these bases.

Because I also feel that you talk about disclosure when certain

events occur, it is a closed system. They are not going to do that

unless something is there that triggers—that they are forced to do

that. So I just wanted to throw that out.

Mr. RIEGLE. Could I say one thing? And I appreciate your making that point.

Senator Rudman and I both exclaimed at the high number of Lou

Gehrig’s disease, but here is my point, and that is there is also a

tendency in terms of how we divide the work up. The Defense Department goes out and fights the war. The war ends. The people

who fought the war muster out of the military, and they come, in

essence, under the jurisdiction and umbrella of the Department of

Veterans’ Affairs. But the problem is the Department of Veterans’

Affairs didn’t know everything that might have happened that the

Defense Department knows about. There is no way in the world

they can begin the kinds of treatment regimes that they need or

to argue for the money and the support in the health recovery systems for the veterans that have come out.

So there is this awkward division of responsibility. This crowd

sends them in, maybe responsible for the fact that they get sick,
23

but then, once they leave the service, you know, it is this, and they

get dumped over on the next doorstep at an agency that has, in my

view, never been richly funded. Then the question is, well, what do

we do with this, what happened?

And you go back and knock on the door of the Defense Department. You say, what happened out there in the Gulf arena or what

happened on this base that just closed? What is the history of the

use of chemical items or anything else that may have been there

that one can plausibly start to think might be a predicate for causing a high incidence in Lou Gehrig’s disease? If the Defense Department isn’t over there providing all that information willingly,

the full disclosure to the Department of Veterans’ Affairs, how do

they know what they may be looking at here?

And, yes, years do pass. I lost a lot of Vietnam veterans to Agent

Orange in my district and State, people whose lives I think would

be alive today if there had been an honest dealing with that problem earlier in time.

I had a veteran describing being out there after the Agent Orange came down. He described what happened to the forest—the

jungle canopy as being like wilted spinach and, you know, what it

was like to be in that situation.

I mean, we know an awful lot more sometimes than we want to

face up to, and I think here we have got a problem where the

Defense Department institutionally has a deep, rich history of not

providing this information, of covering up their mistakes, not wanting to have to sort of go back and reengineer, retool, accept

responsibility.

I haven’t seen anybody being willing to accept any responsibility

for what went wrong in the Gulf War that has given us a hundred

thousand sick vets. I haven’t seen anybody volunteer for that

assignment.

Mr. RODRIGUEZ. Senator Rudman, you mentioned that you felt

comfortable with what we have done, and I was going to ask from

you some suggestions as to what I should do. Because I do have

over 128 and a lot of them are also civilians that have worked on

that base and how to deal with that and how to get the Department of Defense to do the right thing.

Mr. RUDMAN. Congressman, I sat here with Don Riegle when you

gave us that statement. That appears to me to be a national health

crisis in your district. I never heard of 128 ALS victims on one

base. If that number is accurate, I think—— Mr. RODRIGUEZ. I will send you the documentation and the articles that have been written.

Mr. RUDMAN. I think you ought to get the United States Public

Health Service involved rapidly out there as well as the VA and

others. That is a serious issue. I have no other answer than that.

Mr. RIEGLE. I would say one other thing. I would drill into that.

I would become—my advice to you as you are, you brought this to

light today, I would hound people until they were sick of hearing

from you. Because that is the only way you are going to get any

action on this thing. You are going to have to make yourself up to

the point of being obnoxious by repetition all the way up to the Secretary of Defense, or wherever it takes, and I would encourage to

you do it.
24

The only time I found you get results against these resistant bureaucracies is when you hammer them and hammer them and

hammer them. It is the only thing they seem to understand. I wish

it were not the case, but it is.

Mr. MORAN. Mr. Lynch, welcome to the committee.

Mr. LYNCH. Well, I first of all want to thank both of you Senators

for coming before us and being such champions of our veterans. I

do want to agree with both of you in the sense that this presumption that might be created for Armed Services veterans who have

come back from the Gulf—— Mr. MORAN. Mr. Lynch, your microphone may not be on.

Mr. LYNCH. I do want to speak to the suggestion of a presumption on behalf of our veterans that are coming back from the Gulf.

There is—as far as I am concerned, the ALS example where—in

our reports where it shows that we had this control group of veterans, and in those who were deployed in the Gulf, there is a 200

percent increase in the rate of ALS among those veterans, in my

mind it is the smoking gun that we are looking for. And what Representative Rodriguez and his situation, it could be just an issue

of exposure, just a greater exposure during wartime and active

service.

I also agree with the characterization of a debt owed. All across

my district, there is a consolidation going on with regard to veterans services and facilities, and it is almost as if this is discretionary spending. This is not discretionary spending. This is, as you

have said, Senator Riegle, this is a debt owed for honorable services and sacrifice rendered, and that is the way we should be treating this. And I am just happy to hear your words this morning,

both Senators, and I am just very proud to be on this committee

and I am looking forward to working with you.

Thank you, Mr. Chairman.

Mr. MORAN. Thank you, Mr. Lynch. Mr. Snyder.

Mr. SNYDER. Thank you, Mr. Chairman. Just a comment on the

128 cases you mentioned. I agree with Senator Rudman, if that

number is an accurate number, in a localized geographic area, Mr.

Chairman, we may well want to consider having a hearing on that

particular site alone as a way of bringing focus on that, if you and

the staff determine that the people are alleging 128 cases, that is

going to have phenomenal impact on that area and the Veterans’ Administration in that area.

Senator Rudman, in your written statement, you made very

strong statements about the importance of—your words—meritorious peer reviewed research projects be funded. And I agree with

that. Would you take a few minutes and just talk about why you

made that comment and that statement?

I think a lot of us here do get apprehensive, not in the VA at

all necessarily, but, you know, if we start thinking that politics

may be getting involved in who gets what funding for what research project. Would you amplify that, please?

Mr. RUDMAN. Sure, I would speak of it generally. I am not out

here to damage anybody’s reputation, but you can fill in the blanks.

There were several instances as we were doing our work and we

were not involved in awarding grants, but we were actually looking

at everything that was going on to make sure it was being done
25

right by the VA and the DOD, and we came across some research

grants that had been granted because there had been substantial

political pressure brought by people in Congress, outside of Congress to say, you know, this is worthy, these people are very good

and they have been turned down. They ought to get the grant. And

in several cases, they did.

The thing that troubled me in one or two of those is that after

the money was spent, I forget how much money, but it was millions

of dollars, several million dollars, they came in with a report saying

we believe A, B, C, and we would like another $10 million. At

which point the people at DOD and VA or DOD at this point who

are, after all, dealing with money that you appropriated to them

and asked them to spend carefully said, you know, fine. But before

we give you another tranche of money, we would like you to follow

a protocol that is a standard scientific protocol to prove what you

are trying to prove. They were essentially told, No way. We are not

going to do what somebody else wants us to do from the great universities all over the country. We are not going to do that. We will

get our money anyway. And they have. And I just do not think that

is the way you ought to get Federal money.

Your ranking member says let’s have a 10 percent set-aside for

unique research. I do not have a problem with that. That is different. I am not talking about that. I am talking about people who

have done work. The work has not been validated under a peer review system that normally would be put in place for a second

study. They just want more money without proving where they

were. I, frankly, as you know, am somewhat of a fiscal conservative. I like to be a bit more careful with federal dollars than that.

Mr. SNYDER. I think your point is good. Medical research is no

different than any other part in life. You get what you pay for. If

I buy a new car, I better check out that car substantially before I

pay the money and not afterwards. And that is the whole point of

the peer reviewed projects, and if we bypass that thinking we are

somehow going to help veterans, we may not be helping veterans,

but just waste money and may raise some expectations and hope

that isn’t there. Because this, obviously, is a frustrating issue for

veterans. But it is also frustrating for clinicians and doctors and

nurses.

Mr. RUDMAN. Terribly.

Mr. SNYDER. People talk about the vague symptoms, and yet, you

know that there is a person hurting here. But there is nothing—

I am a family doctor, there is nothing more satisfying than somebody who has a minor cut on their arm and you stitch it up. I know

what the problem is and they are going home well. That is easy.

But that is not at all what these cases were.

Mr. RUDMAN. You would find it very interesting to take a look

at the list of studies that have been funded and where. There have

been studies since 1998. I forget how many. It is over 1 million. It

may be getting closer to 2 now. I don’t know what State you are

from.

Mr. SNYDER. Arkansas.

Mr. RUDMAN. I would not be surprised if there were things at

that university medical school that were funded. I know Michigan,

California, Massachusetts, literally all over this country. I think in
26

Congressman Lynch’s district, there are extraordinary laboratories

with extraordinary people trying to find answers.

Mr. SNYDER. And the Veterans Hospital system has excellent research going on in a lot of different areas.

Mr. RIEGLE. Would you permit me to add one comment, a slightly

different comment to that point? That is, I think that you can have

that proper discussion on where should the research focus be and

peer review and so forth. But I would like to separate that for the

moment from the issue of a response now to sick veterans from the

Gulf War. That is, that however one does the research, there is a

time factor here. And I think just as a person would come into your

office who is desperately ill, I think we now know enough, even

though it is incomplete and even though there are some mixed elements in our knowledge base, that if we see someone who served

in the Gulf War who is now desperately ill, very ill, can’t function

and we cannot pin down exactly where it came from—but we know

one fact, that the person was well enough to go to fight in the war

in the first place, we sent a well person to the war—I think we now

know enough in the forms that it has that I think we should make

a presumption that they should receive some disability payment

help to permit them to subsist and hopefully live long enough for

the research to be completed by whoever it is, whoever does the

research.

See the problem we run into the other way, and the problem that

we are running into is that we have sick Gulf War veterans who

are getting no response because of a long lead time in the research,

whoever does it, and they are dying in the meantime. And I think

we now know enough to know that that is probably not fair. Probably not right. And we should do something about it and we have

the power to do something about it.

Mr. SNYDER. My time is up. But I did not read anything in Senator Rudman’s statement nor meant to imply in anything that I

said that somehow all veterans are put on hold until there is definitive—that is not what anyone is saying, those are separate issues.

The issue of prevention, until we know specific cause itself, makes

it much more different to prevent these kinds of things in the future. But thank you, Mr. Chairman.

Mr. FILNER. Mr. Snyder, if I may. We will have testimony later

on, and I have talked to researchers all across the country—people

who have protocols of treatment based on certain theories that

have been effective in treating Gulf War illness but have been rejected by the peer review system, by a system which did not want

to hear that theory or belief or treatment.

So the problem is, the system that is set up now rejects people

who just have a different way of looking at the problem. And we

are going to hear testimony on that later.

I don’t want to throw out the peer review system. But there is

something wrong with it if it does not allow certain types of research to be done. And certain effective treatments. There have

been treatments, Senator, that have been just dismissed out of

hand by the VA and the DOD. I have personally seen those treatments save lives. I have personally seen that.

You say, Congressman, we do not know anything. We have

knowledge that these bureaucratic and scientific dispassionate peo-
27

ple do not have. Because we have seen it in our constituents and

that is our job. And so that is the problem, Dr. Snyder. And we will

have some testimony on that.

Mr. SNYDER. In the business, you know we call those ‘‘anecdotal

experiences’’ and that is a very dangerous thing for physicians—— Mr. FILNER. But it may be true also.

Mr. SNYDER (continuing). To say I treated this one person in

medical school in 1973—— Mr. FILNER. What if it is 2,000?

Mr. SNYDER (continuing). And did this and they got better.

When, in fact, the point of research that is peer reviewed and gives

you the answers you want is when you go out there and do that

kind of thing on 5,000 people, or look at what has been done before,

it may not be the experience of the Member of Congress that sat

down with one person—— Mr. FILNER. I understand, but what if it is 2,000 that have been

treated successfully and been rejected?

Mr. SNYDER. But Mr. Filner, that is 2,000. I don’t know if that

is statistically significant or not.

Mr. FILNER. If 2,000 people have gotten better, that is not significant?

Mr. SNYDER. Well, that is the point of having scientists sort this

stuff out.

Mr. FILNER. But there is a limit to that expertise and that socalled scientific dispassion. There is a limit to it that has prevented

us from moving forward.

Mr. MORAN. Senators, thank you very much for your time this

morning. We appreciate you taking the opportunity to enlighten us

and we are grateful for that opportunity. Thank you.

We will call the next panel to the table. That includes Dr.

Frances Murphy of the Veteran’s Administration, and Ms. Ellen

Embrey of the Department of Defense, and Dr. Susan Mather and

Dr. Craig Hyams of the VA, and Dr. Michael Kilpatrick of DOD accompany them.

