OSD has not issued a policy, nor has DOD developed doctrine, to address exposures of U.S. troops to low levels of chemical warfare agents on the battlefield. DOD officials explained that low-level exposures were not addressed because there was no validated threat and no consensus on what constituted low-level exposures or whether they produced adverse performance or health effects in humans. Nevertheless, some entities within DOD are preparing chemical defense strategies and developing technologies that are expected to address low-level exposures. OSD has not issued a policy on the force protection regarding low-level chemical weapon agent exposures, and DOD has not developed doctrine that addresses low-level exposures to chemical warfare agents, either in isolation or combination with other contaminants that would likely be found on the battlefield. DOD officials have characterized the primary intent of existing NBC doctrine for battlefield management as enabling mission accomplishment by ensuring force preservation rather than force protection. The operational concept that underlies NBC doctrine and drives chemical warfare defense research, development, and acquisition has been to “fight through” the chemical and biological threat and accomplish the mission, with the assumption that overwhelming conventional capabilities will enable U.S. forces to prevail on the battlefield. Thus, the focus on massive battlefield chemical weapon use has framed the concepts of the role of chemical and biological defense in warfare. In a battlefield scenario, the NBC defense goal is to ensure that chemical exposures to the troops result in less than 1 percent lethalities and less than 15 percent casualties, enabling the affected unit to remain operationally effective. Nevertheless, DOD doctrine differentiates between possible high-level chemical warfare threats in foreign battlefield scenarios and low-level chemical exposures in domestic chemical weapon storage and destruction facilities. In a domestic chemical storage scenario, facilities and procedures are required to ensure that unprotected workers would receive no more than an 8-hour occupational exposure limit and that the adjacent civilian population would receive no more than a 72-hour general population limit, both of which are not expected to result in any adverse health effects. According to DOD, its doctrine does not address low-level exposures on the battlefield because there is no (1) validated threat, (2) definition of low-level exposures, (3) or consensus on the effects of such exposures. Moreover, if low-level exposures were to be addressed, DOD officials said that the cost implications could be significant. For example, increased costs could result from the need for more sensitive chemical detectors, more thorough decontamination systems, or more individual and collective protection systems. However, no studies have been done to evaluate the potential cost implications of expanding policy and doctrine to address low-level exposure concerns for force protection. OSD officials said that any future low-level requirements would need to compete for funds with an existing list of unfunded chemical and biological defense needs. In October 1997, the Presidential Advisory Committee on Gulf War Veterans’ Illnesses noted that existing DOD doctrine addresses only exposure to debilitating or lethal doses of nerve or mustard chemical warfare agents on the battlefield. The Committee subsequently recommended that DOD develop doctrine that addresses possible low-level subclinical exposure to chemical warfare agents. Specifically, the Committee recommended that DOD’s doctrine establish requirements for preventing, monitoring, recording, reporting, and assessing possible low-level chemical warfare agent exposure incidents. In his February 1998 testimony before the House Committee on Veterans’ Affairs, the Special Assistant to the Deputy Secretary of Defense for Gulf War Illnesses stated that DOD does not believe there is a need for doctrine concerning low-level chemical exposures but that DOD would consider taking action if research indicates a need for such doctrine. DOD officials said that there is no validated low-level threat and that the probability of encountering low-level contaminated conditions on the battlefield is minimal. If low-level chemical exposures were to occur, the officials stated that the exposures would likely be inadvertent and momentary—resulting from residual contamination after the use of high-dose chemical munitions. DOD experts on the storage and release of chemical warfare agents have asserted that only in a laboratory could agent dosages exist at a low concentration more than momentarily. Nevertheless, DOD has studied how the intentional use of low doses of chemical warfare agents could be used to achieve terrorist and military objectives. DOD raised concerns over the intentional use of low-level chemical warfare agents in its 1997 study, Assessment of the Impact of Chemical and Biological Weapons on Joint Operations in 2010, which analyzed the impact of state-sponsored terrorist attacks using chemical warfare agents. The study’s threat scenario, which was not validated by any intelligence agency, entailed chemical warfare agents being spread thinly, avoiding lethal levels as much as possible, for the purpose of stopping U.S. military operations and complicating detection and cleanup. The study found that massive battlefield use of chemical and biological weapons is no longer the most likely threat and that U.S. forces must be able to counter and