* NOTE: UNEDITED *
UNITED STATES OF AMERICA
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PRESIDENTIAL ADVISORY COMMITTEE
ON GULF WAR VETERANS' ILLNESSES
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MONDAY JULY 8,1996
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The meeting convened at the Ambassador West Hotel, 1300 North State Parkway, at the hour of 9:00 o'clock a.m.
Mr. Burnett 4
Mrs. Burnett 13
Mr. Samuel Ramos 23
Mr. Nick Kresch 30
Ms. Laura Olah 36
Mr. Troy Albuck 51
Ms. Marguerite Barrett 72
Mr. Terry Reese 78
Ms. Kathi Kelly 84
Ms. Penny Pierce 89
Mr. Chris Kornkven 100
Ms. Christine Eismann 108
Lieutenant Colonel Robert Ryczak 114
Dr. Timothy Gerrity 126
Dr. Duelfer 163
Mr. Igor Mitrohkin 176
Colonel David Schreier 217
Mr. Jack Ross 222
Ms. Patricia Campbell 267
Mr. Tom McDaniels 273
3 1 P-R-O-C-E-E-D-I-N-G-S
2 (9:06 a.m.)
3 MR. GABRIEL: As the designated Federal
4 Official for this Advisory Committee, I_d like to call
5 this meeting to order and turn it over to Dr. Lashof.
6 DR. LASHOF: Thank you very much. I_d
7 like to welcome the Committee and the audience to this
8 meeting of the Presidential Advisory Committee. And
9 as is our custom in all of our meetings, we begin with
10 public comment and I think all of the come-in people
11 who_ve asked to come in are here except for the very
12 first person. Sylvia Roberts is not here at the
13 moment. So we will proceed down the line and save the
14 last spot for her, in case she does come.
15 So, if I can ask Tom Burnett to come
16 forward. Our ground rules are five minutes for
17 presentation and five minutes for questions from the
19 As I understand, Mr. Burnett, you_re going
20 to speak and your wife will speak, so that we have two
21 time slots for you.
22 MR. BURNETT: That is correct, thank you.
4 1 DR. LASHOF: Okay. You may proceed.
2 MR. BURNETT: Good morning. I wish to
3 thank all of you for the opportunity to speak today.
4 I am here to tell you about the current health
5 problems that my son, Scott Burnett, is experiencing.
6 Scott is now 29 years old. He served in
7 the 101st Airborne Division of the U.S. Army from May
8 1988 to May 1992. He was deployed to the Gulf in
9 September of 1990. Upon Scott_s return from the Gulf,
10 we noticed many changes in him. He was very nervous,
11 got frustrated easily and had less energy. He
12 suffered from intestinal problems, headaches, muscle
13 and joint pains, shortness of breath, eye problems and
14 night sweats.
15 In October of 1995, Scott was diagnosed
16 with double pneumonia at one of our local clinics. He
17 was admitted to McLaren Hospital in Flint, Michigan,
18 and he was sent from there to the University of
19 Michigan Hospital in Ann Arbor for a heart transplant.
20 He had only between 10 and 20 percent use of his
21 heart. The doctors at the U of M Hospital then
22 decided to use regular heart medications to stabilize
5 1 Scott and to evaluate him later for a heart
3 We told the doctors and nurses that our
4 son had been in the Gulf War. While they were
5 sympathetic to the situation, nobody seemed to have
6 any answers. We were told that most likely a virus
7 had attacked his heart, causing cardiomyopathy and
8 leading to congestive heart failure. One doctor said
9 that he would be interested in knowing what
10 investigational drugs and vaccines were given to Scott
11 prior to and during his stay in the Gulf. That led us
12 on an almost impossible fact-finding journey. There
13 has been at the least exhausting.
14 We were put in tough with Dr. Garth L.
15 Nicholson at the University of Texas M. B. Anderson
16 Cancer Center in Houston, Texas. Dr. Nicholson told
17 us that there are a large number of members of the
18 101st Airborne Division who were stationed at Base
19 Eagle and Base Echo who were deployed into Iraq who
20 are now very ill. Our son was deployed from one of
21 those bases. However, Dr. Nicholson had no way of
22 knowing this at the onset of our conversation.
6 1 Dr. Nicholson suggested Scott was infected
2 with micoplasma fermentens incognitus and that this
3 organism attacked his heart. He states that there had
4 been many other cases where organisms has attacked the
5 heart also. He also states that the organism can be
6 destroyed with proper antibiotic treatment and that
7 then the heart can heal itself.
8 The soldiers could have been infected with
9 this organism in several ways. Mainly blow back from
10 bombings, scud attacks, vaccine contamination or
11 biological and chemical mine fields in Southern Iraq.
12 After careful deliberations, Scott_s doctors placed
13 him on Doxycyclene on December 22, 1995. His blood
14 samples were sent to Dr. Nicholson for testing. Just
15 last Thursday, we received a tentative positive result
16 from the preliminary tests. We will receive the final
17 results in two to three weeks.
18 The medical tests performed on Scott in
19 January after about a month of taking Doxycyclene
20 confirmed that his heart function had increased to 39
21 percent. He was advised to continue with the
22 antibiotic treatment by the doctors at the U of M at
7 1 Ann Arbor. Scott continues to improve. He remains on
2 antibody treatment at this time. He relapses when the
3 antibiotics are discontinued. He takes several heart
4 medications daily. He sees several doctors on a
5 regular basis. He is starting to regain control of
6 his life. There are several problems with his blood.
7 Excuse me.
8 DR. LASHOF: That_s all right. Take your
10 MR. BURNETT: His immune system and of
11 course, his heart. He has within the past several
12 weeks gone back to his job on a trial basis. He gets
13 very tired each day but is very happy to be able to
14 work. I have some tough questions for which I need
15 answers. I feel that this is the place to start
16 asking. My first question to the Committee is what is
17 going to happen after your meetings are completed?
18 Veterans and their families need help from people such
19 as you who have the expertise, the compassion and the
20 experience to run interference and beg for answers.
21 My toughest question is why hasn_t
22 something been done to notify these veterans of the
8 1 problems that they may possibly experience. The
2 Senate, the DOD, the DUE, the National Institute of
3 Health and other agencies have known for years of
4 problems such as mycoplasma fermentens incognitus,
5 biological and chemical warfare, heart problems,
6 cancers, birth defects and many other problems.
7 Senator Richard Shelby reported to
8 Congress in 1994 on the Persian Gulf Syndrome. I am
9 making a direct quote from that report. _This is a
10 serious public health issue. I have been contacted by
11 thousands of veterans throughout the United States
12 and, regrettably, I have received reports of many
13 young men and women who have after initially
14 experiencing these symptoms died from cancers or
15 unexplained heart failures._ End of quote.
16 Senator Donald Reigle of Michigan also
17 reported much information related to the health
18 consequences of the Gulf War in his report to the
19 Senate in 1994. Not much reporting has been done to
20 the vets involved. The Rockefeller Report reports
21 abnormal heart problems with these innoculations. Had
22 my son, Scott, been aware of the problems that had
1 been known to exist for several years, he would have
2 sought more aggressive treatment prior to his
3 pneumonia and would have not had the problems that he
4 has today.
5 I believe that with today_s technology it
6 would not be difficult for the government to contact
7 each of the 700,000 vets involved. After all, we
8 receive a Form 1040 each year and that goes out to
9 millions. And I_m sure we all get those.
10 I have read reports from the May 1st and
11 May 2nd meeting of 1996 of this Committee. I have a
12 question concerning Dr. Russell_s statements
13 concerning mycoplasma fermentens incognitus and the
14 vaccines given to the soldiers. Is it possible for me
15 to receive a copy of that investigation?
16 I question the time frames discussed for
17 research into the Gulf War illnesses. As you are
18 aware, many vets are sick and need help now.
19 Thousands have already died. We do not have three to
20 five years to research. Perhaps more people need to
21 work at this task and perhaps those who need help in
22 the Middle East could help us now at least
2 I have been in contact with the mother of
3 a young Gulf War veteran from our immediate area.
4 This young man supposedly died from a rare brain
5 disease. He, like my son, was the picture of health
6 before going to the Gulf. What is the probability of
7 two healthy young men from the same area who went to
8 the Gulf could both get serious rare illnesses.
9 I have talked to numerous Gulf vets who
10 have had serious pneumonias during the past two years.
11 What is the probability of a young 20 or 30 year old
12 getting pneumonia?
13 In conclusion, we do not know for sure
14 whether mycoplasma fermentens incognitus caused
15 Scott_s illnesses or whether it was a result of the
16 Pyridogistigmine Bromide, the vaccines he was given,
17 the desert sand, the chemical, biological or
18 environmental exposures, or a combination of all of
19 these factors.
20 However, we are totally convinced that his
21 illness is a direct result of something that happened
22 to him during that Gulf War experience. As for
11 1 Dr. Nicholson, he was the only person who gave us much
2 hope where my son_s health was concerned. Although we
3 cannot prove or disprove his theory, it seems to me
4 that he is on to something. He deserves to be
5 listened to and we have the obligation to listen to
7 In the past, we have been able to resolve
8 most or all of our own problems. But this is an
9 uphill battle all the way. We, as well as the rest of
10 the country, need your help in resolving this Gulf War
11 Syndrome, as it is called. There are countless others
12 who need your help just as we do. We need medical
13 results and we need it soon. I thank you.
14 DR. LASHOF: Let me ask whether you would
15 prefer for Mrs. Burnett to speak next and then our,
16 save questions, or should we have the questions first?
17 MR. BURNETT: She is going to defer her
18 time to someone else who needs it. I understand that
19 there are some people here who want to speak, some
20 veterans that don_t have a time slot. So we will
21 yield any time that we have left to them.
22 DR. LASHOF: All right. Well, then let us
12 1 proceed with questions from the panel. Are there --
2 any of the members have questions for Mr. Burnett?
3 MS. KNOX: I have one.
4 DR. LASHOF: Marguerite?
5 MS. KNOX: You mentioned that his heart
6 function had improved to 39 percent.
7 MR. BURNETT: That is correct. In the
8 beginning, in November, his ejection fraction was
9 between 10 and 20 percent. After going on the
10 Doxycyclene starting December 22, 1995, he was gaining
11 weight and the doctors thought he was taking on fluid
12 and going back into heart failure. He collapsed in my
13 arms. We had to take him back, excuse me. We had to
14 take him back to the University. At that time they
15 found out that he was dehydrated simply because they
16 had been giving him more and stronger diuretics
17 because they thought that this weight gain was fluids.
18 At that point in time they found out that his ejection
19 fraction had improved to the 39 percent from the 10 to
20 20 percent.
21 They advised us to continue the
22 Doxycyclene. They did not expect my son to improve at
13 1 all. They sent him home to die. And I want you
2 people to ask me questions. Any, please, anything
3 that you want to. We have so much information. All_s
4 we have been doing for the past nine months is reading
5 and praying. Any questions at all. I_m sure there
6 must be some. We have medical people there. And I_m
7 sure that they know what I_m talking about when I tell
8 them what cardiomyopathy with congestive heart failure
9 is nothing more than a label to put on something that
10 they don_t know what it is.
11 DR. LASHOF: Could you describe what his
12 responsibilities were in the Gulf and what he feels he
13 was exposed to there?
14 MR. BURNETT: He was connected with the
15 Air Assault of 101st Airborne.
16 MRS. BURNETT: He was a ground soldier.
17 He went over to the Gulf at the onset in September.
18 He was with the 101st Airborne. They were in the
19 desert most of the time. Before the ground war, they
20 went up into Iraq and they were primed and ready to
21 take Basra. It never happened because the war ended
22 the day before their mission was supposed to take
14 1 place. But somewhere, somehow while he was in the
2 Gulf, I mean, he said the chemical detectors went off
3 all the time.
4 They were stationed right in the desert.
5 He never saw a building, a bathroom, fresh water, for
6 seven months. So, it could -- he said that, you know,
7 even the ground, the sand could have been contaminated
8 or he just doesn_t know exactly what happened to him.
9 But, he was the picture of health before he left.
10 MR. BURNETT: There is nothing in our
11 family history. We have searched both sides of our
12 family. There is nothing that would dictate that he
13 would have to have come down with this disease, which
14 is not a hereditary disease anyway.
15 MRS. BURNETT: He said one night he was on
16 guard duty. And he was out by himself. He said there
17 were not too many others around. He was walking. And
18 he said he heard a tremendous blast, but he never knew
19 what it was. He said it just scared him to death. He
20 said, Mom, I just fell to the ground. I don_t know
21 what it was.
22 We don_t know if it was that incident or,
15 1 we just don_t know.
2 MR. EWING: Was he ill at all while he was
3 in the Gulf?
4 MRS. BURNETT: He wrote -- his letters
5 would come back to me. Sometimes they took a month.
6 And there were times when he had diarrhea, but not
7 often. When he came back from the Gulf, he was one of
8 the first to go. So, consequently, he was one of the
9 first to come back. On our way home from Fort
10 Campbell, that was the first day, the second day that
11 we had seen him. In his truck on the way home, I was
12 riding with him. He just totally lost it. I mean, he
13 just, for no reason at all, just totally lost control
14 of himself and just went spastic, like, just green.
15 And every time just the least frustration.
16 From that time on, and he tries so hard to control his
17 emotions. He can_t. It_s been that way ever since he
18 came back. He_s been, ever since he came back from
19 the Gulf, pushing himself. He was a go-getter. He
20 was the one of our three children that when we ask a
21 question and when we needed something done, Scott was
22 the one. The other two are beautiful kids, willing to
16 1 help, but it was always, oh, no, why me, you know.
2 Scott was always, yeah. Ever since he came back,
3 instead of saying something to the effect, I can_t do
4 that, I don_t feel up to it, he_d just get,
5 physically, or not physically, just get belligerent or
6 frustrated, frustrated more than anything.
7 After he went into the hospital, I went to
8 his home. And he has his own house. He lives by
9 himself. I found probably 12 bottles of vitamins,
10 rejuvenating vitamins, vitamins for senior citizens,
11 all of these different kinds of complexes. But he
12 never told us exactly. We knew something was wrong,
13 but he never admitted, he never in his mind, I_m
14 young, I_m tough, I_m strong. I should be able to do
15 this. And he pushed and pushed and pushed.
16 In October he got so sick he called me, I
17 have to go to the doctor, Mom, I can_t. There_s
18 something wrong with me. And that was it. That was
19 the beginning of the end, you know.
20 MR. BURNETT: One thing we have also been
21 told. Almost every place that we have, government
22 agency, that we have talked to was that my son was the
17 1 only one that they have heard of with cardiomyopathy
2 with congestive heart failure or heart problems of any
3 kind. We have learned, just in the past couple of
4 days, that there are literally hundreds and hundreds
5 of these cases. That just doesn_t jive with us. And
6 I think his improvement is -- at the University of
7 Michigan they claim that he only had a 30 percent
8 chance of improving on his own.
9 MRS. BURNETT: And that was just, they
10 expected some minor improvement. The doctors are
11 flabbergasted. They do not know. They look at Scott
12 and they_ll stand there and they_ll shake their head.
13 They don_t believe what_s happened. They don_t know
14 why he got sick. They don_t know why he_s getting
16 The cardiologist is the head of the
17 Cardiac Unit at Ann Arbor. It was such a strange case
18 that, according to my son, and we were there all the
19 time, but sometimes the doctors would come in while we
20 weren_t right in his room. He said, Mom, they_re
21 actually fighting over me. They all want to take care
22 of me. And Dr. Nichols is the one that ended up with
18 1 him.
2 MR. BURNETT: This is Dr. Nichols from
3 Ann Arbor, not to be confused with Nicholson at
4 M. B. Anderson.
5 DR. TAYLOR: Andrea Kidd Taylor. Did your
6 son receive all of the required vaccines? Yes.
7 MR. BURNETT: Yes.
8 (Everyone talking at once.)
9 MS. TAYLOR: The other question I had, you
10 mentioned there were others with cardiomyopathy. Do
11 you have a written list, or where did you find your
12 information regarding the others that you know of with
14 MR. BURNETT: I_m sorry, ma_am?
15 DR. TAYLOR: You mentioned that there are
16 hundreds with cardiomyopathies of veterans who served
17 in the Gulf.
18 MR. BURNETT: This Senator Shelby report
19 and just last night I talked to some -- we just met a
20 couple of veterans here. And they tell me that there
21 are literally hundreds of these type of cases.
22 They_re able to apparently talk to these people
19 1 through computers or whatever. We have a computer
2 person in our family, but it_s not myself.
3 DR. TAYLOR: The reason I ask that is
4 because maybe our staff would like that information if
5 you could, if someone could get that information.
6 MRS. BURNETT: Senator Shelby_s report is
7 one document that we_ve taken this information from.
8 MR. BURNETT: That was a direct quote.
9 MRS. BURNETT: That was a direct quote.
10 I spoke to someone in his office and the lady that we
11 talked to said that he absolutely will verify
12 everything that_s in that report, but I have
13 information at home that we received from the Veterans
14 Administration, the DOD, the National Institute of
15 Health. Numerous other agencies and every one of them
16 mentions heart problems.
17 Our son had no heart problem, no history
18 of a heart problem, nothing. We were told just
19 recently, one day last week in fact, there was no
20 viral cardiomyopathy. The tests concluded that there
21 was not a virus that attacked his heart and that_s
22 what we were initially told, the possibility of virus
1 attacked his heart. But for whatever reason the
2 doctors neglected to --
3 MR. BURNETT: To tell us.
4 MRS. BURNETT: -- tell us --
5 MR. BURNETT: It_s not a viral infection.
6 There is some sort of, or something different than a
7 virus. And that is the best information we have at
8 this point, quoting directly from an infectious
9 disease doctor that he is now seeing, who he has
10 started seeing about a month ago. That_s where we
11 found out that he has -- his immune system is way out
12 of whack.
13 Our infectious disease doctor made a
14 statement, I think it was more of a thought than a
15 statement to us, he was thinking out loud in other
16 words, that I think I_ve got you figured out, Scott.
17 MRS. BURNETT: But he didn_t tell us why.
18 MR. BURNETT: He didn_t tell us why. He
19 was going to take some more tests.
20 MRS. BURNETT: Our main problem with Scott
21 was concentrated on his heart. And of course you can
22 understand that. So, we went to cardiologists and an
1 internist since November, since his first admit to the
2 hospital in November. In April, and in March, Scott
3 was real sick. And we didn_t know, I mean, I was
4 getting to the point where I went to his internist
5 doctor and I told him, I said, I cannot sit here and
6 watch my son turn, take a turn for the worst after
7 he_s gotten so much better. I made an appointment
8 myself. I went to the doctor. I said you_ve got to
9 do something, you know, he_s going downhill again.
10 The doctor said, well, I_ll try to get him back into
11 Ann Arbor sooner. So, he did. But he put him on
12 another antibiotic. Within two weeks, Scott popped
13 back. He was back to feeling much better. Now, don_t
14 get me wrong, he_s not normal. He_s got a lot of
15 problems, but better than he was.
16 When we went to Ann Arbor, he was feeling
17 good. He did good on his stress test. I asked the
18 cardiologist, I said, Doctor, why was he so sick a
19 couple weeks ago and what caused that? The doctor
20 said, I don_t know, but it wasn_t his heart. His
21 heart is getting better. That told me that, well,
22 it_s time that we look somewhere else besides his
22 1 heart. We went to the infectious disease doctor at
2 that point.
3 And now, he still has the problem with his
4 heart, but we_re finding out all along, ever since
5 October when he first got sick, his blood tests are
6 way out of whack. None of the doctors, they kept
7 saying, well, he_s anemic. They didn_t do anything
8 about it. They didn_t check into it.
9 MR. BURNETT: He_s been anemic. They_ve
10 been knowing that since November.
11 MRS. BURNETT: Since October. Yeah, the
12 first part of November. But they were ignoring that
13 and concentrating on his heart. He takes nine
14 prescription medicines every day. He is working full
15 time. He_s just push, push, push, but since he
16 started back to work, emotionally he is so much better
17 off. He had nothing for seven months. He_s a young
18 man, 29 years old, he had no money, no income,
19 nothing. We paid, he does have a job with the State
20 of Michigan. He went through his -- but he_s only got
21 a year and a half on the job. He went through his
22 sick and vacation pay, paid his Blue Cross and --
23 1 MR. BURNETT: Left to his own devices, you
2 know. My wife is talking, number one, he would have
4 MRS. BURNETT: Right.
5 DR. LASHOF: Thank you very much. I_m
6 afraid we_ll have to move on now.
7 MRS. BURNETT: Thank you.
8 MR. BURNETT: Thank you very much.
9 MRS. BURNETT: Thank you for listening.
10 DR. LASHOF: Samuel Ramos.
11 MR. RAMOS: Good morning, good people. I
12 would like to begin this morning by expressing my
13 appreciation to you for the invitation you extended to
14 me to be here today.
15 I will begin with sharing my service
16 history in the Armed Forces and medical history as it
17 relates, excuse me, as it relates to my service in
18 Vietnam and the Persian Gulf conflicts.
19 My service history is as follows. I
20 served a total of 11 years in the Army and National
21 Guard. While in the Army, I served in the Republic of
22 Vietnam during 1969 and 1970. My service was
24 1 honorable and I was privileged to receive the bronze
2 star. I felt I could offer my services to the United
3 States Armed Forces during the Persian Gulf conflict.
4 I voluntarily joined the National Guard and served in
5 the Persian Gulf from January 1991 through April of
7 I was deployed during the time to Dharan,
8 Saudi Arabia, and King Khalid Military City. Again,
9 my service was honorable and received a meritorious
10 service medal.
11 During my service in the Republic of
12 Vietnam I was exposed to Agent Orange. During my
13 service in Saudi Arabia, scud missiles were blown down
14 by Bakus. One scud missile was within 130 feet above
16 The following is a combined analysis of
17 the health examinations completed, done at Washington,
18 D.C. VA Medical Center in June of 1995, United States
19 Air Force Medical Center at Wright Patterson Air Force
20 Base in Ohio in November of 1994. The final
21 diagnosis, all my joints are in deterioration,
22 mechanical low back pain, high frequency sensoral
25 1 hearing loss, a combination of tension-type and
2 migraine headaches, right greater than left carpal
3 tunnel syndrome, chest pain, possible secondary to
4 coronary spasm, major depression, recurrent severe
5 without psychotic features, post-traumatic stress
6 disorder, positional obstructive sleep apnea.
7 From Washington, D.C. VA Medical Center,
8 major depression, idiopathic cardiomyopathy, sleep
9 apnea, gastric ulcer with hylochodoctorpylary, high
10 frequency sensoral hearing loss moderate degree. The
11 diagnoses between the two government agencies concur
12 based on the foregoing information.
13 It is time that not only I but all
14 veterans receive the following. Recognition that our
15 honorable service resulted in medical problems which
16 to date have been denied, thereby resulting in
17 inferior treatment, besides outright denial of
18 officials that we have legitimate medical
19 complications. Two, unbiased medical detection to
20 treat our illness, besides exposure to all information
21 the government has regarding chemicals used by our
22 enemies in the Persian Gulf.
26 1 Three, financial assistance to compensate
2 us for loss of work and inability to work regularly
3 due to illnesses resulting from exposure to life-
4 threatening chemicals.
5 In conclusion, veterans have traditionally
6 waited too long for concise and accurate information
7 regarding service injuries. Compensation has come
8 often too little, too late. This is unlike our
9 attitudes of service when our country calls us to
10 serve. Good people, now is the time for you to act
11 and bring relief to the veterans who served this
12 country. You can give us recognition. We deserve the
13 medical attention our broken bodies need and the
14 financial compensation for us to allow our bodies to
15 rest and heal.
16 I have a letter here from my company
17 commander verifying the scud missiles that we had.
18 Two scud attacks appeared the first night in country
19 and continued five out of the seven nights we were at
20 Kobar Towers. The stress factor of the first week was
21 quite high for the entire unit. At times the scud
22 attacks were a little unnerving. The unit also
27 1 received several scud attacks while at KKMC. The
2 majority of these attacks came without warning. The
3 only warning was hearing the patriot missiles being
4 launched at scuds to intercept them. Usually the scud
5 attacks came at night and no more than two or three
6 scuds were in the attack. We did however receive a
7 severe scud attack that came within 300 yards of our
8 base camp. There were probably six or seven scuds in
9 this attack, and it came in the late afternoon.
10 That is all I have. Thank you.
11 MR. LASHOF: Thank you. Questions from
12 the panel? Elaine?
13 MS. LARSON: So, you_re receiving
14 disability now?
15 MR. RAMOS: No, ma_am. The only thing I_m
16 receiving is 10 percent disability for PTSD. And that
17 was from my, term from Vietnam. I_ve been having
18 problems with the VA trying to receive disability. I
19 have filed for disability in 1991. And yet, to this
20 date, I have not received no answers. I_ve written to
21 my congressman, senators, and nothing has been done.
22 MS. LARSON: You_ve received no answers at
28 1 all.
2 MR. RAMOS: I have received -- the only
3 thing that they tell me is that they have written to
4 the VA and they_re waiting from the VA, answers.
5 MS. LARSON: So you_ve not even been given
6 a denial?
7 MR. RAMOS: I have been receiving a lot of
8 denials, even though, with the medical proofs that I
9 have, I still receive denials. Why, I do not know.
10 MS. LARSON: But your claim is still
11 pending, it_s still open?
12 MR. RAMOS: Yes, ma_am.
13 DR. LASHOF: But did you say that you are
14 receiving disability from your period in Vietnam?
15 MR. RAMOS: Yes, ma_am, which is 10
17 DR. LASHOF: When did you start on that
19 MR. RAMOS: Right after I got back from
20 the Persian Gulf in _91.
21 DR. LASHOF: But it was from Vietnam? It
22 was after Vietnam. Yes, it was after I got back from
29 1 the Persian Gulf. You were not disabled when you went
2 to the Persian Gulf?
3 MR. RAMOS: No, ma_am.
4 DR. LASHOF: How would you compare your
5 experiences in Vietnam with the Persian Gulf, in terms
6 of exposure, stress?
7 MR. RAMOS: From Vietnam, the experiences
8 that I had there were traumatic, a lot worse than what
9 there was in Saudi. But the scud missiles were very
10 unnerving. Not knowing what kind of chemicals they
11 had in there, all the alarms went off when the scud
12 missiles came in, and but, I cannot understand why we
13 have all this sophisticated equipment for detecting
14 and yet, the government denies there was no chemicals
16 DR. LASHOF: Did you have any acute
17 illnesses while you were in the Gulf?
18 MR. RAMOS: No, ma_am.
19 DR. LASHOF: Any other questions. If not,
20 thank you very much, Mr. Ramos.
21 MR. RAMOS: Thank you.
22 Nick Kresch?
30 1 MR. KRESCH: Good morning. My name is
2 Nick Kresch. I_m a Persian Gulf veteran. I_m afraid
3 to speak out for fear of losing my service-connected
4 benefits. But I don_t want to let any other veterans
5 go through what I_ve experienced.
6 On December 28, 1990, my ship, the
7 Theodore Roosevelt, was deployed in the Persian Gulf.
8 I was a Master at Arms and responsible for escorting
9 prisoners back to the United States. On January 19th,
10 we arrived at Abu Dabi Airport. On January 20th, we
11 witnessed an air burst, a ring blew and heard the
12 alarms. The following morning I experienced nausea,
13 headaches, tightness in my chest, muscle pain, joint
14 pain, and excessive perspiration. I arrived home
15 January 29th. On February 4th, my children became
16 ill. On February 11th, they were taken to the
17 emergency room and treated for pneumonia. My children
18 and my wife have had many unexplained illnesses and
20 I have been in and out of many hospitals
21 and have many extensive work-ups and experienced very
22 painful testing, but was never tested for biological
1 warfare or chemical sensitivity. The VA and DOD made
2 me their guinea pig. They told me I was the only one
3 having these kinds of problems and said they were
4 stress-related and it would go away. They turned me
5 away from Wadsworth VA, Veterans Hospital, because I
6 could not buff floors for room and board. I was in a
7 wheelchair. My brown hair fell out and returned
8 white. I had rectal bleeding, fibromyalgia,
9 headaches, memory loss, muscles spasms, night sweats,
10 blood in the urine, fever, bleeding gums, and had lost
11 45 pounds.
12 The Veterans Administration had me on the
13 following medications: Morphine, Methadone, Percoset,
14 Demerol, Darvon, Merinol, Vicodin, muscle relaxers.
15 I lost my family, my friends, my good standing with
16 the community, my freedom and even my self-esteem.
17 I was disrespected, humiliated, lied to
18 and harassed by General Blanks_ staff. Treatment of
19 active duty personnel was intolerable at Walter Reed
20 Hospital. People with the same symptoms as I were
21 held in psychiatric ward. Furthermore, while
22 attending a congressional hearing in Washington, my
1 illness worsened. I went to the VA and was told that
2 the only bed that were open were in the psychiatric
3 ward. When I threatened to call the press, they found
4 an empty ward in the Persian Gulf Referral Center.
5 My family and I have stood in welfare
6 lines, food lines and public housing lines. We were
7 denied by VA and Social Security and given red tape
8 runaround for many years. My wife has been seen at
9 Cook County Hospital with similar symptoms for the
10 last three years because she is uninsurable and the
11 state spend down amount is $2,378 per month. All the
12 wives and children deserve the benefit of the doubt
13 and they desperately need the medical insurance.
14 I_ve seen death, physical pain and
15 emotional suffering belittled by the very organization
16 that was supposed to support them, the Veterans
18 Please ask me any questions, because it
19 was very difficult to put all the horrors of five
20 years into five minutes.
21 DR. LASHOF: Marguerite?
22 MS. KNOX: Now, you mentioned that you
33 1 were fearful of losing your service connection, do
2 receive VA compensation now?
3 MR. KRESCH: Right now we receive 60
4 percent due to the Gulf War Syndrome and 10 percent
5 due to the broken ankle and was given an
6 unemployability rating. And so we_re, with the VA,
7 even though I_m not able to, it_s their determination
8 what happens. They, you know, it_s not permanent. I
9 mean, this could be taken away just as fast as it was
10 given to me, you know. And we had to wait three years
11 to get that.
12 MS. KNOX: Being in the Navy, did you
13 receive Anthrax from the Botchlanim vaccine and did
14 you take BE tablets?
15 MR. KRESCH: In the Navy, I was on an
16 aircraft carrier and nobody told us what we had. We
17 stood in line. We didn_t get the pills, you know, we
18 were on the ship so we didn_t need them. So, no, we
19 didn_t take the pills.
20 MS. KNOX: And you were on the ship the
21 entire time?
22 MR. KRESCH: I was just going over there,
34 1 I was on land for three days, and that was my extent.
2 MS. KNOX: And where were you when you
3 were on land?
4 MR. KRESCH: I was in the United Arab
5 Emirate and Abu Dabi Airport.
6 DR. LASHOF: So, you didn_t have exposure
7 to sand and fuel, or any of the other exposures that
8 we_ve --
9 MR. KRESCH: No. I was there three days
10 and I left January 21st, before the oil well fires,
11 you know, I wasn_t in the desert. Before any major
12 activities occurred and I was well behind the lines.
13 DR. LASHOF: Are you on medication now?
14 MR. KRESCH: Right now I_m just on muscle
15 relaxers. But, all the other drugs that I was on I
16 had grown addicted to them and am currently going
17 through Alcoholics Anonymous and Narcotics Anonymous
18 to get off that.
19 MS. LARSON: Mr. Kresch, how are your
20 children now?
21 MR. KRESCH: I have two children --
22 MS. LARSON: How are they? They were ill
35 1 when you returned.
2 MR. KRESCH: Right.
3 MS. LARSON: How long were they ill and
4 how are they now?
5 MR. KRESCH: Well, the oldest one is nine
6 now and she_s having problems breathing. They_ve
7 always had infections. I mean, if one would get the
8 flu or a sickness, all of us would get it. It was
9 over and over again, as well as my spouse. And the
10 pediatricians just didn_t know what to do. So, with
11 the baby, we don_t, you know, know what -- we went
12 through the registry. They said the baby had heart
13 palpitations. And the older one had asthma real bad.
14 And so if that answers your question.
15 DR. TAYLOR: These illnesses were all
16 diagnosed after you returned, the asthma and some of
17 the other symptoms that your children are
19 MR. KRESCH: Yes. Yeah, because they were
20 born both before the war. The baby was diagnosed just
21 a few weeks ago.
22 DR. TAYLOR: You mentioned, one more thing
36 1 I wanted to ask you about. You_re receiving 60
2 percent disability due to Gulf War Veterans Syndrome,
3 did they give you another diagnosis for receiving the
5 MR. KRESCH: They gave me the diagnosis
6 of, let_s see, environmental hazards, it wasn_t for --
7 everything on my paperwork says Gulf War Syndrome, but
8 as far as the VA side of the pension compensation,
9 they made it very bland. They didn_t say Gulf War
10 Syndrome, because that would indicate, you know, this
11 was service-connected, you know, for this disorder.
12 For the group of symptoms, the whole group of
13 symptoms. They didn_t break it down to each one,
14 well, he_s got fibromyalgia. He_s got rectal
15 bleeding, blood in the urine, they didn_t break it
16 down like that. They just said, well, here_s 60
17 percent for all of them.
18 DR. LASHOF: Okay. Thank you very much.
19 Next person is Laura Olah.
20 MS. OLAH: Good morning. I want to thank
21 the members of the Presidential Advisory Committee and
22 its Chairperson, Dr. Lashof, for the opportunity to
37 1 offer testimony and recommendations.
2 I am here today on behalf of the Depleted
3 Uranium Network of the Military Toxics Project. The
4 national network of people working near or living at
5 the Depleted Uranium Development manufacturing and
6 testing sites, atomic veterans and Persian Gulf War
7 veterans. And as Executive Director of Citizens for
8 Safe Water on Badger, a community-based group
9 responding to Wisconsin_s Military Toxics, to appeal
10 for the immediate testing and treatment of U.S.
11 soldiers exposed to depleted uranium.
12 Depleted uranium, or D.U., used
13 extensively in weaponry by the U.S. military forces
14 during the Persian Gulf War was used for its superior
15 density. D.U. ammunition was armor-piercing and
16 Abrhams tanks and Bradley fighting vehicles were
17 reinforced with D.U. Remarkably, while the U.S. Army
18 acknowledges firing at least 14,000 rounds or 40 tons
19 of D.U. ammunition in Kuwait and Southern Iraq,
20 American and Allied soldiers were not told they had
21 radioactive bullets in their arsenal. And moreover,
22 were not aware of the hazards and precautions required
38 1 when dealing with D.U. and D.U. contaminated vehicles.
2 When D.U. munitions smash into tanks or
3 other objects, they partially burn, producing uranium
4 oxide dust which is chemically toxic and radioactive.
