NOTE: Unedited document




September 4, 1997

Holiday Inn

625 First Street

Alexandria, Virginia


Committee Members:

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.

Robyn Nishimi

Rolando Rios

Andrea Kidd Taylor, Dr.P.H.


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

War veterans.

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

exposure were.

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

admit that.

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

that stress?

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

also stress.

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

memory loss.

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

Dave was.

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.

Thank you.

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

level on.

Thank you.

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

very much.

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

these men?

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

governments here?

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.

Thank you.

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 again.

You may start.

Agenda Item: Implementation: VA Medical and

Clinical Issues

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

center staff.

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

mentioned earlier.

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

keeping missions.

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

future deployments.

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

been undertaken?

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

local area.

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

Vietnam veterans.

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

coming out.

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

care legislation.

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

the programs.


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

similar proportions.

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

8,000 non-respondents.

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.


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

of --

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

data effectively.

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.

[Brief recess.]

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

research funding.

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

next month.

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

that question.

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

that agreement.

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

these entities.

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

test batteries.

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

to go.

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

atomic veterans.

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

this quicker.

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

serological assays.

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

research commitment.

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

Edgewood Arsenal.

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

plume model.

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

and mental.

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

toxicological data.

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

research work?

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

review process.

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

peer reviewed.

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

review panel.

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

next year.

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

sufficiently addressed?

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

looking for?

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

mammalian species.

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

research efforts.

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-

emerging pathogen.

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.


Craig, do you know anything about that -- we can

wait. I mean, after lunch DOD is going to be here to

discuss --

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

study afterwards?

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

possesses --

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

system problems.

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

these symptoms.

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

proprietary information.

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

understand, yes.

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

affiliated institutions.

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

mean that.

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

modeling Ukhaydir.

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

any damage.

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

aerosolized agent.

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

with 11.

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

this effort.

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

went through.

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

modeling briefing.

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

the reasons.

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

veterans' illnesses.

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

Iraqi munitions.

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

at all.

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

munitions went.

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

Desert Storm.

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

accounted for.

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

brutally so.

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

be done.

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. 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

declaration was.

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

worked out.

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

UNSCOM accounting.

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

this issue.

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 do.

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

vertical section?

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 --


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

Special Assistant.

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

home page.

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

case narratives.

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

this afternoon.

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

artillery raid.

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

investigate this.

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

his testimony.

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

this way.

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

interferant is?

MR. STEWART: You mean in terms of the component?


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

interfering factor.

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

the alarms.

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

this matter.

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

the interference?

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

first break.

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

next one?

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

that moves.

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

its propellant.

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

missing something.

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

chemical --

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

following exposure.

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

on Fisher?

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

ASP Orchard.

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

next week.

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

time frame.

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

been doing.

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

Boston area.

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

actually used.

We are checking procurement records of what was

purchased in the Gulf, if there were things that were

locally purchased.

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

knowledge is.

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

seven years.

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

through it.

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. 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

are investigating.

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

that pattern.

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

an exposure.

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

immediate treatment.

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

story together.

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

our material.

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

that went.

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

is tainted.

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

explain that.

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

the registries.

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

us that?

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

right now.

DR. LASHOF: What process was used in selecting

the labs?

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

private donations.

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

were not.

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.

Identify yourself.

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

night sweats.

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

very much.

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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