cope with limited, localized chemical and biological attacks, including attacks delivered by asymmetrical means. This study exposed serious vulnerabilities to the U.S. power projection capabilities that could be exploited by the asymmetrical employment of chemical and biological weapons both in the United States and in foreign theaters of operation. The study also found that the U.S. intelligence capability to determine small-scale development and intent to use chemical or biological weapons, particularly for limited use, is inadequate. Shortfalls include insufficient ability to collect and assess indications and warnings of planned low-level chemical and biological attacks. The report concluded that OSD should significantly increase its level of attention to vulnerabilities posed by an enemy using asymmetrical and limited applications of chemical and biological weapons. The absence of an OSD policy or DOD doctrine on low-level exposures is partly attributable to the lack of a consensus within DOD on the meaning of low level. DOD officials responsible for medical chemical defense, nonmedical chemical defense, NBC doctrine, and NBC intelligence provided varying definitions of low-level exposure, including the Oxford Dictionary definition, no observable effects, sublethal, and 0.2 LD. Despite the differing responses, each one can be depicted as a location along the lower end of a chemical warfare agent exposure and effects continuum. (App. IV describes physiological effects from increasing levels of chemical warfare agent exposures.) Figure 1 shows that one end of the continuum is extremely high exposures that result in death, and the other end is no or minimal exposures that result in no performance or health effects. Between these extremes is a range of exposures and resulting effects. In addition to a lack of consensus on the definition or meaning of low-level exposures, there is a lack of consensus within DOD and the research community on the extent and significance of low-level exposure effects. These differences result from several factors. First, the chemical warfare agent dose-response curves can be quite steep, leading some DOD officials and researchers to question the concern over a very narrow range of sublethal dose levels. Second, the extrapolation of findings from studies on the effects of chemical warfare agent exposures in animals to humans can be imprecise and unpredictable. Third, the impacts of different methods of chemical warfare agent exposure, such as topical, injection, and inhalation, may result in varied manifestations and timings of effects, even with comparable concentrations and subject conditions. For example, many of the effects attributable to chemical warfare agent exposure are subjective and either do not occur or cannot be measured in many animal species. Fourth, the preponderance of information on the combined effects of low-level exposures is lacking. Nearly all research on low-level effects addresses single agents in isolation; defining low levels of an agent when present in combination with other battlefield contaminants has not been addressed. In addition, most research has involved single, acute exposures with observations made over several hours or days. Few studies have examined the possible long-term effects of continuous or repeated low-level exposures. Last, research is not yet conclusive as to what level of exposure is militarily or operationally significant. The impact of a specific symptom resulting from chemical warfare agent exposure may vary by the military task to be performed. For example, miosis (constriction of the eye’s pupil) may have a greater adverse impact on a pilot or a medical practitioner than a logistician. Nonetheless, the dose and effects data are only some of the many factors considered in risk analyses conducted by military commanders. DOD officials told us that trade-offs among competing factors are more often than not based on professional judgment of persons with extensive knowledge based on military and technical education, training, and experience rather than an algorithm with numerical input and output. Despite the lack of an OSD policy on low-level exposures, some elements within DOD have begun to address issues involving such exposures. In describing DOD’s NBC defense strategy for the future, the Chairman of the Joint Service Materiel Group noted that the presence of low levels of chemical warfare agents will be one of the factors to consider before sending U.S. troops to a contingency. Specifically, the future strategy will no longer be primarily shaped by the occurrence of mild physiological effects, such as miosis, but rather the possible long-term health effects to U.S. forces. Lessons learned from the Gulf War are reflected in DOD’s NBC defense strategy, which focuses on the asymmetrical threat. Gulf War Syndrome and low-level threats are identified as two of the concerns to be addressed in the future NBC defense strategy. The Group Chairman added that traditionally the de facto low-level definition has been determined by DOD’s technical capability to detect the presence of an agent. However, the Chairman stated that the low-level concept in future chemical defense strategies will need to be defined by the medical community and consider the long-term health effects of battlefield environments. The Joint Service Integration Group—an arm of the Joint NBC Defense Board that is responsible for requirements, priorities, training, and doctrine—is working with the services to create a joint NBC defense concept to guide the development of a