STATEMENTS OF FRANCES MURPHY, DEPUTY UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY SUSAN H. MATHER, CHIEF PUBLIC

HEALTH AND ENVIRONMENTAL HAZARDS, AND CRAIG K.

HYAMS, CHIEF CONSULTANT, OCCUPATIONAL AND ENVIRONMENTAL HEALTH; AND ELLEN P. EMBREY, DEPUTY ASSISTANT SECRETARY OF DEFENSE FOR FORCE HEALTH

PROTECTION AND HEALTH AFFAIRS, DEPARTMENT OF DEFENSE, ACCOMPANIED BY MICHAEL E. KILPATRICK, DIRECTOR OF DEPLOYMENT HEALTH SUPPORT

Mr. MORAN. Dr. Murphy, welcome back to this subcommittee.

And I know this has been a busy week on this topic and others at

the Department of Veterans Affairs, we are happy to have you here

and we welcome your testimony.

STATEMENT OF FRANCES MURPHY

Dr. MURPHY. Mr. Chairman, thank you for the opportunity to

testify today on the changes in VA health care and benefits assist-
28

ing Gulf War veterans. I have submitted a formal statement for the

record.

The recent commemoration of the 10th anniversary of the Gulf

War makes this an excellent time to reflect upon what we have

learned over the past decade and the resulting changes we have

made in order to improve our response to the needs of Gulf War

veterans.

This has been made all the more relevant by the recent deployment of U.S. troops in the war against terrorism. At this time, I

would like to focus my remarks on just a few important issues.

Based on our experience with Gulf War veterans, we recognize

the critical importance of good health documentation and lifelong

medical records that cover the periods before, during, and after deployment. Our understanding of many Gulf War issues is hampered by inadequate baseline health information and inadequate

documentation of health during active duty. DOD and VA have recognized this shortcoming and are attempting, through the recruit

assessment program, to collect routine baseline health data from

U.S. military recruits. This pilot program was established to obtain

baseline health information for use during military service and for

veterans’ health compensation and research programs.

The VA and Congress have also recognized the importance of

providing health care and health surveillance for veterans as soon

as possible following combat missions in the future. Public Law

105–368 authorized VA to provide health care for conditions

thought to be related to combat for a 2-year period following a veteran’s release from active service. This 2-year period encourages

combat veterans to seek care promptly if they have health problems or concerns that may be related to their service.

It also allows VA to collect basic health information to aid an

evaluation of specific health questions, including those about difficult-to-explain illnesses.

Our experience following the Gulf and Vietnam wars have shown

that health care needs of combat veterans do not always fit into

well-defined, medical diagnostic classifications, and that combat

casualties do not always result in visible wounds. Historically,

many veterans have returned from conflict with difficult-to-diagnose, yet serious health problems. Research currently indicates

that for many veterans, the unifying risk factor appears to be deployment itself, rather than any identifiable exposure.

The insights to be gained from such research have clear implications for future VA health care research and for veterans’

compensation.

VA has responded to this issue in part by establishing two national centers for war-related illnesses. They are located in Washington, DC and East Orange, New Jersey. They will focus on areas

of medical care, research, risk communication and education for

health care personnel. The new centers work with the Departments

of Health and Human Services and the Department of Defense to

ensure that lessons learned are applied to both veterans and active

duty military.

Building on the lessons learned from our experience in the Gulf

War and Vietnam veteran programs, Dr. Garthwaite and I implemented the Veterans Health Initiative. This program enables prac-
29

titioners to better understand and recognize the relationship between health effects and military service, to allow veterans to better document their military history, to prepare health care providers to better serve their veteran patients, and to establish a database for further study.

Several of the planned education modules have been completed

and others are under development. Recently, the Gulf War veterans module has been put up on our Web site for use by our

practitioners.

We have also worked with DOD to develop new clinical practice

guidelines for post-deployment health problems and two symptombased illnesses, chronic fatigue syndrome and fibromyalgia. These

new guidelines will give VA primary care providers the tools they

need to diagnose and treat veterans with such illnesses.

The Gulf War made clear the value of access to timely reliable

information about health risks servicemembers face during their

deployment. In this regard, VA has developed a new brochure that

addresses the main health concerns for military service in Afghanistan and south Asia. It answers health-related questions and describes relevant medical care programs the VA has developed in

anticipation of the health needs of this group of veterans when

they return home from combat and peacekeeping missions abroad.

Work on the Gulf War health issues has significantly increased

intergovernmental coordination between VA, DOD and HHS. The

initiation of the Gulf War Veterans Coordinating Board in 1994,

and the reinvigoration and inauguration of the Triagency Military

Veterans Health Coordinating Board in 2000, has served to institutionalize future interagency cooperation. This formalization of government coordination will play a critical role in addressing health

problems among veterans of future conflicts and peacekeeping

missions.

Increased collaboration has also extended beyond the U.S. borders. On postwar health issues, VA scientists and policymakers

share lessons learned with their counterparts on a routine basis in

Canada, the United Kingdom, and Australia. Based upon the similarities of health problems of war veterans of different countries,

these collaborations have begun to focus on health questions that

consistently arise among military personnel returning from all hazardous deployments. The collective experience of caring for Gulf

War veterans in the United States, Canada, the UK and Australia

has also led to a greater appreciation of the need to assist veterans

with unexplained symptoms.

Mr. Chairman, a veteran separating from military service and

seeking health care today will have the benefit of VA’s decade-long

experience with Gulf War health issues. From the lessons learned

in serving veterans of past conflicts, VA today is in a better position than ever before to meet the needs of all veterans who serve

in all capacities, whether that is at home or abroad.

This concludes my statement, my colleagues and I will be happy

to answer any questions from the members of the subcommittee.

Mr. MORAN. Madam Secretary, thank you very much.

[The prepared statement of Dr. Murphy appears on p. 92.]
30

Mr. MORAN. Secretary Embrey, we are delighted to have you in

front of the Veterans’ Affairs Subcommittee. We welcome your

testimony.

STATEMENT OF ELLEN P. EMBREY

Ms. EMBREY. Thank you very much, Chairman Moran, Mr. Filner, and other distinguished members of the subcommittee. I thank

you for this first opportunity to be here and to testify for my first

time before Congress.

I am accompanied today by Dr. Michael Kilpatrick, who is our

key advisor in health affairs within the Department on deployment

health support. Dr. Kilpatrick has the honor of working through

the entire staff there and advising Dr. Winkenwerder, the assistant

Secretary for Health Affairs on all matters involving the—— Mr. MORAN. Secretary, could you pull the mike closer as well?

Ms. EMBREY. I am sorry. Talk loud? Is it on? It does not sound

like it is on.

Mr. MORAN. You may need to trade mikes with Dr. Murphy. We

are sorry on your debut in congressional testimony to have mechanical difficulties.

Ms. EMBREY. That is fine. This is better. Yes, it is. With your

permission, I would like to submit the Department of Defense’s

written testimony for the record and summarize key messages so

that you will have time to ask questions.

Today, the Armed Forces of the Department of Defense are deployed throughout the world and currently supporting Operation

Enduring Freedom. We are quite mindful of this sacrifice and are

totally dedicated to providing the health care they deserve. And

while we continue to learn lessons from our current and past deployments, and we want to continue to address issues relating to

them, we will continue to vigorously pursue resolution of these

issues particularly those relating to Gulf War.

Before the Gulf War, the Department of Defense had in place

force health protection measures that had served us well in previous deployments. Included in these programs were periodic medical examinations, preventative medicine measures and endemic

disease surveillance. Execution of those programs resulted in very

low rates of preventable diseases during the Gulf War. However,

since the Gulf War, the Department of Defense has been focused

intently on nontraditional force health protection threats.

Department of Defense policies, directives, joint staff memoranda

and other policy initiatives have been incorporated to address the

lessons learned of the Gulf War experience. Pre and post deployment questionnaire assessments have been established to identify

troops needing prompt attention for their health problems. An environmental surveillance program was also established for deployment area of operations to help field commanders avoid or abate

possible health hazards.

We have also been working very hard to establish systems to

capture and use deployment-related medical information to better

monitor the possible long-term health effects and consequences of

their deployments. Better medical recordkeeping, as everyone has

been discussing today, will definitely improve our ability to assess

and group health outcomes from these deployments.
31

Use of effective vaccines are one of the major ways we try to protect the deployment health of our forces. The routine administration and electronic documentation of those immunizations in the

medical records is our near term goal and standard electronic medical information systems are now being developed and interim

measures have been implemented across the services to serve these

objectives.

Within the Department, we have broadened the focus of the

former office of special assistant for Gulf War illnesses to now include future and current deployments. That staff, in cooperation

with the joint staff and the military services, will provide Dr.

Winkenwerder and me with critical assessments and recommendations on ways to improve deployment health-related processes and

systems.

With this information, we will more closely monitor deployment

force health protection matters and assure that the military health

system is responsive to the health concerns of our service members,

veterans and their families.

A key area in which we strive to address the health concerns of

service members and veterans is through our support of scientifically valid medical research. The Department of Defense remains

an enthusiastic partner in cooperative interagency federally-sponsored research efforts with the Department of Veterans Affairs and

Health and Human Services. We are committed to investigating

the possible causes of illnesses and treatments for medically unexplained physical symptoms that affect veterans. In addition we are

actively seeking ways to expand our close collaboration with the

Department of Veterans Affairs to improve medical service to our

veterans.

Over the last 3 years we have developed and tested a patientoriented evidence-based clinical practice guideline to aid primary

caregivers in the assessment of illnesses that can occur after deployments. Clinical use of these guidelines will start next week.

Among our many other collaborative efforts, we have instituted a

single separation medical examination, which will serve the needs

of the veteran, the Department and the VA and help expedite

claims within a 30-day time frame.

In conclusion, the Department of Defense is committed to ensuring the health of our military forces. You have my commitment and

that of Dr. Winkenwerder that the Department will aggressively

assess and address the challenges that lie before us. We are aggressively executing our responsibilities to oversee health protection, fitness, casualty prevention and care of the men and women

we ask to defend our country. Again, I thank you for the opportunity to be here today and I am happy to answer any questions.

Mr. MORAN. Thank you both, Madam Secretaries.

[The prepared statement of Ms. Embrey appears on p. 103.]

Mr. MORAN. Secretary Embrey, as I indicated in my opening

statement, 25 of my neighbors, men and women, were deployed last

Monday for some place in the Middle East. And if I was to have

a conversation with them or their parents or their children to tell

them what assurances, what steps are being taken to greatly ensure their health while serving and upon their return, what would

be that story to those servicemen and women and to their families?
32

And specifically, what I would like to explore is what is the Department of Defense doing differently today in the deployment process

and during the time of service for the—for those who will be veterans of this battle on terrorism, Enduring Freedom, as opposed to

those who became veterans of the Persian Gulf War?

I asked that with more words than probably necessary, but I

would like to have you contrast the deployment and service of those

Persian Gulf War veterans and those who will be veterans of Enduring Freedom. What have we done to improve the chances that

they will return safely, healthy, and live more healthy lives upon

that returning?

Ms. EMBREY. Since the Gulf War, I know there has been 12 specific DOD policies, programs, initiatives, policy and guidance out to

the services to make institutional corrections to the health system

to ensure that through the continuum of care for our members,

whether they are at home or being deployed, that we maintain appropriate support for them and that we maintain good records and

that we have systems in place to assure that they are healthy before they deploy and there is a regular way to do that. That there

is a periodic—before deployment there are assessments that are

provided as a routine measure to determine whether or not, since

the last time they were provided an assessment, if there is anything that would preclude their deployment or eligibility to perform

while they are being deployed. And then another process after they

are deployed to ensure that any issues that arise as a result of that

deployment are captured quickly and put into the record as part

of the system so that we can track and make sure that we are taking care of those individuals.

There has been quite a bit of research ongoing, longitudinal studies, other kinds of initiatives. We set up three separate centers focused on deployment health matters. And since I am only 2 weeks

in the job, this is all my brain can hold at this time. But I am accompanied by a real expert who could probably add more detail if

you would like.

Mr. MORAN. Dr. Kilpatrick.

Dr. KILPATRICK. Yes, I think Secretary Embrey gave you the

overview of the policies, but the question as to how to answer the

mothers and fathers whose sons and daughters are going into

harm’s way, what are we doing differently, to really address that

from the Reserve component side, there is a much more aggressive

campaign to make sure that those people have complete physical

evaluations done when they are brought on active duty, because

this is coming out of being a citizen, now becoming a soldier to

make sure that there is time for that medical evaluation; that the

dental evaluation is done and that people get the dental care they

need before being deployed, because certainly, dental assets are

limited under the deployment situation; to make sure that the required vaccines are up-to-date, that we are not giving a bolus of

vaccines all at once, but that we are giving them when they are

due. And it is catching people up when they are late and being upto-date.

