Remarks by Dr. Bernard Rostker

At the American Legion National Convention

September 8, 1998

New Orleans, Louisiana

 


Distinguished guests and fellow Legionnaires, last March at our Washington Conference I spoke to you about a very important topic, the health of the men and women who protect us all by their service in our armed forces. My remarks centered around the question, "Could the unexplained illnesses affecting many of those who served in the Gulf War be the result of exposure to depleted uranium (DU)?" I told you then that the best answer I can give you is based on three things: testing conducted prior to fielding depleted uranium, testing after the war of the environment on the battlefield of Kuwait, and medical research and monitoring conducted after the Gulf War of those we know who have been injured. The best current information suggests that the actual exposure to depleted uranium during the Gulf War was not medically significant. Another more temperate version interpretation of that statement was suggested in a recent letter from the American Legionís Persian Gulf Task Force which says, "The American Legion is awaiting the completion of the ongoing research agenda before it will concur with definitive statements regarding the causes of Gulf War Illnesses. We (the American Legion) acknowledge, however, that the available scientific evidence weighs against DU as a likely risk factor for GWI." I certainly, concur in the position of the American Legion, both that research should go on, and what the available scientific evidence is telling us.

Today, I would like to clear up any misconceptions concerning what I meant when I said that exposure to DU was not "medically significant" and what medical science has been telling us. But before I do that, I would like to reiterate another conclusion I spoke about in Washington; namely that the use of DU during the Gulf War undoubtedly saved thousands of American lives.

As I noted in March, the only soldiers on the battlefield who should have been most concerned about DU during the Gulf War were the Iraqi soldiers, not because it might have a long term effect on their health, but because their tanks and armored personnel carriers provided them no protection from our DU munitions. DU rounds ripped through their tanks and their guns were totally, and I mean totally, ineffective in penetrating American armor protected with DU shielding-- there were no instances in which the DU armor of our tanks was breached. DU did have an effect on the battlefield. Just ask any American tanker if he wants to face the Republican Guard in battle without every advantage we can provide him, including DU shielding and DU SABOT rounds.

Over the past several months it has become clear that there remains confusion about several issues concerning DU exposure and dose. There are two points that I want to make clear that may help to address this confusion:

First, what is meant by "exposure" and "dose," and why are these concepts important?

On August 4th, my offices recently published our first Environmental Exposure Report on Depleted Uranium in the Gulf. This report is available by calling my office (800-497-6261) or over the Internet (http://www.gulflink.osd.mil). In the report we estimated the health risk from DU by using a health risk assessment methodology modeled on one developed by the National Academy of SciencesUS Environmental Protection Agency. It consists of four steps: Hazard Identification (Exposure), Toxicity Assessment, Dose Assessment, and Risk Characterization. Specifically, as applying this model to DU:

 

 

Clearly, just because a person may have been exposed to a substance does not mean that he or she received a dose that will prove to have health effects. A dose is measured as quantity, frequency, and length of exposure. Not all doses are medically significant. We need to know the dose and toxicity of the substance to determine if a specific exposure/ or dose presents a medical risk. By way of comparison, let me use asbestos as an example. Many of you know that we are completely remodeling the Pentagon. One of the first tasks is to identify the asbestos before removeing it, which is a known cancer causing substance. If, during a visit to the Pentagon you were briefly exposed to asbestos dust you would not immediately assume you were going to get cancer. It would all depend upon the quantity, frequency, and length of exposure--or the dose you received over time. Nevertheless, we insist on strict environmental isolation limits to asbestos exposures and dosage to the ALARA level or the level that is "as low as reasonably achievable." DU is much the same. Here is what we know about DU:

First, in terms of Hazard Identification, we group the exposure during and after the Gulf War into three levels based on the activities of the soldiers involved, and the resulting potential for direct contact with DU dust. These three exposure levels provided a prioritized approach to describing and evaluating the potential exposures that occurred:

 

Level I Ė Soldiers are those in or near combat vehicles at the time these vehicles were struck by DU penetrators, or who entered vehicles immediately after they were struck by DU munitions. These soldiers could have been struck by DU fragments, inhaled or ingested significant amounts of DU dust, or had DU particles land on open wounds, burns, or other breaks in their skin.

 

Level II - Soldiers and a small number of DoD civilian employees are those who worked in and around vehicles containing DU fragments and dust. These soldiers may have inhaled DU dust stirred up during their activities on or inside the vehicles, transferred DU dust from hand to mouth, thus ingesting it, or spread contamination on their clothing.

 

Level III - An "all others" group whose exposures were largely incidental and very brief. This group includes individuals who entered DU-contaminated Iraqi equipment, troops downwind from burning Iraqi or US equipment struck by DU rounds, or personnel downwind from burning DU ammunition.

 

Second, in terms of Dose Assessment the US Armyís Center for Health Promotion and Preventive Medicine (CHPPM) has reviewed existing test data on DU exposures to develop dose estimates for Level I exposures. Level I exposures are being addressed first, because these veterans are expected to have received the highest exposures.