coherent NBC defense program. One of the central tenets of the proposed concept is to provide effective force protection against exposure threats at the lower end of the continuum, such as those from terrorism and industrial hazards. Also, the proposed concept envisions a single process for force protection to provide a seamless transition from peacetime to wartime. Even though the levels and types of threat can differ, a single overall process can meet all joint force protection needs. Thus, the NBC joint concept will address threats against DOD installations and forces for both peacetime and military conflicts. In addition, the joint concept will provide a conceptual framework for defense modernization through 2010, but the specific programs and system requirements necessary for the implementation of the concept will not be articulated. The services are concurrently identifying NBC defense joint future operational capabilities to implement the joint concept. Several of these capabilities relate to low-level exposure, such as (1) improving detection limits and capabilities for identifying standard chemical warfare agents by 50 percent, (2) lowering detection sensitivity limits and detection response times for identifying standard chemical warfare agents by 50 percent, and (3) lowering detection response time for standard biological agents by at least 50 percent. Even in the absence of adopted joint force operational capabilities, DOD is incorporating low-level capabilities in the design of new chemical defense equipment. For example, the Joint Chemical Agent Detector, currently under development, is expected to provide an initial indication that a chemical warfare attack has occurred and detect low-level concentrations of selected chemical warfare agents. The detector will replace currently fielded systems that have a limited ability to provide warning of low-dose hazards from chemical warfare agents. The operational requirements for the detector specify that it will be able to detect low-level concentrations of five nerve agents and two blister agents. However, the low-level requirement necessitates trade-offs between the breadth of agents that the detector can identify and its ability to monitor low-level concentrations for a select few agents. Thus, the next-generation chemical warfare agent detector is expected to have a capability to detect lower chemical warfare agent concentrations in more locations. In the absence of policy—or additional research on low-level effects—it cannot be known whether the current, less capable detectors would have the appropriate capabilities to meet the requirements of a low-level exposure doctrine. Research on animals and humans conducted by DOD and others has identified some adverse psychological, physiological, behavioral, and performance effects of low-level exposure to some chemical warfare agents. Nonetheless, researchers do not agree on the risk posed by low-level exposures and the potential military implications of their presence on the battlefield, whether in isolation or in combination with other battlefield contaminants. DOD has no research program to address the remaining uncertainties regarding the performance and health effects of low-level exposures to chemical warfare agents; however, two new research initiatives are currently under consideration. The majority of the chemical warfare agent research has been on organophosphate nerve agents and related pesticides. At low doses, nerve agents produce a wide range of effects on the central nervous system, beginning with anxiety and emotional instability. Psychological effects in humans from nerve agent VX on skin have been noted earlier than physical effects (e.g., nausea and vomiting) or appeared in the absence of physical effects. The psychological effects were characterized by difficulty in sustaining attention and slowing of intellectual and motor processes. Doses considerably below the LD can degrade performance and alter behavior. These performance and behavioral effects have clear military implications because affected service personnel exposed to chemical warfare agents might not only lose the motivation to fight but also lose the ability to defend themselves and carry out the complex tasks frequently required in the modern armed forces. Moreover, the detrimental effects of exposure to single doses of nerve agents may be prolonged. Concern about low-level chemical warfare agent effects predate Operation Desert Storm. In the 1980s, the Air Force conducted research on the bioeffects of single and repeated exposures to low levels of the nerve agent soman due to concerns about the effects of low-level chemical agent exposures on vulnerable personnel—such as bomb loaders, pilots, and medical personnel—who may be required to work in low-level contaminated environments. The Air Force found that the nerve agent degraded performance on specific behavior tasks in the absence of obvious physical deficits in primates. Thus, even for extremely toxic compounds, such as organophosphate nerve agents, which have a steep dose-response curve, task performance deficits could be detected at low levels of exposure that did not cause any overt signs of physical toxicity. This research was unique because low-level exposures were thought at that time to be unlikely or unrealistic on the battlefield. Table 1 shows examples of research conducted or funded by DOD on the behavioral and performance effects of organophosphate nerve agents. The research examples reveal that sublethal exposures of an agent can have a variety of effects (depending on the species, exposure parameters, time, and combination of exposures) and produce measurable, adverse effects on physiology and behavior (both motor and cognitive performance). In our prior report on Gulf War illnesses, we summarized research on the long-term health effects of chemical warfare agents, which were suspected of contributing to the health problems of Gulf War veterans. The report cited research suggesting that low-level exposure to some chemical warfare agents or chemically related compounds, such as certain pesticides, is associated with delayed or long-term health effects. Regarding delayed health effects of organophosphates, we noted evidence from animal experiments, studies of accidental human exposures, and epidemiological studies of humans that low-level exposures to certain organophosphorus compounds, including sarin nerve agents to which some U.S troops may have been exposed, can cause delayed, chronic neurotoxic effects. We noted that, as early as the 1950s, studies demonstrated that repeated oral and subcutaneous exposures to neurotoxic organophosphates produced delayed neurotoxic effects in rats and mice. In addition, German personnel who were exposed to nerve agents during World War II displayed signs and symptoms of neurological problems even 5 to 10 years after their last exposure. Long-term abnormal neurological and psychiatric symptoms, as well as disturbed brain wave patterns, have also been seen in workers exposed to sarin in manufacturing plants. The same abnormal brain wave disturbances were produced experimentally in nonhuman primates by exposing them to low doses of sarin. Delayed, chronic neurotoxic effects have also been seen in animal experiments after the administration of organophosphate. In other experiments, animals given a low dosage of the nerve agent sarin for 10 days showed no signs of immediate illness but developed delayed chronic neurotoxicity after 2 weeks. Nonetheless, some DOD representatives in the research community have expressed considerable doubt that low-level exposures to chemical warfare agents or organophosphates pose performance and long-term health risks—particularly in regard to the likelihood that low-level exposures are linked to Gulf War illnesses. These doubts stem from the lack of a realistic scenario, the lack of adverse long-term health effects observed in studies of controlled and accidental human exposure or animal studies, and results that are viewed as incompatible with the principles of biology and pharmacology. Researchers we interviewed did agree that the work that has been done to date is lacking in several aspects, including (1) the effects of exposure to low levels of chemical warfare agents in combination with other agents or contaminants likely found on future battlefields; (2) extrapolation of animal models to humans; (3) the breadth of agents tested, types of exposure routes, and length of exposure; and (4) the military or operational implications of identified or projected low-level exposure effects. of soman while the agent is in the blood and before it can affect the central nervous system. Therefore, for each nerve agent there may be a threshold of exposure below which no effects will result. one DOD scientist, “Research can improve our understanding of the relationships among the many factors, such as effects, time of onset of effects, duration of effects, concentration, duration of exposure, dosage, and dose. Improved estimates of effects in humans resulting from exposure to chemical warfare agents are a requirement that has existed since World War I.” Consistent with that assessment, the Army’s Medical Research and Materiel Command is proposing a science and technology objective to establish a research program on the chronic effects of chemical warfare agent exposure. Because previous research efforts have emphasized the acute effects of high (battlefield-level) exposures, there is little information on the repeated or chronic effects of low-dose exposures. The Command’s research effort is in response to this lack of information and joint service requirements for knowledge of the effects on personnel in sustained operations in areas that may be chemically contaminated, thus creating the possibility of a continuous low-level exposure. Additionally, the Joint Service Integration Group has tasked a panel of experts to determine an accepted definition for low-level chemical warfare agent exposure. The panel has proposed a series of research efforts to the Joint NBC Defense Board to analyze the relationships among dose, concentration, time, and effects for the purpose of determining safe exposure levels for sustained combat operations. DOD has funded two National Academy of Sciences studies to support the development of a long-term strategy for protecting U.S. military personnel deployed to unfamiliar environments. These studies will provide guidance for managing health and exposure issues, including infectious agents; vaccines; drug interactions; stress; and environmental and battlefield-related hazards, such as chemical and biological agents. One study is assessing approaches and technologies that have been or may be used by DOD in developing and evaluating equipment and clothing for physical protection and decontamination. The assessment is to address the efficacy of current policies, doctrine, and training as they relate to potential exposures to chemical warfare agents during deployments. The second study is assessing technology and methods for detection and tracking of exposures to a subset of harmful