NOTE: Unedited document
PRESIDENTIAL ADVISORY COMMITTEE
GULF WAR VETERANS' ILLNESSES
September 4, 1997
625 First Street
Joyce C. Lashof, M.D., Committee Chair
John Baldeschwieler, Ph.D.
Arthur Caplan, Ph.D.
Joseph Cassells, M.D.
Thomas P. Cross
David A. Hamburg, M.D.
Marguerite Knox, M.N., N.N.C., C.C.R.N.
Philip J. Landrigan, M.D., M.Sc.
Andrea Kidd Taylor, Dr.P.H.
TABLE OF CONTENTS
Call to Order and Public Comment 1
Ms. Ann McGuire, Designated Federal Official
Dr. Joyce C. Lashof, Committee Chair
Implementation: VA Medical and Clinical Issues 30
Dr. Frances Murphy, Department of Veterans Affairs
VA's National Health Survey 60
Dr. Han Kang
Dr. Frances Murphy, Department of Veterans Affairs
Implementation: Research Issues 72
Dr. John Feussner, Chair, Persian Gulf Veterans
Coordinating Board, Research Working Group
Dr. Timothy Gerrity, Department of Veterans Affairs
Craig Lebo, Department of Defense
P R O C E E D I N G S [9:03 a.m.]
Agenda Item: Call to Order and Public Comment
DR. LASHOF: I am Dr. Joyce Lashof, presently with
the Presidential Advisory Committee. This is our 23rd and
final meeting of the committee. As many of you know, we
submitted to the President what we considered our final
report in January 1997. The President then asked us to
continue working around two major areas: the implementation
of the recommendations in our report and provide oversight
to the DMV investigation of any chemical warfare release.
We are completing that process and today will be
hearing testimony concerning various aspects of the
implementation and tomorrow we will be reviewing our final
special report to the President on this activity.
We will start with public comment, as we have
always done. I will take note of the fact that the number
of people who signed up originally for public comment was
quite small and we have a heavy agenda for today. So, we
had limited public comment. However, we have had requests
from others that came in later, many of whom who have
appeared before the committee before, but we are certainly
hopeful that we will be able to fit them in as well. That
will depend entirely on how and how fast we are able to move
through the main agenda for the day.
So, at the end of the day, if time permits, we
will allow additional public comment. But let me now start
with the public comment that is scheduled for this period.
Mr. Larry Perry from Richfield, North Carolina.
MR. PERRY: Yes, I am here.
DR. LASHOF: Please come forward. As you know,
your presentation should be limited to five minutes and we
will have five minutes for questioning from the committee
and, of course, you can submit any additional written you
would like to the committee and we will consider it.
Thank you for coming.
MR. PERRY: My name is Larry Perry and I would
like to yield my time to Mr. Eddington because he has got
some new information that us, a veteran, and the committee
would like to hear, if that is okay.
DR. LASHOF: That is satisfactory.
MR. PERRY: Mr. Eddington.
MR. EDDINGTON: Thank you, Larry. I appreciate
that gesture on your part.
As I think many of you are aware, my wife and I
resigned from the Central Intelligence Agency last year as a
result of the CIA's failure to deal openly and honestly with
the entire issue of chemical agent exposures among our Gulf
One of our core allegations against the agency was
that it had deliberately withheld information regarding
potential chemical exposures. I myself had submitted a
Freedom of Information Act request to CIA in October of
1994, requested 50 specific documents dealing with this
particular issue; where the weapons themselves were located
within the theater. That request was denied.
Subsequently, in early 1996, at the direction of
then DCI John Deutsch, 300 specific documents detailing the
locations of these chemical weapons were removed from the
Internet, even though they had been properly declassified
and reviewed and competitive authority, that being the
Department of Defense.
As a result, when I made the decision to go
public, I instructed my attorney, Mr. Mark Zade(?), to file
suit in Federal District Court against the CIA in order to
compel them to release not only the 59 documents, but also
the 300 that they had attempted to reclassify in violation
of Executive Order 12958, Section 1.8(c), which specifically
prohibits reclassification of data that has been previously
Now, at the time that we made our allegations, the
chair of this committee described herself as, quote, well-
satisfied, end quote, with the cooperation provided by the
Central Intelligence Agency. Subsequently, in April 1997,
the CIA released 50 additional documents dealing
specifically with the Khamisiyah Weapons Depot in Iraq,
after having repeatedly assured not only this committee but
the American public that it had been completely forthcoming.
Now, I am making these specific points for a very,
very precise reason. Agencies of the Executive Branch in
this administration have developed a well-established
pattern of withholding information from the public that
embarrasses or otherwise undermines Executive Branch
policies concerning Gulf War Syndrome.
To cite but one case in point, the Pentagon is
continuing to withhold specific message traffic dealing with
the handling and final disposition of soil samples taken
during and after the Gulf War, soil samples that were
suspected of containing residue from chemical incidents.
Having seen some of this traffic while working as an
intelligence officer at the CIA, I know that if certain of
these messages were made public, they would greatly
undermine the Pentagon's position regarding the alleged
unreliability of the chemical detection equipment used by
our forces during and after the Gulf War.
There is another specific issue that this
committee was briefed on by both the Central Intelligence
Agency and members of the United Nations Special Commission
and that is the question of whether or not the Iraqis have a
specific marking protocol for their chemical munitions.
Obviously, this is an extremely important issue in that if
you are not able to identify these munitions prior to
demolition, you have a greatly increased likelihood of
chemical fallout from that particular circumstance.
What I have provided to committee staff as of
yesterday, the IFAX(?), is an extract from a June 1985 Iraqi
military staff manual that goes into very specific detail
about how the Iraqis actually mark chemically contaminated
areas. Now, while this specific manual itself does not
address chemical munitions, there are other documents within
the United States Government's archives, within the National
Archives of the Defense Intelligence Agency and elsewhere,
that are still classified that I believe if declassified,
would shed additional information on this particular
To be blunt, contrary to testimony given by
representatives of the Central Intelligence Agency, this,
and similar Iraqi manuals, containing such data were not,
quote, training aids, end quote, with no operational
applicability. These manuals were issued to and used by the
Iraqi military on a daily basis. They are the ground truth
for any serious investigation into the whether the Iraqis
actually marked their chemical munitions.
As a brief side bar, I would point out that the
debriefings from Iraqi prisoners, from the Iraqi 20th and
30th infantry division, among other units, clearly indicate
that these weapons were forward deployed in the Kuwait
theater of operations and that there were specific marking
protocols in use.
This serves to corroborate testimony given before
this committee by a number of veterans, who have talked
about seeing specific marking protocols on munitions, such
as colored skull and cross bones or color coded banding.
It is my view that the Iraqi marking system for
their munitions evolved over time, probably beginning with a
series of color coded bands then involving in the late 1980s
to this more rudimentary skull and cross bone system and
then finally in the rush to produce literally thousands of
these munitions for the Gulf War, they had no time to mark
munitions and simply sent them to the field as is.
There is an additional issue that we have to be
very concerned about here and that is a potential Iraqi use
of the weapons themselves. What I want to do is bring to
the committee's attention the fact that in late 1996, the
Department of Defense declassified yet another document in
which an Iraqi source specifically stated that Iraq employed
low levels of chemical and biological agents on its Scud
To date, the Department of Defense has not denied
this report. Additionally, the Iraqis, we know, had a
specific doctrine that recognized the cumulative effects of
low level exposure to chemical agents. And I will briefly
quote from one of these manuals.
"Nerve agents have a cumulative effect if doses
are used repeatedly on a target..." -- small doses now --
"...are used repeatedly on a target, the effects can be very
severe." And I would submit to you that the Iraqis
understanding of the low level effects of chemical agents
from a military medical standpoint is much more
sophisticated than our own.
In closing, what I would say to this committee is
that it is the view of the Gulf War veterans community and
it is certainly my view that this committee should recommend
to the President that an independent counsel be appointed to
look into the situation regarding witness intimidation,
document mishandling and destruction, the attempted
reclassification of data and other potential federal crimes.
These allegations must be investigated by a
completely impartial officer of the court.
One final data point: The Iraqis themselves have
now established their own Gulf War Syndrome style commission
to investigate a radical increase in the number of rare
cancers and other disorders in areas such as El Bazra,
Onnazaria(?), Asomawa(?) and elsewhere. This, obviously,
would have been in the down wind footprint for any of the
attacks that were actually taking place.
And on a final personal note, I would like to
thank those members of the committee, who have recently
expressed reservations about the original conclusions that
the committee reached in its final report. I think that it
speaks volumes for your intellectual honesty and integrity,
that you have been willing to reexamine those conclusions.
That concludes my statement. If you have any
questions, I will be happy to answer them.
DR. LASHOF: Any member of the committee have a
MS. KNOX: Do you think that low level chemical is
the only cause for veterans' illnesses?
MR. EDDINGTON: No. I don't think there is any
question that we are looking at a multiple exposure
scenario. There were simply too many things on the
battlefield that were going to cause these people problems;
for example, the depleted uranium issue. There is even
better information indicating that the Department of Defense
knew precisely what the long term health effects of DU
A great deal of that information has been gathered
by Swords to Plowshares and other veterans' organizations
and it clearly indicates that there is a very significant
long term cancer risk associated with that kind of an
What I think that Dr. Haley(?) and his team have
basically discovered down in Texas is that a specific subset
of the symptoms being suffered by these veterans are, in
essence, neurological. Now, that can be explained by
potentially a combination of organophosphate pesticides,
exposure to nerve agents, like soman(?), sarin and tabin(?),
the peristamine(?) bromide, potentially.
There are a number of these cholinesterase-
inhibiting compounds that could be responsible for these
neurological problems. But many of these veterans have --
as you are well aware now -- many of these veterans have
badly suppressed immune systems. These people are carrying
around some bugs inside of them.
Dr. Kathryn Murray Leisure(?), who I believe may
have provided information to this committee, if not
testified in front of it, who formerly worked at the Lebanon
VA Medical Center in Pennsylvania, in her 700 patients, she
has found evidence of some kind of a parasite that she
believes is indigenous to the Saudi peninsula.
That is something else that needs to be very
aggressively pursued. But there is no doubt in my mind that
you are looking at a multiple exposure scenario. You cannot
explain all the symptoms being suffered by these veterans
just on the basis of chemical exposure alone.
DR. TAYLOR: How did you obtain the information
that you have regarding the accurate knowledge from Iraq
about their chemical weapons or low level exposures?
MR. EDDINGTON: The documents that I have
referenced here are Iraqi military manuals primarily that
were recovered on the battlefield and I think it is
significant that to this day there are over 4 million pages
-- let me repeat that -- 4 million pages of captured Iraqi
DR. TAYLOR: Who has this information, though?
MR. EDDINGTON: The National Archives, I believe,
has a special project underway right now to try to exploit
some of those documents for some very specific purposes.
The Defense Intelligence Agency has a number of documents
and that is part of what our lawsuit is about, to try to
force those out. The U.S. Army Intelligence and Security
Command is in the process of providing me documents. They
have provided me about 7,500 pages thus far.
We have a number of repositories across the United
States where these documents are located and one of the
points that I would like to make here is that I believe that
the Iraqis have a much more sophisticated understanding of
how these agents worked, both from an acute standpoint, as
well as a non-acute standpoint.
And unless we get into the details of what the
Iraqi military medical community itself knows about how
these agents function, I think we are doing a disservice to
these veterans. After all, Iraq has used these weapons more
frequently than any other country in the world over the
course of the last 85 years. So, I think that they have a
lot to teach us in that respect if we are willing to
actually put the money against the effort to exploit the
documents and get the data out.
DR. BALDESCHWIELER: When the U.N. investigation
team testified before our committee, they said categorically
that the Iraqi chemical munitions were unmarked. I remember
I asked in several different ways about this. They had
access not only to the deployed Iraqi chemical weapons but
also to all the other weapons in the Iraqi pipeline.
Is there any evidence that they found marked
MR. EDDINGTON: Well, one has to remember that
UNSCON(?) is under continual surveillance by the Iraqi
intelligence services whenever they are operating on these
inspection sites. That was one of the major problems that
those of us in the intelligence community ran into to
immediately after the war.
The Iraqis would load up documents at specific
sites, move those documents to other locations and by the
time U.N. inspectors got there, what they were looking for
was gone. So, as I stated just a few moments ago, it is my
belief that with regards to the actual marking of the
munitions, I think because the Iraqis were doing so many
chemical weapon production runs in those weeks immediately
preceding the war, they didn't have the time essentially to
mark those weapons in the traditional fashion that they
would have done otherwise.
I think the vast majority of the Iraqi munitions,
chemical munitions, were probably destroyed during the war
as a result of either the air campaign itself or the
demolition operations that took place in Kuwait and
Southeastern Iraq after the war. Remember that the
intelligence community position during Desert Storm was that
these weapons were forward deployed.
That means that the intelligence community, along
with central command, were putting cross hairs on those
locations and bombing them. The UNSCON inspectors have
never to southern Iraq and gone to places like Arumala(?)
and some of these other field-deployed sites, where these
weapons are most likely located.
So, I think that that goes at least some direction
to explain why they haven't been able to come up with
anything in terms of the Iraqi marking system. The Iraqis
are very, very good at essentially concealing what they
have. In fact, the documents -- these military manuals that
I am referring to in the Iraqi military system, they are
considered classified documents. That is generally not the
case in the United States military. Only a certain subset
of documents are considered classified.
DR. BALDESCHWIELER: It was my impression that the
bombing and the destruction efforts, in fact, are very
inefficient; that is, the number of intact weapons that are
left after bombing or after demolition is quite large. That
is, in fact, what the U.N. inspectors found and, in fact,
they were tasked with deactivating --
MR. EDDINGTON: Well, they found what they could
inside Iraq proper, but there is a difference between
storing the munitions in hardened steel and concrete
reinforced bunkers where a single warhead can penetrate and
only do a certain amount of damage. It is another thing
entirely when you have an open air bermed depot, such as the
one that was located in Arumala, where all you are really
dealing with a three-sided earthen berm with no covering
over the top. If you come at that particular kind of
facility, as the U.S. Air Force did, using clustering bomb
munitions, you are going to cook off, you know, 10, 20, 30
of those revetments(?) at a single time and, thus, destroy a
much larger number of munitions.
It is also important to remember, again, that
UNSCON has never been to any of the areas in southern
eastern Iraq or Kuwait, for that matter, where these weapons
were actually field deployed. Thus, they have no direct
knowledge of it and I am sure that Dr. Metroken(?) and the
rest of the UNSCON representatives will be very quick to
MR. CROSS: From your testimony, can I assume that
the military field commanders did not have access to these
Iraqi manuals prior to or during the war?
MR. EDDINGTON: That is correct. That is correct.
DR. LASHOF: Any further questions? If not, thank
you very much for appearing before us.
MR. EDDINGTON: Thank you.
DR. LASHOF: We will proceed to the next witness,
who is Mr. Edward Barras.
MR. BARRAS: My name is Ed Barras. I live in
western Pennsylvania. I really don't want to be here, but I
traveled five hours to talk five minutes and I am going to
share the five minutes with my daughter-in-law.
My only claim to fame is that I am a good father.
I have three children. December 16th, 1996, I buried one.
He was in the Army seven years. He chased the Republican
Guard to Basra. He slept under the oil fires. He manned a
check point between Baghdad and Basra and he was a
David died -- when he died, I thought that Jesus
Christ had come back for his second appearance because this
cancer crucified him. It just crucified him. And I don't
think that stress did it. When this war began -- first of
all, my immune system is twice as old as David's. I am 56.
When he died, he was 28, in the Army seven years. PT
everyday for seven years. My immune system is twice as old.
I was glued to CNN for three days trying to hear
the whereabouts of the Third Armored Division. Is that
stress? When the doctors walk up and say your 28 year old
son has malignant cancer and he is not going to make it, is
When you spend the last year of your son's life
beside him, is that stress? When you see your son breathing
his last breath, is that stress? When you read what the DOD
and the Pentagon says about the Gulf War illness, that is
You know, my father fought with the Big Red One in
the Black Forest of Germany. He spent seven winter months
in battle and was a platoon leader. On a mission one day, a
sniper shot him in the buttocks. His buddies put him on a
stretcher, hauled him back to a field hospital behind the
front lines. As he was being transported, a sniper shot him
two inches above the heart.
Well, my dad was 68 years old. He died of a heart
attack. He spent 44 years between when he got out of the
Army and when he died. But, you know, I don't have any
joint pain and I endured stress. I don't have any tumors.
I don't have any cancer. My hair is not falling out.
My dad had the same thing. Forty-four years he
spent on this earth between the Army and his death. No
joint pain. No hair loss. No tumors. No cancer. No
I don't believe the stress. Nobody can tell me
that stress -- I know what my son died of. He died of
cancer. I want to know what killed him. And it wasn't
stress. It wasn't stress.
And I made my son a promise. He told me one time,
he said, Dad, maybe I ate too many pieces of pizza, drank
too much Pepsi. I said, David, you are not the 40 year Army
Reserve person, who sat behind a desk for a living. You
were 23 years old. You took PT everyday for seven years of
your life in the Army.
There is no doubt in my mind that David Edward
Barras died from something he picked up over in the Gulf.
It may have been better if David would have been shot on the
battlefield because I could forgive that person, but I can't
forgive the person or persons who are lying to me about
stress. I can't forgive them and I won't forgive them.
I am not that dumb to buy this stress. Stress is
just an easy cover-up. Can you see stress on an x-ray or an
MRI? You know, Bill Cosby's son died about the same time my
son died. Bill Cosby had millions of dollars, the LAPD and
probably the FBI and here I am, no money, no LAPD and no
FBI. They found Cosby's son's killer. I have got to find
my son's killer.
These people out here are my police force. We are
not going to go away and we are going to bang on the door
until it falls in. This is my life's work. I have nothing
else better to do and we will persevere.
I am going to give the remaining time to my
daughter-in-law. I thank you for the time.
MS. BARRAS: Good morning. My name is Carolyn
Barras. My husband, David Barras, was a sergeant in the
United States Army. He was also a Gulf War veteran.
I am here today to speak on my husband's behalf
since he cannot be here to speak for himself. Dave passed
away on December 16th, 1996 from a very rare and deadly
cancer known as leiomyosarcoma. Because this cancer is so
rare, it makes it difficult for doctors to study. It has
been found, however, that most people with this cancer are
in their sixties and seventies, not in their twenties, as
I also find it significant to note that persons
with leiomyosarcoma have been found to have evidence of
chronic fatigue syndrome, which among other illnesses has
plagued thousands of Gulf War veterans since their return
home from the Gulf.
Dave was a tank mechanic stationed with the Third
Armored Division in Gaunhausen(?), Germany at the time that
he and his unit were deployed to the Persian Gulf. They
arrived in Southwest Asia on December 24th, 1990.
After some training in Saudi Arabia, they headed
north and crossed into Iraq on February 24, 1991, as one of
the front line combat elements of Operation Desert Storm.
On February 26, his unit attacked a division of the Iraqi
Republican Guard. The fighting lasted into the next day.
Once the war was over, they were given the task of
destroying any remaining Iraqi tanks and ensuring that Iraqi
bunkers were cleared out. Near the end of March 1991, they
headed for Kuwait, where they spent approximately six weeks
under the smoke from oil fires.
On May 17, Dave and his unit made their return
trip to Germany, the day we had waited for. Less than five
years later, Dave was diagnosed with cancer. He was
scheduled for surgery to remove his prostate and bladder,
which is where the tumor was located. A few months later,
we were given the devastating news that the cancer had
metastasized and was incurable.
I believe with all my heart that were it not for
the Gulf War, Dave would still be here today. My husband
did not have any medical problems to speak of before the
deployment to the Persian Gulf. He and every other soldier
that was sent there had to be cleared medically before
leaving for the Gulf. So, why then did Dave and so many
other soldiers leave healthy and yet return home with a vast
number of illnesses.
It has been over six years since the war in the
Persian Gulf. Our soldiers won a swift victory over there
and yet those in the government, who should be fighting for
our veterans, are still denying that anything happened. To
say that these illnesses were caused by stress is adding
insult to injury.
I cannot comprehend why the government is not
doing all that it can to help veterans and their families.
We should not have to be beating down the door to try and
receive help for those who are still suffering with
While Dave was battling with cancer, he also had
to fight for proper treatment, care and benefits. This, to
me, is unconscionable. Dave served his country with honor,
courage and commitment. Such devotion to his country
deserves answers and our government's complete and total
devotion to finding out the cause of all the illnesses that
the veterans are suffering from.
The DOD should be disclosing all available
information, not trying to hide as they have in the past in
so many times before in our nation's history. When the
truth is known about why Dave and so many others became ill,
which I believe it will at some time, what will be
remembered of this committee? Will it be said that you did
all that you could to help my husband and other veterans?
The choice is yours. We want to know why Dave
became sick. Not that this information can help him now,
but it hope that it will help others that are suffering so
that they won't have to go through what he did.
DR. LASHOF: Thank you very much.
Are there any questions for Mr. or Mrs. Barras?
MR. BARRETT: Could I have ten more seconds?
DR. LASHOF: Go ahead.
MR. BARRETT: I want to say something not from the
bottom of my heart, but from the bottom of my soul. These
kids weren't stressed in the Gulf. These kids were gassed
in the Gulf. Thank you.
DR. LASHOF: I would like to call Noel Stewart.
Is Noel Stewart here? If not, then John Cianci.
SFC. CIANCI: Good morning.
My name is Sergeant First Class Johnny Cianci. I
am a Gulf War veteran. I served with the 119th Military
Police Company in Hafa Aba(?) in Saudi Arabia. I have
traveled from Rhode Island to here at my own expense to
express my opinion.
My unit, we were located approximately 50 miles
from the Iraqi-Kuwaiti border. On numerous occasions we had
a mysterious black cloud pass over our camp. At no time did
we ever -- had any belief that it was chemical or biological
warfare. We were told it was from the oil fields in Kuwait.
After this cloud passed over our camp, we began to
experience problems. For instance, on one date that the
Pentagon and Department of Defense confirms that our
chemicals were released was 4 March 1991. Six years after
the fact, I found medical documents to support that I had
what they call it was a minor stroke.
Eight hours after being -- the bunkers were being
destroyed, I was found wandering in the desert. According
to military records, official military records, I was having
muscle spasm, nausea, dizziness. A lot of other soldiers
started experiencing these problems. We had one member of
our unit that was brought to the rear area. They said he
had a heart attack. I talk to him frequently. He says it
was like his guts fell out of him. That is the only thing
that they could tell him what happened to him.
In May of 1996, I found this document at Rhode
Island Army National Guard State Headquarters concerning
that I had a stroke. When I was asking for a copy of the
document, they refused to give it to me. I went to the
military lawyer. Within minutes, he assured me that I would
get that document, that I was entitled to it. It was a
document mentioning me and a possible minor stroke and to
have a dye test.
A few days later, he told me I wasn't entitled to
it. I began a battle to obtain documents, which lasted over
a year; my medical file being shipped to St. Louis by
mistake. Finally, Congressman Patrick Kennedy intervened.
He obtained this document.
And I ask the committee -- why I provided a copy
of the document and I will read the document and you tell me
why our government would not provide this to a soldier.
"On this date, this office was informed by
Sergeant Cianci..." -- this is 2 May 1991, the date of the
document -- "...that during his refrad(?) physical
examination at Fort Devins, the doctor had reason to believe
that Sergeant Cianci possibly suffered a minor stroke while
on Title X status. The doctor had advised Sergeant Cianci
to report to Walter Reed." He says I should have had a dye
test. I don't remember this conversation.
Attached to that document was a document from the
chief of staff of the Rhode Island Army National Guard,
Colonel James Reed, who is still currently the chief of
staff of the Rhode Island Army National Guard. This
document said make sure we follow up on this and ensure
individual is not released from Title X until he is cleared.
Keep me informed.
I was never spoken to and to this date he still
refuses to talk to me. I can't see any classified
information in that document, why he wouldn't give it to me.
I ended up being out-processed. I was still on active duty
in August of 1996 and doctors looked at me like I had
crossed eyes when I was telling them about this document and
a potential stroke that I might have suffered.
In 1992, I had what they told me was poison ivy.
I had it internally. My stomach was three times its size.
This lasted from May until June of 1992. They told me it
was poison ivy; 1993, I had it; 1994, 1995 and 1996. In
1996, I stated to medical doctors, the military, this cannot
be poison ivy. They told me I was wearing my boots too
What was upsetting was an article that I have been
following the Gulf War and the symptoms most all the last
year after my experience. I read in a recent article
concerning that your conclude that Iraqi weapons were
unlikely to be cause of illnesses reported by Gulf War
veterans, that your panel praises the government response to
ailing veterans and conclude our medical treatment has been
excellent and state the current efforts to research the
problems are appropriate.
In your report, you further urge all possible
exposure to poison gas during the war be thoroughly
investigated. It took six and a half years for the
government to determine my unit, the 119th MP Company was in
an area that could have been exposed. We received a letter
in July of 1997, this year. There is approximately 150
people in my unit. Only about a hundred of us have got the
letters. They haven't even contacted members of that unit,
the only unit they have ever been with who are on active
duty. I can't understand that.
I urge your panel to further investigate causes of
Gulf War illnesses, listen to the veterans who were there,
veterans who answered the call and are concerned about their
health and health of their family. Don't turn your back on
us. We do not want to be like the 20,000 ex-troops the
Pentagon said in an article on August 28, 1997, The New York
Times, 20,000 American troops from the 1940s through the mid
sixties and some of their family members might be at risk
for health problems.
Pentagon officials said that because of incomplete
medical records, the Defense Department would be unable to
track down most of the veterans because few detailed medical
records were kept listing names. I don't want a report, if
I am around in the year 2026.
I still have problems with my left side. In three
weeks, I have been trying to gather information to present
to the committee. I have from one veteran, who started
going to the VA in 1992 because she had chest pains. They
were telling her she had a bad cold. She continued going,
1993, 1994 and 1995, 1996 and 1997. Finally, in 1997, they
found cancer in her.
She has a doctor who says although it is clearly
not possible to attempt to determine whether this neuropathy
is part or due completely to a chemotherapy agent nor due to
any nerve toxins that she may have been exposed to. Five of
the six people that came to my meeting that we had are being
told they have an unknown toxin in their blood or in their
I ask the committee to investigate. Contact the
Rhode Island Army National Guardmen who were there, who are
suffering, who have problems, who can lead you to answers.
Contact the veterans who were there. Start from the ground
DR. LASHOF: Thank you very much.
Are there questions for --
Are you currently on active duty?
SFC. CIANCI: No. I am still a part time member
of the Rhode Island Army National Guard.
DR. LASHOF: Thank you. All right. Thank you
I understand that Nole Stewart has arrived and
would now like to present his testimony.
MR. STEWART: You must forgive me for my dress. I
just got off the airplane and, in fact, I almost didn't get
on the airplane had it not have been for a door jammed and I
got on the plane. I have come from California to give
testimony to this commission.
First of all, I would like to address where I was.
I was in the port city of Jubhail. It is my understanding
that you have negated the fact there was a Scud missile left
intact. I know this to be a fact because I was present and
I was asked to dive on this missile. I was in charge of the
native -- Port Marine construction natives and the diving
commission there. I know that I was asked to take my native
divers, attach a cable to this Scud missile and go down and
attach it and bring it up.
I refused to allow my native divers to go down
because the whole port of Jubhail was covered with dead
fish. I could not see. I was told that the Scud missile
ran out of fuel and the Patriot missiles did not knock it
down. Our government wanted this missile intact, but they
were not afraid that the native divers would get sick. I
was. I studied marine biology in the University of
California. I know that fish don't die from just fuel or
impact. These fish died of some kind of biological warfare
that was intended for the Port of Jubhail.
I understand that you say there was no chemical
attacks at the Port of Jubhail. I ask this commission to
find this Scud missile. It is intact. It is somewhere here
in this country. I know it is because one day later I was
asked to use at night, 12 o'clock, they asked me to cart a
box that was supposed to the Scud missile, the same gunnery
sergeant from the Marine Corps asked me to load this on
board a truck that was to go to Dhahrain and be loaded
aboard a ship and come back to the United States.
Somewhere that Scud missile is here in the United
States and is being studied. I was one of the first Persian
Gulf veterans that asked in 1992 for my benefits. In 1993,
I was involved in a jeep accident. My files from the VA had
been so misconstrued that I am a homeless man. My furniture
has been sold and I have used my last $1,700 to come here to
speak to you.
The atrocities that are being committed against
us, lies, when missiles do exist, anthrax vaccines, the
368th Stevedorean, which is mostly composed of black
stevedores, have never been told that they packed spent
uranium shells on top of their armament that they packed
into those cargo holds. What are you going to do about
I am surprised the NAACP has not come down upon
this commission. I have not received one notice. We packed
at least 100 Iraqi armaments, tanks, personnel carriers for
souvenirs. They are here in this country. Why has not this
commission come forward and demanded where this equipment
The 368th deserves this. Yes, they were a
detachment up in the far reaches of Jubhail. There were
only 400 of us. I am the only American reservist that was
attached to the provisional boat company. We must as
Americans come to realize there was more to this war. Yes,
the professional soldiers want to say we did a good job in a
hundred hours, but we have not done a good job as Americans.
We should be ashamed of ourselves as to what we
have done to the servicemen that went to the Gulf War to
free Kuwait. I do not see anyone here from the Kuwait
government or the Saudi Arabian government or the Jordanian
government or the Israeli government. Why are not these
We gave our lives. Are we to be the next Tuskegee
experiment? Are you going to allow us to die slowly of some
unknown disease? Or is it the fact that our government has
found the solution of the Iraqi chemical weapons and is
saving this solution for the next time that they have to
face a Third World nation?
