Features

2

7

Anthrax Policy. DoD orders servicemembers at greatest risk to be issued the anthrax vaccine.

Health Benefits. DoD officials report transitional health benefits improve for Reserve 

Component personnel.

Air Sampling. Air Force laboratory analyzes 

hazardous waste, water and soil to ensure 

safety.

Vaccine Healthcare Center. DoD establishes Vaccine Healthcare Center at Walter 

Reed Army Medical Center.

Health Care. DoD says Reserve Component personnel need to know about their 

medical benefits.

War Letters. Armed services edition of “War 

Letters” is delivered to deployed troops. 13

2002

On the Cover

8

fall

Phone Home. The VFW’s Operation Uplink 

provides free long-distance phone calls for 

deployed troops and families.

Study Update. The Millennium Cohort 

Study is under way and will evaluate health 

risks of servicemembers.

Pneumonia Vaccine. Thousands of sailors 

and Marines have volunteered to be part of 

largest vaccine trial in military history.

First Aid. Newly redesigned field first aid 

kits may save future lives.

15

10

Aviation Boatswain’s Mate 2nd Class Michael Keys 

from Orlando, Fla., watches an F-14 Tomcat, assigned 

to the “Jolly Rogers” of Fighter Squadron One Zero 

Three (VF-103), gain altitude after launch. 

U.S. Navy photo by Jessica Davis

18

19

Gulf of Oman -- A CH-46 Sea Knight helicopter 

assigned to the “Dragon Whales” of Helicopter 

Combat Support Squadron Eight (HC-8) delivers 

supplies to the flight deck of the aircraft carrier 

USS George Washington (CVN 73) from the 

Military Sealift Command ship USNS Supply 

(T-AOE 6). The Washington Battle Group is on a 

six-month deployment conducting combat missions 

in support of Operation Enduring Freedom and 

Operation Southern Watch. 

U.S. Navy photo by Photographer’s Mate 1st Class David C. Lloyd

In Every Issue

News From Around the World 3 

Combating Information Overload. DoD Asks Eligible 

Donors to Give Blood Now.

Ask Our Doctors 5

How To Keep Healthy During Deployment.

Drugs & Herbs 5

Beware of Weight Loss Drugs Containing Ephedra..

Gulf War Update 9

Database Helps Locate Gulf War Hospital Records

Health Beat 17

Oral Cancer: Are You at Risk?

Resource Guide 20

Suicide Prevention Week 

is November 18 - 22, 2002
Deployment Quarterly fall 2002 • http://deploymentlink.osd.mil

T

he attacks of September 11, 2001, reminded us all that 

America’s enemies will do anything within their power to 

kill and terrorize. The fact that terrorist organizations, and 

the nations that support them, may possess chemical and 

biological weapons means that we must be prepared to face 

threats to our force from risks beyond bullets or artillery. 

The civilian and uniformed leadership in the Department 

of Defense continues to view anthrax as a real and present 

threat to the safety of our armed forces. In response to 

that threat, the secretary of defense has issued a policy to 

vaccinate our service members against anthrax, starting 

with those believed to be at greatest risk of attack.

Independent scientific experts and our own military 

medical authorities have concurred that the anthrax 

vaccine is safe and effective. I hope you’ll check what the 

scientists and physicians — the experts — have to say. For 

example, the National Academy of Science’s Institute of 

Medicine, a national organization whose only function is 

to advance scientific knowledge to improve human health, 

released their findings on the safety of the anthrax vaccine 

in March 2002. This prestigious group of researchers found 

the anthrax vaccine to be safe and effective against all the 

ways people get anthrax infections, including inhalational 

anthrax. In fact, they stated that the evidence showed that 

the vaccine is effective against anthrax caused by all known 

or plausible engineered strains of the disease.

Additionally, researchers found no evidence that people 

face an increased risk of experiencing life-threatening 

or disabling adverse events immediately after receiving 

the anthrax vaccine. Nor did they find any convincing 

evidence that people face an elevated risk of adverse health 

effects over the longer term. You can read their summary of 

the report for yourself on the Internet, at http://www.iom.edu/

iom/iomhome.nsf/WFiles/Anthrax-4-pagerFINAL/$file/Anthrax4-pagerFINAL.pdf

In the next few weeks, you’ll be hearing more about 

the program from leaders in your chain of command and 

members of your medical community. They will tell you 

what we know about the vaccine, and what you can expect. 

They will let you know that local reactions to this vaccine 

are common. The typical reactions include soreness, 

redness, itching, swelling and lumps at the injection site. 

The types and frequency of these reactions are similar to 

those we see with other, more familiar vaccines, such as 

the tetanus and influenza vaccines. During the discussions 

with your leaders and health care providers, I encourage 

you to ask questions. Learn 

the facts!

fromhealthaffairs

Protecting the Force: 

By William Winkenwerder Jr., M.D., M.B.A. 

We in the Department of Defense have no doubt that the 

threat of an enemy using anthrax as a weapon against us 

is very real. Anthrax is one of the top choices of biological 

weapons. The disease is almost always fatal if not treated 

early, and the odorless, colorless spores could be spread on 

the battlefield without warning. 

Several of our potential adversaries have worked to 

develop an offensive biological warfare capability using 

anthrax. One of them, Iraq, has admitted to producing and 

“weaponizing” anthrax. 

As the assistant secretary of defense for health affairs, 

your health and safety are my personal responsibility. 

Knowing that our enemies will use whatever means they 

have to pursue their ends, we have an obligation to use 

every means available to protect you. That includes our 

best intelligence, detection equipment, protective gear, and 

a safe, effective, FDA-approved vaccine. We owe you that 

protection. 

William Winkenwerder Jr., M.D., is the assistant secretary of 

defense for health affairs. He serves as the principal staff assistant 

and advisor to the secretary of defense for all the Department of 

Defense health policies, programs and activities, and subject to 

the direction of the secretary of defense, exercises oversight of all 

Department of Defense health resources.

The Anthrax Vaccine
http://deploymentlink.osd.mil • fall 2002 Deployment Quarterly

DARPA Combats 

Information Overload

ARLINGTON, Va., — In the civilian world, it’s called 

“information overload.” 

That’s when so much information is coming in that the 

receiver cannot separate the wheat from the chaff. 

Senior Airman Alden L. Garlitz, with the 438th Air Expeditionary Wing 

security forces squadron, inspects the underside of a vehicle Sept. 10 before 

permitting it to drive onto the base at a forward-deployed location supporting 

Operation Enduring Freedom. Garlitz is an Air National Guardsman deployed 

from the 173rd Security Forces Squadron at Kingsley Field, Klamath Falls, 

Ore. 

Photo by Master Sgt. John Nimmo

Security Check In the military, information overload can get you killed. 

That’s why the Defense Advanced Research Projects Agency 

set up the Information Exploitation Office. 

“What we’re all about is finding and killing bad guys on 

the battlefield,” said office director Dick Wishner. “We’re 

focused on land and surface targets.” 

There is a certain amount of information a servicemember 

needs. The services collect data in a number of ways, from 

satellites to communications intercepts to human intelligence 

to remote sensors. Part of the rationale for setting up the 

office is the “military gets a lot of data, but not enough 

information,” Wishner said. “What we’re trying to do is 

extract information out of this huge stream of data.” 

But even with all the information coming in, Wishner does 

not try to claim that everything is known.

“I’m not trying to imply that all the data we need is 

available,” he said. “We actually have a shortage of highquality sensors.” 

The office will work with others inside DARPA and the 

services to develop new sensors. Wishner said the office is 

particularly focused on what the military is finding to be the 

norm: situations where servicemembers have restricted rules 

of engagement. 

“You can’t shoot at somebody you think is a bad guy 

unless you can verify there are no neutrals or good guys in 

the weapons splash radius,” he said. “So we’re invoking the 

new sensor technology to do very precise target identification 

and make sure we don’t make any mistakes.” The 

technology would take an image, identify it as friend or foe 

and give that information to the servicemember. 

“We don’t want people trying to make an identification 

from a screen,” Wishner said. “By the time they see it, the 

vehicle is already labeled with what it is.” 

He said the office would work to speed up reaction time. 

He said the services now have similar deliberate planning 

processes.

“The Air Force has something they call ‘find, fix, 

target, track, engage and assess,’” he said. “That’s a fine 

methodology, but there are segments between these that take 

too long.” 

Wishner said the office is looking to synchronize 

everything “so that when you find a guy who’s potentially 

a threat, we can precisely ID him quickly. Then we’ll have 

a shooter platform nearby that can launch a weapon and 

destroy him if we deem he’s a bad guy.” 

He said the office would work with warfighters and 

service laboratories to ensure the products are real, usable 

and needed. The office will also address other problems like 

pinpointing targets under foliage and the problems entailed 

with finding enemies in urban environments. ■
Deployment Quarterly fall 2002 • http://deploymentlink.osd.mil

news from around the world

WASHINGTON — Department 

of Defense blood donor centers 

are asking eligible blood donors to 

give blood to ensure DoD supplies 

and assist civilian blood collection 

agencies experiencing unusually 

severe blood shortages.

“The next few months will be 

tough for us to keep blood supply at 

optimal levels,” said Army Col. Mike 

Fitzpatrick, Armed Services Blood 

Program director. “Summer is the time 

when most military personnel move 

to new duty stations. Add to that 

summer vacations, and you get an 

increased need for blood donations.”

“We encourage military blood 

donors to give blood through the 

Armed Services Blood Program, 

which is supporting civilian requests 

for blood products in the current 

shortage,” said Navy Cmdr. Rebecca 

Sparks, deputy director, Armed 

Services Blood Program.

