PRESIDENTIAL SPECIAL OVERSIGHT BOARD
FOR DEPARTMENT OF DEFENSE INVESTIGATIONS
OF GULF WAR CHEMICAL AND BIOLOGICAL INCIDENTS
April 4, 2000
White House Conference Center
726 Jackson Place, NW
Senator Warren B. Rudman
Secretary Jesse Brown
Rear Admiral Paul E. Busick, USCG (Ret.)
Dr. Vinh Cam, Ph.D.
Command Sergeant Major David W. Moore, USAR (Ret.)
Rear Admiral Alan M. Steinman, USPHS (Ret.)
Mr. Sean O�Shea
Lieutenant Colonel Michelle Ross
Dr. John Feussner
Dr. Bernard Rostker, Ph.D.
Rear Admiral Richard A. Mayo, USN
Captain Peter P. Mazzella, Jr., USPHS
Dr. Mark Brown, Ph.D.
Major General Robert G. Claypool, M.D., USA (Ret.)
Dr. John F. Mazzuchi, M.D.
Dr. Jeff J. Whitehead, M.D.
Ms. Denise Nichols
Mr. Peter Gaytan
Ms. Lisa Spahr
Mr. William Bradshaw
Mr. Richard Schneider
Mr. Keith Boylan
Mr. William Frasure
C O N T E N T S
Call to Order
Opening Remarks and Introduction of Board Members
DoD Low-level Chemical Agent Research
Board Questions to LTC Ross
Research Working Group Update on Low-level Chemical
Exposure and Pyridostigmine Bromide
Exposure and Pyridostigmine Bromide
Board Questions to Dr. Feussner
Panel: OSAGWI Follow-on Organization
Board Questions to the Panel
Health Problems in Canadian Forces in Croatia
Board Questions to Mr. Whitehead
Veterans Service Organization Panel 1
Board Questions to VSO Panel 1
Veterans Service Organization Panel 2
Board Questions to VSO Panel 2
Veterans Service Organization Panel 3
Board Questions to VSO Panel 3
P R O C E E D I N G S
MR. O�SHEA: Good morning, everyone. We�ll go ahead and get started here, if everybody is ready. On behalf of President Clinton, we want to welcome everybody to this public hearing. And I know we have a full agenda today, so I will cut right to the chase.
First we want to say thanks to the distinguished panel that we have here and for everybody who has been participating thus far, and we�d just like to kick it off with Senator Rudman and the full agenda that we have scheduled for today. So, Senator Rudman, I�ll turn it over to you, sir.
SENATOR RUDMAN: Thank you very much. General Cisneros, who heads a college down in Texas, former president Bush is visiting his college today, so I guess that�s a pretty good excuse for not being here.
As most of you know, one of our very special Oversight Board members, Admiral Bud Zumwalt, a giant of a man, a distinguished American patriot, passed away in early January after a valiant battle against cancer. Admiral Zumwalt was an energetic member of this Board, but more than that, he really lived a life of commitment, of service to our nation and particularly to those in the military. And he handled many complex issues facing active service people and veterans in his whole life. His funeral was held at the U.S. Naval Academy. It truly was a triumphant celebration of a life of a warrior.
President Clinton spoke, as a number of distinguished Americans participated in that ceremony. All of us who worked with him, and I also had the occasion to work with him in the last four years in my capacity of Chairman of the President�s Foreign Intelligence Advisory Board of which he was also a member, will miss him a great deal.
I would ask that we all just observe a moment of silence in memory of our friend and colleague, Admiral Bud Zumwalt.
SENATOR RUDMAN: Thank you very much.
I�d like to propose to the Board a motion that we dedicate the final report of this panel that will be presented to the President for the purpose of better serving our distinguished servicemen and women who served in the Gulf War, that that report be dedicated in memory of Bud Zumwalt. Do I hear a second?
RADM STEINMAN: I second that motion.
SENATOR RUDMAN: All in favor? (Chorus of ayes.)
SENATOR RUDMAN: Any opposed? Motion is adopted and the record will so record it; that is the way we will handle the final report.
Can you all hear me in the back of the room? All right.
This is the seventh public hearing that the Board has held. Our last meeting was conducted at Fort Lewis, Washington, and chaired by our vice chairman, Secretary Brown, who will be joining us this morning. The Board has recently taken several actions that I would like you all to be aware of.
In our special report of November 1999, which is available on our web site, the Board approved a number of OSAGWI recommendations to discontinue certain investigations. Let me note that the Board did not approve two of those recommendations. The Board directed that the investigations in publications concerning the Second Marine RECON Battalion injuries and the SCUD information papers be continued.
In November of 1999, OSAGWI asked the Board for relief from a requirement of the prior Presidential Advisory Committee known as the PAC, that all reports, even if based on hearsay evidence of M256 alarms of fox vehicle detections, be investigated. That was their recommendation.
The Defense Department has done, in our opinion, a commendable job of tracking and investigating the multitude of reports and incidents that occurred during the Gulf War. Our Board granted OSAGWI and the Defense Department relief from a number of reported incidents that did not warrant continued expenditure of valuable time or taxpayer dollars in pursuit of uncorroborated reports that lacked basic documentation such as date, time, place, witnesses, log entries and so forth.
However, in granting relief from those requirements of the PAC, I want to point out several things. First, the Board acted on the initial request of OSAGWI only after we requested and received very detailed supporting documentation and it was very detailed. The Board granted relief to OSAGWI on eleven M256 reports and thirty-two fox vehicle reports. Relief was not granted for seven M256 incidents and two fox incidents.
Today we have a full agenda. Later this morning we will hear from Dr. Rostker on the OSAGWI follow-on organization, which we believe is vital. Before we proceed, however, I would like to recognize Undersecretary of the Army Rostker on his nomination as Undersecretary of Defense for Personnel and Readiness. Congratulations on your nomination, and we certainly think you deserve it.
Our expectation is that the proposal that Dr. Rostker will put forth today has been fully coordinated with a PLD to include OSD health affairs, the Joint Staff, the services and the CINC. Recognizing that there will always be differing views, the Board expects that what we will hear today will represent a unified approach as to how an OSAGWI follow-on organization will advance the overall force health protection effort and two, integrate with parallel efforts of DoD and the other departments.