These are questions that you must ask yourself.
You can no longer tolerate the Veterans Administration to
hold up our forms. Must we starve to death underneath
bridges? Our government has come too far. The
Environmental Protection Agency of all our country has even
come close to violating the Soldiers and Sailors Act of
1942. If the President and this commission doesn't come out
strongly and support the Desert Storm veterans, what will
happen to the next veteran in the next war. We need as a
nation, as a people to make a statement to the world that we
will not tolerate this kind of condition.
I have prepared a statement. Yes, I know of other
things, of the Iraqi chemical weapons that were destroyed in
Jubhail. I saw them on a board. I saw the description.
You asked why I don't bring evidence? Because if I would
have photographed such evidence, I would be in Leavenworth.
The individual soldier saw much to capture such
things on film or written records would have ended all of us
up in Leavenworth. It will be hard to resurrect such
records that are almost six years old. It will be your duty
to do so.
I believe God has brought me here this day because
I shouldn't have got here. I spoke in January of 1992 that
stopped five men from going to this war. They had a choice.
You have a choice today. I ask you and plead with you make
the Veterans Administration come to us. Make the army units
recognize that we were in this kind of a condition. I
realize that the Army believed this was a garrison war, but
this was a real war, even though it was 100 hours, we did
free the nation of Kuwait.
DR. LASHOF: Any questions?
[There was no response.]
Thank you very much.
We will now move to a review of the implementation
on various issues presented in our January report and the
first testimony will be on the VA medical and clinical
issues, Dr. Frances Murphy from the Department of Veterans
Affairs will address this.
Thank you, Dr. Murphy. It is a pleasure to have
You may start.
Agenda Item: Implementation: VA Medical and
DR. MURPHY: Thank you, Dr. Lashof, and
distinguished members of the committee for this opportunity
to provide an update on the Department of Veterans Affairs
implementation of the committee's final report
I am pleased to report the VA has made significant
progress and I want to, again, thank the committee for its
work in developing these recommendations.
During my presentation, I will briefly summarize
some of the VA's major Gulf War efforts during the past
year. The Persian Gulf Veterans Coordinating Board has
submitted to the committee a more detailed point-by-point
report of VA's actions and the actions of other departments
that relate to the committee's recommendations.
Therefore, I will only highlight our most recent
activities. As you know, VA continues to work closely with
the Departments of Defense and Health and Human Services to
coordinate federal programs on behalf of Gulf War veterans.
I would like to first cover some of our activities
related to outreach and risk communication. The committee
made strong recommendations regarding the importance of
improved communication related to Gulf War veterans' health.
We agree with the emphasis you placed on the importance of
clear and effective risk communication.
The committee recommended that the VA should
follow the model of field-based outreach demonstrated in our
vet centers in the Persian Gulf Family Support Program when
developing risk communication programs. We agree that the
vet center community-based programs have been highly
effective in communicating with veterans and their families.
On June 3rd and 4th of this year, we held our
national training program to update VA health care providers
and vet center staff on the latest information related to
Gulf War veterans health issues. The program included two
vet center workshop sessions covering community-based
outreach in order to familiarize our medical center staff
with these methods and to encourage our staff to implement
them within their VA community.
In addition, the dissemination of information on
methods used in the vet centers to develop community-based
veterans communications, the VA has taken several other
actions. This year, VHA completed a communications audit
and developed a workbook to assist medical center public
affairs staff to develop better communication with local,
internal and external customers.
One of the examples provided in this workbook is
how to develop a communication strategy for medical center
Gulf War veterans programs. VA also provided a Gulf War
update at the public affairs conference on August 5th and
6th to facilitate community-based outreach by our medical
These efforts are the beginning of VA's commitment
to optimize our field-based outreach to Gulf War veterans
and their families. The committee further recommended that
VA direct its transition assistance program workshop
benefits counselors to specifically mention DOD and VA
programs related to Gulf War veterans illnesses.
The transition assistance program is conducted by
the Veterans Benefits Administrations, Veterans Assistance
Service. They have taken action to ensure that separating
military personnel are aware of the benefits and services
that we provide.
VA has coordinated its TAP efforts with the
Department of Defense to ensure that service members
deployed to the Gulf War receive information on available VA
and DOD health care and compensation programs prior to
discharge from the active military service. We have
provided copies of the briefing slides, which the TAP
benefits counselors used for the committee's review. That
program has been implemented and is currently in use.
The committee also recommended that VA ensure its
initiatives related to women veterans' health-related
programs, specifically provide information about Gulf War-
related programs. Since the VHA Office of Public Health and
Environmental Hazards manages both the women's veterans'
health programs and the Gulf War veterans' health programs,
implementation of this recommendation has been easy to
Gulf War-related women's veterans program
information was included in both the VA's Women Veterans
Coordinators Conference held on May 28th through 30th of
this year and also the Gulf War National Training Program
In addition, a review article entitled "Women in
the Persian Gulf: Health Care Implications for Active Duty
Troops and Veterans" will be published in the October issue
of Military Medicine and was a joint collaboration between
VA and DOD Gulf War personnel.
We would like to express our sincere appreciation
to Dr. Lashof, who spoke with the group at the National
Training Program about your committee's recommendations and
findings. Dr. Lashof, you contributed greatly to the
overall success of VA's training conference.
I have provided copies of the core syllabus to
committee staff and I would be happy to bring copies for any
of the committee members who would like to keep a copy of
the syllabus or review it in detail.
The presidential advisory committee staff visited
VAMCs and found that our registry and referral center
personnel were knowledgeable and well-informed about all
aspects of Gulf War veterans health. However, your
committee has recommended that education of other health
care providers not directly involved in the registry
programs need to be enhanced.
We agree with this recommendation and have
developed a continuing medical education self-study guide on
Gulf War veterans health. We expect to publish this
document and distribute this self-study guide to all VA
health care providers before the end of this year.
The VA shares the committee's concerns about
veterans adverse reproductive health outcomes. We found the
results of the National Health Research Center birth defects
study, which found no increase in the risk of serious birth
defects in the children of men or women who served in the
Gulf War to be reassuring.
However, we realized that continued surveillance
and expanded investigations are necessary to obtain a
complete picture of reproductive health of Gulf War
veterans. The VA is currently reviewing its reproductive
health policies and hopes to enhance the range of
reproductive health services available to veterans for
service connected illnesses.
This review is taking place as part of the
eligibility reform initiative, which involves the
development of a uniform benefits package for health care
for veterans. The committee recommended that the VA should
provide genetic counseling when indicated. At present, VA
has no authority to provide these services to the spouses of
Gulf War veterans. Legislative action to provide genetic
counseling services to Gulf War veterans will be considered
if deemed appropriate, based on available scientific
The committee recommended that a presidential
review directive be issued to instruct the National Science
and Technology Council to develop an interagency plan to
address the health preparedness for and readjustment of
veterans and families after future conflicts and peace
The VA is pleased that the presidential directive
was issued on April 21st, 1997, in response to your
recommendation. Work groups on deployment planning,
clinical care, research, record keeping and risk
communications have already begun their work. The VA is
enthusiastic about the PRD planning process. We consider
this is a key component of assuring that lessons learned
from the Gulf War and previous wars can be applied to
improve the health of military members, who will serve in
The VA will participate actively in each of the
four working groups.
Dr. Lashof, that concludes my prepared statement.
We are grateful for the work of the committee and staff on
behalf of Gulf War veterans. We recognize the central role
you have played in investigation of possible troop exposures
during the Gulf War. And as the President has directed, the
VA will not stop until Gulf War veterans have answers to all
of their concerns.
I would be happy to answer questions that the
committee may have at this time.
DR. LASHOF: Thank you very much, Dr. Murphy.
Let me begin the questioning with one about
primary care. We have heard from many veterans testifying
here that they have had difficulty seeing the same physician
and I know that VA has been implementing a primary care
giver or gatekeeper approach to the provision of medical
Can you tell me how well that is moving along and
how specifically this effort relates to the Gulf War
DR. MURPHY: We are actually monitoring that
process through our self-assessment questionnaire that we do
on an annual basis to assess our Gulf War registry programs.
We specifically asked the centers to tell us how many of the
veterans have been assigned to a primary care team.
When we asked in our 1995 review, it was 67
percent -- excuse me, I am doing this from memory. I hope
that the figures are correct. I believe it was about two-
thirds were assigned to primary care teams.
Last year, it was up to 80 percent or more and we
intend to repeat that self-assessment in October of this
year and hope that we will be reaching close to a hundred
percent primary care assignment for Gulf War veterans who
need follow-up care within the VA system.
This is a transition from what previously was a
hospital-based, inpatient health care system to an
ambulatory care primary care focus for VA. In listening to
Gulf War veterans talk to us and to you about their health
care in the VA system, we have recognized that primary care
alone may not be able to address all of the concerns for
Gulf War veterans, who have complex health care problems and
complex medical conditions.
Therefore, Dr. Kaiser is making case management as
a part of the primary care process a focus for VA over the
next year. He has recognized that this may help us improve
the health care delivery for Gulf War veterans illnesses by
having better coordination of that care for people who need
to see multiple specialists, who need to have all aspects of
their health addressed, including social, community and VA
health care aspects.
We will be doing a program in the next few weeks,
introducing principles of case management to our health care
providers in the field and giving an example of how this has
been effectively used within at least several of our medical
centers to deliver health care to Gulf War veterans.
DR. LASHOF: By case management, are you talking
about a case management team and is this a team approach or
just assuring that the primary caregiver has overall
responsibility and takes responsibility for coordination and
interpreting information to the veteran?
DR. MURPHY: I think there are various ways that
case management can be implemented at a local level and
because of the diversity of VA health care facilities, it
may be implemented in either of those ways at the local
medical center. We believe that the team approach does work
and that if, in fact, there is a consistent group of health
care providers, who are familiar with the veterans health
care issues and are coordinating all aspects of the health
care, both diagnostic evaluations and treatment, that a more
consistent and continuous care can be delivered to Gulf War
DR. LASHOF: Thank you very much.
Other members of the committee have questions they
would like to address.
DR. TAYLOR: I am just curious of the numbers.
You mentioned the June conference, the national training
program to update medical personnel. Was that mandatory or
how many medical personnel -- what percentage of medical
personnel would participate in the training?
DR. MURPHY: There were almost 350 health care
providers who attended and what we normally do with our
national training programs is send each medical center a
notice that the training will occur and ask them to send
their Gulf War health care providers to that conference. In
some cases, that was one individual from the medical center.
In other cases, there were multiple people who chose to
It was very well-received and the evaluation forms
that we got back suggested that they felt that they had
gotten good information that would allow them to provide
better care to Gulf War veterans.
DR. TAYLOR: At least one person from every VA
DR. MURPHY: Yes. The idea behind the national
training program is that we give health care providers an
update on all the latest clinical and scientific information
that has occurred over the last year and it really is viewed
as a train the trainer process. We hope that the health
care provider who attends the national training program will
then go back and do medical grand rounds and other training
for medical center personnel, so that we can greatly
increase the number of individuals who are familiar with the
latest information on Gulf War veterans illnesses.
In order to help facilitate that, our office has
been sending interested VA medical center personnel a
diskette of some slide and briefing materials that they can
use in those kinds of training programs at a local level.
We felt that that has been very successful.
DR. LASHOF: I would commend you on that training
session. I was very impressed with all the speakers and the
material and the book of references and data that were
Other questions? Joe.
DR. CASSELLS: You said you had good feedback from
that conference and from the other efforts that central
office has made to get feedback to the providers in the
field. You talked about a self-study guide that you are
developing for use for VA medical personnel not directly
involved in Gulf War veterans issues.
What kind of evaluation of effectiveness is built
into that self-study guide program? How do you plan to
determine whether it is effective or not?
DR. MURPHY: Well, one of the ways is that it was
designed as a continuing medical education instrument. So,
at the end of completing the reading required for that self-
study guide, there are a series of 25 questions that each
individual is required to answer and send back to our
education center. And they only receive their CME credit if
they get a score of greater than 75 percent correct on the
In addition, we intend to go out and do a spot
survey to assess whether the materials were effective and
easily used by our health care providers. We have printed
enough copies that every VA physician or mid-level provider
will be able to participate in the program.
DR. LASHOF: Go ahead, Joe.
DR. CASSELLS: At the time of our final report or
so-called final report in January of 1997, we had identified
some problems with follow-up care in both the DOD system, as
well as the VA system, and identified staffing problems
impacting negatively on the provision of that care. You
have not commented on any kind of evaluation that VA has
done of its staffing requirements. Have any such efforts
DR. MURPHY: Actually, as part of VHA's
reorganization of its health care system, each medical
center has been required to do an evaluation of what health
care providers and what mix of providers is necessary to
provide adequate and appropriate care to the veterans in its
That has been decentralized authority to the
medical centers and that process is ongoing. As part of the
performance evaluation for the medical center directors,
they are asked to assure that good access and continuity of
care for veterans is available at their medical center.
That is the way we have handled that recommendation.
DR. CASSELLS: In general, how is recruitment and
retention of medical personnel in the VA system going?
DR. MURPHY: I am afraid that I don't have very
specific information on that, Dr. Cassells. I can get that
information for you. My impression, and it is just that,
anecdotal impression, is that at this time, VA has been very
successful in recruiting excellent physicians to our health
care system and that many physicians are staying long term
with the system.
I think many people view the VA health care system
at this point in time, with some of the changes in managed
care and the private sector as a very good place to practice
medicine. So, I think that we are in a better situation
than we were probably ten years ago. But I will get you
specifics on that.
DR. CASSELLS: As part of your case management
strategy, though, are you intending where there are gaps in
staffing within career VA medical personnel to use contract
personnel from the civilian sector, if appropriate?
DR. MURPHY: We have the ability not only to use
contract personnel, but to get part time personnel through
our university affiliations. We also have the ability to
send veterans where we don't have VA physicians able to
provide the care to community physicians and pay them on a
fee basis for the care that is provided.
The eligibility for that is somewhat more
restricted than our general eligibility requirements for
veterans. But we do have the ability to have contract
personnel and also to get fee basis care from community
DR. LASHOF: David.
DR. HAMBURG: You mentioned, Dr. Murphy, the VA
participation in the presidential review directive of April
of this year. In your submitted testimony, you speak about
assuring that the lessons learned from the Gulf War and
previous wars be applied to improve the health of military
members who serve in future deployments.
We have heard this morning some reference to bad
experiences in the aftermath of World War II. Of course, we
have heard many times about lessons to be learned from bad
experiences in the aftermath of the Vietnam War, as well as
the Persian Gulf War.
Could you say a little bit more about the process
by which those lessons learned from previous wars are being
analyzed and incorporated into this effort? I realize the
VA is only part of it, but to the extent the VA is
participating, could you clarify that for us?
DR. MURPHY: Yes. I think we are drawing on
expertise from a wide range of federal agencies with
predominant involvement from VA, DOD and HHS. Each of us
who are involved in the process and other experts that we
are consulting are asked to brainstorm about the most
important areas that can be looked at for enhancements of
pre-deployments, deployment medical surveillance and also
post-deployment clinical care surveillance and readjustment
Those work groups have been set up. They have
just started to meet. So, it is very early in the process
to start talking about the specifics, but I think that we
have a number of individuals, who have experience with other
era veterans and I think that it is very clear that VA's
actions related to Gulf War veterans were implemented more
quickly, more effectively than they were for our response to
We have learned some valuable things from each
deployment and we recognize that we need to refine our
activities in all three areas, pre-deployment planning,
deployment, medical surveillance and also post-deployment
programs. So, we look favorably on the process.
DR. LASHOF: Thank you.
MS. NISHIMI: Dr. Murphy, you had mentioned one of
the hopes of VA's central office was that by training
individuals, who are already familiar with Gulf War
veterans, the coordinators from the medical centers, they
would return to their facilities and do additional training.
To what extent have you assessed that that, in
fact, has occurred?
DR. MURPHY: We have not done an assessment of
exactly how many training programs have gone on around the
country. So, I can't give you specifics on that.
MS. NISHIMI: Has VA's central office made it
explicit to these individuals who attended the conference
that there is an expectation that that is part of their
DR. MURPHY: We did that several times during the
conference and also in a follow-up conference call that was
held in August.
MS. NISHIMI: Then one sort of final question
related to that. Since the committee's final report had
noted that individuals who were familiar with Gulf War
veterans' illnesses were less the issue at VA medical
centers than individuals who were unfamiliar, do you have
any plans for a VA central office-driven training of non-
Gulf War specific personnel?
DR. MURPHY: I think it would be difficult to
implement an on-site conference because we have over 14,000
physicians, both part time and full time in the VA. That
would be a large effort. So, we chose to try first to use
the self-study guide, which gives an overview of a history
of the Gulf War, of the health care and compensation
programs that are available through VA and DOD and
summarizes the major published scientific literature that is
If we find that we still need to refine those
education efforts, we will look at other mechanisms, but I
think that it would -- if we need to, we can move to
regional training conferences and expanded on-sites,
regional, on training as necessary.
MS. NISHIMI: Okay. Thank you.
DR. LASHOF: Other questions? Art.
DR. CAPLAN: I wonder if you could comment for me,
as we again started off today, we have heard about
complaints from certain individuals who have had problems
with red tape or continuity of care being heard by the VA
and if this committee isn't in existence, there is not going
to be a place to go.
So, just for the record in the future, where if a
Gulf War veteran feels that they are not getting response
from the system, what is the ombudsman process or what is
the centralized office going to do to make sure that people
who are Gulf War veterans, who feel that they are not
getting the response that they want, can bring their
complaints and be heard?
DR. MURPHY: We have listened to Gulf War veterans
and some of the concerns and problems that they have
reported to you and to other oversight groups with accessing
the VA health care system. And in order to try to address
those issues and to improve our programs, we felt that we
needed to establish a mechanism for local medical centers
and networks to assess their own programs and to get input
from both veterans, veterans service organizations and the
patient representatives at each medical center.
We set up a program at each veterans integrated
service network. There are 22 of those networks around the
country and a SEAT Program or service evaluation and action
team was established. That team is chaired by the clinical
manager in each network and they have chosen team members
who are composed of patient representatives, Gulf War
coordinators and physicians, quality managers, top
management from the medical centers, veterans service
organizations, veterans representatives, veterans benefits
counselors. So, there is a broad range of expertise that
can be applied to Gulf War veterans health and benefits.
They are receiving input from our complaint
tracking system, from our customer satisfaction surveys and
a number of other mechanisms to monitor veterans, Gulf War
veterans, satisfaction with the care that is being delivered
and to try to identify any problems or trends in those
concerns among Gulf War veterans and then, hopefully, move
from that to some actions and recommendations that will,
hopefully, improve on a local level the implementation of
the national programs that we have set up.
We think that this is the most likely mechanism to
be able to address some of the problems that we have heard
about and we are enthusiastic that this has the greatest
chance of success. Those teams were just established in
March of this year. They provided us their first assessment
in June and are continuing their activities.
You know, as with any new organization or team,
they are just getting familiar with the issues and trying to
assess what are the major problems in their area. But they
are enthusiastic about their work and we think that it
certainly will improve access, continuity of care and
quality of health care at a local level.
DR. CAPLAN: And those team members at different
institutions around the country, their membership and so on
would be on the Internet and made available to veterans who
wanted to get in touch with them?
DR. MURPHY: They are not on the Internet at this
point. We have tried to do some outreach to inform veterans
about those activities and have encouraged, again, the local
network and medical centers to use a community-based
outreach program to let veterans know.
Internet is an interesting suggestion. We will
take that under consideration.
DR. LASHOF: Thank you.
Tom, do you have further questions?
MR. CROSS: Dr. Murphy, my concern in all of this,
because we have heard it time and time again, that when a
veteran, when a problem shows up, sometimes it is a hit or
miss scenario, whether or not he gets diagnosed properly or
whether he has to continually come back and fight the system
to see someone who may diagnose the problem.
Can you assure us that there is a system in the VA
where information is available to your doctors nationwide?
Do the people share the information? How do they do it?
What is the vehicle? Can you comment on that?
DR. MURPHY: There are a lot of mechanisms that we
have tried to use to keep VA physicians well-informed about
Gulf War veterans' illnesses. We have talked at length this
morning about the national training program and trying to
train trainers, who will take that knowledge back to their
local medical centers.
I think that is an important piece. But, in
addition, we do publish newsletters, which cover major new
developments in terms of scientific literature publications
and clinical issues and also the DOD reports that have been
We use national quarterly conference calls to
update physicians at the local level. We have pretty good
participation in those national conference calls with the
national satellite broadcasts on major topic areas related
to Gulf War veterans' illnesses, including the health
effects of chemical warfare agents, latest research updates,
conferences on chronic fatigue syndrome, diagnoses,
evaluation of patients with difficult to diagnose or
undiagnosed symptoms after their Gulf War service.
We have also used quarterly mailouts to our Gulf
War physicians as a means to make sure that they have access
to all of the latest articles and information available.
So, we have tried to use a number of vehicles because we
recognize that we all learn in different ways.
I think it has been a challenge to get the
attention and interest of health care providers, who don't
as a daily activity take care of Gulf War veterans. And we
are using the self-study guide to try to reach out to that
population of those primary care providers and
subspecialists within the VA system.
We would also be happy to provide that self-study
guide to other physicians outside the VA system as they are
MS. KNOX: Dr. Murphy, we talked earlier today
about means testing and just for the record, means testing
in the VA system. You may have received a letter if you are
a Persian Gulf veteran. They request information concerning
your salary and benefits before you receive care at the VA.
If you will just talk about what the record is.
Do Persian Gulf veterans need to fill out a means testing
DR. MURPHY: Well, means testing is really not
required for Persian Gulf veterans to access health care
within the VA system because they have a special eligibility
for health care. By legislative mandate, Persian Gulf
veterans can get outpatient and inpatient care within the VA
health care system if they have a medical condition that
could possibly be related to an exposure, environmental or
hazardous exposure, that occurred during the Gulf. It
doesn't need to be a cause and effect proof between the
medical condition or symptoms and that exposure, but just
the potential that it could have resulted.
So, in its broadest interpretation, we have
relatively good ability to provide Gulf War veterans with
health care. That health care can be provided at no cost to
the veteran. In some cases, some of the local medical
centers have sent out letters asking for income information
from Persian Gulf veterans. I have seen one example of that
and have looked into it and asked them to revise that letter
because, in fact, we don't want Gulf War veterans to have
the impression they will be asked for a co-pay for the
health care provided if they are eligible under priority
So, I think it is an important issue. We are
working with local medical centers. When we find they have
used confusing information or inappropriately means tested
individuals and we will continual to work on that with our
health administration service.
MS. KNOX: I think there is some confusion at the
VA that I work in and practice in concerning diagnostic
testing for veterans, who are undergoing C&P exams. Are
physicians allowed to order diagnostic testing for C&P
exams? Are they to evaluate that veteran as they come into
the facility without any diagnostic testing? Do you know
the answer to that?
DR. MURPHY: I am not sure that I entirely
understand the context of your question, but, yes, it would
be necessary to order diagnostic tests in order to complete
an adequate compensation and pension examination. Often,
what happens is that there are a series of appointments that
are set up and evaluations that are requested at the time
that the C&P exam is first scheduled.
In addition, if the C&P physician, the waiting
physician, finds that the veteran's symptoms are not
explained or may represent an undiagnosed illness, we have
made the recommendation that they go through an exam process
or use the clinical guidelines provided by the Phase 2 exams
to assure that a complete evaluation has been done.
So, further diagnostic testing is not only
possible, but recommended.
MS. KNOX: I will tell you that some of the
physicians are under the impression that they are just
essentially to do a physical assessment and not order any
diagnostic testing. So, I think there is some confusion at
some of the local VAs about C&P testing.
DR. MURPHY: We recognize that we need to improve
the education and expertise of some of our C&P physicians
also. We are working in conjunction with the office
primarily responsible for that to assure that Gulf War
veterans compensation and pension examinations are done in
the optimal way.
So, we hope that in the very near future we will
be able to improve on some of these problems that you
MS. KNOX: Lastly, for C&P exams, Persian Gulf
veterans are not to be charged for those exams nor is their
insurance to be billed. Is that correct?
DR. MURPHY: For compensation and pension exams?
MS. KNOX: Right.
DR. MURPHY: I don't believe so, no. Do you have
an example of --
MS. KNOX: Well, there are some who are being
charged for the diagnostic testing and I think that is an
error and I wanted to clarify that.
DR. MURPHY: If you could give me some specific
examples, I would like to be able to check through on, you
know, those cases, so that we can better understand exactly
what the circumstances are.
MS. KNOX: Okay.
DR. MURPHY: Absolutely.
DR. LASHOF: Let me follow up with one more issue
that came up in the discussion on the answers to the means
testing question. Veterans are eligible if it is considered
possible that it is related to their service. If they go
in, are examined and the physician makes a diagnosis of some
illness and says this is, you know, a common illness. It is
not related to your service in the Gulf, but the person
needs ongoing care, doesn't have health insurance, what is
the degree of means testing that they would then go through
and how do you deal with a veteran who says, well, but I
think it is related? How do we adjudicate those kinds of
DR. MURPHY: There is a local mechanism to assess
whether there is a possibility that it could be related and,
you know, we have recommended that people be very liberal in
the interpretation. For instance, we don't know the cause
of many common medical diagnoses and, therefore, there is a
potential that one of the toxic exposures that have been
possible during Gulf War service could have a relationship
to a broad range of illnesses.
Even when there is no medical proof that such an
exposure caused a Gulf War veteran's illnesses, if there is
a possibility, then we would expect care to be delivered.
If the physician feels strongly that it could not be related
to Gulf War service, then that needs to be recorded in the
medical record. An example of one situation that could
potentially result in that, if a Gulf War veteran walked
outside the hotel today, stepped off the curb and was hit by
an automobile and got a broken arm, it would be difficult in
most circumstances to say that that was related.
On the other hand, even some neurologic
rheumatologic GI conditions, where we can put a name on it,
but don't know the cause could potentially be related to an
exposure and we would, again, expect care to be delivered in
the VA at no cost to the veteran under those circumstances.
DR. LASHOF: Is that generally understood by the
physicians? Is that one of the problems of the argument
over people with diagnoses such as fibromyalgia and chronic
fatigue syndrome and they say, well, that is a diagnosed
illness. You don't fall into the category of undiagnosed.
DR. MURPHY: Well, again, the cause of
fibromyalgia, chronic fatigue and some of the other symptom
syndromes is unknown. And, you know, there is a potential
that an exposure could be related and, therefore, we would
expect, again, for Gulf War veterans to get health care in
our system under those circumstances.
We have tried, you know, to educate our physicians
about those regulations and also to have a good
understanding in our medical administration service staff at
the local medical center so that they understand when care
can be provided to Gulf War veterans at no cost and when
priority care or the special eligibility is relevant.
You know, when we hear about an individual veteran
who is having problems in that regard, central office
personnel will work with the local medical center staff in
correcting their misunderstanding and, hopefully, helping
that veteran get the care that they deserve and are entitled
DR. LASHOF: Your outreach has enabled you to let
the veterans know about the mechanism by which they can deal
with controversies of this sort?
DR. MURPHY: You know, we have tried to deal with
that through the newsletter and as necessary will do more
education and outreach to the veterans in that regard. It
is one of the areas that we focused on with some of our
community-based outreach programs to make veterans aware and
knowledgeable about what services are available to them
under VA and what mechanisms they have if they are having
problems, either with health care or the administration of
DR. LASHOF: Okay.
Art, one more and we will try to move on.
DR. CAPLAN: Just to follow up on this matter, it
seems to me imperative and I would urge you to try and get
VA to issue a clear statement about the liberal or general
policy on this matter, about complaints generated by service
in the Gulf. I mean, the committee has been looking for
some time now at this problem of causation and it remains a
difficult one, but it is not acceptable to leave veterans
fighting battles with doctors or gatekeepers to prove
causation or relationship of the symptoms and illnesses that
we all acknowledge exist to gain entry into the health care
I think a clear directive to the medical system of
the VA is in order about which way that system should be
leaning and leaning hard. There shouldn't be ambivalence
about that and you can't let the veterans hang while the
pursuit of causation goes on. It is simply not doing a
service to them.
So, it seems to me it is just crucial that that be
understood and that that information be out there not just
for veterans but for the people who work as the gatekeepers
in the system.
DR. MURPHY: We agree. VA is committed to provide
lifelong health care to veterans with potentially Gulf War-
related illnesses and one of the intents of the legislation,
which was supported very strongly by VA at the time for the
special eligibility was that there would be no pressure put
on the veteran to in any way have to prove a connection
between causation and an exposure.
We recognize that there has been some difficulty
in individual cases in implementing those policies and for
the committee's information, there is legislation, which VA
supports that would liberalize the language related to that
special eligibility and remove any reference to exposures.
I think that would go a long way towards addressing the
concerns that you have and making it easier for the medical
center personnel to provide the health care that Gulf War
veterans are eligible for.
MS. KNOX: Can you tell us what that legislation
is or what the bill is or --
DR. MURPHY: I can try to -- it is legislation
that is proposed but not yet passed. I have forgotten which
bill it is, but we can make sure our legislative affairs
staff provide that to the committee.
DR. LASHOF: Good. Thank you very much.
Let us move on now and ask Dr. Han Kang to join
you, Dr. Murphy, to discuss the VA's national health survey
at this point.