“In military communities where 

our program does not have blood 

collection facilities, we urge soldiers, 

sailors, airmen and Marines to 

support blood drives in their local 

communities,” Sparks added.

Unlike civilian agencies, the Armed 

Services Blood Program, which 

provides blood products for military 

hospitals and military readiness 

purposes, is not experiencing a blood 

shortage.

Armed Services Blood Program 

officials attribute the fact that they 

have a sufficient 

amount of blood on 

hand to meet military 

needs to two factors. 

First, DoD’s current 

needs are much 

smaller than those 

of civilian agencies. 

DoD collects about 

1 percent of the 

blood collected from 

Americans. Second, 

military personnel 

donate blood at about 

twice the rate that 

civilians do. About 

10 percent of eligible 

military donors 

donate; civilian blood 

collection agencies 

estimate that less than 

5 percent of the 

eligible U.S. 

population donates.

However, a disproportionate number 

of DoD donors are 

deferred from giving 

blood under standards 

implemented last 

fall by the Food and 

Drug Administration, 

which regulates blood 

products in the United 

States.

The standards were 

DoD Asks Eligible 

Donors to Give 

Blood Now

instituted as a pre-cautionary measure 

against exposure to the human form of 

mad cow disease.

About 18 percent of active duty 

military personnel cannot donate blood 

because of duty assignments in the 

United Kingdom and Europe, according 

to Sparks. Because of concerns about 

exposure to the human form of mad 

cow disease, the FDA restricted 

donations from people who lived or 

traveled in these places during specified 

timeframes. DoD issued a policy 

based on that of the FDA, which defers 

military personnel and family members 

who meet any of the following criteria:

• Traveled or resided in the United 

Kingdom from 1980 through 1996 for a 

cumulative period of three months or 

more. 

• Traveled or resided in Europe from 

1980 through 1996 for a cumulative 

period of six months or more. 

• Traveled or resided in Europe from 

1980 to the present for a cumulative 

period of five years or more. 

• Received a blood transfusion in the 

United Kingdom since 1980. 

• Received a bovine insulin product 

produced in the United Kingdom since 

1980. 

The deferral policy also affects 

military retirees and their family 

members who meet any of the above 

criteria.

DoD blood officials have begun a 

campaign to make personnel aware of 

the need to donate blood on a continuing 

basis using DoD’s internal media. The 

Defense Department also has added 

blood recruiting and collection personnel 

at its collection facilities, and encouraged 

commanders to support blood collection 

efforts.

To find out how you can give blood 

through the Armed Services Blood 

Program, contact your local blood donor 

center.

For information on blood deferral 

policies and on risks associated with 

travel or assignment in the United 

Kingdom and Europe, visit the U.S. 

Army Center for Health Promotion 

and Preventive Medicine Web site at 

http://chppm-www.apgea.army.mil. ■
http://deploymentlink.osd.mil • fall 2002 Deployment Quarterly

Q

Q

A

A

drugs& herbs

ask doc

What can I do to keep from 

getting sick while deployed?

— Continued on Page 6

Thank you for sending your 

magazine out here where we 

are in support of Operation 

is just a little embarrassing, so please Enduring Freedom. My question 

don’t publish my name. I have gained 

over 15 pounds since I have deployed and 

am truly struggling to keep the pounds 

off. I am not eating that much. However, 

our work tempo in aircraft support allows 

very little time for exercising. A friend 

of mine gave me a bottle of weight loss 

pills, and I noticed one of the ingredients 

was Ephedra. I have heard this name in 

the news before, but don’t remember the 

specifics. Is this ok to take?

No. If you wanted approval — 

implicit or direct — you have 

asked the wrong person. Here 

is why. I am very conservative 

when it comes to “things” you ingest, 

that are supposed to effect or alter 

some type of 

function in 

your body. 

This includes 

pharmaceuticals, neutra-ceuticals, 

sport supplements, diet products, 

herbal products, etc. However, the 

non-regulated herbal products are 

the ones I would be most concerned 

about. The manufacturers of these 

products are not required to submit 

proof of safety and efficacy to the 

U.S. Food and Drug 

Administration before 

marketing. As a result, the 

adverse effects and drug 

interactions are unknown. 

You are playing roulette 

with your health. Given the 

fact you are deployed, you 

also put at risk those who 

rely on you to do your job.

There is no doubt this 

topic has generated a lot 

of discussion among the 

experts in the various 

segments of healthcare. 

However, here are the facts as I know 

them. 

• Ephedra-containing products 

have been associated with adverse 

cardiovascular events, seizures, 

psychoses, and sudden deaths. 

• These products are not — Continued on Page 8

In the last issue of Deployment 

Quarterly, we discussed how to 

avoid diarrhea or dysentery by 

replaced body 

water lost 

by sweating, 

you may 

develop heat 

exhaustion, 

an inability 

to continue to 

work. If heat 

exhaustion 

or heat stroke 

occurs, you 

will become 

a casualty 

requiring 

assistance 

from medics and possibly evacuation. 

Preventing such heat injuries requires 

you to be aware of the threat. Avoid 

unnecessary exertion during the heat 

of the day. If you must work in hot 

weather, seek out shade, rest often, 

drink plenty of water, and loosen 

your uniform as much as the mission 

permits. Water is key. You should 

drink enough to keep your urine 

light yellow in color (not dark) and 

normal in volume. Drink before you 

get thirsty. If you’re thirsty, it means 

being careful about what you eat and 

drink. There are other important steps 

that you should take to avoid illness 

and injury while you are deployed. 

The need for such steps varies 

according to the health threats in the 

place where you are deployed. If you 

don’t like getting sick in the field, 

find out, before you deploy, what to 

look out for. The more that you know 

about the threats and how you can 

block them, the less likely it is that 

you will get sick. Some of the most 

common and potentially dangerous 

threats are described here. 

Heat can kill. Heavy exercise 

increases your body temperature. In 

warm, humid weather, losing that 

body heat may be difficult. Heat 

exhaustion, or the more serious, heat 

stroke could result. If you get too 

dehydrated because you haven’t 

you’re already at least a pint 

behind.

Cold is also a threat. The most 

common severe cold injury is 

frostbite, which results in the 

permanent loss of skin or larger 

body parts that become frozen. 

Trench foot and immersion 

foot result from prolonged 

exposure of the feet to wet, cold 

conditions. Hypothermia is 

the dangerous, potentially fatal 

lowering of body temperature 

due to loss of body heat. 

You prevent cold injuries by 

keeping your body and its more 

exposed parts warm and dry. Wear 

the available cold weather uniforms. 

Protect your head, face, ears, hands 

and feet from the cold. Keep clothing 

clean and dry. If your clothing 

(especially socks and gloves) gets 

wet, change to dry clothes as soon as 

possible. Eat all your meals and keep 

moving when outside in the cold.

Insects, ticks, and other bugs can 

also be hazardous to your health. 

When deploying, find out which of 
Deployment Quarterly fall 2002 • http://deploymentlink.osd.mil

W

W

— Continued from Page 5

Ask the Doc

Transitional Health Benefits Improve for Guard, 

Defense Enrollment Eligibility Reporting 

System. 

“I think the number one thing a 

member can do upon demobilization is 

to ensure their information in DEERS 

is correct,” said Col. Kathleen Woody, 

director of medical readiness and 

programs in the office of the assistant 

secretary of defense for reserve affairs. 

“That’s paramount because all of 

your benefits are contingent on the 

information in DEERS.” 

The Defense Manpower Data 

Center is sending a letter to people 

who are eligible for this benefit, but 

only if the information in DEERS 

reflects their having served in support 

of a contingency operation such as 

Operations Noble Eagle or Enduring 

Freedom. 

“Our Guard and Reserve members 

and their families have sacrificed a great 

deal by responding to the call to duty 

in support of the war on terrorism,” 

Woody said. “We have an obligation to 

ensure that each individual is aware of 

this transitional health care benefit.” 

Members and families who were 

enrolled in TRICARE Prime while 

on active duty will automatically be 

disenrolled upon release from active 

duty. The Reserve Component member 

or family must actively re-enroll if they 

wish to continue TRICARE Prime during 

the transitional health care period. 

For more information on TRICARE 

and claim forms, call the Worldwide 

TRICARE Information Center toll-free 

at 1-888-363- 2273, visit the TRICARE 

Web site at http://www.tricare.osd.mil, 

or visit the TRICARE service center or 

benefits counselor at the nearest 

military health care facility. ■

Col.(Dr.) John W. Gardner, MC, FS., 

U.S. Army, serves as the program director of 

medical readiness in the Deployment Health 

Support Directorate. He received his medical 

degree in 1976 from the University of Utah 

and a doctorate in public health from Harvard 

University in 1981.

DoD Pays Some 

Employees’ 

Health Premiums 

ASHINGTON — Some DoD civilian 

employees in the Reserve Components 

who are called to active duty will 

see Uncle Sam pick up their Federal 

Employee Health Benefits Program 

premiums.

The new personnel policy, recently 

authorized by Deputy Defense 

Secretary Paul Wolfowitz, applies to 

call-ups for contingency operations 

under Title 10 of the U.S. Code. 

“This is a really good benefit for our 

civilian employees in the Guard and 

Reserve who are deployed in support of 

contingency operations,” said Nancy J. 

Wilson, chief of the Employee Benefits 

and Records Management Division, 

Human Resource Services Center, 

Washington Headquarters Services, at 

the Pentagon.