5 As much as 70 percent of a D.U. penetrator can be
6 aerosolized when it strikes a tank. On penetrating a
7 tank or armored vehicle, a D.U. shell bursts into
8 flames and all but liquefies, searing through the
9 armor like a white hot phosphorescent flare. The heat
10 of the shell causes any diesel vapors in the tank to
11 explode and the crew inside is burned alive. Wind
12 blown particles readily lodge in lung tissue, exposing
13 the host to a growing toxic dose of alpha radiation
14 and capable of inducing cancer and other deadly
15 illnesses. A single microscopic particle of D.U.
16 lodged in the respiratory system is the radiological
17 equivalent of 50 X-rays and can subject lung tissue to
18 8,000 times the annual radiation dose permitted by
19 federal regulators for whole body exposure.
20 Military experts estimate that somewhere
21 between 300 and 800 tons of D.U. debris, mostly
22 particles and small fragments, are still scattered
39 1 around Gulf War battlefields. U.S. Army studies
2 confirm the radioactive properties of D.U. have the
3 greatest potential for health impacts when D.U. is
4 internalized. Equipment contaminated with D.U. oxides
5 becomes a source of contamination when the oxides are
6 resuspended, blown, washed or dislodged during
7 transit. In addition to recovery or maintenance
8 personnel, thousands of ground troops encountered and
9 entered contaminated vehicles and likely ingested or
10 inhaled depleted uranium particles.
11 Ingestion occurs primarily from hand to
12 mouth transfer or from D.U. contaminated water or
13 food, and once inside the body concentrates in the
14 kidneys, liver and bones. Inhalation can occur during
15 D.U. munitions testing, during a fire involving D.U.
16 emissions or armor and when D.U. particles are
17 resuspended by testing or fires. As far back as 1985,
18 Department of Energy tests from M28-9 rounds confirmed
19 D.U. ordinance under severe fire conditions remained
20 in the fire and oxidized to powder rather than being
21 ejected undamaged from the fire, facing significant
22 concerns that exposure to uranium oxides may
40 1 dramatically increase under these conditions.
2 One such fire ripped through the United
3 States ammunition depot in Motorpool on July 11, 1991,
4 setting off a change reaction of explosions at the
5 Black Horse base at Doha, about 12 miles west of
6 Kuwait City. American and British military, as well
7 as the United Nations forces, had bases near Doha.
8 The incident began with an electrical fire on a combat
9 vehicle carrying 155 millimeter howitzer shells. As
10 crew members fought to put out the fire, the vehicle
11 suddenly exploded, pelting soldiers with engine parts,
12 ammunition rounds, phosphorous rounds and shrapnel.
13 The walls of several warehouses used as barracks for
14 American and British soldiers were pierced with holes
15 from flying debris. Waves of explosions which
16 continued for more than four hours incinerated nearby
17 vehicles and tore the roof of the British Headquarters
18 building. One by one, ammunition vehicles, munitions
19 dumps and ammunition storage containers blew up.
20 According to newspaper reports, at least 50 Americans
21 and six Britains were wounded. One American soldier
22 suffered serious brain damage when shrapnel shattered
41 1 his skull. Three other soldiers underwent surgery for
2 abdominal wounds. Six British soldiers from the
3 nearby Saint Georges Lions camp were slightly wounded.
4 As many as 660 D.U. rounds, or the
5 equivalent of 7,062 pounds of D.U., may have been
6 burned in the fire and at least four Abrhams tanks
7 were destroyed. The accident caused the loss of
8 nearly 40 million dollars_ worth of vehicles and
9 ammunition, as well as the loss of several lives
10 during the clean-up operation of scattered munitions.
11 In the end the fires were left to burn out by
12 themselves. Within days DOE, or explosive safety
13 personnel returned to Black Horse Base to begin
14 identifying and clearing out unexploded ordinance and
15 munitions followed by G Troop and other soldiers
16 detailed to clean the area. Nearly 3,000 troops were
17 at the Black Horse Base at the time of the fires.
18 These troops were from the 11th Armored Calvary
19 Regiment, including G Troop Second, First, Third and
20 Fourth Squadrons and the Combat Service Support
22 Sadly, the death toll from this fire is
1 still unknown as among the ashes was depleted uranium.
2 Soldiers were again exposed as they returned for
3 clean-up detail, not knowing the risks of D.U.
4 contamination, approached D.U. armored M1-A1 tanks,
5 carried debris and shrapnel with their bare hands and
6 inhaled the toxic dust from the fires and explosions.
7 There is also a significant concern that soldiers
8 stationed at Camp Doha after the fire were exposed to
9 residual depleted uranium, as even today Camp Doha
10 remains an active base.
11 It is now, now that we do know the dangers
12 and the harm, that we can no longer turn away. And
13 for these reasons we respectfully request that here
14 today the Committee and in particular its Chairperson,
15 Dr. Joyce Lashof, make a modest yet earnest commitment
16 to begin testing of those known to have been exposed
17 to D.U. Beginning with the soldiers at the Black
18 Horse Base near Doha, Kuwait. We appeal to you for
19 funding to support in vivo monitoring, or whole body
20 counts, a testing method that has effectively been
21 used to determine the levels of radioactive material
22 in lungs and other organs of workers at D.U.
1 manufacturing facilities and in Gulf War soldiers who
2 were wounded by friendly fire and carried D.U.
4 We also respectfully request a meeting of
5 the Committee specifically dedicated to investigating
6 the potential health effects of D.U. exposure. And
7 here today, Dr. Lashof, we must respond because now we
8 do know the truth. Thank you. Do you have any
10 DR. LASHOF: Questions? Elaine?
11 MS. LARSON: Do you have an estimate of
12 how many people were exposed to D.U. in this fire and
13 in other areas in the Gulf?
14 MS. OLAH: Well, because there have been
15 -- first of all, the military hasn_t even acknowledged
16 that it_s a problem. Any of their internal reports,
17 that was one thing I wanted to bring to your
18 attention. You should also have a copy of the Army
19 Environmental Policy Institute_s report on depleted
20 uranium, which until recently they denied even
21 existed. So that I don_t know. I do know from my
22 research that at least 3,000 soldiers were at Camp
44 1 Doha at the time of the fire. Beyond that I don_t
3 Have you guys done anything specifically
4 on D.U.? I mean, I_m not the first person that_s come
5 and talked to you about this. I guess I_m looking --
6 only you get to ask questions.
7 DR. LASHOF: No. Staff have been
8 investigating D.U. and it is on our agenda sometime
9 tomorrow for a report on what they have learned about
10 the D.U. So, it is on the agenda. Therefore,
11 continue to explore this and report to the Committee
12 and others have brought it to our attention.
13 MS. OLAH: Okay. Are you --
14 DR. LASHOF: So, we_re not ignoring it.
15 MS. OLAH: No. No. That_s not what I
16 meant to say. Are you willing to dedicate a meeting
17 to the D.U. issue?
18 DR. LASHOF: I can_t respond to that right
19 now. We will have to review what the staff have done,
20 what questions yet remain and what the rest of our
21 schedule is on a number of other issues we have to
22 look into before our work is completed.
45 1 MS. OLAH: All right. I guess I would
2 also encourage you, I understand there_s open spots
3 and there are veterans here that would like to speak
4 and that we should fill those.
5 DR. LASHOF: Well, we_ll see if we have
6 any open spots. The only open spot we had was one
7 person who hadn_t shown yet, and we_ll move along.
8 We_ll take one more before the break.
9 Kimberly Martin. Is Kimberly here?
10 MS. MARTIN: Good morning Committee
11 members and thank you for letting me have the
12 opportunity to speak to you today. I appreciate your
14 My name is Kim Martin. I am a wife of a
15 permanently disabled Persian Gulf veteran. I myself
16 suffer from many different medical problems and
17 symptoms which are very parallel to my husband_s. I
18 spent the complete month of June in Walter Reed Army
19 Medical Center last year under orders from the
20 Secretary of the Army in the care of Major General
21 Ronald Blank and his staff.
22 I was given one free year medical care,
46 1 but they chose to stop seeing me after June. Why, I_m
2 really not sure. I was also given an appointment to
3 be seen by the Department of Veterans Affairs. That
4 was just as big of a disappointment as Walter Reed
6 I_ve been diagnosed by private doctors as
7 having chronic fatigue syndrome, insomnia and severe
8 headaches. Walter Reed diagnosed me with somatization
9 disorder and PTSD. I am not and never have been or
10 served in the military. I_m not a veteran and I never
11 was. Only a few doctors at Walter Reed knew that. In
12 1994 to 1995, several bone scans were done. Test
13 results showed focal area of thinning, involving the
14 outer table of the skull just posterior to the vertex.
15 The overlying soft tissue also appeared depressed in
16 this area. This likely corresponds to the indentation
17 which has been detected clinically. Although the
18 erosion of the outer table appears fairly smooth, my
19 breasts are riddled from lumps. I suffer from
20 gynecological difficulties like burning semen after
21 intercourse. I have to sit in a cold bath to relieve
22 the burning, stinging pain. I have talked to many
47 1 wives with the same burning sensation. I am currently
2 taking high estrogen birth control pills to control my
3 hormones and bloating in the abdomen area.
4 Laparoscopy surgery was performed at Walter Reed to
5 lance a cyst on my left ovary and detach and realign
6 my right ovary. My problems have been compared to
7 early menopause, as one doctor put it.
8 My body is not physically the same as it
9 was before my husband returned from the Gulf. Our
10 son, Devon, was born May 1992. After almost dying at
11 birth, four years later he is currently exhibiting
12 symptoms of difficulty breathing, hyperactivity,
13 rashes, painful muscles, high temperatures and swollen
14 lymph nodes all the time. He also seems to have a
15 speech impairment problem. Our six year old daughter
16 is perfectly healthy.
17 After receiving a call about a new program
18 for spouses and children the VA started, I immediately
19 called for an appointment. I was given an appointment
20 on June 7, 1996. I was unable to keep the appointment
21 because of where I was to be tested is over four hours
22 away in Detroit, Michigan. It makes no sense
48 1 whatsoever to drive over, excuse me, it makes no sense
2 whatsoever to drive that far and take that much time
3 for what? It was made absolutely clear that no matter
4 what I was diagnosed with or how severe my medical
5 problems could be I would not be treated. The results
6 of these tests would only be added to my husband_s
7 registry code sheets. I ask you, what good is that.
8 How does that address my medical concerns? I have
9 talked to other veteran spouses that were told to
10 drive as far as eight hours away. How does the VA
11 expect wives who are taking care of sick family
12 members to drive four to eight hours away, leaving
13 them home alone?
14 Talking with other spouses, one thing we
15 have in common is there are medical universities
16 within the range of one hour to two hour drive. For
17 example, I live near a total of three miles from the
18 University of Notre Dame and two hours from Michigan
19 State University. I realize these are not in the 33
20 locations the VA established, but why can_t the 171 VA
21 medical centers across the country find a location
22 near them for us to go to? Why does it have to be
49 1 universities? Why not an ordinary private practice or
2 medical clinics located in our home towns? If the
3 information the VA is looking for is so important to
4 them, why make it so difficult for us to help them get
6 Since April 1, 1996, the VA has tested 672
7 spouses and children. They expected to test about
8 4,800, spending $2 million to do it. Their goals
9 cannot possibly be met without compromise. It seems
10 that once again the VA is so close but yet so far.
11 This is salt added to injury in the wake
12 of all we have endured in the past five years and will
13 endure for many more to come. My hopes are that my
14 testimony speaks for all the wives who could not be
15 here today, and will be heeded in the thought and deep
16 consideration. We have already sacrificed more than
17 one can ask for in a lifetime. We need our strength
18 to take care of our loved ones.
19 DR. LASHOF: Thank you very much.
21 MS. KNOX: I have one. Did the VA offer
22 any travel pay for you?
50 1 MS. MARTIN: No, ma_am, they did not.
2 MS. KNOX: Is your husband on disability
3 or is he working now?
4 MS. MARTIN: No, my husband has been, was
5 rated and judicated in 1993, excuse me, I_m sorry,
6 that_s wrong. August of _94 he was judicated. He
7 suffers from multiple chemical sensitivity, temporal
8 lobe brain damage, cholitis, gastritis, inflammatory
9 bowel disease, Rider_s Syndrome. There_s tests still
10 pending. We_ve had semen testing done. Nobody can
11 explain why the levels in it are out of range. He is
12 above average.
13 MS. KNOX: He was diagnosed by Walter Reed
14 Army Medical Center?
15 MS. MARTIN: I was diagnosed by Walter
16 Reed Army Medical Facility. Brian was diagnosed by
17 Dr. Francis Murphy in Washington, D.C., at the VA
18 Clinic there.
19 DR. LASHOF: Any other questions for
20 Ms. Martin?
21 If not, thank you very much. And I_ll
22 think we_ll take our break now.
51 1 MS. MARTIN: Thank you.
2 DR. LASHOF: And we will resume at 10:30.
3 We will resume at 10:30.
4 (Whereupon a short recess was taken.)
5 DR. LASHOF: I think we are ready to
7 Troy Albuck? I gather you just arrived.
8 MR. ALBUCK: I did. Thank you.
9 DR. LASHOF: All right. You may begin.
10 MR. ALBUCK: Okay. A few years ago, I
11 began a round of testifying because, not only did I
12 get sick after fighting Iraq, but my family began to
13 have some significant health problems as well. We
14 testified in _93 before the House VA Subcommittee for
15 Oversight and Investigation, the Institute of
16 Medicine, the Illinois General Assembly a few times,
17 and then in _94 before the National Institute of
18 Health and a full Senate VA Committee. I stopped
19 after that because there were some clearly negative
20 repercussions that I was receiving from providing
21 testimony about Gulf War Syndrome.
22 Recently, though, I read a newspaper
52 1 article in the Chicago Tribune about what they were
2 calling Bunker 73, and after looking at the article
3 and getting in touch with some contacts I have from
4 where I used to work, which was the Defense
5 Intelligence Analysis Center when I was an enlisted
6 man, I determined that as an officer in the 82nd
7 Airborne Division leading paratroopers in the war
8 against Iraq, I had captured, led the infantry assault
9 and captured the bunker that was being mentioned.
10 The article went on to say that the U.N.
11 had gone back to that location in the fall of _91,
12 determined that Bunker 73 had contained shells, the
13 shell fragments left behind after demolishing them,
14 showed signs of mustard gas and Sarin. It had been my
15 contention after capturing the ammo depot, looking in
16 the bunker and reporting to my commander that these
17 artillery shells look an awful lot like the kind that
18 we would put a binary chemical agent into or leaflets
19 or tactical nuclear weapons, and I really think we
20 ought to make this bunker off limits because I don_t
21 want to know what_s inside of it.
22 I was told that, you know, the 37th
1 Engineer is coming in. They_re going to rig the whole
2 place for demo. I said, well, I_m not certain that
3 that_s a good idea given what might be in these
4 shells. Well, if there_s any chemicals in there, the
5 reply from my lieutenant commander was, they_ll be
6 burned up in the explosion. Again I stated, I_m not
7 certain that it works that way. It turns out that
8 mustard gas and Sarin aren_t flammable and what we
9 probably did was take those shells, full of whatever
10 the agent was, and just make them into smaller pieces
11 of the same agent.
12 After the demolitions were set to go, my
13 infantry unit was withdrawn to blocking positions
14 about three, yeah, three kilometers, which is a little
15 under two miles outside of the depot to prevent people
16 from going in while it was exploding. We had to move
17 another kilometer further out because we were
18 receiving indirect fire from the secondary explosions
19 from inside the depot. You have to understand that
20 this depot was fairly sizable. The reason I led the
21 infantry assault was I had a mounted unit. WE were on
22 humvees with 55 caliber machine guns, automatic
1 grenade launchers and anti-tank guided missile
2 systems. We were uniquely suited to taking terrain in
3 big gulps like that. The depot itself was three or
4 four kilometers on one side and four or five
5 kilometers on the other side, sort of a rectangle.
6 The large earthern berm or read out all the way around
7 it on the top were anti-aircraft machine guns and
8 inside were dozens upon dozens of bunkers filled with
9 various types of ammunition including the bunker that
10 I spoke of.
11 Outside that position in our blocking
12 positions, the shells that were exploding for about
13 96 straight hours after the beginning of the
14 demolition were raining down on top of us to such a
15 high degree that one of my humvees sustained damage
16 including a flat tire. A lot of the soldiers in my
17 platoon took small shrapnel wounds. So I took it upon
18 myself to move a little bit further away and then
19 report my position to the chain of command.
20 When we went to testify before the
21 National Institute of Health, I spoke to the purported
22 Chief of Intelligence for the Middle East, from the
55 1 Defense Intelligence Analysis Center, a man named
2 Dennis Ross, whose first overhead and first bullet
3 said, the Iraqis had no intention to use chemical or
4 biological munitions at any time during Desert Shield
5 or Desert Storm.
6 And of course, I went to the hallway to
7 seriously question Dennis Ross face to face about this
8 because I had been on the ground, unlike Dennis Ross,
9 and had seen these rounds right there ready to go.
10 And could not get anything other than that_s the way
11 it is kind of response about his overhead.
12 Two years later, I_m talking about the
13 same exact issue. I_m saying the same exact
14 sentences. I_m looking at the same puzzled stares and
15 disbelief. And seeing the same old soldiers out in
16 the lobby of the different hotel talking about the
17 same things. We know what we saw. I mean, I_m just
18 a grunt, but I wasn_t born last night. I was there.
19 I saw it. It was on the ground. I questioned it.
20 And when I got sick, I didn_t say that I knew that
21 that_s what it was from, because again, I_m just a
22 grunt. I_m not a doctor. It_s not up to me to figure
56 1 out what kind of rifle shot the bullet. I just raise
2 my hand when I_m wounded. And I knew that I was sick
3 and that my family was sick. And since nobody could
4 figure it out, I had to really look seriously at my
5 service in the Gulf War.
6 Unfortunately, I hadn_t gotten anyone else
7 who can help me in this, like the Department of
8 Veterans Affairs, all their doctors, and the Gulf War
9 Registry and all their computer files, and all the
10 congressmen that I have spoken to and the boards that
11 I_ve testified before to respond and really do
12 something about this. Just say, yeah, you know what,
13 until we can figure this out 100 percent, we have to
14 treat the wounded.
15 I really want for the Department of
16 Defense to pull the shadow on this.
17 DR. LASHOF: Thank you very much.
18 You became ill at one point?
19 MR. ALBUCK: It was about 18 months from
20 my return to Conus. Initially just slowing down and
21 started to mark it up to old age. But as the symptoms
22 began to pile up, it wasn_t a plausible explanation.
57 1 I was covered with red lesions from head to toe, sort
2 of a bullseye shape, red lesion. And I began to swell
3 up to the point where my lips split open and were
4 bleeding because I guess you can only swell up so far.
5 The right half of my tongue swelled up fairly
6 severely. It was swelling my throat shut and my ears
7 and my eyes. And finally when my airway was being
8 restricted by the swelling, I went to the emergency
10 I saw my family doctor the next day in the
11 hospital, and he said to me that, you know, he_d only
12 practiced medicine for 40 years and he had never seen
13 anything like that. And maybe I should go to the VA
14 because he thought that I picked it up in the jungle.
15 I previously had been in combat in Panama when we
16 parachuted in to catch Noriega. And he was
17 immediately confused, puzzled, dumbfounded and very
18 eager for me to see someone that might know what that
19 was. And his thoughts were that someone in the VA
20 Hospital might. I went to the North Chicago VA. I
21 spent about two months on a ward there. They really
22 were confused. I began to bleed out of a lot of
58 1 places in my body. Had pretty severe joint pain and
2 muscle aches and couldn_t really walk or move much
3 anymore. Sleep pattern disappeared almost entirely.
4 And had a very difficult time digesting any food or
6 They decided to Medivac me to Houston
7 which at the time was the Gulf War Syndrome Specialty
8 Center, but I never really got anything more than
9 Motrin there either. So, you know, no answers were
10 forthcoming. Lots of tests, lots of procedures, but
11 no answers at all. And then Congressman Evans asked
12 me to come out and testify before the House
13 Subcommittee, the VA Subcommittee for Oversight and
14 Investigations which I agreed to do.
15 And that started a round of testimony and
16 hearings and that sort of thing, but never really got
17 anything going for that either. My son was born with
18 a lot of the same symptoms, the same identical red
19 lesions from head to toe, respiratory difficulties,
20 about eight weeks premature, underdeveloped lungs,
21 cranial hemorrhage, bleeding ulcers, calcium deposits
22 on the kidneys. The cranial hemorrhage prevented echo
59 1 so the ventilators eventually blew his lungs apart.
2 So the left lung had to be removed from the lingula
3 up. Lower lobe on the right was totally destroyed.
4 About a dozen pneumothorax, 20 blood transfusions,
5 three cardiac arrests, ran through his entire lifetime
6 limit of medical insurance in 88 days. And the
7 neonatologists who were all very good and the neonatal
8 nurses who were fantastic kept them alive, stood
9 around scratching their heads a lot and didn_t want me
10 in there in their ward because I was covered with red
11 spots and they didn_t know what it was.
12 DR. LASHOF: What is your health now?
13 MR. ALBUCK: I_m in fairly good shape. I
14 still get the red lesions from time to time and feel
15 a little slower than I used to. I think I shouldn_t
16 feel as slow as I do. But, I_ve been working hard to
17 drink a lot of water and not combine foods and not eat
18 much processed stuff and really concentrate on that
19 and exercise a lot. And right now I_m ranked number
20 one on the eligibility list for the Oak Brook Fire
21 Department. So, out of the 612 guys that went to do
22 that, I rose to the top. I tend to be a very average
60 1 individual who just tries real hard. So, I think I_m
2 going to fight through it. My son is fighting through
3 it. He_s disabled, but they_d said he_d be deaf,
4 blind, fail to flourish and probably die within a
5 year. He walks, talks, sees, hears and is doing great
6 in his special education program.
7 DR. LASHOF: I_m glad to hear that. Any
8 other questions? Elaine?
9 MS. LARSON: You said that there were
10 negative repercussions from your testimony. Can you
11 elaborate on that please?
12 MR. ALBUCK: Yes, ma_am. A couple days
13 after we returned from Washington, another family that
14 had been to some of the hearings with us called me and
15 said that their car had been burned and that the
16 incendiaries were placed on the cardboard box that had
17 all the paperwork from the various places that we
18 went, both with the testimonies that we took and the
19 paperwork that we received at the various hearings.
20 And that they were very scared by that, felt it was a
21 message and that they were not going to be available,
22 you know, for us to call anymore because they were
61 1 going to move.
2 The next day I was bringing my son home
3 from physical therapy and he always came home
4 exhausted so I put him right in his crib, went
5 downstairs where I had a computer and fax machine, and
6 kind of did business. And there were a couple guys in
7 my basement and they took me at gunpoint out of my
8 house, through the back door, through the woods, put
9 me in the trunk of their sedan, taped me up, drove me
10 to a cornfield and stabbed me in the back, which
11 punctured my right kidney, and left me in the
12 cornfield. I walked out through a swamp, went to the
13 hospital, the Lake County Sheriff_s Department was
14 very interested for about six hours. The FBI called
15 and said pack up and go home, and they did. And at
16 that point, I went to my house, packed up my family
17 and I left, too.
18 I haven_t spoken to anyone about this for
19 about two years.
20 DR. LASHOF: There was no further followup
21 by any law enforcement?
22 MR. ALBUCK: The only thing I saw was a
62 1 news article in my local paper. The interview was
2 given by the FBI who were never on the scene and they
3 said that obviously I was suffering from post-
4 traumatic stress disorder, which a lot of veterans do,
5 and that it was a very sad thing how we end up.
6 DR. CUSTIS: You seem to have a propensity
7 for being at the wrong place at the wrong time.
8 MR. ALBUCK: Yes, sir.
9 DR. CUSTIS: Are you under any
10 compensation now for --
11 MR. ALBUCK: No, sir. I filed a claim.
12 DR. CUSTIS: Where does it stand?
13 MR. ALBUCK: Well, they noted that I had
14 multiple chemical sensitivity, chronic fatigue
15 syndrome, hives and a bunch of other things that I
16 can_t even pronounce. And that is was obviously not
17 service-connected. And that was basically the end of
18 it. If you don_t, you know, if you cannot
19 service-connect your illnesses then the VA, you know,
20 is not liable.
21 DR. CUSTIS: What time frame was it that
22 you applied for compensation?
63 1 MR. ALBUCK: I went into the hospital, you
2 know, the VA hospital, about 18 months after I got
3 back from the Gulf War. I actually applied for
4 compensation right on, you know, the end of the two
5 year threshold. There_s a two year threshold where,
6 you know, if you get sick, up to two years --
7 DR. CUSTIS: It was within the two year
9 MR. ALBUCK: I don_t remember exactly, you
10 know, whether I was either on or after, I believe I
11 was after, because if I were before, they should have
12 had to help me out. But, all this other stuff started
13 to come up at the same time. I really just dropped
14 the whole thing and hid my family as best I could.
15 Some of my old soldiers and old commanders really, you
16 know, extended themselves to help us out. And so we
17 kept my family in hiding for about a year and a half.
18 About six months ago, I went back into the work force.
19 I_m a preschool teacher, so I can take my two sons, my
20 three and a half year old who is disabled, my one and
21 a half year old to work with me, so that they_re close
22 to me all the time. It_s a very secure facility
1 because the executives from a major corporation_s
2 children are the ones that are taught there.
3 DR. TAYLOR: You mentioned that your
4 symptoms recur? Are they occurring more often or less
5 and are you receiving, or have you received ever any
6 kind of treatment?
7 MR. ALBUCK: Well, they just kind of limp
8 along, you know. Some days are better than others.
9 Treatment, you know, I_ve gone back to my family
10 doctor on occasion and we_ve tried various different
11 medications for allergic reactions to reduce reactions
12 that, you know, those sorts of medicines. I don_t
13 even know all the terms for them. But nothing really
14 seemed to have a direct effect on this. Any time I
15 had symptoms and there was something they wanted to
16 try, you know, if they knew what it was, if it was
17 just hives, then this would clear it up. None of that
18 stuff never seemed to work the way they had thought it
19 would. So I always felt like it was, you know, it was
20 fairly resistant to the doctor_s attempts to, you
21 know, to clear it up.
22 DR. TAYLOR: I just wanted to clarify one
1 other thing. You were in Conus in Iraq, or where
2 were you located during the times that you felt that
3 you were exposed to chemical agents?
4 MR. ALBUCK: Well, if I am clear on
5 everything, Bunker 73 is within a large ammo depot.
6 I led the infantry assault that initially cleared,
7 secured, inspected and then protected that depot
8 complex. I led an anti-tank platoon, a mounted
9 platoon, and I was attached to a rifle company because
10 they were all on trucks and they wanted some people
11 with weapons on their vehicles to lead them around.
12 So that was what my platoon_s job was was to, you
13 know, lead the way for this team, it_s called a
14 company team when they change platoons around, and
15 they took a rifle platoon away and an anti-tank
16 platoon in, it becomes a company team. My element was
17 a mounted element, you know, uniquely suited for
18 crossing the forward edge of the battle area, which,
19 in our location, Highway 8. We crossed a small canal
20 in the Euphrates River Valley, and then out into this
21 depot just short of the Euphrates and this depot
22 splits right in between this canal and the actual
66 1 Euphrates River, and is also paralleled by Highway
2 in Iraq. It_s just southeast of T_Lil Air Base and
3 also southeast of An Nasaria, which is a larger Iraqi
4 city or town.
5 DR. LASHOF: When you identified the items
6 in Bunker 73, oh, any other members of your group
7 identify them with you and did you write up a
8 description in a formal report to your commanding
10 MR. ALBUCK: No. No, I didn_t write
11 anything up. It was simply, you know, the tempo of
12 operations was fairly quick. You know, we got the
13 fragmentary order to secure this ammo depot over the
14 radio. The company commander called officers in to
15 him. He said, okay, here, you need to go to this
16 spot, and I looked at my map, said, well, it_s not
17 tactically sound, but the only route is to go over
18 this canal bridge. That_s the only way we_re going to
19 get these vehicles in there short of, you know,
20 walking all you guys through all this stuff, and, you
21 know, bringing the vehicles up on the road separately,
22 which would take an awfully long time. We_re just
67 1 going to do a movement to contact straight up this
2 high speed avenue of approach and right into the ammo
3 depot, which, you know, in all of our training, isn_t
4 tactically sound, but we had pretty much control of
5 every combat that we entered in Iraq up to that point.
6 When we arrived on the northeast side of
7 the canal bridge, there were some Iraqi individuals in
8 uniform and many that were not in uniform and they
9 appeared to be fighting each other. What we worked
10 out after capturing some of the uniformed individuals
11 and thrashing the rest, kind of sending them on their
12 way, was that they were the guards and administrative
13 staff who had kind of hung around the depot and some
14 looters. And we did find a significant number of
15 looters inside the depot. And the only reason we
16 really cleared them out was because we were going to
17 blow it all up and we didn_t want to, you know, have
18 them get hurt. But then we helped them carry a lot of
19 the small arms ammunition and some of the AK weapons
20 out into the desert. We conducted an AK-47 basic
21 rifle marksmanship because they were conducting a
22 surgency against the authorities that were left in the
68 1 area. And we certainly wanted to help them out with
2 that as best we could. And we gave them, you know,
3 plenty of bullets, a little bit of instruction on how
4 to use the rifles and pointed them in the direction of
5 enemy units and then cleared everyone out of the depot
6 to our radius and then the 37th Engineers was brought
7 in with trailer loads of explosives which they placed
8 at all the bunkers.
9 The complete explosion lasted about 96
10 hours. It began exploding and just kept on with
11 secondary explosions and things coming out of the
12 bunkers, artillery shells, that sort of thing, for a
13 few days. It was quite impressive.
14 DR. LASHOF: We will be hearing more on
16 MS. LARSON: I have a question.
17 DR. LASHOF: Yeah. Elaine?
18 MS. LARSON: Would you feel comfortable
19 giving us the name of the chain of command that you
20 reported that information to?
21 MR. ALBUCK: I don_t see why not. The
22 team company commander was Captain Cooper.
69 1 MS. LARSON: Do you have a first name?
2 MR. ALBUCK: First initial was A. It was
3 like 15 letters long and it was Hawaiian. And I
4 really couldn_t even get close to pronouncing it or
5 remembering how it was spelled. But that should get
6 you pretty close. I know his father was a general,
7 maybe a brigadeer or a major general.
8 MS. LARSON: The second thing, has your
9 spouse been ill as well?
10 MR. ALBUCK: She has -- I_ve been out of
11 contact with her since my younger son was about two
12 months old. So, I just have the two boys myself and
13 I really haven_t had any contact with her at all. She
14 was really traumatized by the, you know, the set of
15 events and so, you know, you can hardly blame her for
16 having a difficult time processing all that.
17 MS. LARSON: What led you to believe that
18 the stabbing related to your testimony and do you feel
19 safe now?
20 MR. ALBUCK: It was pretty clear by the
21 incident what it involved. I also was amazed at the
22 difficulty I had at trying to get information on what
70 1 exactly had happened. And I am at the wrong place a
2 lot of the time, but I also am pretty good at getting
3 around things. And I happen to know somebody in the
4 Israeli Council General_s office in Chicago. And I
5 went downtown and I talked to them for a while. And
6 they told me that they cannot help me in this country.
7 But ultimately some information appeared on my
8 windshield one day, under my windshield wiper. And it
9 led me directly to the folks that were involved.
10 It turns out that one of them was an
11 individual who carries cash from here to the Middle
12 East. And in January, after I was attacked, I placed
13 a call, after I was following one of the guys around
14 and he had a trunkful of cash, and he left O_Hare for
15 Lebanon and the Massad picked him up in Israel and a
16 Chicago man was picked up with $250,000 in cash and
17 placed in custody in Israel. So, it was just a really
18 involved and backwards thing that I knew exactly what
19 the guy looked like. When the Israelis helped me out,
20 that_s exactly who it was. I followed him around
21 until he did something bad and then I made sure he got
22 caught doing it.
71 1 MS. LARSON: I_m trying to understand if
2 there is something important or relevant to the work
3 of this Committee --
4 MR. ALBUCK: Other than -- I can guaranty
5 you that the information is going to be slow in
6 coming. You know, we were there at the NIH. We had
7 our information. We knew exactly what we were talking
8 about. And there_s the Department of Defense saying
9 the exact opposite. And there_s the Defense
10 Intelligence Analysis Center, Chief of Intelligence
11 for the Middle East, first lie, first bullet, no
12 possibility that these guys could be sick from that.
13 It_s just, you know, either it_s an
14 extreme case of the right hand not knowing what the
15 left is doing, you know, just some sort of, you know,
16 monumental ineptness, or it_s got, you know, the only
17 other explanation is that there_s just some real
18 disinformation or delaying and downplaying,
19 diminishing of the truth that it_s causing this to
20 happen, where people who are on the ground have vastly
21 different reports of what they encountered from the
22 Department of Defense reports was encountered by us.
72 1 And, you know, it_s hard for me to say because, you
2 know, I was really in this thing. And I was there,
3 you know, there for the duration. And now I have to
4 say stuff that I really wouldn_t want to have to have
5 ever said.
6 DR. LASHOF: I_m afraid we have to move
7 on, but we will be looking further into the
8 circumstances of Bunker 73 and certainly want to be in
9 contact with you further to get additional
11 MR. ALBUCK: Thank you for your time.
12 DR. LASHOF: Thank you. Marguerite
14 MS. BARRETT: Thank you for giving me the
15 opportunity to speak to you this morning. My name is
16 Marguerite Barrett, and I_m here on behalf of my
17 husband David who is currently a patient at the VA
18 Hospital in Marion, Indiana, and could not be here
20 My husband served in Jedda, Saudi Arabia,
21 for six months and it was shortly after his discharge
22 in August of 1992 that his troubles began. Attachment
73 1 A is a list of the symptoms he has been experiencing
2 since he has been home. It is due to these symptoms
3 that he has been unemployable for the last two and a
4 half years.
5 The last four years have not been easy for
6 David. Instead of going to movies, spending time with
7 friends and spending time with his daughter, who is
8 now four years old, he has been spending his time
9 going from VA Hospital to VA Hospital, trying to find
10 someone who will listen to him so he can find out
11 exactly what is wrong with him. He has had four
12 hospitalizations in the last two and a half years and
13 he is finally at a facility who is taking him
15 This hospitalization has occurred as a
16 result of the negligent care he received at Lakeside
17 VA Hospital here in Chicago. Attachment B is the
18 letter I wrote to Lakeside_s Director, Mr. Joseph
19 Moore. And Attachment C is the written response I
20 received from my letter. In Attachment C, Mr. Moore
21 states that both David and I were fully aware of the
22 care that was given during this stay. I had asked the
74 1 staff to please keep me informed of things as they
2 occurred, but no one ever called me. And every time
3 I called to see how my husband was, I was treated as
4 if I was overbearing, annoying and had no right to the
5 information that I was seeking. I am not sure exactly
6 what David was told because throughout the entire stay
7 he was kept in a drug-induced stupor. Prior to the
8 Lakeside admission, my husband had problems with his
9 short term memory. The drug-induced stupor caused a
10 complete loss of all of his short term memory.