Agenda Item: VA's National Health Survey
DR. KANG: Good morning, Dr. Lashof, and members
of the committee. My name is Han Kang. I am the principal
investigator of the National Persian Gulf Health Survey and
their family members.
Almost three years ago, I present our plans for
conducting this study to the subcommittee of your bodies.
That must have been in October 1995. I am pleased to make a
progress report to you today.
I have a few viewgraphs. With your permission, I
would like to use that to aid my presentation.
DR. LASHOF: Please.
DR. KANG: In response to legislative mandate and
the NIH panel recommendation, VA has initiated a survey
entitled "National Health Survey of Persian Gulf War
Veterans and Their Family Members." The survey was designed
as a retrospective cost study in which the health of
population-based sample of 15,000 troops deployed into the
Persian Gulf is compared to those of 15,000 troops who are
not deployed in the Persian Gulf.
The survey is being conducted in three phases. In
Phase 1 of the study, an OMB-approved structure --
questionnaire was mailed to each of the 30,000 Persian Gulf
War era veterans, who were sampled for the survey. Up to
four follow-up mailings were sent to non-respondents to
increase the response rate in a six month period.
In the second phase, in Phase 2, telephone
interview on a sample of 8,000 non-respondents and the
review of medical records for 4,000 respondents is being
conducted. Through additional telephone interview with non-
respondents, we would like to assess the potential non-
respondent bias and through a review of the medical record,
we would like to assess the validity of self-reported health
In Phase 3, a sample of 1,000 Persian Gulf War
veterans and their family members and an equal number of
non-Persian Gulf War veterans and their family member will
be invited for physical examination.
Dr. Feussner will present a brief description of
the status of that physical examination study.
The primary purpose of the National Survey of
Persian Gulf War Veterans is to estimate and compare the
prevalence rates of health problems occurring among the
Persian Gulf veterans and their families to those of
respective non-Persian Gulf War veterans, as mandated by
Public Law 103-446.
The sample size of 15,000 veterans from deployed
troops and 15,000 non-deployed veteran control were
carefully chosen to provide adequate statistical power to
estimate the population prevalence and to compare specific
health conditions, which are considered important to detect.
During the Phase 2 of the survey, we choose to
validate the following health outcomes: clinic visit within
last one year; hospitalization within last one year;
pregnancy and birth outcomes, which include live birth,
preterm birth, low birth weight and still birth, and then
major birth defects among children born to Persian Gulf War
veterans and their control groups.
Table 1 describes the characteristics of those
15,000 selected among Persian Gulf War veterans and 15,000
selected among non-Persian -- a veteran control group. The
characteristics of two groups are almost identical. By
design, we oversample women. We oversample military
personnel, who serve in the unit National Guard and Reserve
unit. Twenty percent of study population is consist of
female. About 30 percent belong to minority groups. About
half of them are married at the time of deployment.
There is adequate representation from a different
branch of service, Air Force, Army and Marine and Navy. As
I say, we oversample individual who serve in National Guard
and Reserve units. And controls are almost mirror image of
our study groups, with respect to demographic and military
This is a little complicated flow chart just to
show you that the attempt we made to increase response rate
from our Phase 1 study; that is, the postal survey on 30,000
Persian Gulf War-era veterans. Because of the difficulty at
locating veterans, we used the service of the record
maintained by Defense Department, the IRS, taxpayer's
address, as well as a commercial company, which maintained
the credit records. So, we went through many different
combination of record search to come up with the best
response from the Phase 1 mail survey.
After three follow-up mailing response rate,
overall response rate is about 57 percent, which is expected
for the mail survey based on the large sample size. As you
can tell, there is a diminution return. After the first
mailing of the questionnaire, we got 31 percent response.
After the second mailing, we got 23 percent response and
after the third mailing, the response rate is only 12.6
The overall cumulative response rate is 53.7
percent, based on 30,000 entire sample, but about 1,700
letters have been returned undelivered repeatedly. So, if
you deduct that from your denominator, the response rate is
about 57 percent.
Because of the concern over non-respond bias, we
take a look at the characteristics of the respondent and
non-respondent with respect to sex, race, marital status and
rank and branch and unique components. There is no
difference by gender. Both mail and female responded in
equal proportions. Eighty percent of respondents are mail
and 20 percent of non-respondents are female. That is the
same for respondents and non-respondents and also same for
the Gulf veterans and control groups.
But there is some difference in the makeup of
race. It appears that the minority groups are not
responding as much as the other groups. The marital status,
again, the individuals who are married are responding better
than who are single. And with respect to rank, enlisted men
are not responding as much as officers. There is no
difference by branch of service.
With respect to unit component, it doesn't seem to
make a difference whether individual served in active unit
or National Guard or Reserve unit. They are responding in
Based on this analysis, we are now speculating
that the non-respondent -- the main reason for non-
respondent is our inability to locate the individual rather
than other characteristics, for example, the health status
of individuals. We should be able to further analyze that
speculation based on our Phase 2 telephone interview on
This is a flow chart of our Phase 2, the telephone
interview and medical records review process. Out of 16,000
respondents from Phase 1, we random sample 3,000
individuals. That is 1,500 from Persian Gulf groups and
1,500 from control groups.
Also, we plan to sample 1,000 from the 8,000
telephone interview subjects. Today, I am pleased to report
to you that almost 98 percent of individuals who are
selected agreed to the telephone interview because we have
to obtain information on providers. We need to know which
hospital a child was born, where he was hospitalized and so
on and so forth.
So, we conducted telephone interview on 98 percent
of 3,000 targeted populations. Of those interview, 92
percent agreed to give us consent so we can obtain their
medical records. Of those whom we have consent were able to
locate and retrieve about 80 percent of their records. So,
we are very pleased with the success of retrieving medical
records and obtaining the consent from veterans. Veterans
are cooperating very nicely. I thank you for that.
Of those 8,000 targeted telephone interview, today
we completed 3,600 telephone interview. We are still
conducting telephone interview on the remaining study
subjects. One of the difficulty is that, number one, those
8,000 selected are non-respondents. If you recall, I said
non-respondent status is mainly based on our inability to
locate the veterans. We have a very, very difficult time
finding their telephone numbers.
We have address -- for example, one veteran has 11
different addresses since they left Persian Gulf and then
they changed their address and telephone number that we had
three month ago. When we make a call today, that number is
already disconnected. So, we are putting in a lot of
efforts to trace those individuals and try to come up with
an accurate telephone number.
Once we obtain accurate telephone number, we are
able to complete the telephone interview on 84 percent of
the study subjects. So, with respect to both medical
records review and telephone interview, at this point it is
going on very well and we hope to complete our data
collection within the next five or six months.
Because study is still ongoing, I will not be able
to provide you with the data yet. Thank you very much.
DR. LASHOF: What do you think is your timetable
now for being able to analyze the questionnaires and the
telephone interviews, which are clearly important for the
non-respondents? What is your timetable for getting us data
that will be meaningful?
DR. KANG: We hope to complete the data collection
by December of this year and then we will spend the next
three or four months analyzing data and because we want to
combine the result from Phase 1 and supplement that with
result from Phase 2, so that our report has more credibility
than just reporting based on staff report. So, I am hoping
that by May or June of next year, we should be able to
report on the result of the -- at least this phase, Phase 1
and 2 results.
DR. LASHOF: Now, Phase 3 is the actual physical
DR. KANG: Phase 3 is actual physical --
DR. LASHOF: Where do you stand on getting that
DR. KANG: Okay. The rationale for the physical
examination is not only there is a chance of overreporting,
but there is also a chance of underreporting by veteran
because they are not aware of the health problems. For
example, if a person has hypertension, he may not know that
he has hypertension until actually being examined.
Also, there is indices that yet on diagnosis, so
that physical examination is necessary to complete the
picture on health status of the Persian Gulf War veterans.
I am sure Dr. Feussner will make a presentation on the
status of the protocol development and his plan on carrying
out that study. So, if you can just wait for a few more
minutes, Dr. Feussner will make that presentation.
DR. LASHOF: Okay.
Other questions from committee members. Mark.
MR. BROWN: Dr. Kang, have you had the opportunity
or your group had the opportunity to publish any of the
results from Phase 1 or a report on them or are we waiting
until the whole ball of wax is completed to get any
information out of the study?
DR. KANG: That is our current plan, to merge the
information from Phase 2 and then make a complete report on
MR. BROWN: So, we are waiting for the results?
DR. KANG: Right.
MR. BROWN: Are you satisfied that this response
rate of you said 50 --
DR. KANG: 57 percent.
MR. BROWN: -- 57 percent is going to be adequate
with a follow-up -- a telephone follow-up and so forth to
give meaningful results of what the status of our --
DR. KANG: That response rate of 57 percent is
either expected or better than expected based on, you know,
postal survey on large sample. It is a national sample
MR. BROWN: So, you are confident that the results
you will be able to generate will be meaningful?
DR. KANG: Right.
DR. LASHOF: Let me comment further on that. I
think that is why the Phase 2 is so essential because you
are looking at non-responders and you will be able to see
whether the non-responders have the same amount of illness
as the responders. I mean, it is -- if there is bias, it is
going to be bias towards over -- of the responders being
more ill than the non-responders. So, that telephone
interview of the non-responders becomes essential to
interpret the results that you will get from Phase 1.
DR. KANG: Absolutely. Not only we should be able
to look at the non-respondent bias, but also whether there
is a differential between Persian Gulf and non-Persian Gulf
veterans, outcome results. So, it is very crucial for us to
be able to incorporate that information as a part of the
DR. LASHOF: I think you can't look at Phase 1
without Phase 2 because the accuracy of Phase 1 is
questionable without the support of Phase 2.
Other questions? Robyn.
MS. NISHIMI: I am a little bit concerned about
the time lapse between the Phase 1/Phase 2 and then the
actual Phase 3 clinical examinations. My concern is the
difficulty in connecting those physical health exams back to
the results of the earlier phases. The difficulties
increase as the time increases.
How do you intend to address that problem?
DR. KANG: That is a difficulty. We wanted to do
Phase 1, 2, 3 in, you know, very short time frame but under
given circumstance that is not happening. But we are moving
ahead as fast as we can.
MS. NISHIMI: But how can you address that problem
in your analysis?
DR. KANG: Most of the health condition we are
concerned is the chronic health condition. So, the veteran
reported having, say, disease X. Since it is a chronic
condition, we can assume that if he has that condition, the
physician will be able to find that at the physical
examination. So, although in an ideal situation, you know,
we would like to do that in very short time span, but that
is not happening.
DR. LASHOF: The things that are blocking you, who
are we supposed to ask why -- what is the block? If not
you, Dr. Feussner or Dr. Murphy or who?
DR. TAYLOR: Lack of personnel?
DR. MURPHY: I think maybe you should address
those questions to Dr. Feussner.
DR. LASHOF: Dr. Feussner. Okay. We will save it
for when we come back.
DR. MURPHY: One of the ways that, you know, we
will be able to address some of the concerns that Dr.
Nishimi raised is also to reinterview as part of the history
taking with the physical examinations what the current
symptoms are and whether there has been any change in health
status. And the medical records will also help us identify
whether the conditions are chronic, acute or recurrent.
So, I think there are -- you know, while we would
have liked the study to move along more quickly and there
are still clear ways that we will be able to analyze the
DR. LASHOF: Okay. Any other questions for Dr.
Kang or Dr. Murphy?
DR. CAPLAN: Just one quick question. It may be
premature to hope that this study might be repeated five or
seven years out as a kind of monitoring, but since you have
had such trouble tracking down phone numbers and so on, can
you make any provision now to try and facilitate staying in
touch with people who are responders now in case you want to
get back to them later.
DR. KANG: For the respondents, we do ask them to
give us their relative or any other person that we may be
able to contact at a later time. So, we are collecting that
information; mother's name and address.
DR. LASHOF: Okay. Thank you very much.
We will take a break now and I think we will take
15 minutes and come back.
DR. LASHOF: We are going to proceed now through a
discussion of the implementation of the various research
issues. Dr. Feussner is going to do the major first
presentation. We are now to resume with a discussion of the
implementation of the research issues and I am very happy to
welcome Dr. John Feussner, Dr. Timothy Gerrity, Lieutenant
Colonel -- oops, he is not here. Okay. And we have asked
Dr. Han Kang and Dr. Murphy to stay on with this panel as
Dr. Feussner, I believe you will be presenting the
first major testimony.
Agenda Item: Implementation: Research Issues
DR. FEUSSNER: Thank you, Dr. Lashof.
Let me just say that I serve as the chief research
and development officer for the Department of Veterans
Affairs and also as the chairperson in the Persian Gulf
Research Working Group and have occupied both of these
responsibilities now for the past year.
Dr. Gerrity is my special assistant, focuses on a
few high priority research areas. This one, obviously,
being one of them. Dr. Gerrity has been involved in the
research issues relating to the Persian Gulf War since the
onset actually. Prior to coming to VA, Dr. Gerrity worked
for the EPA and was on the ground in Kuwait in 1991,
evaluating the oil fires and such.
This is my first opportunity to present to this
group. I should thank the President for extending your term
and providing me that opportunity. In all honesty, I
especially, perhaps because I am relatively new, I
especially, but the committee in general, I think, the
research working group, in general, appreciate your efforts
on behalf of Persian Gulf veterans.
Prior to today, you had a copy of my draft
testimony. The final testimony is very little changed, I
think, from the last draft that you had. You have asked
that I make a formal presentation on a series of issues and
I have organized -- if you could start with the overhead
transparencies and go to the next one, please -- I have
organized my presentation essentially along the lines of
information that you requested.
In lieu of reading my testimony, I am just going
to make the presentation. There are some details in the
testimony that I will not present in the interest of time.
So, to a degree, the formal presentation is an abridgement
of the official testimony.
The only bit of information I will add to my
presentation that you did not officially request is the
first matter, which is to take a few minutes to provide an
overview of the research working group and then to proceed
sequentially through the four questions you posed; that is,
the follow-up on the PAC recommendations; research that has
been funded this calendar year; research related to the
Khamisiyah demolitions and our current strategies in that
regard and then issues relating to the national survey,
especially folks, you know, in Phase 3.
You have already heard from Dr. Kang that the
analysis of the results of the national survey won't be
completed for some time.
Again, briefly, this provides you with a quick
overview of the organization of the research working group;
three major parties cooperating in this research effort, the
Department of Defense, Veterans Affairs and Health and Human
Services. In DOD, Health Affairs, Division of Defense
Research and Engineering, the Office of the Special
Assistant on Persian Gulf War illness are the major
participants. In VA, my office, Research and Development
Office, as well as Dr. Mader's(?) office, the Office of
Public Health and Environmental Hazards.
Then from HHS, the Office of the Assistant
Secretary, the National Center for Environmental Health in
CDC and the National Institute of Environmental Health
Sciences from the NIH. I apologize for all these
abbreviations. What I will systematically try to do is say
what they are and then -- but for brevity, you got them.
Again, a summary of our charge. It is a complex
and comprehensive charge, but this is a complex and
comprehensive problem as to assess the state direction of
the research. The second is to identify gaps in facts,
concepts, hypotheses and research approaches.
As you know, you have provided us fairly clear
guidance with regards to some of the pressing research
issues. Others have as well, including National Institutes
of Health, the Institute of Medicine of the National Academy
of Sciences, Defense Science Board, Congress and then we
have solicited input from a wide array of investigators,
both inside and outside of the government.
We are tasked with reviewing and developing these
developing research concepts. We do that. The vehicle we
use is the research working plan. We have submitted the
first revision of the research working plan early this year.
We view that as a dynamic document, not a static document to
be modified as new information becomes available; a perfect
example of that being the issue of low level chemical
warfare agent exposure in the Gulf.
To collect and disseminate research information,
the primary vehicle we use at the moment to do this is our
annual report to Congress. In that annual report, we track
research that we believe is relevant to this issue, whether
it is funded by the Federal Government or not, provide some
summary statements about the findings, the strengths and
weaknesses in an effort, again, to assemble and disseminate
the information and then to assure the appropriate peer
review and oversight of the research, we are absolutely and
unequivocally committed to the traditional scientific
process of peer review. That is actually an explicit policy
of the research working group.
As Yogi Bara has often said, you don't know -- if
you don't know where you are going, you might end up
somewhere else. I think it is important for us to keep in
mind what the guiding principles of this research working
group are. They are listed here. The focus is clearly on
research issues related to service in the Persian Gulf, but
also, again, as you know, to be responsible for a spectrum
of research, from basic biomedical research, looking at
issues of toxicology, to the more applied research that
would be involved with large scale epidemiological studies.
Peer review, as I mentioned, is a matter of
policy. Competition is mostly good. We think almost always
good. As you will see, when we present information on the
DOD BAAs and the VA RFPs, BAAs being the broad area
announcements soliciting research activities; the RFPs being
the request for proposals, doing essentially the same thing,
having different names perhaps to confuse everyone.
Coordination and cooperation go without saying.
It is very clear if we can -- the more successful we can be
in facilitating coordination and cooperation among these
three departments, we can't help but to enhance the overall
research efforts as it relates to the Persian Gulf War.
What I thought I would do after that overview --
that is all I was intending to give on an overview -- is to
go through in sequence the recommendations that the
presidential advisory committee has made and where we stand
in terms of our responsiveness to those recommendations.
I would hope that at the end of this presentation
you would be convinced that we have responded to all of
these recommendations, but you will have a chance to make
that judgment for yourself momentarily.
The first recommendation, 2-19, required that
public advisory committees be created for new large scale
epidemiology projects. We did that, initially recommending
to our investigators in VA, DOD, et cetera, that they
appoint such committees for studies that were ongoing and
then required that as an explicit requirement for any new
studies that would come up. We completed our compliance
with that recommendation in December of 1996 and believe
that compliance is a hundred percent.
Recommendation 2-20 dealt with the nettlesome
issue of knowing where the troops are in the midst of
fighting a war. I don't pretend to have any expertise in
that area, but the Department of Defense does. The
Department of Defense recalled their operations officers
from the Gulf War to refine some troop locations. They have
done some feasibility of this GPS, geographic positioning
system, in war exercises, I believe, that went on recently
in California. Additional details on this matter probably
should go to the DOD representatives, if you have questions.
The recommendations, 2-21 to 23, I have a series
of slides that deal with this. This is a complex issue that
deals with research going on with regards to low level
organophosphorus nerve agents. As you know, the sentinel
event stimulating this research was the DOD press release in
June of 1996.
The information on this overhead really reflects
our immediate response to that information. I would
emphasize the date of July of 1996, indicating that this was
an immediate response to this information. In a previous
solicitation, we had identified scientifically very credible
research activities that did not appear to be relevant to
the research mission because their focus was on low level
chemical weapons exposure.
That obviously changed, so that in addition to be
scientifically valid, they were now highly relevant. We
funded those three projects. After an urgent meeting of the
Persian Gulf Research Working Group, expenditure was $2.5
million on these. They are all animal research studies.
They deal with the toxicokinetics of nerve agents at low
exposures. The second deals with the role of genetic
expression of cholinesterase.
There is an interesting project. It really
addresses the question of whether or not there is extensive
genetic heterogeneity in the expression of cholinesterase,
such that the implication in human populations might be that
there are some subpopulations of people who are differently
A third study dealt with dosimetry of sulfur and
mustard agents. The investigators are exploring the ability
to see if we can make some assessments of exposures
retrospectively, again, using animal models.
This next series of slides really represents our
intermediate response to this information; that is, it
became clear that a significant research effort would have
to be mounted in response to this information. The research
working group collaborating with the U.S. Army Medical
Research and Materials Command developed a series of broad
area announcements that are listed here.
The first round of BAAs specifically dealt with
the feasibility of doing epidemiological research around the
Khamisiyah issue. As you know, part of the problem is
defining the exposure and the question is if you have a hard
time defining the exposure, can you do the epi research?
Hence, the desire for a feasibility study.
And then the second part of round one dealt with
animal toxicology issues for low level chemical exposures.
Round two of the BAAs dealt with risk factor research and a
broader spectrum of research, including both human and
animal research. Some of the issues focused on are listed
on the transparency. This round was quite different from
round one in that round two only non-government
investigators could submit for research support. Round
three then dealt with illnesses following war and an
exploration of their possible causes.
The next slide summarizes very briefly the actual
BAA peer review process for submitted applications. The
American Institute of Biological Sciences was tasked with
performing and organizing the scientific peer review. As
indicated here, they identified experts. The proposals were
rated on a score of 1 to 5, with 1 being perfect and 5 being
perfectly awful, and produced summary statements.
Unlike some of the intramural peer review process
in VA where applications are disapproved if they are
scientifically inadequate, in these circumstances, no
applications were disapproved. They were just given
increasingly poor scientific merit scores so that a -- int
he VA intramural program, a score of 5 would really lead to
a disapproval and no consideration of the project for
The results then from the peer review went to a
subcommittee of the research working group with
representatives from the three departments. Dr. Gerrity
chairs that subcommittee. The information on the reviews,
the quantitative information on the reviews and the priority
scores of reviews were evaluated. Then, in addition to
that, the specificity of the reviews to the solicitation and
the relevance of the research questions to the solicitation
were also considered.
We established a score of 3 or worse as a floor,
indicating proposals that were scientifically flawed, that
we would not be happy funding, with proposals above that
score being of sufficient scientific quality to merit
I appreciate the fact that choosing these
dimensions is somewhat arbitrary. We have tried to be
consistent throughout the process, however. Once we were
done with this process, we would then make recommendations.
In this particular case, since this is a BAA from DOD, make
recommendations for funding to DOD. Those recommendations
are shown on the next slide.
These are the summary statistics from the two
phases of the first round and the second round. We were
unhappy to receive no applications to investigate the
feasibility of epidemiological studies relating to the
Khamisiyah pit demolition.
As I will mention, we have engaged the medical
follow-up agent, the Institute of Medicine, to help us with
this matter and, again, as I will mention later, they have
submitted a proposal to do the same. With regards to the
chemical weapons agents, $2.8 million was committed for this
research; 22 applications were submitted; four were approved
and our intention is to fund those four.
Where we sit with this is that the DOD contracting
officers are negotiating with the investigators. Assuming
that nothing goes wrong, so far nothing has gone wrong,
these proposals will be funded. The priority score on the
right is a priority score for the entire 22 applications.
As you can see, they range from quite good to
quite bad. The second phase relates to hazard exposures;
$10 million committed for that effort. And you can follow
the numbers to see how the submissions and approvals go.
With regard to the number of applications
receiving approval scores in excess of 3, that is -- I am
sorry -- priority scores better than 3, about a third -- 3
or better -- about a third of the applications were approved
and about a fifth are to subsequently funded.
The next slide shows that seven of these to be
funded studies involve animal research and five human and
then you can see the array of exposures that are being
investigated; sarin, organo, peristamine bromide,
insecticides, vaccines, stress, et cetera, a broad array of
hazardous exposures, including chemical weapons issues.
The next slide really looks at very briefly more
of a long range perspective on this research problem. As
you know, as many of you know, issues around low level
exposures, regardless of the nature of the exposure, are
very difficult research questions when one is trying to
establish causal associations between exposures and
This first item here was our effort to not only
engage the research community in this country, but engage
the research community in the rest of the world to help us
with this issue of low level nerve agent exposure. We feel
that this is within the charge of the research working group
vis-a-vis identifying research gaps, generating new
hypotheses. We thought in that context to create -- to
sponsor a workshop on the health effects, specifically on
health effects of low level chemical warfare agent
As you can see, that workshop was held in March of
1997, in conjunction with the Society of Toxicology meeting
in Cincinnati. There is no question that this created a
forum for investigators around the world with expertise and
interest in this area to meet one another, to share ideas,
to present their work.
We had over 200 participating scientists,
scientists from Japan to Israel and most places in between
attended and in many cases presented their research. This
was a fairly spirited scientific meeting.
The last item on this really relates to our
ongoing efforts to develop a rationale long range research
strategy for low level exposure to nerve agents. These
agents are not new. Research in these agents has been going
on at least for the duration of this last half century, but
-- so, we are really proposing to do research around the
more difficult issues, which is the low lever exposures.
We have produced a draft. A preliminary draft of
this research strategy is being circulated. Within the
research working group we hope to have a draft, a final --
well, the penultimate draft available by next -- sometime
This relates to your recommendation to us to worry
about cancer in veterans, who served in the Persian Gulf.
That is a sensible recommendation, as you know. The
difficulty with implementing that recommendation at this
point in time is that many exposures have long latencies
between the time of the exposure and time the cancer is
That notwithstanding, we published -- Dr. Kang
published the first study that looked at mortality among
deployed and non-deployed Persian Gulf veterans. There were
no disease specific excess deaths. That is to say -- that
is not to say there wasn't cancer in both groups. There was
no difference essentially in the cancer rate between the
groups. The great advantage of this study is it really
provided some high quality information, created a database
that now can be used for future studies.
The limitation of the study, it really only looks
at mortality two years out. So, perhaps, it is not
surprising that there isn't any disease specific cancer
excess mortality. It may take a decade or better to answer
There is another two year look at this problem,
which will encompass deaths through 1995 and we hope to have
some preliminary information on that presented at the APHA
meeting, where we have a session on Persian Gulf research in
November of this year.
You asked us to follow veterans with imbedded
uranium. We are continuing the clinical follow-up of those
patients at the Baltimore VA Medical Center. In addition to
that, in addition to the follow-up of patients, veteran
patients, that have this stuff on board, the Armed Forces
Radiobiology Research Institute is pursuing animal research,
looking at the toxicology of this issue and is focusing
specifically on cancer, renal disease and reproductive
You asked that the Department of Defense collect
an archive sera. Essentially, my understanding is that the
Department of Defense agrees with that and this instruction
signed by the Secretary of Defense essentially indicates
I hope I am not going through these too quickly,
but I am sensitive the time constraints and you did make a
lot of recommendations.
Recommendation No. 2-24 reminded the research
working group to consult with other agencies. As I
mentioned, we do that. The VA, DOD, HHS expertise is a core
member of the research working group, representatives from
the EPA are also represented on the research working group.
And we also call on appropriate expertise when we need it on
an ad hoc basis.
For example, some of the recent research related
to leishmaniasis has been interesting and has caused us to
assemble investigators from not only VA, DOD and CDC, but
also individuals from the FDA, from the private research
sector, the corporate research sector, as well as public and
private universities. So, our sense is that as indicated in
our sponsoring of the international conference, that
whatever expertise exists certainly in the United States and
the rest of the planet is at our disposal and we are
inclined to use that expertise.
The next recommendation, 2-30, Dr. Murphy
commented on during her testimony, the presidential review
directive. As she indicated there are four working groups
that have been formed to address this recommendation. We in
VA specifically are responsible for the research piece. Dr.
Gerrity chairs that working group. We are trying to develop
strategies and should have something to the National Science
and Technology Council by December of this year.
With regard to Recommendation 3-1, this deals with
the cause and prevention of excess deaths due to external
causes among veterans. As you know, in the original
mortality study, there was some excess mortality in deployed
Persian Gulf veterans that was attributable to other causes,
accidents, et cetera.
This has been observed -- this slight increase in
mortality has been observed after previous wars. You asked
that VA follow up and see if we could elucidate some of the
reasons for that excess mortality. Dr. Kang in the
Environmental Epidemiology Service is tasked with doing
that. They have selected deployed and non-deployed veterans
from the mortality study, who died in auto accidents and are
using data from the Department of Transportation, fatal
accident reporting system to see if risk profiles, risk
factors can be identified and maybe some explanations
generated for why this slight excess mortality was observed.
The next one is Recommendation 3-2 about issues
related to musculoskeletal conditions. We have at least
four groups currently focusing on musculoskeletal diseases
in two dimensions; in the pain domain, primarily in the area
of fibromyalgia; in the fatigue domain, primarily in the
area of chronic fatigue syndrome. Several of our VA-funded
environmental hazard centers are specifically dealing with
As a matter of fact, yesterday morning, we had a
planning meeting involving experts from inside and outside
VA with expertise in both fibromyalgia and chronic fatigue
syndrome, to see if we can't plan a multi-site VA
cooperative study to assess whether currently available
therapies are actually effective in reducing the symptoms
and the disease burden for these patients.
The meeting actually went quite well. It was our
sense that we can, in fact, plan such a trial. Our
coordinating center at West Haven will be responsible for
coordinating the planning of the trial. That is going to go
forward. It usually takes us about six to twelve months to
plan a complex multi-site study such as this, even working
as fast as we can. Many of the issues in terms of
diagnosis, treatment strategies, outcome measures are
nettlesome, even with all the experts around the table. It
is an interesting task to gain consensus, but we will go
forward with this, but probably really won't have a research
defensible document until sometime late spring of 1998.
Recommendation 3-3 dealt with research on a
causes, preventions, treatment of stress-related disorders.
I understand that this is a contentious issue. I would tell
you that stress is a real biological phenomenon. I am sure
my heart rate is not at its usual 52 beats a minute as I sit
here talking with you and that has a lot to do with my
neuroendocrine homeostatic mechanisms.
But before I get to that, Part 4 of our broad area
of the BAA focused on causative factors for post-war
illnesses. Clearly, that includes stress as a cause of
illness or a modulator of illness expression. These
proposals were reviewed in the usual fashion that I
mentioned earlier and have been through the research working
group and we would expect them to be funded by December if
there are no logistical glitches.
The next slide summarizes what has happened to
date with this BAA, again, proceeding in the same fashion as
on the earlier tables; the number of dollars committed, the
number of proposals submitted, all of the approved proposals
representing human studies. And we expect them to be funded
by the end of the calendar year.