For our panelists, I encourage you to candidly state your positions; departmental turf is no grounds on which to fail to give our service persons and veterans less than one�s frank opinions and recommendations.
Dr. Mazzuchi, Dr. Claypool, Dr. Brown, Dr. Mazzella, we await your comments.
The Board has invited the veterans service organizations, the Departments of Health and Human Services and Veterans Affairs and the Military and Veterans Health Coordinating Board to give us their ideas as to how they will interact with the follow-on organization. We will also listen with interest as to how remaining Gulf War illness issues will be addressed after OSAGWI ceases as such next January.
One issue in particular deals with outreach and the utility of future town hall meetings. One of OSAGWI�s outreach efforts, the web site GulfLink, is a hallmark of an ongoing full disclosure effort of the government for the public and our veterans community. I would hope to see that effort would be maintained.
On the other hand, the DoD town hall meetings seemed, in our opinion, to have become a forum for our veterans to focus their individual grievances on the VA, its benefits and health care delivery system. The specific subject of Gulf War illnesses does not dominate the public comment at these town halls. Without regard as to the benefit of the forum itself, is there a strong sentiment or justifiable reason to continue these town halls? Dr. Rostker and our other panelists, I will appreciate your thoughts on this issue.
Another issue is completing the phasing out of the OSAGWI retrospective investigations. Over the next eight months, OSAGWI will become a significantly scaled-down follow-on organization. The design of that follow-on organization is solely a planning responsibility of DoD. However, there must be a provision for integration and cooperation with the VA and other organizations on issues of mutual interest. The Board is anxious to learn of plans for that.
Before we hear from our first witness, I will ask our distinguished Board members if they have any comments. First, I will call on Dr. Cam. Do you have any opening remarks, Doctor?
DR. CAM: I am very honored to serve on this Board, and I am very anxious to learn about your concerns on the following organization. Thank you.
SENATOR RUDMAN: Thank you. And Command Sergeant Major Moore?
CSM MOORE: Thank you for being here. I am, too, pleased and honored to serve on this Oversight Board, and I wish that between all the efforts of the participants, that we will have a positive end result.
SENATOR RUDMAN: Thank you very much. And finally I want to call on Admiral Steinman. Let me just say publicly that I want to thank Admiral Steinman for his extraordinary efforts on behalf of the Board. Of course he has a background that none of the rest of us have and that has been extraordinarily valuable to us and he has been -- really given us yeoman service, and I guess for a former public health officer and a Coast Guard Admiral, I guess that�s the least we could expect.
RADM STEINMAN: Well, thank you, sir, for those kind comments. I, too, am honored to serve on the Board and in the interest of saving some time, I think I will reserve my comments to the question and answer sessions for each individual issue.
SENATOR RUDMAN: Thank you, Admiral.
We�re now ready to begin the hearing. We�ll hear from our first witness, Lieutenant Colonel Michelle Ross, Office of the Deputy Assistant of the Secretary of Defense for Chemical Biological Defense. Colonel Ross, I understand you have just released your annual report to Congress on DoD�s chemical and biological defense program.
Please feel free to reference your report as you point out the progress you have made and the areas in which you require assistance. That would include funding shortfalls that the Board should be aware of. Thank you for being here.
LTC ROSS: Good morning gentlemen, ma�am. You have a copy of my briefing slides in front of you, and you also have a copy of the DoD strategy report that I�ll be discussing.
The overview of my presentation is to discuss the Department of Defense�s research plan to investigate low-level chemical exposure to chemical warfare agents. I�ll just give a brief -- very brief introduction of the background that generated this research effort. I�ll discuss the plan and -- the outline and the objectives of the plan and give you a status update of where we are with the research program.
As you know, Congress directed the Department of Defense to develop a five-year research strategy to address low-level exposure to chemical agents that came out of the Strom Thurmond National Defense Authorization Act in 1999 and this -- it was generated from the Presidential Advisory Committee and the Special -- your Special Oversight Board to -- with the recommendations to investigate low-level exposures to chemical agent.
Independent of the Advisory Committee recommendation, the General Accounting Office issued a report on the fact that they identified a gap in the Department of Defense�s research program to look at this research effort.
Next slide, please.
The Office of the Special Assistant for the Gulf War Illness has identified numerous lessons that relate to the chemical and biological warfare issues. These lessons apply to many areas of chemical defense, doctor-in-training, leadership, operations and material and these lessons have been briefed to the services both for training and -- both their training and doctrinal organizations and also have been briefed to disaster preparedness engineers and in public forums.
For example, these recommendations and lessons were briefed at the worldwide chemical conference a few years ago that�s sponsored by the U.S. Army Chemical School.
OSAGWI issued a report in �96 looking at the possible effects of organo-phosphorous low-level nerve agent exposure and stated that there was at that time no scientific evidence to support a causal link between low-level exposures and the undiagnosed Gulf War illnesses, and this was briefed to the PAC, the Presidential Advisory Committee.
However, they did recommend that additional research continue to investigate low-level exposures and that was also supported by the military -- next slide, please -- also supported by the military veterans health coordinating board which as you know was established in 98 to ensure coordination among the agencies, the Department of Defense, VA, Health and Human Services, and to address health matters for all the service members, veterans, deployed civilians and their dependents.
Our five-year plan, which I�m going to discuss in a minute, will fully coordinate with the Military [and] Veterans Health Coordinating Board, and our goal is to ensure that there�s minimal duplication of effort and also to leverage departmental resources.
In front of you, you have a copy of the Department�s strategy to address low-level chemical exposures and you can have that for your reference. Yours is bound in � there�s a spiral -- there we go. This is a strategy that was written and published in May of �99. This is an unfunded research -- at the time it was an unfunded research plan. And there are two broad objectives to this plan. One is to generate hazard data -- hazard assessment data that will identify low-level exposure concentrations and the associated health effects, and the other general objective is to provide information to develop or potentially modify policy or doctrine related to low-level chemical exposures.