11 It has been said that joining the military
12 will make you a more responsible person. From all
13 that I_ve seen and everything my husband has been
14 through, the military takes independent and
15 responsible people and reduces them to shells of their
16 former selves left to be cared for by their families.
17 Our situation has gotten so severe that I have had to
18 take charge of our household and am in the process of
19 being made power of attorney over David_s legal,
20 financial and medical affairs.
21 Despite all of this the VA feels that our
22 situation does not warrant an increase in my husband_s
1 30 percent disability. How sick does an unemployable
2 veteran have to be before assistance can be granted to
3 help take care of his or her family? And what does it
4 take for a veteran to be treated with the respect that
5 they deserve? Thank you.
6 DR. LASHOF: Thank you. Any questions
7 this Committee would like to direct?
8 What is your husband being treated for now
9 in the hospital in Marion?
10 MS. BARRETT: For the longest time when he
11 was going to the different VA Hospitals all they were
12 addressing was the depression that he was going
13 through and they were just trying to treat him with
14 the drugs. He is just now, after almost four years,
15 just now getting a physical, as far as trying to
16 address the physical symptoms that he_s been going
18 When he came home from Saudi Arabia, my
19 husband weighed 150 pounds and he is six foot two. He
20 is now down to about a little under 130 pounds and he
21 has not been able to maintain any weight whatsoever,
22 no matter what he eats.
1 DR. LASHOF: Can you tell us anymore about
2 the treatment he is actually receiving now?
3 MS. BARRETT: While he was at Lakeside, he
4 was given medication. He asked for therapy. He was
5 not given any therapy. They were talking about
6 putting him through a PTSD program. He has yet to be
7 put through one. He has been asked to be put through
8 a stress treatment program. They_re just now talking
9 about putting him through one. While he was in
10 Lakeside, he was given medications that clashed with
11 each other and caused him to get into a very violent
12 state. Since we took him down to Marion VA, in
13 24 hours his total demeanor has changed and he_s never
14 had any experience of any violence before he was taken
15 to Lakeside. At Lakeside, the only response they had
16 to his violent rage was to strap him down. I mean,
17 they didn_t try to figure out if it was a clash in the
18 medications he was given or anything like that. He_s
19 just now being checked. They_re just now checking to
20 see if he can be put into a stress treatment program
21 and a PTSD program.
22 DR. LASHOF: Thank you.
77 1 MR. CROSS: Is the disability he_s
2 getting, is that for his medical symptoms or his
3 psychological symptoms?
4 MS. BARRETT: I think it_s for his
5 psychological symptoms. This is just now the first
6 time anybody has listened to his physical symptoms.
7 Before they just gave him drugs. But now, he_s just
8 now -- they_re just now starting to listen to his
9 physical symptoms and being willing to give him a
10 complete physical.
11 MR. CROSS: And he is at a VA Hospital
13 MS. BARRETT: Marion, Indiana.
14 MR. CROSS: How far is it a drive for you
15 from where you live to there?
16 MS. BARRETT: Two and a half hours.
17 MS. KNOX: You_ve had a child since the
18 Gulf War. Is that child healthy?
19 MS. BARRETT: So far, yes. And his
20 daughter from his previous marriage has been,
21 thankfully, very healthy.
22 DR. CUSTIS: Where is your home base?
78 1 MS. BARRETT: Mishawaka, Indiana.
2 DR. CUSTIS: How did you wind up in
4 MS. BARRETT: Because when my husband was
5 stationed at Grissom Air Force Base, that was the
6 closest VA facility. And after he was discharged from
7 Grissom Air Force Base, he had married somebody who
8 lived close to there and that_s where he lived. So
9 when he moved back up to Mishawaka, he continued the
10 treatment there at Marion because that was the only
11 facility where the doctors knew him and knew his case
13 DR. LASHOF: Thank you very much. I
14 appreciate your coming. Terry Reese?
15 MS. REESE: First of all, I would like to
16 thank the Committee for letting me speak on today and
17 thank the other Gulf War veterans and their families
18 for the support that they_ve given us.
19 I just want to start out by saying that
20 there_s not a day that goes by that I don_t stop
21 wondering when is this all going to end and why did it
22 begin? Is it worth it? The people said that history
79 1 tends to repeat itself. And if it_s true, why can_t
2 we utilize the experiences from the past as a stepping
3 stone for the future. Everyone remembers the big deal
4 with the Agent Orange incident and how long the
5 process took for us to rectify the problems with that.
6 And the U.S. is spending billions and billions on
7 machinery, weapons and chemicals. Why can_t we demand
8 that the women and the families that put their lives
9 on the line day in and day out get the support that is
10 needed for them? There_s been reports of babies being
11 born with defects, muscles and nerve abnormalities,
12 arthritis, skin rashes, hair loss, chronic fatigue,
13 weight losses, headaches, and many, many more symptoms
14 that people have been coming up with, and still there
15 is no answer. There has to be something.
16 And I never felt more angry than when I
17 was being seen by a physician and I was told that
18 everything I was going through was normal. That was
19 when I was 25. I don_t know too many 25 year olds
20 that wasn_t in the Gulf War that are going through
21 these things that I_m going through so I don_t know
22 how it could be normal.
80 1 When I was told that they could not find
2 what was wrong with my muscles and nerves, I had two
3 abnormal EMGs that was done, physical medicine, at
4 Fitzsimmons in _93 out in Denver, Colorado, and they
5 told me to follow it up with the VA once I was out of
6 the military after active duty, it seems like a slap
7 in the face to me if they cannot deal with the issues
8 while I was on active duty. What_s the purpose?
9 Just, excuse me. Just think if I was to wait to join
10 the military after the Gulf War, I wouldn_t have to
11 deal with these issues either.
12 I think this is very sad that a lot of
13 people are going through the things that they_re going
14 through and we cannot get the support from the VA_s or
15 the active military from the Department of Defense.
16 Now, I_m currently going through the process of going
17 to the VA in Battle Creek and it_s pretty much the
18 same thing. I have to travel two and a half hours to
19 go see a doctor for 15 minutes in one day. And I have
20 a family and a wife and two children to support. And
21 it_s really hard. And I just don_t know what to do
22 anymore. There_s days that I don_t know if I_m coming
81 1 or going. Short term memory loss, and stuff like
2 that. I live in Niles, Michigan, and I grew up there
3 all my life up until I was 18 when I joined the
4 military. I left in 1987. And I just moved back
5 there currently in January, and it seems really weird
6 when you wake up from day to day and you can_t
7 remember the places that you grew up at or the faces
8 that look familiar but you can_t remember the names.
9 And that_s all I have to say. I_ll take your
10 questions now.
11 DR. LASHOF: Any questions on anything the
12 Committee has for Mr. Reese?
13 MS. LARSON: What did you do in the Gulf
14 War and how long after the war did your symptoms
16 MR. REESE: When I was in the Gulf War, I
17 was with the 24th Infantry Division. I was working as
18 a 31 Kilo, which is communications. We used to run
19 telephone lines and stuff like that. And we would go
20 out and do long distance radio checks and
21 communications with the radios.
22 When I shortly returned, it was in, I
82 1 think January of _92 that I started noticing problems
2 with my skin. I had went to a physician when I was
3 down in San Antonio going through an AIT course down
4 there. And my skin was really dry and it was like
5 cracking in spots real bad. Anytime I moved my arms
6 and stuff like that, the skin would just open up and
7 it would start bleeding sometimes. The only thing
8 that really worked for that, they gave me some steroid
9 cream, it_s called a west pore. And I used that for
10 like about eight months. And my skin is really
11 irritating now. I can_t use anything that has alcohol
12 in it as far as like regular lotions and stuff like
13 that. I_ve been using a Eucerin lotion and I can_t
14 use any cologne or anything. If I just put it just on
15 my hands, it just makes my eyes start watering and
16 it_s very irritating.
17 MS. LARSON: It was about a year after?
18 MR. REESE: Right. Somewhere within six
19 months to a year after I had came back. I started
20 noticing that and I had real bad cases of diarrhea and
21 stuff like that. They said I might have a lactose
22 tolerance problem, but they can_t really figure it
83 1 out. They can_t pinpoint what it is.
2 DR. LASHOF: Any other questions?
3 DR. TAYLOR: Are you working now?
4 MR. REESE: I_m currently working as a
5 home car, as part of a nursing association. And I do
6 that part time. I work about maybe 16 to 20 hours a
7 week. But whenever I go to work, if I work like an
8 eight hour day and I come home, it_s like my body goes
9 through a complete shutdown and I can sleep from like
10 10 to 12 hours and I wake up and I_m still tired that
11 whole day. And I never was like that before. I used
12 to play basketball and baseball, everything like that.
13 If I get out on the court and try to play basketball
14 now, I run up and down the court two or three times
15 and I_m dead dog tired. I just can_t do it anymore.
16 MR. CROSS: Are you presently getting
17 compensation at all from the VA?
18 MR. REESE: No. When I got out of the
19 military, at first I had moved down to Florida and I
20 was down there for about four months. And I started
21 the process down in Pinellas County. And things got
22 a little hard, so I moved back up here so I could be
84 1 with my family and get support from them.
2 And I_m currently trying to get the
3 process going with Battle Creek, but I_m still waiting
4 on the records to come from the Florida station.
5 DR. LASHOF: Okay. Thank you very much.
6 We appreciate it.
7 MR. REESE: Thank you.
8 DR. LASHOF: Kathi Kelly.
9 MS. KELLY: I_d like particularly to thank
10 Mr. Miles Ewing for allowing me to testify today. I
11 don_t have any record of United States military
12 service. I was a civilian in Iraq during the Gulf
13 War. I went to Iraq. I flew into Baghdad on one of
14 the last civilian planes that went into Baghdad. And
15 from January 15th until the 29th of 1991, I was in a
16 camp on the border between Saudi Arabia and Iraq on
17 the Iraqi side. And so, like so many of you, I saw
18 the bombers going overhead. I heard many, many, many
19 explosions. But perhaps, unlike you, when I was
20 evacuated to Baghdad on January 31st until February
21 4th and staying in a very well fortified bombing
22 shelter, I was in the underground area huddled
85 1 together with parents and their children. And I held
2 children in my arms. I played with them in the
3 daytime but sometimes held them at night. And I saw
4 their parents, themselves shaking with fear, and
5 trying to soothe the children and say things would be
6 all right when there was certainly no guaranty for
8 I was then evacuated to Amman, Jordan. I
9 spent some time in mid February in a refugee camp just
10 outside of Iraq. And there I most clearly remember
11 sharing just the tiniest portions of food with very
12 hungry and very frightened displaced children. And
13 then again, in March of 1991, I returned to Iraq and
14 I went to the Ammaria shelter, the site of the bombing
16 And so today it_s very clear, I hope, that
17 the competency and the composition of this Commission
18 says that all of you are willing to say to the people
19 here that something did happen during the Gulf War,
20 that these people were there and that they did sick.
21 And hopefully, the intent now is to say that nobody_s
22 asking questions to try and see, well, who_s to blame
1 and are we responsible to do something about it, but
2 rather to acknowledge that the government of the
3 United States has the resources to do something about
4 has happened. And that when a government chooses to
5 go into a war, that government is by all means
6 responsible for the consequences of that warfare.
7 And it certainly is my hope that the agony
8 and the frustration and the panic and the pain and the
9 fear that all of you have felt will begin to be
10 redressed and in some measure you can be compensated
11 and be restored to happiness and health.
12 I mainly speak to you, the Gulf War
13 veterans, and I ask you out of that space of real
14 terror and unhappiness that you_ve experienced that
15 you might extend a hand of friendship to the Iraqi
16 children, to the Iraqi families, to the Iraqi
17 civilians. For them the war has simply never stopped.
18 It_s been an ongoing war. A most terrible warfare
19 comprised of economic sanctions.
20 I went back to Iraq in March of 1996. And
21 again, held children in my arms, and I_m really
22 certain that the baby I held for 15 minutes didn_t
1 survive that day. And that is one of 567,000 children
2 who have died since the imposition of sanctions in
3 August of 1990.
4 Those children bear no responsibility for
5 their government. Children under five, like our own
6 children, simply cannot control their governing
7 forces. And yet, because of the terrible corrective
8 punishment, they_ve been called upon to pay the price.
9 And they paid a very terrible price. Children
10 continue to suffer from malnutrition, stunted growth,
11 starvation. The death rate continues, as high as
12 10,000 per month.
13 We recognize that our government has
14 responsibility for the Gulf War veterans, I don_t
15 think that any of us is thinking people can simply
16 say, well, it_s Saddam Hussein_s fault. His
17 government bears responsibility for the people who
18 suffer there. And as we recognize that each of these
19 people has a right to decent and complete medical
20 treatment, mustn_t we also recognize that the people
21 in Iraq today, because of the sanctions, can_t get
22 medicines, can_t get spare parts to repair the
88 1 equipment that they once had, and that civilian people
2 continue to pay a terrible price.
3 And Dr. Custis, you said that, and
4 Mr. Arbuck perhaps said that the propensity to be in
5 the wrong place at the wrong time. Surely we can_t
6 say that a whole nation of children are in the wrong
7 place at the wrong time. And so I simply beg of you
8 to keep in your commissions here, and in your
9 professional competency, a recognition that there are
10 in fact many different veterans of that war. And that
11 they suffer most atrociously. And may we all be
12 haunted by those questions. Thank you for your
14 DR. LASHOF: Thank you. In what capacity
15 had you gone to Iraq originally and returned?
16 MS. KELLY: Dr. Lashof, I was part of the
17 international group called the Gulf Peace Keeping.
18 I_m afraid we couldn_t have been more irrelevant in
19 terms of stopping the war. We hadn_t anticipated that
20 it would be an air war initially, and we were on the
21 ground in a bordering camp between Saudi Arabia and
22 Iraq. And we reconstituted ourselves after evacuation
89 1 to try to ride along the roads that were being bombed.
2 By bringing in medical relief supplies, which were
3 very paltry, we mainly hoped that we might safeguard
4 the roads so that people who were refugees and needed
5 to flee, or people who were bringing in humanitarian
6 relief might be able to travel with some measure of
7 safety on those roads.
8 DR. LASHOF: Thank you very much. Are
9 there any questions that any member of the Committee
11 MS. KNOX: Have you had any illness
12 yourself since having been present in the Gulf?
13 MS. KELLY: No.
14 DR. LASHOF: Thank you very much. We
15 appreciate you coming forward.
16 Penny Pierce.
17 MS. PIERCE: And I, as well, thank you for
18 the opportunity to speak today. I_m speaking as a
19 scientist who completed several studies of women who
20 served in Desert Storm.
21 And as you_ve heard in previous testimony,
22 the Gulf War posed unique threats on our fighting
90 1 forces, but I_m here today to remind all of us that a
2 large majority of those fighting forces were women.
3 Yet, there_s been a lack of attention to assessing if
4 there are long term outcomes of toxic exposure common
5 to the combat scenario that may pose particular and
6 specific threats to women_s health.
7 Since the end of the war, there have been
8 increasing concerns about the possible health effects
9 for both men and women, and yet there_s been little
10 systematic research devoted particularly to the women
11 who were deployed at this time in unprecedented
12 numbers. To my knowledge the two studies I_ve
13 conducted to date with my collaborator, Dr. Vinniker,
14 at the Institute for Social Research at the Institute
15 of Michigan are the only randomized studies focusing
16 solely on the health effects of service in the theater
17 on women_s health. These studies were conducted with
18 the support of the Tri-Service Nursing Research
19 Program and we_re most grateful to them for their
20 continued support.
21 In the first study we selected from the
22 Data Manpower Center tapes of all people who served
91 1 during that time. A stratified randomized sample of
2 525 women from both active guard and reserve forces.
3 We had a group that were deployed to the Gulf and a
4 comparison group that were deployed during the same
5 time but deployed elsewhere. We also conducted a
6 followup study two years later. The initial study was
7 done in 1991 to _93 and our followup study was in
8 September of _94 to August of _95.
9 We again measured the health status of
10 this same sample of women. In this followup study we
11 were looking to see if the physical health findings
12 that were reported in the first year of the study were
13 limited to that initial time of readjustment or if
14 they did continue for an additional period of time.
15 It_s important that you know that in the
16 first study we asked the respondents to report all
17 conditions or symptoms for which they had sought
18 medical services during their entire career, which
19 was an average of about ten years for this group. And
20 results comparing the ratings of both their general
21 health as well as gender specific health problems
22 indicated there were absolutely no differences between
92 1 those deployed to the Gulf and those deployed
2 elsewhere on any of these baseline symptoms.
3 Therefore, the women that were deployed to the theater
4 and those deployed elsewhere were equivalent in terms
5 of their prior physical health.
6 When we analyzed problems based on the
7 length of time in the theater, we found very
8 significant findings. By the way, the average length
9 of time was about 120 days in theater. Among the
10 general health problems, there were significant
11 differences in the first survey in reports of skin
12 rashes between women who did not deploy to the theater
13 and women who were in the theater over 120 days. So,
14 there_s some indication that the length of exposure is
16 There were significant differences in
17 findings of depression between those deployed
18 elsewhere and those deployed less than 120 days in the
19 Gulf. Unintentional weight loss was another symptom
20 that was significantly different between these two
21 groups. And reports of the frequency of insomnia was
22 also significantly different. Headaches was another
93 1 symptom that was also significantly different in these
2 two groups.
3 Health problems in general were higher for
4 those that had served in the Persian Gulf region and
5 ratings were highest among those that reported they
6 were no longer in the military, and presumably some
7 had left the military due to health reasons.
8 When we conducted the followup survey two
9 years after the first and four years after the war, we
10 found a different display of symptoms with the
11 exception of skin rashes, which did persist among
12 those who had served in the theater. Remember the
13 first year survey reported depression, unintentional
14 weight loss and insomnia. These were no longer
15 statistically significant. However, the reports of
16 cough and respiratory problems did persist in this
17 four year period. Also, reports of memory problems
18 persisted and for some they worsened.
19 So, returning again to the initial survey,
20 there were no differences in the two groups on gender
21 specific health issues which reported reproductive
22 issues as well as gynecologic issues in these women.
94 1 However, when the same group was measured two years
2 later, again there are striking differences between
3 those deployed to the Gulf and those that were
4 deployed elsewhere. We found significant differences
5 in reports of lumps and cysts in the breast and
6 findings of abnormal pap smears, which were actually
7 a two and a half fold increase over the two year
8 previous findings.
9 In summary, these results indicate to us
10 as scientists that there is sufficient evidence to
11 warrant further study of the group of general health
12 symptoms that include rashes, depression, cough,
13 fatigue, unintentional weight loss, insomnia,
14 headaches and memory problems. Within our group, it_s
15 a small group, it_s clustered in about 8 percent, if
16 you look at those who report these as severe problems.
17 We need to look much more closely for other
18 explanations for the vague configuration of symptoms,
19 despite the fact that they do not fit into existing
20 diagnostic categories.
21 We need vigilant followup and care of
22 those that are no longer in the military, since it
95 1 appears that poor health following the Gulf War may
2 have been a contributing factor to their leaving the
3 military and perhaps they_re in the VA system, but I_m
4 pessimistic about that.
5 The incidence of gender specific health
6 problems in particular warrants further attention.
7 And points directly at some of the unique health care
8 needs of military women. Specifically, we need
9 rigorous followup on the significant findings
10 concerning these changes in breast lumps that have
11 occurred over time as well as cervical alterations
12 that are reflected in this two and a half fold
13 increase among women who served in the Persian Gulf.
14 We need to know if there are gynecological
15 reproductive problems that pose a risk to future
17 The opportunity to study health
18 consequences of Persian Gulf women in a timely fashion
19 meets a very long and critical need. I_ve offered for
20 you several priorities. First, I think we should
21 commit the needed resources to establish, if nothing
22 else, the prevalence of these health problems among
96 1 Gulf War veteran women and men alike in very well
2 defined epidemiologic studies.
3 Second, we need to document and monitor
4 the health effects of occupational and environmental
5 stressors that are typically found in combat, to
6 better understand the effects of these on gender,
7 menstrual cycle, reproductive capability, and perhaps
8 the interaction of these factors on the health and
9 well being of American women who serve their country
10 in uniform.
11 The third priority acknowledges that women
12 play a key role in the military readiness of this
13 country, and keeping them healthy is as vital to our
14 nation_s defense as any other member. And it_s time,
15 particularly given findings of scientific studies like
16 this one and hopefully others, that this attention
17 will be given to better pre-deployment health
18 screening of women, improved gender specific health
19 care to women in deployed locations and better
20 surveillance and treatment of health problems in the
21 post-deployment period. Thank you very much for your
22 time and attention this morning.
1 DR. LASHOF: Thank you very much. Have
2 you submitted to staff the data from your paper?
3 MS. PIERCE: I believe Miles has the
5 DR. LASHOF: Okay. Thank you. Other
7 MS. LARSON: Has this study been
9 MS. PIERCE: The papers are in review
10 right now. I_ve offered a pre-publication draft of
12 DR. LANDRIGAN: Was your sample a national
14 MS. PIERCE: It was drawn from the
15 database provided by the DMDC, randomized, stratified,
16 according to active duty guard and reserve, those that
17 were deployed to the Gulf, those deployed elsewhere
18 and also on parental status. So, it was like a three
19 by nine.
20 DR. LANDRIGAN: And what was your response
21 rate from each of those groups?
22 MS. PIERCE: The first was very high. It
1 was around 93 percent. By year four, because of the
2 movement, in part, of this population, it was 87, 88
3 percent. Very high response rate.
4 DR. LANDRIGAN: And when you calculate
5 those rates, your denominator is the full 525?
6 MS. PIERCE: Right. You have --
7 DR. LANDRIGAN: Was it questionnaires on?
8 MS. PIERCE: We started with the telephone
9 interviews with the Institute of Social Research. So
10 women were contacted personally. There were a series
11 of questionnaires in each round of surveys and one
12 went to their significant other that also reported on
13 health effects.
14 DR. LANDRIGAN: Thank you.
15 MS. PIERCE: Mm-hmm.
16 DR. BALDESCHWIELER: Did I understand that
17 there were 525 in each branch of the study?
18 MS. PIERCE: No. That was total. That
19 was just a sample size based on the measures we were
21 DR. BALDESCHWIELER: And do you have some
22 sense of the consequence which you have significant
99 1 finding with respect to breast lumps, for example?
2 MS. PIERCE: I can give that to you.
3 MR. EWING: Staff has all the tables done.
4 And we_ll make them available to the whole Committee.
5 MR. CROSS: In this questionnaire, were
6 there any questions about care or services offered by
7 the VA, whether it was positive, negative, in terms of
8 these women?
9 MS. PIERCE: Yes. Actually one of the
10 things I was interested in as a nurse-scientist was if
11 people sought care for some of these symptoms. And if
12 they did, where did they go and what was their
13 satisfaction with the care they received.
14 It_s difficult to disentangle because of
15 the large number of guard and reservists. Those
16 people reported that they went to a civilian doctor.
17 And the highest satisfaction was with the civilian,
18 next was with active duty and the lowest satisfaction
19 rate is with the military, with the VA, excuse me.
20 But that_s in part because they_re small numbers, too.
21 It seems that people, particularly women,
22 are not using VA facilities.
100 1 DR. LASHOF: Any other questions? If not,
2 thank you very much. We appreciate your testimony.
3 Chris Kornkven had asked to present again.
4 We have five minutes left, Chris, and you can have
5 that. Even though you have presented in the past, I_d
6 appreciate it if you would limit yourself to five
8 MR. KORNKVEN: Thank you, Dr. Lashof. I
9 also understand others have provided testimony in the
10 past more than once. I appreciate the opportunity.
11 My testimony today will provide a single
12 person_s perspective in seeking health care from the
13 Department of Veterans Affairs. I have been seeking
14 treatment at the Oklahoma City VA Agency since early
15 1992. And stopped seeking treatment from the VA
16 medical system in February, 1996. During this period,
17 the following items have been discovered and were
18 reported to the VA.
19 I have reported blinding headaches for
20 more than a year with only offers of aspirin.
21 Eventually, an MRI was reluctantly performed in which
22 a nasal mass was discovered. There has been
101 1 absolutely no treatment to date. I have reported
2 memory loss since returning from the Gulf. This has
3 been dismissed as a result of stress with no other
4 attempts at finding the cause or other treatment.
5 I have reported skin problems since
6 returning. After a skin sample was taken of many
7 brown spots that have been appearing, I was told,
8 _It_s not skin cancer yet._ And I could _come back as
9 needed._ There has been no further treatment to date.
10 I have reported problems breathing and
11 have had instances of pneumonia and bronchitis since
12 returning. I have been questioned by VA doctors about
13 whether I have ever had surgery on my chest with no
14 explanation. Other than antibiotics for the pneumonia
15 or bronchitis, the only other attempts at treatment
16 have been frequent chest X-rays.
17 I have reported intestinal problems that
18 include diarrhea for more than a year before a strange
19 type of bacteria was found. I was given a two week
20 course of antibiotics in which the symptoms receded
21 somewhat. When the symptoms returned worse than
22 before, I reported this to the VA for more than
102 1 another year. During this time I also reported having
2 rectal bleeding. I was eventually given an
3 appointment in which the bleeding was described as
4 hemorrhoids after no examination.
5 When the doctor found no evidence of this
6 in my medical records, he continued to dismiss the
7 problem until I insisted something be done. By the
8 time I left Oklahoma months later, a followup still
9 had not been performed. This bleeding continues.
10 I have reported joint pain for many months
11 and have been given a followup to see a rheumatologist
12 in 1994. To date I have yet to see a rheumatologist,
13 and the joint pain has been dismissed as fibromyalgia.
14 No other treatment other than Motrin has been given.
15 I have reported my wife and I having a
16 miscarriage in which the fetus had to be surgically
17 removed. And my semen burning her. There have been
18 no attempts at finding the cause of either other than
19 mysterious questions asked by some doctor from the
20 Houston VAMC.
21 Other blood and urine samples have shown
22 glaring abnormalities with no attempts to discover the
103 1 problem. I have been told of these abnormalities
2 months after the sample was taken. I have requested
3 over several months that a urine test for depleted
4 uranium be performed. After many excuses and attempts
5 to ignore this, I finally was successful after
6 requesting congressional help. After waiting the
7 period needed for the results, I began inquiring about
8 them from the Chief of Staff. Three months went by
9 during which I was told they had called the Baltimore
10 facility performing the test, left messages, but
11 Baltimore would not return their phone calls.
12 I called the Baltimore facility, spoke
13 with the doctor overseeing the testing and had him fax
14 the results. During the conversation I was told, _I
15 had a higher D.U. count than those carrying around
16 fragments in them._ I was also told there was nothing
17 for me to worry about and that I probably got it from
18 the drinking water where I live. I believe the
19 Environmental Protection Agency would be interested in
20 hearing that one.
21 I understand D.U. contamination may cause
22 kidney problems. I have been questioning for many
104 1 months as to whether this may be the cause of the
2 urine abnormalities, but they have been unanswered.
3 I also question if this may cause liver problems, and
4 the only response I_ve ever received is a question of
5 whether I_ve ever had an ultrasound of my stomach,
6 since it has been painful to the touch since I have
8 I have reported chest pains since
9 returning and instances of my heart racing as high as
10 160 beats per minute with no activity. After going
11 through tests with results varying from _no problem_
12 to not being able to start a test due to abnormalities
13 showing, I was given an appointment with a
14 cardiologist. After the initial examination in which
15 problems were discovered, I was given followup.
16 Unfortunately, this followup was scheduled for a year
17 after the initial visit. Several attempts to correct
18 this were ignored until once again I requested the
19 help of my congressman. When the appointment was held
20 after a couple of failed attempts, I was told the
21 heart problem I was having was due to an abnormal
22 heart valve.
105 1 After many physicals and no heart problems
2 prior to the Gulf, I was surprised to hear this. I
3 was also told this type of problem was hereditary,
4 nicely avoiding the VA_s rating guidelines. Many
5 types of treatment at this facility consisted of
6 providing a quick prescription for whatever the
7 reported problem may be. The number of prescriptions
8 that I have been given totaled 27 at one point. I
9 began wondering about the interaction of all these
10 medications and requested over several months through
11 the Chief of Staff an appointment with the pharmacist.
12 I eventually had this appointment for my
13 own doing with no attempts by the Chief of Staff.
14 During this appointment I was told two of the
15 medications I was given interacted, causing heart
16 arrhythmias and _some people have died from it._ To
17 date my insurance has been billed more than $35,000
18 for these appointments with the VA, ranging from a few
19 minutes to half an hour. Most were with medical
20 students. I have little wonder why claims are denied
21 once a veteran reports having medical insurance.
22 Due to problems in obtaining treatment, I
106 1 have contacted the Persian Gulf Veterans doctor, the
2 patient advocate, the Assistant Chief of Staff, the
3 Chief of Ambulatory Care, the Chief of Staff, the
4 congressional liaison, and finally, the Director of
5 the Oklahoma City VAMC. Since problems continued in
6 obtaining treatment or appointments, I have contacted
7 six different members of Congress to include three
8 congressional committees. The problems continue.
9 I then contacted the VA Inspector
10 General_s office which opened an investigation. This
11 resulted in the Inspector General_s office requesting
12 a response from the Director of the Oklahoma City VA.
13 The Director provided excuses for each of the problems
14 I had identified. After two months of waiting for
15 results, I called the Inspector General_s office and
16 was told they were satisfied with the Director_s
17 response and refused to investigate further.
18 Due to the publicly shown support of the
19 Gulf War veterans by First Lady Hillary Clinton and
20 the continued gross negligence with no resolution, I
21 contacted the First Lady_s office with some of the
22 issues that I had raised. The result was her office
107 1 referring her problem back to the same VA staffers
2 that had been the cause of all of the problems in the
3 first place.
4 I have thought of filing an SF-95 claim
5 for the damages with the VA, but I_ve given up, secure
6 in the knowledge that it would end up in months of red
7 tape. I can no longer jeopardize my health by seeking
8 treatment through the VA medical system. And so have
9 given up any further attempts at seeking treatment for
10 these problems from them. Thank you.
11 DR. LASHOF: Are you seeking treatment in
12 the private medical sector?
13 MR. KORNKVEN: No, ma_am, I am not because
14 I have a wife and an 18 month old little boy. My
15 little boy is showing problems. I cannot jeopardize
16 my health care insurance by myself seeking treatment.
17 DR. LASHOF: Thank you. Any other
18 questions? Okay. Thank you very much.
19 MR. KORNKVEN: I appreciate the
21 DR. LASHOF: Okay. Because of weather
22 conditions in New York, Mr. Duelfer, who was to
1 present at this point, has not been able to get here
2 yet. He_s still trying. He may be in the air by now.
3 So we_re going to move to what was originally
4 scheduled for 1:45. That is Christine Eismann,
5 Lieutenant Colonel Robert Ryczak and Dr. Timothy
6 Gerrity. If they_ll come forward now, they will
7 present reports on the research funded by DOD through
8 the 1995 Broad Agency Announcement. I want to thank
9 the three of you for being able to rearrange your
10 schedule and come on at this point. Will help us get
11 through what we have to get through.
12 Ms. Eismann, you wish to start?
13 MS. EISMANN: Yes. Good morning.
14 DR. LASHOFF: Thank you very much.
15 MS. EISMANN: Good morning. My name is
16 Christine Eismann. I_m here representing the
17 Department of Defense. I work in the office of the
18 Director of Defense Research and Engineering and have
19 responsibility for oversight of all DOD biomedical
20 science and technology programs. I also served as a
21 DOD representative on the Selection Subcommittee of
22 the Persian Gulf Veterans Coordinating Board_s
1 Research Working Group.
2 Today, in reference to your questions
3 concerning new research being funded through the DOD
4 Broad Agency Announcement. I_d like to comment
5 briefly on the planning and execution of these DOD
6 funded studies as an introduction to some of the more
7 detailed presentations that will follow.
8 Since the emergence of Persian Gulf War
9 illnesses, which I_ll shorten to PGI, and the
10 establishment of the Persian Gulf Veterans
11 Coordinating Board in 1994, the Departments of
12 Defense, Veterans Affairs and Health and Human
13 Services have worked diligently to try to answer
14 questions concerning the etiologies of medical
15 problems arising from military service during the
16 Persian Gulf War.
17 Throughout this process the Departments
18 have maintained several guardian principles for
19 management of PGI research efforts. The first of
20 these is a commitment to approaching the problem of
21 PGI in a well organized, coordinated and cooperative
22 fashion across the federal agencies. Part of this
110 1 effort, which is managed through the Persian Gulf
2 Veterans Coordinating Board, is to centralize all
3 available information and expert opinion concerning
4 PGI to identify gaps in our knowledge concerning PGI
5 and to utilize these data to identify and then pursue
6 new paths for research investigation.
7 Resources are limited. So we must focus
8 our attention on the most likely causes of PGI as
9 supported by evolving scientific data and yet we have
10 striven during our activities to err on the side of
11 inclusion where reasonable doubt remains concerning
12 the potential etiologies of PGI.
13 Our second guiding principle is a
14 commitment to securing the very best research
15 performers_ hypotheses and experimental designs from
16 all possible sources including the federal, civilian,
17 national and international communities. This
18 commitment follows an appreciation at all levels
19 within the Departments of our responsibilities, both
20 to achieve an optimal investment of taxpayer dollars
21 and also to assist our military veterans to secure
22 diagnoses and treatments for the disabilities and
111 1 illnesses they_re suffering following their service
2 during the Persian Gulf War.
3 It_s with these principles in mind that
4 the Departments planned and executed a PGI research
5 strategy supported with FY _95 funds appropriated to
6 the DOD. Please recall that Public Law 103-337
7 required the Secretary of Defense to conduct PGI
8 studies in coordination with the Secretaries of VA and
9 HHS specifically in areas of epidemiology,
10 pyridostigmine bromide and clinical research. The FY
11 _95 Appropriations Conference report contained
12 $5 million for PGI research within the cooperative DOD
13 VA medical research program account and provided
14 guidance that these funds should be used to support
15 competitively awarded and independent PGI research
17 The Deputy Secretary of Defense later
18 directed that additional funds be provided for PGI
19 studies. VA agreed with utilization of additional
20 funds from the cooperative DOD VA medical research
21 program account and the available funding for PGI
22 research was increased to $7.3 million. The VA, as
112 1 lead agency for PGI research, guided the efforts of
2 the Selection Subcommittee in creating a sound
3 investment strategy for PGI funds. The Selection
4 Subcommittee utilized the August 1995 working plan for
5 research on Persian Gulf Veterans illnesses, which
6 identified research gaps and questions yet to be
7 answered concerning PGI.
8 This plan itself was based on previously
9 documented expert opinions from the Institute of
10 Medicine, the Defense Science Board Task Force and the
11 NIH Technology Assessment Workshop. Early on the
12 evaluation process, the Selection Subcommittee reached
13 consensus concerning areas that required additional
14 investment to round out the national portfolio of PGI
15 research relative to ongoing studies and complete
16 research efforts.