In addition to these DOD BAAs that come through
the research working group, as you know, Congress supports
formally a VA, DOD research collaboration. In the context
of that research collaboration, VA and DOD, myself and Dr.
Johnson Winiger(?) identify research priorities relevant to
both agencies. Clearly, stress-related disorder is one of
those. The VA, DOD jointly released an RFP, request for
proposals, for stress-related disorders. The focus of this
solicitation was to look at the neurobiology of stress.
For example, the role of neurotransmitters,
immunologic and neuroendocrine disregulation, as the stress
response, which is a normal physiological response, is
manifest, looking for -- if there are ways to characterize
any heritability or any potential markers that might be
associated with the control of the stress response;
biomedical measures, in addition to psychological measures,
for example, that might be able to identify subjects
especially at risk for accentuated stress responses.
Finally, we tasked the medical follow-up agency,
the Institute of Medicine, last fall to help us create a
research model for studying the exposure effects
relationships with regards to stress. The medical follow-up
agency has been working on that task over the past year. We
expect to see their proposal by the end of this month.
Actually postponed our meeting because of scheduling
conflicts this week.
The next slide discusses research on the same
issue, on stress-related disorders. I just wanted to be
sure that you are aware of some other activities going on in
the Department of Veterans Affairs. The first is a VA-
funded multi-center diagnostic study looking to create much
more portable and efficient computerized neuropsychological
This study was originally funded in the fall of
1996. It was delayed because we facilitated a sabbatical
for our investigator to go to Europe to help collaboration
on Persian Gulf research issues with our European
colleagues. She has returned recently. The study is ready
The second is in the summer of 1996, I funded the
what I believe is the first large scale treatment trial of
post traumatic stress disorder. This is a treatment trial.
The principal investigator is out of White River Junction,
New Hampshire. It focuses on war zone-related PTSD. The
study sample includes 360 patients. It is a traditional
two-arm parallel designed trial. Patients get treatment A
versus treatment B. No patient gets no treatment.
The treatment, the intense treatment is a trauma-
based focus group therapy, a much more intensive effort to
control and ameliorate symptoms, symptoms from this illness
or the outcome measure.
Then, finally, given the success of this treatment
trial, the single treatment trial of PTSD, we released a
program announcement asking for additional ideas about
additional treatment trials for PTSD. We asked
investigators to think about special populations. Just like
the first trial dealt with war zone-related PTSD of special
populations, we mentioned in our program announcement, were
women veterans, Persian Gulf veterans and the so-called
This program announcement is a relatively new
solicitation. The difference between program announcement
and RFPs or BAAs is that the latter has deadlines you have
to meet. The former announces this as a priority research
area and the deadline for submitting ideas for research is
open. That is, there is no deadline.
To date, this RFA hasn't been out very long, a
little over a month. To date, we have had 35 separate
inquiries from 35 different investigator teams. I am not
sure where this is going to go, except to say that we will
be doing a lot more research on this in the future than we
have done on this in the past.
You asked HHS to make public education on this
mind/body link a priority. Again, the notion that somehow
the mind is separate from the body is a -- as a physician,
is kind of a non-starter, but it seems that that perception
in our general society is that somehow stress and stress-
related diseases are not acceptable. That is very
unfortunate. You suggested we try to work on that. We are.
HHS has a plan, I think. It is a surgeon
general's report essentially dealing with mental health that
should be ready for dissemination in year 1999 to 2000.
Recommendations 3-4 to 7 deal with the issue of
what we intend to do with data from spouses and children's
program in a research mode. That is a problematic issue
because these data really are registry data as self-
selected, self-motivated volunteer data has very limited
research applications. We are working on this. Also
working -- Dr. Murphy may be able to say better about
matters related to travel and expense for reimbursements for
spouses and children. We can talk about this a little
better in a specific context with Phase 3, but I think your
recommendation was a much more general context than the
Phase 3 survey.
Next recommendation -- the same recommendation
dealt with the fact that the government should consider
routinely sampling military for reproductive health
outcomes. The San Diego Naval Health Research Center is
working on the feasibility of this, trying to develop plans
for the data and personnel requirements and how this would
flow logistically. I don't believe that this has been
accomplished as yet, but there may be more information
provided about this this afternoon.
The last recommendation on the next slide,
Recommendation 4-1 was technically not a recommendation, but
it is good to be prudent and your comments were certainly
well-taken about the low level chemical warfare exposure
issue and the persistence with regards to potential
infectious etiologies. We quite agree with your admonition
to be prudent in this area.
I have talked briefly about our expanding research
portfolio on the effects of low level chemical exposure.
The next slide shows a bit of the ongoing research,
specifically related to L.tropica. We are working -- this
is a DOD-funded project out of the BAA, working to develop
serological tests for L.tropica. This is a very difficult
issue. There are no credible serological tests for this
infection at the moment. There is some preliminary research
going on, as I mentioned, at the University of Washington.
There are some skin testing, diagnostic testing
being developed primarily at Walter Reed and then some of
our investigators at the Portland Environmental Hazards
Research Center are collaborating with the University of
Washington investigators in a case control study, seeing if
we can actually use some of these test serologies.
The next slide, this, I guess, is getting a little
technical. I apologize for that. I will try to go through
One of the issues in developing new diagnostic
technologies is how you know if a patient has the infection
or not. In this case, of leishmaniasis, that is not quite
as easy as you might think. What the research working group
has decided to do, since we are making some modicum of
progress in creating or since the scientific community is
having some modicum of success working up new serologies, is
create an explicit serum panel against which these new tests
as they are developed can be tested so we can get some
relatively objective information about what the operating
characteristics of these new diagnostic tests are likely to
be and then, of course, the CDC has issued an RFA for new
The final thing that I want to comment on, again,
is not something you specifically tasked the research
working group with, but in a way, indirectly, I believe you
did and that is encouraged us to remember that infectious
problems and novel infectious exposures are likely to be
future problems. In that context, again, using the modality
of the VA, the congressionally-funded VA, DOD research
collaboration, in collaboration with Dr. Winiger at DOD, we
put together an RFA specifically focusing on problems of
emerging pathogens, new organisms that we are going to be
hearing about in the future.
This LOI went out -- again, I should say maybe
very tangentially that the way this collaboration works with
DOD is that DOD and VA, the research leadership agree
mutually on research priority. We convene committees,
review committees, that are co-chaired by a DOD and a VA
investigator. These RFPs, both VA and DOD investigators can
apply and the review is done jointly by VA and DOD. This
really is a research collaboration.
In response to this initial LOI on emerging
pathogens, we had 160 letters of intent, of which we
encourage 60 full applications. The review of those
applications is going on now. We would hope to fund in the
ball park of 20 projects out of this. We initially agreed
to invest about $3.2 million in this research area. Because
the response has been so intense, we have doubled the
I think this really does put us in a position
perhaps to be a little more anticipatory about future
infectious etiologies at any rate.
Now I am ready for the next one.
The next question -- that was the first question,
but remember there are only four and this gets progressively
shorter because there is some redundancy built in.
This issue asked for research that was funded
since December of 1996. Much of what I have been talking
about for the past 30 minutes has been new research funded
since December of 1996. I just wanted to summarize it for
you on these next two slides. The first is the DOD BAAs,
which we believe will produce approximately 15 new research
projects in the areas that I showed.
The joint VA-DOD RFAs on the neurobiology of
stress and emerging pathogens, we would expect about 30 new
research proposals to come out of this. And then the PTSD
diagnostic test, diagnostic study, the treatment trial,
possible additional PTSD treatment trials and then the
planning for the fibromyalgia chronic fatigue trial, on
balance, in the ball park of 50 additional research projects
that will be coming on board very soon.
I also wanted to remind you that VA has funded
three environmental hazards research centers. We have four
but there is one new one. That is what I wanted to show you
on this slide. In the past, VA has funded three
environmental hazards research centers specifically focusing
on many of the issues that we have been discussing.
We have added to that a fourth center through the
competitive peer review process; I might add, an intensely
competitive peer review process. That center is located at
the Louisville VA Medical Center. It is just coming up to
speed and its focus will be on hazards as they relate to
reproductive health issues.
The CDC has an RFA for two new cooperative studies
that this review process has gone on. Funding decisions for
these two new studies ought to be made momentarily, probably
by the end of the month anyway. And then our collaboration
in several domains with the medical follow-up agency, I
mentioned the Khamisiyah, one. This is a different issue
relating to potential chemical weapons exposure from the
I believe this summarizes -- these two slides
summarize effectively the research effort that has gone on
over the past nine to twelve months.
The next issue is one that you will hear a great
deal more about this afternoon. Keep in mind that
essentially all the low level chemical research activities
that have gone on in the context of the research working
group have been stimulated by the information made public
about the potential exposures with Khamisiyah.
In addition to those, our research efforts, the
Official of Special Assistant in Gulf War Illnesses has
commissioned additional studies that are in the process of
proposal development. One is a request to the medical
follow-up agency dealing with the feasibility of doing an
epi study with regards to the Khamisiyah exposure, using the
That proposal has been reviewed by the AIBS.
There are some revisions that will have to be made to that
proposal and that is ongoing now by the medical follow-up
Then the second issue has to deal with the
activities at the San Diego Naval Research Health Center,
looking to develop research protocols that use existing
databases. There are databases about mortality -- a large
database about mortality, about hospital use, birth
outcomes. And can these databases be used to inform
outcomes issues for soldiers that were potentially exposed
under this plume versus those that were not?
My last few slides, two or three slides, deal with
the National Survey of Persian Gulf Veterans. Dr. Kang
presented you the research methods involved in Phase 1 and
Phase 2. You should remind yourselves that Phase 1 and
Phase 2 were surveys, mail and telephone surveys.
Phase 3, the level of complexity in Phase 3 steps
up rather dramatically because we are not just talking to
people now or asking them to answer questions. We are
actually bringing them in, examining them, examining their
spouses, examining their children.
Dr. Kang from the Environmental Epi Service and
Dr. William Henderson, who is the chief of our cooperative
studies coordinating center in Chicago, are two of the
primary proponents as we have developed a Phase 3 research
protocol. A complete draft of the Phase 3 research protocol
is on my desk. An incomplete draft is in my briefcase, but
the research protocol, shall we say, is fairly fresh.
The next slide shows the primary hypotheses that
are being -- that is our intention to investigate in Phase
3, looking at differences between deployed and non-deployed
veterans who served in the Persian Gulf, looking at such
issues as fibromyalgia, chronic fatigue, post traumatic
stress disorder, neurological abnormalities, both peripheral
and central, and measures of general health, both physical
The next slide shows some of the secondary
hypotheses, not to imply -- the researchers among you know
that this doesn't imply that these are of secondary
importance. What it implies is a statistical power to
detect small differences is far greater for the primary
hypotheses than for the secondary hypotheses. But, again,
looking at issues, other illnesses, arthritis, hypertension,
respiratory complaints, looking at the difference in
prevalence of the above conditions in spouses of deployed
versus non-deployed veterans and looking for differences in
major birth defects in children conceived after the Gulf
War, again, in the context of these two groups.
The final slide that I wanted to show deals with
some of the intended logistics of the Phase 3 study. We
believe that it will take approximately 15 collaborating VA
medical centers to get us the patient samples that we
require to address these hypotheses rigorously.
We would intend to study a thousand deployed and a
thousand non-deployed Gulf War veterans and their family.
The final sample size for this observational study should be
in the ball park of about 5,000. We really don't anticipate
any actual patient intake for Phase 3 beginning until
sometime early 1998.
I hope that -- it was my intention in this
presentation -- you gave me 40 minutes. I apologize for
talking at 70 miles an hour, but I gave it to you in 40
minutes. It really summarizes what in my view is a
significant, complex, carefully directed research effort. I
wish I could also give you all the research answers. As you
know, if the questions were straightforward and if the
questions were simple, research wouldn't be needed. We
would already know the answers and already be acting upon
I know we have time for questions. There are
members at the table and members in the audience who are
expert in -- more expert in many of these areas than I am
and I hope you don't mind if I defer to their expertise in
answering your questions.
DR. LASHOF: Thank you very much, Dr. Feussner.
That is really a very comprehensive review. Frankly, I
think it gives a big, rather good picture of the extent of
our recommendations, which I think were thorough and
comprehensive. And I think you have been very responsive to
those recommendations and that this is an excellent research
portfolio designed to address many of the issues we have
As we go through the questions, you may ask -- you
may call upon whomever you wish to address them.
DR. FEUSSNER: Thank you.
DR. LASHOF: I would like to ask you a few things
about the broad agency announcement and the ones on the CW
agents and the exposures. Unfortunately, these
transparencies aren't numbered, so I can't say, well, if we
go to transparency number something or other, but in one of
the tables you say on CW agents, there are four animal
studies going to be looked at and you present sarin/PB/ and
then underneath insecticide/heat.
My question specifically there is are we looking
at synergistic effects between different agents or is this
-- we are looking at sarin. We are looking at PB. We are
looking at insecticides. We are looking at heat. Are we
talking about we are -- we have studies that are
specifically addressing the possible synergy between those
two or interactivity, if you will, if not synergy?
DR. FEUSSNER: Dr. Gerrity chaired that -- our
research working group subcommittee. I think I will ask Tim
to address that question.
DR. LASHOF: By all means, go ahead.
DR. GERRITY: Dr. Lashof, in both cases of the CW
agents, as well as with respect to the more general
hazardous exposures, those are studies that are looking at
interactions, as well as the compounds alone.
DR. LASHOF: They are doing them both?
DR. GERRITY: They are doing both.
DR. LASHOF: Can you give me an idea -- you have
got four animal and you have five human and three animal --
what the balance is? How many are going to be individual
versus how many are dealing with interactivity?
DR. GERRITY: I can provide you with precise
detail of that later, but to the best of my recollection,
all of them are interaction studies.
DR. LASHOF: Okay. Fine.
My next question along this line is that the next
line actually talks about the workshop you have held
involving 200 participating scientists and international
panel and so on and your efforts to develop a strategy for
effects of low level exposure in nerve agents and your
internal review and then the external review should be
completed by October of 1997.
So, maybe you won't be able to answer this
question at this point, but from that kind of an extensive
review, pulling in the best people we have, do you get a
sense that there is a great deal more research that needs to
be done that isn't funded at this point and that you would
need additional funding to do? Or are you satisfied from
what you are funding and what you are coming up with in this
strategy that this is probably -- we never say everything is
sufficient in research. I don't know a researcher anywhere
in the world who will say they have done sufficient research
on any question.
But within the realm of prudence and scientific
ability, what is your assessment of how far along we are in
being able to have these researches funded and answer the
major questions we are trying to address and at what point
would you need to say, heaven's, we are going to need to do
a lot more because there is x, y, z out there? You get the
gist of what I am after.
DR. GERRITY: There are two specific areas that we
are identifying tentatively right now as areas of need for
additional research and they are somewhat interconnected.
The first one is in the area of toxicokinetics, of
organophosphorus nerve agents. We feel that there is
insufficient knowledge of the behavior of sarin once it
enters the body at very low concentrations that would enable
us to do the sorts of extrapolations that we may be required
to do between animal and human when we look at the animal
Connected to that is that one of the
recommendations of the research working group and the
working plan was for the development of biomarkers and we
feel that there is a need to develop biomarkers for exposure
to organophosphorus nerve agents so that in the future, we
would be able to do retrospective looks at populations that
may have been exposed and actually try to ascertain that
There has been some modest progress along those
lines from the group in The Netherlands, but we think more
can be done.
DR. LASHOF: In your work in identifying these and
your whole approach, which certainly is one that we have
reviewed in the past, your process for peer review, et
cetera, do you -- are there any areas at this point that you
see the need to go outside of the peer review or competitive
or an RFP or BAA process for identifying researchers and
DR. FEUSSNER: I actually think there is a very
short answer to that question and the short answer to that
question is "no." I don't -- at least in all of the
research that we have looked at in this whole area, it
hasn't come to our attention that there are research issues
that are so novel, so promising, et cetera, that they
couldn't benefit from the traditional peer review process,
not just in the context of getting the best science, but
with regards to human studies, also in the context of
protecting human subjects.
So, I would say the answer to that question --
short answer to that question is "no." As I said earlier in
my presentation, that the research working group as a matter
of policy has emphasized, stressed repeatedly the benefits
of and need for going through and being responsive to the
peer review process.
You could argue that even -- you could argue that
the peer review process, while the best mechanism we have,
is imperfect, but even with an imperfect peer review
process, there are opportunities to revise and resubmit
projects. There are opportunities to appeal decisions that
have been created or decisions that have been made in the
peer review process.
So, I think having those opportunities available
negates the need for going outside that process.
DR. MURPHY: I think there is one exception to
that and that would be when there is a significant public
health concern and I think the CDC Pennsylvania study is a
very good example of an issue where there was a potential
for a contagious or infectious illness and we asked for a
quick response. When that kind of public health concern
arises, there might be a need to go outside the usual peer
DR. LASHOF: That is usually an epidemiologic
investigation or a disease investigation.
DR. MURPHY: That is correct.
DR. LASHOF: Rather than a research. So,
obviously, there are many times in public health where we
have to do a very quick and deliberate field investigation.
That doesn't fall under research in that sense and certainly
is not peer reviewed.
I think there are also times when there are very
specific questions and if you haven't gotten proposals in,
that you may want to do directed research toward, but I
don't know of any time that even when you do that, that you
need to go beyond peer review, that that still should be
DR. FEUSSNER: I think that I would like to
respond to that the way I frame that in my own mind. When
we have -- when we announce or request applications and get
none, that puts us in a bit of a bind because we feel that
the research is a priority and nobody is volunteering to
help us do it.
I put that under the rubric of competition, that
we are out there competitively trying to identify the
highest science. Even if we go in a directed mode and say,
okay, we have no -- the competition hasn't produced any
products so now we have to develop a research proposal.
Even for the situation where we have done that with the
Khamisiyah epi study with a medical follow-up agency, we
have asked them to prepare a proposal. They have. That
proposal has been submitted to peer review.
Some clarification and revisions were requested.
Quite frankly, I think what will happen in that is -- what
usually happens in the peer review process is the final
protocol will be better than the original protocol and will
advantage itself from the peer review process.
So, we are still able to have peer review, but in
that circumstance, we really weren't able to compete the
idea for the best science because nobody responded to the
DR. LASHOF: I concur.
I note that although witnesses at this point are
from the VA and that this has been VA policy and you have
spoken for the research working group, which does include
DOD, but is Craig Lebo here? Oh. Would you come forward,
please. We expect you to be part of this panel.
Could you address DOD's approach to this same
question, which Dr. Feussner just answered?
MR. LEBO: I really don't think I can add anything
to what Dr. Feussner said. The DOD perspective on the
conduct of research has been to do it through a competitive
process and the peer review process has served the DOD and
specifically the Army in executing that very well.
I think specifically as reported here are more
evidence of the same, that the competitive process has
DR. LASHOF: Has DOD funded anything outside of
competitive without a peer review?
MR. LEBO: Ever?
DR. LASHOF: Currently, now, around Gulf War and
specifically around chemical or any other aspect of this.
MR. LEBO: Not that I am aware of, no, ma'am.
DR. LASHOF: Not that you are aware of. Is there
anyone who is aware of any such? Dr. Feussner.
DR. FEUSSNER: If I could just clarify that, in my
testimony I commented on a legislatively mandated project
that the DOD funded, that did not avail itself of the usual
peer review mechanisms, but that is a legislatively mandated
DR. LASHOF: Could you describe that one for me
and tell me -- or DOD or whoever, which one of the
legislative mandate that was? I mean, I remember that there
was one around infectious and it was denied for a long time
because although it was legislatively mandated, we did
require or the research working group required that there be
a review panel -- subjects review panel and that once a
protocol passed that, you could fund it, but you weren't
going to fund something that didn't pass a human subjects
Is that the one you are referring to or are there
DR. FEUSSNER: Yes, that is the one I am referring
DR. LASHOF: Okay. And that now has passed the
human subjects review panel and is now being funded? What
is the status of that? Maybe you could describe that one.
DR. GERRITY: That study has passed two IRBs to
separate institutions that are participating in the study.
We, the research working group, despite the fact that it is
external to our normally desired and required processes, we
are monitoring that protocol as it moves forward.
DR. LASHOF: Okay. Are there other questions?
DR. TAYLOR: I just wanted to get clarification
regarding the studies that have been approved. The listing
that is in the back, I guess, under Section -- Tab 4, does
that list all of the studies that are ongoing that have been
approved? Pages 30 -- I guess in the very back, 36 --
DR. FEUSSNER: I believe that that is the annual
report to Congress and all of those projects are funded,
ongoing, et cetera.
DR. TAYLOR: Are there any additions to that list
that we don't have?
DR. FEUSSNER: Yes. Basically, this report was
prepared for Congress early in 1997. It essentially
includes nothing of what I presented to you today.
DR. TAYLOR: Okay. That is what I was trying to
get clarification on.
DR. FEUSSNER: So that roughly the additional 50
projects that we have gone through with the BAAs, the RFPs,
et cetera, are not part of that document yet.
DR. LASHOF: So, we have all this, plus 50?
DR. FEUSSNER: That is correct. Approximately 50.
DR. TAYLOR: And will there be a listing somewhere
of those universities and who received the funding?
DR. FEUSSNER: Yes. What we will do with this is
we prepare this report annually and, so, I think it is due
again in the winter and at that point, funding decisions on
many of these projects will have been made. And as that
happens, these projects will be included in that document
and that document will be updated.
DR. TAYLOR: In the winter, sometime this year or
the beginning of next year?
DR. FEUSSNER: Yes. Probably the beginning of
DR. GERRITY: But I would say that it is highly
likely that there will be a public announcement when the
contracting process is complete and has been set for rounds
1 and 2, the BAA awards are expected to be made by the end
of this month and for round 3 -- and Craig can correct me on
this if I misspeak -- that for round 3, awards are expected
sometime in late calendar year 1997. So, I would anticipate
there would be some public announcement about that.
DR. LASHOF: Other questions?
DR. CASSELLS: You talked about areas of possible
expansion of research related to low level exposures to
chemical weapons. In the response to the BAAs that have
come in so far, are there any other areas, other than low
level exposures where more emphasis on research might be
appropriate? Have you noticed any gaps that haven't been
DR. FEUSSNER: The items in response to Dr.
Lashof's question, the items that were mentioned about the
toxicology of low level exposures, several of those issues,
I think, would benefit from additional research. There is a
huge body of research dealing with these nerve agents, much
of it dating back to the fifties and earlier. However --
and Dr. Gerrity will correct me if I misspeak -- there is
not a huge body of information about low level exposures and
likely disease or patient outcomes from low level exposures.
But as you know, as the exposure gets low,
especially at a threshold below any symptomatology, it gets
very difficult to assess and measure the exposure and
because of that problem, it then gets very difficult to
attribute outcomes disease -- causal disease outcomes. I
think one of the reasons that the research is focusing on
animal models is that they can purposefully be exposed to
low levels and then studied and then we will see if --
tentatively make some inferences about what might or might
not be happening in the human condition related to the
experiments in animal models.
DR. BALDESCHWIELER: I have several questions on
your low level exposure work. First of all, in the animal
studies, can you tell us what animals and, in particular,
what you are assaying for; that is, what effects are you
DR. FEUSSNER: Tim is going to address that
question as best his recollection will allow. We could
provide you a fair amount of additional detail in a readily
digestible form in terms of abstracts, et cetera, especially
easier to do after final decisions have been made about the
funding of these, but generally I am going to rely on Tim's
DR. BALDESCHWIELER: This is a particularly
important issue as to what you look for because you only
find what you look for, of course.
DR. GERRITY: I agree with Jack on the one point
and that is that we do want to be cautious about talking in
great specifics about individual protocols because the
negotiations haven't been complete and we don't want to
suggest to anyone that we are going to go forward when those
negotiations aren't complete.
But that is a good way also to hide the fact that
I am not -- I don't have at my fingertips all the details
about these and we will provide this committee with those
details very shortly I would say and you will be able to see
that at that time.
I can just briefly say that the animals that --
and vaguely that the animals cover lower and higher
DR. BALDESCHWIELER: And just roughly the kinds of
things that you will be assaying for?
DR. GERRITY: There are neurophysiological
outcomes, neuropathological outcomes, both central and
DR. BALDESCHWIELER: Your chart shows that you
will be doing five human studies and I wondered if you could
give us some feeling for that. Will these be human
volunteers exposed to low levels of --
DR. GERRITY: None of those involve that type of
exposure. These are primarily human epidemiology exposures
-- I mean, human epidemiological studies and not studies
involving controlled exposures.
DR. BALDESCHWIELER: And then finally, your March
1997 workshop involved a large number of presentations. I
wonder, were there any useful human data, for example, from
occupational exposures that were new?
DR. GERRITY: I would probably say the one new
piece of information that was provided to this workshop came
from a presentation by a Japanese investigator, who was
looking at a very small group of individuals who had
experienced moderate symptomatic responses to the Tokyo
subway accident and was following these individuals up at a
six to eight month follow-up period of time.
One paper coming out of that work is in press and
another paper has been submitted for publication. These
studies looked at neurobehavioral, neurophysiological and
psychological outcome measures.
I hesitate, because I am not one of the
investigators, to talk about that because I don't want to
jeopardize publication of these papers.
DR. LASHOF: Rolando.
MR. RIOS: I have got more of a general question.
If we had known about the low level exposures,
say, soon after they occurred, say, in 1992 or 1991, would
we be able to -- what would be in the research? In other
words, would we be able to tell the veterans or give them
more information or be able to respond to their question as
to what is wrong with me?
DR. FEUSSNER: Well, you are asking a very
difficult "what if" question. I would have to say that if
we were aware of the exposures sooner, we would have acted
sooner in creating a research agenda and a panoply of
research projects to address this.
So that would we be farther ahead? Maybe. It
really would -- much of that research would probably not be
human research. Even if we had known earlier, fundamental
issues of potential exposure, who might have been exposed or
might not have been exposed, where people were, those basic
issues would still be nettlesome problems.
In order to say that the patient has a clinical
problem or disease x as a result of exposure would have
required that we know that those potential exposures
Now, as a clinical epidemiologist myself, I kind
of feel like the closer you get me to the sentinel event,
the more likely I am to find information and data that might
clarify the situation.
MR. RIOS: For example, like you mentioned the
issue of defining exposure. Is it possible that trying to
define exposure five years after the fact, is the research
compromised to the point where, you know, we have lost some
very important information?
MS. KNOX: [Comment off microphone.]
DR. FEUSSNER: There is no question that the
problem of defining the exposure, the multiplicity of
exposures, the intensity and duration of exposures severely
compromises one's ability as an investigator to make
inferences about a causal relationship between the exposure
and the outcome. It is possible that if information was
known a week, a month, a year after the event, that it would
have been easier to find data, easier to find records, et
I think the problem, however, that would not be
ameliorated by time is the ability to know if an exposure
occurred or not or the ability to say with confidence that
you were exposed or you were not exposed because I can
measure these variables.
The question you asked is a very difficult
MR. RIOS: See, if a veteran asks me, well -- if
he says I am sick. I feel sick. I am ill. Why is there no
answer? Am I being honest or am I correct in saying, well,
to some extent we don't know the answer because the
government was very slow in coming out with the information
as to what you were exposed to? Is that correct?
DR. MURPHY: I think it is very difficult often to
assess what causes a particular disease. And I think one of
the best examples is, you know, we started a war on cancer
many years ago and we still don't know the cause of most of
the human cancers that exist. We can often do very well in
diagnosis and treatment without actually being able to link
a particular exposure or a particular cause with that
MR. RIOS: No, I understand. I just want to make
sure that if I answer it that way, I am being honest.
DR. MURPHY: I think those are the kinds of
difficulties that we are going to have in answering
veterans' questions for a long time in the future.
DR. FEUSSNER: Maybe I could -- I don't like
answering questions in the negative but in this case I would
say having the delay certainly did not facilitate the
MR. RIOS: If I said it compromised the research
-- or am I going too far?
DR. FEUSSNER: Well, it is always easier in 20/20
hindsight to know what might have been. I think under the
best of circumstances, it is very difficult to know who was
exposed, where people were, et cetera. I do not believe
that we would be dramatically enlightened about this problem
if we had known about it two or three or four years later.
One of the comments that was made, quite frankly,
at the international conference is some of the investigators
told us off the record that they would be flabbergasted if
we are able to shed new light on these agents that have been
studied and investigated for 50 years. Our response to
that, of course, is, well, sometimes you don't find if you
don't look. And folks haven't looked hard at the low level
issues and the scientific technology has improved a bit over
the past half decade. So, just because we didn't find it
before doesn't mean we are going to find it now.
The other side to that coin is just because we are
looking for it now with more sophisticated science doesn't
guarantee that we are going to shed a whole lot of new light
on this issue either. I think what is important and the
point that you made is that we look hard rather than assume
anything, especially in the context of the previous history
and perhaps also especially in the context of the future
I mean, the information -- we are awaiting the
publications from the Japanese on the civilian exposures to
low level -- to these chemical weapons. Perhaps that kind
of threat further validates the research efforts and
research dollars that are being expended now.
DR. LASHOF: Other questions?
DR. HAMBURG: You mentioned in your presentation
genetics in a couple of places, one in relation to the
cholinesterases and another in relation to neurobiology
distress. If I understood you correctly, you were getting
at the problem of differential susceptibility. With the
profound developments in genetics, it does raise in relation
to almost all these issues the possibility of clarifying
differential susceptibility questions.
Could you say just a little bit more about how the
genetic aspects of the research are being developed? Is
there a separate distinct program on that or is it an aspect
of every program or how have you organized to see to it that
the power of genetics is brought to bear on these problems?