The research effort started, even though this was not specifically funded and the initial efforts were funded within the research laboratories. They funded within house. My boss, Dr. Anna Johnson-Winegar, who is the deputy assistant to the Secretary of Defense for chemical and biological defense, established a working group to oversee and get a handle, if you will, around all the research efforts that have been ongoing for the last few years and we�ll hear more about those with the next speaker.
So we put together a working group; Dr. Winegar is the chair of this group and there are a number of stakeholders that I�ll outline in the next slide. But before I get to that, could you go back two, please? Back one more. Here we go.
Let me tell you about the objectives of the group. The main objectives are to identify the ongoing research efforts because there are a number of these and to -- as I mentioned before, to minimize or prevent duplication of efforts. Now, I think you can appreciate that the investigation of low-level exposure is a very complicated problem. You have to define an event that has no -- or potentially no immediate clinical signs, perhaps identify clinical signs that are long-term or come out later.
Even the definition of low-level is not well-defined. You can look at -- in terms of safety and health, you can look at short term exposure limits, threshold limits, time weighted averages, if you�re familiar with those terms, permissible exposure limits, there�s all different ways in terms of the safety and health arena of identifying what these levels are.
And the levels for nerve agents -- and this is for other chemicals, organo-phosphorous, compounds and others -- the levels for nerve agents have not been well documented or worked out. So we -- this group decided that we need to start with -- on common ground, if you will, even when it comes to the selection of animal models or the types of exposure, whether we�re going to have inhalation exposure or perineal exposure of these agents.
So the goal is to get everyone started on the same sheet, if you will. There are so many questions, and this is such an enormous task that we felt that if we could start commonly, that we could go from there and address these other related issues as time went on.
The other focus is to direct the investigations to address operational issues because while this is very interesting science, we -- our objective is to answer some specific health and operational questions. There are a number of � there�s basically two levels of effort. One is a medical effort and one is a non-medical effort.
For the medical objective, the surgeons general are interested in establishing medical threshold limits for the deployed personnel, and so they�re looking for numbers and hard data so that they can make some decisions about policy decisions about what�s safe and what�s not and look at risk assessments.
On the non-medical side, this information can generate what level -- for our detector technology, what levels; what are the low-levels that we need to design our detectors to be able to identify and key on? We don�t have good information on that yet so that�s where we�re going right now.
Next slide, please.
The group is inclusive and we have tried � we�re trying to include all the stakeholders that have an interest in this area. We have policy folks, strategy and threat reduction, Health Affairs, Joint Staff, all the services are represented; Navy, Air Force, Marine Corps, the Office of the Specialist Assistant for Gulf War Illness is a mem -- has a representative, the Military and Veterans Health Coordinating Board, SBCCOM--Soldier and Biological Chemical Command, of course the medical research folks, the medical research and material command, the Environmental Center for Health Promotion and Preventive Medicine and it�s not -- and we�re open.
If someone steps up to the plate and says they�d like to -- they are interested, they want to be included, the doors are certainly open.
Next slide, please.
This is a summary of the current funding for the program. It�s -- this is what�s in the President�s budget today, and it is approved by Congress. We also have numbers -- we have projected funding in the POM, in the FY02 to �05 which is � isn�t finalized yet, but it�s under discussion right now.
So this effort is a long-term effort. We hope to generate some good information, coordinate the generation of good information within -- certainly within the next year or two and at least have some hard information to start answering some of these questions. But I think you can appreciate the scope of the effort and the fact that it�s going to take a while to get the answers to our complete satisfaction.
Are there any questions from the panel?
RADM STEINMAN: Thank you for that interesting presentation. Just briefly, could you comment for the benefit of the Board members and our audience or summarize the recent finding about the adequacy of the protective clothing that was used in the Gulf and before?
LTC ROSS: I know there are some issues associated with some of the lots that went out on the BDO, the battle dress over garments. The equipment is safe and although there were some problems with certain lots, in general, I mean -- the equipment is rated to be safe and protect against chemical agents.
We have some follow-on suits that are soon to be procured and released. It�s called JS list, and it�s further a follow-on product, if you will, that has -- reduces the seams that are in the current or the original battle dress garment. It�s a lightweight suit. It has � it�s breathable, it causes minimal heat casualties, much unlike the first generation suit.
So the suits are safe but they�re improve � we�re improving on them for a number of operational reasons. I mentioned the heat and the bulkiness and so forth. There are a number of issues that need to be improved on and we�re doing that.
RADM STEINMAN: I guess if I were a veteran I guess the bottom line answer would be I wore the suit in the Gulf; was it sufficient to protect me against potential exposure to chemical agents?
LTC ROSS: Well, of course it depends on when you put it on in terms of exposure. When were you exposed? If you were exposed -- obviously if you were exposed to agents before the alarm went off and you weren�t suited up or you didn�t have your mask on, there�s always potential for that. If you have your protective suit on, your face mask on, absolutely; fully protective if you were adequately protected when the -- when the exposure occurred.
RADM STEINMAN: That was my question. The suits that were used in the Gulf were adequate to protect against potential exposure to chemical weapons?
LTC ROSS: Yes, sir.
RADM STEINMAN: If they were donned correctly.
LTC ROSS: Yes, sir. That�s correct.
SENATOR RUDMAN: Dr. Cam, you have a question?
DR. CAM: I have a couple questions. Thank you for your presentation.
My first question is can you define the difference or is there a relationship between the DoD definition of low-level chemical exposure and what�s commonly called occupational exposure?
LTC ROSS: Well, that�s certainly one of the questions that we�re addressing right away. There is no good definition of -- there is no DoD definition of low-level. Some � what�s been discussed is 100 times or two logs below the occupational safe levels for exposure, specifically the � it�s called the IDLF -- H, excuse me. The immediate danger to life and health.
That�s the level of exposure that will -- where you can observe any effects immediately, like myosis, pinpointing of the pupils or shortness of breath. That�s called -- referred to as the IDLH level. And it�s been discussed that the low-level or the nerve agent low-level DoD definition is 100 times below that. But it�s not well-defined, and that�s certainly something we need to address, and we are. We�re looking at that right away.