17 We further agreed that the FY _95 funds
18 should be used to support multiple worthy research
19 efforts rather than one or two large studies because
20 there were so many yet unanswered questions regarding
21 PGI. The DOD retained responsibility for managing
22 this new PGI research program. The U.S. Army Medical
113 1 Research and Material Command managed the development
2 and publication of the DOD Broad Agency Announcement
3 and all aspects of the external peer review proposals.
4 Following this peer review, the Army
5 provided the Selection Subcommittee a prioritized list
6 of proposals judged to have high scientific merit with
7 associated relevant scores and funding requests. The
8 Selection Subcommittee respected the prioritization of
9 research proposals developed through the peer review
10 process and altered the order of funding only where
11 proposals required an unacceptable level of funding or
12 were considered to be of low relevance to the
13 investment strategy for PGI.
14 This investment strategy resulting from
15 the efforts of the Selection Subcommittee and the
16 independent peer review process included 12 proposals
17 that fully met the direction of Public Law 103-337.
18 The proposals are all of high scientific quality and
19 in our view contribute to a balance overall portfolio
20 of PGI research. This concludes my statement.
21 DR. LASHOF: Thank you very much. I think
22 we_ll move through and hear the presentations by
114 1 Lieutenant Colonel Ryczak and Dr. Gerrity and then
2 open it up for questions.
3 MS. EISMANN: Thank you.
4 DR. LASHOF: Lieutenant Colonel?
5 MR. RYCZAK: Good morning. I_m Lieutenant
6 Colonel Robert Ryczak, a U.S. Army Science and
7 Technology staff officer at the headquarters of the
8 U.S. Army Medical Research and Material Command, which
9 is a subordinate command of the Army Medical Command.
10 I am here to address your request for a
11 briefing on the new research being funded through the
12 auspices of the Department of Defense_s Broad Agency
13 Announcement in response to the congressional mandate
14 of Public Law 103-337, Section 722.
15 The first part of your request was for
16 descriptions of the research studies funded
17 specifically in response to the special mandate of the
18 public law. Twelve studies have been funded. Funding
19 for these studies totals $7.301 million. I have
20 previously provided the Committee a copy of each of
21 the twelve proposals_ protocols. I have also
22 submitted to you for this meeting an information sheet
115 1 on each of the twelve funded studies. In each of
2 those sheets I have provided the study title, the name
3 and institution of the principal investigator, the
4 funds awarded, the period of performance and a short
5 description of the study_s objectives.
6 The first study, Feasibility of
7 Investigating Whether There is a Relationship Between
8 Birth Defects and Service in the Gulf, funded at
9 $427,000, will attempt to identify all children born
10 to Gulf War veterans living in California and to
11 determine if congenital birth defects diagnosed during
12 the first year of life can be identified as well.
13 The second study, a Controlled
14 Epidemiological and Clinical Study Into the Effect of
15 Gulf War Service on Servicemen and Women of the United
16 Kingdom Armed Forces, funded at $865,187, addresses
17 the prevalence of unexplained illnesses, including
18 chronic fatigue-like symptoms in members of the United
19 Kingdom Armed Forces who were deployed to the Persian
20 Gulf and who have served or are serving in Bosnia.
21 Since virtually no data exists on the prevalence of
22 symptoms and illnesses among other Coalition Forces or
116 1 among indigenous populations, this study is important
2 in helping assess the results of prevalence studies
3 among U.S. Persian Gulf veterans.
4 The third study, Epidemiological Studies
5 of Persian Gulf Illnesses Persian Gulf Women_s Health
6 Linkage Study, funded at $778,704, will address the
7 effects of Gulf War service on military women_s
8 health. The studies will compare the incidence,
9 prevalence and risk of illnesses and general health
10 outcomes of women deployed in the Gulf War theater of
11 operations with Gulf War era women who were not
12 deployed to the Gulf.
13 The fourth study, the effects of
14 Pyridostigmine in Flinders Line Rats Differing in
15 Colanergic Sensitivity, funded at $354,089, will study
16 the possibility that some of the individuals reporting
17 adverse reactions to pyridostigmine may have had
18 predisposing genetic conditions that made them more
19 sensitive to pyridostigmine and contributed to
20 symptoms of multiple chemical sensitivity after
21 exposure to pyridostigmine.
22 The fifth study, Neurobehavioral and
117 1 Immunilogical Toxicity to Pyridostigmine, Permethrin
2 and DEET in Male and Female Rats, funded at $933,947,
3 is a multidisciplinary study using male and female
4 rats to examine any neurobehavioral toxicity and
5 immune response alterations after exposure to
6 pyridostigmine bromide, permethrin and DEET either
7 alone or in combinations. Human lymphocyte cells will
8 also be studied for inhibition of immune response as
9 a result of exposures to these two materials.
10 The sixth study, Disregulation of the
11 Stress Response in the Persian Gulf Syndrome, funded
12 at $970,578, will test the hypothesis that
13 abnormalities in some of the neurohormones important
14 in human response to stress are at least partly
15 responsible for some of the unexplained symptoms
16 suffered by some Gulf War veterans as well as symptoms
17 in other conditions, such as chronic fatigue syndrome,
18 fibromyalgia, somatoform disorder and multiple
19 chemical sensitivity.
20 The seventh study, Neuropsychological
21 Functioning in Persian Gulf War Veterans, funded at
22 $353,428, will study whether Gulf War veterans show
118 1 cognitive impairments suggestive of central nervous
2 system damage at a greater rate than do veterans who
3 were not deployed to the Gulf.
4 The eighth study, Fatigue and Persian Gulf
5 Syndrome Physiologic Mechanisms, funded at $553,698,
6 addresses the symptom of abnormal fatigue in Gulf War
7 veterans. The study will examine the possibility that
8 mechanisms used by muscle cells to use oxygen and
9 produce energy for work may be impaired in patients
10 suffering abnormal muscle fatigue and the inability to
12 The ninth study, Psychological and
13 Neurobiological Consequences of the Gulf War
14 Experience, funded at $264,000, will continue to
15 follow the course of symptoms of post-traumatic stress
16 disorder in a population of Gulf War veterans. This
17 study of how such symptoms, as well as memory
18 function, change over time in the veterans will lead
19 to a better understanding of PTSD and the elements of
20 risk that would cause and continue PTSD symptoms over
22 The tenth study, Evaluation of Muscle
1 Function in Persian Gulf Veterans, funded at $906,248,
2 address the causes of ongoing chronic fatigue and
3 muscle weakness in Gulf War veterans with unexplained
4 illnesses. The study will be a comprehensive
5 multidisciplinary approach to evaluate abnormalities
6 in skeletal muscle function in Gulf War veterans.
7 The eleventh study, Characterization of
8 Emission from Heaters Burning Leaded Diesel Fuel in
9 Unvented Tents, funded at $282,861, will provide
10 detailed information on pollutants produced in
11 unvented tents from heaters that burn leaded diesel
12 fuels. This information is needed to assess potential
13 exposure of service personnel who served in the Gulf
15 The final study, Diagnostic Antigens of
16 Leishmania Tropica, funded at $611,594, will attempt
17 to develop a sensitive method to diagnosis
18 leishmaniasis, a tropical disease in military
20 The second part of your request was for a
21 description of how these studies address the
22 congressional mandate of Section 722 of Public Law
1 103-337 and the two modifications to the three
2 requests for proposals published in the Commerce
3 Business Daily soliciting proposals for this research.
4 Section 722 directed the Departments of
5 Defense, Veterans Affairs and Health and Human
6 Services to conduct studies and administer grants for
7 studies to determine the nature and causes of Gulf War
8 veterans_ illnesses and appropriate treatment of those
9 illnesses. The three Departments approved the
10 language in the three requests for proposals for this
11 research initiative. The three requests for proposals
12 specifically included the public law_s description of
13 the nature of the studies to be conducted and funded
14 by the three Departments.
15 An interagency selection subcommittee
16 representing the three Departments recommended the
17 twelve studies for funding. The Department of
18 Veterans Affairs is conducting one of the studies.
19 The Department of Energy is also conducting a study.
20 Ten of the twelve studies are being administered
21 through grants. The public law directed that the
22 studies be undertaken by the three Departments include
121 1 at a minimum three specific types.
2 The first type was to be epidemiological
3 studies on the incidence, prevalence and nature of the
4 illnesses and symptoms and risk factors associated
5 with the symptoms or illnesses. Three of the funded
6 studies are this type. One epidemiological study
7 addresses birth defects. Another examines the
8 illnesses and symptoms experienced by veterans of one
9 of our coalition partners and the third focuses on
10 military women.
11 The second type was to determine the
12 health consequences of use of pyridostigmine bromide
13 alone or in combination with exposure to pesticides,
14 environmental toxins and other hazardous substances.
15 One of the twelve funded studies examines
16 pyridostigmine alone in rats. A second looks at the
17 effects of pyridostigmine alone and in combination
18 with permethrin and DEET in rats as well as effects on
19 human immune response cells.
20 The third type directed by the public law
21 was to be clinical and other studies on the causes,
22 possible transmission and treatment of Persian Gulf
122 1 related illnesses. The remaining seven funded studies
2 are in this category. Five studies addressed the
3 causes of unexplained symptoms of stress, cognitive
4 impairments, abnormal fatigue, post-traumatic stress
5 disorder and memory function and chronic fatigue and
6 muscle weakness.
7 The sixth study concerns the possible
8 exposure of veterans to airborne contaminants from the
9 burning leaded diesel fuel in heaters in unvented
11 The seventh study focuses on developing
12 sensitive and accurate ways to quickly diagnosis
13 leishmaniasis. The individuals covered in these
14 studies are all drawn from Gulf War veterans, Gulf War
15 era veterans who did not deploy or their spouses and
16 children. These research populations were among those
17 specified in Section 722 of the public law.
18 The research working plan developed by the
19 Research Working Group of the Interagency Persian Gulf
20 Veterans Coordinating Board was one of the resources
21 used by the scientific peer reviewers in assessing the
22 relevance of submitted proposals. The Interagency
123 1 Selection Subcommittee used the research working plan
2 in their selection process. This was done so that all
3 twelve funded studies would be consistent with the
4 coordinated plan of studies directed by the public
6 As prescribed in modification one to the
7 three requests for proposals, both federal and non-
8 federal proposals were subjected to the same
9 independent scientific peer review. All proposals,
10 federal and non-federal, went through the evaluation
11 and selection process as a single set of proposals.
12 However, modification one stated that a minimum of $5
13 million was to be reserved for non-federal proposals
14 only. Both federal and non-federal institutions could
15 compete for any remaining funds. This was to comply
16 with the intent of Congress stated in the FY _95
17 Defense Appropriations Conference Report 103-747 that
18 $5 million within the cooperative DOD VA medical
19 research program element be competitively awarded for
20 independent research on Gulf War Syndrome.
21 Of the $7,301,334 awarded, $6,754,447 or
22 92-1/2 percent were awarded to non-federal
124 1 institutions. Ten of the twelve awardees were non-
2 federal. Modification two to the three requests for
3 proposals identified several special interest areas.
4 These areas were symptoms, illnesses in Coalition
5 Forces and indigenous populations compared to
6 appropriate control populations.
7 The identification of potential risk
8 factors associated with the Persian Gulf deployment.
9 The effective validation of self-reported symptoms,
10 particularly the issues of recall and selection bias.
11 The ecology and epidemiology of leishmania species and
12 the development of an effective diagnostic or
13 screening test and treatment regimen for
15 One of the twelve awards was for an
16 epidemiological study within one of the Coalition
17 Forces. Another study was to develop diagnostic or
18 screening tests for leishmania species.
19 The third part of your request was for a
20 list of study topics which were rated 1.5 or better on
21 scientific merit but were not selected for funding.
22 There was one such proposal. The topic was a multiple
125 1 project international cooperative study of U.S. and
2 the coalition partner veterans to estimate the
3 prevalence and incidence of illnesses and symptoms to
4 undertake clinical, neurophysiological research to
5 improve case definitions for further epidemiological
6 studies to conduct binational case control studies of
7 the relationships of risk factors and illnesses and
8 symptoms to study in animals the effects of
9 pyridostigmine and bromide components of
10 pyridostigmine bromide in concert with risk factors
11 identified in the epidemiological portion of this
12 effort. The proposed cost of this program proposal
13 was $7.128 million.
14 The fourth and final part of your request
15 was the identification of the source of funding for
16 this research and a list of the amounts provided in
17 each of the awards. All $7.301 million awarded came
18 from the FY _95 congressional appropriation for the
19 cooperative DOD VA medical research program element in
20 the DOD budget. I have earlier in my presentation
21 listed the dollar amounts for each of the twelve
22 awards. These figures are also on the one page
126 1 information sheets on each of the twelve studies.
2 This concludes my presentation.
3 DR. LASHOF: Thank you very much,
4 Lieutenant Colonel. Dr. Gerrity, you can proceed.
5 DR. GERRITY: I have one overhead that I_m
6 going to need in my presentation. Miles?
7 Good morning. My name is Timothy Gerrity
8 and I_m the Deputy Director of Medical Research
9 Service in the Office of Research and Development in
10 the Department of Veterans Affairs, the lead agency
11 for coordination of research on Persian Gulf veterans
13 Ms. Eismann and Colonel Ryczak have given
14 you an excellent account of the origin and results of
15 the Department of Defense_s Broad Agency Announcement
16 of 1995 soliciting proposals for research on Persian
17 Gulf veterans illnesses. I_m here today to discuss
18 the range of selected research projects and the
19 thought processes that went into their selection.
20 I was a member of the Selection
21 Subcommittee of the Research Working Group of the
22 Persian Gulf War Veterans Coordinating Board that made
127 1 the final selection and recommendation to DOD of
2 research proposals for funding. I will frame my
3 remarks within the context of the August 5, 1995
4 working plan for research, DOD_s mandate contained in
5 Public Law 103-337 as presented by Ms. Eismann, and
6 other areas of consideration.
7 I will also address research gaps that may
8 currently exist as they have been identified by the
9 Research Working Group.
10 The areas of inquiry that the working plan
11 for research identified in August of 1995 as having
12 significant gaps in knowledge at that time were, one,
13 information on the prevalence of symptoms, illnesses
14 and/or diseases within other Coalition Forces. Two,
15 information on the symptoms, illnesses and/or diseases
16 within the indigenous populations within the Persian
17 Gulf area, including Saudi Arabia and Kuwait. Three,
18 information on the prevalence of reverse productive
19 outcomes among Persian Gulf veterans and their
20 spouses. Four, simple and sensitive tests for
21 L. tropica infection that could lead to quantitative
22 prevalence of L. tropica infection among Persian Gulf
128 1 veterans. And five, information on the long term
2 cause-specific mortality among Persian Gulf veterans.
3 Funding for research to fill these gaps
4 was identified by VA and DOD from the Cooperative DOD
5 VA Medical Research Program contained in the 1995
6 Defense Appropriation Bill. Besides these specific
7 areas, Public Law 103-337 directed the DOD focus
8 research in the areas of epidemiology, clinical
9 research and research on the health effects of
10 pyridostigmine bromide alone and in combination with
11 other substances.
12 Congress further intended that $5 million
13 from the DOD VA program should be devoted to
14 externally peer reviewed research by non-federal
15 researchers. DOD and VA also identified an additional
16 $2.3 million from the DOD VA program to fund research
17 by either federal or non-federal investigators.
18 In order to ensure that the best and most
19 appropriate research was funded, a two-step process of
20 review was used. The first step involved the
21 scientific peer review of 111 submitted proposals.
22 The second step involved the Selection Subcommittee of
129 1 the Research Working Group. The purpose of the
2 Selection Subcommittee was to provide a secondary
3 examination of research proposals for relevance after
4 their review for scientific merit.
5 The Subcommittee met four times beginning
6 in December 1995 and concluding its work on January
7 24, 1996. The reviewed submissions that that
8 Subcommittee received for secondary review include
9 only the abstracts of the proposals, review summary
10 statements redacted of identifiers of specific
11 investigators and institutions, priority scores for
12 science and relevance and an indication of whether the
13 proposal was from a federal or non-federal
15 The Subcommittee agreed in advance that it
16 should not rereview proposals for scientific merit.
17 The Selection Subcommittee had to arrive at research
18 priorities satisfying both science and policy
19 requirements. To accomplish this, the Subcommittee
20 established the following guiding principles.
21 One, fund research of high scientific
22 merit as judged by DOD_s Merit Review Panels.
1 Two, fulfill the requirements of the law
2 requiring the DOD to fund certain categories of
3 research, epidemiology, clinical research and research
4 on pyridostigmine bromide.
5 Three, fill gaps identified in a working
6 plan for research on Persian Gulf veterans illnesses.
7 Four, avoid unnecessary duplication of
8 other ongoing research.
9 And five, allow as broad an approach as
11 The Subcommittee also agreed in advance
12 that a few very large projects, each consuming large
13 portions of the allocated budgets, should not be
14 selected over a greater number of smaller, high
15 quality projects, thereby ensuring a diversity of
16 topics and approaches. Prior to receipt of abstracts
17 and summary statements, the Subcommittee used these
18 principles to arrive at a consensus on the areas which
19 the Subcommittee felt should be emphasized. These
20 areas encompassed all gaps identified by the working
21 plan for research along with research on PB alone and
22 in combination with other compounds in response to
1 Public Law 103-337.
2 It was felt that other than the need to
3 identify meritorious PB research, the mandate of
4 Public Law 103-337 was probably broad enough to
5 encompass the gaps identified by the working plan for
6 research. And that the only concern would be the
7 extent to which meritorious research on PB could be
9 The Subcommittee did not set out to fund
10 any one identified area of research emphasis at a
11 predetermined funding level. Such an approach could
12 have led to funding scientifically inferior work at
13 the expense of meritorious research that was relevant
14 but not necessarily in areas of identified emphasis.
15 Instead, the Subcommittee considered first
16 and foremost scientific merit, starting at the top of
17 the list, and selecting projects in descending order
18 as they were judged to fit the defined research needs.
19 The availability of research funds exceeded the total
20 value of meritorious research projects specifically
21 addressing identified areas of emphasis, and by
22 identified areas of emphasis, I am referring to the
132 1 working plan for Persian Gulf research.
2 Therefore, it was decided to fund
3 meritorious research projects that, although not
4 identified as being in identified areas of emphasis,
5 were nonetheless highly relevant to Persian Gulf
6 veterans_ illnesses. In most cases, this led to the
7 selection of projects that would complement the
8 existing research portfolio.
9 If I could have the overhead projector
10 now. The table which you see up there, with apologies
11 for the size of the print, lists all twelve projects
12 that were selected by the Selection Subcommittee and
13 they_re identified by project names. What identified
14 areas of emphasis within the working plan for Persian
15 Gulf research that a project may have satisfied. And
16 the lastly the selection of rationale as one
17 incorporated both the requirements of law as well as
18 the requirements of science and policy.
19 Among the projects falling in identified
20 areas of emphasis, Project One is a study focusing on
21 the prevalence of symptoms and illnesses in a
22 population of women Persian Gulf veterans compared to
133 1 a non-deployed group of women Persian Gulf era
2 veterans. In addition to assessing overall health
3 status, reproductive health will be a major component
4 of this project.
5 Project Six is an epidemiological
6 investigation of the health of servicemen and women
7 that were part of the United Kingdom Coalition Forces.
8 This study will allow comparison to the prevalence of
9 symptoms and illnesses in U.S. Persian Gulf veterans
10 with a non-U.S. cohort that served in the Persian Gulf
11 with U.S. forces. It will also augment research
12 conducted in response to a British Medical Research
13 Council solicitation for proposals that was recently
15 Project Seven is directed at developing
16 diagnostic antigens of L. tropica. This research
17 augments other ongoing research and will help to
18 achieve the goal of a simple and sensitive diagnostic
19 test for L. tropica infection.
20 Project Eight is a study of the
21 feasibility of investigating possible relationships
22 between Persian Gulf service and adverse birth
134 1 outcomes. This project will capitalize on the largest
2 state birth defects registry in the State of
4 As the table shows, three of the five
5 specific areas of inquiry identified by the working
6 plan for research were captured by the BAA, although
7 Public Law 103-337 was satisfied in virtually all
9 The projects selected that are not in
10 identified areas of emphasis but are in areas of
11 ongoing research bring in deep strengths to the
12 ongoing research portfolio.
13 Projects Two and Nine expand the current
14 repertoire of research on pyridostigmine bromide.
15 Project Three brings new clinical research
16 questioning whether an adverse endocrine response to
17 stress may be responsible for some of the symptoms of
18 Persian Gulf veterans.
19 Projects Four and Five investigate
20 physiological and biochemical mechanisms of muscle
21 fatigue bringing state of the art magnetic resonance
22 imaging technology to bear on this problem.
135 1 Project Ten augments the ongoing studies
2 of the Fort Devens Reunion Cohort by the Boston VA
3 Environmental Hazards Research Center by allowing the
4 inclusion of two new study groups, a treatment-seeking
5 group and a non-deployed group.
6 Project Eleven is a continuation of a
7 longitudinal study of Persian Gulf veterans for the
8 progression of post-traumatic stress disorder.
9 Lastly, Project Twelve is a study to
10 characterize emissions from heaters in unvented tents.
11 There is only one ongoing DOD study that is attempting
12 simulations of tent exposures. Because of the
13 strength of the reviews of Project Twelve, it was felt
14 by the Subcommittee that it would provide valuable
15 information augmenting the DOD study.
16 Two areas of inquiry identified in the
17 working plan for research will not be addressed by the
18 current round of DOD VA funding. Namely, epidemiology
19 of indigenous populations and long-term mortality of
20 Persian Gulf veterans. There were no scientifically
21 meritorious submissions addressing these issues.
22 Studies of indigenous populations would be fraught
136 1 with many difficulties, particularly in the ability to
2 draw generalizable conclusions. It is therefore
3 understandable that meritorious proposals were not
5 Consistent with VA_s continuous
6 involvement in mortality studies of other veteran
7 cohorts, VA is committed to the study of the long-term
8 mortality of Persian Gulf veterans through repeated
9 studies at regular appropriate intervals. VA has
10 already completed a mortality study that has been
11 reported to this Committee.
12 The question now is what, if any,
13 additional research is needed. DOD and VA are making
14 additional funds available that will allow funding of
15 up to another three projects from the BAA list of
16 meritorious proposals. These are to be announced
17 shortly. These projects will, if funded, cover
18 topical areas similar to the other twelve projects.
19 At the present time, the Research Working
20 Group does not consider funding through a targeted
21 solicitation of additional research in the areas
22 already covered by ongoing research warranted. The
137 1 Research Working Group does, however, encourage
2 researchers to submit research proposals to
3 investigator-initiated merit review programs available
4 through DOD, VA and HHS.
5 This method of funding research is a
6 mainstay of the biomedical research community and
7 should be relied upon to support highly meritorious
8 research in important areas of concern for human
10 The recent announcement by DOD that an
11 Iraqi munitions bunker probably containing chemical
12 weapons was detonated by U.S. forces shortly after the
13 conclusion of the conflict raises concern the previous
14 assumptions of the absence of chemical weapons
15 exposure are incorrect. Ongoing research relative to
16 chemical weapons exposure and effect includes
17 epidemiology studies that have the potential for
18 identifying chemical weapons exposure as a risk
20 For example, the Portland Environmental
21 Hazards Center is stratifying its population sample of
22 deployed veterans according to whether deployment was
138 1 during Desert Shield alone, Desert Storm alone, Desert
2 Clean-Up alone, or a combination of these. This
3 stratification by time in conjunction with troop unit
4 location should help identify illness clusters that
5 could relate to a potential chemical weapons exposure.
6 In addition, researchers at Portland are
7 also working to identify DNA adducts in skin
8 epithelium which could be markers of exposure for
9 mustard. And lastly, researchers at VA Medical Center
10 in Boston have established informal ties with
11 investigators in Japan at the Saint Lukes Hospital
12 that it_s seen victims of the tragic Sarin exposure of
13 one year ago. And this could be important in
14 comparing responses.
15 In the 1995 working plan for research,
16 further research on chemical weapons exposure and
17 effect beyond what was ongoing was not recommended.
18 Because of the new evidence, the Research Working
19 Group has now altered its position on this topic. VA
20 and DOD have committed to spending at least $3 million
21 from the DOD VA Cooperative Research Program on
22 additional research focused on the health effects of
139 1 low level chemical weapons exposure.
2 Because of the urgent nature of this
3 issue, VA and DOD are pursuing three paths for funding
4 new research. First, VA and DOD will attempt to
5 identify ongoing research related to issues of low
6 level chemical weapons exposure that could be enhanced
7 to conduct additional research. Second, the Research
8 Working Group Selection Subcommittee will examine
9 proposals submitted to the last BAA that were
10 meritorious but not selected due to the perceived lack
11 of relevance at that time.
12 An attempt will be made to identify
13 projects within this category that are focused on
14 issues relating to low level chemical weapons
16 Lastly, DOD will issue a focused request
17 for applications for new research proposals. The
18 Research Working Group will assist DOD in the
19 development of the language of this RFA.
20 In closing, I want to say that the process
21 by which new research on Persian Gulf veterans_
22 illnesses was obtained represents the delicate balance
140 1 that exists between the need to sponsor so-called
2 directed or targeted research and the awareness that
3 some of the best biomedical science springs from
4 researchers on initiative. Because of this natural
5 tension, the Selection Subcommittee sought to respect
6 primarily the peer review process while at the same
7 time it followed the aforementioned guidelines.
8 The Research Working Group believes that
9 the projects selected encompass the best science that
10 can be brought to bear on the subject of Persian Gulf
11 veterans_ illnesses. Additional research on low level
12 chemical weapons exposure and health effects is now
13 being vigorously sought by DOD and VA. I_m confident
14 that the ongoing research, along with newly funded
15 projects, will lead to some answers as well as
16 stimulate new research questions. This concludes my
17 prepared remarks.
18 MR. HAMBURG: At the same time you point
19 out that recent developments made the question of low
20 level exposure to chemical antigens more salient than
21 it had been before. And so you_re trying to find some
22 way to stimulate new research that otherwise would not
1 have been done. My question is whether, in a related
2 fashion, there_s some important research gaps, some
3 matters of concern to Persian Gulf illness, that did
4 not elicit any proposals or, at any rate, proposals of
5 adequate scientific quality so that you are not going
6 down a particular line of inquiry for want of adequate
7 proposals. Is there some way which you_re thinking
8 about stimulating work in important research gap areas
9 that may now be missing?
10 DR. GERRITY: As I stated in my prepared
11 remarks, one of the areas identified in the research
12 working plan as a research gap was data on the
13 prevalence of symptoms and illnesses in indigenous
14 populations. At least at this time it_s perceived
15 that that could be a very difficult undertaking. The
16 results of which, if they would have any specific
17 validity to the populations themselves, there might be
18 a difficulty in generalizing those, hence the risk of
19 investing large sums of money might not be advised.
20 However, we had stated this in the
21 modification number three to the BAA that this was of
22 interest and we received no submissions, at least
1 within the scientific meritorious range that addressed
2 this problem. However, I think if we saw something in
3 that area come to us, we would certainly want to
4 examine that in terms of its approach, should another
5 funding opportunity arise.
6 Right now, neither the Department of
7 Defense nor the Department of Veterans Affairs have
8 identified funds beyond what we want to direct toward
9 the issue of chemical weapons, toward any additional
10 research. However, the Research Working Group itself
11 is engaged in an ongoing discussion of research issues
12 particularly. Now, we_re in a situation where
13 research findings are beginning to be made available.
14 And as these findings become available, these may
15 affect our thought processes and could potentially
16 lead us to seek additional research.
17 MR. CAPLAN: I was wondering, since the
18 time frame for many of these projects is going to
19 extend out over years to complete, what thought has
20 been given in the Research Working Group to either
21 interim reports or monitoring of research as it goes
22 along so that important findings or findings of great
143 1 concern to veterans would be available, at least in
2 timely manner. Is there any monitoring committee or
3 oversight charged with interim or ongoing monitoring
4 of results?
5 DR. GERRITY: I would place that
6 responsibility within the domain of the Research
7 Working Group to conduct that. We have a database of
8 research projects that are ongoing that are funded by
9 the federal government. Unfortunately, it only
10 reflects those research projects which were funded by
11 the federal government. We don_t have the capability
12 of going beyond that in any sort of accurate way.
13 However, we_re made aware of research that is being
14 done in the private sector. I would argue that the
15 vast majority of credible meritorious research
16 projects are being funded by the federal government,
17 although not necessarily being conducted by federal
19 This database is of great use to us in
20 monitoring interim progress. Again, you know, we try
21 to exercise caution as we look at that vis-a-vis
22 respecting a scientist_s right to avoid prepublication
144 1 of their data and thereby jeopardizing the publication
2 of peer review literature.
3 But, you know, we feel that this is right
4 now a good mechanism by which to proceed.
5 DR. LASHOF: Elaine?
6 MS. LARSON: I want to followup on that
7 with a comment first and then two short questions.
8 Again, the data will not be available on any of these
9 studies for at least seven years post-war. Be that as
10 it may, some of us are going to feel compelled to say
11 what was said at the first meeting. And that is that
12 there are certain things that can_t be studied after
13 a certain amount of time because the data aren_t
14 available. You mentioned recall bias and all kinds of
15 bias. And in the future, one would hope that it will
16 not only be possible to get better information but
17 even cheaper to do it as it_s going along and not
18 start four or five years after.
19 Anyway, enough about that. Two questions.
20 First of all, this Committee has not heard much
21 testimony at all, if I recall, that leishmaniasis has
22 been a major issue here. And yet, we_ve heard
145 1 testimony at three or four of our Committee meetings
2 about this mycoplasma. And I_m wondering why
3 leishmaniasis, it_ll be great to have a good rapid
4 diagnosis test, but why that_s a priority when it
5 really, as far as I know, isn_t a major issue that we
6 don_t understand in this war and yet mycoplasma keeps
7 coming up. So that_s one question.
8 Second is, what_s the relationship of this
9 women_s health linkage study with the work just
10 presented by Dr. Pierce, or is there any linkage at
11 all? Two different funders, but it sounds like
12 perhaps this is a bigger study. What_s the
13 relationship and is there coordination between these?
14 DR. GERRITY: I_d like to answer your
15 initial comment and I think you will find general
16 agreement that, within both DOD and VA, that we could
17 do a much better job of providing databases and
18 forming databases that could help prevent some of
19 these problems that lead to time lags in getting
20 research results in the future. And VA and DOD are
21 cooperating right now in terms of trying to establish
22 better linkage between the two departments in this
146 1 arena.
2 Moving, though, to your specific
3 questions. L. tropica. That_s not, in our perception
4 of the Research Working Group, that has been an issue
5 which has risen and fallen in interest. One of the
6 things that we look at in looking at the selection
7 process, you might argue is an intuitive approach,
8 too, and that isn_t articulated explicitly anywhere.
9 And that is where can you take advantage of
10 opportunities to learn something that would have the
11 potential of having value, particularly because the
12 quality of the research is high enough to satisfy
14 And I think in the case of the selection
15 of the particular L. tropica study that was the case.
16 It was a very highly scientific meritorious proposal.
17 We_re hoping that it will be able to link up with some
18 research that is going both at the Portland VA
19 Environmental Hazards Research Center as well as
20 research on L. tropica antigens at Walter Reed. I
21 think that there would be general agreement that if we
22 could identify a reliable serum antigen test, that it
147 1 would be valuable to apply it because I think that
2 amongst some members of the community of concern for
3 this, there still is some question about whether one
4 might not be looking at some low level infection or
5 occult infection.
6 And in addition, and in the broader sense,
7 I think, we have to be concerned about infection by
8 L. tropica in veterans because, as we are becoming
9 aware as our World War II veteran population ages, and
10 enters into health conditions that reduce their immune
11 status, that L. tropica infections that occurred due
12 to service in the Middle East back in the 1940's
13 during World War II are now turning into active
14 opportunistic infections and so, I think that, you
15 know, in a sense that although it_s not necessarily a
16 burning issue right now, I think it_s important
18 One other question. The women_s health
19 linkage. The Research Working Group is right now
20 beginning to work at bringing the various federally
21 funded investigators together to link them up so that
22 they can where appropriate take advantage of targets
148 1 of opportunity to work together to ensure that where
2 appropriate they are looking and asking some similar
3 questions. One has to be very cautious in that
4 because we value the independence of researchers as
5 well and we don_t want to homogenize their research
6 efforts either, but we do recognize the value of
7 bringing different groups together. Nothing has been
8 done right now linking the women_s health linkage
9 study to that of Dr. Pierce, but I would anticipate
10 that efforts will be made along that.
11 MS. LARSON: I just have to followup with
12 one more thing about leishmaniasis. Are you implying
13 that there may be vets who are infected who are not
14 currently diagnosed and that you_re looking for
15 something that_s more sensitive and specific or just
16 faster? I_m pushing on this because I don_t -- I see
17 why it would be useful to use this opportunity, but I
18 am not sure what, anyway, I_m not sure if you_re
19 looking to diagnose more cases.
20 DR. GERRITY: Well, the answer to that
21 question is yes. Because there is some thinking
22 within the parisitology community that there could be
149 1 a very mild form of this L. tropic leishmaniasis, that
2 has not been diagnosed. In large part because
3 positive diagnosis is so difficult to do. The risks
4 attendant with that diagnosis, you know, involving a
5 bone marrow sample, often are not, merit is given the
6 cases that are being presented.
7 DR. LASHOF: John?
8 DR. BALDESCHWIELER: Let me go back to
9 Elaine_s question on the mycoplasma. We_ve heard
10 considerable comment on that. And as far as we know,
11 there_s only one investigator who has hypothesized
12 this as a cause of the symptoms we_re seeing. Are we
13 getting any proposals from other investigators or is
14 there any attempt to broaden this?
15 DR. GERRITY: We were certainly going to
16 have a process open to credible proposals involving
17 mycoplasma. Indeed, I think we would have welcomed
18 it. We didn_t see those.
19 MS. LARSON: Did you see any, credible or
20 not? You said credible proposals. Were there any
21 proposals on mycoplasma?
22 DR. GERRITY: I_m hesitating. The reason
150 1 why I_m hesitating is because I don_t want to venture
2 into areas of confidentiality.
3 MS. LARSON: Oh.
4 DR. GERRITY: When it comes to identifying
5 research, you know, research that was not funded.
6 MR. RYCZAK: Yes, there were proposals
7 that addressed mycoplasma, but none of them were high
8 enough to get the funding that was only able to fund
9 about 10 percent of the proposals. Fifty-five of the
10 proposals submitted were considered to be of
11 scientific merit, and they added up to over $68
12 million. And when you only have a $5 million pot, we
13 just didn_t get that far down the list.
14 DR. LASHOF: John?
15 DR. BALDESCHWIELER: Let me ask also about
16 the proposal entitled _Disregulation of Stress
17 Response._ Do we have abstracts of these proposals?
18 Can you tell us roughly the hypothesis that_s going to
19 be explored in this proposal?
