TAB K - DU Notification and Medical Follow-up Program

This Information Paper outlines the program for arranging follow-up medical monitoring and treatment for veterans potentially exposed to depleted uranium (DU) during or following the Gulf War.

Background

On July 8, 1998, the Department of Defense (DoD) and the Department of Veterans Affairs (DVA) will institute a medical follow-up program to evaluate veterans who received the largest DU exposures during the Gulf War. The highest exposures (Level One) occurred during friendly fire incidents in which US combat vehicles were struck by DU munitions fired from US M1A1 tanks. Soldiers riding in or on these vehicles were potentially exposed to DU through fragments embedded in their bodies, inhalation/ingestion of DU particles created upon impact/penetration, and wound contamination. As a result, some soldiers may still retain DU in their bodies. Other soldiers in Level One entered a struck vehicle immediately after it was struck, and could have inhaled or ingested the fine DU particles still suspended in the vehicle’s interior. Personnel classified as Level II participants are believed to have received lesser exposures, but still warrant evaluation. These personnel may have been exposed to DU oxides, residues, and fragments while working in or on US vehicles contaminated with DU.

Objectives

Personnel in Levels I and II will be contacted by the Office of the Special Assistant for Gulf War Illnesses for two purposes.

First, the veterans will be informed about the availability of the DoD and DVA depleted uranium medical screening programs and they will be encouraged to enroll in the program for which they are eligible. Also, they will be informed that a follow-up letter will be sent within a week.

Second, the veterans will be asked about their experiences in the friendly fire incidents, or other possible exposures. These data will be used to reconstruct the veterans’ possible DU exposure levels. These data will also be used to identify additional personnel who were potentially exposed to DU.

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 evaluation. It is likely that most soldiers will have normal levels of uranium in their bodies. This program will provide reassurance to them. The program requires a 24-hour urine collection and a detailed medical history in addition to the examination Gulf War veterans receive through the Comprehensive Clinical Evaluation Program or the Department of Veterans Affairs Gulf War Registry. The follow-up will be executed in phases.

Implementation

In Phase I, the pilot program, friendly fire victims contacted by the Office of the Special Assistant for Gulf War Illnesses in October 1997 will be re-contacted and urged to obtain a medical follow-up. The Office of the Special Assistant will send the notification letter at Attachment A, informing veterans of their eligibility for the new medical follow-up program. The notification letter will include the DU Fact Sheet shown in Attachment B.

In Phase II, veterans not previously contacted, but believed to have been in or on vehicles at the time they were struck by DU munitions, will be contacted. Also included in this group are senior leadership from each unit which incurred DU-related friendly fire losses. Phase II will begin on July 15, 1998, and will follow a scenario similar to Phase I, with minor modifications. These soldiers will require a more detailed and flexible notification interview, since some of them were not personally exposed, but may have information regarding soldiers who were. The interview will include questions designed to estimate exposures as well as to identify other soldiers who may have been exposed to DU.

In Phase III, beginning on July 29th, the Office of the Special Assistant will contact other personnel who were possibly exposed to DU. This phase will include personnel who entered DU-contaminated vehicles such as personnel serving in the following organizations or functions: 144^th Service and Supply Company, Battle Damage Assessment Teams, Logistics Assistance Officers, radiation control teams, and unit maintenance organizations. The Office of the Special Assistant is currently compiling a list of personnel in Phase III. While the medical follow-up protocols and procedures are expected to remain the same for this phase, the information gathering portion of the notification script will be tailored to the specific functions performed by the contacted veterans. By analyzing the medical results from phase I, II, and III veterans, the decision will be made to discontinue notifications, or to add a Phase IV to notify and evaluate veterans with lower exposures.

Some Gulf War veterans have expressed concerns about potential DU exposures, which were at much lower levels than those experienced by the veterans involved in the Level I or Level II categories. For example, some veterans are concerned about potential exposures due to climbing on damaged Iraqi vehicles, or due to being present in the South Compound during the fire at Doha, Kuwait in July 1991. While they are at much lower risk than the veterans in the friendly fire incidents, veterans with these lower exposures may still have questions for their physicians. Veterans in these lower exposure categories will not be identified or contacted by OSAGWI, but they may refer themselves to the DoD or VA for medical advice. If these individuals and/or their physicians believe it is warranted, they will receive a DU medical evaluation.

Attachments
Attachment A Depleted Uranium Notification Letter
Attachment B Depleted Uranium Fact Sheet

May 27, 1998

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