Depending on their health care plan, 

Wilson pointed out, participants can 

save up to $50 a week.

Eligible DoD civilians also may 

obtain retroactive reimbursement of 

their Federal Employee Health Benefits 

Program premium payments if they 

were called to active duty for certain — Continued on Page 12

ASHINGTON — A recent change to 

health care benefits will be a big help 

for National Guard and Reservists who 

were mobilized in support of the war 

on terrorism. 

Under the revised transitional health 

care benefit plan, Guard and Reserve 

who were ordered to active duty for 

more than 30 days in support of a 

contingency and have more than six 

years total active federal service are 

eligible for 120 days of health care 

following their period of active service. 

Guard and Reserve members with 

less than six years service will get 60 

days of continued medical care. Under a 

worldwide demonstration project, family 

members are also covered under this 

plan. This program is retroactive to Jan. 

1, 2002. 

Eligibility for these benefits will 

be determined by information in the 

these creatures to guard against where 

you are going. Defenses against biting 

insects include proper wear of the 

uniform to cover the skin, the use of 

permethrin repellant on the uniform 

and DEET on the skin. Bed netting is 

a very effective barrier against biting 

insects at night when sleeping. You 

can get added protection by treating 

the netting with permethrin. In many 

parts of the world, malaria — spread by 

mosquitoes — is an important threat. 

Protective drugs, like chlorquine, 

mefloquine or doxycycline can keep 

you from getting sick from malaria, 

even if you can’t keep all of the 

mosquitoes from biting you.

Field bivouac areas should be kept 

clean so that you don’t attract flies, 

biting insects, rats and other wild 

animals. Human waste (feces) should 

be disposed of in accordance with 

military doctrine. Flies are capable of 

carrying disease-causing germs from 

latrines to exposed food. Rats and 

other animals can bite humans and 

may harbor insects that carry disease. 

Leftover food and trash should be 

carted away, burned or buried in 

accordance with command guidance. 

You should keep the area where you 

sleep free from spilled food, crumbs or 

water, so that you don’t draw pests to you.

There are many other precautions 

which you should take to stay healthy 

when deployed. There’s not enough 

space here to discuss them all, but you 

can learn more from a variety of sources. 

Detailed information about the health 

threats of a region should be available to 

units deploying there. Each of the services 

has printed manuals about hygiene and 

sanitation in the field. Medical officers, 

medics, preventive medicine and public 

health technicians are reliable sources 

for tips to stay healthy. Don’t miss the 

pre-deployment briefings about the medical 

threat in the region where you’re going. 

There are also many Internetbased Web sites where you can find out 

what to guard against when you deploy. 

Several examples can be found at 

http://chppm-www.apgea.army.mil/deployment/

shg.asp. ■
http://deploymentlink.osd.mil • fall 2002 Deployment Quarterly

W

research

hen an airplane smashed into the 

side of the Pentagon Sept. 11, 2001, 

the focus was on terrorism and the 

immediate attack, but people had to 

return to work. Dealing with the fear 

that absorbed the nation after that day, 

those people didn’t need the added 

fear of contaminants in their air. 

To ensure the safety of their working 

environment, the personnel in the 

chemistry division at the Air Force 

Institute for Environment, Safety and 

Occupational Health Risk Analysis, 

located at Brooks Air Force Base, 

Texas, analyzed samples of the air for 

asbestos and dangerous metals. 

“We analyzed samples of air 

simulating what people would 

breathe,” Kurt Greebon said. Greebon 

is a chemist at Air Force Institute for 

Environment, Safety and Occupational 

Health Risk Analysis and the acting 

technical branch chief for Inorganic 

Industrial Hygiene. 

Since no packages were going in or 

out of Washington, D.C., at the time, 

the Surveillance Directorate Chemistry 

Division at AFIERA tapped into their 

chemical laboratory network to find a 

suitable lab nearby that could analyze 

the samples quickly. 

The Surveillance Directorate 

Chemistry Division, which handles 

more than 60,000 samples a year, 

works with 10 contract labs throughout 

the country to analyze hazardous 

waste, water and soil samples from 250 

military bases around the world. They 

work with the Air Force, Air National 

Guard and Air Force Reserves as well 

as other branches of the armed forces. 

“We analyze samples to ensure 

health and safety in the workplace 

and the environment,” said 

Juanita Gilliland, chief of program 

management for the Surveillance 

Directorate Chemistry Division. 

During the anthrax scare, Air Force 

Institute for Environment, Safety and 

Occupational Health Risk Analysis 

chemists analyzed many samples 

Air Force Lab Soothes Air Contamination 

by rita boland of white powder from different 

locations to determine the identity 

of the substances. 

“We can support people on any 

environmental or occupational 

analysis,” Gilliland said. “If we 

can’t do it [at Brooks] we send it to 

one of our contract labs.” 

The Surveillance Directorate 

Chemistry Division sends 

assessment teams to the contracted 

labs periodically to ensure the 

work meets Department of 

Defense standards. U.S. Central 

Command Air Forces is one of the 

important customers they support 

by analyzing air and soil samples 

to ensure a safe environment for 

those deployed. The Surveillance 

Directorate Chemistry Division 

has also worked on projects with 

JP-8, the fuel in jets, and aviators’ 

breathing oxygen. 

They analyzed samples of JP-8 

in the air and on clothing to determine 

how much had been absorbed by 

people working with the planes. Those 

results helped develop guidance for 

safer clothing and protective gear for 

the workers. 

The Surveillance Directorate 

Chemistry Division checks that 

companies who provide oxygen for 

pilots don’t supply contaminated 

canisters. They have also analyzed 

oxygen samples after crashes to see 

if contamination played a role in the 

accident. 

In certain cases, the division sends 

equipment for gathering and analyzing 

out to the site, so the material doesn’t 

have to be shipped or contaminate 

anyone in the lab. 

The Surveillance Directorate 

Chemistry Division once received a 

package that a chemist identified as a 

chemical warfare object before it was 

opened. The sample was returned to 

the sender. “I didn’t want to open it,” 

Greebon said. 

The chief of Surveillance Directorate 

Chemistry Division, Air Force Lt. Col. 

Dave Gibson, has been working with 

the FBI and the Centers for Disease 

Control and Prevention to establish a 

system for chemical response in the 

event of a chemical weapons attack. 

According to Gibson, such a system is 

still speculation and many logistical 

aspects must be arranged. 

“We want to prompt the system and 

say, ‘Are you guys ready for to handle 

a chemical event?’” Gibson said. 

Despite Surveillance Directorate 

Chemistry Division’s role in 

recent events, its mission is mainly 

unchanged from the pre-Sept. 11 

era. The chemists still focus on 

providing timely and valid analyses 

to keep people safe in their working 

environments. 

“Nothing has consistently changed,” 

Greebon said. 

The Surveillance Directorate 

Chemistry Division used to examine 

mainly drinking water, but with 

new regulations, drinking water has 

become safer and the examination 

requirements moved from one year to 

two years. The chemists now analyze 

more soil, air, hazardous waste and 

charcoal tube samples, though they 

— Continued on Page 12
Deployment Quarterly fall 2002 • http://deploymentlink.osd.mil

S

Drugs & Herbs

— Continued from Page 5

Cmdr. Gene DeLara, Medical Service Corps, U.S. Navy, serves as the 

medical planner in the Directorate 

for Deployment Health Support. He 

has a Doctorate of Pharmacy degree 

and a Masters of Business AdminisVaccine Healthcare Center Helps 

Protect Troops, Trains Doctors

by austin camacho

ome people fear vaccines more than they 

fear the illnesses they can prevent. In 

response to growing concerns about the 

safety of immunizations, the Department 

of Defense created the Walter Reed 

National Vaccine Healthcare Center. Dr. 

Renata Engler, director of the National 

Vaccine Healthcare Center, says that the 

center has been established as the lead 

agent for a much broader approach to 

supporting immunization health.

“It’s intended to become a network of 

vaccine healthcare centers of excellence,” 

Engler said.

Engler, an expert in dealing with 

adverse reactions to drugs, is chief of the 

Allergy and Immunology Department 

at the Walter Reed Army Medical Center 

in Washington, D.C. She and Dr. Bryan 

Martin conceived the center while 

running a Walter Reed Army Medical 

Center program that provides training 

in immunization and allergy nursing 

skills to medical professionals of all the 

military services. Her vision for the 

National Vaccine Healthcare Center is 

to develop a network throughout DoD 

to improve immunization delivery, 

education and research, and to better 

manage the adverse effects of vaccines.

Engler says the center’s mission is to 

provide clinical support and leadership 

for immune readiness, in collaboration — Continued on Page 14

with the Centers for Disease Control 

and Prevention. Together, the two 

organizations will develop programs 

to enhance vaccine safety and 

effectiveness. They will also work 

to increase vaccine acceptability, a 

growing issue in the military and 

America in general. For people in 

uniform, the controversy has mostly 

surrounded the Defense 

Department’s Anthrax Vaccine 

Immunization Program. 

“When the anthrax vaccine program 

started, a lot of questions and issues 

arose,” Engler said. “Servicemembers 

had concerns about adverse events.”

According to Engler, front line 

personnel weren’t properly prepared 

and, unlike other vaccines, clear 

provisions weren’t made for medical 

exemptions. For example, if a doctor 

chooses to exempt a servicemember 

from his or her next hepatitis B shot, 

there is a system in place to manage 

that situation without the person 

being barred from deployment. 

Also, she says, the basic message 

the Pentagon sent to servicemembers 

— that the vaccine is safe and effective 

— may have been over-simplified. 