20 DR. GERRITY: I would do it at great risk
21 of not doing justice to that hypothesis, since that
22 does not fall within an area of my scientific
151 1 expertise. I, you know, I mean, very generally, it is
2 hypothesizing that, having given that caveat, it is
3 hypothesizing there are individuals who possess, who
4 have abnormal neurohormonal response to stress and
5 that this could potentially account for the
6 development of symptoms that often result in diagnoses
7 of chronic fatigue syndrome, fibromyalgia and chemical
8 sensitivities. And that is the principal hypothesis
9 that is being addressed by that research project
10 that_s being done at Georgetown University.
11 MS. KNOX: Mr. Gerrity, I have a couple of
12 questions. One is concerning the gap of research
13 that_s related to the mortality studies. I don_t
14 think veterans feel comfortable with the mortality
15 study that the VA has given to the Committee. Are
16 there any other research studies or proposals that
17 have been offered that deal with veterans who maybe
18 have died in private institutions as well?
19 DR. GERRITY: Well, okay. At the risk of,
20 no, let me go back. The answer is no.
21 MS. KNOX: The second question that I
22 have, go ahead.
1 DR. LASHOF: Just so as not to confuse
2 anyone, the mortality study that was presented to us
3 wasn_t limited to deaths at VA hospitals, was it?
4 DR. GERRITY: That is absolutely correct.
5 That is the area that I wanted to touch on.
6 DR. LASHOF: It was a VA --
7 DR. GERRITY: It was all inclusive because
8 it went into the Social Security death records, state
9 death records, the VA_s own death records. It is
10 estimated, you know, that its capture of deaths is in
11 the upper 90 percent of all deaths.
12 DR. LASHOF: Yeah. You used the National
13 Death Index.
14 DR. GERRITY: National Death Index, yes.
15 So, I mean, it was inclusive. It would include people
16 who died in private hospitals.
17 MS. KNOX: The second question. The study
18 that you have, that the VA_s provided for spouses to
19 come to VA institutions, do you foresee that there
20 will be any travel pay allotted to spouses and
22 DR. GERRITY: I_m probably the wrong
1 person to have that question addressed to, because I_m
2 not familiar with what legislative authority VA has to
3 do that. So, I will demur that, but I can have the
4 appropriate people at VA get an answer to that
5 question back to you.
6 MS. KNOX: Okay.
7 DR. LASHOF: Phil?
8 DR. LANDRIGAN: I_d like to start off by
9 joining with Dr. Hamburg in saying I think you_ve done
10 a good, credible job of organizing the peer review
11 process here. It_s very parallel, of course, to
12 what_s done at the National Institutes of Health, and
13 I think you_ve made a diligent effort to pull in good
15 Let me ask you a couple of questions.
16 Now, first of all, you said that for the future you
17 would hope that you could organize studies and get
18 science rolling sooner after deployment of troops than
19 was the case here. Clearly one of the fundamental
20 building blocks to achieving that goal would be to
21 have good accurate registries in place in future
22 deployments of who went where when, what units they
154 1 were with, what was their baseline health status.
2 Take the specific case of Bosnia. We_ve
3 got troops that have gone over there recently. Do
4 these building blocks exist for that deployment?
5 DR. GERRITY: Currently what is in place
6 is, and again, I want to hesitate that I can_t really
7 speak for DOD, but I will tell you what DOD and the VA
8 have discussed and what is in place by policy put in
9 by the Assistant Secretary of Defense for Health
10 Affairs, Stephen Joseph, is that there will be pre and
11 post-deployment health evaluations. And I think that
12 it has to be clear that that does not necessarily
13 include physical exams on every individual, but it
14 does involve the administration of health
15 questionnaires, both pre and post-deployment.
16 DR. LANDRIGAN: Were those in fact done
17 pre-deployment to Bosnia?
18 DR. GERRITY: I_ll demur on the answer
19 since I don_t know. I mean, I have assumed that they
20 have been, but I can_t speak authoritatively.
21 DR. LANDRIGAN: And the followup question
22 is whether the database is computerized because,
155 1 again, one of the problems we gathered from previous
2 testimony before this Committee, that one of the
3 problems with tracking back to the people that were in
4 the Persian Gulf is that the records were neither
5 centralized nor often computerized. And it_s awfully
6 difficult under those circumstances to reconstruct a
8 DR. GERRITY: Yeah. As I understand it,
9 my colleagues at DOD can really speak better to this,
10 but DOD has projects in place that are looking toward
11 the future in terms of the computerization of their
12 databases for deployed troops, including their health
13 records, and constructing them in such a way that they
14 will then be able to be transferred over to the --
15 DR. LANDRIGAN: That_s good. And I
16 understand that Bosnia is a bit peripheral to the
17 Persian Gulf, but on the other hand, we_re putting in
18 a lot of time on this Committee and we_d like to see
19 that some of the lessons are carried into the future,
20 the procedures that have been suggested.
21 DR. GERRITY: I have some definite
22 agreement on that assessment.
156 1 DR. LANDRIGAN: Now, let me ask you a
2 particular question about the studies that you hope to
3 get going in the next round of people who might have
4 been exposed to CW agents. It strikes me that the
5 scientific problem that you have here is that the
6 number of people who may have been exposed to those
7 agents is only a fraction of the 700,000 or so members
8 of the DOD who were in the Gulf region. And
9 therefore, if you_re really going to get human studies
10 underway of good statistical power that are able to
11 examine health effects in this fractional group,
12 you_re going to have to have a recruitment strategy
13 that somehow enables you to come up with an enriched
14 sample. It_s fine to mine the cohort at Portland, for
15 example, and see if you can pick people up, but my
16 guess is that in any one VA the number of people who
17 will have had that exposure is not going to be very
19 And I wonder if this, you might want to
20 give some thought to this, I don_t have the answer as
21 to how you might do it. But in putting out this RFA,
22 you might want to specifically encourage people to
157 1 come forward with strategies for national recruitment
2 of persons who may have been heavily exposed. I think
3 if you_re going to do clinical and epidemiologic
4 studies of the effects of these agents, that_s a
6 DR. GERRITY: Yeah. There are two issues.
7 One is the specific one of the individuals who were at
8 the detonation of Bunker 73. The much broader issue
9 is one has to suggest that there is always the
10 possibility that this could be a broader issue, so,
11 you know, one still wants to look at the larger cohort
12 of 670,000 deployed troops.
13 Now, what is going on right now --
14 DR. LANDRIGAN: I think it_s fine to do
15 that, but Sutter_s Law applies.
16 DR. GERRITY: Exactly, no. No, well, let
17 me just tell you some specifics that I didn_t go into
18 in my testimony, actually because some of these
19 specifics arose subsequent to the submission of my
20 written statements.
21 Both DOD and VA are matching the
22 individuals within the 37th and 307th which were there
158 1 with the records on the VA health registry and the
2 DOD_s CCEP, with the understanding that this is not a
3 research tool. One cannot pose research questions to
4 it. However, you could certainly be, I think we owe
5 it to look at that to determine whether or not there
6 would be sentinel events that would come out of
7 looking at, for example, in the extreme, are all, you
8 know, are all on the registry or are none on the
9 registry. I think that_s very important. That_s
10 going on right now, and we expect to have results
11 within, actually, the next couple of weeks on that.
12 The other is to look at what other data
13 can be mined on those identified individuals. And we
14 have some preliminary data, for example, from the
15 Naval Health Research Center where they have gone and
16 taken, not just the 37th, but they_ve gone out into
17 the 82nd Airborne, it was, although not home or close
18 in, they were around the area of the detonation and
19 looked at the hospitalization records, basically
20 looking at them as a subset of the DOD hospitalization
21 study that the Naval Health Research Center did.
22 They found that overall there is a
159 1 difference between those who were in the 82nd and
2 those who weren_t in terms of hospitalizations.
3 However, when one goes down into ICD non-specific
4 discharge diagnoses, it ends up being accounted for by
5 musculoskeletal injuries and overall injuries which
6 would be intuitively consistent with the fact that the
7 82nd Airborne is an airborne contingent that is likely
8 to experience physical injuries.
9 None of the other ICD-9 categories showed
10 any difference. Again, I_ll caution that it_s, you
11 know, this is a quick look that I think we needed to
12 take to see whether or not, you know, something showed
13 itself. Nothing there did, but we_re not going to
14 stop there. I_ve asked again to try to get an
15 immediate response on this. Each of the Environmental
16 Hazard Research Centers that the VA has as being, if
17 you will now, VA_s environmental hazards experts that
18 we have brought on board. We_ve asked them to put
19 together some pre-proposals and some ideas for
20 conducting epidemiology amongst those particular
21 cohorts, and we_re going to be looking at those.
22 Those are amongst our real short term responses to
160 1 this situation.
2 DR. TAYLOR: I_m wondering, will your
3 chemical research be the same as before the peer
4 review process as well for submitting your proposals
5 regarding chemical warfare?
6 DR. GERRITY: In answer to the long-term
7 issue of an RFA, that would be a competitive peer
8 reviewed RFA. If we felt that we needed to get
9 something off the ground in the short term, we would
10 look at doing, if you will, instead of prospective,
11 more retrospective peer review. But definitely, we
12 will not launch anything that has not undergone
13 scientific external peer review.
14 DR. TAYLOR: And given the urgency now of,
15 there_s a lot of concern that there was chemical
16 warfare exposure. How soon do you see any of these
17 projects taking place or?
18 DR. GERRITY: Well, I think you_ll just
19 have to see it evolve over the next, you know, several
20 weeks to months. I think that, you know, as you know,
21 we have operated under the assumption with respect to
22 our health research agenda that there were no
161 1 exposures. That situation has, the face of that
2 situation has changed. We feel that we owe it to the
3 Persian Gulf veterans to address it vigorously with a
4 research response.
5 MR. CUSTIS: I have nothing.
6 DR. LASHOF: Let me come back to the issue
7 of the mycoplasma question. I gather there were none
8 of high enough scientific merit in this connection to
9 rise above the group to get into the funding. But
10 let_s get back to this issue of targeted versus going
11 for the best that_s submitted. Would you consider
12 that research on the mycoplasma hypothesis deserves a
13 targeted specific RFA in view of the fact that many
14 veterans are now being treated by their physicians
15 based on this theory of which there has been really no
16 solid decent research. And we do the veterans a
17 disservice if we continue to have that theory out
18 there. People being treated based on it, and yet we
19 have no good data that tells us it_s right or wrong.
20 DR. GERRITY: I would generally agree with
21 that statement. And I think this is something that I
22 want to take back with me to the Research Working
162 1 Group for a discussion. I, too, am concerned that
2 there are treatments being given that have no support
3 in adequate clinical science being done.
4 DR. LASHOF: We_d like a further report on
6 DR. GERRITY: Yeah.
7 DR. LASHOF: Yeah. Marguerite?
8 MS. KNOX: Just clarify for me again, when
9 Phil asked about pre-deployment evaluations done on
10 soldiers to Bosnia. You said that yes, they were
11 having pre-deployment evaluations but they may not
12 necessarily be physical exams. Is that correct?
13 DR. GERRITY: Correct.
14 MS. KNOX: And so that still does not
15 adhere to the recommendation that we made in our
16 interim report. If we continue to send soldiers
17 abroad without giving them a physical exam prior to
18 and after, we cannot do an epidemiological study. So,
19 I think that that really needs to be addressed.
20 DR. LASHOF: Okay. I think that we_ll
21 have to break now for lunch. Thank you very much. I
22 think this has been a very worthwhile session. And we
1 will resume. We_re going to have to cut lunch short
2 because -- has arrived, I gather. And so we will have
3 to resume promptly at 1:45.
4 (Whereupon a recess was taken.)
5 DR. LASHOF: We_re ready to resume our
6 session. And I_m very pleased that Dr. Duelfer was
7 able to get out of New York and get here. And he is
8 accompanied by Igor Mitrohkin, correct? And they are
9 from the United Nations Special Commission and will
10 proceed to discuss their findings.
11 DR. DUELFER: Thank you very much. And I
12 apologize for the delay and the disruption to your
13 schedule. I wanted to begin with a few brief comments
14 on the background, what the Commission is and what
15 it_s tasks are. And then I will turn to our
16 understanding of what Iraq had in its inventory and in
17 its possession with respect to chemical weapons and
18 with respect to biological weapons. I will then
19 discuss our destruction activities in Iraq, and that_s
20 an activity which in fact we_re rather proud of. Then
21 I will turn to the specific questions related to the
22 area and the depot of Khamissiyah, where we have had
1 three inspections. And then finally, I have a video
2 that we_ve put together with some segments of our
3 activities in these areas, and I will ask Igor to
4 narrate that.
5 So, let me begin by stating, first of all,
6 that the Special Commission was created by the
7 resolution which ended the Gulf War, the cease fire
8 resolution known as Number 687. And among other
9 requirements, it required Iraq to rid itself of its
10 weapons of mass destruction. It created this Special
11 Commission to render harmless, destroy or remove all
12 of the agents and associated materials that were part
13 of the Iraqi weapons of mass destruction program.
14 This is chemical weapons, biological weapons and
15 ballistic missiles with a range greater than 150
17 I_ll just mention that in the nuclear
18 area, the International Atomic Energy Agency had
19 primary responsibility for removing the Iraqi nuclear
20 program. The slide, you know, basically is an excerpt
21 from that resolution. There are a lot of other
22 requirements on Iraq. The Commission, however, is
165 1 strictly focused on the weapons of mass destruction.
2 What Iraq had. The next line. What I am
3 going to tell you is a mix of what the Iraqis have
4 told us and what the Commission believes. And when
5 I_m telling you something that the Commission
6 believes, I will try to separate that. Because our
7 experience with the Iraqis has not been one of -- we
8 don_t have a lot of confidence in what they tell us.
9 And that_s been part of the problem why it_s taken us
10 so long to get to the bottom of what in fact they were
12 In the period between 1981 and 1991, Iraq
13 produced about 4,000 tons of chemical weapons agents
14 and approximately 100,000 chemical munitions. During
15 the period 1987 to 1991, Iraq produced around 30,000
16 liters of biological weapons agents, that_s
17 concentrated agents, and more than 200 biological
18 weapons munitions. You can see from this that the
19 biological weapons program began later. That_s why
20 the starting point that I mentioned is 1987 to 1991.
21 In January 1991, after the beginning of
22 the Gulf War, both chemical and biological weapons
166 1 were deployed to over a dozen different sites in Iraq.
2 And these are indicated on this chart. According to
3 Iraq_s declaration, most recent declaration that is,
4 in June 1996, most of these sites, as you can see on
5 the chart, were located in the central part of Iraq
6 and only two locations were in the southern area of
7 Iraq, namely, Nassiriyah and Khamissiyah ammunition
9 Iraq has told us that they deployed 6,240
10 artillery shells with mustard agent in them at the
11 Nassiriyah ammunition depot and 2,160 rockets with
12 Sarin were declared to be stored at the Khamissiyah
13 ammunition depot. At the time of the war, Iraq_s
14 chemical weapons arsenal consisted of about 30,000
15 filled munitions. And these included all sorts of
16 munitions, that is to say warheads for ballistic
17 missiles, the Al-Hussein scud warheads, aviation
18 bombs, artillery shells and various types of 122
19 millimeter rockets.
20 Now, some of these munitions were dual
21 capable in the sense that they were both for chemical
22 and biological. In this case, I_m pointing
167 1 specifically to the missile, the scud missile
2 warheads. They were to be used with both biology and
3 chemical agents, not at the same time obviously, but
4 for either one.
5 The BW arsenal, per se, was smaller
6 according to the Iraqi declaration. They had roughly
7 200 aviation bombs and 25 warheads for ballistic
8 missiles. That_s the next line. These are the
9 warheads for the Al-Hussein -- I use the term Al-
10 Hussein and scud interchangeably. Al-Hussein is the
11 Iraqi-built scud missile.
12 Let me turn to the destruction activities
13 that we_ve conducted in Iraq. In order to fulfill the
14 requirements of this Resolution 687, the Commission
15 had to conduct and build facilities for the
16 destruction of all these agents and munitions. Our
17 approach was to require Iraq to bring to its main
18 chemical weapons facility, Muthanna Estate
19 Establishment, all of the munitions and agents that
20 they had in the country. That was our goal. And at
21 that location, we would build a destruction facility
22 which would serve this purpose.
168 1 This slide shows an incineration unit
2 which the Iraqis constructed specifically for the
3 purpose of destroying mustard agent. In addition to
4 that, we had, there was already existent a hydraulysis
5 unit which had been used in the production of chemical
6 agents and it was modified for the destruction, by
7 hydraulysis, of nerve agent.
8 Next slide. That_s the hydraulysis unit.
9 Now, that was the procedure which we established, and
10 in fact, which we accomplished. We had a chemical
11 destruction group operating at Muthanna from 1992, the
12 summer of 1992, until the summer of 1994. They
13 destroyed roughly 28,000 munitions, 480,000 liters of
14 live agent, 1.8 million liters of precursor chemicals,
15 liquid form, and also one million kilograms of solid
16 precursor material.
17 The one exception to this pattern of
18 destruction on the part of the Commission was at
19 Khamissiyah. In 1991, when we did our initial survey
20 of where Iraq had agent and munitions, our team went
21 to Khamissiyah and found that the condition of the
22 munitions there was so fragile, that they were so
169 1 damaged, that they did not want to remove those
2 munitions to Muthanna Estate Establishment for
3 destruction. What they found, and this is in October
4 of 1991, was approximately 463 122-millimeter rockets
5 with chemical, these were the chemical versions.
6 Later, let me go to the next slide. Wait.
7 I_m sorry. No, stay with that one. I_m sorry. In
8 February and March of 1992, we sent a special mission
9 to that area to destroy those munitions and agent at
10 that location so as not to risk moving them the 500
11 kilometers to the Muthanna Estate Establishment. Now,
12 I_m going to be discussing three locations, and I, if
13 you get confused, I apologize, but just bear in mind
14 there are going to be three locations around
15 Khamissiyah. One of them is the depot, and that_s
16 where the Iraqis stored the 122-millimeter rockets
17 initially. Then I_m going to discuss a second area
18 which is variously described as a pit or open area.
19 That is an open area where they moved some of the 122-
20 millimeter rockets. A third location is going to be
21 a location not far from Khamissiyah, but it_s also an
22 open area and it_s the area where they moved mustard
170 1 artillery rounds.
2 Now, those mustard artillery rounds were
3 in fact in good condition when we found them, and
4 those were moved back to Muthanna Estate Establishment
5 for destruction. We developed with a team of experts
6 a procedure for the destruction of these munitions at
7 Khamissiyah which involved both the explosion of the
8 rocket as well as at the same time the incineration of
9 the agent. What we did was dig out these pits, as you
10 can see there, filled half rounds of these 55-gallon
11 drums with diesel fuel mixed with a little benzene.
12 The rockets were laid across them, usually about 20 at
13 a time, or some number about like that. The rockets
14 were opened with plastic explosives, small amount, I
15 guess, perhaps a detonation cord. And at the same
16 time the explosion went off, the diesel fuel and
17 benzene ignited and burned the agent. We took a lot
18 of precautions with respect to personal protection,
19 with respect to setting up clean zones, testing the
20 weather, the wind and so forth. Before the
21 destruction activity was taking place, we had a
22 helicopter in place which, you know, launched and did
171 1 a visual survey of the area to make sure there was no
2 wind in the area. And in this process we destroyed
3 the rockets which we found at Khamissiyah.
4 One other point I want to mention which
5 drives a lot of our work. And that is that our
6 responsibility is to assure the Security Council, the
7 U.N., that all Iraqi munitions and agents have been
8 destroyed or accounted for. Accounting for this stuff
9 is a very difficult problem because even when we know
10 how many things were brought into Iraq, and we know
11 how many things we destroyed in Iraq, there is an
12 uncertainty because Iraq claims to have destroyed a
13 large number themselves. They claim that in 1991,
14 after the war, they, through unilateral action,
15 destroyed a large amount of their weapons of mass
16 destruction, particularly munitions in the chemical
17 area and also biology area. They claim that they
18 destroyed all their biology agent and a large number
19 of their chemical munitions. We have inspected
20 locations where they claim to have done this, and we
21 have not found that their claims are inconsistent with
22 other information we have, but we_re not able to
172 1 verify it.
2 That uncertainty in our ability to conduct
3 an accounting has driven a lot of our work. And that
4 uncertainty caused us to send yet another inspection
5 mission to Khamissiyah this past spring. And here
6 again, I mentioned that Igor was the Chief Inspector
7 at this inspection. But again, now turning strictly
8 to the area of Khamissiyah.
9 In October 1991, we sent our first
10 inspection to that area and we found 300 122-
11 millimeter rockets at the depot. Now, there_s three
12 locations again. I don_t know if you can see it.
13 There_s the arrow pointing straight down, that_s the
14 depot. Then there_s also an open storage area, below
15 and to the right, that spot. Now, in between those
16 two locations are where we found all the
17 122-millimeter rockets. Some of them were at the
18 depot and some were at what is known as Bunker 73.
19 The rest were found at the open storage area.
20 These contain Sarin, a mixture of G
21 agents. The rockets which were on there each had two
22 plastic containers which contained this agent. The
173 1 bunker, when it was investigated in October _91, was
2 found to be completely destroyed. There were rockets
3 dispersed all over the area. There was a lot of
4 unexploded ordinants. An exact accounting was
5 impossible at that time. And again, for safety
6 reasons, due to the condition of the munitions, due to
7 the condition of the bunker area, we decided not to
8 conduct the full scale investigation of that until the
9 following spring.
10 In October of 1991, our inspectors also
11 went, if we go back to the previous. We also went to
12 the third spot which I mentioned, where that star is,
13 just below the -- that_s the location of the 155
14 millimeter mustard rounds. And those in October 1991
15 were found to be in good condition. They were
16 subsequently shipped back to Muthanna for destruction
17 there. They had been moved to that site, according to
18 the Iraqis, from the Nassiriyah ammunition depot,
19 which is 20 kilometers northwest of Khamissiyah.
20 Now, the following spring we sent a team
21 to destroy the 122 millimeter rockets in that area, in
22 February to March _92. They conducted the demolition,
1 as you saw in that photograph, roughly 463 rockets
2 were destroyed and then we asked the Iraqis to
3 continue some investigation in the area if they could
4 find others.
5 Now, in spring of this year, again, to
6 assure ourselves on the accounting of the munitions,
7 we had yet another inspection of the area and Iraq
8 described in greater detail their version of the
9 events surrounding the movement of the munitions to
10 Khamissiyah. They told us that they had moved 2,160
11 chemical rockets with GB and GF just before the
12 beginning of the war, that is in the period between 10
13 to 15 January, 1991. They moved them from Muthanna
14 Estate Establishment to the Khamissiyah depot, where
15 they were put into Bunker 73. Now, these were rockets
16 with the warheads attached. And as soon as you do
17 that, you know, it means they_re prepared for use.
18 Unfortunately, the rockets also began to leak quickly,
19 the Iraqis found. And they claim that they began
20 moving them when they found the leaking ones to an
21 open area. And that was the reason why they moved
22 down to that second open storage area. By the time of
1 the Iraqi retreat, which was early March _91, they
2 state that they moved approximately 1,100 rockets to
3 that open storage area. So, roughly there_s 1,000 at
4 the open storage area and 1,000 in Bunker 73.
5 They say that they were roughly intact at
6 the time of their retreat. They also state that when
7 they returned to the site after Coalition Forces had
8 withdrawn, that they found that Bunker 73 had been
9 destroyed and they also found that some of the rockets
10 located in the open area had been destroyed as well.
11 So, with respect to Khamissiyah, I would say, you
12 know, that roughly there were 2,000 122 millimeter
13 rockets filled with G agent. We have destroyed 463 of
14 them, but our numbers were all subject to some leveled
15 uncertainty. I think, you know, both -- even the
16 Iraqis given those numbers are subject to some
18 Let me just comment that, and in all of
19 our discussions at all levels with the Iraqis, they
20 have stated that they never used either chemical
21 weapons or biological weapons. That, you know, they
22 were simply just not used. And we have seen no
176 1 evidence, by the way, that would contradict that.
2 And let me just leave my statement as it
3 is. I_ll ask Igor if he has anything to add at this
4 point. We have a short video which he will narrate
5 which gives a little bit better flavor of our
7 MR. MITROHKIN: Thank you. I will just
8 give the reasons for our last inspection in the area
9 of Khamissiyah before as I became Executive Chairman.
10 And the one reason was to control the counting of
11 these weapons provided by the Iraqi side. And the
12 other reason was to confirm particular type of 122-
13 millimeter chemical warheads which Iraq stored at this
14 particular site.
15 And if we will come back to our slides, we
16 need to show three more slides. Yeah. So, we go
17 there. As a result of this mission, the result was to
18 rid them of these type of weapons and we_ve got some
19 evidence and now we can prove that indeed the same
20 type of chemical weapons have been stored in both
21 ammunition depot and the open area. This is how
22 Bunker 73 looks like now. The Iraqis backfilled this
177 1 area with soil because of the severe construction
2 activities being built around this area.
3 Next slide please. But even now from what
4 remains of 122-millimeter chemical warheads and the
5 regional footprints in this area. And next slide
6 please. And even found some strong evidence of the
7 chemical origin of these weapons. You can see a
8 plastic container and residue covered with plastic.
9 This construction has been used only for GW
10 application by the Iraqis. Thank you very much.
11 MR. DUELFER: We can go through a video
12 very quickly.
13 DR. LASHOF: Please do, yeah. Okay.
15 MR. MITROHKIN: I will give you some
16 comment concerning this.
17 MS. LARSON: While we_re switching the
18 plugs, could you just elaborate on how the Iraqis said
19 the scuds were destroyed or the rockets were
20 destroyed. By whom and how?
21 MR. DUELFER: They claim that they
22 destroyed them unilaterally in 1991, excuse me, 1992.
178 1 But again, you know, we have still some uncertainty
2 about the accounting for those, and that_s one of the
3 greater problems of our work right now, to assure that
4 they still do not have new inventory of some of these,
5 both missiles and warheads.
6 DR. BALDESCHWIELER: Question also. Is
7 there any evidence of contamination of the ground
8 surrounding this area?
9 MR. DUELFER: At Khamissiyah?
10 DR. BALDESCHWIELER: Yes.
11 MR. MITROHKIN: In May 1996 there was no
12 evidence. In _91, yes. There were a lot of evidence
13 and we had eight, ten buses leading on camps and was
14 a serious contamination. In February, March _92,
15 there was a serious contamination, too, especially
16 when we conducted the transportation of munitions from
17 one area, open area, to the destruction site, several
18 missiles leaked heavily and we even put them into the
19 plastic sleeves, in order to prevent contamination.
20 DR. BALDESCHWIELER: Both mustard and the
22 MR. MITROHKIN: No, only GB because, as
179 1 Mr. Duelfer mentioned, all mustard 155 millimeter
2 shells were in good condition. They were not leaked
3 and they were transported to the Muthanna Estate
4 Establishment where they had been filled for the
5 destruction purpose.
6 DR. BALDESCHWIELER: In your last
7 inspection, did you try to disturb the soil and see if
8 you could get a positive reading from elements of soil
9 that were shaded from sunlight?
10 MR. MITROHKIN: Yes, sir. We used the
11 standard equipment including cams and also some French
12 equipment designed not only for military application
13 but also for the civilian chemical industries which
14 allows to identify subproducts or single elements.
15 And both types of equipment didn_t give us any
17 DR. LASHOF: We_re going to go ahead with
18 the videotape and then we_ll take more questions.
19 MR. DUELFER: Let me just point out. Igor
20 was at each of our inspections to Khamissiyah, in
21 October _91 and the spring of _92 as well as the last
180 1 DR. LANDRIGAN: Igor, could you move
2 closer. We_re having a little difficulty hearing you.
3 MR. MITROHKIN: Okay. This is Khamissiyah
4 ammunition depot in February _92. This is Bunker 73.
5 The remains of Bunker 73. You can see a lot of
6 122-millimeter missiles in the area around, the
7 surrounding area, and also in the bunker.
8 At that time the Commission didn_t know
9 exactly the type of these weapons and we were not able
10 to confirm that the same 122-millimeter rockets were
11 stored in the open area outside the facility.
12 This is the open area, which is located
13 about three kilometers to the southeast of the bunker.
14 This is the Iraqi workers trying to put chemical
15 rockets, especially those of them which were leaked,
16 into plastic sleeves. It_s also February _92.
17 The first inspection in October _91 found
18 approximately 300 missiles. By the second inspection
19 sent to Iraq to destroy rockets fond before identified
20 more rockets. When the inspection team decided to
21 leave the site after the destruction of 300 rockets,
22 the search for other remaining munitions was carried
181 1 out. And we found more munitions under the bank,
2 under the soil. We used a land mine detector. This
3 is the British piece of equipment. Worked very good.
4 MR. DUELFER: That_s Igor holding it.
5 MR. MITROHKIN: Yeah, that_s me. I was
6 the safety officer for this mission.
7 MR. DUELFER: Safety always comes first.
8 MR. MITROHKIN: But when identified some
9 metal pieces we were not sure that those were chemical
10 rockets, and we asked the Iraqis to check it. A lot
11 of metal fragments were identified in this area. We
12 put yellow flags, according to our procedure. It was
13 the more informational approach. And this is the
14 example of the Iraqis trying to get it out. And
15 indeed, a lot of chemical rockets were taken out of
16 the bank.
17 DR. LANDRIGAN: Now, were these fused?
18 MR. MITROHKIN: Yeah. No, no, no. Sorry.
19 The rockets were completely, I would say, prepared for
20 use, but without fuses, of course, because fuses
21 according --
22 DR. LANDRIGAN: First they discharge the
182 1 propellant?
2 MR. MITROHKIN: Yeah. Warheads were
3 attached, cables connected, because the assembling
4 procedure includes not only the installment of booster
5 tubes but also the connection of cables.
6 This was a real live chemical rocket.
7 MR. DUELFER: We had absolutely zero
8 injuries during our entire destruction process, by the
10 MR. MITROHKIN: But the duration, of
11 course, was quite dangerous. And of course, being
12 responsible for carrying out of such operation we
13 tried to arrange our own decontamination procedures
14 which applied also for the Iraqi personnel involved.
15 When we found the evidence that a lot of rockets were
16 still under the bank, we decided to continue the
17 collection of rockets. And we used water, the
18 simplest way. Okay, next.
19 As I mentioned, we didn_t believe to the
20 Iraqi, to the effectiveness of the Iraqi
21 decontamination procedures and all decontamination
22 activities were carried out by the Commission_s
183 1 personnel. In this particular case, we might use a
2 Swedish personnel. Okay, next please.
3 All the rockets found in this area were
4 transported by the Iraqi site under the Commission_s
5 supervision to another site. This is the destruction
6 site. Stop here please. The pit and we transported
7 rockets using regular trucks.
8 We destroyed not more than 40 rockets for
9 a single demolition because we calculated the quantity
10 of agents to be destroyed, the purity of agents, and
11 we took into account the particular location, because
12 in back the Basra Highway was located about five miles
13 to the south of this place. This is the destruction
14 pit, barrels. The procedure was extremely primitive
15 indeed. We use the plastic explosives basically only
16 quarts in order to open the munition. And after the
17 opening, the agent itself was burned.
18 All operations with explosives were
19 carried out by the Commission personnel only, because
20 we also didn_t trust the Iraqi side of this. Stop
21 here. Of course, the area was secured. We used also
22 helicopter, this is the German. And then demolition.
2 And this is the area of Bunker 73 in May
3 _96, a couple weeks ago. The area was backfilled with
4 soil, but even after that several chemical rockets or
5 their components were found in the footprints. This
6 is the engine. There were rockets around.
7 This is the inspection team.
8 DR. BALDESCHWIELER: Was there any
9 evidence of unburned agent in the aerosol form from
10 the explosion?
11 MR. MITROHKIN: No, sir. The, again,
12 equipment was used but no any readings. The most
13 important for us was to find an evidence of the
14 chemical origin of these weapons, and we found it.
15 MR. TURNER: What is that?
16 MR. MITROHKIN: You see, this is the
17 plastic container inside the warhead. This is also,
18 but it_s better to take the next, yeah, plastic
19 container. This is an indication of the chemical
20 nature of this warhead and also the booster tube is
21 probably ballistic.
22 DR. TAYLOR: And you say that there_s no
1 evidence of contamination now in the soil there, in
3 MR. MITROHKIN: Yes, because the agent
4 used by the Iraqis in order to fill these weapons was
5 not stable. It was a makeshift Sarin and Cyclosarin.
6 The normal stability could not be more than a couple
7 days, under several circumstances. If, for example,
8 it was steel inside the warhead, maybe a couple years,
9 but not more than two years in any case. This is the
10 plastic container again.
11 We also checked other buildings
12 surrounding Bunker 73. All of them destroyed, but we
13 checked this in order to verify are there any remains
14 of chemical warheads or chemical rockets, or any other
15 122-millimeter rockets. We checked about 20 bunkers
16 around or remains of these bunkers and no any evidence
17 of 122-millimeter chemical rockets. Only in Bunker
18 73. Who_s next?
19 Then we visit again the open area. The
20 landscape of this area has changed indeed. This is
21 the open area. Even now several rockets are still
22 existing because when the inspection team left Iraq in
1 March 1992 it was an understanding that more munitions
2 were still under the bank and the Iraqis were guided
3 to continue the situation, according to the
4 declaration. They indeed conducted during several
5 months the digging of this area. And when we visited
6 this site in May _96, we found that the whole bank
7 disappeared because of the digging.
8 What_s interesting that we can confirm
9 that this the same type of chemical 122-millimeter
10 rockets which was found in Bunker 73. Thank you.
11 That_s it.
12 MR. DUELFER: That_s our presentation.
13 DR. LASHOF: Thank you very much. I don_t
14 have questions for either Mr. Duelfer or for Igor.
15 John? Please.
16 DR. BALDESCHWIELER: In your central
17 demilitarization area, back at the, where you took
18 grounds to be demilitarized. How did you deal with
19 the assembled rockets and shells? How did you drain
20 the agent from those?
21 MR. MITROHKIN: Basically taking into
22 account that there were no fuses installed. The
187 1 munitions were transported from the open area to the
2 destruction area without any disassembly. The
3 probability of the explosion, according to our
4 calculation, the probability of the non-authorized, I
5 would say, explosion was not high indeed. And we
6 didn_t disassemble any complete rockets.
7 DR. BALDESCHWIELER: In the central
8 facility, where you showed a picture of incinerator?
9 MR. MITROHKIN: You mean in Muthanna
10 Estate Establishment?
11 DR. BALDESCHWIELER: Yes. How did you
12 drain the agent from the munitions before
14 MR. MITROHKIN: Normal procedures for most
15 of Iraq_s munition we simply open the filling plug.
16 If no filling plug, were drilled manually.
17 MR. DUELFER: Some of the mustard rounds,
18 the artillery rounds, were opened explosively, with
19 just a small amount of plastic explosive.
20 DR. BALDESCHWIELER: In the incinerator
22 MR. DUELFER: No. No, no, no.
188 1 DR. BALDESCHWIELER: Outside the
3 MR. MITROHKIN: Yes. We established a
4 special area for DOD operations not far from the
5 incineration unit and some operations were carried out
7 DR. BALDESCHWIELER: But some of the
8 munitions have a drain plug?