For the active duty component we are focused and aggressively

looking at making sure that people’s physical examinations are

done on time. Their dental evaluation is done annually so what
33

when they are deployed, there is a quick assessment: Has anything

happened to you since your last complete checkup that you have

a concern about before you deploy?

Once they are deployed, we are trying to make sure we get the

appropriate medical assets. DOD is working very hard because today’s war is a different deployment situation than we have done in

the past. We do not have battalions or garrisons, large groups of

people in one place. We have small groups of people who are highly

mobile, and that makes it very difficult for the medical assets in

the Department of Defense to be able to carry along with those

individuals.

Secretary Embrey and Dr. Winkenwerder were just down with

the Special Forces command last week, and they were wanting to

use a Palm Pilot to keep track of symptoms so that they would

know on what day they had symptoms and that information would

be then provided back to the Department of Defense to be able to

do that on-the-job assessment.

I think, finally, in the theater, we have people doing essentially

environmental surveillance, looking at the soil, the water, the air,

for pollutants. And that information is being categorized as to

where people are located and what were those kinds of exposures.

And I think Secretary Embrey talked about coming back, the clinical practice guideline. The primary care physician will now be asking, do you believe that the symptoms that you have, the worries

that you have about your health today could be related to a deployment, and if the person answers yes, then the full medical focus becomes what was your exposure, what was your concern, what is the

basis of that, what are the symptoms, how do we do the appropriate medical testing? Much better than going to a clinic, that is,

kind of everybody gets the same evaluation.

Mr. MORAN. Thank you. In the interest of time, I would ask for

you to submit to the record in writing a couple of things for me.

The 12 points, the policy that you described, Madam Secretary, and

then I am especially interested in knowing the vaccination immunization protocols that our servicemen and women undergo today before and during deployment. What are we vaccinating for? I would

like to know that.

Mr. Filner.

Mr. FILNER. Thank you, Mr. Chairman. Were vaccination

records, immunization records, shot records kept for the Persian

Gulf War?

Ms. EMBREY. There is a requirement to maintain immunization

records on paper. It has been a long-standing policy of the Department. And if the immunizations were administered in the field,

then that record should have been taken.

Mr. FILNER. That is what I would assume. Could you make those

available, of Gulf War veterans, to the committee?

Ms. EMBREY. I guess I have the power to say yes.

Mr. FILNER. I have asked this question before and I was told

they did not exist. If you say they exist, I would like to see them.

Ms. EMBREY. I said they should have been there.

Mr. FILNER. So you will try to provide those to this committee?

Ms. EMBREY. I will request that what we have is provided.
34

Mr. FILNER. Do you know if any part of the vaccination protocol

included antibiological warfare vaccines?

Ms. EMBREY. Could you restate the question?

Mr. FILNER. Was there any part of the vaccination program

aimed at biological weapons that we knew Iraq had access to and

might use?

Ms. EMBREY. I believe the anthrax vaccination and botulism

toxin.

Mr. FILNER. Those are the only two?

Ms. EMBREY. Yes, sir.

Mr. FILNER. But that would show up in any records that you

would have? All right. I think we would like to see those.

Do you know why it took so long for the Department of Defense

to acknowledge the impact of the events at Khamisiyah?

Ms. EMBREY. I am not familiar with the events at Khamisiyah.

I do know that the Department has devoted a significant amount

of research in trying to understand if there is a scientific basis to

link outcomes with the deployment.

Mr. FILNER. Well if you deny that there was anything going on

and then say it only affected a couple of people, there would be no

reason to figure out that if there was any link. And that is what

the Department of Defense did for years. Basically. Denied that

any event occurred and then when they had to admit it, first said

it only affected a few people and then had to acknowledge maybe

100,000 people could have been affected?

Ms. EMBREY. Sir, I am here now ready to address your issues.

I am not then. I am here and I am today.

Mr. FILNER. So you would not stonewall on any of these kinds

of issues that came up either now or in the future?

Ms. EMBREY. For the current deployments and for the future, absolutely not.

Mr. FILNER. We will see. Why do you think, by the way, that

there is so much distrust of the agency that you are working for?

The distinguished Senator from Michigan used the word

‘‘stonewalling.’’ The undistinguished Congressman from California

used the word ‘‘stonewalling’’ I mean, why would there be a sense

that we are not getting the truth?

Ms. EMBREY. I cannot speak for their opinions and their frustrations, but I do believe that any time we believe by just observation

that people who have sacrificed for our country are not being given

a fair shake, I think that it is important that we look into it and

do the best we can for those folks and make sure that we are taking care of them. I can’t argue with that emotion, and I believe that

we need to do what we can to investigate whether or not this is

something that is related to the deployment, and that we should

take care of it. And if it isn’t, do what we can to take care of it

if it is within our ability to do so. And I think this committee is

very——

Mr. FILNER. I am glad to hear the words, we will see what actions actually come from your agency.

Dr. Murphy, if the result of illness is, as you were quoted, deployment as opposed to other factors, why wouldn’t you support the

recommendation of Senator Riegle that we have a presumption of
35

a problem and treat all veterans who were there? Would you accept

that recommendation?

Dr. MURPHY. Sir, that is a policy and a legislative issue that we

have not taken up in the Department, and I do not have—— Mr. FILNER. Why?

Dr. MURPHY (continuing). I do not have a position on that at this

point.

Mr. FILNER. It would follow from your own statement that deployment was the cause, and anybody that was deployed should be

given treatment. That is not the policy right now of the VA.

Dr. MURPHY. If you review the historical records going all the

way back to the Civil War, it is clear that after every deployment,

individuals have come back with a group of multisystem symptoms

after combat. Those symptoms occurred after the Vietnam war,

after the Gulf War, and certainly what I think we need to prepare

to expect after—— Mr. FILNER. So what does that mean? What does that lead you

to do then, if that was the case? That means we do what we did

in all those wars and do not make the presumption?

Dr. MURPHY. We have a presumption created for undiagnosed illness compensation.

Mr. FILNER. Undiagnosed illness. If something is diagnosed, you

do not give any treatment. I mean, if they have a diagnosed ailment, it seems rather strange.

Dr. MURPHY. If they have a diagnosed illness, we have a direct

compensation system that also has the ability to deal with those.

Mr. FILNER. So all veterans who were in the Gulf are getting

treatment based on presumption or diagnosis, are you saying?

Dr. MURPHY. Well, let’s separate health care from benefits programs. Yes, every Gulf War veteran is eligible to receive health

care in the VA. They can enroll and receive the full complements

of health care benefits. Outpatient, inpatient, and long-term care.

Related to disability benefits, VA has separate compensation regulations for diagnosed and undiagnosed illnesses in the Gulf war

veterans.

The current policy is not consistent with the program that Senator Riegle proposed.

Mr. FILNER. I would like the Department to examine that and

give our committee a response to his suggestion.

Mr. MORAN. The committee and witnesses will recess briefly to

allow members to go vote. It is my understanding that it is just one

vote and then no more for the day. If you will give us a few moments we will recess and pick up where we left off. Thank you.

[Recess.]

Mr. MORAN. The committee will reconvene; and, assuming Mr.

Rodriguez can speak loudly, we will ask for your help and

assistance.

Mr. RODRIGUEZ. I don’t know if you heard me earlier that at

Kelley Air Force Base I have 128 patients who have been identified

with Lou Gehrig’s disease, but I have been trying to get a volunteer

study done on employees, and this includes civilians in the base.

A lot of civilians are veterans, and I can understand the VA has

a difficulty going into a base, but I think with maybe a joint effort

it would be extremely helpful. Because I know that we have had
36

some articles in a variety of magazines on this issue, and it is a

real serious situation and a very difficult one. Mortality rates of

those people that have worked at that base would be helpful in trying to identify some of the causes and some of the results.

I just wanted to mention that to you because I will be contacting

you later on and getting your help and assistance in that area, and

I know you had your colleague next to you who is probably familiar

with some of the situations there, but we are trying to get some

additional assistance and some additional resources along the two

studies, especially for those—and that includes civilians. I know we

have had a difficulty, but we all understand that even some of the

spouses that have had some problems with the children, there has

got to be a way of reaching out to those people that have also

worked out on those bases.

It might not just be the Gulf War. It might be a combination of

things that occur that have resulted. And I don’t know if you want

to make my comments—except you will be willing to work with me,

I know.

Ms. EMBREY. Absolutely. I am willing to work with you, and it

is also the President’s specific objective to have the Department of

Defense work with the VA on issues where it is to our mutual benefit to collaborate and provide support to our communities of

interest.

Mr. RODRIGUEZ. Remember that the VA doesn’t have too much

resources so you need to provide them with some resources.

Ms. EMBREY. I believe this committee has control over that.

Mr. RODRIGUEZ. Not the way we have been working lately.

Let me ask Dr. Murphy, I know that we have found and maybe

it goes to both—we found I know there are clusters of Lou Gehrig’s

disease and like in Kelley and elsewhere and with the Gulf War

veterans, and I am just wondering where do we go from here in

terms of research or how we can maybe come to grips with this a

little bit better.

Dr. MURPHY. The recent study that was reported at a joint meeting of DOD, VA, and HHS investigators sponsored by the Military

Health Coordinating Board showed that there was approximately

a two times increased rate of ALS in those who served in the Gulf

War compared to those who did not deploy. There were two further

follow-up phases in that study that will look at some questionnaire

survey data on self-reported exposure information and also to do

some genetic typing to determine whether there is any genetic predisposition that can be identified in this group.

In addition, Secretary Principi, has, instructed VA’s research

service to develop a research program specifically focused on looking at causes and treatments for ALS; and we expect a report from

the Office of Research and Development on those activities.

Mr. RODRIGUEZ. Thank you very much. Thank you.

Mr. FILNER. Would you yield, Mr. Rodriguez?

Mr. RODRIGUEZ. Yes, sir.

Mr. FILNER. When you talk about groups and spouses, I will tell

you pets have also evidence of illness—that suggests contagion,

right? Doesn’t suggest contagion? What does it suggest?

Dr. MURPHY. I think you should not draw that immediate conclusion. An epidemiologic study would be necessary to look at all of
37

the factors that might be affecting a cluster or on outbreak of illness, and what you have described so far would not distinguish

between an infectious or a chemical environmental effect as an

example.

Mr. RODRIGUEZ. I don’t know if I have any more time, but I know

when I mentioned the base, you have a lot of civilians there. Most

of them tend to be veterans, but we might have some nonveterans.

So some of the contamination or some of the problems could be

base related in terms of activities that were done in the base for

the last so many decades.

Mr. FILNER. Yes. But in her testimony she said it looks like deployment. So if somebody not deployed comes down with the virtual

similar thing, that would suggest contagion to me.

Mr. RODRIGUEZ. Yes, but——

Mr. FILNER. I am not a doctor. You are. You said it suggests certain studies. I can’t figure out why these haven’t been done a dozen

years after the war. Have they been done, the ones you are talking

about?

Dr. MURPHY. There are a lot of studies under way, and as we

identify a problem we then have to answer the questions that result from that new issue that has been identified.

Mr. FILNER. These problems have been suggested to you for

years and years and years, and I am glad you are doing some of

it now, but it suggests you are not going into it with the enthusiasm and the commitment that you need here.

Mr. RODRIGUEZ. Let me make just one additional comment.

Where we find ourselves now in terms of having to deal with the

bioterrorist and chemical terror—and this is for us, too, and the

Department of Defense and VA. As we look in terms of preparing

the first responder teams, including the VA, and I know we set up

some kind of a project where we are going to identify four sites in

the country for first responder teams, there is a real need for us

to look at some preventative types of things, that we might look at

that from the Department of Defense and the VA perspective in

terms of first responder teams that might help to look at identifying some of that.

I was just in Jerusalem, and I was surprised to see some of the

things they were doing in that area, and I am not sure where we

are at in terms of doing that to see how we—you know, not only

in terms of dealing with the ones we already have but possibly prevent future occurrences from occurring. That might be helpful, and

that would be good for the Department of Defense as well as the

VA.

Dr. MURPHY. Mr. Rodriguez, I think your point is very well

taken, and I can tell you that Secretary Embrey and I have actually already met about these issues both together and with the Department of HHS.