agents. This study will assess tools and methods to detect, monitor, and document exposures to deployed personnel. These studies do not address issues of risk management; those will be the focus of a third study. Although DOD and congressional interest concerning the effects of low-level chemical exposure increased after events in the 1991 Gulf War, relatively limited funding has actually been expended or programmed in DOD’s RDT&E programs in recent years to address issues associated with low-level chemical exposure on U.S. military personnel. However, DOD has developed proposals to fund two low-level research efforts, which are under consideration for implementation. For fiscal years 1996 through 2003, DOD has been appropriated in excess of $2.5 billion for chemical and biological defense RDT&E programs. (See app. V for general DOD chemical and biological program funding allocations and trends for fiscal years 1990 through 2003). Fiscal year 1996 was the first time that RDT&E funding for all of DOD’s chemical and biological defense programs was consolidated into six defensewide program element funding lines. These program elements are (1) basic research, (2) applied research, (3) advanced technology development, (4) demonstration and validation, (5) engineering and manufacturing development, and (6) management support. Table 2 shows total actual and projected research funding by RDT&E program element for fiscal years 1996 through 2003. Three low-level research efforts—totaling about $10 million—were included in DOD’s fiscal year 1997 and 1998 chemical and biological defense RDT&E programs. These research efforts represented about 1.5 percent of the approximately $646 million in combined obligational authority authorized for chemical and biological defense RDT&E for these 2 fiscal years. Funding for the largest of the three—an $8-million effort in the fiscal year 1998 program that dealt with chemical sensor enhancements—was provided by the Conference Committee on DOD Appropriations. Another fiscal year 1998 effort—costing almost $1.4 million—involved the development of sensitive biomarkers of low-dose exposure to chemical agents. The remaining effort, included in the fiscal year 1997 program, developed in vitro and in vivo model systems to evaluate the possible effects of low-dose or chronic exposures to chemical warfare agents. This project cost approximately $676,000. DOD officials told us that these projects were not part of a structured program to determine the performance and health effects of low-level exposures. However, two elements within DOD have proposed multiyear research programs on low-level issues. DOD has requested funding for the U.S. Army Medical Research and Materiel Command’s science and technology objective on the chronic effects of chemical warfare agent exposure. If approved, this research program is projected to receive an average of about $2.8 million annually in research funds for fiscal years 1999 through 2003. The purpose of this undertaking would be to investigate the effects of low-dose and chronic exposure to chemical agents to (1) gain a better understanding of the medical effects of such exposure, (2) provide tools for a medical assessment of personnel, and (3) develop protocols for subsequent protection and treatment. Figure 2 reflects DOD’s programmed RDT&E funding for fiscal years 1999 through 2003 and shows the proposed science and technology objective in relation to other research program efforts. Another research program involving low-level chemical exposures will be proposed in the near future to the NBC Defense Board for approval. A panel of experts, tasked by DOD to study the issue of defining low-level and chronic chemical exposure, has proposed a series of research efforts to be undertaken over the next several years to address the definitional dilemma surrounding this issue. Funding levels for this effort have not been established. DOD’s current NBC policy and doctrine do not address exposures of U.S. troops to low levels of chemical warfare agents on the battlefield. NBC defense doctrine is focused on ensuring mission accomplishment through the prevention of acute lethal and incapacitating effects of chemical weapons and is not designed to maximize force protection from exposure to clinical and subclinical doses. Moreover, DOD has no chemical defense research plan to evaluate the potential performance effects of low-level exposures or the implications they may have for force protection. Even though research funded by DOD and others has demonstrated adverse effects in animal studies, the literature does not adequately address the breadth of potential agents; the combinations of agents either in isolation or in combination with battlefield contaminants; the chronic effects; animal-human extrapolation models; or the operational implications of the measured adverse impacts. We recommend that the Secretary of Defense develop an integrated strategy for comprehensively addressing force protection issues resulting from low-level chemical warfare agent exposures. The strategy should address, at a minimum, the desirability of an OSD policy on the protection of troops from low-level chemical warfare agent exposures; the appropriateness of addressing low-level chemical warfare agent exposures in doctrine; the need for enhanced low-level chemical warfare agent detection, identification, and protection capabilities; the research needed to fully understand the risks posed by exposures to low levels of chemical warfare agents, in isolation and in combination with other contaminants that