So the answer to your question is we don�t yet have a good definition but that�s one of the very important things about standardizing the research so that we can all start looking at the same levels and then working backwards from there.
DR. CAM: My second question is how do your program goals integrate with the Research Working Group pending concerning low-level chemical effects, doctrinal requirements for protection and the most important I feel is lessons learned from prior conflicts.
LTC ROSS: Yes. I touched upon that in my talk and also in the back of your packet are specifically written out paragraphs to those questions. We�re aware of the research that�s been going on, and I think it�s going to be discussed in the next -- with the next speaker, some of the progress in that area.
By including representatives of that group and including the work that�s been done and is ongoing, we�re including them and they�re part of our group and they will have input into not only the status of the research but the direction that it�s going.
As I explained, the Research Working Group will focus the work, understand what�s going on now, focus and direct the ongoing studies so that everyone�s interests and questions can be addressed.
DR. CAM: Thank you.
SENATOR RUDMAN: Thank you very much for bringing us up to date on what you�re doing; appreciate it.
LTC ROSS: If you have any other questions, just let me know.
SENATOR RUDMAN: Thank you. Next witness, Dr. John Feussner from the Research Working Group will update us on low-level chemical exposure on PB.
We welcome the vice chairman. I wonder, before you start if you had any opening remarks at all?
SECRETARY BROWN: No.
SENATOR RUDMAN: All right. Thank you for being with us, Doctor. If you�d bring us up to date on what you�re doing.
DR. FEUSSNER: Good morning, sir. Now that the Secretary has arrived, I am prepared to begin.
SENATOR RUDMAN: All right.
DR. FEUSSNER: I appreciate the opportunity to update you on the research activities ongoing with the Research Working Group. I have chaired the Gulf War Research Working Group since 1996.
May I have the next slide, David?
What I want to do briefly this morning is review for you the goals and functions of the Research Working Group. I have just one or two slides that -- from the 1999 annual report to Congress that demonstrate the scope of the research effort and then focus on the status of low-level chemical agent research, pyridostigmine bromide as you requested.
Next slide, David.
This slide briefly reviews the functions of the Research Working Group, I think fairly typical activities for such a body, to look at the direction of the research, identify gaps that could be filled with additional research, identify potential new research approaches, disseminate these research concepts and then work to continue to develop what we believe is a coherent overall research portfolio.
Next slide, please.
The current Research Working Group portfolio has 145 active research projects. By the end of this calendar year, we will have expended cumulatively in the area of $150 million, and the research effort continues in a very broad and diverse group of areas, 14 specifically.
Next slide, please.
This histogram is taken from the 1999 annual report to Congress. I show it just to demonstrate the diversity of the research effort ranging from central and peripheral nervous system abnormalities through chemical weapons, DU, PB, reproductive health and more recently treatment trials. It�s a diverse and, we believe, comprehensive research effort. Unfortunately, approximately -- only approximately a third of these research projects have actually been completed to date.
Next slide, please.
Some of the conclusions that have been drawn from the initial wave of research projects are listed here. It�s clear that veterans who served in the Gulf report more symptoms. We are in the midst of a -- the Congressionally-mandated phase three survey that involves actually examining veterans spouses and their children and to see what physical concomitance there are on examination to the reported symptoms and to see what the health status of the spouses and the children might be.
The initial epidemiological research which continues, shows that there is no increased mortality, disease-specific mortality from service in the Gulf, no increased use of acute hospitalizations which might be viewed as a marker of illness sufficiently serious to require hospitalization, no increase in birth defects among offspring, and long-term studies to look actually at the veterans� health status are being planned, although preliminary results from the population-based epidemiological study at Iowa are available.
From that study, approximately 90 percent of veterans report their health status to be good to excellent and approximately 14 percent report their health as deteriorating over the period of observation from �96 to �99.
SENATOR RUDMAN: Doctor, let me ask you a question while that slide is still up there, just really a statistical question. The bullets following the top one, no increased risk for hospitalization, mortality and so forth and so on, compared to non-deployed veterans compared to the population --
DR. FEUSSNER: Compared to non-deployed veterans there�s no increased risk of mortality. There are two caveats. And -- well, before we get to the caveats, in general, the health status of these soldiers is superior to the health status of the general population, perhaps not unexpected since they are selected for service in the military by being -- for being healthy.
The two caveats to these observations are as follows. The first is the period of observation is short, relatively speaking, certainly less than a decade. Many dangerous exposures or for example exposures to chemicals that in the future could cause cancer are related to dose of the exposure, but also there is frequency along latency time.
So these -- why I say these results are preliminary, unfortunately the epidemiological studies will have to continue probably for at least another decade to see if associations occur later reflecting the latency associated with a toxic exposure.
SENATOR RUDMAN: Would you expect, let�s say in the case of some of these exposures that might lead to some form of cancer, what do you expect, 20-year incubation period, 25-year period? I mean, what do we -- does anybody know?
DR. FEUSSNER: Well, I think that you�re in the right ballpark. I think you�re talking about 10- to 20-year latency periods.
SENATOR RUDMAN: The other question I had is kind of a curious statistic there; no increase in the risk for mortality except motor vehicle accidents.
DR. FEUSSNER: Yes.
SENATOR RUDMAN: This is the -- those who were in the Gulf compared to those who were not deployed or again are we talking about the general population?
DR. FEUSSNER: No, we�re talking here about the deployed versus non-deployed. This is not a new observation. In previous deployments, it has been noted that this association with motor vehicle accidents, perhaps risk-taking behavior, results in increased mortality from these causes.
There is additional follow-up on this and my recollection is that this initial observation is decrementing through time.
SENATOR RUDMAN: Okay. But those kinds of statistics were similar in other deployments in which things were checked out where you would find veterans who returned from a conflict who tended to be -- have more accidents, therefore you might assume that probably their driving abilities were the same, you might have to assume they were willing to take more risk, drive faster and so on and so forth.
DR. FEUSSNER: That�s fair.