9 MR. MITROHKIN: Yes.
10 DR. BALDESCHWIELER: I assume some of the
11 rockets did not?
12 MR. MITROHKIN: Basically all munitions
13 had filling plug, with the exception of 122-millimeter
14 rockets and 155-millimeter shells. But with 155-
15 millimeter shells it was easy because there was a
16 possibility to take out the booster tube from those,
17 and most of them were stored also by the Iraqis
18 without boosters. This made the situation easier.
19 All aerial bombs, they had the filling plug. Even a
20 Hussein chemical warhead also had the filling plug
21 because it was the special aluminum container inside
22 the warhead and this container had the filling plug.
189 1 The warhead was fixed in the vertical position, the
2 filling plug was opened and the chemical agent was
3 liquidated from the filling hole.
4 DR. LASHOF: Elaine?
5 MS. LARSON: You did not destroy any
6 biologic agents; is that correct?
7 MR. MITROHKIN: None.
8 MS. LARSON: So, the information about
9 biologic agents was just what was reported by the
10 Iraqis, and you assume -- they reported that they
11 destroyed the toxins?
12 MR. DUELFER: That_s correct. That_s one
13 of the difficulties we have now is to verify their
14 statements and their claims. Now, there_s, you know,
15 secondary evidence which we can endeavor to collect
16 through interviews of personnel, through, you know,
17 knowledge about fermenter capacity and so on and so
18 forth, and knowledge about the time they were
19 operating, you know. We can try to test elements of
20 their description to see if they_re, you know, they_re
21 consistent with other facts that we know.
22 But the short answer is, we never
190 1 destroyed any Iraqi agent. They claim they did that
2 all themselves. And we haven_t seen such --
3 MS. LARSON: Are you aware of any
4 information that would lead you to believe that CBW
5 agents were in fact used?
6 MR. DUELFER: We have seen no evidence at
7 all that it had been used. The Iraqis have said they
8 deployed it, though. I mean, they deployed it before
9 the war, and out into, you know, various locations.
10 DR. LASHOF: Art?
11 MR. CAPLAN: I just want to go back to
12 your first visit to this depot, Bunker 73. When you
13 got there, you said they had moved some of the armed
14 missiles and then realized they were leaking so they
15 took them to the open pit. When you first got there,
16 and were looking for contamination, what sort of
17 radius did you look around in? I_m trying to get a
18 feel for what level of contamination and what distance
19 you were able to detect the presence of these agents
20 that might have leaked or that they might have
21 distributed by trying to destroy some of these weapons
22 there at that particular location?
191 1 MR. MITROHKIN: During our first visit, we
2 used only the chemical agent monitoring system, the
3 well-known cams, the British equipment. And the
4 equipment was used only when we had the evidence of
5 potential chemical weapons, munitions. Without this
6 evidence, of course, the area itself was not checked.
7 MR. CAPLAN: You made no general survey?
8 MR. MITROHKIN: No, sir. When 122-
9 millimeter chemical rockets or rockets supposed to be
10 chemical weapons were found. After that we carried
11 out the, I would say, search of this area. But also
12 it had been very limited. The area was covered with
13 unexploded ordinants and the, even movement in this
14 area was restricted. That_s why we didn_t visit all
15 of the bunkers in this area. The open area wasn_t
16 rated much better because in the open area we even had
17 an accident. Being not familiar with this type of
18 weapons, we tried to take samples of agents from
19 chemical warheads. And during the drilling, the agent
20 makeshift, Sarin and Cyclosarin, under the high
21 pressure inside the munition was pushed and about two
22 liters of the agent leaked through the seal used by
192 1 our DOD expert.
2 Taking into account that we liberated the
3 special safety standards and for this particular
4 duration only the rubber protection seal could be used
5 because the German protection seal which normally is
6 used for the destruction of chemical munitions from
7 World War II in the specialized facility, but only the
8 regular protection seal. And only this fact saved us.
9 MR. CAPLAN: One other question. How long
10 would it take to fuse one of these ready-to-go rockets
11 and fire it?
12 MR. MITROHKIN: If the fuses are
13 calibrated, it means if this is a proximity fuse and
14 the timing is installed already, is the standard
15 operation that doesn_t take more than couple seconds
16 per rocket. And if the personnel is trained, it_s not
17 a problem. Could be done very quickly.
18 DR. LASHOF: Elaine?
19 MS. LARSON: I_m just curious why they had
20 produced all of these agents and deployed them and
21 then didn_t use them. When were they going to use
22 them then? I mean, what were they waiting for?
193 1 MR. DUELFER: Iraq has long experience in
2 this area. And in our discussions with them they have
3 explained that, you know, in the war with Iran in fact
4 they felt that these weapons saved their country in a
5 sense, because they had enormous attacks on Iranians
6 and, you know, they had experience that led them to
7 believe that these weapons were useful. However, they
8 also have told us that in the case of the Gulf War,
9 that they were deterred from using them in that case.
10 We_ve gotten actually somewhat mixed
11 explanations. On the one hand they will say that
12 their possession of these weapons deterred the
13 Coalition Forces from attacks on them in Baghdad,
14 either directly or with other weapons of mass
15 destruction. On the other hand, they say that perhaps
16 they were deterred from using them because others
17 might have used such weapons. So, you know, it_s a
18 question of deterrence, I suppose, that they_re
19 fundamentally saying.
20 DR. LASHOF: Okay. Marguerite?
21 MS. KNOX: Yeah. I have a couple of
22 questions. Can you clarify for us what the difference
194 1 in the findings in 1992 versus 1996? I know you said
2 you left instruction with Iraq to destroy the rest of
3 those missiles. What were the differences in the
4 findings when you returned in 1996?
5 MR. MITROHKIN: Yes, indeed. I will start
6 with the second part of the question. We found that
7 Iraq did conduct the operations according to the
8 guidelines received from the Special Commission. We
9 found the rockets under the bank, because the open
10 area was located in a distance approximately 30 feet
11 from Kamal. All this bank is not existing now. The
12 Iraqis digged it out, trying to verify remaining
13 rockets. And what did we see in particular? A couple
14 complete rockets even in May _96, at least according
15 to our understanding, confirms that at least some
16 activities were carried out in this area by the
17 Iraqis. And the Iraqis also didn_t deny that there
18 was a possibility of more rockets under the bank of
20 Concerning the first part of the question,
21 what_s the difference between findings. In _91, of
22 course, the Special Commission was not familiar with
195 1 the system of chemical weapons produced and procured
2 by Iraq. For example, in _91, the Commission thought
3 that it was only one type of 122-millimeter chemical
4 rockets produced by the Iraqis. A couple years later,
5 we found that Iraq produced in total about five types,
6 five different types of 122-millimeter chemical
8 MS. KNOX: And can you name those?
9 MR. MITROHKIN: Basically, there are
10 technological differences and the differences in
11 construction. Looking from outside, you will never
12 recognize the difference. For example, how many
13 containers, what material was used for the containers
14 and for the warhead, what was the range of missiles,
15 and several issues like this. And we tried in _96 to
16 confirm that warheads found and rockets found in
17 Bunker 73 completely adequate to rockets found in the
18 open area, because we didn_t believe the Iraqis that
19 1,100 rockets were moved when they found that they
20 were leaking in Bunker 73. We_re being suspicious in
21 this respect because they are the Iraqis.
22 Why you found that they_re leaking only
1 after the transportation, not during the
2 transportation, if you have leaking weapons, that_s
3 very strange that you found this only after putting
4 them into the bunker.
5 MS. KNOX: Right.
6 MR. MITROHKIN: This was our concern. And
7 taking this into account, we had a feeling that maybe
8 there were different types of chemical 122-millimeter
9 rockets in the bunker and in the open area. And
10 that_s why we need to collect some information
11 concerning the construction of this type of chemical
12 weapons, and what did we find? Basically the
13 confirmation of two plastic containers in warheads,
14 inside Bunker 73, and two plastic containers in
15 warheads in the open area, which is the confirmation
16 of the same type of weapons.
17 MS. KNOX: Right. If you were suspicious
18 in _91 and you returned in 92, why did you wait four
19 years to return in 1996?
20 MR. MITROHKIN: There are several reasons
21 for this. One of the reasons is related to the level
22 of our investigation. Before 1995, Iraq completely
1 denied any deployment of chemical weapons to any
2 military facilities. Before _95, the Iraqi refusal
3 line was that chemical weapons have never been
4 deployed to the Minister of Defense, which was the
5 main concern for us because we found this illogical,
6 that the weapons produced was not designated to be
7 used by the Minister of Defense. And even this
8 information, which has been provided by the Iraqis
9 concerning the location of chemical weapons, this
10 information was requested to be provided by Iraq in
11 1991. Finally it was provided first time only in _95.
12 In the latest of our declarations there were several
13 modifications of this latest declarations. And I
14 could not say that the situation is clarified
15 completely now.
16 DR. LASHOF: Okay. Phil, go ahead.
17 DR. LANDRIGAN: Do you have information
18 that you could produce maps of areas of contamination.
19 Perhaps not fully quantitative, but at least
20 qualitative or semi-quantitative. I_m thinking that
21 the generation of that sort of map would help define
22 focus areas for subsequent epidemiologic studies.
198 1 MR. MITROHKIN: Of course we can do this.
2 But I must say from the beginning that we didn_t find
3 any large areas of contamination with G agent because
4 of the nature of this CW agent. The contamination was
5 very limited and basically it was the radius of dense
6 feets around particular warheads. But not more. For
7 example, after the demolition, we, of course, checked
8 the, not only potential distances of contamination,
9 but practical distances. And the distance was not
10 more than about 800 meters.
11 DR. LANDRIGAN: Do you have reason to
12 think that there were areas in southern Iraq, apart
13 from this area that you_ve been describing, the
14 general area, where also there might have been
15 contamination with this agents, or was it restricted
16 to this one area?
17 MR. MITROHKIN: In central Iraq?
18 DR. LANDRIGAN: Southern, mainly in
19 southern. I_m thinking mainly in southern.
20 MR. MITROHKIN: We have no any other
21 evidence that there were other contaminated areas in
22 southern Iraq. In central Iraq, there were
199 1 contaminations in the area around the Mohammadia
2 storage facility, was the primary storage area located
3 not far from the Muthanna Estate Establishment. In
4 central Iraq, in the area was contaminated indeed, but
5 not more than for couple square kilometers.
6 DR. LANDRIGAN: Yeah. Thanks.
7 MR. MITROHKIN: And of course around the
8 Muthanna Estate Establishment was contaminated
9 heavily, because agents in bulks were destroyed there
10 during the war.
11 DR. TAYLOR: I guess the question I have
12 about the contamination again. So none of these
13 chemicals can remain airborne for any specific length
14 of time? They can_t become airborne.
15 MR. MITROHKIN: No.
16 DR. TAYLOR: No?
17 MR. MITROHKIN: No.
18 DR. TAYLOR: Only the -- I_m a little
19 confused still. The contamination again, only
20 specific areas when that small section that you were
21 talking about?
22 MR. MITROHKIN: Right. Because this agent
200 1 would be vaporized immediately, being put on the
2 ground. And this is the reason of this agent, this G
3 agent, it_s not persistent agent. It was not designed
4 for the contamination of the area. It was designed
5 for the inhalation exposure. And that_s why it_s
6 difficult to believe that this agent can create any
7 contaminations or any long scale contaminations.
8 Only if the source of contamination is
9 still available, like leaking munition, there is a
10 possibility of some contamination. But again, the
11 agent itself was not persistent.
12 DR. TAYLOR: It_s not persistent.
13 DR. CUSTIS: Not to belabor the question,
14 we have been briefed on the opinion that Sarin
15 specifically does get into the explosive cloud and
16 that winds will disperse those particles and it would
17 be contradictory as to the direction and distance of
18 that dispersion. You_re saying none of this is true?
19 MR. DUELFER: Let me just throw -- our
20 responsibilities are strictly to find munitions in
21 Iraq and get rid of them. I mean, we_re not appearing
22 before you as experts on the effects of these agents.
201 1 So I_m a little bit -- I want to caution, you know,
2 what we say with respect to contamination, those sorts
3 of things, that is not -- our expertise and why we are
4 here is to tell you what we have found in Iraq. So,
5 I mean, I just -- don_t take us as experts on
6 dispersion or inhalation or any of those sorts of
7 things. Igor Mitrohkin happens to know a great deal
8 about that, and because he was a safety officer on a
9 lot of our destruction activities, you know, has
10 intimate knowledge of these things. But, you know,
11 our role is we are a U.N. body charged with certain
12 activities under the resolution. So, if we offer
13 opinions on these types of things, they are opinions
14 only. Forgive me for sounding a bit bureaucratic.
15 I_ll turn to Igor to answer your question.
16 DR. LASHOF: You may answer, Igor, any way
17 you want. There_s no independent -- individual or
19 Let me try a few and then I_ll get back
20 and give us a round because we_re going to run short.
21 I_d like to review a little bit the time table here.
22 As I understand it, our forces went in in March of _91
202 1 and blew up the rockets and things that were in Bunker
2 73. At that time, assuming that none of them were,
3 they didn_t contain rockets with chemical weapons.
4 You went in October of _91, several months
5 after we had been in, and found evidence that they had
6 obtained chemical weapons. Is this correct? And at
7 that time you did notify our government of that
8 finding, our DOD, that you think that they might have
9 blown up some weapons that had contained chemicals?
10 MR. DUELFER: We make regular reports to
11 the Security Council, who are our bosses, as it were,
12 public reports that are official U.N. documents, that
13 describe our activities. And we have described what
14 we found at Khamissiyah ever since we first made that
15 inspection in October _91. I mean, this is, you know,
16 it_s common knowledge that we in fact were rather
17 pleased with ourselves of destroying the weapons at
18 Khamissiyah in the spring of _92. And that was our
19 first chemical weapons destruction activity.
20 DR. LASHOF: And so, and then you have
21 similar reports for your other visits in _95 and of
22 course we know you_ve reported in _96?
203 1 MR. DUELFER: Yes.
2 DR. LASHOF: That_s your routine all the
3 time. So that our government was informed, obviously,
4 all along the way. And what I gather you_re telling
5 us is that in _95 you were more convinced that there
6 were more weapons there than you might have thought
7 there were in _92. But in _92 you were convinced that
8 there were chemical weapons?
9 MR. DUELFER: Oh, absolutely. We knew in
10 October _91 that there were chemical weapons there.
11 DR. LASHOF: Yeah. I mean, in October _91
12 that there were chemical weapons. But this question,
13 if that_s not in your realm to answer I_ll understand,
14 what were the things you saw in _91 that enabled you
15 to determine that there were chemical weapons and yet
16 our government had gone in earlier in _91 and blown it
17 up, thinking there were no chemical weapons.
18 MR. MITROHKIN: If I may, I have one
19 comment. In _91, we didn_t establish the fact that
20 the weapons, the chemical weapons stored in the area
21 of Khamissiyah ammunition depot was destroyed by the
22 Coalition Forces. We are not able to make this
204 1 assessment even now. If representatives of other
2 institutions, U.S. governmental agencies, have more
3 information, they will admit this to you, I am sure.
4 But we are not able to prove this fact. We can tell
5 you only what Iraq admitted with this respect. Being
6 asked to provide explanations, how the weapons were
7 destroyed, they provided us in May _96 these
8 explanations. In October _91, Iraq was not able to
9 explain how the weapons were destroyed. The
10 explanation provided to the Special Commission was
11 very general, that the weapons were destroyed during
12 the war, but how it was destroyed in particular, no
13 explanations were presented by the Iraqis.
14 Even now when Iraq admitted during this
15 inspection with the Chief Inspector that the weapons
16 were destroyed by Coalition Forces, as the Chief
17 Inspector, I cannot prove this or I cannot disprove
18 this. I can tell you only what I was told by the
20 MR. DUELFER: I think part of your
21 question is how did we know that there were chemical
22 weapons in October _91 and if the Coalition Forces
205 1 were there in March, why didn_t they know. One
2 important factor is the Iraqis did not mark a
3 conventional munition any differently from the
4 chemical munition. When we went there in _91, they
5 were already dissected as it were. And so you can
6 readily determine and see that they were chemical
7 agents and munitions.
8 DR. LASHOF: You mean because they were
9 partially destroyed?
10 MR. DUELFER: They were intact.
11 DR. LASHOF: If they were intact, you
12 could have told.
13 MR. DUELFER: The regular chemical
14 detectors, as I understand it, I_m not the expert, but
15 regular chemical detectors would not be able to
16 determine a conventional rocket from a non-
17 conventional one.
18 DR. LASHOF: I see. Go on.
19 MR. MITROHKIN: One more comment. What
20 Mr. Duelfer just mentioned, this is very important.
21 The Iraqi practice, practice, was not to mark chemical
22 munitions as a special weapons, as chemical munitions
206 1 or any other munitions other than conventional
2 munitions. This was the idea, this was the mentality
3 and this was the practice. Chemical weapons were not
4 marked and had not any marking system which could be
5 used in order to identify that this is a chemical
6 munition and this is a conventional munition. And
7 they tried to produce munitions, basically, using as
8 much as forcible empty casings from conventional
9 weapons. It_s all private speculation, but, for
10 example, it was the problem for the Special Commission
11 because the Special Commission undertook several
12 additional steps in order to identify the origin of
13 the weapons.
14 For example, the drilled menu in
15 munitions, because there was not any other
16 possibility. The regular military detection equipment
17 doesn_t work in this case, because even the munition
18 in good condition, chemical munition, if it_s not
19 marked and if empty casings from conventional weapons
20 is used, there is only one way to drill munition and
21 to take sample. And this is what the field workers
22 did in two years.
1 DR. BALDESCHWIELER: But they must have
2 some numbering system.
3 MR. MITROHKIN: No. And this was, again,
4 this was the Iraqi idea to cover chemical weapons
5 under the conventional weapons purposes.
6 DR. BALDESCHWIELER: But how would they
7 know themselves?
8 MR. MITROHKIN: In this respect we had
9 several accidents. For example, when at first I found
10 a Hussein chemical warhead, and this was shown in
11 photo and slide, I also was the member of this
12 inspection team. I was Deputy Chief Inspector. The
13 Iraqis tried to assure us that the warhead held only
14 one component of the Iraqi binary system. And all of
15 us commissions experts and the Iraqis were standing
16 around the warhead without any protection equipment.
17 The warhead was open because the Iraqis were
18 absolutely assured that this was empty warheads from
19 the one component.
20 Finally, we found that this particular
21 piece was found with G agent. The Iraqis were
22 surprised, we had been surprised and since that, we
1 have been under procedures established by the
2 Chairman. Each Iraq_s declaration should be
3 challenged. We have this experience.
4 MR. CAPLAN: So that does mean, though,
5 that it would be relatively easy for them to make a
6 mistake, fused a missile and shoot it in error,
7 perhaps, speculatively?
8 MR. MITROHKIN: I cannot give you any
9 response in this particular respect. But logically
10 you are right.
11 MR. TURNER: I have two questions about
12 Khamissiyah specifically, which I think are
13 clarifications. In Bunker 73, the U.N. has only found
14 evidence of rocket casings that are consistent with
15 Sarin and Cyclosarin nerve agents; is that correct?
16 MR. MITROHKIN: Yes, sir.
17 MR. TURNER: You found no evidence of
18 mustard rounds in Bunker 73?
19 MR. MITROHKIN: No. And we have no
20 evidence that these types of weapons, 122-millimeter
21 rockets, have ever been filled with mustard, only with
22 G agent.
209 1 MR. TURNER: The second area I_d like to
2 clarify about Khamissiyah is, if I understood your
3 testimony correctly, Mr. Duelfer, there is a
4 suggestion by the Iraqis that not only were Sarin and
5 Cyclosarin filled rockets at Bunker 73 destroyed
6 during the war, but also some in the site of the open
7 pit; is that correct?
8 MR. DUELFER: That_s correct. That_s what
9 the Iraqis have told us.
10 MR. TURNER: And you have nothing to
11 verify the latter part?
12 MR. DUELFER: We have no reason to believe
13 it or disbelieve it.
14 MR. TURNER: Okay. If you could put up
15 the map again, Mr. Ewing, of Iraq? Mr. Duelfer, if
16 you could indicate the other sites where the U.N.
17 found damaged chemical warfare munitions in Iraq on
18 the map when Miles gets it up, I think that would be
19 very helpful for the Committee.
20 MR. DUELFER: One location, Mohammedia,
21 which is, I can_t find the end of this. There, yeah.
22 MR. TURNER: That_s Mohammedia?
210 1 MR. DUELFER: There.
2 MR. TURNER: So they_re both central Iraqi
4 MR. DUELFER: That_s correct.
5 MR. TURNER: Can you give us some idea of
6 the quantity and type of chemical munition that was
7 found at Al-Muthanna?
8 MR. MITROHKIN: In Mohammedia --
9 MR. TURNER: Mohammedia, that_s fine.
10 MR. MITROHKIN: Mohammedia, we had several
11 hundred dumps filled with mustard that were destroyed.
12 Some of them had already leaked. Also, not more than
13 ten aviation bombs filled with G agent, also a mixture
14 of Sarin and Cyclosarin. A lot of empty 122-
15 millimeter casings and several thousand of mortar
16 bombs filled with CS were there.
17 MR. TURNER: That_s what you found.
18 According to the Iraqi declarations, at Mohammedia,
19 how much in some kind of quantitative term of mustard
20 agent was destroyed during the war?
21 MR. MITROHKIN: In total, let me calculate
22 this. Let_s take 200 aerial bombs, 60 liters in each,
211 1 couple times, not more.
2 MR. TURNER: You were going to talk about
3 Al-Muthanna also. I_m sorry, at Mohammedia, you also
4 had some Sarin-filled aerial bombs?
5 MR. MITROHKIN: Yes.
6 MR. TURNER: And my information is three
7 metric tons. Does that sound in the correct area?
8 MR. MITROHKIN: Couple tons. Yeah, couple
10 MR. TURNER: At Al-Muthanna, again, the
11 same kind of question. What can you tell us about
12 what the Iraqis had indicated is the quantity of
13 chemical munitions that may have been destroyed there
14 during the war?
15 MR. MITROHKIN: In general, in Muthanna,
16 in Muthanna, several thousand 122-millimeter rockets
17 stored in the bunker area of the Muthanna Estate
19 MR. TURNER: So those are the same kind of
20 Sarin, Cyclosarin rockets were destroyed at
21 Khamissiyah were the type --
22 MR. MITROHKIN: Same type, different kind.
212 1 Also, maybe you have this information that the
2 Muthanna Estate Establishment was consisted of
3 different areas and it was a huge storage area in the
4 Muthanna Estate Establishment with underground
5 bunkers. During the war when the facility was
6 destroyed, they stored 122-millimeter rockets, 155-
7 millimeter shells, also aviation bombs, including
8 different calibers. And heavy contaminated those who
9 were in the -- I believe the production facilities
10 located in the Muthanna Estate Establishment, because
11 the production was carried out also in January. The
12 day before the destruction the facility had produced
13 chemical weapons. And as a result of the destruction,
14 the area was heavily contaminated.
15 And also, stocks of agents in bulks.
16 Mainly in mustard.
17 MR. TURNER: What information does the
18 U.N. have on the quantity of agent that may have been
19 released around there? Can you give us any kind of
20 idea with respect to nerve agent or mustard agent?
21 MR. MITROHKIN: Several tons of mustard.
22 MR. TURNER: And this is at Al-Muthanna.
213 1 MR. MITROHKIN: Yes. Basically bulk
3 MR. TURNER: Bulk agents were released
4 there, presumably during the air war.
5 MR. MITROHKIN: Yes.
6 MR. TURNER: Just kind of a final point to
7 clarify. The testing that you described doing for
8 contamination. Now, that is conducted when you_re
9 there, obviously, which is several months after the
10 end of the war. So that, if I understood your
11 testimony again correctly, or your comments here
12 today, correctly, the likelihood of finding evidence
13 of Sarin after that kind of passage of time is pretty
14 remote; is that correct?
15 MR. MITROHKIN: Yes.
16 DR. LASHOF: If they_re urgent, we_re way
17 over time. But, just on important issues.
18 MR. CAPLAN: Just one last question which
19 has come up in our hearings frequently, and I_m just
20 curious to have an opinion about it. In your view,
21 were the chemical and biological weapons, well, you
22 didn_t find any biological weapons. The chemical
214 1 weapons you found, is it your view that the Iraqis had
2 ample capacity to manufacture these that nothing came
3 from outside the country, the source of the actual
4 chemical weapons?
5 MR. MITROHKIN: This is a most complicated
6 question addressed to us. If you consider chemical
7 weapons as a system including agents, precursor
8 chemicals, equipment required for their production,
9 filling technology, empty casings of munitions,
10 components of these munitions, parts of the components
11 of munitions, of course Iraq was not able to create CW
12 arsenal on its own. Several components, including
13 precursor chemicals, key pieces of equipment,
14 basically dual use equipment, had been procured by
15 Iraq from the outside.
16 We have no evidence that Iraq imported
17 chemical weapons itself as a final product, either CW
18 agents or CW munitions. But we have evidence that
19 some empty casings supposed to be used later for CW
20 purposes have been exported by Iraq. The same is
21 related to minor precursor chemicals and equipment,
22 but not to chemical weapons itself as a final product.
215 1 DR. LASHOF: One more, John.
2 DR. BALDESCHWIELER: Let me come back to
3 the question of lot numbers and serial numbers. In
4 their manufacture, did the Iraqis have any system of
5 identifying lots and serial numbers on individual
7 MR. MITROHKIN: Depending on type of
8 munitions. For some munitions they had serial
9 numbers. For example, Al-Hussein missiles.
10 Al-Hussein missile was a strategic weapons for Iraq.
11 It was, it delivered the most sufficient range. After
12 the modification, regular munitions had 300
13 kilometers. Al-Hussein had 600 kilometers. Because
14 they had the serial numbers for the missile itself and
15 for its particular components, for engine, for the
16 warhead, but not for the piece of chemical weapons.
17 And without any knowledge, it was not possible to
18 differentiate, for example, the chemical missile and
19 the conventional missile. Both of them had serial
20 numbers, but only some Iraqi responsible agencies had
21 lists of numbers that applied to chemical weapons and
22 to conventional weapons. And no special marking
216 1 system. Of course, not any instructions or menus,
2 like in other countries that processed chemical
3 weapons by the regular procedure that a short menu was
4 even put on the box. This is not the case for Iraq.
5 DR. BALDESCHWIELER: Could you follow a
6 forensic trail. For example, if you found a munition,
7 could you establish where it had been assembled, for
8 example, and, you know, where the individual parts,
9 for example, had been produced?
10 MR. MITROHKIN: Yes. We did this
11 individually for each particular type of chemical
12 weapons. But this was a long investigation for each
13 type. It took more than one year. For this
14 particular type found in Khamissiyah, it took us three
15 years to establish and to finalize the investigation
16 from the beginning to the end, who produced, how many
17 were produced, who assembled this, what was procured,
18 what was produced, indigenously, where it was filled,
19 and so.
20 DR. LASHOF: Okay. Thank you very very
21 much. We do appreciate your coming down. It_s been
22 very helpful. We_re going to proceed directly to the
217 1 presentation concerning compensation from the Persian
2 Gulf Coordinating Board_s Compensation Working Group.
3 Colonel David Schreier and Mr. Jack Ross.
4 Colonel Schreier, are you going to start,
5 or is Mr. Ross going to start?
6 MR. SCHREIER: No, I will start. Good
7 afternoon. As was said, I am Colonel David Schreier.
8 And I am the Principal Director for Military Personnel
9 Policy within the Office of the Assistant Secretary of
10 Defense to enforce management policy. Now, we_ve had
11 policy oversight and responsibility for the DOD
12 Disability Evaluation System since August of 1995.
13 And prior to that time, the Assistant Secretary of
14 Defense for Health Affairs had this responsibility.
15 This afternoon I_d like to speak with you
16 for a few moments about the DOD Disability Evaluation
17 System. I_ll detail the mission of our system in
18 comparison with the Department of Veterans Affairs
19 Disability System. The components of our system and
20 the procedures we employ to adjudicate a case in a
21 manner that is fair and equitable for both the
22 Department and the affected member.
1 And finally, I want to provide a picture
2 of the levels of appeal built into this system to
3 ensure that this is fair and equitable. Next slide
5 Many times there is confusion about the
6 roles and missions of the DOD and the Department of
7 Veterans Affairs Disability Systems. While they are
8 similar and use the same standard for rating
9 disabilities, each system has a different character
10 and charter that is mandated by statute.
11 The purpose of the DOD System is to
12 determine the service member_s medical fitness for
13 duty and, if the member is found to be unfit for duty,
14 to compensate the member for a shortened military
15 career. The DVA System, however, has a different
16 charter. The DVA_s purpose is to determine if the
17 disability is service connected and, if it is,
18 compensate the member for the loss of civilian earning
20 Further, the law prohibits DOD from
21 evaluating members for disability after they have left
22 the service. Once a member is separated, disability
1 evaluation and compensation comes to the Department of
2 Veterans Affairs. Next slide please.
3 The DOD Disability Evaluation System
4 consists of two major components. The Medical
5 Evaluation Board, or MEB, and the Physical Evaluation
6 Board, or PEB. The MEB is composed of three medical
7 doctors. Their role is to decide if a diagnosed
8 medical condition fails to meet medical retention
9 standards. If so, they refer the member to the
10 Physical Evaluation Board, which will decide if the
11 member is fit for duty.
12 The PEB consists of two line officers and
13 one medical officer. Their job is to determine
14 fitness for duty. And there are two types of PEB_s.
15 The first is the informal PEB. This is the initial
16 review of a case referred by the MEB. The member is
17 not present at an informal PEB. Once the informal PEB
18 makes a fitness determination, the member can either
19 accept their findings or request a formal Physical
20 Evaluation Board.
21 The formal PEB is the first level of
22 appeal and satisfies the requirement for a full and
220 1 fair hearing as mandated by law. The member may
2 appear in person before the formal PEB, have Counsel
3 present and present new evidence or documentation.
4 The formal PEB is not bound by the informal PEB and
5 makes its own fitness determination. Next slide
7 This is a graphic depiction of the
8 Disability Evaluation System process. It starts with
9 identification of a medical condition that may impair
10 a member_s ability to perform his or her duties. For
11 reservists, this has to be a condition that is a
12 result of performing military duty. The MEB then
13 determines if the condition meets medical retention
14 standards. If it doesn_t, the member is referred to
15 the Physical Evaluation Board.
16 The PEB is responsible for determining
17 fitness for duty. As I said before, the member_s case
18 file goes before the informal PEB. If the member does
19 not concur with the findings of the informal PEB, he
20 or she can request a formal Physical Evaluation Board.
21 If a member is determined fit by the PEB,
22 the member returns to work. If determined unfit, the
221 1 member is assigned a disability rating and, based on
2 the rating and years in service, either separated or
4 Members separated from the service for
5 disability are entitled to the full range of
6 transition benefits afforded to other separating
7 members. Next slide please, Alex.
8 The last item I_d like to discuss is the
9 appeals process. As mentioned, there are several
10 levels of appeal and automatic review to ensure fair
11 and equitable treatment for both the member and the
12 government. The formal PEB is the first level of
13 appeal. If a member disagrees with the formal PEB,
14 the member can appeal to the Service Disability Agency
15 as indicated. Beyond that, the Service Secretary is
16 the approving authority for all disability separations
17 or retirements, and the member may appeal to the
18 Service Secretary.
19 Finally, even after separation or
20 retirement, the member may appeal the case to the
21 Service Board for Correction of Military Records and
22 to the courts.
222 1 The DES is, in our opinion, a well thought
2 out system and processes over 26,000 members each
3 year. The bottom line is that we have a system with
4 multiple levels of appeal and review to protect the
5 interests of the member and to help ensure we do the
6 right thing by our people. Thank you very much.
7 DR. LASHOF: I think maybe we_ll take --
8 go ahead and hear the GAO presentation. And then take
10 MR. ROSS: Good afternoon. My name is
11 Jack Ross. I am the Acting Director of the Department
12 of Veterans Affairs Compensation and Pension Service.
13 I am pleased to be here today to speak to you about
14 VA_s Compensation Program for Persian Gulf Veterans
15 Suffering from Undiagnosed Illnesses. Although
16 undiagnosed illnesses will be the focus of my remarks,
17 I would like to provide as background some discussion
18 of compensation issues in general.
19 Compensation is a benefit paid to a
20 veteran for service-connected disability. Various
21 forms of compensation have existed since colonial
22 times. The aim of this compensation has always been
223 1 to provide an amount that would help a disabled
2 veteran maintain an adequate standard of living.
3 Currently, compensation is intended to replace income
4 lost due to a disabled veteran_s decreased earning
6 Under 38 United States Code 1110, we have
7 authority to compensate for disabilities that arise
8 from diseases or personal injuries incurred in or
9 aggravated by the line of duty during active military,
10 naval or air service. By line of duty, we mean that
11 a disability must not either be the result of the
12 veteran_s own wilful misconduct or the result of drug
13 or alcohol abuse. A veteran must have been released
14 from active duty under other than dishonorable
15 circumstances. It is VA_s policy to grant service
16 connection for any condition that can be attributed to
17 service, no matter how long after service the
18 condition became manifest.
19 Service connection may be granted in one
20 of three ways. First, direct service connection.
21 Generally, direct service connection is granted for
22 chronic conditions that are documented from service
224 1 medical records. However, direct service connection
2 may be granted for a disability that does not appear
3 until long after service if the evidence supports the
4 conclusion that it is related to an incident occurring
5 on active duty.
6 Secondly, the service connection can be
7 granted through aggravation. If a medical condition
8 that pre-existed service becomes worse during service
9 beyond what would be normally expected, we may
10 establish service connection for this worsening of the
12 Lastly, presumptive service connection.
13 For some chronic diseases, the statute and regulations
14 provide presumptive periods. A disease first
15 appearing during a presumptive period is considered to
16 be related to service unless there is affirmative
17 evidence to the contrary.
18 Most presumptive periods are one year
19 following release from active duty. VA evaluates
20 disabilities according to the Schedule for Rating
21 Disabilities which is Part 4 of Title 38 Code of
22 Federal Regulations. Evaluations are made in ten
225 1 percent increments from zero percent to 100 percent.
2 Evaluations of more than one disability are taken
3 together to determine the combined valuation, which is
4 reached not by adding the individual percentages but
5 by applying a combined ratings table found in 38 CFR
7 The rating schedule was designed to assess
8 as far as is possible the average impairments
9 resulting from the disability in civilian occupations.
10 We are currently revising the rating schedule
11 systematically to incorporate needed clarifications
12 and ensure that it takes into account the latest
13 scientific and medical knowledge available.
14 As I stated earlier, 38 United States
15 Code 1110 authorizes us to compensate for disabilities
16 that arise from diseases or personal injuries. The
17 accepted definition of disease includes the notion
18 that it is manifested by a characteristic set of
19 symptoms and signs whose etiology, pathology and
20 prognosis may be known or unknown.