DR. FEUSSNER: Well, we have actually just begun
that whole issue of the potential implications of genetics
in a whole array of diseases very recently. The study that
I mentioned that was funded last summer is a study from
overseas looking at the potential genetic heterogeneity
expression of cholinesterase and, yes, you summarize that
issue very explicitly.
In the RFAs, we have identified that as a priority
issue, in part, to see what types of research ideas are
stimulated and where the excellence is. Now, having said
that, we have formally contacted and have met with many of
the scientists at HUGO, the human genome project at the
National Institutes of Health. We have had a series of
meetings with them and us in some part because their
capacity to do this kind of research is far superior to
ours, but -- now I am actually just -- when I say that, I am
talking about the VA, not the DOD -- and in addition, we
also in many cases have patient populations and given the
integrated nature of the VA, can facilitate questions
relating to applications of genetic discoveries in human
The issue that we are focusing on at the moment
with HUGO has to do with a new discovery of genetic
relationships for Parkinson's disease. As you may know, Dr.
Hamburg, some of our investigators in Seattle have
discovered a genetic component of Renner's(?) syndrome,
which is a disease of premature aging. Last spring, one of
our investigators in Denver found a schizophrenia gene that
codes for proteins that actually modify the threshold for
evoked auditory potentials.
So that we have a system -- a relatively
systematic view of the implications of genetics in medical
conditions, but we have just begun collaborating and
discussing with our colleagues at HUGO in a systematic way.
So, we are just very much at the front end of that frontier.
DR. HAMBURG: Thanks.
DR. LASHOF: Are there further questions? I have
a couple more.
Sometime back at one of our sessions around the
research, we asked about any studies being funded in
relation to mycoplasma, which had been put forward. You
mentioned some studies on emerging pathogens. I am not sure
whether one would consider mycoplasma an emerging or non-
Did you get any proposals -- are you funding
anything in that area at this point?
DR. FEUSSNER: There is a specific expertise --
and I will ask Dr. Gerrity to embellish these comments, if I
don't get it completely -- there is a significant research
expertise with regards to mycoplasma-based in DOD at Walter
Reed and some non-federal investigators, Dr. Nicholson and
colleagues, are on the West Coast, looking at either novel
mycobacterium or mycobacterium that seemed to be infectious
under certain circumstances.
The DOD is specifically facilitating the
collaboration between those two expert groups.
Do you recall exactly where that collaboration is?
DR. GERRITY: The collaboration that is occurring
is amongst -- is actually for, as I understand it -- it
would be much, of course, if you spoke directly to the
Walter Reed contingent, but my understanding is that Dr.
Nicholson is to train scientists at Walter Reed and at NIH
in his technique and that when that is accomplished then
that those individuals would be then testing sera that are
blinded for this purpose.
I can't say more than that right now about the
progress of that.
DR. LASHOF: Okay.
Craig, do you know anything about that -- we can
wait. I mean, after lunch DOD is going to be here to
MR. LEBO: I can confirm that those negotiations
are ongoing today in my office dealing with bringing to
effect the training exercise that will lead ultimately to a
subsequent testing of blinded sera. That will probably be
awarded in the next few weeks.
DR. LASHOF: Is it the training first and then
there will be -- is it all part of a package that was done
through the peer review process or is it that we are going
to train and then do a peer review process of a particular
MR. LEBO: If there is a subsequent study, it
would be subject to the peer review process. This is simply
a service of learning that technology that Dr. Nicholson
DR. LASHOF: And making sure both labs would get
the same results on the same sample.
MR. LEBO: That is correct.
DR. LASHOF: So, it is a training thing not a
research study at this point.
MR. LEBO: It is not a research study.
DR. FEUSSNER: That is correct.
DR. LASHOF: That is helpful.
MR. RIOS: One more question.
Are you familiar with the study that Dr. Haley did
out of the University of Texas?
DR. FEUSSNER: The series of papers published in
the Journal of the American Medical Association?
MR. RIOS: Right.
DR. FEUSSNER: Yes, that is correct, I am.
MR. RIOS: Can you comment on it?
DR. FEUSSNER: Yes. The short of it is that Dr.
Haley studied a number of patients from one naval unit. I
believe it was the 26th Seabees. And he made some
observations about an array of symptoms that existed in
those patients and then proposed that there were a series of
syndromes, using factor analysis to say that there syndrome
A, syndrome B, syndrome C.
We actually -- I think Dr. Murphy would concur --
we did not think that there was a single Persian Gulf
veteran's illness and we agreed and actually knew or thought
we knew that there were patterns of problems that patients
were having; central nervous system problems, such as
cognitive dysfunction, peripheral nervous system problems.
So, quite frankly, despite its limitations, we
thought that Dr. Haley's studies did confirm that there are
a series of symptoms that patients have. In my own opinion,
sophisticated factor analysis wasn't necessary to say that
patients who have cognitive functions from central problems
are different from patients who have peripheral nervous
As a physician, I feel like I can do that without
consulting a statistician. But I think that he also pointed
out the problems with -- I think he called them
neuroarthromyopathies. I, again, as a physician, don't find
it useful to cluster all those things together because they
are quite different. So, I would not like to cluster a
neuro problem, for example, with fibromyalgia.
So, I think there was some limited value to those
observations. The population was constrained. It was a --
these were volunteers, self-reported information.
Another study, the Iowa study, funded by the CDC,
basically was a population-based study that also found a
higher prevalence of certain symptoms, such as fibromyalgia,
chronic fatigue syndrome, respiratory things. Some of the
issues that we showed as the primary hypotheses in Phase 3
would be recognizable as symptoms that are occurring, seem
to be occurring with greater frequency in Persian Gulf
DR. GERRITY: You know, in addition, there were
some conclusions about relationships between exposures and
outcome that really are mere speculation. The types of
outcomes that were looked at and the way the study was
conducted, because it could not quantify exposure in any way
merely remains in the realm of speculation and not
conclusion, although there was an implication that this was
somehow conclusive evidence.
DR. FEUSSNER: But I think, again, it was research
that built toward the observation that this is much more
complex. There is a wide array of illnesses that these
patients are experiencing and I think in that sense, despite
the constraints on the population and the constrained
methods, that is a consistent story that is emerging. And I
think in science that having an observation be replicated in
different populations has value.
DR. TAYLOR: Just as a follow-up then to Orlando's
question, will any of the most recent approved research
projects address anything in Haley's study or try and
identify exposure or go in that direction at all?
DR. FEUSSNER: Well, identifying, confirming and
measuring exposure is highly problematic. We -- and Fran
can correct me if I am wrong, but I think some of these same
symptoms emerged just from the registry information that VA
collected as it asked patients to come in. We are -- for
example, in some of these areas, the issue -- take, for
example, fibromyalgia or chronic fatigue syndrome -- seem to
be legitimate problems. Patients have legitimate symptoms.
These illnesses have definitions. They are imperfect, but
at least there are case definitions. In some cases, there
are single citronals(?), primarily in Europe, of a variety
of treatment strategies that purport to import to improve
Quite frankly, that is one of the reasons we have
gone forward in that particular case to see initially if it
is sensible to try to plan treatment trials so we can define
definitively treatments that work and treatments that don't.
I was very encouraged with the meeting that we had
with experts in fibromyalgia, chronic fatigue yesterday. As
I said, we are going to plan that study. It is going to be
hard. It is going to take a lot of patients. It is going
to take a lot of time, but as our cooperative studies are
wont to be, the research result is likely to be definitive
as the studies will be high quality research projects that
are internally valid and give answers that are applicable to
the kinds of patients that were studied.
So, I think it is worth following up on those.
Some of the difficulties with some of the information is --
and I am expanding out from Dr. Haley's studies -- is in
some ways deals with finding -- studying patients very
carefully with highly sophisticated diagnostic technologies
and finding things that are not normal, but that are also
not known to be abnormal. That is, these are things that
are different and you find them in patients who have
symptoms and you can't tell if the symptoms are related to
the findings because you don't know if the findings are
Some of the studies that will be published shortly
will show some abnormalities in testing that are within the
range of normal and the patients have symptoms. And the
question is, well, is the range of normal too broad? Is
this an incidental finding that doesn't bear on the symptoms
so that part of the frustration with the research process is
that it is incremental and it is not very often that a
penicillin is discovered that cures a problem and, boom, we
are off and running.
That was a long and torturous answer to your
question, but your question actually is a very hard
DR. GERRITY: I would like to also respond partly
to it because I think you were asking about what the content
of the coming research portfolio is.
What I can say is, number one, is that the types
of outcomes that Dr. Haley was looking at is both a part of
the current research portfolio, as well as a part of
research that we are expecting to fund with humans coming up
through this process.
So, in terms of the outcomes that are looked at
and being looked at in Persian Gulf veterans, that is not
DR. LANDRIGAN: One question. I am fairly
familiar with Dr. Haley's work because I had a chance to
review it for the Journal of the American Medical
Association earlier in the year and comment editorially upon
it. And at that time, I expressed my concern that there
were some rather serious flaws in his three studies that
surrounded selection of subjects, the fact that he had a
very poor response rate, only 41 percent, as I recall, from
the battalion of Seabees whom he was studying and those
problems of selection were compounded further by the fact
that of the whole battalion, only 23 or 24 of the troops
actually went through the detailed neurological examination.
I seemed to think that that somewhat undercuts the value of
the findings, but be that as it may, I would be curious to
know did Dr. Haley and his group submit a grant application
to the recent VA review and how did they fair in that
DR. BALDESCHWIELER: Can they answer? That may be
DR. FEUSSNER: I would say two things.
Dr. Landrigan wrote the editorial in JAMA that
accompanied the Haley papers and I have nothing to add to
his editorial comments. I agree with him entirely.
The question specifically about the investigator
and submissions is confidential at the moment because formal
decisions haven't been made about funding and no
announcements have been made about funding.
So, I would prefer --
DR. LANDRIGAN: Thank you very much. I
DR. FEUSSNER: Thank you.
DR. LASHOF: Okay. I have -- we cannot take
questions from the audience at this point. I am sorry. Our
process doesn't allow that.
One more question about the Phase 3 trial that we
wanted to ask Dr. Kang and some of the complexities of that.
Are they pretty well resolved and can this get moving a
little bit faster and why do we have such a delay --
DR. FEUSSNER: Yes. I think the answer to your
question is that we actually -- well, the answer to your
question is "yes." I think they can be resolved. As you
know, the level of complexity of the research goes up
dramatically as you go from surveying people to actually
getting them to come into clinics to examine them, et
We have used the past period of time to develop
what in my view is a very complete and very substantial
research protocol now. The penultimate draft of that
research protocol is in the office and what we will do with
that is, since we are modeling the conduct of this study
after our typical VA multi-site cooperative studies, we will
have that mail reviewed by members of our cooperative
studies evaluation committee and not wait for the next
committee meeting, which will be coming up in the spring.
The hypothesis issues, the measurement issues and
the statistical issues, both the power matters and the
problem with multiple outcome assessment, adjusting for
that, have been fairly well resolved. One of the
contentious issues in discussion -- well, one of the
problematic issues in discussing this is how we would do it,
whether we would have patients go out to private clinic x,
y, z, around the United States or do this inside VA and
there was some honest difference of opinion about what the
patients' preferences might be.
Dr. Kang suggested instead of coming up with what
the patient preferences might be ourselves, we actually
survey the patients. So, we did that. We did a -- I
believe we commissioned Gallop to do a quick survey for us
to see if the patients had preferences.
We were, obviously, with a problematic response
rate in a simple survey. Imagine how that might be
amplified if now you have to go in, get examined and bring
your wife and kids. My read of the survey instrument is
that the patients, the veterans were essentially neutral.
So that what we will do is do this in the context of a VA
collaborative study. So, all the veterans will be seen and
examined in VA hospitals.
All of the children will be seen and examined in
our affiliated university settings because that is the
greatest way to facilitate that. The spouses of veterans
had some preferences about being in or not being seen at the
VA. So, we will allow -- as we set aside the dollars to do
this study, we will assume that roughly half the spouses
will not want to be seen in VA and will also go to our
But I think virtually all of the logistics, all
the statistical issues have been worked out. The protocol
-- I haven't seen the penultimate draft, but I saw an
earlier draft. It was in very good shape. The review will
be expedited and I think we ought to be ready to hit the
DR. LASHOF: Very good. Thank you very much.
Are there any last minute -- further questions
before we adjourn?
MS. KNOX: I just want to validate something.
Since I interrupted Rolando earlier, I wanted to see if,
indeed, that is the reason that you think there may not have
been any submissions regarding the Khamisiyah
epidemiological studies and, further, since it is -- it is
an epidemiological nightmare to try and go back six years
out, do you have any further suggestions on recommendations
that we can make regarding future conflicts for DOD?
DR. FEUSSNER: Well, the first question, I think,
is a fair question. As much as the exposure issues were in
flux, it may be difficult for an investigator to be willing
to take a risk, develop a proposal and then the model is
made available some weeks or months later that kind of
invalidates all the work they did.
That is difficult. On the other hand, it takes --
we don't have the actual data. All we have to rely on is
model data. The medical follow-up agency or the Institute
of Medicine actually has an advantage now because they know
what at least a plume model shows and it looks like we will
be able to have an answer -- keep in mind, this was for a
feasibility study, not for an epidemiological study, but
just the study of can we do a study.
So, I think we will get at the answer to that
question in a relatively efficient way.
I have to admit I forgot the second part of your
MS. KNOX: The second question was can you make
any further suggestions on recommendations that we could
make that you could add to, for us to give DOD concerning
future conflicts in epidemiological studies?
DR. FEUSSNER: Well, I think actually you have
dealt with that from my read of your final report, talking
about getting information, more health information that
defines the base date, creating mechanisms so that we know
where people are. Although having never been in a war, I
just can't imagine what it must be like to think about
collecting data in the context of that kind of a hostile
situation. But the base date, trying to create mechanisms
to locate soldiers during a conflict and then trying to work
at mechanisms to have better databases and even, perhaps,
merge -- databases ultimately merged between the Pentagon
and the VA are strategies that would dramatically improve
the post-conflict scientific evaluation.
I think you have covered those. I should say
parenthetically that we did -- one of our investigators in
New Hampshire in collaboration with the Pentagon did make
base date psychological testing measurements on some of the
troops that were deployed in the Bosnia peacekeeping
mission. So that -- I only mention that as evidence that
your requests are sensible and we are trying to accommodate
them, but they are also -- if they weren't so hard, somebody
would already be doing them.
But I can't think of any additional things that
you already haven't thought about.
DR. MURPHY: I think you also --
DR. LASHOF: Thank you very much -- oh, okay,
Fran. Then I am going to try to wrap this up.
DR. MURPHY: Sorry, but you also made an important
contribution in recommending the presidential review
directive and the plan that will be developed in that regard
and that plan will then receive independent review and that
process, I think, will bring forward better recommendations
and better plans for the future.
So, I think not only the recommendations that have
already been made, but that process will bring us forward
into the -- protecting troops in future deployments.
DR. LASHOF: Okay. Thank you very much. I think
this has been a very worthwhile morning.
We will adjourn for lunch and reassemble at 2
[Whereupon, at 1:05 p.m., the meeting was
recessed, to reconvene at 2:00 p.m., the same afternoon,
Thursday, September 4, 1997.]
A F T E R N O O N S E S S I O N (2:00 p.m.)
DR. LASHOF: I think we are ready for our session.
We will begin the afternoon with a presentation by
Mr. Robert Walpole from the Central Intelligence Agency.
Thank you for being with us again. It is a pleasure to have
Agenda Item: Investigations of Chemical Warfare
Agent Incidents During the Gulf War: CIA.
MR. WALPOLE: Thank you. I am pleased to get an
opportunity to appear before the committee, and I really
Six months ago when we met in Salt Lake City, even
though it was my birthplace, I still went to that meeting
with a lot of fear and trepidation.
I understand the issue much better now. So, I
don't quite have the same fear.
I want to try to cover quite a lot of material in
the time allotted to me today. The first slide here walks
through the order of the material that you have before you.
I want to first discuss our efforts so far on
You had asked a question in a letter about the fly
outs from the Khamisiyah Pit, so I will briefly discuss
At the meeting in Buffalo, the question of the
MARCENT, the Marines Central Command Cable, was raised. So,
I have got a paper on that and I will briefly discuss that.
I will discuss Maymunah very briefly. That was
raised by UNSCOM at the meeting in Buffalo.
Then finally, I will have some concluding remarks
on the efforts of the task force up to this point.
On Ukhaydir, just as some background, we indicated
last time, as did UNSCOM, that Ukhaydir was a site that
there was a potential release of agent.
It was declared in 1996 that there were 6,394 144-
mm mustard rounds there. In late April 1997, UNSCOM found
three shells near a formerly damaged section of the road.
That raised some questions.
We in UNSCOM assessed that those shells from
Ukhaydir were later moved to Fallujah for two reasons.
One, the exact same number was declared to be at
both locations. Two, the shells arrived at Fallujah at
about the same time that they disappeared from Ukhaydir.
One question that we discussed at pretty good
length at the last meeting was the magnitude of shells that
could have been destroyed during the bombing.
UNSCOM has accounted for 6,380 shells at Fallujah
in September of 1991. That was 6,159 shells that were
painted gray. All of those were filled with agent.
That was 117 shells that were painted green. Ten
of those were filled with agent, but they showed no signs of
One hundred four were burned or charred. Ten of
those still contained all their agent.
So, we have 6,179 that were filled with agent. In
addition, I mentioned before that UNSCOM found three shells
at Ukhaydir in April of 1997. They were all filled with
That leaves a potential for 212 shells to have
released agent as a result of the bombing, since the ones
that were full of agent could not have released their agent.
Now, what about the most likely release or
releases. Last month I indicated that they probably
released their agent on bombing from the 14th of February.
We still believe the 14th of February. It was
actually bombing on the night of the 13th, the morning of
the 14th, a few minutes on each side of midnight, of
February, is the likely case.
However, we have examined the crater that was
created by that bombing and we see no evidence that there
was any burning in that crater, because the bomb goes into
the ground and then explodes.
Because there was no burning, we can't see that as
the damage mechanism for the 104 shells that show burn
The Iraqis, as you remember last month, I
indicated, claimed they were burned at Al Muthanna. That
still may be true and it may not have anything to do with
the bombing campaign.
That said, we have always indicated to you that if
we are not certain about something, we will take the worse
case, the more conservative approach.
So, in trying to figure out a damage mechanism
that would have burned those shells, we discovered that the
bunker near the stacks of some of these shells was bombed on
the 20th of January.
There was burning from that bombing and the
burning could have reached shells stacked outside that.
We have assumed, for the purpose of our modeling,
that those 104 shells could have been burnt from bombing on
the 20th of January.
Ninety-four of them were all that released agent.
So, that is part of our modeling on that date.
Now, on the 700 shells that were stacked outside
the building that was bombed on the 13th and 14th of
February, we assessed that 11 of those might have
Now, there are two reasons for that assessment.
One is, in fact -- if you could skip ahead to the slide on
the crater, this is what the crater looked like to us. That
is an artist's rendering.
We had two stacks of shells on the road. The
stack that was hit by the crater, you can see that there are
shells on both sides that were not affected.
These shells are in pallets of eight shells each.
The way this bomb works, it goes into the ground, detonates,
creates a hole in the ground, and then everything sinks into
It is designed to actually go into a road and
sometimes not collapse until vehicles are driving over it,
and then collapse that way.
With all the weight of these shells, it would have
collapsed during detonation.
With no burning shown from the crater, the
assessment is that the bomb would have detonated
underground. Any damage to shells -- immediate damage to
shells -- would have been from kinetic energy of the impact.
That would have been anywhere from 10 to 12
rounds. We have used 11 as the middle bound number.
The other reason we used 11 is that is what ends
up being missing by the time you do the math.
Since the 104 we pushed to the 20th of January and
all the others were accounted for except the 107 dark green
ones, which showed no indication of damage, then we are left
Since they are unaccounted for, we will consider
them aerosolized and released the agent.
The 560 number I have there, that is the
assessment based back on that photograph -- not the
photograph, the line drawing of the crater. That is how
many would have fallen into the crater.
Of the 560, 14 to 70 would have leaked agent. Now
the 14 to 70 numbers come from drop tests, 14 if you drop
from 7 feet, 70 if you drop from 40 feet.
The crater certainly wasn't 40 foot deep, but
these are the drop tests that are off the shelf that I could
use. So, I have a range there for those numbers.
Now before I go beyond that, what we did, even
though we assessed that somewhere between 14 and 70 leaked
agent, we modeled 107.
We modeled 107 because I have 107 of that 117 dark
green shells that didn't have agent.
While I don't believe they leaked agent as a
result of the bombing because there is no indication of any
damage to them, I think they leaked prior to our bombing
That is a number that I have to account for. We
will again do the worst case, as I have indicated before.
That also incorporates the number 14 and incorporates the
number 70, any other number I can come up with. So, we
modeled 107 for the leaking under that.
Now, we used multiple transport and diffusion
models in this. In the Khamisiyah efforts, CIA used the
NUSSE4 model and the Omega weather model.
For this one, all we have at this point is the
Omega weather model. We ran that with NUSSE4, we ran that
with VLSTRACK and we ran that with SCIPUFF.
We do not have a complete ensemble of models like
we have with Khamisiyah. We only used the one regional
scale weather model up to this point.
DOD provided the unit information that you see on
the map in your paper there. The initial runs indicate that
any release from the 20th of January would not have reached
We have not published a plume yet from the 20th of
January because we do not have the weather data on which
direction the wind was going.
The paper indicates that any plume coming from
that would have gone about 40 kilometers. If you draw a 40-
kilometer circle and go in any direction, you are not going
to reach troops. So, I am not worried about that.
Once we get the ensemble together and all the
weather data, then we will publish a plume on that one.
On the modeling for the 13th and 14th, we do have
a plume. You can put that map up. The green area there is
general population limit.
Because it was so small on the size of the map, I
didn't bother showing a lethal area. Nobody is near it,
That was aerosolization from 11 rounds that is
leaking from 107 rounds, and it travels about -- isn't that
about 120 kilometers, something like that?
This is multiple models. We expanded that
comparable to the way that the model for Khamisiyah was
Do not consider this the ensemble approach yet,
because we have not run the COAMPS weather modeling against
One of the reasons that we run two different
weather models is to give us higher confidence in what the
weather is doing.
That was recommended by the IDA panel for the
Khamisiyah effort, which certainly would be recommended for
We did not have it, but I had made a personal
commitment to get you a plume by this meeting. So, we have
done that with the one weather model that we have up to this
The bottom line of that -- in fact, I don't have
Rafha on this map and I apologize. Rafha is straight south
of -- right there where he is pointing. That is where Rafha
All the little red dots are where the troop
locations would have been. That was the information
supplied by DOD.
The bottom line there is that it does not appear
that the release from Ukhaydir reached troops. We had
indicated that before in Buffalo.
Next steps on this is to continue our modeling
effort with DOD. The weather data, as I indicated before,
is still being worked.
When the COAMPS regional weather model is
completed, we will be able to run the entire ensemble and do
that composite approach as we have done before.
We will also apply that to Al Muthanna,
Muhammadiyat, and Bunker 73.
Okay, let me move to flyouts. This is all
detailed in this paper here in a lot more detail than I just
I gave you a copy of the slides that I used, plus
a copy of the paper that has got more detail. The paper has
the map at the end.
On flyouts, there is a section -- I will point
this out, now, too. This paper, the thick paper, this is a
joint CIA/DOD publication on modeling.
This walks through everything that we did on the
Khamisiyah modeling, all the viewgraphs that we used in the
presentations before the media and you and everybody else.
The last section of the report has got all the
maps of where the plumes went.
There is a box in this paper -- I think it is on
page 15 -- I don't remember what page it is on now -- it
doesn't matter. There is a box in the paper on flyouts.
That is what I am going to be briefing here today, is the
section on flyouts.
There were few flyouts from the Khamisiyah Pit.
Soldiers said they witnessed up to a dozen flyouts. The
number is low because most of the charges were placed on the
warhead end of the rockets. We indicated that in our
It was not at the end of the rockets. So, the
rockets would not have been ignited.
Any rockets that left the pit would not have had
the proper stability, the launch angle or the thrust to go
any appreciable distance.
We modeled several rocket flyout possibilities.
The maximum range of these 122-mm rockets is 18 kilometers.
We don't believe that any flew that far, and following are
First, the tail stabilizing fins on these rockets
as they are crated have a band or a clamp around them.
Unless that band is released, the stabilizing pins don't
release, and so the rocket doesn't have any stability.
In those cases, the rockets would only go about
two to four kilometers.
Depending on the launch angle and the thrust
achieved from the way the ignition occurs, any rockets that
had the fins even deployed would only go between five and 15
kilometers. They wouldn't go maximum range.
So, any plumes from the flyouts we assess would
have been small. In the drop tests that we did at Dugway,
the rocket buried itself 30 feet into the ground and didn't
release any agent.
We believe that any longer-range flyouts in the
Khamisiyah Pit would have done the same thing.
If one of the rockets did spill agent, the general
population limit exposure would have been about 50 meters
wide and 1,000 meters downwind. So, you are not talking
about a long range there.
We do not show any flyouts in the modeling plumes
that we have presented to you and in the paper here. U.S.
tests on 115-mm rockets -- and I point out here, there is a
typo in the modeling paper.
The modeling paper says 155 mm. We didn't pick
that up because that is the number we used for the mustard
round at Ukhaydir.
The tests the United States performed were on 115-
mm rockets. They showed that most flyouts only went 200
meters and that the maximum range was about two kilometers.
These are well within the Khamisiyah plumes that
we had for the general population limit anyway.
We don't believe any flyouts actually burst. We
are not able to determine whether any flew a certain
distance outside our plume, and where they burst, where they
would have gone. So, little dots around wouldn't have been
We have no soldier reports of impacts. We just
had soldier reports of some flying out of the pit.
That is everything on flyouts.
The next thing I wanted to talk about was the
MARCENT cable. This was raised in Buffalo when I was
briefing the ARCENT, the Army Central Command Cable of 17
I was asked about the Marine Central Command Cable
of 17 sites. This one turns out being 16 locations, because
two were a duplicate. So, you are only going to find 16
write-ups in the package here.
Obviously our efforts include searching for any
site that could be of help to determine any causes for the
So far, having looking carefully at all of the
sites -- these included -- we have only found evidence of
chemical munitions at two in the theater of operations,
Khamisiyah and An Nasiriyah.
That said, in this list of 16 -- and I am not
going to walk through all 16, I am going to let you look at
these separately -- but they fall into a few categories.
First is, there are four that were large Iraqi-
built field storage facilities with 50 to 125 revetments.
Six were Kuwaiti-built permanent facilities, taken over by
the Iraqis, and none appeared to be used for storage of
Five were deployment areas for Iraqi motor
transport units associated with logistic support. One of
these was outside the MARCENT area of responsibility, just
west of the Kuwaiti-Iraqi border. Then there was one
location where there was no indication of munition storage
We don't know what information CENCOM used in
formulating this MARCENT list. We have reviewed the
information and we find no evidence of equipment, structures
or unusual security, that suggested the presence of chemical
munitions at those sites. So, that is the MARCENT list.
Now, on to Maymunah, that was raised by UNSCOM.
If you remember, in the UNSCOM presentation, they walked
through several different sites, had a very nice map at the
end that showed how they were tracking where the various
As we were looking at the list of sites, there has
been a lot of discussions about Al Muthanna, Fallujah, An
Nasiriyah, Khamisiyah and Ukhaydir, but nothing on Maymunah.
So, we wanted to make sure that we have for you a paper that
talks about Maymunah.
It is a well-secured munitions depot, about 10
kilometers south of Al Amarah. It was constructed in the
last 1970s, contains 32 storage bunkers.
The Iraqis declared, in June 1996, that 4,100
sarin-filled rockets were there. During Desert
Shield/Desert Storm, on the basis of UNSCOM accounting
efforts, UNSCOM assesses that these rockets were eventually
moved to Al Muthanna.
Other than the Iraqi declarations, we have no
evidence that chemical munitions were stored there. It was
not on intelligence lists as a suspect site before the war,
and we have no evidence that the depot was bombed during
This is in a sense to check a box, so that no one
says, well, gee, we haven't talked about Maymunah. No
bombing. Munitions seem to be accounted for. We don't seem
to have a release here at all.
You had also asked that I briefly discuss what we
are doing about accounting for the shells. While we are on
Maymunah, that is a good time to do that.
As was very clear from the presentation from
UNSCOM in Buffalo, they have a lot of detailed information
on accounting, both Iraqi declarations and production
records, that give a handle on some numbers.
We have initiated discussions with UNSCOM to try
to help sort that information out. We are hoping that,
depending on the detail of that information, that that will
be able to sort out whether there are any unaccounted-for
munitions and, if there are, where they are.
The simple numbers that we get from the
presentation that UNSCOM gave in Buffalo give us anywhere
form 550, which was the declared number to have been
destroyed during the war, up to about 708, which you get by
subtracting 12,792 from 13,500.
So, we have got a potential for several hundred
rounds to be accounted for at this point. These are mustard
On the sarin rounds, they appear to be all
We are working with UNSCOM. We will get all the
detailed information for you when that effort is completed.
Finally, let me close with some comments on the
status of the efforts of my task force. When George Tennet
appointed me as the special assistant earlier this year, he
tasked me with managing and reviewing all intelligence
aspects related to this issue, and getting to the bottom of
the issue of Gulf War illnesses.