SECRETARY BROWN: Doctor, just to follow-up on that. Have you noticed the same mortality occurring after other conflicts such as -- I don�t know if you have historical data of World War II, Korea, Vietnam and some of the other lesser conflicts like in Grenada? Did you notice the same thing or do we have data on that?
DR. FEUSSNER: Mr. Secretary, I think we do have data on that. My recollection is -- I don�t know about all the deployments specifically but my recollection is that this issue of an increased risk of accidental death has been reproduced and has been observed after previous deployments. And we do have the data to follow this observation at least with regards to the Gulf War cohort prospectively through time.
SECRETARY BROWN: Now, how do you frame that from a scientific perspective? Exactly what are you saying? Are you saying that there may be something physically happening, increasing hormones or whatever that would modify their normal behavior after having been in a hazardous area or are you saying something that has more to do with misconduct or � I�m trying to get a sense on what does this mean.
DR. FEUSSNER: No. I don�t think that there should be any allusion to any kind of misconduct, nor do we have any evidence that there�s some changed biological state, neurochemical changes in the brain, et cetera. I think our notion is, at the moment at least, that the kind of individuals that participate in war and participate in this deployments have a -- in a pre-existing sense may be more risk-takers and that that would get them into difficulty at all stages in the game.
So I don�t think we�re suggesting -- I don�t believe we have any information suggesting any kind of biological basis and there is no intention to suggest misconduct or inappropriate behaviors.
SENATOR RUDMAN: But what you are saying is the statistics are there.
DR. FEUSSNER: Yes.
SENATOR RUDMAN: And the statistics indicate higher risk from motor vehicle accidents after deployment than before deployment or non-deployment.
DR. FEUSSNER: Yes.
SENATOR RUDMAN: You�re not saying why.
DR. FEUSSNER: Correct.
SENATOR RUDMAN: You don�t have -- you haven�t really looked into the why; you�re simply saying that that�s the fact.
DR. FEUSSNER: Yes; that�s correct.
RADM STEINMAN: One other question, Doctor, before you leave the general conclusions. Do you have any data that looks at the longitudinal changes in the signs and symptoms of Gulf War vets who have been recorded in the CCEP of the VA registry? One of the frustrations is we can�t figure out whether the vets who are originally presented as ill are getting better, is there a change in incidence rate of symptoms. Are there studies looking at these longitudinal changes?
DR. FEUSSNER: At the moment, I don�t think we have very good data. For example, let�s say that we would ask a fairly simple question. Here is the group of veterans who we�re concerned about. Let�s say what their health status is at point A and then take those individual veterans and follow them through time to say this is better, this is worse or this is the same.
I think the data in that regard are not robust. Now, what I would say, however, is that the Iowa study, which is a population-based study, does have some initial data, as I alluded to earlier, suggesting that self-reported health status is rated by veterans as good to excellent overwhelmingly, 90 percent of the time, and that for a minority, 14 percent, there�s the perception that their health status has clearly deteriorated over time.
That particular study made its first observation in 96, has a subsequent one in �99 and could be funded to have a third in �02 and in that regard, provide us longitudinal data. Unfortunately, the survey -- the national survey, phase one through phase three, are more like snapshots of the population and don�t provide us an opportunity to link say data that is obtained now with health status data that was obtained straight away. My impression when phase one was conducted is the focus was more on exposure history than on health status and while they are improving data on health status later, not so in the early stage.
Now, in the two treatment trials, we will be studying not quite two thousand Gulf War veterans, all of whom have been selected because they are quite ill. And in those trials, there are treatment groups that are more intense and less intense. So within the context of perhaps some of the sickest Gulf War veterans, we�ll have pretty good data, at least over a short period of time, two to three years, whether their health status is deteriorating, staying the same or improving.
You would predict with the overwhelming majority identifying their health status as good to excellent that there would be a ceiling effect and that what would happen is that through time, the natural tendency would be for those patients to get less well as opposed to better.
RADM STEINMAN: But what you�re saying then, as I understand it, there is not a research program currently underway to look at those veterans who registered in the CCEP or the VA registry to track them longitudinally to see whether they�re getting better, worse or staying the same.
DR. FEUSSNER: That�s correct.
SENATOR RUDMAN: Yeah; go ahead.
DR. CAM: Just to go back to the point you made that there was a link, are you planning on studying about this link at all?
DR. FEUSSNER: Well, that�s very problematic. Going back five or ten years and asking what health status was five or ten years ago is very problematic.
DR. CAM: Is it possible to have another study in the future covering that gap?
DR. FEUSSNER: Again, what you really want to know is the longitudinal nature of the health status and the best data that we have again comes from the Iowa study. We will have information 96, 99 and into the future. I think it would be very difficult to say start in �00, �01 or �02 and then ask patients or ask veterans what their health status was ten or so years ago and then know what the health status was. So I think that�s a problem.
One of the issues that we have dealt with as we are moving into the area of post-deployment health is -- one of the lessons learned is that we -- in the Gulf deployment, not having as good a measure as the base state, that is the pre-deployment state, and then not having very good measures immediately post-deployment, which could then serve as base measures down the future, is an issue I think that we�re going to try to address as we move. It�s, if you will, a lesson learned from this particular situation, moving to the future.
SENATOR RUDMAN: I want to keep you on schedule if we can. We know we�re interrupting you a lot, but we�re going to try to keep you on schedule.
DR. FEUSSNER: Where am I?
SENATOR RUDMAN: I think we had finished with that. That�s the new slide.
DR. FEUSSNER: Okay. What I will do now is talk briefly about the low-level chemical warfare agents research and then the research on Pyridostigmine bromide, insecticides, et cetera.
The Research Working Group really had no research plan involving exposure to chemical warfare agents until 1996 when new information about Khamisiyah was raised and introduced concern about chemical weapons exposure. At that time, recommendations were made to look at the long-term health effects, especially of low-level chemical exposures.
In the period immediately around the release of information about Khamisiyah, the Research Working Group in fact had received four excellent research proposals reviewed as scientifically credible but had not funded them because they did not appear to be an appropriate priority for the research funding. The first step was taken to go back, contact those investigators and initiate those for research projects.