21 After the return of U.S. Forces from the
22 Persian Gulf, many veterans began exhibiting symptoms
226 1 that could not be attributed to a known clinical
2 diagnosis. They often have combinations of non-
3 specific symptoms that do not fit a single case
4 definition. There have been concerns that these
5 illnesses were caused by various chemical exposures or
6 other environmental hazards in the Persian Gulf.
7 Since these widely varying symptoms cannot
8 be attributed to the characteristic signs or symptoms
9 of known diseases, we are unable to pay compensation
10 for them under the usual statutory authorities.
11 Therefore, we strongly supported legislation giving us
12 that authority. Public Law 103-446 authorized us to
13 pay compensation to Persian Gulf veterans with chronic
14 disabilities resulting from undiagnosed illnesses that
15 appeared either during active duty in the Persian Gulf
16 or to a degree of ten percent or more within a
17 presumptive period thereafter.
18 On February 3, 1995, we published 38 Code
19 of Federal Regulations 3.317 to implement the criteria
20 for establishing service connection for undiagnosed
21 illnesses. Significant features of the regulation
22 include a two-year presumptive period following
227 1 service in the Persian Gulf, a definition of chronic
2 disability as one that has existed for at least six
3 months, a requirement that there be objective signs of
4 chronic disabilities resulting from undiagnosed
5 illnesses, and a requirement that a disability may not
6 be attributable to a known clinical diagnosis.
7 The two-year presumptive period. The one
8 year period established for most chronic diseases
9 seemed insufficient to meet the special circumstances
10 of Persian Gulf veterans. Many of them did not begin
11 to document their undiagnosed illnesses until an
12 examination was held in conjunction with VA_s Persian
13 Gulf Health Registry. The Registry, however, did not
14 begin full operation until November 1992, well over a
15 year after the first veterans began returning from the
16 Gulf. Therefore, we determined on two years as an
17 adequate period allowing all veterans of the
18 hostilities an opportunity to document their
20 Definition of a chronic disability. So
21 long as we are dealing with a known disease whose
22 clinical course is familiar, chronicity may generally
228 1 be determined from observing the various
2 manifestations of the disease. This process, however,
3 is not appropriate for dealing with an undiagnosed
4 illness whose clinical course cannot be predicted.
5 Therefore, we adopted six months as an objective
6 standard for determining chronicity. It is a period
7 commonly accepted within the medical community for
8 distinguishing chronic conditions from acute
10 Since some illnesses have intermittent
11 episodes of improvement and worsening, any undiagnosed
12 illness presenting such fluctuations over a six month
13 period will be considered chronic.
14 Objective indications of chronic
15 disabilities. Objective indications allow us to
16 determine the existence of a disability, when it first
17 appeared and the degree of impairment it produces.
18 Objective indications include both signs in the
19 medical sense of evidence perceptible to an examining
20 physician and non-medical indicators. Non-medical
21 indicators would include such things as time lost from
22 work, evidence that a veteran has sought medical
1 treatment for his or her symptoms, changes in the
2 veteran_s physical appearance and changes in the
3 veteran_s mental or emotional attitude. The
4 importance of non-medical indicators cannot be
5 discounted. Where an undiagnosed illness manifests
6 itself solely through symptoms which cannot be
7 verified medically, non-medical indicators assume a
8 proportionately greater importance. Non-medical
9 indicators are provided to us in the form of lay
10 statements. A lay statement may be submitted by any
11 person who is able to establish that he or she is
12 reporting observations that are based on personal
14 Disability not attributable to a known
15 clinical diagnosis. Public Law 103-446 governs only
16 compensation based on illnesses that cannot be
17 attributed to a known clinical diagnosis. Once a
18 diagnosis is obtained, we cannot consider entitlement
19 under that law. However, as in any case we will
20 consider entitlement under all other statutory and
21 regulatory provisions.
22 At 38 Code of Federal Regulations 3.317,
1 Subparagraph B, we have listed 13 signs or symptoms
2 that may be manifestations of undiagnosed illnesses.
3 This list represents the signs and symptoms most
4 frequently encountered in over 17,000 examinations in
5 VA_s Persian Gulf Health Registry. The 13 signs and
6 symptoms are broad categories encompassing a number of
7 different complaints. The list is not exclusive. We
8 will consider any sign or symptom as a possible
9 manifestation of an undiagnosed illness. We evaluate
10 the degree of disability resulting from an undiagnosed
11 illness by using criteria contained in the Rating
12 Schedule. We apply the criteria for a disease or
13 injury that produces a similar type of disability. We
14 evaluate different types of disabilities as
15 manifestations of either a single illness or more than
16 one illness, whichever is to the veteran_s advantage.
17 Because of concerns about the possible
18 role of environmental hazards in causing the
19 unexplained illnesses in Persian Gulf veterans, we
20 centralized Persian Gulf compensation claims based on
21 environmental hazards in the Louisville Regional
22 Office beginning December of 1992. In October of
231 1 1994, we redistributed these claims to four regional
2 offices known as Area Processing Offices, or APO_s.
3 The APO_s are located in Louisville, Nashville,
4 Phoenix and Philadelphia.
5 Persian Gulf claims based on undiagnosed
6 illnesses are also now centralized at the four APO_s.
7 The authority granted by Public Law 103-446 has
8 presented a unique set of challenges. Prior to that
9 statute we established service connection for
10 diagnosable diseases with well-defined clinical
11 courses. Under Public Law 103-446 we may now
12 establish service connection for disabilities
13 resulting from unexplained illnesses whose clinical
14 courses cannot be predicted and whose manifestations
15 may be entirely symptomatic.
16 Furthermore, some of the illnesses have
17 appeared only after the veteran_s service in the
18 Persian Gulf, delaying the veteran_s efforts to seek
19 medical assistance and consequently documentation of
20 illness. A decision to grant service connection is a
21 bi-parthied process. First we determine that the
22 claimed disability is related to service. Once the
232 1 relationship to service is established, we determine
2 the degree of disability according to the Rating
4 In making these determinations, we
5 routinely rely on such evidence as service medical
6 records, VA examination records, or records of VA
7 hospitalization or outpatient treatment, medical
8 records from private physicians or hospitals and
9 occasionally lay statements. To set a simple case
10 history, a veteran claims compensation for a stomach
11 condition. A review of military medical records,
12 which we routinely obtain, discloses several episodes
13 of complaints of and treatment for stomach problems.
14 No diagnosis is given in the service. Examination at
15 VA medical facility discloses that the veteran
16 currently has a duodenal ulcer. After a review of the
17 entire evidence of record, the Rating Board at the VA
18 regional office of jurisdiction determines that the
19 veteran_s current ulcer condition is related to a
20 stomach problems in service. Grant service connection
21 and assigns the appropriate degree of disability as
22 provided in the Rating Schedule.
233 1 The point to be brought out is that we
2 have an established diagnosis, duodenal ulcer, and a
3 well documented medical history of complaints from
4 service medical records and VA examinations, allowing
5 us to determine service connection. If the medical
6 records had contained a diagnosis of duodenal ulcer,
7 the grant of service connection would have been an
8 even simpler decision.
9 However, this case history would become
10 somewhat more complex if the service medical records
11 disclosed no complaints or treatments for a stomach
12 disorder. However, let us assume that some medical
13 evidence, whether from VA or private sources, reveal
14 that the ulcer appeared within one year following the
15 veteran_s separation from active duty. Duodenal ulcer
16 is one of the chronic diseases for which service
17 connection may be presumed provided they appear to a
18 degree of ten percent or more within one year after
19 service. Therefore, in this situation we may
20 determine service connection on a presumptive basis.
21 We can increase the complexity of the case
22 history still further by assuming that the service
234 1 medical records disclose a single complaint of stomach
2 disorder for which the examining physician could
3 establish no diagnosis. A year and a half after
4 separation from service the veteran claims
5 compensation for a stomach disorder. VA medical
6 examination discloses no verifiable signs of a G.I.
7 disorder and the examining physician is unable to
8 provide a diagnosis, but does record the veteran_s
9 history of stomach problems. There is no other
10 medical evidence for consideration. In a situation
11 such as this, with complaints of stomach problems
12 during and after service but no underlying diagnosis
13 to explain them and no history of chronicity to link
14 them as manifestations of the same illness, service
15 connection would be denied under normal criteria.
16 However, with the advent of Public Law
17 103-446 it may now be possible to grant service
18 connection for this undiagnosed stomach ailment in the
19 case of Persian Gulf War veteran. The situation as
20 set out includes a complaint recorded in service
21 medical records, given the two-year presumptive period
22 for undiagnosed illnesses, an indication of such
235 1 complaint in service medical records is not necessary.
2 We have adjudicated compensation claims
3 for all types of conditions for over 80,000 Persian
4 Gulf veterans and have granted benefits to 25,000 of
5 these claims. As of June 28, 1996, we had reviewed
6 the claims of slightly more than 11,000 Persian Gulf
7 veterans for entitlement to compensation based on
8 either exposure to environmental hazards or
9 undiagnosed illnesses. The claims of 10,348 have been
10 reviewed under both sets of criteria. To date we have
11 granted compensation to 1,324 veterans for
12 disabilities claimed to have resulted from exposure to
13 environmental hazards or undiagnosed illnesses. Of
14 these, 532 veterans are receiving compensation for
15 undiagnosed illnesses. The remainder receive
16 compensation for disabilities due to environmental
18 Although there have been proportionately
19 few grants of compensation for undiagnosed illnesses,
20 reviews by both the General Accounting Office and VA
21 indicate that we have awarded compensation for
22 diagnosed condition for as many as 40 to 60 percent of
236 1 the over 11,000 veterans claiming these types of
2 conditions. Nonetheless, in response to concerns over
3 the low number of grants of service connection for
4 undiagnosed illnesses, the Compensation and Pension
5 Service recently undertook a review of a sample of 468
6 cases in which undiagnosed illnesses were found not to
7 be service connected.
8 A review disclosed errors of coding in the
9 tracking system we used to monitor these cases. The
10 miscoding had no effect on the outcomes of the cases.
11 Our review also disclosed several instances of
12 incomplete development for evidence and failure to
13 obtain current medical and lay information, which
14 could affect the outcome of a claim. On the basis of
15 our findings, we are undertaking a second adjudication
16 of the over 11,000 cases in the tracking system to
17 correct problems of development, adjudication and
18 coding. We also have published more detailed
19 instructions to our field offices emphasizing proper
20 development and adjudication of these cases and
21 specific instructions for coding.
22 In response to concerns about the adequacy
237 1 of the two-year presumptive period, the Secretary has
2 asked us to conduct a further review of Persian Gulf
3 undiagnosed illness cases. He has specifically
4 requested an analysis of our experiences with these
5 cases, the medical and scientific information
6 supporting an extension of the presumptive period
7 beyond two years and the basis justifying the cutoff
8 point for whatever extended period might seem
10 Upon completion of the analysis, the
11 Secretary will decide how next to proceed. This
12 concludes my statement. Thank you.
13 DR. LASHOF: Thank you very much, Mr.
14 Ross. Questions from the panel?
15 DR. TAYLOR: I have one question of
16 Mr. Ross. Regarding the disabilities, compensation
17 received due to environmental hazards, how are you
18 defining environmental hazards? What are those, the
19 ones where the cases have been reviewed and approved?
20 MR. ROSS: Environmental hazards could be
21 anything. It could be exposure to benzene, it could
22 be exposure to the oil fires in the Gulf where they
238 1 experienced breathing problems shortly thereafter, any
2 of those types of disabilities.
3 DR. TAYLOR: And so you had 700 cases that
4 have been approved and they_re receiving compensation?
5 MR. ROSS: A little over 800, ma_am. Yes,
7 DR. CUSTIS: A number of years ago the
8 American Medical Association was critical of the VA
9 for being too generous in their rating schedule and
10 arguing that it should be more in keeping with
11 industrial compensation. Does that argument still go
13 MR. ROSS: I_m not familiar with that
14 argument, sir. I couldn_t address that.
15 MS. NISHIMI: Mr. Ross? I understand that
16 you_ve consolidated the undiagnosed illness claims in
17 four offices, I believe you said. But, as I am sure
18 you are aware, the American Legion opposes the
19 consolidation and recommends that it go back to the
20 field offices. Is VA considering the Legion_s
21 viewpoint and where do the whole thing just stand?
22 MR. ROSS: There are two schools of
239 1 thought with regard to centralization. Centralization
2 focuses the issue. It allows a certain degree of
3 specialization for the very unique type of claims.
4 And that school of thought tends to support the
5 centralized four processing offices.
6 The other school of thought tends to
7 indicate that you are a little closer to the problem
8 with regard to the individual representatives, if in
9 fact you maintain jurisdiction in the regional office.
10 However, I would point out this. That the initial
11 adjudication for undiagnosed illnesses, although it is
12 processed at one of the four processing offices, if an
13 individual disagrees with that claim, jurisdiction
14 then reverts back to the regional office of
15 jurisdiction for the hearing officer_s review of the
16 case. So, in that sense, at least the individual is
17 afforded the opportunity at the regional office level
18 to have their claim reconsidered.
19 DR. LASHOF: As I understand it, the
20 Coordinating Board, as the Working Compensation Group
21 is a subgroup of the Coordinating Board, which is
22 trying to coordinate, because they_re the VA. Is that
1 an active group and what are the kinds of issues that
2 come before the Working Group?
3 MR. ROSS: Doctor, I_m sort of new at
4 this. I_ve only been on board now for about three
5 weeks, and I_m not familiar with how the subgroups are
6 actually structured.
7 DR. LASHOF: Do you know, Colonel Schreier?
8 MR. SCHREIER: I_m afraid I don_t.
9 DR. LASHOF: Okay. We_ll have to go back
10 to someone else and try to find out.
11 We_ve heard a lot of testimony from
12 veterans who feel that they_ve been waiting a very
13 long time, a year, two years, to find out whether or
14 not their claims are going to be approved or not. Do
15 you have data on how long it usually takes you from
16 the time the claim is filed til the time action is
17 taken one way or the other?
18 MR. ROSS: Yes, we do. There is a very
19 common misimpression among veterans throughout the
20 country that their claim takes two or three years for
21 initial processing, when in fact on average right now
22 claims are taking about 151 days, initial claims.
1 What a veteran tends to think in terms of his or her
2 claim is from the date he first files an application
3 to its completely adjudicated through all of the
4 appeals processes. So in fact a veteran may well file
5 a claim with one of the four, the area processing
6 offices, and have a determination made within, say,
7 six months. But then they are dissatisfied for one
8 reason or another and they want to appeal that case.
9 Then it may stay in the hopper for a hearing officer
10 for another three or four months, and then if the
11 veteran remains dissatisfied, it could go to the Board
12 of Veterans Appeals where the case may await call-up
13 and final decision for another year to two years.
14 DR. LASHOF: Do you think that_s a
15 reasonable length of time for a veteran, say someone
16 has totally disabled, has no income, to take two years
17 before he can get a final reading?
18 MR. ROSS: If we are talking about each
19 segment, Doctor, if we_re talking about the 150 days,
20 I don_t think that is a reasonable period of time. We
21 have set a goal for ourselves of 102 days as a
22 reasonable period, and we are moving toward that goal.
242 1 Two to three years ago we were well in the area of
2 over 200 days to process original claims. And as I
3 just mentioned, we are now down to 151 and our goal is
4 102 days.
5 The other areas, in terms of appeals,
6 there are areas that we don_t have any control over.
7 There are requirements of the law that give the
8 veteran a year to file an appeal, and our clock never
9 stops ticking. The veteran has one year, and many of
10 them wait six months before they file their appeal.
11 Service organizations or attorneys who represent
12 veterans, they also have certain provisions under law
13 in which they have time to develop their evidence, and
14 we have no control over that. Yet we are charged with
15 the time lengths.
16 We also have periods that are mandated by
17 due process that we have to allow.
18 DR. LASHOF: Well, I understand that. And
19 obviously, it_s to the veteran_s advantage to have
20 time during which he has time to file. So, let me ask
21 the question another way. Assume that he_s turned
22 down and he files immediately for an appeal, from the
243 1 time he files for the appeal, how long does it take
2 before it_s heard and action taken before he_s ready
3 to file the next appeal?
4 MR. ROSS: If in fact he is filing or
5 perfecting his appeal to the Board of Veterans Appeals
6 in Washington, D.C., the Board of Veterans Appeals,
7 the most recent data that I have heard from them is
8 that they are reviewing the cases complete from start
9 to finish within 90 days.
10 However, if in fact the veteran has a
11 service representative, depending on the service
12 organization, it ranges anywhere from 120 days up to
13 396 days that the service organizations are holding
14 cases for review.
15 DR. LASHOF: The service organization
16 being the reason for the long delay rather than --
17 MR. ROSS: It_s the veteran_s
18 representative. Yes, ma_am.
19 DR. LASHOF: I see. Don?
20 DR. CUSTIS: This all reminds me, what
21 loss of FTE are you going to be visited with?
22 MR. ROSS: In each of the next two fiscal
244 1 years, it looks like we will lose at least 400 people
2 in each of the next two fiscal years.
3 DR. CUSTIS: How is this going to impact
4 the time lengths?
5 MR. ROSS: Obviously, with fewer FTE_s to
6 process the cases, our case load could turn around and
7 go the other way. Time lengths could in fact
8 increase, rather than decrease as it has been. We are
9 hoping that technology will at least stem the tide to
10 some degree.
11 MR. MCDANIELS: You state in your
12 statement that you published more detailed
13 instructions emphasizing proper development and
14 adjudication of cases. This is including obtaining
15 lay evidence?
16 MR. ROSS: Yes, sir, it is.
17 MR. MCDANIELS: Why do you suspect it_s
18 difficult to obtain lay evidence? It seems like lay
19 evidence would be something quite easy to provide, if
20 you were a veteran?
21 MR. ROSS: You know, that was surprising
22 to me when I initially read those findings where we
245 1 had developed from veterans lay statements and they
2 were not provided. I don_t know why lay statements
3 aren_t provided in every instance.
4 MR. MCDANIELS: But the applications for
5 disability compensation, they ask for or they state
6 that lay evidence is acceptable?
7 MR. ROSS: Yes. I will expand on that a
8 little bit. In the traditional sense of what
9 credibility is attached to lay statements, the
10 specific regulations which apply to undiagnosed
11 illnesses give far greater weight to lay statements
12 for those types of disabilities than any other
13 disability we_ve ever considered in the past. It_s a
14 separate category, if you will. And as this evolves
15 we are learning bit by bit the necessary steps that we
16 have to take to elicit information from veterans and
17 veterans and their representatives are also going
18 through that same learning curve.
19 DR. LASHOF: Okay. John?
20 DR. BALDESCHWIELER: If I can come back to
21 the 151 days, or the 102 days, if you can achieve
22 that, is that an issue of cueing basically or is it,
246 1 I mean, what literally goes on if it takes that long?
2 MR. ROSS: Actually, if you look to the
3 case, there are certain time frames within that that
4 we actually have no control over. First of all, when
5 we get a claim in, we have to request the veteran_s
6 military records. And typically that can take
7 anywhere from a week to a month, you know, on average.
8 So there_s 30 days that we really can_t act on. Then
9 in other instances we have to go back to the veteran,
10 say, for the lay statement or for private medical
11 records or for evidence that he or she may have, and
12 we have to give them 60 days to provide that
13 information before we can act on the claim. So
14 there_s another 60 days that we have no control over.
15 And I would say in a, normally you_ve got
16 a 60 to 70 day window in there that you_ve got no
17 control over whatsoever, that you cannot completely
18 adjudicate the claim. It_s not like an insurance
19 claim where one bit of evidence goes in and it_s acted
20 upon. There are two or three things that have to
21 occur. We have to get the veteran_s military records,
22 we have to get him a current examination, and we have
247 1 to develop evidence that he or she may have.
2 DR. BALDESCHWIELER: Are you adequately
3 staffed to handle the backlog, or there must be a
4 significant backlog?
5 MR. ROSS: The backlogs are all going down
6 at present time, sir.
7 DR. BALDESCHWIELER: Because that must
8 vary enormously with time. That is, following the
9 Gulf War, presumably you have a large pulse of claims.
10 MR. ROSS: Any time that there is an armed
11 conflict of that magnitude, our work load rises and
12 our staff does not rise correspondingly. And it takes
13 a while for us to get it manageable again, get it
14 under control, but our backlogs and our timeliness,
15 our backlogs have been going down for the past year,
16 year and a half, and our timeliness has been steadily
18 DR. LASHOF: Thank you. David?
19 MR. HAMBURG: We heard a lot at this
20 Commission about the burst of new research on Persian
21 Gulf illnesses and there_s also an intensification of
22 clinical experience over those problems. Could you
248 1 tell us more about how the compensation system takes
2 into account the changes in research and clinical
3 experiences. How does it update itself in light of
4 new information?
5 MR. ROSS: In terms of undiagnosed
6 illnesses, right now all we need is a statement from
7 a physician in essence that says Persian Gulf Syndrome
8 or Persian Gulf Symptom, or undiagnosed illness, any
9 of those kinds of things. That would, in conjunction
10 with the veteran_s medical history during service and
11 the associated lay statements and what his current
12 condition is, would allow us from an adjudicative
13 standpoint to grant the benefit.
14 If, for instance, say tomorrow, this is
15 just a hypothetical situation, it was disclosed that
16 the Sarin that was found in the chemical weapons did
17 in fact cause a specific type of disability or
18 disabilities, the minute that that medical knowledge
19 was made available to us, we could then grant, not on
20 the basis of an undiagnosed illness, but on the basis
21 of a known diagnosable entity.
22 DR. LASHOF: Art? Go ahead.
249 1 MR. CAPLAN: Just two questions for
2 Mr. Ross. When someone appeals a decision, do they
3 have to forego all the benefits that they might have
4 been awarded while they_re appealing?
5 MR. ROSS: Oh, no. Oh, no. That_s --
6 MR. CAPLAN: So those continue?
7 MR. ROSS: There_s absolutely no loss.
8 MR. CAPLAN: And my other question for you
9 is, do you need a representative or an attorney to
10 work the system, or another way to put it is, how user
11 friendly is this? I mean, people have come before us
12 and said they_re lugging around documents trying to
13 find signatures. Occasionally we see evidence of
14 failure to move forward with claims because people
15 don_t get the medical evidence or statements that they
16 need in. Could I go to a web site and be told how to
17 take this claim forward myself? Is it something you
18 would claim to be user friendly?
19 MR. ROSS: I would say that, given all of
20 the avenues that are available to veterans today, I
21 know when I got out of the service I was as green as
22 could possibly be. That was back during the Vietnam
250 1 era. There were county veteran service officers to
2 help me. There were national service organizations
3 like the American Legion, DAV, people like that there
4 to help me, and they were almost waiting in line
5 literally when I was discharged.
6 There are a number of avenues to pursue.
7 The VA itself is not adversarial in the initial claims
8 process. If you went into any VA regional office and
9 said, I want to file a claim, they would assist you in
10 filing the basic claim. After a decision is made,
11 that environment changes somewhat.
12 DR. LASHOF: Okay. Marguerite?
13 MS. KNOX: Yeah. I just have one question
14 for the Colonel. We_ve had several testimonies from
15 active duty soldiers who have been hesitant to go and
16 have their CCEP because they are afraid that they may
17 be medically retired and lose their benefits that they
18 would get if they retired from the military after 20
19 years. Can you talk about, say they got 50 percent
20 medical disability, what would they really get, and I
21 know it would depend on rank, but what are the other
22 benefits that they_re losing as to why they do not do
2 MR. SCHREIER: Off the top of my head, I_m
3 not sure what they would be losing. I mean, they and
4 their family members continue to have access to the
5 military medical system. They continue to have access
6 to commissaries and exchanges. They have the full
7 range of transition benefits that any separating
8 service member has access to.
9 MS. KNOX: So those would be life-long
11 MR. SCHREIER: Well, some of the
12 transition benefits have an expiration date associated
13 with them, because they are meant to assist the
14 individual in transitioning back to civilian life.
15 But yes, the commissary, exchange, military medical
16 system, at least up until the time that they_re age 65
17 and come under Medicare, then that takes over. They
18 are losing, generally speaking, when we speak of a
19 military member retiring at 50 percent of their basic
20 pay, that_s closer to about a third of their actual
21 income because of the other allowances that they
22 receive for housing and subsistence and anything else
1 that may be in the total pay package.
2 MS. KNOX: So about two-thirds of their
3 salary is what they_re losing?
4 MR. SCHREIER: I would think that would be
5 the predominant thing that is causing them concern and
6 perhaps also the fact that it_s a significant life
7 change, going from an environment where they are, if
8 they_re concerned about it, apparently an environment
9 where they feel relatively comfortable into a
10 different environment.
11 MR. CROSS: Colonel, I think there_s two
12 other issues that they lose if they raise their hand,
13 because I know, I_ve had active duty veterans, you
14 know, raise a concern. If they get into this process
15 where they seek medical retirement or medical
16 evaluation, let_s say, they_re instantly stricken off
17 of any promotion lists.
18 MR. SCHREIER: That_s not true.
19 MR. CROSS: Now, in my experience they
20 are. And also, reenlistments are jeopardized because
21 they_re in a medical hold status. So that_s the fear,
22 to me, because obviously you want to get promoted, so
253 1 obviously you make more money. And on the other
2 to stay in for 20 years you have to reenlist to
3 continue your career. So, those are two areas that I
4 sense that there are a concern about.
5 MR. SCHREIER: I will agree that the
6 individual is probably going to, well, it comes back
7 to the same thing. They feel threatened that there_s
8 going to be a change in the environment. I think,
9 though, that I will dispute the fact of being removed
10 from the promotion list. I think that is bad
11 information that you have been given. There may be an
12 extraordinary case where that occurred, but I can for
13 the life of me not imagine how that would have
14 occurred. But I_ll take it that if someone told you
15 it happened, it happened. In that case, I_d be
16 interested in knowing the specifics. The individuals
17 that are being evaluated and would be coming up on an
18 enlistment point typically what will occur is that the
19 individual can continue there on a current enlistment.
20 They can be extended until there is some resolution of
21 the case, whether or not they are medically qualified
22 to reenlist. So it_s not that we have an individual
254 1 who perhaps has 11 years_ service, is coming up at the
2 end of the 12 year enlistment that would carry him to
3 12 years, we_re not going to throw them out the door
4 at the 12-year point if they_re undergoing some
5 medical assessment. But nonetheless, you_ve got an
6 individual that feels threatened that their livelihood
7 is at risk.
8 MR. CROSS: Now, also, out of that 26,000
9 figure that you processed last year, are those claims
10 that are still in that group? Are there claims for
11 Gulf War Syndrome requesting retirement based on that?
12 MR. SCHREIER: I_ll say yes, but I_m going
13 to quibble on terminology. An individual doesn_t
14 request retirement through the Disability Evaluation
15 System. An individual comes to the medical community
16 through their local medical treatment facility and
17 reports a condition, or a supervisor or commander asks
18 them to go because of some problem that they detect.
19 And if the medical community then
20 documents that they have a medical condition, it_s
21 three doctors who recommend that he be evaluated for
22 continued service through the Physical Evaluation
255 1 Board. The individual, of course, can present them
2 with information that would help them along the way,
3 but the individual does not request medical
4 retirement. That_s solely based upon the medical
5 condition that they have and an assessment on their
6 ability to perform military duties.
7 DR. LANDRIGAN: Question for Mr. Ross.
8 Mr. Ross, to what extent does the VA consider
9 compensable psychological diagnoses, post-traumatic
10 stress disorder and the like?
11 MR. ROSS: If we_re talking about a
12 diagnosis, a diagnosable condition such as post-
13 traumatic stress, that can be evaluated anywhere from
14 zero percent to 100 percent based upon the degree of
15 impairment in the individual case, but that_s a
16 diagnosable condition. You could have an undiagnosed
17 illness just as well, which could fall into that
18 category, but there would not be an associate
20 DR. LANDRIGAN: Are you implying that in
21 the latter case it would not be compensable?
22 MR. ROSS: No, we are being compensable in
256 1 the latter case. Yes, sir.
2 DR. LASHOF: Okay. Thank you very much.
3 Appreciate it. We_re running a half hour behind time.
4 I suggest we skip the break but takes five minutes to
5 stand up and stretch and just take a five minute break
6 in that place.
7 (Whereupon a recess was taken.)
8 DR. LASHOF: Can I get our Committee to
10 Okay. I think we_re almost all here. I
11 think we_ll resume and the first item now is an update
12 or a review of our meeting on reproductive health,
13 which was held in Seattle on June 17th and 18th. All
14 of you have a fairly detailed summary of our meeting.
15 It was really an excellent one, and I must say it was
16 a really crash course in biology, enteretology and all
17 aspects of reproduction and development embryology.
18 The briefing material was extremely thorough, and we
19 had a very extensive panel of experts in the various
20 areas. And we looked at biologic plausibility, we
21 looked at reproductive toxicology, we looked at the
22 epidemiology and the research on infertility and
257 1 subfertility and fetal loss and birth defects. We
2 looked at the federal research on evaluating the rates
3 of congenital anomalies and what data we are trying to
4 get. We assessed reproductive health in special
5 populations. We dealt with the problems of diagnosing
6 and defining syndromes and determining their
7 prevalence. And we dealt with the genetics referral,
8 both the VA and DOD.
9 I don_t want to go through the findings on
10 all of them. They_re detailed in your book and we_ll
11 be discussing them again tomorrow when we do the
12 review of risk factors. But I just want to make a few
13 points and then sort of open it for questions and let
14 you all ask questions about anything that you read in
15 here that isn_t clear or that you want further
16 additional information on or want us to look at.
17 One key issue clearly is the biological
18 plausibility of birth defects due to abnormal sperm
19 because of exposure of the veteran or soldier in the
20 Gulf after his return. I mean, going through the
21 biology of spermatogenesis, it appears that unless
22 conception occurred within 60 to 90 days upon return
258 1 it would be highly unlikely for there to be any birth
2 defect in the offspring due to exposure to the male
3 while he was abroad, as sperm turn over within 60 to
4 90 days. That, I think, is an extremely important
6 We also looked at the toxicology and we
7 looked at what studies have been done on the various
8 toxic substances they were exposed to and what is
9 known about any of those causing birth defects, and so
10 far there_s no evidence that any of the chemicals have
11 been known to do so.
12 I don_t want to detail all the others.
13 But those I thought were two critical issues. We did
14 review the various epidemiologic studies that are
15 still going on. And, as you heard earlier today,
16 there_s a new study that_s being funded to also look
17 at the incidence of birth defects.
18 One important point in the diagnosis in
19 defining syndromes that I thought was extremely
20 important that we did hear testimony about. How the
21 variation in diagnosis and how when the birth defects
22 or syndromes are reported as occurring in a certain
259 1 number, when one goes ahead and goes back and has the
2 children examined by experts in the field, one finds
3 a lot of misdiagnoses so that it_s often difficult to
4 accept statements that have not followed up with a
5 detailed diagnosis by a pediatric specialist in
6 congenital defects.
7 I think those are the major points that I
8 wanted to raise. And let me just open it up for you
9 to ask questions of myself or Kathy, or Marguerite.
10 Do you want to add anything to my very brief summary?
11 You were at the meeting.
12 MS. KNOX: No. I think it_s important,
13 like you said, that there is a study that came out
14 today from DOD that_s going to fund research
15 concerning that, and I think that it_s notable. Also
16 money is going to be funded from the Shea Bill, is
17 that correct, on, is that right, Robyn?
18 MS. NISHIMI: The Byrd Amendment. That
19 would depend, obviously, if that language is retained
20 through the legislative process. It_s encouraging,
22 MS. LARSON: I_ve got a question. The two
260 1 studies that are reported about Golden Harr Syndrome.
2 One of them the conclusion is, or it looks like it
3 might be that there isn_t enough of the sample size to
4 tell, even with 75,000 infants, or, you know, infants
5 being studied. And the second one is in the process
6 somewhere. Is that an answerable question given these
7 two studies? I can_t tell from reading and I wasn_t
8 there so, it_s on page four.
9 DR. LASHOF: Kathy, do you want to tackle
10 that one?
11 MS. HANNA: Thanks. The study that_s
12 being done by the CDC, in cooperation with the Naval
13 Health Research Center, is taking, let me just explain
14 briefly what the study is. They reviewed 75,000
15 records that came from the Defense Manpower Data
16 Center of reported births and used IDC codes to try
17 and classify very inclusively any case that might be
18 Golden Harr. And Golden Harr is a very broad spectrum
19 syndrome, and so any clinical aspect that fell within
20 the Golden Harr category was included. So they were
21 very inclusive. They then sent those cases, they
22 collected detailed medical records on those cases, and
261 1 sent them to the CDC, blinded, for clinical
2 dysmorphalogists and geneticists at CDC to review the
3 records and validate the diagnosis as to whether it
4 was Golden Harr or not.
5 They did that without any knowledge of
6 whether these children were born to Gulf War veterans
7 or not. And their study design would require many
8 more cases. I think they reviewed 360 cases
9 altogether that were not Golden Harr but had been
10 originally diagnosed as Golden Harr, but after they
11 reviewed the records, they excluded many of those
13 They would have to get many more records
14 before they would feel comfortable that they had a
15 powerful enough statistical sample to rule out any
16 differences, but within their confidence intervals
17 right now, they are ruling out that there_s any
18 increased incidence in Golden Harr.
19 MS. LARSON: What_s the incidence about in
20 the general population?
21 MS. HANNA: That_s a good question, too.
22 It_s very difficult syndrome to diagnosis, and so
1 depending on when the diagnosis was made, when the
2 study was done, and what the population was, the
3 literature reports Golden Harr as being anywhere from
4 one in 2,500 births to one in 25,000 births. And that
5 big difference is due to the difficulty in diagnosing
6 it and the fact that it is quite often misdiagnosed.
7 The more, I think, conservative estimates
8 are that it_s probably in the range of one in 15,000
9 to 20,000 validated Golden Harrs.
10 MS. LARSON: Well, out of the 75,000 you_d
11 only get 30 cases at the most, and then you split
12 those into two groups, and you_ve got the little
14 MS. HANNA: Right. That_s the big problem
15 with that study.
16 MS. LARSON: And what_s the status of the
17 Dr. Aaronetta study? Where is she on that? That_s
18 the first one from San Diego?
19 DR. LASHOF: Yeah. Yeah.
20 MS. HANNA: Yes. They_re still collecting
21 cases. You mean, on the Golden Harr study?
22 MS. LARSON: Yeah, on birth defects, yeah.
1 They_re in the middle of this epidemiological study
2 which sounds very useful to answer the --
3 MS. HANNA: Right. I would expect that
4 they would have preliminary data by September that
5 they_ll be able to report to the Committee.