She says people have to remember 

that vaccines are prescription drugs, 

and even the safest prescription 

medications have a 1 to 2 percent 

incidence of adverse reactions. So 

she would expect one out of 100 people 

who get a drug to have a reaction close 

to the time of the drug’s administration. 

That would raise a question about the 

risk of re-exposure. 

“With the anthrax vaccine — which 

requires six doses in 18 months — it’s 

not a surprise that this became far more 

visible than with vaccines you get once 

every five or 10 years,” Engler said.

Engler believes that training for the 

people delivering vaccines has been 

deficient, both in the military and in the 

civilian sector. In that way, she says, the 

military system is no different from the 

rest of the country. 

“Immunization health care is a 

national issue,” Engler said. “The 

concerns people have, the questions, 

and things we need to do to make 

immunizations better are not unique 

to the military. If we don’t do better 

as a nation, we’ll lose the trust of the 

public. They won’t immunize their 

children, and we’ll see diseases come 

back and other negative effects that are 

preventable.”

Congress directed the CDC’s national 

immunization program to work with 

the Army to develop clinical vaccine 

safety improvements. While DoD 

developed the Vaccine Healthcare 

Center, the CDC has launched a parallel 

initiative — the Clinical Immunization 

regulated by the Food and Drug 

Administration.

• There are no safety and efficacy 

studies for these amphetamine-like 

products which acts as a stimulant in 

the body.

Don’t be fooled by slick marketing 

and misinformed friends. I won’t 

name the various brand names here for 

obvious reasons. However, the FDA 

is warning consumers not to consume 

ephedrine-containing products. Read 

the label. You may find names like 

Ma huang, Chinese Ephedra, Ephedra 

sinica, epitonin or some variation. Any 

of these ingredients listed indicate the 

presence of ephedrine. Many of these 

products are marketed under a variety 

of brand names with labels that claim 

or imply weight loss, increased energy, 

aphrodesia, euphoria and other 

effects. 

I think a better idea is talk 

with a dietician and the medical 

folks at your location or via 

the Internet. I bet with slight 

modifications and realistic 

tration degree. DeLara is both a 

pharmacist and medical planner holding the 

1805 Plans, Operations, and Medical 

Intelligence specialty code. 
http://deploymentlink.osd.mil • fall 2002 Deployment Quarterly

W

ASHINGTON - The Office of the 

Special Assistant for Gulf War 

Illnesses announced that it is 

offering assistance to those Gulf War 

veterans who have had difficulty in 

obtaining copies of their inpatient 

hospital records from the Gulf War. 

Collaborating with the Department 

of Veterans Affairs, the National 

Personnel Record Center and the 

Department of the Army, the office 

is creating a consolidated database 

to retrieve hospital records for all 

patients treated in Army, Navy and 

Air Force Gulf War hospitals. Veterans 

who are interested in securing 

information from these records are 

encouraged to contact the office to 

request a data search.

In the military, the disposition and 

storage of records is governed by 

each service, DoD regulations and 

statute. Medical records fall into two 

categories: individual health records 

and inpatient hospital treatment 

records. 

Individual health records 

include clinic visits, diagnostic 

tests, immunizations, dental care 

and, in some cases, discharge 

summaries of inpatient care. These 

records represent a history of a 

service-member’s medical care and 

accompany them throughout their 

military career. Upon a member’s 

separation or retirement, the 

individual health record is retired to 

the Department of Veterans’ Affairs 

Record Management Center in St. 

Louis, Mo.

Inpatient hospital treatment records 

are created each time a servicemember 

is admitted to a military medical 

treatment facility for care. These 

records document all treatment and 

procedures performed while the 

member is hospitalized. If the patient 

is evacuated to another facility, a copy 

of the treatment record accompanies 

the patient and the original record 

is retained with the hospital’s files. 

Defense Department guidelines call 

for hospital in-patient treatment 

records to be retired within a span 

of four to 10 years, depending upon 

the facility’s record disposition policy 

to the National Personnel Records 

Center 

where they 

are archived 

under the 

name of the hospital transferring the 

records. 

War often skews even the best 

policy. In a fast-paced, chaotic battle 

environment a servicemember’s 

individual health record may be 

maintained by his unit and never 

reach the hospital administering 

care or the individual may receive 

treatment in a number of facilities. 

The in-theater hospitals did not 

have transcriptionists, so discharge 

summaries were not done in most 

cases. Also, the in-theater hospital 

generally did not have copy machines, 

so when a patient was transferred to a 

hospital, the original record was sent 

with the patient.

After the war, veterans seeking 

their medical records had to know the 

name of the facility that treated them 

during the war in order to obtain 

the record from the hospital or the 

National Personnel Records Center. 

The need for a database grew out of 

the concerns veterans expressed about 

locating their records. Many veterans 

thought that their records were lost or 

destroyed. 

gulf warupdate

— Continued on Page 13

“The records were never lost or 

destroyed,” explained Mike Boyle, 

an investigator on the medical issues 

team. “If veterans didn’t know the 

name of the hospital that treated them, 

there was no way of finding their 

records.” 

To come up with a solution for 

veterans, the staff built on the work 

accomplished by the Department 

of the Army. The Army created 

an electronic database which cross 

referenced the patient’s name and 

Social Security number with the name 

of the admitting hospital and dates 

of care for 10,500 in-patient treatment 

records before sending the records 

to the records center in St. Louis. 

This accounted for approximately 

70 percent of the Army Gulf War 

inpatient records. 

Staff members flew to the records 

center in St. Louis to examine more 

than 2,000 boxes identified as Air 

Force and Navy hospital records from 

the Gulf War. The hands-on effort, 

augmented by Army Reservists, 

resulted in the identification of 7,000 

additional Air Force and Navy inpatient hospital records. Rostker’s 

team added this list of individuals 

by name, Social Security number and 

hospital facility name to the Army’s 

electronic database. 

“We literally examined and 

reviewed every record,” said Boyle, 

explaining how the team provided the 

bridge to unlock the information.

Boyle hopes that this effort will 

assist veterans who require records to 

establish a claim with the Department 

of Veterans Affairs due to servicerelated illness, as well as those who 

wish to keep track of their medical 

conditions.

Individual health records of former 

servicemembers are archived in 

two locations, Boyle said. The VA 

Database Helps Locate 

Gulf War Hospital Records

Editor’s Note: This article appeared in 

the August 1998 edition of GulfNEWS. 

Following the article is a brief update to 

the project.

“The records were never lost or 
Deployment Quarterly fall 2002 • http://deploymentlink.osd.mil

W

by rudi williams

american forces press service

hen some Guardsmen and Reservists 

who are sick, injured and suffering 

from some disease return from 

deployments or training, they don’t 

know which way to turn for medical 

care. 

That disturbs Kathleen Woody, 

director of the Department of Defense 

Reserve Affairs’ Reserve Medical 

Readiness and Programs. Because, she 

said, not knowing what their benefits 

are can be a big problem for Reserve 

Component personnel. 

Woody recently spoke at the 

seminar entitled “Post-Deployment 

Care Risk Communication and 

Terrorism: New Clinical Approaches” 

held in Alexandria, Va. 

Active duty servicemembers have 

access to military treatment facilities 

whereas health care providers for 

Reserve Component personnel are in 

the civilian community. Therefore, 

their exposure to military health care 

is limited, Woody pointed out. 

A critical information pipeline 

is needed to ensure that Reserve 

Component personnel are educated 

about their medical benefits before 

and after they’re deployed, she said. 

“In their post-deployment, they 

may not be sensitive to the fact 

that whatever symptoms they’re 

manifesting might be related to their 

deployment,” said Woody, an Air 

Force Reserve colonel who has served 

as a critical care nurse and nurse 

educator in civilian life. 

She said someone in the medical 

field might make the connection, but 

a mechanic out on the flight line may 

not associate their problem with their 

active duty service. 

“Hopefully their civilian physician 

Reserve Component Personn

Need to Know About Medica

will,” said Woody. “However, 

they may not because the civilian 

community doesn’t have the same 

access or understanding of military 

medicine as the military physicians 

do.” 

More than anything in risk 

communications is the need to 

communicate the risk of postdeployment, immunizations, 

medications and medical procedures 

for Reserve Component personnel, 

Woody said. 

“We need to drill it down, not just 

to the commanders 

and down to the 

troops, but we need 

to reach out to the 

communities and 

civilian medical 

providers,” Woody 

pointed out. “The 

whole gist is to get the information 

out to people who need to be sensitive 

to Reserve members in the areas 

they’re deploying to. And, we need 

to ensure that Reservists know what 

their benefits are.” 

Reserve Component personnel are 

only entitled to military medical or 

dental care for any injury, illness or 

disease incurred or aggravated in the 

line of duty. That includes travel to 

and from military duties. But they 

must be tested to ensure the injury, 

illness or disease happened while they 

were on active duty, the colonel noted. 

“For example, if you feel that your 

illness is related to your deployment, 

you can ask for evaluation and 

treatment of that medical condition. 

You don’t have to be in an active duty 

status to do that,” Woody explained. 

“Often the Reserve member doesn’t 

know that. It’s very important for 

commanders to know the process 

and pass the information on to their 

troops.” 

One example of this ignorance 

occurred during the anthrax 

immunization program. 