Subsequently, in the ensuing years, DoD has had a series of broad agency announcements related to the issue of low-level chemical weapons exposure.
Next slide, please.
Around this same time, the Research Working Group involving VA, DoD, CDC and EPA developed a specific strategic plan for research on the health effects of low-level nerve agent exposures. At that time we, if you will, field tested the initial plan at the International Society of Toxicology meetings in Cincinnati and then published their strategic plan in the 1997 annual report to Congress, and it�s that plan that has guided our actions over the subsequent three years.
Next slide, please.
More nettlesome is the issue of what a low-level exposure is, especially problematic if patients have -- or if the soldiers have no symptoms, no explicit knowledge of exposures.
We within the strategic plan have created an operational definition, minimal reduction in enzymes, biological proteins that could serve as a vial marker for exposure to nerve agent. Of course, acetylcholinesterase levels were not measured systematically during the conflict and that the patient have no or minimal observable clinical signs or symptoms. So from a medical care perspective, these would really be classified as sub clinical exposures.
Next slide, please
Now, much of the research portfolio is actually listed on this slide. Several large-scale epidemiological studies really revolving around the potential exposures due to the Khamisiyah demolition, one of these projects, again looking at hospital utilization, has been published out of the Naval Research Center in San Diego.
The medical follow-up agency, the Institute of Medicine, is helping us with the major epidemiological study, looking at those that might have been exposed in Khamisiyah versus those that are not, and then a third project being developed in Portland.
The second issue here has to do with epidemiological studies of long-term effects of acute exposures. This really reflects the experience of the Aberdeen site in the fifties and the sixties. Again, this is a study that is -- that we have asked the medical follow-up agency at the IOM to help with. We�re looking for neurological and psychological sequelae.
The advantage that this study has is that we have clear knowledge about the dose and duration of exposures that the soldier volunteers had at Aberdeen and so might be able to develop some concrete results from known exposures, even low dose. To develop biomarkers for CW exposures, while the research is proceeding and may succeed in trying to develop biomarkers, we really haven�t any research products yet that could be used in a general way.
And then the fourth category is toxicological studies, looking at long-term effects from CW exposures. Most of these studies actually look at exposures to low doses of sarin.
Next slide, please.
At the moment, there are 19 research projects that the Research Working Group is tracking specifically dealing with low dose CW exposure. The statistics are listed here. The amount of money, the amount of projects completed and the number that we expect to complete this calendar year. Most of these projects should be finishing up before the end of the year.
Next slide, please.
SECRETARY BROWN: Doctor, can you give me a list -- just a few of the 19 projects?
DR. FEUSSNER: Yes. I brought -- I could actually give you the list, but you want some examples. Chronic organophosphate exposure and its effect on memory in the Medical College of Georgia, the toxicokinetics of some of these things, that is, how they are metabolized in the body; this is a rodent study being done in the Netherlands. Long-term effects of sub clinical exposures to sarin out of Albuquerque, butylcholinesterase, which is another enzyme that degrades some of these chemicals and what its genetic variability is, out of the University of Nebraska.
So those are some of the studies and I believe what we�re passing out is the list -- the actual list of the active studies.
SENATOR RUDMAN: Are any of these that are now complete produce any particularly surprising if yet-to-be-corroborated result or are you not in a position to talk about that yet?
DR. FEUSSNER: May I have the next slide, please?
I don�t think there are any particularly surprising results at this point in time. The only epidemiological study to produce results is the one I had mentioned out at San Diego, and it has shown no increased hospitalizations among veterans. Again, that�s a fairly blunt cut of the data.
We have had some success developing biomarkers, so-called adducts to some of the toxins but again those haven�t been field-tested. But other than that, the results to date have not been particularly surprising. We have noted genetic � what�s called genetic polymorphism. That is variability. You may have one capability to destroy or protect yourself from these chemicals, and someone else who is apparently looks just like you might have a dramatically lower ability to do that. That had been suspected before, but basically we�ve confirmed that.
Next slide, please.
What we would say is that the projects that currently are funded in our perspective are addressing the research questions that exist in the strategic plan. These projects are highly variable from very basic biological studies that are looking at what happens in animal models to large-scale epidemiological studies that are trying to tease out differences in exposures and outcomes.
We have not noted any new issues that have come to bear since we created the original strategic plan, so basically we�re still on the original plan and we would deduce, at least at this point in time, that our funding line is probably adequate. But that is conditioned on -- that is -- the caveat there is whether new information would become available or depending on whether the active research projects now ongoing would come up with research observations that require follow-on studies.
I would like to move to the next slide, which talks about issues of pyridostigmine bromide. This is a medication that was used in the Gulf. The Research Working Group did identify PB as a priority for subsequent research in the original working plan for the research group that was published in 1995. A variety of expert panels and presidential commissions have recommended that we look at issues of the pyridostigmine bromide itself, insect repellants that were used in the Gulf, DEET, which is a component in for example Off!, permethrin, and organophosphate pesticides.
Again, DoD has played a prominent role in this line of research and has announced BAA [broad agency announcement] is looking at PB and the interactions with other chemicals from 1995 through 1999.
Now, the research question is on this next slide, and the question is does short term low-level exposures to PB or these other chemicals alone or in combination cause significant harm, specifically specific neurological effects. There are seven specific projects that focus on these issues of interactions between PB and low-level nerve agents.
The research, as we said earlier, is complicated straight away dealing with low-level exposures. Now we�re going to be adding onto that one or more interactions and the research gets even more complicated.
The next slide shows the commitment of resources to date, 27 projects, about $21 million. Several of these projects have been reviewed or have been completed and the results published.
Next slide, please.
SENATOR RUDMAN: I have the same question or maybe you�re going to tell us --
DR. FEUSSNER: Yes, I�m going to get to --
SENATOR RUDMAN: All right.
DR. FEUSSNER: Not this one but the next one.
SENATOR RUDMAN: All right, go ahead. We�ll let you do it your way.
DR. FEUSSNER: Thank you, sir. I appreciate that.