 

To estimate the intake, the amount of DU taken into the body by inhalation, CHPPM developed a "worst case" estimate which is twice as large as any exceeds known exposures in the Gulf. The maximum radiation dose for Level I individuals for this In other words, this "worst case" as it turned out is estimated was 0.96 rem. For comparison, the average radiation dose to a member of the US population from background radiation is 0.3 rem per year. In other words, the "worst case" is the same as living in the United States for about three years, and importantly, is less than one-fifth the annual dose limit allowed by the EPA Nuclear Regulatory Commission for industrial workers., which is 5 rems per year. The chemical exposure for heavy metal toxicity based on the same dose scenario was about 9 milligrams of soluble DU. For individuals near the tanks who did not enter the crew compartment, intakes of soluble DU are calculated to be much less, in the microgram range (14 micrograms). Most medical experts agree that DUís heavy metal toxicity is the primary health concern, not DUís radiological hazard. This point has drawn considerable attention in the third and fourth phases of our methodology: Toxicity Assessment and Risk Characterization. And this leads us to the next topic.

 

The Toxicity Assessment and Risk Characterization work continues on two fronts. Several organizations have reviewed the limited existing medical literature on DU and the much more voluminous literature on natural uranium. In addition, the VA has been monitoring the health of 33 - Level I - soldiers that who were exposed to DU. Here is a sample of what these reviews have told us:

 

 

 

 

 

To assess the health of Gulf War veterans exposed to DU, we also have information from medical evaluations of those that we know have been most heavily exposed to DU. This is a unique source of informationbecause we would never purposefully imbed our soldiers with DU fragments, but because of unfortunate battlefield injuries, from friendly fire incidents, enabling us we are able to evaluate to evaluate these exposures directly. "Since 1993, the Department of Veterans Affairs has been monitoring 33 vets who were seriously injured in friendly fire incidents involving depleted uranium. These veterans are being monitored at the Baltimore VA Medical Center. Many of these veterans continue to have medical problems, especially problems relating to the physical injuries they received during friendly fire incidents. About half of this group still have depleted uranium metal fragments in their bodies. Those with higher than normal levels of uranium in their urine since monitoring began in 1993 have embedded DU fragments. These veterans are being followed very carefully and a number of different medical tests are being done to determine if the depleted uranium fragments are causing any health problems.

 

"The veterans being followed who were in friendly fire incidents but who do not have retained depleted uranium fragments, generally speaking, have not shown higher than normal levels of uranium in their urine.

 

"For the 33 veterans in the program, tests for kidney function have all been normal. In addition, the reproductive health of this group appears to be normal in that all babies fathered by these veterans between 1991 and 1997 had no observable birth defects."

 

This last July (1998) the DoD and VA instituted a medical follow-up program to evaluate the remaining veterans who received the largest DU exposures during the Gulf War --Level 1 and Level 2. The follow-up program is aimed at ensuring that Gulf War veterans with higher-than-normal levels of uranium in their bodies are identified and given appropriate monitoring and treatment. The follow-up will be executed in phases. It is likely that most soldiers will have normal levels of uranium in their bodies. The program requires a 24-hour urine collection for urine uranium level and a detailed DU exposure questionnaire in addition to the examination Gulf War veterans receive through the CCEP or the VAís Gulf War Registry. Should any health problems be detected, there will be an opportunity for a medical follow-up with a local primary care physician and/or specialists. The staff at the Baltimore VA is available to consult with primary care physicians about how to assess DU exposures clinically, how to interpret the results of tests for urinary uranium, how to educate veterans who have concerns about DU, and other relevant clinical questions.

 

Let me make this perfectly clear. While we are focusing on soldiers in Level 1 and 2, the implementing directive from the VA states, "if the veteran was not identified by DOoD as a possible DU exposure, but ... has a high level of concern after counseling by a DoD or VA registry provider, a DU protocol examination should be completed."

 

Of course, this program is built on the existing Baltimore VA program. Unfortunately, the results of the Baltimore program have sometimes been misrepresented, but here is the description that Dr. McDiarmid has approved for the DU "Fact Sheet" that accompanies the new follow-up program:

 

"Since 1993, the Department of Veterans Affairs has been monitoring 33 vets who were seriously injured in friendly fire incidents involving depleted uranium. These veterans are being monitored at the Baltimore VA Medical Center. Many of these veterans continue to have medical problems, especially problems relating to the physical injuries they received during friendly fire incidents. About half of this group still have depleted uranium metal fragments in their bodies. Those with higher than normal levels of uranium in their urine since monitoring began in 1993 have embedded DU fragments. These veterans are being followed very carefully and a number of different medical tests are being done to determine if the depleted uranium fragments are causing any health problems.

 

"The veterans being followed who were in friendly fire incidents but who do not have retained depleted uranium fragments, generally speaking, have not shown higher than normal levels of uranium in their urine.

 

"For the 33 veterans in the program, tests for kidney function have all been normal. In addition, the reproductive health of this group appears to be normal in that all babies fathered by these veterans between 1991 and 1997 had no observable birth defects."

 

DoD and VA plan to evaluate the DU testing results for the Level I and II soldiers and will then determine if further testing is warranted. Our office plans to release an updated Environmental Exposure Report on DU in the Gulf War in about one year.

 

Let me raise one final point The American Legion has been a leader in pressuring the DoD in DU training. As you know, The Deputy Secretary of Defense ordered a review of the current training and asked my office to monitor this training. After the first of the year, I will be sending field site evaluation teams to monitor DU training and report back to The Deputy Secretary of Defense on program execution. This is an area where we intend to be very proactive.

 

Again, in closing, let me say that I concur with the position taken by our organization. Specifically, "The American Legion is awaiting the completion of the ongoing research agenda before it will concur with definitive statements regarding the causes of Gulf War Illnesses. We (the American Legion) acknowledge, however, that the available scientific evidence weighs against DU as a likely risk factor for GWI."

 

Thank you very much.

Return to GulfLINK