Mr. MORAN. Mr. Rodriguez, thank you. Your comments about

preventative or precautionary efforts are exactly on what we are

trying focus on as to what do we do to prevent those kinds of problems that we experienced in the past. So I appreciate those

comments.

Dr. Snyder.
38

Mr. SNYDER. Just one question for the record, Secretary Embrey,

that relates to what Mr. Filner asked before the break. Would you

provide information, please, on what the recordkeeping for vaccines

was during the Vietnam war and Gulf War? Specifically, was there

a notation made in the medical record, or was the only written

record the shot card that the person carried around during the Gulf

War? Was there an independent list made as the vaccines were

given in which they said here is a list of the ones that we gave this

day? And is there also good recordkeeping of the geographic location as well as the date at which the vaccine was given?

That is just a question for the record. Thank you.

Mr. MORAN. Thank you, Doctor.

Thank you, panelists, for your testimony this morning.

I do hope there is significant cooperation between your two departments and the Department of Health and Human Services. I

do think we have a lot to learn and a lot of progress that can be

made in protecting our future veterans. Thank you.

I anticipate that there will be follow-up questions as well that

can be answered in writing. Thank you.

Our next panel is Panel 3, and I call them to the table.

Dr. James Holsinger, he is the former VA Under Secretary of

Health; Dr. Enrique Mendez, former Assistant Secretary of Defense

for Health Affairs at the Department of Defense; Dr. Sue Bailey,

who is also former Assistant Secretary for Health at the Department of Defense; Dr. Ronald Blanck, the former Army Surgeon

General; and Dr. Garth Nicolson, the President at the Institute for

Molecular Medicine.

We welcome you to our committee. We will begin with Dr.

Holsinger.

General Blanck had to leave our committee. His statement will

be made part of the record.

[The statement of Dr. Blanck appears on p. 108.]

STATEMENTS OF HON. JAMES HOLSINGER, M.D., FORMER

UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS’ AFFAIRS; HON. ENRIQUE MENDEZ, M.D., FORMER ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS,

DEPARTMENT OF DEFENSE; HON. SUE BAILEY, D.O.,

FORMER ASSISTANT SECRETARY OF DEFENSE FOR HEALTH

AFFAIRS, DEPARTMENT OF DEFENSE; AND GARTH

NICOLSON, PH.D., PRESIDENT, INSTITUTE OF MOLECULAR

MEDICINE

Mr. MORAN. Dr. Holsinger, thank you very much for your participation today.

STATEMENT OF HON. JAMES HOLSINGER, M.D.

Dr. HOLSINGER. Mr. Chairman, it is a pleasure to be here, members of the committee. It has been almost a decade, about 8 and

a half years since I had the opportunity to appear before this subcommittee or a portion of the House Veterans’ Affairs Committee.

It is a pleasure to be back.

My understanding was that we were going to address today, at

least this panel, the lessons that we have learned from our experience during and following the Persian Gulf War.
39

From 1990 to 1993 I served as the Chief Medical Director and

Under Secretary for Health in the Department of Veterans’ Affairs.

In doing so, I was responsible for developing VA’s policies concerning the health care of Persian Gulf veterans returning to the

United States, leaving the military forces of the United States and

becoming veterans.

By 1991 I had served for over 20 years in the Department of Veterans’ Affairs. During most of this time the VA was under siege

concerning our response to the Agent Orange issues stemming from

the Vietnam war. Within a matter of months following the cessation of hostilities in the Persian Gulf, the health care concerns

of veterans of this conflict, which later became known as the Persian Gulf syndrome or Persian Gulf War illness, became evident.

My deeply felt concern at this time was that America’s veterans

of this conflict not be subjected to similar insensitivity that occurred following the Vietnam War. As a result, I issued instructions to all VA medical centers that veterans who complained of

health care problems which they believed stemmed from their service in the Gulf be treated for those conditions just as we were then

treating veterans of the Vietnam War who claimed exposure of

Agent Orange.

At the time that I issued this directive, the Department of Veterans’ Affairs did not have congressional authorization for this action. Following discussion within the Department, rather than

withdrawing the directive, the Department issued regulations supporting my action. We continued to develop the Persian Gulf registry for veterans of this conflict and developed three specialized

centers, VA medical centers, to diagnose and treat veteran patients

who could not be adequately diagnosed in the VA medical center

closest to their home.

Then chairman Sonny Montgomery understood the dilemma at

an early date, and he introduced H.R. 5864 in the 102nd Congress.

On September 16, 1992, he held hearings on the possible adverse

health effects of service in the Persian Gulf and on VA’s efforts to

establish a Persian Gulf registry for tracking the health care status

of these veterans.

Then Deputy Secretary Principi and I appeared before the committee representing the Department. The result of this hearing was

enactment of Public Law 102- 25, Title VII, the Persian Gulf War

Veterans’ Health Status Act of November 4, 1992.

As we testified on September 16, 1992, the Veterans Health Administration was poised to act immediately upon enactment of enabling legislation to issue a directive entitled the Environmental

Medicine Persian Gulf Program. I signed this directive just 1

month later on December 7, 1992. Throughout this period following

the end of the Persian Gulf War until this directive was issued, the

Veterans Health Administration was engaged in the treatment—

the treatment—of Persian Gulf War veterans with symptoms to be

later defined as Persian Gulf War syndrome.

As Mr. Principi testified on December 16, we acted, ‘‘immediately, using authority we now have, because we see an immediate

need. But we are also asking the Congress for additional

authority.’’
40

Mr. Montgomery commended the Department for, ‘‘getting ahead

of the curve on this issue.’’ I believe that it is important to recognize that the present Secretary of Veterans Affairs, Mr. Principi, served as Deputy Secretary

during our last conflict, and during the intervening period he

chaired the Principi Commission on Service Members and Veterans

Transitional Assistance. Clearly, the Nation is fortunate to have

Secretary Principi, a person who fully and completely understands

the health care issues that could arise from the war on terrorism.

In addition the President of the United States has indicated his

intent to nominate Dr. Robert H. Roswell for the position of Under

Secretary for Health. Dr. Roswell served with me following the Persian Gulf War as the Associate Chief Medical Director for Clinical

Programs. Dr. Roswell also clearly understands the potential issues

resulting from armed conflict.

But what lesson did we learn from this experience? I believe we

were hampered in our efforts to provide health care for Persian

Gulf War veterans by not having stand-by legislation available

when we needed it. What do I mean? While waiting for the full

support of the Congress, we had to spend months waiting to get

our expanded program initiated since enabling legislation was required. My one recommendation today is that this committee

should see that legislation is enacted that will establish stand-by

authority for the Secretary of Veterans Affairs to develop and implement the examination of veterans of the current as well as future conflicts who may have unusual symptoms or complaints, establish specialized treatment programs for these veterans, as well

as establish the appropriate registry for tracking purposes.

Based on our experience from the Vietnam War as well as from

the Persian Gulf War, it is clear that as a Nation we should expect

difficult health care issues to arise in relationship to future combat

situations. I believe that the veterans of the future wars deserve

to have expeditious care from the Department of Veterans’ Affairs

and that this can best be accomplished by providing the Secretary

of Veterans Affairs with authority to establish the appropriate program in a timely fashion as the need arises.

Mr. Chairman, I appreciate the opportunity of appearing before

you today.

Mr. MORAN. Thank you very much, Doctor.

[The prepared statement of Dr. Holsinger appears on p. 111.]

Mr. MORAN. Dr. Bailey, welcome.

STATEMENT OF HON. SUE BAILEY, D.O.

Dr. BAILEY. Thank you. Mr. Chairman, thank you for the opportunity to testify here today.

In my role as Assistant Secretary of Defense for Health Affairs,

I was responsible for the Military Health System and was the principal advisor to the Secretary of Defense on health issues, including

force health protection.

In deployments in the Gulf War as well as in Bosnia, Albania

and Kosovo, the government has gained great insight into the importance of deployment force health protection. Applications of

those lessons learned will necessarily include improvements in preand post-deployment health assessments, troop monitoring sys-
41

tems, medical record systems, environmental and biohazard assessments and medical surveillance overall.

Since returning from deployments to the Gulf, many veterans

have complained of a variety of symptoms that have come to be

known as the Gulf War syndrome. However, to date there has been

no scientific verification of a specific syndrome, but both the Department of Defense and the Department of Veterans’ Affairs have

provided comprehensive medical examinations and, most importantly, treatment for Gulf War veterans suffering any symptom or

illness.

There has also been extensive research conducted to determine

causes of physical symptoms as yet unexplained. An Interagency

Research Working Group continues to explore the potential health

effects of deployments, including long-term studies such as an evaluation of the health of service members during and after their military service.

At this time there is no clear evidence of any single environmental factor or health-related exposure that can explain the

symptoms and illnesses of these veterans. It is essential that there

be improved health surveillance and further research into the combined effects of multiple health-related exposures before and during

deployment.

Understanding the effects of deployment begin with baseline

health assessments prior to mobilization and continue indefinitely

during and following military service. Efforts to obtain these assessments, to access them in the field and record and monitor force

surveillance, short and long term, have been hampered by the lack

of an electronic health system. Without application of currently

available information system technology, it will continue to be difficult to provide for health intervention related to personal health

data or to apply epidemiological techniques that are so essential to

deployment force health protection.

Appropriate surveillance also depends upon accurate troop monitoring capability. During the Gulf War the location of units was

often well known, but the actual movement of individuals within

those units was not. Computer models that would have provided invaluable data about health-related exposures were dependent upon

accurate troop location information that was not always available.

Many service members experienced multiple health-related exposures that can only be fully documented in relationship to their location at any given time.

Mr. Chairman, thank you for the opportunity to testify, and I

would be happy to answer any questions.

Mr. MORAN. Madam Secretary, thank you for your time.

[The prepared statement of Dr. Bailey appears on p. 114.]

Mr. MORAN. Dr. Mendez.

STATEMENT OF HON. ENRIQUE MENDEZ, M.D.

Dr. MENDEZ. Mr. Chairman and members of the committee, I

thank you for the invitation to appear before you today.

I am Enrique Mendez, Jr., M.D., Major General, U.S. Army, retired. From 1990 to 1993 I served as Assistant Secretary of Defense

for Health Affairs in the Department of Defense.
42

I understand from your letter, Mr. Chairman, and a subsequent

conversation with a member of your staff that the purpose of this

hearing is to ascertain whether lessons learned from the Persian

Gulf War have been integrated in present day deployments, so my

opening remarks were prepared with that objective in mind.

Operation Desert Shield, in response to the Iraqi invasion of Kuwait, commenced in the same year that I became Assistant Secretary and was followed by Operation Desert Storm in early 1991.

The clarity of the recollections of the events of those days is affected, in my mind, by the passage of time, but it is also colored

by the development of actions that have taken place in subsequent

years. Nevertheless, I agree that the lessons learned in the past

are indeed important to the way you react and operate in the future and that examination of such lessons is certainly a worthwhile

endeavor.

The health-related lessons learned before, during and following

the Persian Gulf War can in my judgment be grouped into certain

broad categories:

• The need for improvement in the availability of data on individuals regarding pre-deployment health status, exposures during deployment and post-deployment health status.

• The need to improve the recording of medical information at all

levels and having ready access to that data. The availability of a

health record that includes deployment, immunization and exposure histories; a record that can transition seamlessly from the

Military Health System to the Veterans Health Administration.

• The need to communicate health information in a timely and

understandable manner to troops, commanders and other leaders,

medical personnel and other interested parties. This communication to be inclusive of possible hazards and risks as well as the why

of actions aimed at protecting the health of personnel and is to continue with relevant information after deployment.

• The need to improve the identification and evaluation of health

risks in a timely manner.

• The need for systematic assessment of symptoms that are not

readily explained or undiagnosed conditions, and the establishment

of epidemiological studies.

• The need to continue work in developing new vaccines, determining possible long-term effects of exposures and assessing the

interactions of multiple exposures.

Many of the concerns and the actions followed in those days, sir,

were triggered by the possibility of the use of chemical and biological weapons against our personnel. Recent events further strengthen the need to educate and train health professionals in the diagnosis and care of casualties resulting from the possible use of weapons of mass destruction. As a former medical school dean, I certainly support actions necessary for that to be implemented.

Mr. Chairman, I thank you again for the opportunity to appear

before you today.

Mr. MORAN. Thank you very much.

[The prepared statement of Dr. Mendez appears on p. 117.]

Mr. MORAN. Dr. Nicolson.
43

STATEMENT OF GARTH NICHOLSON, PH.D.

Mr. NICOLSON. I am Professor Garth Nicolson from the Institute

for Molecular Medicine in Huntington Beach, and I guess I represent private researchers involved in studies on Gulf War

Illnesses.