would be likely found on the battlefield; and the respective risks, costs, and benefits of addressing low-level chemical warfare agent exposures within DOD’s chemical and biological defense program. In oral comments on a draft of this report, DOD concurred with our recommendation that the Secretary of Defense develop a “low-level” strategy but disagreed with the implied priority order. DOD stated that it is also concerned with force protection and the possible impact that low-level chemical agent exposures might have on a service member’s health and emphasized that a valid data-based risk assessment must serve as the foundation for any change in policy or doctrine. In addition, DOD provided us with updated plans and proposals to develop an overall requirements and program strategy for low-level chemical agent monitoring. DOD agreed that the absence of an OSD policy or a DOD doctrine on low-level exposures is partially attributable to the absence of a consensus within DOD on the meaning of low level. However, DOD expressed concern that we did not assert a working definition of low level as it might apply to a force projection or battlefield scenario. DOD disagreed with our selection of examples of low-level research illustrated in table 1, stating that the studies were more appropriately categorized as “low dose” rather than low level. Finally, DOD believed that we misinterpreted the report, Assessment of the Impact of Chemical and Biological Weapons on Joint Operation in 2010, by failing to understand that the asymmetrical application of chemical agents does not equate to “low level” for the purpose of producing casualties, but rather for the purpose of disrupting operations by the mere detectable presence of these agents at levels that may have no medical effects. In our recommendation, we listed a number of elements that should be addressed in developing such a strategy, but we purposely did not articulate a priority order beginning with research. Rather, we advocate that DOD develop a strategy to analyze policy, doctrine, and requirements based on existing information and to reassess policy, doctrine, and requirements as the results of a low-level research program are reported. We did not define low level in our report because the definition requires an interpretation of both exposure effects data and military risk and performance data—analyses best performed by DOD. Furthermore, because a consensus of the meaning or definition of low level is lacking, we find no basis for DOD’s characterization of the research examples in table 1 of the report as “low dose,” rather than “low level.” Regarding the 2010 Study, we disagree with DOD’s statement that there may not be medical effects for low-level chemical agents. Rather our work shows that low-level exposure can have medical effects that cannot only result in casualties, but also disrupt operations. The plan of action and low-level toxicological and technical base efforts provided by DOD did not fully address the strategy that the report discusses. The strategy will require a plan of action incorporating medical and tactical analyses, as well as the nonmedical research and development projects described by DOD. As agreed with your offices, unless you publicly announce its contents earlier, we plan no further distribution of this report until 30 days after its issue date. At that time, we will send copies to other congressional committees and the Secretary of Defense. We will also make copies available to others on request. If you have any questions concerning this report, please call me at (202) 512-3092. Major contributors to this report were Sushil Sharma, Jeffrey Harris, Foy Wicker, and Betty Ward-Zukerman. The scope of our study was limited to chemical defense and low-level exposures that may cause adverse effects on performance. To determine the extent to which low-level exposures are addressed in doctrine, we reviewed Department of Defense (DOD) documents and interviewed agency officials. We asked questions designed to elicit the treatment of low-level issues within the nuclear, biological, and chemical (NBC) doctrinal architecture (i.e., Joint Publication 3-11; field manuals; training circulars; and tactics, techniques, and procedures). After determining that low-level issues were not addressed in the war-fighting doctrine, we asked representatives of the doctrinal, intelligence, and research communities why low-level issues were not addressed and under what circumstances they would be addressed. To identify research on the performance effects of low-level exposure of chemical warfare agents, we reviewed relevant government and academic research (published and unpublished) and interviewed researchers within and outside of DOD. To identify relevant literature, we interviewed DOD officials currently responsible for prioritizing chemical and biological defense research needs. We also interviewed DOD researchers at the Army’s primary center of medical chemical defense research and development (the Army Medical Research Institute for Chemical Defense) and nonmedical chemical research and development (the Edgewood Research, Development, and Engineering Center at the Aberdeen Proving Ground). We interviewed staff at the laboratory used by the Air Force to conduct low-level exposure effects on animals before the Army was designated as executive agent for chemical defense and the Air Force’s effort ceased. We sought historic programmatic information from the Naval Medical Research and Development Command, which funded portions of the Air Force’s low-level animal