OSAGWI had commissioned an extensive literature view on this issue of PB by Rand. Rand identified these seven areas or hypotheses that should be investigated. We�re pleased that the original Research Working Group, in fact, covered all of these projects.
Issues about penetration of these chemicals into the brain was an important one. The standard scientific information available at the time was that they do not. Differences in susceptibility, we talked about the genetic differences in these proteins and how different people might react to them differently. Issues of interaction. Bromism is a very rare illness associated really with exposure to bromide. In my 25 years I�ve never seen a case of bromism, but I�m just a youngster.
And then other projects relating to the effects of this chemical of the neuromuscular junction, it works where the nerve meets the muscle to tell the muscle how to behave. And then the regulation of this chemical and could exposures in the short run to PB or other drugs actually have unknown and unintended consequences that extend beyond the brief exposure period.
Next slide, please. Oh, that�s the next slide.
Basically, the issue has been concern over whether PB cross a blood brain barrier, can have effects in the central nervous system, that are unanticipated. What we have to say is that on balance, the research suggests that it does not. There was an initial study published by an Israeli group of scientists that showed that PB associated with stress, in this particular case the stress was a swimming stress, allowed the chemical to cross the blood brain barrier of mice and that, of course, was of concern because soldiers taking this medication in the Gulf were exposed to multiple stressors, perhaps chemical but certainly physiological stressors.
That research has not been able to be corroborated but as other scientists have attempted to replicate the research under the same conditions and with the same animal species and have not been able to do that.
DR. CAM: Do you happen to have any preliminary finding on that study done by Dr. Gary Gilkensen on immunotoxicity due to co exposure to PB and stress? It�s kind of related to what you just said.
DR. FEUSSNER: Actually, I don�t off the top of my head.
DR. BRIX: That�s a very new project that was just very recently ended and there are no results yet. Sorry.
DR. CAM: Okay. And just a minute to ask you the study done by Dr. Abou-Donia at Duke University. The last time I talked to him, I thought he was about getting some interesting findings on long-term effects on sub chronic exposure to sarin alone and was dressed for other chemicals. Do you know anything about that?
DR. FEUSSNER: I don�t think -- actually I was a professor at Duke myself for 23 years and Gary Gilkensen was from Duke before he moved to Charleston so I know these people very well in my previous life. I don�t have any new information, however.
DR. BRIX: No, Dr. Abou-Donia has not published his recent findings from his studies.
DR. FEUSSNER: Yes, sir.
CSM MOORE: Doctor, do you have any data what PB can or has or the effect it has on a normal -- when I say normal, a person that would have the adequate -- all the normal health that they should have versus a person who has a shortfall or lack of a better expression, the health is not as good? So you have one person with good health and one with not-so-good health. What effect would it take on a person that�s normal, and what is medically considered not normal?
DR. FEUSSNER: Research would suggest it would not have any effect. Pyridostigmine bromide is from a family of drugs; physostigmine, which is a similar drug, has actually been used as a treatment for a rare muscle illness called myasthenia gravis for about a half century in the United States and is a very important drug, potentiating the effect of the chemical transmitter allowing those patients to have a more normal muscle actions.
The research suggests -- the volume of research suggests that the PB doesn�t -- it in fact probably does not cause -- cross the blood brain barrier so it would have no effect on the brain. We have other studies that have been recently published, this year, that have looked at the effects of this where it�s supposed to act, where the nerve and the muscle meet.
And what those -- what that research suggests is that the PB in fact can cause damage at the junction where the nerve and the muscle meets. This is an -- again, an animal model experiment. As those observations are extended through time, the conclusion is that the bad effect of the agent at the neuromuscular juncture where the nerve and the muscle meet is very short-lived and that once the chemical is removed, the neuromuscular junction repairs itself and reverts to a normal state.
So the body of research, at least at this point in time, doesn�t impugn PB. Now, we have learned that there are -- as I said earlier, there are differences in different people on how they might metabol -- destroy and -- I don�t know of a better word than metabolize -- these chemicals, and we do know that there is gender differences. That is, for whatever reason, women would be more susceptible to the adverse effect of this drug than men would be.
So we have learned a lot more about this agent than we had in the past but at least at the moment there doesn�t seem to be anything to impugn this as a cause of sustained illness.
CSM MOORE: One other quick question. With the damage in the nerve, how would that affect the person behavior?
DR. FEUSSNER: May I have the next slide, please?
I don�t know that it would. This shows some additional results from the research. The first bullet actually reflects Dr. Abou-Donia�s work with massive doses of PB demonstrating some synergy. These are doses of the drug that actually are extremely harmful to the animals and far exceed any doses that a person would be exposed to.
There are studies that show changes in behavior in animal models when they get pyridostigmine bromide. And the way this is expressed in the animal is, for example, the animal reflexes would be slower so if it were to do a task, it wouldn�t react as quickly as it might.
The animals -- if I challenge the animal such that the animal would be startled, in the presence of the drug, the startle reaction is blunted. So that there are results that show that Pyridostigmine does have behavioral effects in animal models and what�s hard to get to is whether or not those observations kind of carry over to humans.
Most of these results are done using rodent models, and we don�t understand exactly why these behavioral effects are observed. You would think it would be effect on the peripheral nervous system when you see the reflexes being blunted and previous -- the data that I talked to you about in terms of not crossing the blood brain barrier, would suggest not a central effect but we simply don�t know the answer to that yet.
SENATOR RUDMAN: Go ahead.
DR. FEUSSNER: I actually only have two more slides, so I�m almost on time.
This is really a summary of the status of PB as I gave for the CW. A little over two dozen projects, the spectrum of research methods here is variable. Our notion at this point in time is that our funding is probably sufficient but, again, as something new comes up or if these research results produce something that�s positive that we would want to follow on, then that could change.
Last slide -- I believe this is the last slide.
Yeah. This just basically says we�re working on it.
SENATOR RUDMAN: Well, essentially, as you know, PB is an issue, which in some -- in the minds of some veterans is a very serious issue. Many of them are convinced that, in fact, it has produced the problem. I have to assume that you have some time to go yet before these projects are done.
DR. FEUSSNER: Yes, sir.