I did deliver written testimony to this committee. Somehow it

ended up in a building in Virginia, and didn’t quite get over into

the committee, but it can be downloaded from our website as well

as the publications that I would like to discuss today on ALS and

the Gulf War family study.

We believe that there were multiple toxic insults, including

chemical, biological and, in a few cases, radiological exposures during the Gulf War that led to chronic illnesses with relatively nonspecific signs and symptoms. We don’t think there is a separate

Gulf War Syndrome. We think these illnesses can be explained, as

we published more than 6 years ago, by calling them chronic fatigue syndrome or fibromyalgia syndrome; and I am delighted to

see that the various agencies involved in studying this have accepted those two diagnoses for Gulf War victims.

I want to focus today on biological exposures because I feel that

these were very important in a subset of Gulf War veterans; and,

in particular, we are very interested in some of the autoimmune

disease that may have resulted from these exposures.

In studies of over 1,500 United States and British veterans with

Gulf War illness it has now been found not only by our laboratory

but by the University of Texas at San Antonio and two other commercial laboratories that approximately 40 to 50 percent of these

Gulf War illness patients have an invasive bacterial infection called

mycoplasma, and this is compared to probably 6 percent in the

unvaccinated, nondeployed population. This has been confirmed in

a large VA trial called the VA Cooperative Clinical Program No.

475. Those studies were conducted at the University of Texas

Health Science Center at San Antonio, and again they found 40

percent of the Gulf War veterans from 30 VA hospitals around the

country showed evidence of this mycoplasmal infection.

What we found in the Gulf War veterans that really distinguishes them from civilian illnesses, chronic fatigue syndrome and

fibromyalgia syndrome, was the presence of a particular species of

mycoplasma called Mycoplasma fermentans. More than 80 percent

of the Gulf War veterans who were positive for this type of infection had had only this one species, but that is not what we see in

civilians, although 60 to 70 percent of civilians with chronic fatigue

syndrome have a similar infection. We see a variety of different

species of mycoplasma in those civilians. So we think there was

something unique about the exposures during the Gulf War.

Similarly, in studies that we were involved with in Europe, we

found the same situation, more than 60 percent of European chronic fatigue syndrome patients also showed evidence of this infection,

but most of those patients have another species, Mycoplasma

hominis. So there is something unique about the Gulf War.

We started studying family members who came down symptomatic after the Gulf War, and we have a publication that is in

press in the Journal of Chronic Fatigue Syndrome where we have

studied family members. These family members were chosen from
44

the 40 percent of the Gulf War veterans who were positive for

mycoplasmal infections.

We examined military families or 149 patients, which included

42 veterans, 40 spouses, 32 other relatives and 35 children, with

at least one family member complaining of illness, selected from a

group of 110 veterans with Gulf War illnesses. In 107 family members, there were 57 patients, or 53 percent, that had essentially the

same signs and symptoms as the veterans and were diagnosed with

either chronic fatigue syndrome or fibromyalgia syndrome. Most of

these patients, or 72 percent, had the same specie of infection that

we found in the Gulf War veterans.

So they didn’t look like the civilians with chronic fatigue syndrome that have a variety of different species of mycoplasmal infections. The family members had the same infection that we found

in the Gulf War veterans, and there was a significant difference between not only healthy members and sick members in these families studies but even within individual families there was a significant difference between the patients that showed no symptoms and

the presence of this infection and the patients that showed symptoms who had this infection.

Again, that is in press in the Journal of Chronic of Fatigue Syndrome. It can be downloaded from our website.

Next I would like to talk about ALS or Lou Gehrig’s disease, and

I am sorry that the congressman had to leave who was interested

in what may have happened at Kelley Air Force Base. We are not

only interested in what happened at Kelley Air Force Base but also

at a number of other bases around the country where there are unusual instances of Lou Gehrig’s disease or ALS. I don’t think there

has been an adequate study of this topic.

We have been studying ALS in Gulf War veterans, both British

and U.S. Veterans and a few minor number of Australian veterans,

to see if they have the same types of infections that we found in

40 percent of the veterans with Gulf War Illness. Only in the case

of the Gulf War veterans with ALS, we found 100 percent of those

veterans had the same infection (Mycoplasma fermentans) with

only one exception, one Australian veteran who had an infection

with Mycoplasma genitalium, a very similar type of infection but

not the same as Mycoplasma fermentans.

ALS is a very serious, uniformly lethal disease. It is a complicated disease. It has a genetic element, and we don’t understand

all the aspects of this, but we feel that mycoplasmal infections are

one of the important elements in ALS. Because even in the civilian

population that has ALS, we find that 85 percent of those patients

have the same class of infection. Although in civilians not all of

them have Mycoplasma fermentans, they have many other mycoplasma species. But again in the Gulf War veterans almost all ALS

patients have Mycoplasma fermentans.

My last comments are directed at the vaccines. Because there is

a strong association between Gulf War illnesses and the multiple

vaccines that were administered to British and U.S. Veterans, and

there are a number of studies now in the medical literature on

topic.

I will just mention one, conducted by Dr. Lea Steele from Kansas, who examined Gulf War illnesses in nondeployed veterans
45

from Kansas who had been vaccinated in preparation for deployment and compared these to nondeployed veterans who were not

vaccinated, and they found higher evidence of the symptoms that

very much looked like Gulf War illness.

They also did another study where they examined deployed Kansas veterans, and they found a much higher rate of chronic illnesses in those deployed veterans compared to nondeployed veterans, and this has also been found in VA studies and other studies

that have been conducted.

We think that the multiple vaccines, at least some of them, the

experimental vaccines, may have contributed to this problem. The

reason for this really comes from a publication in the Journal of

Vaccine where 6 percent of commercial vaccines were found to be

contaminated with mycoplasmas. So this is a commonly found contamination in vaccines.

Why did it show up in the Gulf War? Well, we think because

they received multiple vaccines all at once, within a few days,

sometimes as many as 20 or 25 different vaccinations, and this

could have immune suppressed them; and it is very well known

that multiple vaccines can cause immune suppression.

In addition, the chemicals they were exposed to in the Gulf could

also have contributed to immune depression, and even minor contaminants in a vaccine that might not affect a healthy person

under those circumstances could hurt them.

Now, I have gone over my time, so I will be glad to answer any

other questions about the possible origin and why we feel that the

Department of Defense and Department of Veterans’ Affairs has

not been completely candid about this subject.

Part of it goes back to a U.S. Patent which was given to an Army

pathologist, Shyh-Ching Lo, and the title of that patent is ‘‘Pathogenic Mycoplasma,’’ and it is the patent for Mycoplasma

fermentans. So essentially the same infection that we found is a

U.S. Army patented infection. The question is, how did it end up

in our Armed Forces?

For years at the USUHS, or Uniformed Services University of

Health Sciences, people who were preparing in medical school to

practice in the military were taught that these infections were

very, very dangerous. Contrary to what Dr. Steven Josephs and

others have testified to Congress and sent information to Congress

stating that these infections were not pathogenic, that these infections were not causing disease and were not a problem, actually

medical students at USUHS were taught completely opposite of

those misleading statements.

Also, the word coming from the Armed Forces Institute of Pathology where these infections have been shown to be lethal in man

and in nonhuman primates was completely contrary to testimony

of officials from the Department of Defense.

So I will be glad to discuss that.

Also, in my testimony in 1998 to this committee I listed four or

five different things that I felt should happened, and I would love

to give a rundown on if those have ever happened or not. Thank

you.

[The prepared statement of Mr. Nicholson appears on p. 119.]
46

Mr. MORAN. Dr. Nicolson, one of the questions that I have tried

to pose and will pose in writing to the Department of Defense is

what were the protocols during the Persian Gulf War for deployment related to vaccinations and immunizations and what are they

today in the deployment during Enduring Freedom and are we

doing something different today than we were then or are we simply replicating past vaccination immunization procedures.

And, Dr. Bailey and Dr. Mendez, if you would be so presumptuous as to advise those who currently occupy the positions you

previously held, what in short summary would you suggest to your

counterparts today that they should be doing in regard to preventative measures in regard to this deployment?

Dr. BAILEY. Well, I, first, would like to commend someone who

was part of the war in Kosovo, General Wesley Clark, who allowed

me and my team in both predeployment into Albania and then into

Kosovo. And I say that because it is by way of saying we were very

intent upon not repeating any errors that may have been made or

any of the protocol that may have been less than perfect in terms

of medical surveillance, for instance.

General Clark, by allowing us in, it meant that we had our occupational and environmental specialists there on the ground immediately in Albania, weeks before the entry into Kosovo. I was there

and stood on the tarmac as they prepared those forces, and we

looked at everything from the pesticides being used, the way they

were being used, whether they were recorded or not, whether, for

instance, on the tarmac they would in the Gulf and in other wars

try to keep the dust down because we know that particulate matter

can be very dangerous, but in doing so they had used an oil-like

substance which we felt also could be an environmental hazard in

the Gulf War. So we were able to inquire and affect the way in

which we controlled the dust there. In fact, they were using water

but adding a surfactant which dealt with the surface tension and

theoretically would have been better than just water.

So it is those kinds of specifics that were looked at because General Clark and others as part of the Armed Forces and at the Department of Defense are concerned about medical surveillance and

environmental protection, that we changed those kinds of elements

and made sure we were not only affecting a healthier environment

for troops but also recording them. So there have been things specifically that were done.

I would also add that it is essential that we do appropriate medical surveillance not only of the health status of those coming into

a deployment during and after but also because we need to know

if in fact there has been, for instance, a biologic attack. As you

know, our ability to provide detection is still at this time relatively

limited, and therefore we need to know in theatre if in fact there

are illnesses which are not at the average adnoviruses or viruses

that may be striking but in fact we have been attacked days before.

So real-time medical surveillance is essential and was going on

in those deployments and in Bosnia as well where I also saw decontamination sites that we were able to identify as absolutely necessary at our field hospitals and at the hospitals there in Bosnia.

So I would say that much has already been done and more needs

to be done to be certain that we are doing a better job of recording
47

what is going on, effecting it at the time, and it is so essential that

we also record it.

Dr. MENDEZ. To continue with the thought on surveillance, I suggest that the material that is gathered from information on individuals, has to dovetail with other materials in the clinical record of

the patient so that eventually we have the totality of the picture

of that individual in order to ascertain something that has indeed

bothered the committee, namely the matter of exposure; the when,

where and so on of that exposure. Further, within the research

that goes on in the Department, particular attention should be paid

to the matter of multiple exposures.

As it has been alluded to here today—by multiple exposures I am

talking not only about exposure to toxic substances but also exposure to substances that are used for certain preventions, such as

pesticides, vaccines and so on, so that you can make correlations

in terms of symptomatic expressions and the matter of multiple

exposures.

I believe it is important in the whole matter of surveillance to

educate; to educate not only the soldier, but also to educate ourselves, the physicians and the rest of the medical personnel. We

have had particular orientation to casualties; the care of that casualty, the evacuation of that casualty, the stabilization and so on— and that is indeed good, but I am talking about the need for balance between that orientation and what we have discussed here

about preventive medicine, risk communications and the maintenance of health. I think all of these are pieces of force health protection, and their integration is a necessity if these programs are

really going to be productive.

That is all for now, sir.

Mr. MORAN. Thank you very much. Dr. Filner.

Mr. FILNER. Dr. Mendez, Dr. Bailey, did you hear the information I asked for from Ms. Embrey about the vaccination records?

Are those available and can they be provided, from your

experience?

Dr. BAILEY. One of the problems we had following the Gulf War

was obtaining that kind of data. I have personally stood in warehouses and looked through boxes, looked for red crosses on boxes,

looking—— Mr. FILNER. So it is not as easy as she suggested?

Dr. BAILEY. We had to go through military logs to see if we could

find information that would have——

Mr. FILNER. The reason I am asking, if Dr. Nicolson is correct

that the infection might have been carried within these vaccines,

wouldn’t it be important to figure out if that was correct?

Dr. BAILEY. I think we are in a new generation of force health

protection today, and it is a new generation. We have turned a corner here that has not been turned probably since the Civil War. I

think medical records have been kept, as I used to say, in a stubby

pencil way since that time and since the Middle Ages—— Mr. FILNER. We have requested this kind of information, and we

have never been able to get it. I requested it again, and Ms.

Embrey said she is going to get it for me. I hope we get it.

Did Dr. Nicolson have published papers and theories or grant requests when you two were involved?
48

Dr. BAILEY. Let me back up and answer your question. The answer is an electronic medical system that needs to be paid for, appropriated, and installed. That would solve the problem. So we

would have the appropriate records.