6 The other study that you were referring
7 to, the Golden Harr study, has been done. It_s
8 records that have been collected by the Association of
9 Birth Defect Children and they -- it_s a self-reported
10 questionnaire. The questionnaire is sent out to their
11 mailing list, which is basically families of children
12 with birth defects. And these individuals fill out
13 the questionnaire and send it back and then it is
14 coded as to whether it_s Golden Harr or not.
15 The problem there is the denominator.
16 Although they do have reported cases of Golden Harr,
17 it_s not clear what their entire population is, in
18 terms of their denominator. And they_re also going
19 to, they_re also continuing to collect data and they
20 have said that they will report that to us as
22 DR. LASHOF: I think the other problem
264 1 with that report was that, you know, these are self-
2 reported cases on Golden Harr and given the difficulty
3 on the diagnosis, I mean, obviously not self-reported
4 by the child but the parents have given that diagnosis
5 and submitted it.
6 MS. HANNA: There_s 3,000 birth defects.
7 Thirteen were Golden Harr.
8 DR. LASHOF: All right. And that sounds
9 so high and doesn_t fit.
10 MS. HANNA: The denominator is birth
11 defects, so it_s actually very low. In that 3,000
12 cases of birth defects, 13 of those were Golden Harr.
13 DR. LASHOF: Yeah. And 270 involved Gulf
14 War. Of the 3,000 cases, only 270 involved Gulf War
15 veterans, and of those 270, they_re saying it_s Golden
16 Harr, 13 had Golden Harr.
17 MS. HANNA: They_re saying 13 of the 270.
18 MS. LARSON: Okay.
19 MS. HANNA: The problem is --
20 DR. LASHOF: That_s just out of line.
21 MS. HANNA: Right. The problem is that
22 they actively solicited surveys from Gulf War families
265 1 that believed that they had a child that had been born
2 with Golden Harr. So, there are problems with this
3 sample, but we_re trying to follow up with them and
4 get additional data.
5 The other thing I_d like to add about the
6 Golden Harr and tie it into the biological
7 plausibility is that I think we heard fairly
8 convincing testimony in Seattle that if an agent were
9 a mutagen, it_s very unlikely that it would be site
10 specific, meaning that it would be very unlikely that
11 it would produce one type of anomaly. It_s more
12 likely that it would result in pre-implantation loss.
13 It_s more likely it would result in an infertility or
14 transient infertility or subfertility. So, the
15 biological argument having to do with whether an
16 exposure could create that specific of a mutation that
17 would create one specific syndrome is very hard to
19 MS. LARSON: Well, what_s the potential
20 for causing some permanent change, genetic change
21 somehow, in the sperm or whatever. I mean, I can see
22 the turnover of the sperm is every 60 to 90 days,
266 1 right?
2 DR. LASHOF: Right.
3 MS. LARSON: But is there such a case as
4 something that totally changes the sperm from then on?
5 DR. LASHOF: Not according to any of the
6 biologists who reported to us in Seattle. That would
7 have to be the sperm cell that was damaged and they
8 had not, Ray said that that had not occurred, and they
9 had no evidence that it could occur.
10 MS. LARSON: Ever you mean? So that means
11 that the cases that occurred a year after, well, you
12 know, a year and a half after --
13 DR. LASHOF: Any time, even 90 days after
14 they return from the Gulf would be --
15 MS. LARSON: For males.
16 DR. LASHOF: For males. I mean, female
17 was exposed while she was over there. Because the ova
18 are there for a long time, and the risk could be
19 affected, but not the male.
20 Okay. Any other questions on that? No?
21 Let_s move on to the next item on our agenda, which is
22 the Gulf Family Support Program. Patricia Campbell
267 1 from the Medical Center at North Little Rock? Go
2 ahead and proceed. Sorry. Little distracted up here.
3 MS. CAMPBELL: I_m very honored to be able
4 to share this information with you about our Persian
5 Gulf Program. Arkansas, as many other states, had a
6 large number of National Guard and reserve personnel
7 activated during the Persian Gulf War. In
8 anticipation of the social impact of the military
9 operations, the Department of Veterans Affairs Medical
10 Center and Social Affairs in Little Rock applied for
11 and received a grant of $95,000 for a pilot project to
12 provide mental health services to veterans of
13 Operation Desert Shield, Desert Storm and their
14 families in the spring of 1991.
15 The overall goal of the program, which was
16 operational from June through September 1991, was to
17 assist veterans and their families coping with the
18 stress and consequences of war. This goal was
19 accomplished using a multitude of services, most
20 important of which was outreach, counseling and
21 referral services and advocacy.
22 The outcomes of this pilot project set the
268 1 stage for the development and implementation of the
2 Persian Gulf War Family Support Program which funded
3 32 sites in 26 states selected for the Persian Gulf
4 War Family Support Program established by Public Law
5 102-405 October 9 of 1992. This law authorized the
6 Secretary of Veterans Affairs to provide marriage and
7 family counseling to veterans awarded a campaign medal
8 for active duty service during the Persian Gulf War,
9 veterans who were members of reserve components called
10 or ordered to active duty during the war, and their
11 spouses and children.
12 Additionally, all other medical centers
13 were mandated to provide counseling services within
14 their existing social work mission without funding.
15 Ten million dollars was appropriated for fiscal years
16 1993 and 1994 to carry out this program. With the
17 submission of a bound report no later than July 1,
19 Experience has shown us that 10 to 20
20 percent of the Persian Gulf veterans have had
21 difficulties upon return to their families, but only
22 one to two percent sought treatment. Therefore, the
269 1 program considered outreach and access to services to
2 be a critical issue in its implementation.
3 Program planning began in February of 1992
4 based on the legislative proposal and services were
5 initiated in September 1992. Training was provided to
6 78 staff members to ensure the staff had a clear
7 understanding of the services to be provided and our
8 reporting system.
9 The training centered on developing
10 effective working relationships with community
11 agencies, creating outreach goals and strategies,
12 developing assessment and treatment goals, using
13 therapies based on the need of the clients and
14 providing marriage and family counseling services to
15 veterans and their families.
16 Staff were instructed to use a strict
17 perspective in providing services and to develop an
18 aggressive outreach program. They were offered
19 several outreach and implementation strategies which
20 had been found to be successful with other programs.
21 Coordinators and other staff members were encouraged
22 to adapt the strategies to fit the constraints and
270 1 opportunities of their particular service settings.
2 A critical component of this program was
3 that family members could be provided services whether
4 or not the veteran requested them. Outreach efforts
5 were concentrated on two target populations. Family
6 support groups and community networks were contacted
7 to ensure that all eligible persons were aware of the
8 availability of these services.
9 Briefings were presented to National Guard
10 and reserve units which had personnel activated during
11 the war. During unit briefings, staff described the
12 program, the type of problems that some veterans and
13 their families were facing, and they encouraged
14 persons to contact Persian Gulf staff if they had
16 Outreach efforts at briefings included the
17 collection of information from veterans in attendance
18 to expedite their enrollment in the program. Our
19 staff worked irregular tours of duty in order to be
20 accessible to the veterans and family members taking
21 advantage of the program services and to attend the
22 monthly drills of each unit.
271 1 The coordinators conducted psychosocial
2 assessments and utilized the multi-problem screening
3 inventory to ascertain the level of functioning of the
4 client. A strict perspective was utilized in
5 providing counseling, reviewing and building on the
6 strength of the family.
7 Interim and final MPSI_s were also given
8 to measure progress. With the emergence and increase
9 in the number and the types of physical symptoms being
10 reported, staff began to refer veterans to the
11 evaluation or triage clinics at their medical centers.
12 Family members were referred to their local physician
13 for physical symptoms they encountered.
14 The establishment of the Persian Gulf
15 Registry in 1992 provided more specialized and focused
16 evaluation and treatment. The development of the
17 Centers of Excellence also provided another
18 opportunity for veterans to be evaluated and to
19 receive even more and enhanced medical treatment.
20 Dr. Robert Roswell, who_s the Chief of
21 Staff at Birmingham Alabama VA, also provided his
22 medical expertise to some of the funded sites as well
272 1 as other medical centers. He assisted in the
2 diagnosis and treatment of veterans and assisted with
3 referrals to local physicians.
4 The funding of the program was not
5 continued beyond September 30, 1994. However, some
6 medical centers have retained the counseling component
7 of the program and incorporated it with other duties
8 of the coordinators. For example, East Orange, New
9 Jersey; Washington, D.C.; Hines VA, here in Chicago;
10 Birmingham, Alabama; Little Rock and Decatur. We
11 would normally say it_s Atlanta, Georgia.
12 The medical center in Columbia, South
13 Carolina, has also maintained some of the outreach
14 activities, for which the coordinator continues to
15 return to the National Guard and reserve units
16 occasionally to conduct presentations and workshops.
17 While in reviewing our final report there
18 appears to be a decline in the number of requests for
19 services from Persian Gulf veterans, we must remember
20 that number one, family members are no longer eligible
21 for services. Two, veterans must meet all eligibility
22 criteria for service. Three, veterans were told that
1 the program no longer exists. Therefore, they do not
2 ask for services that have been terminated.
3 The program was considered a success and
4 could easily be replicated in other areas. It is the
5 first time that the Department of Veterans Affairs was
6 proactive on a national level in identifying persons
7 eligible for and making services available to them.
8 Secondly, counseling services were
9 provided to family members, whether or not the veteran
10 chose to request services. And thirdly, there was a
11 notable improvement in the family_s level of
12 functioning, which may be attributable to the
13 existence of the family_s strict approach to
14 counseling. And I thank you.
15 DR. LASHOF: Thank you very much. We
16 appreciate the very brief summary of a fairly
17 extensive project. Are there questions that the panel
18 would like to address to Ms. Campbell? Tom?
19 MR. MCDANIELS: Thanks again for coming.
20 Could you tell us that when you were conducting
21 outreach in your region, did you feel you had
22 saturated all the veterans as far as getting
1 information out to them? Did you feel that you had
2 saturated the region?
3 MS. CAMPBELL: For our area in Arkansas,
4 because we initially had the pilot project, we were
5 able to reach more of the veterans that were
6 activated. However, when the nationally funded
7 program was implemented, we were only able to fund
8 sites that had veterans in a close proximity of about
9 50 miles or so with 4,000 or more veterans being
10 activated. So they did limit the national program.
11 MR. MCDANIELS: Do you feel that most of
12 the veterans in your region knew about the Persian
13 Gulf Health Registry Program?
14 MS. CAMPBELL: One of the things that our
15 program tried to do was make sure that we worked very
16 closely with Medical Administration Service, with the
17 Department of, let_s see, Veterans Benefits
18 Administration, I_m sorry, I_m getting my acronyms
19 mixed. And with all community agencies to make sure
20 that we were able to share as much information as we
21 possibly could.
22 Sometimes what we would do is we would
275 1 send out information about the Persian Gulf War Family
2 Support Program, but then when we had an opportunity
3 to present or to speak to a group, we would then make
4 them aware of the other services that were available.
5 The other thing that our staff also did
6 was that, the titles were program coordinators, but
7 what they honestly did was provide case management
8 services. Because a lot of times someone would come
9 in saying that they do have a psychosocial problem,
10 but then they would start mentioning their medical
11 problem as well.
12 Our goal as social workers is to make sure
13 that we take care of the whole person. Therefore, we
14 would tell them about what services were available.
15 And we would also help walk them through the system
16 and help make sure they got the paperwork completed
17 correctly, that they knew when their appointments
18 were, and that we did everything that we could to help
19 them know that those services were available.
20 DR. LASHOF: The program ended in _94 and
21 it basically ran for two years; is that correct?
22 MS. CAMPBELL: Yes, it did.
276 1 DR. LASHOF: Did you feel that that was an
2 adequate length of time for a program like this? Or
3 did you feel that there was a lot of need that you
4 hadn_t been able to meet at that point?
5 MS. CAMPBELL: I believe that there were
6 a lot of needs that we were not able to completely get
7 addressed. But it was based on funding for the
8 program. I have concerns about programs that are
9 implemented and then they stop and then they_re
10 reimplemented and stopped. And that_s just because
11 when you_re providing services or counseling to a
12 person, you don_t want to, we call it open them up or
13 get them talking, and then not be able to complete
14 that process. And in some cases that_s what happened.
15 And that_s why -- the sites that I said that had
16 continued their counseling component are still in
18 MS. NISHIMI: Were there any other needs,
19 you said --
20 MS. CAMPBELL: I think, and I would like
21 to see programs of this type work closer with the
22 Persian Gulf Registry, or let them be integrally
277 1 connected to make sure that as veterans are going
2 through the system that they have someone they can
3 contact when they don_t really understand the process
4 or they don_t know what the process is. Because
5 sometimes when you have a lot of people coming in, we
6 may fail to tell them everything that has to be done.
7 And may not really explain to them the time limits
8 that it would take or what they can look for in
10 MR. MCDANIELS: But there still are
11 Persian Gulf coordinators at each VA Medical Center
12 who are supposed to do that?
13 MS. CAMPBELL: No, not --
14 MR. MCDANIELS: Not the social workers but
15 as far as attached to the environmental health side of
16 the house?
17 MS. CAMPBELL: Most facilities are trying
18 to do that. We do, in cases where they do not have a
19 person assigned to the Registry, then they just
20 contact the Social Work Office and they send someone
21 down. But there_s not someone assigned in all cases.
22 DR. LASHOF: Well, I guess one of the
278 1 issues is, if it_s a transition service, and it_s
2 designed to help, as it says, the transition from the
3 military into the civilian, how long should one try to
4 plan for that, if it_s a transition service you don_t
5 expect that type of service to get into long term
6 therapy for those who need continual counseling or
7 psychological help over a long period. What would be
8 an adequate time for transition?
9 MS. CAMPBELL: One thing in my remarks I
10 did not explain to you that in March of _93, it became
11 questionable whether or not the program was going to
12 be continued past September of _93, and that had an
13 impact on the program as far as some staff members
14 were temporary staff and they found other jobs, they
15 were replaced, veterans were starting to be told that
16 the possibility of this program not existing past that
17 time also, I think, had a negative impact on it. So,
18 some veterans were starting to be referred to other
19 agencies, or to other groups to try to make sure that
20 was done.
21 And I, you know, two years I think would
22 be enough if we knew for sure that this is the time
279 1 limit, and we could say in the very beginning, this is
2 how long we will be here for. Not that we_re here and
3 we_re not going to be here, or I_m not sure if we_re
4 going to be here. But if we can say for sure that for
5 this period of time you can count on us to be here.
6 We will provide these services for you.
7 DR. LASHOF: Do you think, from your
8 experience, that that is an adequate enough length of
9 time for transition services, or would you think it
10 needs to be longer?
11 MS. CAMPBELL: I think for the majority of
12 veterans and their families, it probably will be,
13 because, in our report we determined that I think 62
14 percent of the veterans and 70 percent of their family
15 members were age 35 and under, and, you know, I think
16 it_s because they_re so integrated in their
17 communities at that age, they have an ability to
18 rebound from, you know, whatever is happening.
19 There are others that may need continued
20 treatment, but in that case I think I would be looking
21 at long term, you know, psychiatric care or counseling
22 services, and they would fall into a different
280 1 category for me.
2 DR. LASHOF: That_s the distinction I was
3 trying to make. Thank you. Marguerite?
4 MS. KNOX: For future counseling, do you
5 not think that that transition or counseling should
6 have been started earlier than when it did for the
7 Gulf War?
8 MS. CAMPBELL: I think it would have been
9 very good for the veterans and their families as well,
10 because, by the time our program started in September,
11 veterans were coming home, they were already having
12 problems, there was an increase in the divorce rate in
13 Arkansas that was very noticeable. But I think this
14 is a program that would be easily replicated so if
15 there was another conflict such as this or another
16 war, then we could implement it a lot earlier and
17 prepare the families for the veterans_ return.
18 MS. KNOX: So maybe in our recommendations
19 that would be something that we would need to address,
20 that it would be for this type of program to be
21 implemented at an earlier stage than what it was for
22 this conflict?
281 1 MS. CAMPBELL: I believe that would be
2 very good. It would also give the family members a
3 chance to begin their adjustment process to having
4 this person come back in their home all of a sudden.
5 DR. LASHOF: David?
6 MR. HAMBURG: If I understood you
7 correctly, you said that some of the counseling
8 services imbedded in the Family Support Program were
9 continued in some places after the program itself
10 ended. Could you say a word about the conditions that
11 would foster such counseling services, and more
12 generally, whether family oriented counseling services
13 at the present time are reasonably available to
15 MS. CAMPBELL: I think what affected that
16 continuation basically was the support of the
17 management of the Medical Center, that they believed
18 in the program, that a need was demonstrated, and I
19 would have to be honest to say also, we had varying
20 results from different funded sites based on the
21 commitment of that medical center.
22 DR. LASHOF: Elaine?
282 1 MS. LARSON: You said that the program was
2 considered a success. What measures of success were
3 used to evaluate the program?
4 MS. CAMPBELL: The multipurpose screening
5 inventory, multiproblem screening inventory, I_m
6 sorry, was developed by Dr. Walter Houston out in
7 Tucson, Arizona. And that looks at the functioning
8 level of a person and their psychosocial adjustment.
9 It specifically addresses certain problem areas such
10 as anger, problems with your partner, problems with
11 your family, unemployment, drug abuse, alcohol abuse.
12 And when the client first begins counseling, he would
13 be given, he or she would be given that MPSI. Then in
14 the middle of treatment we would give it again and
15 measure the levels of discomfort, so to speak, I
16 guess, and there was an improvement, a continued
17 improvement in them.
18 MS. LARSON: And that wasn_t given to any
19 vets who did not have the service?
20 MS. CAMPBELL: No. That was not.
21 MS. LARSON: Okay. Do you have any idea
22 how many family members used the services without
283 1 involvement of the veteran?
2 MS. CAMPBELL: I think I can find that
3 right here.
4 MS. LARSON: I_m just wondering if
5 sometimes problems were identified via a family member
6 and got the veteran into the system somehow.
7 MS. CAMPBELL: What I would think about,
8 to put it, because I don_t see it here immediately.
9 I think about approximately 20 percent of the family
10 members came in on their own initially, and we tried
11 to include the veteran if he was willing to come in.
12 If not, the counseling would continue with just the
13 spouse or the children.
14 DR. LASHOF: Thank you very much.
15 Appreciate it.
16 Okay. That will wrap up the day. No, not
17 yet. Tom is going to talk about outreach and give us
18 our staff briefing on outreach, where we stand, what
19 we know and what we_ve yet to learn.
20 MR. MCDANIELS: Today I_m presenting
21 information about outreach efforts associated with
22 special government sponsored readjustment programs.
1 Specific populations of Gulf War veterans and military
2 broadcasts. This briefing will focus on these outreach
3 elements, and after summarizing each I will present
4 staff findings and suggestions for possible Committee
6 Immediately following the Gulf War, VA_s
7 Vet Centers and Persian Gulf Family Support Program
8 provided services to assist Gulf War veterans and
9 their families in the post-conflict readjustment
10 process. Staff with these programs performed a
11 significant amount of outreach about the readjustment
12 services available to the veteran population. As
13 illness began to be reported and clinical procedures
14 were established to evaluate Gulf War veterans, the
15 outreach aspects of Vet Centers and the Family Support
16 Program continued to educate the public.
17 For the Vet Center and Family Support
18 Program, I will present suggestions for possible
19 Committee findings and recommendations after
20 summarizing both of them. Next slide please.
21 Vet Centers provide readjustment and
22 psychosocial services to all veterans of conflicts.
1 There are 196 centers, each staffed by a team leader,
2 two or three counselors and an office manager. Vet
3 Centers are located away from the local VA medical
4 center, although it administrative supports the Vet
5 Center with supplies, personnel, fiscal processing and
6 other logistical services.
7 The Vet Center provides the medical center
8 a consultation referral information and expertise in
9 the area of providing psychosocial services to post-
10 conflict veterans. Next slide please.
11 Since they were established in 1979, Vet
12 Centers have developed a working relationship with the
13 veterans community, veterans service organizations,
14 local VA medical personnel, local military bases and
15 guard and reserve units. Through this community
16 network, Vet Centers are able to provide outreach and
17 did so immediately following the Gulf War. Next slide
19 More than 69,000 Gulf War clients have
20 visited Vet Centers since May 1991. Gulf War veterans
21 comprise the largest percentage of the post-Vietnam
22 era group of clients during this period. Now, I_d
286 1 like to briefly touch on the Family Support Program,
2 some outreach aspects. This is the same program that
3 Ms. Campbell just spoke about.
4 Public Law 102-405, oh, next slide please.
5 Public Law 102-405 directed that VA provide
6 readjustment assistance to Gulf War veterans, and VA
7 established the Family Support Program on October 1,
8 1992. Again, there was $10 million appropriated for
9 each of the fiscal years, _93 and _94, and it was
10 designated at 36 sites around the country. Next slide
12 Initially, the program provided services
13 to assist veterans with readjustment difficulties.
14 But in response to concerns about emerging illnesses
15 among Gulf War veterans, coordinators conducted
16 regional Gulf War illness related outreach and
17 enrolled clients into VA_s Persian Gulf Health
18 Registry, which began evaluating patients in November
19 of 1992.
20 Community outreach was a major component
21 of the Family Support Program. Coordinators prepared
22 briefings which included registering veterans into the
287 1 Family Support Program, referral into the VA Health
2 Registry, informing veterans and VA medical staff of
3 policies relating to Gulf War veterans, providing case
4 management and providing general information on Gulf
5 War environmental hazards and exposures. Coordinators
6 also developed networks with the veterans community.
7 Coordinators at the 36 sites closely monitored the
8 services provided for the program_s initial two-year
10 Some stats here. More than 2,800 outreach
11 briefings were conducted for approximately 70,000
12 persons and approximately 22,000 Family Support
13 Program outpatient visits were made by the veterans
14 and family members nationwide. Funding for the
15 program ended October 1, 1994. Some VA medical
16 centers continue to fund aspects of it, incorporating
17 them into the facility_s general budget.
18 Staff have made the following findings.
19 The first finding. In their geographic areas, Vet
20 Center staffs have established working relationships
21 with the veterans community, veteran service
22 organizations, local, municipal and state veterans
288 1 liaison offices, in-region guard and reserve units,
2 community social services organizations, local VA
3 medical center personnel, and military establishments.
4 These relationships enable Vet Centers to
5 provide education and outreach to local communities
6 about issues in clinical programs concerning Gulf War
7 veterans, and it appears that a significant amount of
8 Gulf War veterans used their services.
9 The second finding. The outreach
10 initiative of VA_s Persian Gulf Family Support Program
11 was an effective method of communicating information
12 about Gulf War veterans_ illnesses. In particular,
13 they established government clinical programs to
14 veterans, reservists, National Guard and local
15 communities. The outreach components used trained,
16 knowledgeable personnel in the field to establish a
17 communications network with the community and deliver
18 specific information directly to the target
20 And based on those two findings, staff
21 suggests that the Committee recommend, given the
22 effectiveness of Vet Centers and the Persian Gulf
289 1 Family Support Program, DOD and VA should consider
2 these examples of field-based outreach when developing
3 education and awareness campaigns for active duty
4 service members, reserve and guard personnel and
5 veterans. Broader, less specific, outreach methods,
6 such as hotlines and public service announcements,
7 should be viewed as an important supplement but not
9 Do you want to discuss the finding?
10 DR. LASHOF: Are there questions? Art?
11 MR. CAPLAN: One issue that came up in the
12 earlier discussion comes up here, too. You might want
13 to also, since this is still relatively new, call for
14 some systematic evaluation so that the Vet Centers, we
15 heard that some did well, some didn_t, according to
16 some measures, but it would be useful probably to
17 evaluate them and make sure that whatever was working
18 well was picked up correctly and that client
19 satisfaction was taken into account and feedback
20 there. So, I wouldn_t just go with what was tried,
21 even though I don_t have any reason to doubt that it
22 was good, but we need to make sure that we_re on top
290 1 of it as an outreach experiment.
2 MR. MCDANIELS: I also want to point out
3 that with these readjustment programs, the outreach
4 component is significant, but it is only one part of
5 it. And I_m trying to extract just the outreach
6 component of the whole readjustment program as well.
7 Okay. Now, I_ll discuss the Transition
8 Assistance Program. The National Defense
9 Authorization Act of 1991 authorized DOD, VA and the
10 Department of Labor to provide comprehensive
11 transition assistance for service members separating
12 from active duty. The Department has developed a
13 memorandum of understanding that established the
14 three-day Transition Assistance Program workshop and
15 assigned each department responsibilities for its
17 Department of Labor coordinates the
18 execution. Department of Defense arranges the
19 participation of service members and provides
20 logistical support. And VA presents veterans benefits
21 information. TAP Workshops continue to be held
22 periodically at major U.S. military institutions in
291 1 the United States and overseas, and service members
2 are directed to attend within a 180 day period before
4 TAP_s main objective is to prevent and
5 reduce long-term unemployment problems among veterans
6 by educating them about goal setting, decision making,
7 labor market information and job search techniques.
8 However, informing veterans about VA benefits is also
9 a high priority set forth in the memorandum of
10 understanding between the three departments. Staff
11 have made the following finding about the VA briefing
12 section of the Transition Assistance Program.
13 The finding is, 90 percent of separating
14 active duty service members attend Transition
15 Assistance Program Workshop briefings conducted
16 jointly by the Departments of Defense, Labor and
17 Veterans Affairs. VA benefits briefings during the
18 TAP Workshop could be an effective method of outreach
19 about DOD and VA programs for evaluating Gulf War
20 veterans_ illnesses. Yet, there is no evidence their
21 clinical programs ever receive mention.
22 Staff suggests the Committee recommend VA
292 1 should direct its TAP Workshop benefits counselors to
2 specifically mention DOD and VA programs related to
3 Gulf War veterans_ illnesses.
4 DR. LASHOF: Any questions for Tom? I
5 guess not. You_re selling us.
6 MR. MCDANIELS: Okay. Now, I_ll discuss
7 outreach to women veterans. More than 40,000 women
8 served in the Kuwaiti theater of operation. Cognizant
9 of the increased role of women in the Armed Forces and
10 specific medical needs they could have, Congress
11 authorized new and expanded services for women
12 veterans in VA medical centers and Vet Centers in the
13 Women_s Veterans Health Program Act of 1992. Every VA
14 medical center has a women veterans coordinator who,
15 in addition to coordinating clinical services, also is
16 responsible for outreach to the female veterans
18 Vet Centers provide outreach about
19 specific VA programs for women and building referral
20 networks for non-VA medical and social services.
21 Staff have made the following finding about outreach
22 to women veterans.
293 1 The finding is, through the initiatives of
2 the Women Veterans Health Programs, VA has implemented
3 a range of efforts to inform women veterans about
4 available health services. Based on this finding
5 staff suggests the Committee recommend VA should
6 ensure that its initiatives under the Women Veterans
7 Health Programs specifically provide information about
8 Gulf War related programs.
9 The brief history on this is that I_ve
10 seen different outreach components target for women
11 and they do attempt to bring women in, or the focus is
12 to bring women into the VA medical centers. It_s just
13 that I haven_t seen it specifically targeted for
14 bringing them in for the VA Persian Gulf Health
15 Registry. And the coordinators of this program, in
16 addition to the next finding, which will about Latino
17 veterans, they do a lot of outreach that_s not
18 literature, that_s based on making contact with the
19 community. So, I can_t say or suggest that they
20 haven_t been mentioning these programs, but in the
21 written literature it_s not obvious that they_re
22 trying to get the veterans in for Persian Gulf health
294 1 exams. So, the idea here is to instruct them to
2 specifically mention that.
3 DR. LASHOF: Any questions. Art?
4 MR. CAPLAN: I don_t know if this makes
5 sense to do it here or not, but one of the issues that
6 has been around for a while is the underrepresentation
7 of women in research, in addition to letting people
8 know about Gulf War Health Registry. There may be the
9 ability to let them know about research projects or
10 studies that they could be eligible for, too. That_s
11 part of that coordinating.
12 DR. LASHOF: Do you want to go on?
13 MR. MCDANIELS: Yes.
14 DR. LASHOF: Any other questions? The
15 advantage of being on at the end of the day.
16 MR. MCDANIELS: I suppose so. Now, I_ll
17 briefly discuss --
18 DR. LASHOF: We_ll think about it over
19 night and get you tomorrow.
20 MR. MCDANIELS: Now, I_ll briefly discuss
21 outreach to Latino veterans. New Mexico, Texas,
22 California and Illinois, as well as the metropolitan
1 areas of Boston, New York City, Chicago and Milwaukee
2 have large Latino veterans communities. Vet Centers
3 in these regions typically have a Spanish-speaking
4 staff member who, in addition to bridging potential
5 language difficulties, also can address cultural
6 barriers that could make Latino veterans and families
7 more comfortable in the Vet Center setting.
8 VA outreach unique to this population
9 includes establishing relations with Latino veterans
10 service organizations and Spanish language media for
11 publicizing VA programs and acting as a liaison with
12 other veterans service organizations and VA personnel
13 for assistance in filing disability compensation
15 The staff have made the following finding
16 about outreach to Latino veterans. The finding is, in
17 regions with significant Latino populations, Vet
18 Centers and VA medical centers attend to delivering
19 bilingual cross-cultural outreach in service centers.
20 And based on that finding, staff suggests the
21 Committee recommend VA should ensure that its outreach
22 to Latino population specifically provides information
1 about Gulf War related programs.
2 DR. TAYLOR: I have a question about that.
3 DR. LASHOF: Sure. Sure.
4 DR. TAYLOR: Is any of the written
5 material in Spanish?
6 MR. MCDANIELS: Yes.
7 DR. TAYLOR: Okay. So they do have it in
8 their own language.
9 MR. MCDANIELS: But again, it_s, the
10 written literature that I_ve seen does not
11 specifically target the clinical programs for Gulf War
12 veterans. It_s targeted for Spanish-speaking
13 veterans, getting them to, or alluring them to the
14 fact that the VA center is there and the types of
15 services they provide. But again, it_s not Gulf War
17 DR. LASHOF: Okay. Moving right along?
18 MR. MCDANIELS: Okay. I will now talk
19 about the outreach through the military media. The
20 American Forces Information Service and its
21 broadcasting arm, the Armed Forces Radio and
22 Television Service, which is AFRTS, comprise the bulk
297 1 of DOD_s internal information services. AFIS oversees
2 the European and Pacific editions of the Stars and
3 Stripes newspapers and the approximately 1,100
4 military funded newspapers in the U.S. and overseas.
5 AFRTS delivers radio and television
6 programming for service members overseas and aboard
7 ships. AFIS has produced several media products
8 pertaining to Gulf War veterans illnesses. Since
9 early 1992, Stars and Stripes has printed 118 stories
10 with headlines related to Gulf War veterans illnesses.
11 The coverage appears to be similar to the civilian
12 media sporadically covering topics as issues evolve.
13 Circulation for the papers is 75,000
14 worldwide, with readership estimates at 175,000.
15 Since early 1994, AFRTS has broadcast 19 television
16 and 43 radio spots on Gulf War related illnesses.
17 AFRTS estimates one million people are stationed
18 overseas and aboard ships. Although a few print
19 stories and broadcast spots communicate how to
20 register for either the DOD or VA clinical programs,
21 most are general news stories on research efforts and
22 exposures that possibly could have adverse health
298 1 effects.
2 AFIS also produces an internal information
3 plan, a collection of single-page briefs with topics
4 of interest to military personnel, such as voter
5 registration, drug and alcohol abuse, equal
6 opportunity and military benefits. The plan is
7 distributed to public affairs officers at all units
8 throughout the military, and they are encouraged to
9 disseminate this information to service members.
10 In 1996, a Persian Gulf illness brief
11 explaining DOD_s comprehensive Clinical Evaluation
12 Program was added to the plan, but DOD_s telephone
13 hotline is not listed. The staff have made the
14 following findings about DOD_s internal information
16 Finding, while newspaper articles and
17 television and radio broadcasts disseminated by DOD_s
18 American Forces Information Service provide adequate
19 media coverage of Gulf War illness related issues, few
20 of the media products performed the outreach functions
21 of publicizing government sponsored Gulf War veterans
22 clinical programs and methods of referral into them.
299 1 The next finding is, although produced
2 this year, DOD_s 1996 internal information plan of
3 Persian Gulf illnesses describes DOD_s CCEP, it fails
4 to provide the most basic information on how to
5 register for it.
6 And the two recommendations based on these
7 findings. Staff suggests the Committee recommend, as
8 with other outreach efforts and as noted in the
9 interim report, it is difficult to evaluate the
10 effectiveness of AFRTS and AFIS health communication
12 And the Committee_s recommendation for
13 refined performance measures also applies here.
14 Likewise, DOD and VA officials using media products
15 for outreach initiatives should be aware of the
16 difficulty in enumerating the actual readership and
17 viewership figures and concern how effectively the
18 message saturates the targeted population.
19 Staff suggests the Committee recommend DOD
20 should reissue its internal information plan on Gulf
21 War related illness and make a special effort to note
22 that the revision provide the toll free number and
300 1 that individuals are encouraged to register for the
2 Comprehensive Clinical Evaluation Program. It also
3 should take this opportunity to provide updated
5 DR. LASHOF: Tom, can you tell us more
6 about what they really cover in terms of information
7 about what the government_s doing, like the funding of
8 epidemiologic studies, the research studies that are
9 going on, things about general defects and just all of
10 the things that we_ve been looking into and hearing
11 and learning about as part of this. How much of that
12 information does get out to the veterans, not only am
13 I concerned about the military media for the active
14 duty, but how do you get information about this out to
15 the general veterans other than their reading
16 misleading information in our public media?
17 MR. MCDANIELS: Right. You_re talking
18 other than through the military media?
19 DR. LASHOF: Yeah.
20 MR. MCDANIELS: That is --
21 DR. LASHOF: I_m thinking about both, what
22 the military media does and what else other than the
301 1 military media?
2 MR. MCDANIELS: From what I_ve seen,
3 again, it_s very similar to the civilian press. Just,
4 I would say, the hottest topics, the hottest
5 headlines, they will, like this Committee, for
6 example, they_ll run a story on that.
7 But they have not specifically run stories
8 on health consequences and health effects and risk
9 factors, as much as just general --
10 DR. LASHOF: Stories around what efforts
11 the government_s doing, what research efforts are
12 under way?
13 MR. MCDANIELS: There has been some of
14 that. There has been, but nothing in these areas is
15 significant. It_s just a story here or a story there.
16 DR. LASHOF: Do you think we could look a
17 little further and think through some recommendations
18 about what might be done to get more objective data
19 and information out to the veterans about what_s going
21 MR. MCDANIELS: Yes. That is something we
22 -- that_s next on the list. It_s an ongoing thing.
302 1 But, yeah, this definitely, how to communicate better
2 to the veterans, both we_ll be looking at the
3 information itself and also the channels through which
4 it travels.
5 DR. LASHOF: Okay. Thanks. Other
6 questions? If not, I think we can recess for the day
7 and we will resume tomorrow morning at 8:30. We_re
8 going to try to start early and keep on time. I_ve
9 got a tough schedule tomorrow.
10 (Whereupon, the proceedings went off the
11 record at 5:11 p.m.)