“Many of our Reservists were 

getting the anthrax immunization 

during their weekend duty and 

returning to their communities,” she 

said. “They didn’t know that one of 

 “If you feel that your illness is related 

to your deployment, you can ask for 

evaluation and treatment of that medical 

condition. You don’t have to be in an active 

Soldiers from Bravo Company 1st Battalion 295th Infantry of the Puerto Rico Army National Guard, 

92d (Sep) Infantry Brigade, wait to have their records reviewed during the Mobilization 

Deployment Readiness Exercises at Camp Santiago Training Site, Salinas, Puerto Rico. 

U.S Army photo by Juan Torres Diaz
http://deploymentlink.osd.mil • fall 2002 Deployment Quarterly

nel 

al Benefits

the common reactions to the vaccine 

is the nodule. Many of the civilian 

physicians didn’t know nodules are 

common to the anthrax vaccine.” 

Consequently, she said, some 

physicians put patients on antibiotics, 

while others lanced the nodule. 

“They didn’t know that in time 

the nodule would resolve itself,” the 

colonel said. 

“It has been quite a challenge to get 

information about anthrax down to the 

lowest level,” Woody said. “There are 

a lot of issues that Reserve Component 

members had with the anthrax vaccine, 

especially our pilots and aircrew 

members.” 

Since Reserve Component personnel 

are stationed around the world, 

Woody said it’s important from a risk 

communication standpoint that they’re 

given the right information about their 

medical benefits. 

“When they’re finished with their 

deployment, all they want to do is 

to go home — back to the Reserve 

community and their jobs,” she noted. 

“So, they’re probably not going to 

report or be aware of a lot of things that 

happen post-deployment.” 

She told the audience about the 

dilemma of a soldier who was in 

Somalia before the 

Army Rangers. He had 

emotional problems and 

a hard time focusing. 

The soldier didn’t 

know where to go for 

help or what resources 

were available after he 

returned home. 

“He had to be 

referred to [Department 

of ] Veterans Affairs 

for treatment,” Woody 

said. “It’s important to 

get information to the 

command level so the 

commander can provide 

guidance to people.” 

Woody emphasized that it’s also 

important that the facts are straight. 

“They need to be correct and 

not anecdotal,” she added. “There 

needs to be a comprehensive 

communications plan to reach out 

to Reserve members in their civilian 

communities.”

Educational programs should be 

targeted to military health care 

providers as well as commanders, 

servicemembers and civilian health 

care providers, Woody said. 

“It needs to be part of an overall 

communications plan so that your 

information is built from the top 

and drilled down,” she said. “The 

message needs to be consistent all 

the way down.” ■ 

Keep Out

Staff Sergeant James L. Walters, a security forces 

member attached to the 405th Air Expeditionary Wing, 

installs concertina wire on top of a barrier protecting 

the secret compartmented information facility at a 

forward-deployed location in support of Operation 

Enduring Freedom. Walters is an Air National Guard 

member deployed from the 129th Security Forces 

Squadron, Moffett Federal Air Field, Calif. When not 

activated, he is a police officer in his hometown of 

Placerville, Calif.

U.S. Air Force photo by SSgt. Cheresa D. Clark
Deployment Quarterly fall 2002 • http://deploymentlink.osd.mil

still work with drinking water 

samples occasionally. They 

study the samples to ensure they 

meet standards determined by 

the Environmental Protection 

Agency and occupational health 

organizations. 

The equipment used by the 

Surveillance Directorate Chemistry 

Division is valued at around 

$6 million and has names like 

gas chromograph and mass 

spectrometer. All of the tools break 

down samples into individual 

chemicals to identify the amount of 

pollutants or hazardous materials in 

a particular environment, natural or 

occupational. ■ 

crises on or after Dec. 8, 1995, according 

to a June 3 Defense Department 

personnel document listing the change. 

Filing procedures for these payments 

are still being developed and will be 

announced when available.

Reserve Component members 

affected by the retroactive policy change 

include those called to active duty in 

support of operations in:

• Bosnia, by Executive Order 12982, 

effective date Dec. 8, 1995.

• Iraqi Crisis, by Executive Order 

13076, effective date, Feb. 24, 1998.

• Kosovo, by Executive Order 13120, 

effective date, April 27, 1999.

• Sept. 11, 2001, terrorist attacks on 

America, Executive Order 13223, with 

effective date Sept. 14, 2001.

The personnel document noted 

that to be eligible for retroactive 

reimbursements, the DoD civilian 

employee must have been: enrolled in 

the Federal Employee Health Benefits 

Program at the time of call-up and 

elected to continue coverage while on 

active duty; a member of the Reserve 

Components of the armed forces; 

ordered to active duty voluntarily or 

involuntarily in support of a contingency 

operation as defined in Section 

101(a)(13), of Title 10, U.S. 

Code; and placed on civilian leave without 

pay or separated from service 

to perform active duty.

The maximum period of eligibility for 

each period of active duty is 18 months.

Defense Department civilian 

employees who are Guardsmen are 

ineligible for reimbursements for periods 

they are or were ordered to duty under 

Title 32 of the U.S. Code or any 

provisions of state, territorial or District of 

Columbia codes.

Current eligible participants must 

provide their personnel administration 

offices with an official written copy of 

orders stating they are being assigned 

to active duty in support of a 

contingency operation under the 

Title 10 authority. 

Upon receipt of valid military 

assignment orders, the servicemember’s 

personnel office will prepare and 

forward the required paperwork. 

It’s important that individuals 

notify their benefits specialist as soon 

as possible, Wilson said. The specialist 

will work with the employee to make 

sure that all applicable benefits process 

smoothly, including the new provisions for 

payment of Federal Employee 

Health Benefits Program premiums, 

she noted. ■

Health Benefits

— Continued from Page 6

Air Sampling

— Continued from Page 7

“We analyzed samples 

of 

air simulating what 

Naval Air Station Fallon, Nev. — Air Force Lt. Col. Russ 

Thomas, playing the role of a downed pilot, shields his 

face as a HH-60 Pave Hawk helicopter lands to extract him 

during exercise Desert Rescue. 

U.S. Air Force photo by Staff Sgt. D. Myles Cullen

Pilot Down
http://deploymentlink.osd.mil • fall 2002 Deployment Quarterly

S

ometimes the dead still speak to us, 

and sometimes the moms and dads and 

grandpas and grandmas we 

know today take on the voices of 

young men and women. 

This is the power of “War Letters,” 

edited by Andrew Carroll. 

The book, released last year, was 

a New York Times bestseller. It is a 

compendium of American war letters 

from the Civil War to today. The 

letters are immediate and give the 

flavor of life and death in the military 

or on the home front. The letters are 

by turns sad, funny or hopeful. They 

give voice to those killed in battle or 

remind us what our veterans sounded 

like when they were in their late teens 

and early 20s. 

The book is available to servicemembers in another blast from the past 

— an Armed Services Edition. Carroll 

is traveling the country giving away 

copies to servicemembers free. He 

started at the Pentagon and will visit 

many major bases in weeks to come. 

Armed Services Editions trace their 

lineage to World War II. Publishing 

houses created compact, condensed 

books that would fit in the cargo 

‘War Letters’ Giveaway Highlights Legacy of 

by jim garamone

american forces press service

pockets of troops’ fatigues. The U.S. 

government distributed more than 120 

million of these books from 1943 to 

1947. Titles ranged from westerns to 

philosophy. 

The “War 

Letters” ASE 

is the first of its kind since 1947. Carroll 

got the idea when he first saw an 

original ASE in a used bookstore. 

“I immediately was drawn to these,” 

he said. “It just seemed, what a great 

thing to bring back!” 

Well before Sept. 11, Carroll spoke 

with his publisher about re-releasing 

a “War Letters” ASE. His publisher 

researched it and, while not cheap, 

came up with 10,000 ASE copies that 

look exactly like the World War II 

versions. 

Fast forward a few months. Carroll 

had been working with the Veterans of 

Foreign Wars on the Legacy Project, a 

national volunteer effort that 

asks Americans to save and 

preserve their war letters. 

All the proceeds from the 

retail “War Letters” book 

goes to veterans groups. 

“The VFW asked if I 

was bringing back the 

ASEs,” he said. “I said, 

‘Yeah,’ and they said they 

wanted to underwrite 

some.” The VFW signed 

on to produce 2.5 million 

books. 

“It’s really great 

because it means we can 

do this launch in a huge 

way and really make a very powerful 

statement, especially to the publishing 

industry that this is something they 

might want to bring back,” Carroll said. 

“I sincerely hope that ‘War Letters’ 

is not the last of the new editions, that 

other publishers will say ‘’Let’s do this 

too. Let’s give books to the troops.’”

Carroll said such books as “Black 

Hawk Down,” “D-Day,” “We Were 

Soldiers Once ... And Young,” and 

“Undaunted Courage” would be ASE — Continued on Page 16

maintains records for Army veterans 

discharged after 1992; and Air Force, 

Marine and Navy veterans discharged 

after 1994. 

To obtain copies, veterans may call the 

VA’s toll-free number (800) 827-1000. For 

all other records, veterans should write to 

the National Personnel Records Center, 

9700 Page Ave., St. Louis, Mo. 63132.

To obtain VA Form 180 Request for 

Medical Records, go to http://www.va.gov

or go to a local VA office.

Update

The Department of Defense’s Office 

of the Special Assistant for Gulf War 

Illnesses concluded its effort to establish 

an Inpatient Treatment Records Database 

of the surviving Gulf War hospital 

inpatient treatment records archived at 

the National Personnel Records Center 

in St. Louis, Mo., in May 2001. The need 

for this database grew out of the concerns 

veterans had expressed about 

locating and obtaining copies of their 

hospital treatment records. Because 

hospital records are archived by 

hospital and not the patient’s name 

locating records can be a daunting 

task. To come up with a solution, 

staff members worked with NPRC 

to search more than 2,00 boxes of 

records in order to identify and 

capture information necessary to 

create a database. 

