OSAGWI has been the focus of the Board�s oversight of DoD investigations of chemical and biological incidents. This emphasis reflects the role of OSAGWI as the lead DoD agency for investigating potential chemical and biological exposures during Operations Desert Shield and Desert Storm (ODS) in addition to researching other possible causes of Gulf War illnesses.

The Deputy Secretary of Defense established OSAGWI on November 12, 1996, in the wake of DoD revelations that U.S. and coalition personnel may have been exposed to low-level nerve agents following the destruction of enemy ammunition stores at Khamisiyah, Iraq. In his November 1996 memorandum, the Deputy Secretary of Defense designated Dr. Bernard Rostker, then Assistant Secretary of the Navy for Manpower and Reserve Affairs, to become his Special Assistant and direct OSAGWI in addition to his existing responsibilities. The memorandum made Dr. Rostker "responsible for all of the Department�s efforts regarding illnesses being experienced by those who served in the Gulf War," and OSAGWI assumed the mission of determining the causes of Gulf War illnesses, ensuring that veterans received proper care, and identifying and publicizing within the Defense community the many lessons learned from the Gulf War.

DoD provided OSAGWI with considerable resources to accomplish its mission. Initial plans provided for a 110-person organization, a nine-fold increase over the Persian Gulf Illnesses Investigation Team (PGIIT), OSAGWI�s immediate predecessor within the Office of the Secretary of Defense (OSD). By Fiscal Year 1999, OSAGWI engaged 196 personnel, 26 of whom were government employees and the remainder contractors. The Special Assistant�s allocation of assets within his organization clearly reflected OSAGWI�s tripartite mission and its many responsibilities. Appropriately, the Investigations and Analysis Division (IAD), the largest subunit, was responsible for researching and analyzing all potential exposure incidents, environmental issues, and other factors that may have contributed to Gulf War illnesses. Resources for the other divisions appear to be appropriate to their missions and OSAGWI priorities.

OSAGWI has worked to describe and to explain in detail specific incidents of suspected chemical exposures as well as potential environmental hazards both during and after the Gulf War. The organization has released 17 case narratives, 4 environmental exposure reports, and 9 information papers. In addition, OSAGWI commissioned the RAND Corporation to conduct eight reviews of scientific literature pertaining to Gulf War illnesses, of which five have been released. These investigations and their contribution toward achieving this key OSAGWI mission enumerated in Deputy Secretary White�s November 1996 memorandum will be discussed in the following two chapters.

OSAGWI has devoted considerable resources to ensure that Gulf War veterans receive adequate care. This effort incorporates activities of elements of IAD as well as the Public Affairs Branch, the Medical Outreach and Issues Team, and the Information Technology Team. The Board believes that OSAGWI has fully achieved its goal of assisting the veteran and that the organization has developed the template for success that other government agencies should use in the future.

Perhaps most noteworthy is OSAGWI�s sustained effort to provide veterans and the public with as much information as possible through the Internet, a telephone hotline, and town hall meetings. In addition, OSAGWI has increasingly used VSOs and military service organizations (MSOs) to provide information to Gulf War veterans.

OSAGWI�s web site, GulfLINK, has provided the public, and especially the veterans community, with a valuable resource for furthering its understanding of Gulf War illnesses. The user-friendly site has received several awards and has been rated one of the best federal government web sites. GulfLINK averages more than 200,000 visitors per month and offers a wide array of information as well as hyperlinks to other web sites. Visitors can access speeches, all OSAGWI publications, and a host of other data. Of particular note is the hyperlinking of most source documents to the footnotes found in the case narratives and other official releases.

The toll-free hotline system also deserves mention. Operated by the Veterans Data Management Team (VDM), a branch of IAD, the hotline provides OSAGWI with the means to receive and react to leads and calls for assistance. Moreover, the hotline also provides OSAGWI with the ability to alert thousands of veterans to services in addition to locating witnesses for case narratives and other research initiatives.

The Public Affairs Office (PAO) has also contributed to the organization�s increasing ability to inform the veterans community and others. The office has enabled OSAGWI to develop a closer rapport with VSOs and MSOs, a noteworthy achievement considering OSAGWI�s initial missteps with these organizations. VSOs and MSOs regularly receive updates and briefings on OSAGWI activities and other GWI initiatives, such as the comprehensive therapy program offered at Walter Reed Army Medical Center (WRAMC). OSAGWI leadership also meets with VSO/MSO leadership counterparts, and OSAGWI now regularly sends information displays and veteran contact managers to major VSO and MSO national and regional conventions.

OSAGWI has conducted town hall meetings in thirteen metropolitan areas throughout the country and in overseas locations to discuss the results of its investigations as well as to learn and respond to veterans� concerns. The Special Assistant selected the sites based on his wise determination to reach as many veterans as possible. OSAGWI went to great efforts to publicize the meetings and to stimulate media interest. The meetings, in general, provided OSAGWI with additional sources of information and enhanced its credibility. In addition, PAO utilized editorial boards and other media coverage to increase public awareness of GWI issues.

Beginning in 1998, OSAGWI began an ongoing program to visit major military installations to increase its contact with active duty and reserve component forces. Depending on the installation�s military population, OSAGWI conducted the visits over a two- or three-day period. Briefings were provided to Gulf War veterans, service members who deployed to the Persian Gulf after 1991, and other interested personnel. OSAGWI targeted leaders as well as junior personnel, and the briefings typically lasted one hour, followed by a question and answer period. Board and staff members have observed several of these installation visits, and OSAGWI incorporated Board comments in an ongoing effort to optimize the effectiveness of its presentations.