Dr. MENDEZ. In my case, Dr. Nicolson published after I had left.

I just checked with him as to the timing.

Mr. FILNER. I have read some of your work, Dr. Nicolson, and

you didn’t go through it today, you didn’t have time, but you also

have a protocol of treatment based on your theory of what has gone

on and, as I understand it, those treatments have been very

effective.

Mr. NICOLSON. Yes. In fact, several people from your district

have been successfully treated.

Mr. FILNER. I saw a couple who were dying literally and were

going through the treatment that Dr. Nicolson prescribed and are

now fully functional. He has described that in thousands of cases,

if I am not mistaken, but you can correct me if I am wrong.

Mr. NICOLSON. I don’t think it is thousands, because we don’t

have the resources to study thousands, but we certainly have published in small sets of patients the results, and those results were

finally taken very seriously by the VA. They went over our data

and also data from some VA physicians in certain VA hospitals

that had embraced our ideas and were treating patients and getting successes like Dr. Victor Gordon who has hundreds of patients

whom he had successfully treated using our protocols.

This formed the basis of Cooperative Clinical Program Number

475, which was a very simple treatment program, doxycycline, 200

milligrams per day, versus placebo in a blinded study for 12

months, and that trial has been completed although we haven’t

seen the results yet but I am not confident of the VA’s ability to

conduct this trial.

Mr. FILNER. So your treatment is being taken seriously. I know

that for many years it was not.

Mr. NICOLSON. Correct.

Mr. FILNER. I mean, there was this refusal to even look at your

theories or your treatment.

Mr. NICOLSON. We were actually ridiculed. We know that. So it

has been a long, difficult struggle for us, but we started in this as

a family situation because our daughter served in the Gulf War in

the 101st Airborne Division as a crew chief in the Black Hawk helicopter and came back from the deep insertions into Iraq and slowly

came down with these nonspecific signs and symptoms while at

Fort Campbell training to be a pilot and she couldn’t ever complete

her pilot training because of these illnesses.

Mr. FILNER. You have the credentials of an established researcher and teacher and clinician, and they had nothing successful, and yet they refused to look at your stuff. I just could never

understand that, and it leads to my skepticism when I hear some

of the earlier testimony.

I mean, you may be wrong, but you at least thought you had

proved an effective treatment. It would seem to me that the established authorities ought to have grabbed it and studied it and

jumped on it.
49

In my view they may have been using the mycoplasma to develop

an antibacterial warfare vaccine, and it got introduced into the vaccines that were being given, and so, as I just said earlier, friendly

fire may have caused all of this, and that would explain why there

would be resistance to looking at the truth.

I don’t know if my conclusions come from your work, but it is a

possibility, as I understand it, and we ought to trace it down. National security involves the truth here as far as I am concerned.

Mr. NICOLSON. Congressman Filner, as you know, this has been

a long struggle for us, and it doesn’t explain all the Gulf War illness, and this is one thing we have been criticized for. We only find

this in a subset of patients, but these were patients, by and large,

that were exposed to a lot of toxic materials and this being one element of that toxic exposure that we think can explain illness in a

subset of patients, particularly the patients who spread their illnesses to immediate family members. This we found often, and I

just could not believe the denial that has been going on for years

that these illnesses couldn’t be passed to family members. Because

we found the same signs and symptoms, the same infection in family members, and they responded the same way to our therapeutic

protocol. These are spouses, children, and other family members.

So this is what I couldn’t believe, their absolute denial that something like this could be transmitted.

It is even worse than that because we are now afraid that our

blood supply might be at risk. There is a study that will be published soon in the Journal of Chronic Fatigue Syndrome—I am an

associate editor of that journal, so I know this publication will be

coming out soon—that shows that 6.4 percent of Belgium chronic

fatigue syndrome patients came down with this condition after a

blood transfusion. I am sure this is a problem because there is a

certain percentage of carriers among apparently healthy people. We

have been very interested in that.

The one thing that characterizes a carrier, that is, a person that

might have the infection but be nonsymptomatic, is the fact that

we can’t detect other additional infections in carriers, but when we

start to look at symptomatic patients, for example, with chronic fatigue syndrome, we almost always find multiple viral and bacterial

infections. It could be if you have one infection you might be able

to withstand that, but if you are exposed to chemicals, other infectious agents or other toxic materials you may succumb to that type

of infection. If it compromises your immune system, you may succumb to that type of infection.

Mr. FILNER. My time is up, but can you give us those five things

again that you recommended back in 1998? We will submit that to

those agencies to see if they have done any of them.

Mr. NICOLSON. There were five items that I listed at the end of

my testimony to this committee in 1998, and I wanted to see if any

of these have been addressed in the intervening period of time.

The first one was that we must correct the notion that immediate

family members cannot contract illnesses from veterans with Gulf

War illness. Denial that this has occurred has only created a serious public health problem, including the spread of illnesses to the

civilian population and potential contamination of our blood supply.

I have to remind the committee that much of the blood that is put
50

into the national blood supply comes from the military. There was

a hold immediately after the Gulf War on donations from military

personnel if they had served in the Gulf, but as far as I know that

was removed within 6 months or less than a year, and it has returned back to the normal situation. So here we have a situation

where these contaminants could be introduced into the blood

supply.

I mentioned the European study on this. We should institute immediately a study in the United States similar to this European

study that showed that chronic fatigue syndrome can result from

a blood transfusion.

The second item was I was critical of was the diagnostic system

used by the Department of Defense and Veterans’ Affairs to determine an illness diagnosis, and I suggested that that be replaced by

an international system called the ICD–10 system of diagnosis.

There is a category for chronic fatigue syndrome, the so-called

G93.3 category, that can be used to diagnose chronic fatigue

syndrome.

Well, this is one item that I think has been changed recently.

They now are accepting the diagnosis of fibromyalgia syndrome

and chronic fatigue syndrome, first described and published by us

as a way to describe the condition of Gulf War illness within the

VA system. So I think that this is a step in the right direction.

The third item was denying claims and benefits by assigning

only partial disabilities due to post-traumatic stress disorder

should not be continued. At the time, patients were being rushed

into a diagnosis of post-traumatic stress disorder without careful

consideration that other exposures could lead to other illnesses besides this one. We had complaint after complaint after complaint,

year after year after year of active duty Armed Forces personnel

and retired Armed Forces personnel being given a diagnosis of this.

Now, I would hope this has been changed recently.

Number four was research efforts must be increased in the area

of chronic illness. Unfortunately, Federal funding for such illness

has often been rebudgeted or the funds often removed.

The classic case that I used in 1998 was Dr. William Reeves of

the CDC in Atlanta who sought protection under the Federal Whistle-Blowers Act after he exposed misappropriation of funds allocated to work on chronic fatigue syndrome at the CDC. Essentially,

those funds disappeared or were reallocated.

It is estimated that approximately 3 percent of the adult U.S.

Population suffers from chronic fatigue syndrome or fibromyalgia

syndrome. So I think this is a very important illness category, and

Congress recognized this, and Congress appropriated funds, but

somehow those funds never quite made it to the researchers like

ourselves that were trying to study this process.

Finally, the last item which you have been touching upon is that

past and present senior Department of Defense and VA administrative personnel must be held accountable for the entire Gulf War illness mess that we found ourselves in after the war and persists up

until this day. And the reason for this is that there will be future

deployments. We will be going to war again, and just as we have

seen now, we will have to straighten this out so that history doesn’t

repeat itself. We have seen that there are illnesses associated with
51

deployment in Bosnia, and I am sure we may see this again. So we

have to make sure, absolutely sure, that we solve this problem of

what happened during the Gulf War to prevent future occurrences

of just the same kind of problem that we faced and failed to correct

for over a decade.

Mr. MORAN. Thank you, Doctor. Dr. Snyder.

Mr. SNYDER. Dr. Holsinger, I don’t understand your comments

about enabling legislation, when you were in the Department that

you had to wait months before you could institute treatment programs for enabling legislation. Why can’t the Secretary just say,

well—obviously, clinicians are going to be treating them. They are

going to see patients. You don’t have authority to set up some kind

of a registry. I don’t understand.

Dr. HOLSINGER. I will be happy to explain that. Part of the problem we historically had going through the Agent Orange issue was

the need to have legislation that would allow us to treat individuals who were nonservice-connected for Agent Orange exposure.

When we came out of the Persian Gulf War, when we first began

hearing about the Persian Gulf War illness, or syndrome as it was

called at that time, we had no legislative authority. I issued a

memorandum of——

Mr. SNYDER. No legislative authority to see veterans who did not

have service connection who were not otherwise eligible for VA

health care?

Dr. HOLSINGER. Correct. So what I did was to direct that we

would treat anyone claiming Persian Gulf syndrome the same way

we treated individuals who claimed exposure to Agent Orange but

who had no—there was no direct cause and effect connection at

that point in time. So we had no disease entity for which we were

authorized to treat an individual as an outpatient, for example.

Mr. SNYDER. So you are suggesting that there ought to be legislation authorizing the Secretary of Veterans Affairs through some

kind of public notification to say——

Dr. HOLSINGER. I think he should have standby authority when

this occurs in the future to be able to act.

Mr. SNYDER. Would it be kind of like a temporary service connection or——

Dr. HOLSINGER. It doesn’t have to be service connected. It simply

has to be that he has the authority to treat such an individual who

claims this type of exposure within the treatment system. What we

moved to do was to try to get around this problem, and I take a

certain amount of umbrage with my colleague on the far left who

indicated we didn’t do anything when in fact we did. I spent 15

years of my career in the VA wrapped around the Agent Orange

axle. I put out the directive that we would take care of these veterans early in the game when we first heard about this because I

didn’t want to have another agent hung around our neck for the

next 15 years. I found out the next day that the Deputy General

Counsel of the VA was sitting in the Secretary’s office demanding

that I retract the directive because I did not have legislative authority to issue it. My point was there was no law that said I

couldn’t, and since there was no law that said I could, why couldn’t

we? The answer was, well, because the law doesn’t work that way.
52

I am not a lawyer. I am just a dumb physician. I think you take

care of patients. And the issue was that the law works by having

legislation enacted that authorizes you to do things. I didn’t have

such a law. So we finally resolved the issue in the Secretary’s office

by the Secretary recommending that we write a rule since there

was no law either way, and we operated under a rule for months.

It just so happened that prior to the time I went to see the Secretary, I had a phone call from Congressman Sonny Montgomery,

who was chair of this committee at the time, who was home in

Jackson, and he said, ‘‘Jim, that was one of the smartest things

you’ve ever done.’’ he said, ‘‘I am pleased with what you did.’’ That

is why in our hearing later he said we were ahead in this game.

Because we were, we were treating the patients from the very beginning in the VA. But he said if you need a law, I will get it for

you, and it was on that basis that we ended up with the hearings

and we got legislation and were prepared to move immediately to

handle it. But if we had standby legislation for the Secretary to be

able to issue those kinds of rules immediately upon understanding

that there is an issue out there, you could move very quickly to

move such veterans into the treatment queue and not have issues

of the Inspector General telling you that you were erroneously

treating veterans and wasting the taxpayers’ money, which happened to me multiple times when I was in VA.

Mr. SNYDER. Thank you. Dr. Nicolson, correct me if I am wrong,

do I hear you say that you are now satisfied that there isn’t now

an ongoing trial with sufficient numbers to test your protocols?

Mr. NICOLSON. Yes.

Mr. SNYDER. That was funded through the VA?

Mr. NICOLSON. As a joint DOD-VA clinical trial.

Mr. SNYDER. I got the impression that when you said you were

ridiculed that implies you had applied for Federal funding in the

past for your research. What was the earliest time that you applied

for funding from some Federal body?

Mr. NICOLSON. I believe that my first application was in 1995

and again in early 1996.

Mr. SNYDER. And just my last question. You don’t have to go into

any detail about this. Do you have any reason to think that anyone

who is evaluating your applications has some kind of a conflict of

interest?

Mr. NICOLSON. I don’t know if that is the case or not. I do know

that the funding line was drawn precisely above my application,

and this happened more than once. In fact, it was the subject of

a GAO investigation to see if there was anything that they could

find that was not correct or inappropriate about the review process,

and I don’t think they were able to get the information that they

needed to come to a conclusion.

Mr. SNYDER. You haven’t reached any conclusion in that regard?

Mr. NICOLSON. I have my own personal conclusions. I think it

was stonewalled. I think there were just too many things in what

we were studying that pointed back to the Department of Defense.