Through out the project, NPRC 

staff was continuously given updated 

inventory lists for their use in helping 

Gulf War veterans to obtain copies of 

their records.

The final Inpatient Record 

Database contains 28,007 records for 

22,444 admissions to U.S military 

hospitals in the Kuwait Theater 

of Operations and 5,563 records 

for evacuee admissions to U.S. 

military hospitals in Germany. Of 

the total number of admission 

records in Germany, 1,998 records 

Database

— Continued from Page 9

— representing 36 percent — were 

newly identified patients having no 

corresponding record of treatment 

from a hospital in the Kuwait Theater 

of Operations. Of this number, 645 

were patients who had not been 

identified as Gulf War veterans by the 

Defense Manpower Data Center. 

The net result of the combined 

efforts of this office and the NPRC has 

been to reduce, on average, the turn 

around time for veterans to receive 

a copy of their records from eight to 

three weeks.

To obtain copies of inpatient 

hospital records from hospitals 

deployed to the Gulf, veterans should 

call the (800) 497-6261 to request a 

database search. Staff members will 

complete a request form and forward 

it to the veteran 

for signature and mailing to the record 

center. ■
Deployment Quarterly fall 2002 • http://deploymentlink.osd.mil

Safety Assessment Centers of Excellence. 

Their first four sites are in operation. 

The CDC can’t provide health care, but 

their program will serve as a platform 

for research on rare adverse events.

Engler says the National Vaccine 

Healthcare Center program will provide 

five vital services, starting with what 

she terms a much-needed educational 

outreach. To start, she says, the center 

will provide a core staff accessible by 

phone or e-mail for consultations, so 

that those involved in immunizations 

will have clinically skilled people to 

back them up and help them address 

their needs. Her team is also examining 

Internet training options. 

“We’re working on a Web-based 

distance learning tool for core 

immunization education for training 

people to understand the standards,” 

Engler said. “And, I want the centers to 

be an advocate for the resources to do 

that effectively and efficiently.”

A second focus for the center is quality 

improvement in the Vaccine Adverse 

Events Reporting System, also known as 

VAERS. This system, if used properly, 

provides a central place for clinicians 

to see if people receiving a particular 

vaccine show an increased incidence of 

symptoms. However, reports may not 

always be made. In the military, where 

primary health care providers are asked 

to see a patient every 15 minutes, there 

is little time to ask all the right questions 

and get symptoms reported properly. 

Engler says she will encourage both 

doctors and patients to be more diligent 

in that area.

“Although the quality of the VAERS is 

generally better if a health care provider 

participates in the process, beneficiaries 

need to know that they can file their 

own VAERS,” Engler said. “By letting 

everyone know how to access the VAERS 

system when they get their shots and by 

providing additional support through 

the regional centers, we eliminate some 

of the barriers to effective adverse event 

reporting. We will also be reaching out 

to the provider community.”

Clinical support is also a pivotal role 

for the National Vaccine Healthcare 

Center. The center will expand and 

standardize the support offered by 

Walter Reed’s Department of Allergy 

and Immunology to evaluate and 

manage complex adverse events that 

appear to be related to immunizations 

in general, and to the anthrax 

vaccine in particular. By providing 

confidential consultations to health 

care providers they can spread their 

knowledge.

A quality improvement program for 

data collection is the fourth mission. 

Engler says we need to increase what 

we know about attitudes and beliefs 

regarding immunizations among 

providers and among servicemembers 

and beneficiaries. This is also a way 

to compile more data about adverse 

events associated with vaccines.

Finally, the center supports 

clinical research. Engler says studies 

are needed to monitor the results 

whenever changes are made in the 

way vaccines are given. Such research 

would scientifically validate vaccine 

administration strategies or suggest 

useful changes.

When the Walter Reed Vaccine 

Healthcare Center was established 

in September 2001, the planners 

didn’t expect it to do all those jobs 

alone. Engler hopes to see three new 

sites opened within the next year. 

The Navy Ambulatory Care Center 

in Portsmouth, Va., which serves 

the Portsmouth Naval Shipyard, is 

expected to be one of them. Centers 

are planned soon for the Wilford Hall 

Medical Center at Lackland Air Force 

Base, Texas, and the Womack Army 

Medical Center at Fort Bragg, N.C. 

Other centers are also planned for 

Europe and the Pacific region. Further 

in the future, Engler says, we may 

see several centers with smaller 

staffs assigned to training sites and 

troop concentration areas because 

of their special support needs.

“We would then be building, 

with the CDC, a national network 

that’s cohesively linked for data 

sharing,” Engler said. “It would 

be a national resource, not just 

to help the servicemember, but 

to help the whole immunization 

mission.”

Now that the first steps toward 

a network of National Vaccine 

Healthcare Centers have been 

taken, Engler hopes that people 

can be better educated about the 

relative risks of vaccines. Even 

more importantly, she hopes that 

medical personnel will be 

able to better care for those who 

have symptoms that might be 

associated 

with those vaccines. She says for the 

individual whether or not a vaccine 

really is the cause of illness should be a 

secondary issue.

“We need to focus on helping people 

because the limits of our knowledge 

may not for many years allow us to 

prove or disprove a solid link between 

symptoms and vaccine administration,” 

she said.

Engler does not think that the known 

low incidence of adverse reactions to 

vaccines should stop people from 

having that important health protection. 

However, she says that does not reduce 

the importance of any adverse reaction.

“Even if only one person in a 

thousand has a serious problem, we 

have to make sure that we take very good 

care of that one person,” said Engler. 

Individuals or medical personnel 

who have health-related questions 

about vaccines can contact a consultant 

at the Walter Reed Vaccine Healthcare 

Center via e-mail at askvhc@amedd.army.

mil. The Anthrax Vaccine Immunization 

Program can 

field general questions about anthrax 

vaccine at AVIP@otsg.amedd.army.mil. ■ 

Vaccine 

— Continued from Page 8
http://deploymentlink.osd.mil • fall 2002 Deployment Quarterly

C

ountless numbers of deployed 

servicemembers have used millions 

of free phone minutes to call loved 

ones back home, courtesy of the 

Veterans of Foreign Wars’ Operation 

Uplink. Operation Uplink, now in 

its sixth year, has distributed more 

than two million pre-paid phone 

cards — representing more than 18 

million minutes of free airtime — to 

servicemembers and hospitalized 

veterans worldwide. 

“Sometimes a five-minute phone 

call to a loved one is all that it takes 

to ease the burden of loneliness,” 

said VFW Special Programs/Projects 

Manager Joanne Dickerson. “No one 

person is immune. Operation Uplink 

gives a person the chance to call home 

— from anywhere in the world — free 

of charge.”

Dickerson noted that the cost of 

long distance phone calls can be 

very expensive which might prevent 

someone from calling home. For 

example, a 10-minute call from 

Albania can cost $25, and a 10-minute 

call from Saudi Arabia is $15. 

“A soldier, sailor, airman or Marine 

can use one of our pre-paid [Operation 

Uplink] phone cards and talk to 

someone for at least 10 minutes,” said 

Dickerson. 

According to Dickerson, the 

Operation Uplink cards provide 10 

minutes of free airtime domestically 

and nearly that same amount when 

calling internationally. The cards can 

be used from phones anywhere in 

the world, including aboard military 

ships. 

“As soon as we hear that a group 

or unit is deploying, we get the cards 

to them as they’re boarding the plane 

so that they can call home,” said 

Dickerson.

The calling cards are available for 

all servicemembers on a first-come, 

first-serve basis and can be obtained 

Calling Home 

for Free

by lisa gates

through the VFW’s national 

headquarters, state and local VFW 

posts and ladies’ auxiliaries. 

“We get lots of requests for phone 

cards every month,” said Dickerson. 

“We encourage people to use their 

local VFW post as a resource.”

However, Dickerson said, military 

units or servicemembers requesting 

phone cards can write to Operation 

Uplink, VFW National Headquarters, 

406 West 34th Street, Suite 718, Kansas 

City, Mo. 64111. In the letter, Dickerson 

asks, that the military address of 

the intended recipient or group is 

also provided. Additionally, family 

support centers and Veterans Affairs 

hospitals can also request to receive the 

phone cards.

In recent years, some 7,000 

Operation Uplink phone cards have 

been given to servicemembers in 

Kosovo and another 25,000 pre-paid 

phone cards to troops stationed in 

Korea. Shortly after the attack on the 

USS Cole, the VFW arranged to have 

more than 600 domestic and the same 

number of global Operation Uplink 

phone cards delivered to the families 

and crewmembers within 24 hours.

“I also get lots of thank you 

messages from servicemembers 

who have used the card,” said 

Dickerson. “This is an important way 

for the public to connect with our 

servicmembers and to show them our 

appreciation, especially now.”

“Being able to call home and talk 

to my four-year daughter makes a 

difference in my deployment. Thank 

you,” wrote an Army sergeant who 

sent a message to Dickerson.

“I used the card to let my wife and 

two children know that I arrived in 

Korea safely. The card could be used 

from any base phone so it made it 

easy to make my first call home,” said 

another message received by Dickerson 

from a deployed servicemember.

Although the VFW’s Operation 

Uplink is a not-for-profit program, 

funding is provided for by private 

donations from individuals, VFW 

posts, ladies’ auxiliary units and 

private corporations. 