studies. We monitored ongoing DOD-funded Gulf War illnesses research that addresses potential long-term health effects from low-dose or chronic chemical exposures. Last, we discussed current research with leading academics in the field. We reviewed the compilation of relevant low-level research literature to characterize coverage (variety and combinations of agents or contaminants), methodologies employed, and effects observed. These observations were discussed and validated in our interviews with researchers in chemical defense, both within and outside of DOD. In addition, we employed a research consultant from academia to review the literature to substantiate both the comprehensiveness of our compilation and the validity of our conclusions. To determine what portion of the chemical defense budget specifically addresses low-level exposures, we reviewed DOD documents and interviewed DOD program officials. We examined DOD planning and budget documents, including the NBC defense annual reports to Congress and joint service chemical and biological defense program backup books for budget estimates. In addition, we analyzed chemical defense-related data for fiscal years 1991 through 1999 contained in DOD’s Future Years Defense Program—the most comprehensive and continuous source of current and historical defense resource data—to identify annual appropriation trends and ascertain the level of funds programmed and obligated for research, development, test, and evaluation (RDT&E), as well as procurement, and the destruction of chemical munitions. We interviewed DOD officials to verify our observations about low-level efforts and to obtain information about potential programs currently being developed to expand DOD’s efforts to understand the effects of chronic and low-level exposure of chemical warfare agents on military personnel. We contacted the following organizations: Armed Forces Radiobiological Research Institute, Bethesda, Maryland; Defense Intelligence Agency, Washington, D.C.; DOD Inspector General, Washington, D.C.; Department of Energy, Washington, D.C.; Edgewood Research, Development, and Engineering Center, Aberdeen Proving Ground, Maryland; Israel Institute for Biological Research, Ness-Zonia, Israel; Joint Program Office, Biological Defense; Falls Church, Virginia; National Ground Intelligence Center, Charlottesville, Virginia; National Research Council, Washington, D.C.; Office of the Secretary of Defense, Washington, D.C.; Oregon Health Sciences University, Portland, Oregon; University of Texas Health Center at San Antonio, San Antonio, Texas; University of Texas Southwest Medical Center, Dallas, Texas; Air Force Armstrong Laboratory, Brooks Air Force Base, Texas; Air Force Research Laboratory, Wright-Patterson Air Force Base, Ohio; Army Chemical School, Fort McClellan, Alabama; Army Medical Research and Materiel Command, Frederick, Maryland; Army Medical Research Institute of Chemical Defense, Aberdeen Proving Navy Bureau of Medicine and Surgery, Washington, D.C.; and Walter Reed Army Institute of Research, Washington, D.C. We performed our review from September 1997 to May 1998 in accordance with generally accepted government auditing standards. No common names exist for these agents. The institutional structure and responsibilities for NBC defense research, requirements, and doctrine derive from provisions in the National Defense Authorization Act for Fiscal Year 1994. The act directed the Secretary of Defense to assign responsibility for overall coordination and integration of the chemical and biological program to a single office within the Office of the Secretary of Defense. The legislation also directed the Secretary of Defense to designate the Army as DOD’s executive agent to coordinate chemical and biological RDT&E across the services. The Joint NBC Defense Board, which is subordinate to the Under Secretary for Acquisition and Technology, provides oversight and management of the NBC defense program within DOD. The NBC Board approves joint NBC requirements; the joint NBC modernization plan; the consolidated NBC defense program objective memorandum; the joint NBC research, development, and acquisition plan; joint training and doctrine initiatives; and the joint NBC logistics plan. The Joint Service Integration Group and the Joint Service Materiel Group serve as subordinates to the NBC Board and execute several of its functions. Both groups are staffed with representatives from each of the services. The Joint Service Integration Group is responsible for joint NBC requirements, priorities, training, doctrine, and the joint modernization plan. The Joint Service Materiel Group is responsible for joint research, development, and acquisition; logistics; technical oversight; and sustainment. These two groups and the NBC Board are assisted by the Armed Forces Biomedical Research Evaluation Management Committee, which provides oversight of chemical and biological medical defense programs. The Committee is co-chaired by the Assistant Secretary of Defense for Heath Affairs and the Director, Defense Research and Engineering. Figure III.1 illustrates the relationships among the various organizations responsible for NBC defense. USD (A&T) ATSD (NCB) DATSD (CBM) Loss of consciousness, convulsions, flaccid paralysis (lack of muscle tone and an inability to move), and apnea (transient cessation of respiration) This appendix provides general information on the funding trends for DOD’s Chemical and Biological Defense Program for fiscal years 1990-97 and 1998-2003. Funding is shown in four categories: disposal, which