I committed to him and to myself at the time that
I would be completely honest and as thorough as humanly
possible. I have stood by that commitment, sometimes
In the course of our events to date, we have
reviewed our previous search criteria. We have conducted
more searches, broader searches.
We have ensured the passage of all documents that
we uncover to the Department of Defense and others.
We have supported ongoing modeling efforts,
implemented a comprehensive communication strategy with your
committee -- I think your staff will probably attest to that
-- as well as with others.
We have continued to manage declassification
efforts, and have provided, and continue to provide,
analytical papers to support relevant information released.
Early on we discovered that this effort could not
simply be one of declassification. We must go beyond that.
Measures of our success must include looking at the breadth
of our efforts.
Counting only the number of documents released, or
measuring how quickly we released those documents would be
somewhat short sighted.
This is the first time the agency has fully
integrated an analytic component into the task force. With
this analytical team, we are able to run to ground every
thread of information and interest we find, and prepare
papers to put these documents into analytical context.
For example, the large amount of material that we
have released on Ukhaydir is all new analyses and based on
UNSCOM reporting and new analysis of older information.
It is not a release of old documents. In fact,
releasing older documents that have no bearing on the
veterans' illnesses would be of no value.
The information we have released on Ukhaydir, I
think, has been of significant value.
This broader approach is designed in part to
discover and illuminate any evidence about the potential
exposure of U.S. forces to chemical weapons or other
hazards, to facilitate inquiries into those potential
exposures, and to ensure the honest review of information
surfaced in government investigations.
We directed components to conduct new searches for
relevant documents, employing broader search terms and time
periods than had previously been used.
Components captured over a million documents as a
result. As you can imagine, searching a decade's worth of
documents using over 20 pages of search terms, we captured
many documents that were not related to veterans' illnesses.
They were not even related to the Gulf War.
For example, the word "facility" was one of our
search terms. That captured numerous unrelated documents.
The reason we did that, when I got into this
effort, was one of the questions I was asking was, why did
we miss these Khamisiyah documents.
I determined, we are going to do a very, very
broad search to make sure that DOD has in its hands
everything that could conceivably be related to the issue,
plus a whole lot more that was put together in an electronic
search package that they could use. So, it is not like they
have to read through these reams of documents through the
rest of their careers.
One of the reasons we broadened the search was to
do this broader net for DOD. Another reason was to create a
pool of documents for our own searches for additional
documents pertinent to the veterans' illnesses.
Most of the documents released to date relate to
Khamisiyah. The task force is currently conducting analyses
related to potential causes of the illnesses -- ones that we
feel we have intelligence on, biological, chemical,
radiological, environmental and foreign-reported illnesses.
These analyses are being used to generate tailored
search criteria to review this million-plus set of
documents, to identify those that contain information
pertinent to illnesses questions.
Pertinent documents will be reviewed for release.
As necessary, additional analytic papers will be prepared by
the task force, to place the released documents into some
context that is understandable.
Probably no one in this room could wish more than
I would that we would be done sooner than we are. Six
months ago, I naively thought that we would be able to do
this in the 60 days that was originally announced. That
simply has not been the case.
I believe anyone aware of our activities
recognizes that we proceeded at a rapid pace and
accomplished a significant amount to date.
While I do see light at the end of the tunnel, I
expect that completing the critical declassification efforts
I just described is still going to take some time.
With that, I am ready for questions.
DR. LASHOF: You did very well. Thank you very
much, Mr. Walpole. Are there questions?
MS. NISHIMI: I have a question about the modeling
for the 13th and 14th. You had indicated that only part of
the modeling because COAMPS other weather part wasn't done.
When do you anticipate finishing that?
MR. WALPOLE: The date that the modelers are
giving us is about November 1 for completing that. Weather
models take a lot longer than the transport and transfusion
models do to run.
I mean, that is the date they are throwing around.
We would like to push that sooner, but as of a few days ago
they are still talking about November 1.
DR. LASHOF: Let me ask; is it significant? I
think you gave us the information that, no matter what the
weather was, that the circle you would draw --
MR. WALPOLE: That was on the 20th. On the 13th
and 14th, the range still is short. It is not even halfway
to where the troops are located. So, it probably is not.
For me to feel confident that we have done an
ensemble approach of this modeling effort, I want to have
the other weather model involved.
DR. LASHOF: I am sorry, go ahead, Barbara.
MS. NISHIMI: I just wanted to know when it might
MR. TURNER: Mr. Walpole, if I understood
correctly, on the flyouts from Khamisiyah, your best
assessment is that, given the fact that the fins would not
have deployed, that any impacts would have actually been
within the day one plume that you have already modeled; is
that a correct understanding?
MR. WALPOLE: That is correct. Even if any flew
out we expect that, by flying further than the plume
distance, they would have flown enough that they would have
buried themselves into the ground and not released agent, so
you wouldn't have seen a plume anyway.
MR. TURNER: On the inputs for Ukhaydir, the
assessments of how many munitions were actually involved in
the two different releases that you think happened there,
can we just focus for a little bit on the 13th and the 14th?
MR. WALPOLE: Sure.
MR. TURNER: If I understand your analytics
correctly, you pursued two basic kinds of analysis. You
assessed the various Iraqi declarations and did a numerical
analysis of what you anticipated to be the release there.
Then you also did, as a separate analytical
effort, an assessment of what would happen from the kinetic
release when the bomb actually hit on the road.
Is that correct; there were two different paths
that led to the assessment?
MR. WALPOLE: Yes, that is a fair way to describe
that. As I indicated, if we use the Iraqi declarations, you
get a total of 212 that could have released agent.
We modeled 94 on the 20th. We modeled 11 and 107
for the 13th and 14th. If you total those, that would be
Those numbers are all driven by the Iraqi
declarations. As I indicated in Buffalo -- because you had
asked me the question about why am I believing the Iraqis.
MR. TURNER: Exactly.
MR. WALPOLE: The fair answer to that is, got me,
because they got a lot of other things wrong. But if I
don't believe the Iraqis, I don't know from intelligence
that I even have mustard rounds on that road.
It is only because the Iraqis declared that there
were mustard rounds on that road, that I think the stacks of
material I had there are mustard rounds. That is why I felt
I needed to pursue that approach.
Then we decided, well, let's just assume that they
are mustard rounds anyway, and this is getting to the other
half of your point.
If we look at the kinetic destruction, look at the
crater, what actually happened, there we had a lot of bomb
experts looking at this and other analysts looking at this
saying, well, how many could have fallen into that crater.
Well, looking at both sides of the stack that had
those intact, measuring the size of the stack, knowing how
the pallets are set up, and then determining whether they
were set vertically or horizontally, the pallets, you come
up with about 560 that could have fallen into the hole.
The kinetics give you about 11, which
interestingly enough, 10 to 12, matches so closely with the
Iraqi declarations that that seems to work. So, it was
driven from both directions.
If the 107 rounds did not leak agent here, and
something else did leak agent here, by using the 107 we have
even captured over 100 rounds beyond what the Iraqi
That is what you are getting at. Even if we
ignore the Iraqi declarations, the kinetics and the math
have helped drive this model and even given us a better
certainty of how many could have released agent.
MR. TURNER: I guess my point was that, even
should the Iraqis change their accounts down the road, that
you have an independent basis for assessing this quantum as
being the right amount to model; is that correct?
MR. WALPOLE: Yes. Since we have 560 in the hole,
they could change their amounts by almost 560 rounds and we
would still be comfortable with what we have done here.
MR. TURNER: You also alluded to, at one point in
your testimony, when you do the various computations, coming
up with between 550 and 700 mustard rounds as being missing.
Is that still a potential source of concern the
committee should be paying attention to, Mr. Walpole?
MR. WALPOLE: I know UNSCOM is trying to pursue
that. The math that I have looked at up to this point, I am
not sure how valid the numbers are. That has got to be
The 550 is a number that the Iraqis declared as
having been destroyed during the war.
When I asked Mr. Delfor after the meeting in
Buffalo where that declaration came about, I said, was this
a serious calculation or how did that come about.
My impression from his answer -- I won't try to
put words in his mouth -- my impression was basically, the
Iraqis kind of felt they needed to account for some
uncertainty that they were showing then, numerically, and
550 sounded like a good number. So, I don't think there was
any rigor to that number.
The 708 number that I come up with is taking
13,550, which is the largest number I seem to get from
I am subtracting that 12,792 that UNSCOM indicated
at Buffalo that they have accounted for through destruction.
This is all of mustard rounds. That leaves 780 if you do
the math, right there.
But the 13,500 could be off. As I have looked at
other numbers, I can't get to 13,500.
MR. TURNER: Is it the agency's intention to
follow through on investigating these various estimates of
delta, if you will, the missing quantity, and run them to
MR. WALPOLE: Oh, absolutely.
MR. TURNER: And your task force's future, you
intend to be in business how long?
MR. WALPOLE: I am afraid to answer that.
DR. LASHOF: There is a transcript being run here,
so I would urge your caution.
MR. WALPOLE: When I have talked with Mr. Tennett
about this on a couple of occasions, I told him that no
matter what we do relative to a task force -- large, small -
- I would recommend that he retain a special assistant on
Whether it is me or somebody else almost doesn't
matter. I think I am probably stuck. There is quite a
learning curve on this issue.
For some time. Even if I am able to get another
job somewhere else within the agency, I would be the special
assistant, a point of contact for DOD and others, when I do
It would have to be a job that would relate -- my
former job in the non-proliferation center, of course, does
relate because this is a proliferation type issue.
I expect that we are going to have to have what
you would consider a task force, even if it is part-time
people within the old work spaces, continue with the
declassification effort until that is done.
Issues like this accounting, completing this
modeling, they all have to be completed.
DR. BALDESCHWIELER: I am interested in the
assumptions that are inherent in calculating the vertical
distribution of agent in your modeling efforts. What do you
assume about the vertical distributions?
MR. WALPOLE: Are we talking about Ukhaydir or
DR. BALDESCHWIELER: Well, let's start with
MR. WALPOLE: John, will you join me at the table
here? John understands this modeling stuff much better than
I understand horizontal and vertical, but how they
go about this --
MR. TURNER: Would you introduce him?
DR. LASHOF: Yes, introduce your colleague.
MR. WALPOLE: John Kopsky on my task force. He is
the one who is handling the modeling efforts.
DR. LASHOF: Welcome, John. Go ahead and respond.
MR. KOPSKY: In terms of the agent distribution,
some was exploded, like at Khamisiyah, when the charges were
put on the warhead.
The height was about two meters, and we monitor
the cloud growth from that, the heat and the diffusion and
turbulence and what not.
So, it grows and could go up to 100 meters, for
example. We don't throw it up that high initially, but we
let it grow that high.
DR. BALDESCHWIELER: But if you look at the
turbulent distribution vertically downwind, how high does it
get, for example, in your model? Does it increase in height
MR. KOPSKY: No, it stays below the planetary
boundary layer. There is a sheer layer and the area at the
time, around 10 March to 14 March, it was about, I think,
600 to 800 meters in height. You are talking 3,000, 4,000
That is a small part. That was only approximately
two percent of the agent at Khamisiyah. The other 16
percent of the agent virtually -- you have to remember the
pit -- it was on the ground level. It spilled out.
So, you have, in essence, something evaporating.
That doesn't go very far.
MR. WALPOLE: Page 13 of the big paper has a pie
DR. BALDESCHWIELER: I understand that. Suppose
you look at page 27, at the limits of the contour of the
general population level on day one.
At the extreme of the contour downwind, what would
be the equivalent contour vertically?
MR. KOPSKY: This height is 1.5 meters. This is
at the height of a human. The chart that you see, you would
have to be human sized. It goes up higher.
DR. BALDESCHWIELER: What do we see if we drew a
MR. KOPSKY: On some of the runs I have seen, it
probably went what, 600 meters?
MR. WALPOLE: I think it was between 600 and 800
meters at the highest. Larry?
LARRY: At the hottest point in the day. At night
it drops down lower.
MR. WALPOLE: Then it goes much lower. They
actually ran vertical simulations. We saw those running
over time. Since people are breathing at a height closer to
the 1.5 meters, that is what this plume represents.
MR. WALPOLE: In fact, there are some down drafts.
The territory going south toward sort of the extent of that
plume is only rising up. So, there is a tendency to
basically collapse that cloud. It is dissipating as well.
DR. BALDESCHWIELER: If I recall the video shots
that we saw of the destruction of Bunker 73, there seemed to
be plumes of smoke that went up to considerably higher
MR. KOPSKY: There are plumes of smoke in that
case, but it is also diffusing out. What you have to have
here is not only the agent -- the plume has to stay close to
the ground to where the people are. Also, it has to stay
close enough. This is a dosage contour, not a concentration
So, the slower something moves over that point,
the higher the dosage is. In the case of the plumes -- we
did model the rise.
Specifically, we are going to remodel the bunker,
Bunker 73, as Bob mentioned, using the same models we have
MR. WALPOLE: These models take into account all
those factors; the vertical rise, the wind directions each
way, run the model and then give us a lay down.
This is a lay down at the 11 hour point. Day one
happens to be 11 hours because the detonation took place at
4:30, 4:15 in the afternoon. The model runs until 3:00 in
the morning. Then the next day, day two, is a 24-hour run.
DR. BALDESCHWIELER: So, you have a way of
modeling, for example, a circumstance where the material is
carried to higher altitude, say 10,000 feet, and then --
MR. KOPSKY: No, excuse me, it never gets that
high. If you really look at the smoke plumes, if you are
talking about the March 4 bunker --
DR. BALDESCHWIELER: Yes.
MR. KOPSKY: That was a lot of heat from the
explosion of the shells there. Those bunkers go much higher
much faster. They still don't go up to 10,000 feet.
MR. WALPOLE: High explosives warheads.
MR. KOPSKY: Yes, high explosives. What we are
talking about more is it will slowly move downwind, but it
stays below -- there is a mixing layer. It doesn't go
beyond that. At nighttime it comes down. It actually comes
closer to the ground.
DR. BALDESCHWIELER: You could have an effect in
which a bolus of agent was carried to high altitudes, say
5,000 to 10,000 feet, and then carried downwind and then
rained, precipitated down.
MR. KOPSKY: We didn't see any mechanisms for
that. We looked for that. You have to have something
energetic like the oil fires.
The Kuwaiti oil fires had enough heat energy to
throw them up above the mixing layer.
MR. WALPOLE: When you have a constant heat source
like the Kuwaiti oil fires or you have a situation like
Chernobyl, where you are driving heat into a plume of
contaminant, then it is going to run a chance of penetrating
the planetary boundary layer.
Here you are not, and particularly in the pit
where we had a limited number of explosives.
DR. LASHOF: Any other questions?
If not, I want to thank you very much, not only
for your testimony today, but for your work over the last 10
months and the work of the task force.
You have been very responsive to the committee and
the staff and I have found it a pleasure to work with you
and your colleagues. I thank you for that.
I think we are now ready to proceed further on to
the investigations of chemical warfare agents from the DOD
perspective, and Dr. Rostker, MS. Davis, LTC Morris, LTC
Nalls, Mr. Thomas Stewart, I believe, are all going to join
us for this presentation.
Dr. Rostker, I presume you will kick it off and
call upon your colleagues as you wish.
Agenda Item: Investigations of Chemical Warfare
Agent Incidents During the Gulf War: DOD.
DR. ROSTKER: This is an overview of our
presentation this afternoon.
As Mr. Walpole did, I would like to take the
opportunity to review with you the work of the Office of the
Special Assistant, as we approach our first year
Last January you finished your report to the
President and the American people. At that time, you
praised the government's effort in caring for its active
duty servicemen and women and veterans who served in
Operation Desert Shield and Desert Storm.
You were "less sanguine about the government's
investigation of incidents of possible exposures of U.S.
troops to chemical and biological agents."
In your reports, you characterized the Department
of Defense's "investigatory effort" as having been slow and
superficial with no credible attempts to communicate with
the public on these communications.
We in the Department of Defense had substantially
come to the same conclusion. We did recognize that "in
November 1996 DOD announced it was expanding its efforts
relating to low level chemical agent exposure."
The initiatives you hoped for would begin to
restore public confidence in the government's investigation
of possible incidents of CW agent exposure.
We are rapidly approaching the one-year
anniversary of the establishment of the Office of the
This is a slide which I believe you have seen
before, which shows our organization.
I would like to report to you today on our
expanded effort. Hopefully you will find our efforts over
the last year are credible, because they reflect the fact
that we care deeply about our service personnel and
We are dedicated to trying to get at the bottom of
why so many of our Gulf War veterans are ill today.
While most of you are aware of our efforts to
report in detail on specific chemical incidents, this is
just the tip of the iceberg of the range of activities of my
Our commitment starts with the veterans
themselves. We have a number of activities and outreach
programs to bring the veterans into our investigations, and
to be available to answer any questions they might have
about what happened in the Gulf.
We have an active incident reporting hot line.
Instead of just recording and tabulating incident reports,
we follow up each and every report with a debriefing by one
of our contact managers.
These calls often take a half hour or more, and
establish a one-on-one relationship between a person in my
office and a reporting veteran.
When we started the call back program in December,
we had more than 1,200 veterans who had contacted us without
any follow up from DOD.
Today, I can report to you that we have attempted
to reach every one and have successfully contacted 1,000
veterans from the original list.
In addition, almost 1,500 veterans have tried to
reach us since our new office was established. We have
debriefed almost 1,200, or 82 percent of the veterans who
cared enough to share with us their experiences.
The contact managers report feedback from the
veterans. It is overwhelmingly positive, and this is
reinforced by my own meeting with veterans.
They are often surprised and pleased that someone
on behalf of DOD has called. The information these veterans
provide become part of our case management process.
Their first-hand accounts become a valuable part
of our investigation.
Our commitment to keeping veterans informed
extends to our presence on the internet through Gulflink
Gulflink provides a means to post new information
immediately, at the same time it is released in the press
room at the Pentagon, to our veterans.
Typically, we get about 19,000 home page hits in
any given week. I would remind you that a home page hit
doesn't mean a new person is there. It means they are
working their way through it. But it is a rather large
We peak during important times, such as when we
announced the results of our analysis of fallout from the
explosions at Khamisiyah, at over 70,000 hits per week.
Gulflink now includes access to declassified
information, our 24 hour e mail system, news articles and
While Gulflink has been a great success, we do
recognize that many veterans do not have internet access.
To reach them, we developed a bi-monthly
newsletter called Gulf News.
In addition, we have mailed over 150,000
notification letters concerning possible exposure, and have
surveyed over 21,000 veterans about specific chemical
Our commitment to reaching out to our veterans
extends to veteran service organizations. I have initiated
a series of approximately monthly meetings with VSOs, to
give their representatives direct access to information
about programs at the Pentagon which are not normally
Recent meetings have covered such topics as
chemical protection, reconnaissance vehicles, depleted
uranium, and medical record keeping.
Finally, my personal commitment to meet with
veterans at their conventions and at town hall meetings
throughout the United States.
Last spring we traveled to 11 cities to meet with
veterans to hear what they had to say, so that I could
better understand their concerns and how we might better
meet their needs.
All of this outreach and communication would be of
little value if we did not have something to say.
Last December I initiated a formal way to
investigate incidents or cases, as we call them, and to
report them to the American people and to you.
We increased the size of the staff and set them to
investigating the most important incidents of possible
chemical or biological agent exposure, using a formal
protocol established by the international community, to
certify chemical incidents.
We devised the concept of a case narrative as a
means of getting the results of our investigations to you
and the American people, even before they are finalized, and
to engage the veterans, those who actually served in the
Gulf, to help us get the full story out.
I insisted that these case narratives not only be
fully documented and footnoted, but wherever possible,
linking our footnotes to the actual documents that were
available to the public on our web site.
To date we have published six case narratives and
one information paper. By the time we reach our first
anniversary, we will have published 13 case narratives and
four information papers.
The narratives and papers are the most
authoritative account to the American people about what
actually happened in the Gulf.
As part of this process we present facts. Then
based on the facts, we make an assessment of the likelihood
that our troops were exposed.
Our assessments run through definite through
unlikely, likely, to definitely not. The most important
thing, however, is not our judgement, but the facts we
We welcome you and anyone else to make their own
No discussion of the last year would be complete
without a review of the Khamisiyah demolitions. Last year
at this time, we had placed before the American people the
fact that U.S. troops had most likely destroyed 122-mm
rockets that were filled with sarin.
I say most likely, because there were still many
unexplained pieces to the Khamisiyah tale that seemed
Some of these facts were brought out in our
Khamisiyah narrative, and the subsequent CIA paper of
intelligence surrounding Khamisiyah.
Unfortunately, last year we were unable to
complete our analysis of the fallout at Khamisiyah because
of the poor information at hand.
Following the President's commitment to the
veterans of the Gulf War, that we would leave no stone
unturned, we undertook an unprecedented effort to bring the
best analysis possible, including extensive ground testings
at Dugway Proving Ground, and the development of new
computer simulation models.
The answers we got put many of the pieces of the
Khamisiyah puzzle into place. It cost a lot of money. It
took a priority effort of many people and organizations and
it was worth it.
This work has a profound effect, not only on our
understanding of Khamisiyah and other sites in this war, but
also how we approach this problem in the future, and even
how we will conduct medical research.
These are but a few of the highlights of what, for
us, is a crusade. We all care deeply about the department
and its people.
We care about how they view the department, and
how it serves their needs.
As you look back over the last year, hopefully you
will agree that, while we still have much more to do, we are
on the right path. Thank you for letting me make that
statement. With that, we are prepared to continue with the
DR. LASHOF: Proceed.
MS. DAVIS: Dr. Lashof, members of the committee
and staff, thanks for the opportunity to appear before you
You requested testimony on the Investigation and
Analysis Directorate's progress on several investigations,
and on any case narratives released since the July meeting
in Buffalo, as well as updated status reports on several
cases about which we have previously provided testimony.
As requested, we have available the lead analyst
for each of these cases, who is prepared to respond to
Additionally, you requested us to discuss our
plans to address the next set of case investigations.
We are prepared to provide testimony first on the
11th Marines and Kuwaiti Girl's School cases. At this time
I would like LTC Art Nalls, who is the chief of the chemical
and biological warfare agents division, to talk about the
11th Marines case.
He is accompanied by Tom Stewart, who is the lead
analyst for that case. Art?
LTC NALLS: Thank you. Good afternoon. I have
been asked this afternoon to give us an update and refresh
our memory on where we are with the 11th Marines
The first point I would like to make is that this
is not a single incident, but a collection of incidents that
have revolved around the 11th Marine Regiment in Kuwait
before and during the ground war.
The 11th Marine Regiment was really five artillery
battalions task organized as the 11th Marines, and included
some of the units of the 12th Marines artillery regiment,
and were in close proximity to the 12th Marines regiment.
Some of the key people that we have identified to
contact and interview, you are going to see some of the key
players in the 12th Marine regiment.
I just wanted to get that clear. It actually
involves the two artillery regiments. It was composed of
some 20 allegations of possible chemical detections.
Several of those were by the 11th Marine units
themselves, and some appeared to have been a response by the
11th Marines to calls on the tactical nets supporting and
adjacent units that had detected chemical agents.
In each of these events, the 11th Marines upgraded
their protective posture to MOPP 4, and took the appropriate
precautions of going through the 256 kit detections.
They were subsequently all declared false alarms.
But our investigation focuses on were they actually false
alarms, or was that the correct assessments.
To take someone's words from earlier testimony
today, our job is to dig deep, and not just to assume.
The investigation was initiated from the Persian
Gulf Investigation Team, after review of our Fox and 256
matrix, that showed a pattern of several of these detections
belonging to the 11th Marines.
In response to your suggestions in Buffalo, we
have upped the priority of our investigations into the 11th
Marines and we have also refocused our investigations.
We have added more resources to it to try to get
the job done quicker. Additionally, instead of looking at
all of the 20 events, we have focused on those events which
were reports of multiple detections.
This slide is somewhat busy, but I will try to
simplify it. The top part here are incidents by day, 17,
18, 19, 29 and 30, through the months of January and
The bottom part here, in gray, is an expansion by
hour from zero zero zero zero, midnight, until 2400, of the
four days during the ground war.
As I said earlier, we focused our attention on not
all 20 incidents, because that is quite a big handful, but
we focused them on the ones that are in red.
You see one that is on the 10th, and you see three
on the 26th of February, as the ground war is raging.
It is important to note that this one on the 10th,
which does involve the 11th and the 12th Marine regiments,
the oil well fires do not appear to be a factor in that,
because that had not started yet on the 10th.
So, these are the four events that we are looking
at in closer detail, the 10th and the three events that were
multiple alarms on the 26th.
The incidents were reported in various command
chronologies, and through NBC officer and NCO logs, they
seem to corroborate some of these events.
Our interviews and investigative process outlines
the process that we have done for other chemical incidents.
We have attempted to contact and talk to the people who were
in a position to know who, because of their billet or
because of their training, were cognizant of all the events
going on at the time, and who had the sufficient training to
make a proper assessment of the information given to them.
This outlines the people that we have identified
and people that we have actually succeeded in interviewing
The top part here are in the overall command
structure. They would have been cognizant of all the events
of the 11th Marines.
You can see that the ones that are in red here are
the ones that we have actually succeeded in contacting and
we have interviewed.
The ones in yellow, we have the contact
information. The ones in blue are ones that we have
identified but we haven't got complete phone numbers and all
the contact information on those people.
Below the horizontal line here, these people here
where it says perspective on the 12th Marines, those are
people that were in the area and also associated with the
artillery raid on the 10th of January.
That was the very first event we investigated.
You can see here, again, the red ones are the ones that we
have actually completed. So, we are about halfway through.
During the ground war, the three events that
happened on the 26th, there were other operations officers
around the area, and those are the people we have identified
that we want to talk to.
You can see here these are the specific people
that we have identified. We have had about a 50 percent
completion rate on identified, actually locating, and
interviewing those people.
I would like to also point out that this list
continues to grow. This is a dynamic list. As we interview
one person, they often lead us to somebody else who is
likely to know something. They suggest, why don't you
contact so and so.
Where we are. We are still seeking some
interviews. As I said, we are about halfway through the
Our focus is on who declared the alert. What was
the original source of the alert. That is particularly
curious to us on the 10th of January, before the war.
There was an artillery raid, but we have been
unable to locate any source of initiation for that chemical
It appears to be that some people were just
performing a 256 test. There does not appear, at this
particular point, to have been an M8 alarm or a Fox vehicle
alarm, or something along that line that initiated a
potential chemical alert.
We want to find out who actually initiated it.
What was the unit reaction. Did they go to MOPP 4. What
did they do to attempt to confirm the results. Who finally
gave the all clear, and on what basis did they make that
Based on what we have right now, especially the
incident on the 10th indicates that it might have been an
instance of better safe than sorry.
Some people were most probably just performing a
256 kit detection in response to an unusual smell or
something that they saw on the battlefield in response to an
We have found no indications of alarms having gone
off on the 10th, to springload this.
One of the comments from one of the commanders was
that his NBC team appeared to be very aggressive in
performing chemical detection tests.
As I said, earlier, on the 10th the oil well fires
had not started. So, the oil well fires did not appear at
this point to have been a factor at all on the incident on
the 10th, but could very probably have been a significant
factor on the events during the ground war on the 26th.
Oil well smoke, as you know before from previous
testimony, is an interferant for both the M8 alarms, Fox
vehicles, and for the 256 kit detectors.
Our status is that we are continuing to
MS. DAVIS: If the committee wishes, we are
prepared for questions.
DR. LASHOF: I was going to say, if that completes
what you were going to present on the 11th Marines, we will
take questions on that. Then we will move through them
sequentially and take questions on them.
LTC NALLS: That is fine, ma'am. I would like to
point out that at the end of the table is Mr. Tom Stewart,
who is the team leader for this. He could have a level of
DR. LASHOF: Sure. What is your time table for
completing? When do you estimate you will be able to
complete the 11th Marine one?
MR. STEWART: My estimate is that we will publish
on Gulflink somewhere around the middle of December. That
takes into account extensive coordination that takes place
on all of these papers, which go on for weeks, both internal
and particular external.
With that in mind, that would require that we
complete at least the initial draft of that paper by the
middle of October.
DR. LASHOF: Could you tell us more about what is
the external review? I understand your internal. What
external review do you have of the narrative?
MS. DAVIS: As is not unlike other instances where
you are trying to coordinate information across agencies, as
we complete our case narratives, they are provided within
DOD to other staff agencies and the services for their
review, to make sure that we have got the facts right and we
haven't called a Marine a soldier, and things like that.
Additionally, we have the documents reviewed by
CIA and DIA to make sure that, as we have used the
intelligence community for input, that what we have said is
consistent with their knowledge and their assessment of what
is going on.
In some cases, for instance, the Czech French
narrative that we will be putting into external review, we
will have it reviewed by the Department of State because of
the fact that we are talking about allied countries.
In addition to that coordination -- and we send
them back, we get comments back, we incorporate the comments
into the narratives to make sure that they are as full and
as complete as we can make them -- we also send courtesy
copies to Veterans Affairs, to your staff, to Health and
Human Services, et cetera, other interested agencies within
the federal government.
DR. LASHOF: Thank you. Other questions?
MR. BROWN: A question for Dr. Rostker, I guess, a
little bit off the topic we just heard about, but getting
back to the issue of modeling the incidents at Ukhaydir, the
mustard released in the incidents at Ukhaydir, I guess we
are all a little disappointed that this hasn't been more
completed, that we don't have the complete exposure modeling
done on that.