Medical personnel received customized briefings to enhance their sensitivity to the special nature of Gulf War illnesses. In addition, OSAGWI conducted evening town hall meetings to encourage attendance of spouses and other veterans. These meetings featured a question-and-answer format in which the audience could present questions directly or submit written questions for the moderator to present. VA representatives often attend the town hall meetings to respond to questions regarding benefits and clinical care issues. Cumulative attendance at these installation visits has exceeded 3,000 attendees, many of whom requested various OSAGWI publications.

The Lessons Learned Implementation Division (LLID) has the responsibility of "institutionalizing validated observations/findings" and ensuring that they are implemented. The LLID has taken the lead in facilitating service-wide implementation of DU training. The division has chaired several joint service meetings, and LLID is making great strides in updating DU training. In June 2000, the LLID conducted an in-depth conference on stress that has catalyzed DoD efforts on this important, yet often misunderstood, subject.

The LLID has also reviewed OSAGWI case narratives and environmental exposure reports to identify lessons learned and then to disseminate those lessons throughout the Defense community. The Board had stated misgivings in its Interim Report about such efforts being a form of mission creep because other DoD agencies have responsibility for implementing lessons learned. However, the Board has since determined that the LLID represents a promising means of ensuring that our forces can leverage the lessons that can be gleaned from the Gulf War and future military deployments.

The Board informed DoD in a September 1999 meeting that OSAGWI needed to expand its focus from strictly Gulf War issues to the development of a "future oriented" organization that would also address the multiple aspects of military operations before, during, and after a deployment. In particular, the Board stated that the emphasis on retrospective investigations did not best serve present and future veterans.

At the September 1999 meeting, the Board received and approved OSAGWI recommendations to discontinue certain retrospective investigations and environmental exposure reports that would not have contributed to a better understanding of Gulf War health problems. The November 1999 Special Oversight Board Special Report summarizes these recommendations (Appendix I). The Board also requested that the Department begin to transition OSAGWI from the "retrospective" investigative organization to one that will focus on the multiple aspects of "deployment" of our military forces, "anticipate" the needs of future deployments, and enhance DoD�s many ongoing initiatives to optimize force health protection.

Dr. Rostker charged OSAGWI with developing a concept for a permanent organization that would still lead DoD�s Gulf War illnesses effort while also protecting the health of the armed forces. Following lengthy coordination throughout the Department and with many veteran organizations, Dr. Rostker presented his proposed organization to the Board at its April 2000 public meeting. The Board concurred with his concept, as did the major veterans groups that also testified at that session.

The Secretary of Defense announced the new position of Special Assistant to the Secretary of Defense for Military Deployments on July 26, 2000. After consultation with National Security Council (NSC) staff, the position title was modified (to include the organization's new missions and functions) to the Special Assistant to the Secretary of Defense for Gulf War Illnesses, Medical Readiness, and Military Deployments (OSAGWIMRMD).

The Board believes that the Department, OSAGWI, and the military services have made significant contributions to:

• understanding the nature of events that took place in the Gulf that many have interpreted as having a consequential relationship to veteran ill health;
• recruiting respected individuals and organizations to analyze and report on issues central to the Gulf War illness issue;
• presenting reports to the American public on the circumstances of events that occurred, were reported to have but never did occur, or occurred at a different place or time during the Gulf War;
• furthering Gulf War illness basic and applied medical and scientific research;
• achieving significant improvement in departmental awareness, appreciation, and understanding of service member and veteran health matters;
• addressing military dependent health matters;
• recognizing the interrelationship(s) of military members, military deployment, in-theater events, military and dependent health, veteran transition to civilian life, and veteran health matters and how these matters are simultaneously independent and related to each other and can have dramatic influence on public opinion and the public�s perception of its government�s conduct;
• restoring trust and fostering improved dialogue and relationships with the American veteran community;
• preparing for future deployments of our military service members; and
• fulfilling the President's directive(s) to "leave no stone unturned" to uncover (if possible) the reason that our Gulf War veterans were (are) ill.

It is also the opinion of this Board that DoD and VA have met the spirit of the PAC recommendations to search for the cause(s) of Gulf War illnesses.

Another PAC Special Report recommendation stated that "DoD, VA, and DHHS should complete the comprehensive risk communication program for Gulf War veterans, as well as for forces deployed in the future; community-based outreach should receive particular focus."

In response to this PAC recommendation on risk communication and outreach, DoD (OSAGWI and its successor, OSAGWIMRMD) conducted multiple town hall meetings as well as military installation visits, both in the continental United States and overseas. Board members attended several of these outreach sessions. As a general observation, most of the audience issues at these DoD outreach town hall meetings centered on VA medical care, medical benefits, and general health and specific illnesses of either veterans and or family members.

The Board commends OSAGWIMRMD for its conduct of these town hall sessions and the positive approach taken by the DoD in situations that were in some cases openly hostile. However, attendance has been declining at the town hall meetings that have been the centerpieces of recent installation visits. Moreover, attendees have focused not on DoD areas of concern but on the quality of VA treatment and compensation. The leadership of the new OSAGWIMRMD has indicated it will most likely suspend further installation visits until it can develop a more effective alternative, and the Board agrees. However, the Board also believes that periodic meetings with veterans, in addition to maintaining an informative worldwide web site, 1-800 toll-free operators, and other existing outreach initiatives, must be continued. The VA should assume the lead for Gulf War illness-focused town hall meetings because veteran questions have centered on that department�s services. OSAGWIMRMD should assume a supporting role in such meetings, and the Military and Veterans Health Coordinating Board (MVHCB) should facilitate the transfer of responsibility from DoD to VA for Gulf War illness-focused town hall meetings. OSAGWIMRMD should use those meetings to inform the public about its new responsibilities and use DoD news media, installation visits, and other initiatives to ensure that the active and reserve components of each military service also understand the organization�s enhanced mission.