Mr. SNYDER. That is a different answer. The question I asked

was do you think that anyone who reviewed your application had

a conflict of interest?
53

Mr. NICOLSON. I don’t know. It is not just the scientific review

process but also the process of administrative review after peer-review that can adversely affect a grant’s priority score. This may

have resulted in the over abundance of grants awarded for psychiatric studies on Gulf War veterans.

Mr. SNYDER. Thank you for your time.

Mr. MORAN. Secretaries, thank you for joining us, thank you for

your past service to our country and your testimony today and, Dr.

Nicolson, thank you for your interest in this topic. We may have

some follow-up questions for you all as well.

Our final panel, if they would join us. Steve Robinson, the Executive Director of the National Gulf War Resource Center; Patrick

Eddington, Associate Director of Government Relations for the

Vietnam Veterans of America; and Paul Hayden, Associate Director

for Legislation for Veterans of Foreign Wars.

STATEMENTS OF STEVE ROBINSON, EXECUTIVE DIRECTOR,

NATIONAL GULF WAR RESOURCE CENTER, INC.; PATRICK G.

EDDINGTON, ASSOCIATE DIRECTOR OF GOVERNMENT RELATIONS, VIETNAM VETERANS OF AMERICA; AND PAUL HAYDEN, ASSOCIATE DIRECTOR OF LEGISLATION, VETERANS OF

FOREIGN WARS

Mr. MORAN. Mr. Robinson, if you would start out off this panel,

I would appreciate it.

STATEMENT OF STEVE ROBINSON

Mr. ROBINSON. Thank you. I would like to start out by thanking

the chairman and the members for this opportunity. So often we

don’t get to hear the voices of the veteran advocate on this issue,

and it is very pleasing to be here.

I am going to try not to read directly from my testimony but talk

to you. I want to throw out a word, spin, and I have heard two different statements from two different experts on the DOD and VA

side. Both of them say—and they always say this. They will say

there is a specific cause, they cannot say a specific cause linked to

a specific disease, and the other statement I heard was at this time

there is no single cause for what we call Gulf War illnesses. That

is spin. Let me tell you why. We will never find a single cause for

Gulf War illnesses. It is a multitude of things. It is going to be

more than one single factor that is figured out. There are many researchers that are doing independent work that are on track. Now

I will step into a little bit of my statement.

More than a decade ago U.S. Forces were deployed to fight a war

that would be won in a matter of hours rather than years, and the

speed of battle and the technology that was deployed ensured our

success as we achieved our objectives. Generals were lauded as heroes and soldiers returned home to parades and fanfare. Many soldiers left the military immediately and others continued to serve.

Not long after the Gulf War ended, veterans believed they were ill

as a result of their service in the Gulf War. The President of the

United States and the Department of Defense made a critical decision at this moment in time that I believe will be soon the most

studied and dissected decision of my generation. The leadership of

our Government had to choose what to do, to tell the truth about
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the events that occurred to Gulf War veterans or to begin a long

protracted public affairs campaign designed to delay the truth, control the story, and to fund the coffers of Beltway contractors.

You have heard it here today, ‘‘It is all in your head.’’ The lessons

learned from the Gulf War today are still it is all in your head. To

understand what we have learned we first have to understand

what we believed prior to the Gulf War, troops, equipment and intelligence. What we believed then, we believed we were the best

trained, best equipped army in the world and that we should expect 60 percent casualties when we went into the breach. That is

what they were told. The Iraqi army was the third largest army

in the world. That is what we believed. What we know now, our

leaders were given overstated intelligence assessment about the

Iraqi army and the threat. We went to war with defective chemical

suits. Chemical and biological agent alarms were purchased and

sent to the field even though it was known in 1988 that they did

not work. The fox vehicles capabilities were not fully understood

before the deployment and Khamisiyah was a known chemical

weapons storage facility prior to the Gulf War.

That is what we know. Under biological weapons and our preparedness, what we believed then: Anthrax, botulism and other

weapons of mass destruction will be used offensively against you,

us. Therefore we should inoculate our forces to protect them and

we are not going to tell our soldiers about what shots they are getting. We are going to violate all standing policy on the use of investigational new drugs because here at the DOD we know what is

best for soldiers.

What we know now: It is not rational to inoculate for every perceived threat or strain of biological agent or chemical weapon. Usually inoculations occur when you intend to use a weapon offensively

because it is almost certain that some of it will come back onto

your own forces. The decision to give the U.S. Forces the anthrax

vaccine made no sense. The vaccine was only approved for cutaneous anthrax and is still not FDA approved for inhalational anthrax

use.

This experiment continues today on postal workers who must

waive their rights should they need to sue someone if they have a

severe systemic reaction to this vaccine. We know that the Department of Defense is so far into bed with Bioport it doesn’t matter

how many times Bioport deceives the Nation, fails inspection and

harms soldiers. DOD will be there for the former Joint Chiefs of

Staff and its foreign-owned company.

We also know that pyridostigmine bromide as a pretreatment for

Sarin exposure was also an experiment. Conventional wisdom says

you don’t give healthy people a drug designed for sick people. That

is just my common sense analogy.

These and other decisions are what I would like to call the Black

Beret factor. The Black Beret, you know, was a big stink. I am an

Army Ranger. The Black Beret factor is the suspension of common

sense, regardless of all conventional wisdom, and the implementation of policy even though it is in violation of standing law or directly harms the end user.

Under research, investigations, and turning stones, what we believed then: We believed DOD would look into what happened to
55

Gulf War veterans and provide accurate reports that were sound

in methodology and investigational practices. We believed DOD

would fund studies and research that would seek to find answers,

and we believed they would be forthcoming in revealing any intelligence that would unravel the mystery of Gulf War illnesses. We

believed that no stone would be left unturned. We believed that the

mistakes made during the Gulf War would result in lessons

learned that would be implemented to protect soldiers in future

conflicts to come.

What we know now: DOD’s investigational methodology is suspect and it leans away from the veteran. In doing so, the veteran

has suffered for the last 10 years, waiting to be recognized and

compensated fairly for their injuries. We know that the vast majority of research conducted was funneled to Beltway contractors who

realized the gravy train the investigation would produce. We know

that independent research was crushed, stalled, demonized, and

ridiculed by the Office of the Special Assistant for Gulf War Illnesses. We know that DOD has not been forthcoming in revealing

the important intelligence matters of the Gulf War as they begin

to conclude the Gulf War investigation.

There are several areas of intelligence and investigation they

have eventually ignored, and we know they did not turn every

stone. They turned selected stones. We also know that DOD is not

implementing the lessons learned from the Gulf War that were

passed into law, and this blatant disregard for their own policy

right now endangers soldiers who are called to deploy into hazardous areas around world where chemical and biological agents may

be used in a time of war.

We know that the truth will come out. It always does and the

recent events of terrorism that have catapulted us into this new

world is a place where truth is the most important public affairs

tool available.

America is stronger than most people understand. We can withstand looking at our mistakes and learn from them. For Vietnam

veterans it has taken 30 years. For Gulf War veterans we are at

10 years and counting. The charge I would like to leave with the

committee today is please invest in the truth today so we can protect the soldier of tomorrow.

Thank you.

[The prepared statement of Mr. Robinson appears on p. 130.]

Mr. MORAN. Thank you. Thank you very much, Mr. Robinson.

Mr. Eddington.

STATEMENT OF PATRICK G. EDDINGTON

Mr. EDDINGTON. Mr. Chairman, members of the committee,

thank you very much for providing Vietnam Veterans of America

the opportunity to be here today to provide our views on lessons

learned or lessons unlearned from the Gulf War as they may be.

I have a statement for the record, Mr. Chairman, and I would ask

that it be included without objection.

Mr. MORAN. So ordered.

[The prepared statement of Mr. Eddington, with attachment, appears on p. 135.]
56

Mr. EDDINGTON. Thank you. It would be difficult for me to top

what Senator Riegle said during his presentation. I am biased. My

wife worked for Senator Riegle during the Gulf War illness investigation in 1994. So I will confess to that, but I want to present

this subcommittee with some evidence that the problems that Senator Riegle described as being exigent in 1993 and 1994 are still

with us today.

Let me briefly start with the DOD side of the House. We have

had testimony today from numerous witnesses from the Defense

Department indicating that things have changed, that they are

doing a better job of keeping track of deployment-related medical

issues and concerns, and I think that DOD’s own pre and post deployment health forms really put the lie to that notion, Mr. Chairman. I have here DD Form 2795, which is the official

predeployment health assessment form used by the Department of

Defense, and what is fascinating about this form is what it doesn’t

ask. There is no space on this form whatsoever for mandatory vaccinations such as the anthrax vaccine. There is nothing on here

about that whatsoever, and that is significant for a number of

reasons.

In 1998, the National Defense Authorization Act explicitly required the Defense Department to do pre and post deployment

health examinations, full-blown physicals, to include blood draws

on anybody who is going to be deployed outside the United States

in a combat theater of operations. Based on conversations that I

have had with Steve Robinson and some of the data that that we

have been digging up at VVA and talking to veterans or family

members thereof who have been deployed, it is not happening. The

blood draws are not taking place, and that is absolutely vital when

we talk about these vaccines because if we go down the road and

we ultimately find that some of these vaccines are responsible for

causing illness and that data is not properly entered into the medical record of the veteran right up front, trying to establish service

connection for that down the road becomes virtually impossible.

That is one of the massive lessons learned from that, from the

entire Gulf War experience, and that simply is not happening. You

can take a look at any of these forms, and I will be happy to provide copies to your committee for your complete review, but what

is really damming as far as we are concerned is that they do a better job of keeping track of the vaccinations for service dogs than

they do for the veterans themselves. We have got rabies, distemper,

hepatitis and leptospirosis. On this form they are covering all their

bases there, but when it comes to the veteran, his or herself, it simply is not happening.

That is just one example. There are many, many others. Some

of my colleagues will undoubtedly talk about the government Computer-based Record Initiative that DOD and VA have had in place

for years, which has gone nowhere in terms of trying to create a

unified medical record that would be with the service member

throughout his or her entire life, to include their time as a veteran.

That is an area that still needs a lot of work. But I want to touch

briefly on some of these other issues that have been brought up as

they affect the VA.
57

In her written statement Dr. Murphy alluded to these little

green and white cards, these health risk assessment cards, military

service history cards that are being produced by the VA’s Office of

Academic Affairs. This is a wonderful product. We love these

things. The problem is they are not getting out into the VA system

as a general rule. They are simply not making their way out. We

know this because when we go to medical conferences sponsored by

the VA we have an annoying tendency to take these things with

us and ask the VA personnel from across the country have you

seen any one of these? And we usually get blank looks.

So we commend the VA for trying to do something about the

problem, but there is no fundamental management follow-through.

We would suggest that you need to have a directive essentially

issued by the VHA to make sure these are in use by every clinician

and every medical provider throughout the entire VA medical

system.

That gets back to this whole concept of what Dr. Garthwaite, the

former Under Secretary for Health at the VA, described at the Veterans Health Initiative. It is a great vision. It is a wonderful vision.

It puts this kind of thing at the core of what the VA is supposed

to be doing. The problem that we have found is that there is no

genuine implementation. It is simply not happening across the system, and in fact from our standpoint, as we made clear in our written statement, which I won’t rehash here, we think there is some

fundamental resistance within the Veterans Health Administration, their senior leadership, in making this an absolute maximum

priority, and for Vietnam Veterans of America we have encountered this with the latest chemical exposure controversy to affect

American veterans, and that is the Shipboard Hazard and Defense

Program, which was the DOD chemical and biological warfare testing program on American ships during the 1960’s. This problem

has been dragging on for the last 51⁄2 or 6 years, and to give you

a sense of why we are so frustrated with it I have attached to our

testimony an e-mail, an internal VA e-mail generated by the Chief

Officer of Public Health and Environmental Hazards from September of 2000, in which she essentially says that they don’t want to

do a directive to the field on SHAD, they don’t want to go down

the road of establishing a registry for SHAD veterans, et cetera.

We don’t understand Dr. Mather’s full reasoning on that because

her full reasoning was redacted in the FOIA, but I would suggest

that the committee follow up, if I may, to find out why we are continuing to have these kinds of problems and reluctance on the part

of the leadership to pursue these issues in an aggressive fashion.

I see that my light is on. I will simply conclude by saying we

have a long way to go in terms of getting the kind of medical record

keeping we need to help prevent the kinds of problems that happened to Gulf War veterans, and I urge this committee on behalf

of the fathers and mothers of Gulf War veterans, many of whom

served in Vietnam, to aggressively follow up on these problems.

Thank you, Mr. Chairman.