I guess I was under the impression after our
meeting at Buffalo, that was going to be done by now.
I guess my question is, is it fair to say that the
CIA has completed its part of it and that we are now just
awaiting some data from DOD?
DR. ROSTKER: No. I think Mr. Walpole covered
that subject thoroughly. We worked together in this. We
are waiting on some weather data, but this is a joint effort
by both agencies.
MR. BROWN: I guess my question is, what is the
hold up and when will that modeling be completed? When will
that be wrapped up?
DR. ROSTKER: I think Mr. Walpole covered that in
MR. BROWN: I guess my impression is that the hold
up is not really within the agencies, that the DOD is
withholding the application of the so-called COAMPS
modeling. It is not CIA's responsibility at this point.
DR. ROSTKER: We have worked this as a joint
effort with all of our resources. It is a joint product.
The weather data takes time and we have explained this
MR. BROWN: We will just have to wait, then, I
guess is your answer.
MR. TURNER: As I understand the current schedule,
it means that the COAMPS data will not be available until
after this committee's report is due to be submitted to the
President. I think that is the problem, Dr. Rostker.
If I could just return to the 11th Marines here,
for a second. If I understood what you were saying about
the event on the 10th, oil well smoke is not a likely
explanation for those positive 256 kits. There weren't any
oil well fires; is that correct?
DR. ROSTKER: That is correct.
MR. TURNER: Have the marines who took those tests
been interviewed yet?
MR. STEWART: Yes and no. There were obviously
several people involved. In fact, probably several dozen,
not all of whom would know the details of the incidents.
It is interesting, in that this particular case
came to light not through any documentary source whatsoever.
It came over our 1-800 line.
That was the beginning of it. We were able to get
back with that individual who had called in and debrief that
He gave us quite a bit of detail on the incident
and also names of other people to contact. We have, as late
as yesterday morning, contacted another one of those
individuals, someone who was in the immediate area where
this original contact was. These are the key people in the
There is another individual, who we have been
trying for weeks and weeks to get a hold of. Frankly, this
is an example of the kinds of problems that we face in this
This gentleman is out of the Marine Corps. He is
a long-range trucker. He has lived in nine or ten different
places in central Missouri the last 10 years, the last one
being a post office box, and he does not have a phone.
We have sent him a letter, as we have done with
perhaps six or eight other individuals so far, that we have
simply been unable to contact. We are trying to go at it
We anticipate that we will eventually talk to that
person, but we can't be entirely sure. He was one of the
people who worked the 256 kits, so he is obviously critical
to the estimate of that particular incident.
I would also point out that, for that particular
incident, as late as yesterday we were getting conflicting
information about what actually happened; in fact, to the
degree that we are not entirely sure that it would be an
incident of multiple detections.
There are differences of opinion about M8 alarms
and differences of opinions about how many 256 kits, for
example, were positive or negative.
These are the kinds of issues that we are trying
to get to the bottom of. We need to do that by talking to
additional people and we are certainly working hard on that.
DR. BALDESCHWIELER: Is it generally accepted now
that the oil well smoke interfered with all three principal
alarms; that is, Fox, M8, and the 256 kit?
MR. STEWART: My understanding is that they are
all potential interferants with all three of those systems.
DR. BALDESCHWIELER: Is it known what the actual
MR. STEWART: You mean in terms of the component?
DR. BALDESCHWIELER: Yes.
LTC NALLS: We have documentation from CBDCOM,
that we asked that exact same question on all three of the
Yes, the hydrocarbons are. When you have a
hydrogen, carbon, oxygen, sulfur combining in various
different ways, you get some heavy molecules that just drive
these types of detectors crazy, all of them.
DR. BALDESCHWIELER: Does this mean that none of
the detections after the oil well fires began are credible?
LTC NALLS: No, I don't think we are willing to
say that. I think that we said that we recognized that
while the oil well fires were going, that could be an
Our investigation doesn't stop there. We are
still going to go back and look at the other indications
that could be present.
MR. MARK BROWN: I would just jump in here with an
observation. I have seen that data from CBDCOM. You guys
sent us the data where people were trying to experimentally
interfere with the different detectors, all the detectors
that Dr. Baldeschwieler just mentioned.
There is some information about interference from
red kiminitric(?) causing some false positives in some of
I have never seen anything showing that oil well
fires cause false alarms; I mean, experimental data showing
that fact. If you have something like that, I would sure
like to see it.
I thought that was absent. I have heard the
speculation made, but I haven't ever seen any data where
somebody has actually tried that and gotten a false positive
with a 256 kit or even an MM8.
LTC NALLS: I have a memo I will be glad to share
with you back at the office. It specifically says the same
types of interference -- diesel fumes, diesel exhaust.
MR. MARK BROWN: Is it speculation or is it
someone actually trying to prove it.
LTC NALLS: No, I will be glad to share that with
DR. BALDESCHWIELER: Is there actual experimental
work that has been done to show this?
MR. MARK BROWN: I have not seen such actual
experimental work done to show this.
MR. TURNER: We have contacted CBDCOM to pursue
DR. LASHOF: Any further questions? Let me clarify
that, LTC Nalls. You say that the memo that you have makes
a statement about this or presents experimental data to show
LTC NALLS: I would hate to speak from memory off
the top of my head. I do have the memo. I might have it in
my briefcase. I would be glad to share it with you at the
DR. LASHOF: Okay, we will get back to it then.
LTC NALLS: If I don't have it in my briefcase, I
will get it.
DR. LASHOF: Okay. Are we ready to move on to the
MS. DAVIS: Now I would like to ask LTC Dee
Morris, the deputy director of IOD to discuss the Kuwaiti
Girl's School case. LTC Morris is also the lead
investigator in this case.
LTC MORRIS: Thank you. As we briefed in
Charleston, the specific nature of this case was the
reported detection of three agents, specifically phosgene,
phosgene oxime and mustard, by a fox reconnaissance vehicle
and other detection equipment after the Gulf War.
This particular case came to light when the
commander of the chemical unit that was called to the
incident to provide the fox detection made a statement
through his chain of command in January of 1994.
The specific purpose of this statement was to
provide information which might have allowed his chain of
command to change his curriculum that he was teaching at the
United States Army Infantry School.
Subsequent to this, statements were made during
the Defense Science Board investigation. There has also
been testimony associated with both the Reigle Report and
Congressman Shay's committee.
We have spent an awful lot of time talking about a
tank at the Kuwaiti Girl's School. I would like to show you
today what we are talking about.
These particular photos were unearthed in the
archives of the United States Army Corps of Engineers. We
have established the pedigrees of these photos and have
talked to the photographer.
They were taken approximately the 15th of July
1991, about two to three weeks before the incident which
involved the fox.
What I would like to highlight here is what
appears to be a small rust stain in this particular photo
These were taken in sequence. We have access to
the negatives, and they were taken one after another. What
this actually shows is wisping of vapor coming from a small
bullet hole which is subsequently documented by just about
everybody who has had experience with this tank.
That particular vapor is rust colored, reddish
orange, and is indicative of the red fuming nitric acid,
which we ultimately believe are the contents of this tank.
I would like to establish a color convention here.
The items that are listed in subsequent slides in green are
things that we have already briefed you about, specifically
things that were briefed in Charleston.
In the last couple of months there has been a
significant amount of effort and a lot of new information
that has come to light, and that is listed in red.
So, we are dividing this to give you a full
picture, because you need to see the progression of
information here to better understand what we are talking
We have essentially interviewed just about anybody
and everybody who has been associated with this incident, to
include some folks that people might not have expected would
have been involved.
The Corps of Engineers TransAtlantic Division and
some of the folks who work for both the defense
reconstruction assistance office and the Kuwaiti emergency
recovery office -- both offices part of the Corps of
Engineers -- did, in fact, come in contact with this tank.
We had located documents in the Corps of Engineers
files which led us through a series of contractors, to
actually talk to people who had dealt with this tank, in
addition to folks who performed analysis.
What we have also done is we have established a
dialogue with the British Gulf War veterans illnesses unit.
We expect to interview a significant number of people while
we are in Europe in the next two weeks.
The significant new information among the reports
on this particular incident are the fox tapes. Prior to the
15th of August this year, we did not have in our hands and
had not been able to locate in the U.S. files the fox tapes
from this particular incident.
Based on an inquiry that we had sent to the
British government asking questions specifically about this
case, their search of their files revealed a copy of the 14-
page fax which the chief of staff for Task Force Victory,
who was also a chemical officer, had sent to Edgewood
requesting their assessment.
We are confident that this particular document
that they have sent us is essentially a verbatim copy. It
is even addressed to the individual at Edgewood.
This particular incident is also mentioned in an
American Embassy/Kuwait cable, and all the information that
is in there has been corroborated independently.
In addition to the tests that were performed on a
variety of detection equipment with red fuming nitric acid,
which Dr. Brown had indicated earlier, we were also able to
uncover a message that was generated in 1991 and was
actually during the Desert Storm period.
Units were advised that red fuming nitric acid
which was, again, an oxidizer used in a variety of missiles
-- the SCUD and others -- could in fact cause false
positives on the mustard scale.
This was something that just going back through
the messages we were able to find.
We continued to seek Portin Down analysis results.
I would like to remind everyone that Portin Down did not
complete a final report on this particular subject. They
do, in fact, have an interim report which they have
indicated they will provide to us when we are in England in
the next two weeks.
We also have been provided the name of the injured
British soldier and I have been told that I will have the
opportunity to talk to him while I am over there.
In addition, in going through some of the
additional information that we have found on this particular
case, we have identified a number of other British personnel
who had information or could potentially provide details
which would allow us to fill in the gaps and make this a far
more complete story. Those folks are all listed there.
We do, in fact -- and I know specifically I will
be able to talk to the Portin Down individuals who are still
alive who had done the actual testing and sampling and some
of the folks who may have assisted the primary investigator
in the analysis.
We are continuing to seek the remaining fox
operators and we do hope to interview all of them.
Royal Ordinance and Passive Barriers, Ltd, were
two British companies that were involved in this particular
Royal Ordinance, we believe, had something to do
with putting the British EOD team on this tank to look at
it. We have indication that Passive Barriers was involved,
at least initially in planning for its disposal.
The tapes that we have were classified by the
officer who sent them. We initiated declassification
efforts on those tapes as soon as we had them in our hands.
The British did, in fact, transfer them to us via
secure means. As soon as they are declassified, we will
provide them to Bruker and to NIST for further analysis, as
we have done in further cases involving fox tapes, where we
have used not only CBDCOM, but Bruker and NIST.
As I said in May in Charleston, there are a number
of reports in which accounts of critical facts differ.
However, by being able to pull together all the pieces that
we have now pulled together, we have been able to establish
a reason for why this tank would have been where it was.
Specifically, that was that this particular school
-- at this point I would like to interject the fact that
somewhat like the problem we had with Khamisiyah, there are
at least three names of this particular school that we find
in message traffic.
We initially thought we might have had more than
one tank. By going back through and learning a little bit
about the way the Kuwaiti's governmental structure is and
how they name schools, we came to the conclusion that all of
those names did, in fact, relate to the same place.
This particular place was a missile maintenance
facility during the war. This particular missile system
did, in fact, use red fuming nitric acid as the oxidizer for
It was not a SCUD site. It was a site that was
used for a much smaller missile. That would explain why we
are only dealing with one tank, as opposed to several, which
we would have expected for SCUDS.
Another thing is that there are three agents that
have been reported throughout time on this particular story;
particularly phosgene, phosgene oxime and mustard.
Upon reviewing the tapes, only phosgene and
mustard were alerted for. Neither is confirmed by the
spectroanalysis on those tapes.
We have, in fact, made those tapes available to
staff members for their review.
Specifically, the tapes reveal a presence of
nitrogen dioxide in 100 percent relative intensity. This is
most likely from nitric acid plus some hydrocarbon
Of note here, the analysis that Edgewood performed
at our request as to what red fuming nitric acid would do if
it was challenged into an MM1, when they came back and gave
us their initial assessment of these tapes, they reminded us
that the mass peak, 46, does in fact appear at 100 percent
intensity on a known sample of red fuming nitric acid. On
these fox tapes, that is what we see.
We have also, just yesterday, received information
that the Kuwaiti National Petroleum Company has also
assessed the contents as red fuming nitric acid.
They did, in fact, take possession of this tank
and they used it at one of their company sites. We do not
have the specific documentation in our hands, but we have
been provided the information, courtesy of our brethren at
the Central Intelligence Agency, as to who we need to
contact officially to get this information.
The status of this particular case is that there
are still a lot of loose ends that we need to pull together.
We hope to use our visit with the British in the next two
weeks to do that.
They have specifically offered me the opportunity
to conduct joint interviews with them of the various people
we have requested to see.
I am also accompanying Dr. Rostker in October to
Kuwait. If we haven't wrapped that particular piece up, we
hope to do that at that time.
Finally, this particular narrative is going to be
coordinated through our review process and final writing is
going to occur almost simultaneously.
We did submit what we knew on this as of what we
are testifying about today to peer review earlier today and
it has completed that process.
Our peer review process is an internal analytical
review to make sure that we have looked at all of our holes,
and that those of us who are very close to this thing aren't
When we get back from England, we will go through
and rewrite what we have to rewrite based on what we have
found out, and progress it through the process. We are
hoping to put this out within the next two months.
Subject to your questions, that concludes my
DR. LASHOF: Are there any questions? I think we
are going to have to move through these cases a lot faster,
if we are going to get to them and then get to some general
questions that we have about the whole process.
DR. ROSTKER: I would just like to make one
comment. I know you have been very critical of the time we
have taken in these cases, and the fact that we have often
not drawn a conclusion.
This is an example of the care that we give to all
of the cases.
DR. LASHOF: Can we hold that discussion until we
finish? That is relevant to this in terms of how you select
them, what is the priority, what is the standard, which ones
are worth pursuing more thoroughly.
I didn't want to pursue it right now on this one.
I would rather listen to them all and then come back to that
issue. It is an issue between us and you over a period of
time. Whoever is next, go ahead.
MS. DAVIS: Who is next. Now it gets to be my
turn again. What you have asked for is an update on where
we are with a couple of cases.
First, I will address the case narratives that
have been released since the July meeting in Buffalo. Then
I will provide status reports on both ASP Orchard and the
Czech French detection case. We can pause for questions at
any point during this, or I can just keep right on going.
On Al Jubayl, as we have testified during the last
two hearings, the Al Jubayl case covers a number of
incidents reported to have occurred in January, February and
March of 1991.
We note in this slide the four events we
identified and investigated; that is, the loud noise, SCUD
interception, the SCUD impact, and a purple T shirt
Additionally, we included in the case narrative a
general discussion of the environmental conditions that
existed in this industrial city.
The Al Jubayl case narrative was made available to
the public and press and published on Gulflink on August 13.
It includes our assessment of the likelihood of
the presence of chemical warfare agent for each of the
incidents investigated, and our assessments are noted up
We have assessed that it was unlikely that either
the loud noise incident on January 19th or the noise and
flashes of light reported late on the 20th and 21st of
January involved chemical agents.
We have also assessed that chemical warfare agent
was definitely not present in either the SCUD that landed in
the Al Jubayl harbor on February 16 or the fumes which
turned the brown T shirts purple on March 19.
I would like to note, based on some discussion
earlier today, that the SCUD that went into the harbor on
February 16 was, in fact, retrieved by DOD.
As we note in our narrative, the SCUD was pulled
out of the harbor. It was inspected at the time, and then
it was sent to the Army Missile Command in Huntsville,
Alabama, where it currently stays.
Part of my investigation unit has gone down and
actually looked at it.
DR. LASHOF: And you found that there was no
MS. DAVIS: We found that there were no chemical
agents; that is correct.
We are in the process of preparing to send letters
to notify units in Al Jubayl during the incidents in
question, of the results of our investigation to date.
The targeted population is members of units who
were in the vicinity of Al Jubayl on the dates of the
incidents, those veterans whom we interviewed to obtain
information about this case, and anyone else who had contact
at our office expressing an interest in Al Jubayl.
We expect to send out approximately 37,000 letters
providing a synopsis of the Al Jubayl narrative, and we will
begin the mailing within the next two weeks. That is all I
have on Al Jubayl. Are there any questions?
DR. LASHOF: Any questions on Al Jubayl? Good,
let's move it along.
MS. DAVIS: The SCUD piece case narrative was also
published on August 13. This case focuses on the analysis
of a piece of the SCUD missile that was provided to you, to
the PAC staff, by a veteran to determine if it contained
chemical warfare agents.
The sample was reported to be a piece of a SCUD
missile hit by a Patriot missile near King Faud Military
Airport on or about January 19, 1991.
While analysis of the sample by the Missile and
Space Intelligence Center found that the sample was
consistent with metallurgic properties of SCUD missiles,
chemical analysis by the U.S. Army Edgewood Research and
Development Center found no evidence of chemical warfare
agents on the sample.
Accordingly, our assessment in this case is that
it is unlikely that such agent was present.
The most recently published case narrative deals
with the only documented report of chemical warfare agent
exposure to a U.S. soldier during the Gulf War.
When I say only documented report, it is the only
report contemporaneously documented, report that we have.
On March 1, 1991, Army PFC David A. Fisher was
exposed to a chemical agent while exploring enemy bunker
complexes in southeastern Iraq.
He developed blister symptoms roughly eight hours
Medical evaluation and treatment diagnosed the
exposure as liquid mustard chemical warfare agent. Fox
vehicle readings of the bunker and PFC Fisher's clothing
alarmed for mustard agents. The testing of a urine sample
gave positive results for a mustard breakdown product.
Although later analysis of physical evidence did
not confirm the exposure, experts concluded that the skin
injuries that PFC Fisher suffered were most likely caused by
exposure to mustard agent.
Our assessment for this incident is that chemical
warfare agent is likely.
I would like to make the point here that we say it
is likely rather than definitely yes, frankly because the
subsequent testing was unable to confirm the contemporaneous
Given just that degree of uncertainty, we can't
say definitely when we can't say definitely. Any questions
DR. LASHOF: Any questions on the Fisher incident?
If not, move right along. We are doing better.
MS. DAVIS: Turning now to the cases about which
you requested a status report, the first case is that of the
As we testified before you last month in Buffalo,
this test concerns detections of sulfur mustard, HT mustard,
and benzylbromide on February 28, 1991 at an ammunitions
storage point located southwest of Kuwait City, by a fox
vehicle attached to the Marine Corps Task Force River.
This narrative has completed internal review,
which means that it has been reviewed internal to the Office
of the Special Assistant and it has been circulated for
external coordination within DOD and other interested
We are in the process of obtaining and
incorporating comments from that review into the case
narrative, and we anticipate publishing it on September 23,
immediately after Dr. Rostker returns from his Europe trip.
Our assessment is that it is unlikely that
chemical warfare agents were present in the ASP.
The other case you requested a status report on
were reports of possible chemical agent detections by the
Czech and French troops during the first several days of the
air war between January 19 and 24, 1991, in the vicinities
of Hafferabaton and King Talhil Military City.
The primary sources of information on this case
are Senator Shelby's report to congress in 1994, the records
of his visit to coalition countries, the report of the
Defense Science Board, and numerous unit logs, such as the
SANCOM NDC desk logs.
As DOD has previously testified before this
committee, after examining check procedures and equipment,
we have described the principal detections by the Czechs as
credible, although the source of the chemicals is still
The credibility of the French reports cannot be
assessed because the French have not publicly disclosed
details of their chemical detection processes, despite a DOD
request for additional information.
Our current assessment of the Czech and French
detections is indeterminant. We know we don't know.
The interim case narrative is about to begin
external coordination within DOD and other interested U.S.
Additionally, Dr. Rostker is taking the draft
narrative to deliver to appropriate agencies in France and
the Czech Republic during his fact-finding trip beginning
We hope to obtain comments and additional
information from those coalition countries which we can
incorporate into our narrative.
The reason you don't see a target publication date
up there is, frankly, it depends on how much information we
get back at that time.
DR. LASHOF: any questions on either of these?
MS. DAVIS: Finally, you requested information on
our plans to address the next set of case investigations,
including a description of the events associated with the
case, how the case came to DOD's attention and the expected
I am prepared to do this in excruciating detail,
but I think we will probably keep it at a high level list,
given where we are in the schedule.
Before I begin I would like to note that, in
addition to cases in progress that we brief you on today, we
expect to publish interim case narratives on the Al Jabhar
and Talhil cases by the end of this month.
We also have information papers in internal review
on the M8 chemical alarms and MOPP gear and procedures,
which are expected to be published early in October.
We are anticipating a substantial revision of the
Khamisiyah case narrative, which incorporates all the
information that we have obtained from the CIA, from the
plume modeling and so forth.
We expect, we hope, that we will be able to
publish that revision in November, as well as the first of
the environmental cases on depleted uranium. So, that is
what we have coming up as far as the first wave, if you want
to call it that, within the next couple of months.
As I testified before the committee in Buffalo, we
have undertaken a comprehensive review of all the
information we currently have on incidence issues and units,
with a view to determine where we are and what we think
needs to be characterized as a case for further
We didn't focus merely on chemical and biological
investigations, but we looked at the totality of possible
causes of, and issues surrounding, Gulf War illnesses.
That is what I would like to cover and I will do
it as quickly or as slowly as you need me to do it. I am
prepared to talk in both the chemical, the environmental and
the medical arena.
This slide lists those cases which the chem bio
division will focus on in the upcoming months. They are
roughly in the order of priority based on what we consider
to be the criticality of the issue and how it contributes to
an understanding of critical events.
It also is a function of information currently
available, and frankly, resource availability. As people
are finishing up other cases, they will be commencing these
The first couple of cases on this list, going down
certainly through biological warfare, represent issues that
we have done some work on.
We have information gathered. Things like An
Nasiriyah is the result of the investigation that we have
On Talhil, we have a substantial amount of
information we have already collected on An Nasiriyah
because it is a related case. I would expect that those
would be sort of the first of the first in terms of the next
set of cases coming out.
Many of the other cases that are on there are ones
that either derived from cases we had already worked on, or
were recurring questions.
For instance, at the bottom of the first column
where you see the case that talks about samples, there we
are looking to do an information paper that is going to talk
about the work of the joint captured material exploitation
center, and the chemical and biological samples and others
that were taken during the war.
It continues to be a question. What did they do
and what happened. What do the results of the testing of
the samples show.
Many of the ones that you see on the second column
are ones, frankly, that as you all know we have had on our
list of things to do once we have, for instance, the fox
investigations based on the matrix that had been in
existence for some time and the cases that we have already
worked out of the original list of 21.
Right now that other fox investigation that we are
aware of consists of three detections that are otherwise not
being handled in one of the other cases, and so on.
I can either stop here. I guess I would like to
go to the environmental case list very quickly. It is 48.
This slide lists both those cases under
investigation by the environmental occupational exposures
division, and those which will be investigated after the
first set has been completed.
As noted, there is a trip to the Middle East
scheduled for October, where we hope to gain insight,
especially on environmental issues that are endemic to the
The first three in the left-hand column, depleted
uranium, that case is currently in internal review. We
expect to publish it in the October/November time frame.
Oil well fires is actively under investigation and
we have targeted release of that narrative in November or
December, as we get toward the end of the year, as we have
with the pesticides case, which is also actively under
As those cases are published, then we will just
begin to work our way down the list, through the remaining
issues that have been identified as significant
environmental issues or occupational issues that need to be
DR. LASHOF: Let me stop there and ask one
question about that list. Many of these are under
investigation by research centers that have been
established, have they not?
You have an environmental research center in the
MS. DAVIS: There very well may be ongoing
research about the medical effects of, say, pesticides as an
However, what we are trying to do is tell the
story of specifically what happened in the Gulf. What were
the exposures that occurred, based on the information that
we are able to find after the fact. So, ours is not a
research effort per se.
DR. LASHOF: Give me a sense of how you would go
about trying to learn things about the pesticides and
insecticides used in the Gulf.
What methodology are you going to use for that,
compared to what is being done in the VA survey in which
people are questioned, which has been in the history and the
CCAP and everything else. How are you going about that.
MS. DAVIS: Among other things, for instance, for
pesticides and insecticides specifically, we are looking at
the supply system.
We are looking at material safety data sheets,
what kinds of things were in the inventory, what was taken
to the Gulf, what can we find out about records of what was
We are checking procurement records of what was
purchased in the Gulf, if there were things that were
What we are going to be able to describe, we hope,
is literally the extent of what was used, and in what
DR. ROSTKER: If I might, this is a major concern
to the British. They have already published an extensive
paper on what was used in the Gulf, the type of chemicals,
how it was applied, safety precautions and the like.
So, we have, in fact, a very good model of a paper
that I think we need to have as complete a story as the
British already have on the table.
One of the issues, for example, is the contracting
with Saudis, who did a lot of the spraying. We are not
quite sure what they sprayed and how they did it.
We weren't even in control of all the spraying
during that period of time.
DR. TAYLOR: Let me ask a follow-up question as
far as learning what the exposures were. You still would
not be able to identify what our troops, the amounts that
they were exposed to from, say, an airborne concentration
point of view.
You are just talking about quantity, the amount
that was actually used?
MS. DAVIS: That is correct, at this point. We
were hoping in the course of being able to talk to the
people who actually applied the pesticide, that we are going
to be able to determine, one, what was sort of normal usage
and also whether there were any instances of extraordinary
usage. I guess that is probably the best way to say it.
The only way we are going to do that is by talking
to the people who were actually there and who were
responsible for the actual application.
DR. ROSTKER: For example, at Al Jubayl, the
troops report that when they went into their tent area that
had been prepared for them, there were dead rodents, there
were dead insects, that there had been heavy spraying before
they went in. Some of the sprays are persistent.
DR. TAYLOR: Who actually conducted these
DR. ROSTKER: In some cases it was U.S. troops.
Some was contracted out to the Saudis.
DR. TAYLOR: Do you have material safety data
sheets on hand? Are you still investigating? Are you
trying to collect all of them now?
DR. ROSTKER: That is correct.
MS. DAVIS: That is correct.
DR. TAYLOR: Why is it taking so long at this
point to find out.
DR. LASHOF: Things like this you should have
known years ago.
DR. TAYLOR: On the pesticides and insecticides,
that we don't have material safety data sheets on the actual
content of what was actually done.
MS. DAVIS: We actually do. The hardest part,
frankly, as we have pulled things together is to be able to
turn the clock back.
We are finding that in the course of the supply
system, when for whatever reason a material safety data
sheet is updated, it is updated, and they don't keep the one
that they necessarily had in place in 1991.
So, we do have some difficulties with actually
being able to walk them back. There are some things that we
have got all the chemical compounds and so on. We are just
not able to find the historical document that shows, again,
that this is actually what it is. We are still working
DR. ROSTKER: I think you know that many of these
pesticides are gynophosphates, just as the nerve agent is.
So, we are talking in the same continuum.
DR. LANDRIGAN: I am a little nervous about the
problems the colonel alluded to of the inaccurate detections
and the fact that there seems to be a fair degree of non-
specificity in the positive readings.
I wonder if you have an organized plan in the
laboratory to test the range of false positives and false
negatives. That just seemed to be all over the place.
LTC MORRIS: There has been a significant amount
of effort over time, as these particular devices have been
developed, to try and articulate what the interferants are.
One of the reasons that we are putting out, for
instance, an information paper on the M8 A1 alarm and one of
the reasons that we put one out on the fox vehicle is to try
and articulate that, and to look at what the state of
One thing that we have found is that the state of
knowledge in 1990 and 1991 is different than it is today.
Quite frankly, the Gulf War provided a considerable
contribution to that state of knowledge.
There were things that were determined post war to
be interferants to the various detection systems that
people, quite frankly, hadn't anticipated.
So, what we are looking at is what testing has
already been done and if something cannot be explained, much
as we have done with several of our cases with the fox
vehicle where we just don't understand why we are getting
the reports, we do things like ask them to challenge things
with a particular compound and see what it does.
I am sure if there are some we come in contact
with, we may ask that to occur again.
DR. LANDRIGAN: There are two sets of issues here.
One is historical reconstruction of actual events. The
other is, what is the performance capability of the machine.
I understand that the machines -- at least I am
sure they have become more sophisticated in the last six or
I would suspect that you still have some vintage
1991 instruments around.
LTC MORRIS: Yes, we do.
DR. LANDRIGAN: It would seem reasonable to do a
series of bench tests where you expose these instruments to
simulated oil fumes and a series of other contaminants and
see what happens. Maybe that is happening.
LTC MORRIS: That has been done on sort of a hit
or miss basis. Specifically, when we requested the tests on
the MM1 for the red fuming nitric acid, I got a little
impatient with my friends up at Edgewood and said, what is
taking you so long. Why haven't you just run this stuff
They said, well, we are in the process of getting
an Operation Desert Shield/Desert Storm MM1 shipped in
because we don't have one on post. We want to use that
instrument to do our test.
We are aware of these and while we probably
haven't done everything that we are thinking about right
now, it is all within the realm of possibility and it is
part of turning over the proper stones.
DR. LANDRIGAN: I just remember back when I was a
third year medical student, one of the things they used to
teach us was when you got a positive result on a patient,
before you sent the patient to surgery, you confirm the
Sometimes that meant going back and getting
another blood sample or doing another biopsy, but making
sure of the data before you went ahead.
LTC MORRIS: That is what we are trying to do.
DR. LANDRIGAN: Good.
DR. LASHOF: Okay, other questions. Okay, go
MS. DAVIS: I guess finally, and it is the -- our
focus on medical issues is different than the other cases we
If you think in terms of a continuum of focus, we
have had the narrowest focus on the chemical incidents, and
that is what actually happened at a certain place and time.