includes the costs associated with the chemical stockpile disposal program; RDT&E; procurement; and operations and maintenance, including the costs for military personnel. After the end of the Cold War, DOD funding for chemical and biological programs increased from about $566 million in fiscal year 1990 to almost $1.5 billion in fiscal year 1997. These funds include all military services and the chemical munitions destruction program. Adjusted for inflation, the total program funding has more than doubled (see fig. V.1) over that period and is programmed to continue growing—peaking in fiscal year 2002 with a total obligational authority in excess of $2.3 billion (see fig. V.2). Agent that inhibits the enzyme acetylcholinesterase. Transient cessation of respiration. Symptoms as observed by a physician. Process based on perception, memory, and judgment. Effects resulting from a specific unit of exposure. Difficult or labored respiration. Waste material discharged into the environment. Lack of muscle tone and an inability to move. Gray unit of radiation. Kilogram. Median lethal dose. Milligram. Constriction of the pupil of the eye. Toxins that exert direct effects on nervous system function. Family of chemical compounds that inhibit cholinesterase and can be formulated as pesticides and nerve agents. Measures designed to preserve health and prevent the spread of disease. Nasal secretions. Manifestations of an exposure that are so slight as to be unnoticeable or not demonstrable. Microgram. Agent that produces vesicles or blisters. The first copy of each GAO report and testimony is free. Additional copies are $2 each. Orders should be sent to the following address, accompanied by a check or money order made out to the Superintendent of Documents, when necessary. VISA and MasterCard credit cards are accepted, also. Orders for 100 or more copies to be mailed to a single address are discounted 25 percent. U.S. General Accounting Office P.O. Box 37050 Washington, DC 20013 Room 1100 700 4th St. NW (corner of 4th and G Sts. NW) U.S. General Accounting Office Washington, DC Orders may also be placed by calling (202) 512-6000 or by using fax number (202) 512-6061, or TDD (202) 512-2537. Each day, GAO issues a list of newly available reports and testimony. 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Summary: Pursuant to a congressional request, GAO reviewed the Department of Defense's (DOD) approach for addressing U.S. troop exposures to low levels of chemical warfare agents during the Gulf War, focusing on: (1) the extent to which the DOD doctrine addresses exposures to low levels of chemical warfare agents; (2) the extent to which research addresses the performance and health effects of exposures to low levels of chemical warfare agents, either in isolation or combination with other agents and contaminants that would be likely found on the battlefield; and (3) the portion of resources in DOD's chemical and biological defense research, development, test, and evaluation (RDT&E) program explicitly directed at low-level chemical warfare agent exposures. GAO noted that: (1) DOD does not have an integrated strategy to address low-level exposures to chemical warfare agents; (2) it has not stated a policy or developed a doctrine on the protection of troops from low-level chemical exposures on the battlefield; (3) past research indicates that low-level exposures to some chemical warfare agents may result in adverse short-term performance and long-term health effects; (4) DOD has no chemical defense research program to determine the effects of low-level exposures; (5) less than 2 percent of the RDT&E funds in DOD's chemical and biological defense program have been allocated to low-level issues in the last 2 fiscal years; (6) DOD's nuclear, biological, and chemical (NBC) doctrine is focused on mission accomplishment by maximizing the effectiveness of troops in a lethal NBC environment; (7) it does not address protection of the force from low-level chemical warfare agent exposures on the battlefield; (8) according to officials, DOD does not have a doctrine that addresses low-level exposures because there is no: (a) validated low-level threat; (b) consensus on the definition or meaning of low-level exposures; or (c) consensus on the effects of low-level exposures; (9) past research by DOD and others indicates that single and repeated low-level exposures to some chemical warfare agents can result in adverse psychological, physiological, behavioral, and performance effects that may have military implications; (10) the research, however, does not fully address the effects of low-level exposures to a wide variety of agents, either in isolation or combination with other agents and battlefield contaminants; chronic effects; reliability and validity of animal-human extrapolation models; the operational implications of the measured adverse impacts; and delayed performance and health effects; (11) during the last 2 fiscal years, DOD has allocated nearly $10 million, or approximately 1.5 percent of its chemical and biological defense RDT&E budget of $646 million, to fund research and development projects on low-level chemical warfare agent exposure issues; (12) however, these projects were not part of a structured DOD research program focused on low-level effects; and (13) DOD does not have a chemical and biological defense research program designed to evaluate the potential effects of low-level chemical warfare agent exposures, but funding is under consideration for two multiyear research programs addressing low-level effects.