[The prepared statement of Mr. Eddington, with attachment, appears on p. 135.]

Mr. MORAN. Thank you. Mr. Hayden.
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STATEMENT OF PAUL HAYDEN

Mr. HAYDEN. Thank you, Mr. Chairman. On behalf of the 2.7

million members of the Veterans of Foreign Wars of the United

States and its Ladies Auxiliary, I would like to take this opportunity to thank you for including us in today’s hearing. We appreciate that after 11 years the Veterans’ Affairs Committee’s interest

in the health and well-being of our Nation’s Persian Gulf War veterans has never wavered.

In their 1998 report, your colleagues in the Senate stated that

the Gulf War experience can be seen as a microcosm for continued

concerns regarding our Nation’s military preparedness and ability

to respond effectively to health problems that may arise after deployments. We agree.

Further, in our opinion the most grievous finding was a failure

of both agencies to collect information adequately about, keep good

health records on, and produce reliable and valid data to monitor

the health care and compensation status of Gulf War veterans who

were ill following their deployment to the Persian Gulf. As a result,

basic research questions could not be answered and thousands of

Persian Gulf War veterans continue to suffer from undiagnosed

illnesses.

We concur with the Chair of the IOM Committee on Strategies

to Protect the Health of Deployed U.S. Forces that while the accomplishment of the mission will always be the paramount objective, soldiers must know that their health and well-being are taken

seriously. Failure to move briskly to incorporate these lessons

learned, such as improved medical surveillance, accurate troop location, exposure monitoring, will only erode the traditional trust

between the service member and the military leadership and could

jeopardize the mission.

Taken at face value, it would appear that DOD through the Office of Special Assistant for Gulf War Illness, Medical Readiness

and Medical Deployment has begun to address its past problems by

implementing lessons learned. We believe it important to note,

however, the recent finding by the Institute of Medicine in its report, ‘‘Protecting Those Who Serve,’’ the recommendations of which

we concur, which stated few concrete changes have been made at

the field level. The most important recommendations remain

unimplemented despite the compelling rationale for urgent action.

Additionally, a January 8, 2002, New York Times article seems

to back that finding. A Pentagon official in Deployment Health described the new mindset in military health care as trying to train

people to ask questions, which is a change in military culture. Senior leaders need to understand that there is a major shift.

While OSAGWI, or the Office of Special Assistant for Gulf War

Illness, and DOD have received input from numerous expert panels

and have sought to implement changes based on lessons learned,

it is our opinion that they have failed to carry out DOD-wide

changes in an effective and efficient manner. We believe that only

a total commitment from the highest levels of DOD coupled with

aggressive Congressional oversight can ensure swift enactment.

Up to this point our testimony has focused primarily on DOD,

and rightly so. As we have heard today, in order for VA to properly

care for and compensate a veteran, it depends on accurate and
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timely information from the veteran’s military health care record.

We believe that every veteran is entitled to a comprehensive lifelong medical record of illnesses and injuries they suffer, the care

and inoculations they receive, and their exposure to different hazards. Further, the transfer of this record from DOD to VA should

be seamless and communication between the two agencies needs to

be streamlined so that data can be given to frontline health care

and benefit providers.

Because that is not always the case, the problems experienced by

veterans in the past, and not just Persian Gulf War veterans, has

been their inability to convince VA that their disability is service

connected. According to Title 38, USC, the burden of proof is placed

upon the veteran. In cases such as these, Congress has a long history of creating presumptives for specific cases, such as Vietnam

veterans and exposure to Agent Orange and presumption for service connection due to undiagnosed illness for Persian Gulf War veterans. This committee should be prepared to offer timely solutions

in the future.

In addition, we are very pleased with Secretary Principi’s recent

action to get out in front of science and service-connect Persian

Gulf veterans with ALS. We would hope that future Secretaries

would act similarly given the situation.

Further, we are pleased that the Congressionally mandated Persian Gulf Illness Public Advisory Committee is a reality. This is a

positive step, and we believe future deployment specific advisory

committees will be useful. The VA should remain vigilant in its

role as the chief advocate for our Nation’s veterans, and once again

Congress must use its powers of oversight and legislation to ensure

that future generations of veterans receive the care they were

promised by a grateful Nation.

As a Persian Gulf War veteran and a VFW member, I can only

hope that we have helped to make the road for future veterans a

little easier to travel. This concludes my statement.

[The prepared statement of Mr. Hayden appears on p. 154.]

Mr. MORAN. Gentlemen, thank you very much for your testimony. A couple of things, just observations, before we conclude today’s hearing. Mr. Eddington, we will specifically ask Department

of Defense about the blood samples, your suggestion that that is

not taking place, and see if we can get a direct answer from them

in regard to whether or not they are following the statutory

requirements.

We have heard a lot today about the issue of establishing a baseline, the importance of medical records beginning to end, and it

seems to me that for two accounts, a statutory requirement and,

secondly, for that baseline, that blood sample is a significant issue.

So we will ask the questions and be happy to relate to you and others what the results of those questions would be.

Mr. EDDINGTON. I thank the Chair for his diligence.

Mr. MORAN. You are very welcome. And Mr. Hayden, I think you

raise a point that we as Members of Congress face. We often hear

about policies, and this is the policy of the Department and we

have new procedures in place and the real question has to become

are those policies ever really effective, what is really happening in

the field? And you point out a certain culture or mindset of the De-
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partment of Defense and the military. I think we need to follow up

to find out what the reality is as compared to what the Department

is saying is their policy.

Mr. HAYDEN. Thank you.

Mr. MORAN. So I appreciate that reminder. If you three and

other veterans organizations have suggestions for this committee in

this regard, we would welcome those and look forward to working

with you as we try to not only solve the difficulties that many servicemen and women face from the past but reduce the number of

those servicemen and women that will face difficult health conditions in the future.

So I thank you for the reminder and for your service to our

country.

Our committee I think is about to adjourn. The record will remain open for 5 additional days for additional statements that may

be necessary to complete this record. Again, I think this topic is an

important and timely one, and it is one that falls to us to not walk

away from and to continue to provide oversight, and we have had

some suggestions today about legislative efforts as well.

So again I appreciate the participation of our panelists today, the

participation of our committee members, and the committee stands

adjourned at this time. Thank you.

[Whereupon, at 12:45 p.m., the subcommittee was adjourned.]
(61)

A P P E N D I X

PREPARED STATEMENT OF CHAIRMAN MORAN

‘‘Protecting the Health of Our Troops in Afghanistan’’

We are here this morning to examine the preventive procedures in place in the

Departments of Defense and Veterans’ Affairs to protect the health care of servicemen and women who have been and will be deployed to Afghanistan. The question

we are here to answer is whether or not the lessons learned from the troop deployments to the Persian Gulf War have been integrated into the current deployment

procedures of these Departments. We must take steps today to ensure that these

veterans have a healthy life when they return home.

Following the unspeakable acts of terror last September 11, the President admonished the Nation to prepare for a long struggle, a military and moral struggle,

against terrorism. On Monday, I witnessed the departure of 25 reservists of the

388th U.S. Army Reserve unit in my hometown of Hays, Kansas. I watched the sacrifice of these families, who are forced to give up their loved ones to a call to duty.

America’s war on terrorism has come home.

As we now look at the deployment of thousands of United States military forces

in combat in Afghanistan and elsewhere, we should remember, and learn from,

those who have served us in the past. American veterans, many of whom are here

today, put their lives on the line to protect all of us in the active military services.

I hope today’s hearing will be informative for everyone, and will lead us to better

solutions for the concerns that arose after the Desert Storm, Somalia, Kosovo, Bosnia and other recent military operations.

As a Subcommittee with jurisdiction over the V A health care system, and as

Members of Congress with a strong interest in and support for our military, we

want this hearing to serve as a public record of our concerns about those being deployed in harm’s way on foreign shores.

We have distinguished witnesses here today to offer their views to the Subcommittee. We are privileged to have two former United States Senators, who conducted reviews and investigations on Gulf War Veterans. We have current and

former officials from DOD and VA to review the roles they played in the Gulf War

and how policy was formulated to deal with the known risks—as well as to discuss

some of the problems later uncovered that were not anticipated in the immediacy

of the deployment itself.

We will review and hear testimony on the current deployment, and hear how we

benefited from the knowledge gained by past mistakes. We also will hear from advocates of veterans of the Gulf War, who will provide recommendations to ensure the

health of our troops. We look forward to all their testimonies.

I am also closely following the work of the Kansas Persian Gulf War Veterans

Health Initiative, a program monitoring over 7,500 Kansas veterans of the Persian

Gulf War. They have completed a baseline study of the health of Kansas Persian

Gulf veterans. They are currently planning a second study on neurological problems

of these veterans.

Kansas State Representative Dan Thimesch, who serves a leading role in the

work of that study, is submitting testimony on the work to date. I look forward to

reviewing Representative Thimesch’s testimony.

This is a very important hearing, with important implications. It will not be our

last work on this subject. It falls to Congress to be vigilant.

The active duty and reserve forces called to serve in the war on terrorism, whether in Central Asia or elsewhere, will be veterans in the future. We want to help

ensure that troop health is maintained and that veterans return with the greatest

possibility of leading a healthy life.
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WRITTEN COMMITTEE QUESTIONS AND THEIR RESPONSES

CONGRESSMAN EVANS TO WARREN B. RUDMAN

1. In hindsight, was the case narrative approach necessarily the best use of DOD’s

resources in investigating reasons for service members’ adverse health after

service in the Gulf? Do you believe this was the most appropriate use of the Department’s resources or should it have investigated more into original research

and other investigations?

Response: DOD has conducted a dual-track strategy for investigating the

undiagnosed symptoms that have prompted almost 12,000 Gulf War veterans to

claim compensation.

First, the Department has funded 111 studies to determine possible medical

causes and treatments for the undiagnosed symptoms some veterans have experienced since the war. DOD has coordinated its research portfolio with the Departments of Veterans Affairs and Health and Human Services to avoid redundant projects and to leverage the results of their 193 total projects funded at

$174 million.

Second, DOD established the Office of the Special Assistant for Gulf War Illnesses (OSAGWI) to investigate the release of nerve agents at Khamisiyah and

to determine if other exposures to chemical or biological warfare agents (CWA

and BWA, respectively) occurred during or after the Gulf War. OSAGWI conducted comprehensive Investigations of Khamlsiyah, numerous alleged chemical

detections, and the actual release of CWA at three Iraqi weapons locations during the air campaign. The resulting case narratives have permitted DOD and VA

to identify and notify veteran cohorts that may have been exposed to CWA without unnecessarily alarming the almost 600,000 veterans who were not potentially exposed.

2. On what basis do you praise the ‘‘exceptionally high medical readiness of units

returning from deployments to Bosnia, Kosovo, Kuwait, Haiti and Rwanda?’’

What improvements in Force health protection have contributed to this medical

readiness?

Response: I based my statement on health and readiness data that Special

Oversight Board staff examined. The Board’s charter did not permit my staff to

evaluate fully these deployments, so I can only surmise that improved medical

intelligence, deployment procedures, command emphasis, and implementation of

other lessons learned from the Gulf War contributed to the high readiness. The

proof of that high readiness is obvious from the fact that we have not heard the

kind of medical complaints following those deployments that we heard after the

Gulf War.

3. Sen. Riegle will assert that detection warnings went off ‘‘tens of thousands of

times’’ as the air war took place, yet DOD claims all the detections wei8 false.

Your Board found that there was no effort by DOD to ‘‘cover-up’’ information

about the Gulf. Is it fair to assume, then that you share DOD assumptions that

all of the bio-chemical detections in the Gulf were false alarms?

Response: DOD had no biological detectors during the Gulf War, and we will

never know how many chemical detectors did alarm during the air campaign.

No empirical data exists to substantiate claims that ‘‘tens of thousands’’ alarms

occurred. What we do know is that none of the CWA released at Al Muthanna.

Muhammadiyat, and Ukhaydir reached the Saudi border. We also know that

none of the chemical agents in the Iraqi inventory could have risen into the jet

stream unless they were heated to temperatures hotter than those DOD uses to

incinerate chemical munitions. Moreover, we know that M8 chemical alarms

could not detect the very low levels of CWA released just ten miles away at

Khamisiyah, so detecting even lower levels of CWA emanating from Iraq hundreds of miles away would have been beyond the chemical alarm’s capability.
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CHAIRMAN MORAN TO DR. JAMES HOLSINGER
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CONGRESSMAN EVANS TO DR. JAMES HOLSINGER
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CONGRESSMAN EVANS TO DR. SUE BAILEY
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Æ