In the environmental cases, we open the lens
somewhat, not only to cover specific incidents, such as DU
contamination, but what was happening in the theater
generally, as with oil well fires and pesticides.
These issues begin to bump against the question
of, if we didn't do it completely right or if we could do it
better, what should we have done. What should we do better
the next time.
When we come to medical issues, we recognize that
we are almost purely in the arena of policy issues or of
descriptions of lessons learned and their implementation.
Accordingly, the medical issues we intend to
investigate as shown here have a much more systemic focus
than those described earlier for the other cases.
As you can see, and not surprisingly given the
things that you have found in doing your work, a huge focus
is on record keeping, and sort of where are the records and
where should the records be and how should we do it.
That is all I have at this point. We are prepared
to answer any additional questions or go into any additional
detail on any of these.
DR. LASHOF: We will open it up for questions.
Let me go back, then, to one of the issues that we
discussed in Buffalo that applies across the board to the
case narratives and how you lay out the evidence.
You made, I think correctly, the point that you
will lay out the information that you have, indicate the
basis on which you draw your conclusion, but that it will be
a public record and people can draw their conclusions.
You have various sources of information, various
kinds of data. I wondered whether you have at this point
come to any more objective criteria that you are going to
use in coming to your conclusion.
Granted, each of us can read a narrative and
decide how much weight we want to give to this, that or the
A certain amount of information should carry more
weight than other kinds of information. One can sort of lay
out a priority of those things that get the most weight and
those that not.
At least we often do that in other kinds of
things. I don't know how applicable it is in this
situation, or whether you have made an attempt to do that
and found that wanting.
What kind of criteria leads you to other than your
gut feeling, after you look at a thing saying, well, gosh, I
guess that is unlikely.
There is something in between. I know we don't
have ABC and we add it up and you get a score of this, it is
this, and if you get a score of that, it ends up there. I
know we are nowhere near that in this situation.
I hope we are a little further on that, well, to
me that looks like.
MS. DAVIS: I would love it if we could put
together a mathematical model that would add it up and we
would have all the answer.
Actually, I think the thing we have found by
applying what we consider to be the analytic rigor of doing
the assessment, on the one hand we make sure that we really
have covered all the bases, that we have looked in all the
places and we have pulled out as much evidence as we can.
The more we do that, the more we find that you
can't take -- granted, in the number of cases we have looked
at so far -- you cannot take a given piece of evidence, a
given type of evidence, and say, this one is going to trump
them all every time or this one ought to be worth a 10 every
I think this is consistent with the discussion
that we have had before, for instance, about fox vehicles
and fox vehicle capabilities.
I think all of us would like to say, that is
something that ought to have over-powering weight, all other
things being equal.
What we are finding is that it doesn't, and that
it might be equal to other evidence, but it is not
necessarily overwhelming and it does not necessarily trump
In other cases -- for example, the case we point
to with Camp Monterey. What the fox found there and what
the fox found there was absolutely what was there,
regardless of what other people might have thought was
there. It was the case of what was the evidence that was
DR. ROSTKER: I would make, first of all, two
points. In exactly these cases there are international
discussions. There are international protocols. There are
accepted ways of looking at it.
What you take from the matrix of information is
what Ann said, that there is no predominant. You are
looking for a pattern. You are looking for pieces to fit
That is why Khamisiyah, the tests at Khamisiyah,
were so important. It helped put that pattern together. In
other cases, the pattern doesn't come together.
One of the things that is most troublesome is when
we find we don't agree with first-hand reports,
Sergeant Grass' reports, for example.
It is very difficult. We are never ever saying
that he didn't see what he saw. There are substantial cases
-- the girl's school is an example of it. Colonel Johnson
knows what he saw.
There is a great deal of evidence to date to
suggest that that is not the case. So, you have to balance
these things and ultimately it is as objective as you can.
It is not subjective. I woke up last night and it
came to me. It is objective in the sense that we put
together the various pieces of information, and you look for
It is like sitting on a jury. You have to be
comfortable as it comes together and tells a consistent
We are luckier than on a jury in some respects.
There is a definite no and a definite yes and there is some
wiggle room in here.
Most of the cases, we have moved toward the center
on the wiggle.
The objective standard, which becomes critical
then, is at what point do we notify people that they were
exposed or not exposed.
I think notification is very important, but we
have to be very careful with notification in terms of
scaring people when we truly do not believe that there was
I would rather be late in the sense of not meeting
a deadline I arbitrary set on a time table and right. I
would rather be late than wrong.
If it takes a little more digging to be able to
pull the facts together so we can say more definitively with
which way we come out with, I come out with getting right
rather than getting it early.
This is a different situation than if we were
talking about people in an acute situation who had just been
potentially exposed to a leak and we needed to get them to
We are talking about an event that occurred seven
years ago. Being a month early or a month late is, in my
judgement, less important than getting the story right.
It also goes to the issue of credibility that you
talked to last January. I can -- maybe I can -- recover
from being late. I can't recover from being wrong. I can't
recover from publishing a case narrative and then 60 days
later coming back and saying, wait a minute, I have got it
100 percent wrong.
I haven't had to do that because we have been very
careful. But in being careful, we have clearly missed
deadlines that we would have liked to have had, and I am
sure you would like to have had.
So, in a sense, I throw myself on the mercy of the
court. But if there is a sizeable lead that we can go
after, I am not going to publish.
We had the Czech case narrative ready two months
ago. We were expecting to be able to go to Europe in
I didn't see it made sense to publish that case
without going to the French of the Czechs. Knowing we were
going to do it I said, put the case on the table and I think
we have shared it with you. It is not ripe to publish.
To the best of my knowledge, we will be right
rather than timely, and I put that all in a relative sense.
DR. LASHOF: Just to try to learn from history, if
we hadn't had the revelation of Khamisiyah, which everyone
said is a watershed event, would we be doing any of what you
have been doing over the past few months with all these case
studies at Talhil, the girl's school?
DR. ROSTKER: There was a stand-up of an effort,
as you know, the PGIT, 12 people. That clearly did not have
a concept of reporting to the American people.
There is a line in an excellent marine report on
chemical and biological activity in the Gulf War, mainly on
the adequacy of their training.
The line says there are enough first-hand
incidents that we should not treat this categorically. I am
afraid that we treated it categorically.
The essence of the case narrative is not to treat
it categorically. It is to take the most significant cases
and to try to get to the details of the individual case in a
way that will pass scrutiny.
We will never convince some people. We published
the Al Jubayl case, and there are press accounts of people
saying, well, what do you expect.
I can only tell you that I can look at that case
and I know that is the best case that we can present and we
have drawn the appropriate conclusions.
I can't turn -- it is in my constitution. I can't
turn out a sloppy job, a job that I don't think is complete,
just to meet a deadline.
I truly understand that that has created problems,
particularly for the committee with your limited tenure. I
appreciate the fact that you wanted all of this to be done.
Just as John Walpole said, he thought he signed on
for 60 days. I thought I signed on for 30 days and it is
approaching a year.
DR. LASHOF: You didn't really think you signed on
for 30 days?
DR. ROSTKER: I really originally did. But I have
never been able to say no to John White, so here I am.
A reporter asked me just today, when is the end of
this. My answer is, it is going to take as long as it
DR. LASHOF: Are there other questions around this
MR. TURNER: Dr. Rostker, you have adverted to
both credibility and the department's kind of historic
series of positions with regard to possible chemical agent
exposures during the Gulf War.
I just wanted to raise with you three specific
narratives that you have reached some kind of assessments
on; the Czech detections which has not yet been issued but
Anne said the end determinant was likely, Khamisiyah, which
I believe the end determinant was likely, and Fisher where
the assessment, again, was likely.
Now with respect to each of those, as somebody who
has looked at the evidence independently of you, I don't see
how you get to those conclusions.
With Fisher, the evidence is, with the exception
of an absence of confirmatory testing down the road,
overwhelming that mustard was present there.
With respect to Khamisiyah, this committee, in its
final report, characterized the evidence as overwhelming in
January of this year. If anything, the evidence has built
in great amount above that.
With respect to the Czech detections, the
assessment that I recall the department as positing in
testimony before us was that those were credible.
Now, the reason I raise this is that this feeds a
perception that even where there is overwhelming evidence on
one side of the balance, DOD is unwilling to bite the bullet
and say, yes, this is a definite exposure scenario.
DR. ROSTKER: First, let me take the three that
you have. You quite adequately and correctly characterized
the Fisher case.
The only hesitation is because of the lack of
confirmatory evidence. You could use the words "very
likely." There is just a little bit of a problem and we
chose to believe that it is likely that this occurred. We
can be into the semantics.
Khamisiyah, there are two pieces of information
that are new. The likely -- I know in my opening statement
I talked to the fact that last year we said that it may have
There were very disturbing parts of Khamisiyah, in
terms of the reporting and why alarms didn't go off and the
like, that for me the testing has substantially cleared up,
and I mentioned that in the report.
I want to see what the army IG comes up with.
They will be, I think, reporting out very shortly. Then we
will rewrite the Khamisiyah story.
I am quite convinced that there was a release
there. So, I may disagree with my colleague. As I said in
my opening statement, it was a very expensive effort that
was worth it, because it really helped put the Khamisiyah
As far as the Czech French detections, I want to
talk to the French and the Czechs and better understand
that. Then we will see where that goes.
We have not questioned the accuracy of their
equipment, the type of equipment and the like. The part
that neither of us understand is where did it come from.
MR. TURNER: Do you have a realistic expectation
that you are ever going to know the answer to that question?
DR. ROSTKER: I think that is critical.
DR. LASHOF: This statement, I think, helps us get
to the point I was trying to make. Are there certain
criteria that you feel you have to have before you move
from, say, likely to definite.
From what you just said, I would have to read that
one of the criteria you want is a source. In the absence of
a source, you are not going to say anything more than
I mean, our range can be from very unlikely to
likely to very likely to highly likely. I mean, there is a
spectrum here and some things do it and some don't.
DR. ROSTKER: You are being categorical in a way I
am not prepared to be categorical. I simply indicate that
before we publish something, it would make sense to talk to
the French and the Czechs and we will see where it comes.
One of the questions I would like to know better
is where did this come from. I think that is a significant
question for the whole puzzle of chemical weapons on the
I didn't necessarily mean to suggest that I have
to have that piece of information before we make a
We have certainly made the determination that the
observations that the French and the Czechs have are
credible. We are not walking away from that observation.
There is more to this puzzle and, given the
opportunity to talk to them, particularly the Czechs -- one
of the questions I am very interested in the Czechs is, did
they have other results that they didn't share with us.
There has been a charge that the battlefield was
constantly flooded with low level chem. The check detectors
were quite sensitive. Is it true that they only detected on
those few days? That would be important information to
assess the larger picture.
Again, that is part of the story we want to get
out and we will be in Prague next week.
DR. TAYLOR: I guess I just have one question
regarding the time that it takes. I understand the fact
that DOD wants to move slowly before making a response. But
how does that help in improving the credibility among the
veterans that you are doing everything possible to get to
the truth and that you are going to relay that information
to groups that served in the Gulf.
DR. ROSTKER: Ma'am, I didn't use the word slowly.
I said, I want to make sure that we are presenting the best
When my staff comes to me and says, here are five
more people that Sergeant Jones says we need to interview, I
don't want to be in a position to say, I am sorry, we can't
interview those people because we have to publish next week.
So, these things have slipped and Bob Walpole has
had exactly the same experience in the CIA in working with
this massive information.
We have six case narratives out. We are very
close to having a whole slew out. We will have 13 out by
Again, I appreciate the fact that you won't, in
this capacity, be there. We will be happy to share the
working drafts, which occur well before.
In fact, we do share. One of the coordinations is
with you. So, it is well available to the committee, all of
It is just a matter of making sure it is of good
order. I have frankly had nothing but good comments for the
scholarship of the case narratives, the footnotes, the
linking to the internet, so people could see the primary
People haven't come up to me and said, boy,
overkill. They have, I think, become to people in Congress
and the press a credible series because of the care with
which we are producing them.
I guess it is like no wine before its time, but we
haven't been wasting our time. We have not been slow
rolling any of this material. But it has got to be as good
a job as we can make it.
DR. CAPLAN: Two comments about conclusions that
are drawn from different kinds of evidence. I appreciate
the desire to be accurate and get it right.
At the same time, the problem is that if you are
conservative in the conclusions that you are willing to draw
based on the evidence you have got, it has a direct impact
on not only the connection between the conclusion and the
evidence that supports it, but the direction that research
takes and then determinations about even eligibility for
benefits for others.
One of the tensions that this committee feels is
that its level of evidence in support of a degree of
conclusions is going to be a little different, perhaps, than
you might find useful in terms of cinching the narrative
together between evidence and outcome.
I would like you to comment on the fact that if we
are trying to set a research agenda, if we are talking
about, can I reasonably say that I might be sick because I
was exposed to X, and the most we are ever going to hear is
maybe, where does that leave the veterans?
DR. ROSTKER: First of all, I believe that the
whole issue of compensation and treatment is off the table.
Every press interview, every time we talk, we have stressed,
if you have any concern for your health there are two
registries you should go to. I think you have heard that.
The second is the work that the whole community
has supported, including your committee, to move to the 10-
year presumptive period.
It is beyond me why I was or was not under a
Khamisiyah plume is going to have an impact on whether or
not you are going to be compensated or not.
We compensate in this country. We do not
compensate for exposure. We compensate for physical
ailments. That is what the test is.
It is immaterial whether or not you were under or
not under the Khamisiyah plume. So, I don't see where the
speed has anything to do with it.
DR. CAPLAN: I have great sympathy for that split.
It is something I think we should have as policy, the doing
right by access to health care and to disability.
I think the committee has heard for a long time
that what you and I are in agreement about has not been put
into practice with respect to access at all points.
So, this constant attempt to get to the cause or
establish the absolutely epistomologically certain outcome
about where exposures were, or why someone's particular
report was to be credible or not, I think is caught up, or
has been -- I hope it isn't any more -- but I think it has
been caught up in this problem of benefits, disability-
related harm, finding yourself eligible to compensation and
DR. ROSTKER: Certainly not from our report. It
doesn't play anything to do. We call it strictly as we see
It is not going to help an individual or our
understanding of this phenomenon if we get it wrong and say,
yes, we think you were exposed to something, then come back
later and say, no, we don't think you were exposed to it.
To the extent that it is a reasonable time frame -
- we are not talking about years here. We are talking about
a dedicated staff doing their work and we need to bring
these facts out.
DR. CAPLAN: Let me just follow up with one other
question. I think about a year and a half, two years ago,
maybe now, we confronted the problem of what to do with
certain weapon detection, some of which you are now writing
case reports about, the Czech detections, the fox vehicle
reports, 256 test kits positives and so on.
I think one of the things that has been terribly
damaging to the DOD credibility on this is the notion that
our own troops report what they saw and have found it time
and again discounted.
In some cases it may be appropriately so, as you
point out yourself, with Gunnery Sergeant Grass and so
Maybe something else was going on and the events
may have supported different observations, depending on how
My worry is that because we have many veterans who
feel that their self reports were discounted, because we
were in a situation where some of the chemical weapons
detection equipment that we put out there was presented as
absolutely trustworthy, and only now seven years later are
we getting into the fact that interference can occur with
these machines in ways that we still don't understand, do
you feel confident that as part of your case narrative
process you can point the finger backward and explain how it
is that that sequence of events could have come to be.
DR. ROSTKER: You say it extremely well. You have
exactly the same notion I have, and that is why I am so
careful with the case narratives.
I feel I have to be able to explain to people,
reasonable and others, the logic of the presentation. I do
not relish telling a soldier or a marine that what he saw or
she saw was not correct.
I also have an obligation to them and to the
others not to call things hastily. I only know how to do it
methodically and thoroughly, well documented, divorcing my
opinion from the facts we can bring forward.
Jim Schlessinger used to say, when he was
Secretary of Defense, everybody is entitled to the opinion,
everybody is not entitled to their facts.
We try to be as objective as we possibly can with
the facts, presenting all the cases, and then separating the
conclusion from the presentation of the facts, for exactly
the reasons that you state.
There will be people who, because we don't come
forward and make some conclusion, presume that the process
MS. KNOX: I think the problem, Dr. Rostker, is
that we are not sure that that process is reproducible. It
is like Jim said earlier.
These three events that we find are very
conclusive, you find are just simply likely. I mean, it is
either a positive finding or it is a negative finding.
If you have a female that is pregnant, is she
likely to be pregnant or is she pregnant? How do you
DR. ROSTKER: If we were dealing at that degree of
specificity, I agree with you.
MS. KNOX: In Sergeant Fisher's situation we
really are. You know, he had evidence of burns. We have
evidence of mustard agent. We don't know where it came
from, just like we might not know who impregnated a woman.
But we know that she is pregnant.
DR. ROSTKER: I would have liked to have been
quite definitive. I would like to have seen confirmations
in areas where we would have reasonably expected to see
A likely determination is heavy words for us. I
think this likely occurred. I would take it to the bank.
There is still something out there.
The case where it was nailed completely was the
Monterey case. All the pieces fell together.
I think Khamisiyah is falling together, that there
was a release. We can satisfy -- to me, I can answer the
I am not 100 percent sure that the plume as we
have depicted it is precisely right.
DR. LASHOF: Nobody is asking that.
DR. ROSTKER: The parts of the Khamisiyah story
that have disturbed me have now fallen into place, and that
is what I said in my opening statement. Again, let's agree
on the facts.
MS. KNOX: That is what we can't agree on. We
can't agree on the process because we can't reproduce it.
DR. ROSTKER: This isn't hard science. We can
reproduce the interviews with the people. We can reproduce
where there were objective tests.
We are really discussing, given a body of facts,
whether you look at them and characterize them as definitely
or we look at them and characterize them as likely.
MS. KNOX: Why can't we characterize them as
negatively or positively.
DR. ROSTKER: I think likely is a very positive
statement. We are not saying it didn't occur. We are
saying it likely occurred. You would look at the same facts
and say it definitely occurred.
Definitely is a pretty hard word. Likely, to me,
is a pretty positive word also. It is the only disagreement
I think we have here.
I don't think you are saying our scholarship in
terms of investigating and reporting the Fisher case is
wanting. I think you have got to the end and were
disappointed that we didn't use a slightly different word
than you might use. They are both very positive words.
DR. TAYLOR: Can I ask another question? Just to
make sure and verify that I understand what you stated
earlier, regardless of whether it is likely, unlikely or
their exposure occurred or not, veterans that have illnesses
will be taken care of.
DR. ROSTKER: Yes, ma'am.
DR. TAYLOR: We have heard over the course of the
last two years that there have been problems. We are hoping
that that is resolved and that is the direction that we are
DR. ROSTKER: My understanding of the policy is
anybody who served in the Gulf will be examined in either of
If there is no diagnosis to a based upon
condition, so it is undiagnosed, the medical authorities
can't explain it, we have an obligation in the government to
presume that it was because of something that happened in
the Gulf, and provide appropriate medical care and
appropriate compensation commensurate with the degree of
DR. TAYLOR: That is good.
DR. ROSTKER: Yes, ma'am.
DR. LASHOF: Are there any further questions
around this area?
MR. CROSS: Is part of your charter, then, to make
recommendations on that very aspect, or are you going to
publish a narrative just based on what you spoke about?
DR. ROSTKER: I don't understand the question,
MR. CROSS: We started talking about the veterans
of the Gulf War and that they are eligible for health care
and should be given health care.
Are you going to publish findings on that or
DR. ROSTKER: What I just said is the policy of
the United States Government. There is no question about
that. So, I don't feel I have to uniquely say that.
Within the Defense Department, one of my major
goals is to make sure that everyone who requires care gets
We have been looking at the reserve community and
other aspects of that. But what I just indicated is the
policy of the United States Government.
DR. LASHOF: Any further questions along this
area? If not, I would like to go back to some issues that
we were discussing before the noon break, when you weren't
We earlier reviewed where we stood with the
research effort and the implementation effort of our final
report around research, and we heard testimony from the
research working group about all of the solicitations under
the VAA and the competition.
Is it my understanding -- let me rather put it
another way. Has there been any research funded by DOD
outside of the VAA, non-competitively.
DR. ROSTKER: I think you are referring to the
research we are funding with Dr. Nicholson and Dr. Haley.
DR. LASHOF: Could you tell us about that?
DR. ROSTKER: First, in terms of Dr. Nicholson --
DR. LASHOF: Whatever order you want.
DR. ROSTKER: There has been a long-standing offer
to confirm -- let me use that word -- the technique that
Dr. Nicholson has pioneered.
I use the word confirm because it is not clinical
research. It is a process of qualifying some laboratories
that would have common samples, and to verify the
diagnostic, the analytic techniques for identifying
mycoplasmas in the blood stream.
It is a controversy within the medical community.
I think it was important to extend again, given, frankly,
the Congressional testimony and the public discussions, it
was important to extend that offer again with the National
Institutes of Health being an honest broker.
We are still in negotiations to define which labs
will be qualified, and we will see where that goes. It was
out judgement that the issue was not serving the veterans
well, by leaving open the notion that there was a technique
that was having positive results that we were, in the
Department of Defense, not willing to support.
DR. LASHOF: Let me say that this committee said
that we felt it was essential that we pursue the question of
testing for mycoplasma.
What I would like to know is how much you are
funding and whether the funding is restricted to training
people into a technique that is reproducible, period, or
whether then, once you have labs reproducing it, what
further studies are being proposed or will be proposed, or
are those being funded or will they be competitively done,
once there is a common testing methodology.
DR. ROSTKER: The extent of our association, our
involvement, is strictly, at this point, on the issue of the
There has been no commitment to do any further
work, clinical work.
My understanding is that it is several hundred
thousands of dollars. We will get the exact figure for the
DR. LASHOF: What labs are involved? Can you tell
DR. ROSTKER: It has changed. I would have to get
it for you. There were some labs that were unacceptable and
some others were suggested. I am not sure where we are
DR. LASHOF: What process was used in selecting
DR. ROSTKER: This was an agreed-upon process
between Walter Reed and Dr. Nicholson and it is still in
It has to be a set of labs that would be
acceptable to both parties and to NIH.
DR. LASHOF: Fair enough. Do you want to proceed
to tell me about Dr. Haley's research?
DR. ROSTKER: Yes. Dr. Haley made presentations
to the senior leadership of the department. The
presentations were viewed as credible and a determination
was made to partially fund elements of Dr. Haley's proposal.
The elements that would be funded are those that
were credible to the peer review process.
DR. LASHOF: I am sorry, what peer review process?
DR. ROSTKER: The process of submitting --
Dr. Haley submitted a very major proposal, equal to the full
budget that was available. It was larger than the full
budget that was available.
Some of his tasks were recommended. Others were
not. We agreed to fund a portion of that in concert with
The part we were most interested in is that which
would be confirmatory or not confirmatory to some of the
conclusions that we drew in papers published in JAMA.
He had been criticized for small sample size.
There were other problems in terms of interpretation.
Again, I think it serves the best interests of the broad
community to try to resolve some of the controversy around
this particular research.
DR. LASHOF: Are you telling me that the portions
that you are funding were ones that your research working
group reviewed and approved as scientifically sound?
DR. ROSTKER: That is my understanding.
DR. LASHOF: That is interesting, because your
research working group didn't seem to be --
DR. ROSTKER: There was a whole series of tasks,
and some of the tasks were recommended and some of the tasks
It was my understanding that we would be funding
tasks that had been recommended.
DR. LASHOF: Did that recommendation go back to
the research working group for their approval and agreement
and passing on it?
DR. ROSTKER: No, the decision to do this was made
at the highest levels of the Department of Defense.
DR. LASHOF: By the scientists in your department
or the political arm?
DR. ROSTKER: No, not by the scientists in our
DR. LASHOF: In our discussion this morning, I
think you should know that all the scientists that were here
felt strongly that research should not be funded unless it
has been through the peer review process.
There are times when limited, objective, sole
source contracting are indicated for special things.
Certainly like Nicholson and his mycoplasma technique, he is
the only one who has the technique and we ought to find out
whether it is real or not.
If we are looking at what are epidemiologic
studies, I assume. At least, what Haley did with his factor
analysis was a form of epidemiology.
There are many people competing for those funds.
He competed for them, I assume, from what you are telling
That is proprietary. Usually we don't know who
competes and doesn't get funded. You told me that he
competed and wasn't funded and now you have decided to fund
what he competed for and wasn't funded.
That is very unusual and is not something that the
scientific community, I think, will take lightly.
DR. ROSTKER: I appreciate that.
DR. LASHOF: Any other questions along that regard
or any other regard? Any other questions anyone has for
Dr. Rostker and his staff?
If not, thank you very much.
We said, if we had time at the end of the day, we
would allow an additional public comment. We are a little
bit past our adjournment time, but I am willing to hold 15
minutes if the committee is willing. Where is that list.
We will limit you to five minutes. We are going
to have to adjourn at 5:00. Leanne Johnson Flint was the
first one. We will ask her to come forward. Is she here?
Once more, Leanne Johnson Flint. She is not here.
Then Daniel Sullivan, Sr. Is Daniel Sullivan here? I guess
we have outlasted our public commenters.
Denise Nichols. Is Denise Nichols here? Does she
still want to present?
Agenda Item: Public Comment.
MS. NICHOLS: I am going to make my three comments
very quick, because we do have some people who signed up
after the fact that are here, that we would like to allow,
that have not testified.
My three comments that we have, I think, that go
for our community of veterans would be that, you know, I am
listening to comments that have been brought out as the
control of the studies that have been done.
We have talked to researchers. We have looked at
denial letters. We feel that should be investigated
independently of how that process has been done.
As a background, there is a letter from
independent researchers that have been denied. I personally
saw a letter, a denial letter, for funding for research.
They made a comment that it is controversial,
Current political implications.
As a person who is a health care provider with a
master's degree, I have to question what is going on. I
thought that this committee, while they are deliberating,
this is something you could look over, the denial letters,
that should be available to you, to look over.
You can blank out the names even, but to look over
the reviewer comments. If you see some of those comments, I
have to question whether there is something else going on.
So, look at the studies that have been turned down
and look at the reasons, and review those. The individuals
should really go through another process, not this
Another question or comment is that we in the Gulf
War veterans community, just like you mentioned to
Dr. Nicholson, we have a great deal of concern that --
(portion off microphone) -- even though we had informed
consent out in Kansas City.
I have some questions about that record. We would
like to look at it. We have an interesting situation. The
IGG and RFG has been asked for information for six months.
Something doesn't work right there. It is some of
the things that they have been doing for the veterans
community in research of late, when you are looking at
information, when you are looking at what progress has been
done with these vaccines with so many shot records missing,
or shots not recorded, and knowing that things have gone on
in government before, the Tuskegee experiments, that are
they doing a good job? Are they withholding information?
Are they doing a good job with this chemical?
We have had a lot of people looking at that, and I
have expended the same amount of energy on vaccines and
looking to see what happened.
I don't think that has been looked at. I have
some open questions in that area. I went back and pulled
research just to see what was going on in that time period.
We have had vaccines developed for AIDS research.
If they are looking at faults in the test, we need to look
at these things. There is some vaccine research going on
that has not been addressed.
I think it needs examination because there were
some things going on at that time. There is a vaccine being
developed and there were some political problems in
development dealing with mycogenesis.
They knew they had a problem with Gulf War vets
being sick. The time tables match.
I would like them to make that information
available and allow individuals to share that. There is a
concern that that has to be looked at.
I have some questions. I am not making any
accusations. I am just asking that some time be spent
looking into that. It is very serious indeed, if it has
occurred. Thank you.
DR. LASHOF: Victor Sylvester? Is he around? We
have heard from him in the past. If there is anyone else in
the audience who wishes to be heard, I will hear them out.
MS. ZOLDICE: Good afternoon. My name is Carolyn
Zoldice. I am a registered nurse from Delaware. I came
down, hearing the panels were convening on Tuesday.
I am a Gulf War veteran. I served with Fleet
Hospital 15 outside of Al Jubayl as part of the navy
I have experienced some Gulf War illness and I was
particularly gratified to hear Ms. Knox try to discern
between likely, positive, negative, and it was really nice
for me to hear that.
I have one question. I do wish that the VA panel
was still here. This panel here, to me, has talked about
treatment, has talked about identification of illness. But
the VA has said that it is not a medically defined
So, what kind of treatments are they proposing? I
don't want them to throw money at me and say, go away. That
is not my point. That is not going to do me any good. That
will buy me a bottle of Tylenol.
What I am hoping is that they can do this as a
defined diagnosis. I hope that this panel can work with
I am hoping that I don't have to keep going with
these AIDS-like symptoms that I have -- the fatigue, the
I have had myself tested for AIDS three times now
because I work in an HIV population. It is just frightening
to me that nobody at the VA will give me a medical
diagnosis. But they say they are going to treat me? I
think they have already treated me quite well. Thank you
I just really would like this panel to study what
kind of treatments. We hear so much about causes. We hear
so much about depleted uranium, vaccines, combinations.
Yet we all agree that we probably will never know
in what combinations, in what weather, wind, all of that.
We probably will never know.
What and how is the VA going to treat me if I go
to them? How are they going to treat me? With what? Thank
DR. LASHOF: Questions?
If not, is there anyone else in the audience who
wishes to be heard before we adjourn for the day? If not,
we stand adjourned for the day and we will resume tomorrow
morning at 9:00.
(Whereupon, at 4:55 p.m. the meeting was recessed,
to reconvene the following day, September 5, 1997.)
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