“Due to a large monetary donation 

from a private corporation last year, 

we had 30,000 pre-paid calling cards 

on hand that were distributed to 

servicemembers and veterans right 

after Sept. 11,” said Dickerson. The 

donation from the private corporation 

provided cards for the troops serving 

in Operation Enduring Freedom for the 

2001 holiday season.

To learn more about this program, 

visit the Veterans of Foreign Wars Web 

site at http://www.vfw.org. The Veterans 

of Foreign Wars, based in Kansas City, 

Mo., is the oldest major veterans’ 

group in the U.S. The VFW and Ladies 

Auxiliary have 2.7 million members, 

combined. ■

Courtesy of the VFW

Since 1996, Operation Uplink has provided 

more than 7.5 million minutes 

of free long-distance calling cards to 

hospitalized veterans and active duty 

military personnel and their families. 

For more information about Operation 

Uplink and other services and programs 

offered by the Veterans of Foreign Wars, 

go to http://www.vfw.org.

For More Information
Deployment Quarterly fall 2002 • http://deploymentlink.osd.mil

A

n ongoing Department of Defense 

health study will ultimately examine 

health surveys submitted by 140,000 

current and former servicemembers 

across two decades. 

The joint-service Millennium Cohort 

Study will evaluate the health risks 

of military deployments, occupations 

and general military service, said Navy 

Cmdr. Margaret A.K. Ryan, director of 

the DoD Center for Deployment Health 

Research in San Diego. 

The Millennium Cohort Study is 

designed to examine the health effects 

of military service on men and women, 

both during service and after they 

leave, Ryan explained. More than 

60,000 servicemembers have signed up 

to take part since program enrollment 

began in August 2001, she added. 

The project “is the largest and 

most ambitious study of military 

people ever,” she added, noting that 

Research Study Evaluates Troops’ Health Trends

by gerry j. gilmore

american forces press service 

participants’ health would be evaluated 

over a 21-year period. 

Ryan, principal investigator for 

the study, works with six other 

investigators. The results of the study, 

she noted, may also be used to develop 

future DoD health policies. 

Active and Reserve Component 

Army, Marine Corps, Navy and 

Air Force members were randomly 

selected and invited to participate in the 

study, she said. 

“People could not volunteer to be 

part of the cohort — that would be a 

different kind of study, like a registry 

project. A cohort study is a much 

stronger study design,” Ryan explained. 

She said the first group, or cohort, 

will ultimately consist of about 100,000 

enrollees. Ryan said participants 

enroll by filling out a paper form 

or signing up online at http://www.

millenniumcohort.org. 

The study will enroll another group 

of 20,000 people in 2004, Ryan said. 

The last 20,000 of the total 140,000 

Millennium Cohort members will enroll 

by 2007. 

Ryan said participants are asked 

to complete surveys about their basic 

health every three years. The surveys, 

she noted, inquire about any acute 

or chronic health problems, possible 

exposures to toxic substances during 

military deployments and healthrelated behaviors like smoking and 

exercise. 

Information gathered from surveys 

is held in the strictest confidence, Ryan 

emphasized, and is only shared as 

summarized, anonymous research data. 

“We take quite a bit of effort to make 

sure that all of the information people 

provide is confidential,” she said. 

“None of this information leaves the 

DoD Center for Deployment Health 

Research.” 

Communications are maintained 

between officials and survey 

participants for the duration of the 

program, Ryan said. 

“We ask cohort members to help 

us track their addresses and so on 

throughout the years, so that we can 

contact them,” she added.

She said participants specify how 

they’ll maintain contact — work 

address, home address or e-mail — 

however they prefer. She noted the 

critical importance of cohort members 

maintaining contact — participants 

are selected scientifically to provide 

an accurate cross-section of the force. 

For example, she said, some people 

invited are currently deployed 

overseas as part of Operation 

Enduring Freedom. Recognizing 

the challenge of enrolling in The 

Millennium 

Cohort Study while deployed, Ryan 

noted people could sign up when 

they return to a more convenient 

location. 

People who’ve received invitations 

to enroll in The Millennium Cohort 

Study should take the time to do 

so, she emphasized. Information 

from the surveys, she said, “is very 

important for the military and for 

veterans.” ■ 

UPDATE: The Millennium Cohort Study
http://deploymentlink.osd.mil • fall 2002 Deployment Quarterly

T

healthbeat

by bureau of medicine and surgery

he most common form of oral cancer 

is known as squamous cell carcinoma. 

It classically develops as a craterlike lesion having a velvety red base 

with rough edges similar to a very 

bad “pizza burn.” However, it may 

appear as white patches, with some 

irregular red patches, mixed together 

in its earlier stages.

An important aspect of squamous 

cell carcinoma is its location within 

the mouth. The lower lip and the 

tongue are the most frequent sites 

with the floor of the mouth not far 

behind. 

Lesions are usually solitary. 

However, in some cases, have been 

found to occur in groups. The 

concern with the location is that 

certain areas allow the cancer an 

easier route to spread to other parts 

of the body, metastasize and lessen 

chances for a good prognosis. Lesions 

found on the back third of the 

tongue have the greatest chance to 

metastasize, usually to lymph nodes 

in the neck.

As with most cancers, the medical 

community still doesn’t know 

everything there is to know about 

what causes squamous cell carcinoma. 

However, they do 

know what increases the risks of 

developing it. 

The use of tobacco products 

Oral Cancer: Are You at Risk?

— smoking, snuff, pipe or cigar — are 

major risk factors. Additionally, the 

use of alcohol products has been found 

to increase the risks of developing the 

cancer.

When these two risk factors are 

put together, it becomes the greatest 

risk factor. This is why the highest 

occurrence of oral cancer is found 

in the middle-aged to elderly male 

population who has a history of 

tobacco and or alcohol use

The treatment of squamous cell 

carcinoma depends on several factors: 

time of detection, size of tumor, 

spread of tumor, etc. Treatments 

may range from surgical removal 

of the tumor, radiation of the tumor 

to chemotherapy. Most occurances 

may require a combination of these 

treatments. 

The overall five-year survival rate 

for all oral cancer patients is about 

40 percent. This percentage is getting 

better as we are detecting the cancer 

earlier and educating patients to the 

risk factors associated with the cancer. 

It is very important that patients 

periodically examine their mouths for 

any changes that could be associated 

with oral cancer. A self-exam is fairly 

simple and could save a person’s life. 

It must be understood that there is 

very little, if any, pain associated with 

oral cancer until the very late stages. 

Therefore, it is imperative that people 

routinely stand in front of the mirror 

and actually take a look inside of their 

mouth. 

Use a mirror with good lighting, 

open your mouth wide enough to see 

all of your teeth and the back of your 

throat. A good time to do this is right 

after you brush your teeth. Look at 

the insides of your cheeks, the roof of 

your mouth, your tongue (especially 

the sides as far back as possible), the 

floor of your mouth, your gums and the 

inside of both of your lips. 

Note anything that appears to be an 

odd color, texture, or shape especially 

when it is only found on one side of 

your mouth. Keep in mind that the 

early signs of squamous cell carcinoma 

usually show up as white or red 

patches or some combination. 

Should you find anything suspicious, 

schedule an appointment with your 

dentist for a professional exam, 

especially if you fall into one of the 

high-risk groups (use of tobacco 

and or alcohol). Your dentist should 

examine an ulcer in your mouth that 

doesn’t heal within two weeks. Dentists 

routinely do an oral cancer screening 

upon your normal check-ups, but do 

not neglect to do a self-exam on your 

own mouth at least once a week. 

Remember, the earlier that squamous 

cell carcinoma is detected, the better 

the prognosis. As with all oral health 

concerns, prevention is the key to 

success. ■

Capt. (Dr.) Angela Pelletier, a 376th Expeditionary 

Medical Group dentist deployed to Ganci Air Base, Manas, 

Kyrgyzstan, from Luke Air Force Base, Ariz., cleans a patient’s 

teeth with assistance from dental technician Republic of 

Korea Army Cpl. Seong-Beom Ryu. Ryu and other South 

Korean military personnel join medical personnel from the 

United States and coalition countries to treat forces deployed 

in support of the war on terrorism. 

Photo by Master Sgt. Keith Reed 

Sick Call

Open Wide
Deployment Quarterly fall 2002 • http://deploymentlink.osd.mil

S

ince October 2000, more than 100,000 healthy sailors, 

soldiers and Marines have volunteered in the largest 

vaccine trial in military history to see if the current 

pneumonia vaccine can reduce the incidence of disease 

among military members.

“From previous research, we know that pneumonia 

outbreaks occur and we know that this pathogen 

circulates in recruit populations,” said Naval Health 

Research Center’s Cmdr. Kevin Russell, Medical Corps, 

who is the principal investigator of the study. “We 

also know that a lot of other pathogens are circulating 

and can cause illness. This study will tell us if giving 

another vaccine to recruits will have a positive impact 

or not.”

The vaccine, which protects against many strains 

of Streptococcus pneumoniae (pneumococcus), is FDAapproved and has been commonly recommended for 

the elderly, the chronically ill and newborns, especially 

since some strains are becoming anti-biotic-resistant. 

The vaccine’s value 

in protecting healthy young adults, however, is 

unproven.

Nearly 192,000 military members will be enrolled 

in the study before it is completed in late 2003. 

Volunteers receive an injection of either the vaccine 

or a placebo, and are followed for up to 24 months to 

assess their respiratory health.

“This study will help answer an important question 

for both military and civilian communities,” said 

Russell. 

Military trainee volunteers from Fort Jackson, 

NC; Parris Island, S.C.; Great Lakes, Ill.; and Fort 

Leonard Wood, Mo., are participating. The Centers 

for Disease Control and Prevention, the Mayo Clinic 

and Foundation, the University of Iowa and Wyeth 

Pharmaceuticals collaborated with DoD and Navy 

researchers on the trials.

Data show that military trainees are at increased 

risk of all respiratory diseases, including pneumonia. 

Outbreaks of pneumococcal disease have occurred at 

Camp Pendleton, Calif., and Fort Benning, Ga. ■

Study Evaluates 

Pneumonia Vaccine 

in Healthy Adults

Maj. Janet P. Broome (left) attends to the medical needs of Army 

Spc. Serena L. Scott, during transport from a forward-deployed 

location in support of Operation Enduring Freedom Aug. 28, 2002. 

Servicemembers with major illnesses and injuries are evacuated from 

forward locations as soon as possible in order to receive specialized 

medical care currently unavailable in their deployed environments. Broome 

is a member of the Air Force Reserve attached to the 438th Expeditionary 

Aeromedical Evacuation Squadron. As a civilian, she is a bone marrow 

transplant coordinator for the University of Alabama at Birmingham School 

of Medicine. 

U.S. Air Force photo by Staff Sgt. Cheresa D. Clark

Healing the Sick

by doris ryan

bureau of medicine and surgery

“Protecting the health of deployed 

military personnel is a paramount 

concern of the Department of Defense.”

— William Winkenwerder Jr., M.D., MBA

 Assistant Secretary of Defense for Health Affairs

Notable quote
http://deploymentlink.osd.mil • fall 2002 Deployment Quarterly

F

ew hospital corpsmen in the world know 

more about saving lives in the field than 

Thomas M. Eagles. 

As a young corpsman in Vietnam, 

he served six years in the battlefield, 

patching up wounded Marines and 

sailors, flying medevac, building 

dispensaries, and even saving an injured 

child from an active minefield.

Master Chief Eagles retired nine 

years ago, but his intense caring for the 

well being of others hasn’t changed. 

He wears civilian clothes now, but he 

still works to save the lives of Marines, 

sailors, soldiers and airmen.

Eagles is now an acquisition project 

officer with the Marine Corps Systems 

Command. His mission is to make a 

better individual first aid kit for Marines 

and Navy medicine personnel to carry in 

the field.

According to Eagles, it’s the first time 

in more than 20 years the kit has been 

revamped.

“My number one imperative [to 

improve the kit] is to provide Marines 

with a new capability to stop bleeding as 

quickly as possible,” said Eagles.

He said that half of warriors wounded 

in the field who die do so because of 

blood loss — a statistic that hasn’t 

changed since World War II, and one he 

has a personal interest in improving.

“I’ve seen Marines bleed to 

death in the field,” said Eagles, grimly. 

“It’s not something I want to see again.”

His search for a way to stop bleeding 

led him to QuickClot, a coarse, 

super clotting powder. An informal 

conversation with a visitor to his office 

lead to a discussion about a moistureabsorbing component of a newly 

developed oxygen generator.

“I asked him if it would stop the 

bleeding,” said Eagles. “He said his boss 

cut himself while shaving and it worked, 

and that his little daughter had scraped 

her knee and it worked on that, too. I 

asked him to send a sample of it to me, 

overnight mail.”

At the same time, the Office of 

Naval Research and the Marine 

Corps Warfighting Laboratory 

were working on developing 

a dressing that would control 

bleeding.

“ONR [Office of Naval 

Research] and MCWL [Marine 

Corps Warfighting Laboratory] 

had money to look at three 

[clotting] candidates,” said 

Eagles. “We had three lined 

up to look at, but one didn’t 

get FDA clearance in time. We 

needed a third, so I asked them 

to look at the sample.”

Eagles admitted that he 

wasn’t enthusiastic about the 

powder.

“I had to change my way 

of thinking,” said Eagles. 

“The others I looked at were 

pads, something corpsmen 

are familiar with. This was 

completely different.”

Besides being exceptionally 

effective in stopping the bleeding, the 

sample, called QuickClot, is simple 

to use — tear a corner off the plastic 

bag and pour the powder on the 

wound. Virtually indestructible, and 

biologically and chemically inert, it is 

well suited for the harsh conditions of 

the battlefield. It’s also much cheaper 

than the other proposed candidates.

Another change to the kit includes 

a newly developed tight-cinching 

battle dressing, made from common 

materials.

“It’s really just an elastic wrap 

bandage, a feminine pad, a Velcro 

strip and a shower hook,” said Eagles.

The big difference from battle 

dressings used in the past is that it’s 

easy and quick to use, and super 

absorbent. In fact, like QuickClot, it 

can be applied with one hand in less 

than 30 seconds. The third new key 

component in the kit is a crinkled 

absorbent vacuum-packed rolled 

bandage that can either be unwound 

and used like gauze or wadded into the 

wound as a back up for QuickClot.

Field First Aid 

Kits Redesigned 

to Save Lives

“The three of them used together 

are incredibly effective in stopping 

bleeding,” said Eagles. “I’m 

convinced it will change the statistics.”

The remaining contents of the 

kit include 10 adhesive bandages 

for scrapes and scratches, water 

purification tablets and Betadine, 

a germ killing liquid. The contents 

fit tightly into an olive green cloth pack. 

Another plus for the new kit is that it 

weighs 11 ounces. That’s five ounces 

lighter than the old one. The weight 

saving is something to be excited about, 

especially when a Marine’s or SEAL’s 

pack may already weigh 80 pounds or 

more.

Eagles said that a few of the new 

field first aid kits are already in use in 

Afghanistan, and are scheduled for 

widespread use in the field with the 

Marines and Navy medicine 

personnel as early as next year. 

One of Eagles’ next projects is to 

evaluate the hospital corpsman’s 

medical kit used in the field. ■

by jan davis

bureau of medicine and surgery
Deployment Quarterly fall 2002 • http://deploymentlink.osd.mil

other resources

Air Force Association

1501 Lee Highway

Arlington, VA 22209-1198

Phone: (800) 727 - 3337

http://www.afa.org

American Legion

1608 K St., NW

Washington, DC 20006

Phone: (202) 861 - 2700

http://www.legion.org

American Red Cross

17th & D Streets, NW

Washington, DC 20006

Phone: (202) 639 - 3520

http://www.redcross.org

AMVETS

4647 Forbes Blvd.

Lanham, MD 20706

Phone: (877) 726 - 8387

http://www.amvets.org

Association of the U.S. Army

2425 Wilson Blvd.

Arlington, VA 22201

Phone: (800) 336 - 4570

http://www.ausa.org

Department of Veterans Affairs

810 Vermont Ave, NW

Washington, DC 20400

Phone: (202) 273 - 4300

http://www.va.gov

Disabled American Veterans

807 Maine St., SW

Washington, DC 20024

Phone: (202) 554 - 3501

http://www.dav.org 

Enlisted Association of 

the National Guard

1219 Prince St.

Alexandria, VA 22314

Phone: (800) 234 - 3264

http://www.eangus.org

Fleet Reserve Association

125 N. West St.

Alexandria, VA 22314-2754

Phone: (703) 683 - 1400

http://www.fra.org

Marine Corps Association

715 Broadway Street

Quantico, VA 22134

Phone: (866) 622 - 1775

http://www.mca-marines.org

Marine Corps League

8626 Lee Highway, #201

Merrifield, VA 22031

Phone: (800) 625 - 1775

http://www.mcleague.org

National Association for 

Uniformed Services

5535 Hempstead Way

Springfield, VA 22151

Phone: (800) 842 - 3451

http://www.naus.org

National Committee for Employer 

Support of the Guard and Reserve

1555 Wilson Boulevard, Suite 200

Arlington, VA 22209-2405

Phone: (800) 336 - 4590

http://www.esgr.org

National Guard Association

of the United States

1 Massachusetts Ave., NW

Washington, DC 20001

Phone: (202) 789 - 0031

http://www.ngaus.org

Naval Reserve Association

1619 King St.

Alexandria, VA 22314-2793

Phone: (703) 548 - 5800

http://www.navy-reserve.org

Navy League

2300 Wilson Blvd.

Arlington, VA 22201

Phone: (800) 356 - 5760

http://www.navyleague.org

Non Commissioned 

Officers Association

225 N. Washington St.

Alexandria, VA 22314

Phone: (703) 549 - 0311

http://www.ncoausa.org

Reserve Officers Association

1 Constitution Ave., NE

Washington, DC 20002

Phone: (800) 809 - 9448

http://www.roa.org

Retired Officers Association

201 N. Washington St.

Alexandria, VA 22314

Phone: (800) 245 - 8762

http://www.troa.org

Veterans of Foreign Wars

200 Maryland Ave., NE

Washington, DC 20002

Phone: (202) 543 - 2239

http://www.vfw.org

Vietnam Veterans of America

8605 Cameron Street, Suite 400

Silver Spring, MD 20910-3710

Phone: (301) 585 - 4000

http://www.vva.org

By Phone

Direct Hotline for Servicemembers, 

Veterans and Families 

(800) 497 - 6261

Department of Veterans Affairs

(800) 827 - 1000

VA Persian Gulf War Registry 

(800) 749 - 8387

VA Benefits and Services 

(877) 222 - VETS

On the Web

Department of Defense

http://www.defenselink.mil

Department of Veterans Affairs

http://www.va.gov/

DeploymentLINK

http://deploymentlink.osd.mil

GulfLINK

http://www.gulflink.osd.mil

TRICARE

http://www.tricare.osd.mil/

re- guide