SENATOR RUDMAN: And you have no idea what they�re going to deduce.
DR. FEUSSNER: That is correct.
SENATOR RUDMAN: And you, I think, have been reluctant to give us any interim reports, which is probably wise, even if you had them, because people tend to jump on them. I would rather see them done. When -- what is the timetable on some of these?
DR. FEUSSNER: Well, the --
SENATOR RUDMAN: On the major PB studies that are going on.
DR. FEUSSNER: Well, I thought that I had that information.
SENATOR RUDMAN: If you don�t have it with you, supply it to us, please.
DR. FEUSSNER: Fifteen of the projects are completed now, so about half of them are done now and the other half are not.
SENATOR RUDMAN: And they�ll be done in what? Are these one-year, two-year projects?
DR. FEUSSNER: Only an additional four will be completed this year; another eight will be multiple years out, to �01 and �02.
SENATOR RUDMAN: Who do you report to?
DR. FEUSSNER: Gee, most everybody in this room, sir.
SENATOR RUDMAN: You can do better than that.
DR. FEUSSNER: Within the Department I report to the Undersecretary for Health. Within VA, I report to the Undersecretary for Health who reports to the Secretary.
SENATOR RUDMAN: Well, the reason I ask is because obviously what happens with these projects is very important, and we�re going to hear about the follow-on organization shortly.
DR. FEUSSNER: Now, we also prepare an annual report to Congress. Unfortunately, our report isn�t ready yet, probably won�t be ready until early summer. And then in addition to that, we are -- Congressman Shays has asked us to put together a summary document separate from the annual report to Congress on each of these fourteen areas and that we hope to have ready by September 30.
SENATOR RUDMAN: But it would be fair to say as of today -- and we have a lot going on.
DR. FEUSSNER: Yes, sir.
SENATOR RUDMAN: But as of today, you do not believe that any of the projects that have been completed in relation to PB and the other issues that you�re looking at have given you any answers that are particularly helpful or surprising.
DR. FEUSSNER: Correct.
SENATOR RUDMAN: I mean, that�s a very important -- it�s very important that people understand that because, you know, I get all kinds of mail from veterans around this country who read something in the newspaper who tell me it�s PB or it�s this or it�s that.
And I can understand when you�re ill, you know, you�re reaching out trying to find something that will tell you, you know, the magic bullet, I found it. But the fact is with all the money that we�ve spent so far and all the research we�ve done, we still have not clearly identified PB as a problem yet, if at all.
DR. FEUSSNER: That�s correct.
SENATOR RUDMAN: Okay. I just want to make sure that testimony is very clear because we get a lot of requests from a lot of people. A lot of people of course are going to disbelieve it because they want to believe what they want to believe but I�ve looked at this list and these aren�t people who are pawns to the United States government.
DR. FEUSSNER: No, sir.
SENATOR RUDMAN: These are independent researchers who have great reputations. I have checked a number of these people out myself in ways that I�m able to do and I am satisfied that you have given money out to people who are seeking the truth and that�s all we can do. If there are those in our society who don�t want to believe that, we can�t deal with that.
DR. FEUSSNER: All of these projects, whether they�re funded by HHS, VA or DoD, go through a very rigorous scientific review process.
SENATOR RUDMAN: I�m aware. I�m aware. In fact, it�s equivalent to what they do over at NIH. It�s the same kind of peer review.
DR. FEUSSNER: That�s correct.
DR. CAM: Can I just follow-up with your comment?
SENATOR RUDMAN: Go ahead.
DR. CAM: Given the exact nature of science and scientific research, can we ever hope that there can one day be established a link or is the answer to this question only in the research, not in speculation? I would like your best estimate on that.
DR. FEUSSNER: Given that there are very few verifiable data on exposures, I think it�s unlikely that we would find the bullet that the Senator referred to that would be the explanation and would, using the scientific dictum of Occam's razor, would provide the simple elegant answer to this problem. No. I think that is unlikely.
Now, having said that, I showed you the diversity and the size of the research enterprise that is looking for those answers. It�s conceivable that one of these projects will find the answer. At the moment, we have not. The President charged us with -- I think his words were leaving no stones unturned and that has been the attitude that we have taken and the departments involved, at least from my perspective, the chairmen of the research committee have been excellent cooperating and collaborating in this common enterprise.
SECRETARY BROWN: Before he�s dismissed I have one more question.
SENATOR RUDMAN: Go ahead.
SECRETARY BROWN: Doctor, can we go back to this here question on the effect on the neuromuscular junction.
DR. FEUSSNER: Yes, sir.
SECRETARY BROWN: Now, kind of help me, see if I understand this here. What we�re basically talking about is the nerve ability to stimulate the muscle.
DR. FEUSSNER: Correct.
SECRETARY BROWN: That is impaired -- and you said that impairment is very mild or --
DR. FEUSSNER: Short-lived.
SECRETARY BROWN: -- short-lived. Okay. Let�s try something like this. If you push that out to the extreme, just push it out to the extreme biologically in the lab, what would the end result look like to the common person or to a scientist?
DR. FEUSSNER: So let�s say that we actually blocked the neuromuscular junction.
SECRETARY BROWN: That�s right.
DR. FEUSSNER: Or damaged it irreversibly. Well, I think the problem -- the spectrum of the problem would be one of muscle weakness that was mild to muscle weakness that was profound to the point where the muscle weakness would be so profound that you might not be able to move or breathe.
SECRETARY BROWN: Would you say that effect could be widespread throughout the body affecting primarily or to include the voluntary muscles?
DR. FEUSSNER: Yeah. I think -- actually there are diseases of the neuromuscular junction where that�s precisely what happens. Patients, fortunately rare, who have myasthenia gravis, for example, have difficulty keeping their eyelids open without the help of medications.
Now, interestingly, the medications used to treat that muscle problem are in a family of drugs like pyridostigmine bromide, physostigmine, et cetera.
SECRETARY BROWN: Now, you mentioned myasthenia gravis twice. What about ALS?
DR. FEUSSNER: Well, ALS is a little more difficult. I think we have a good understanding of myasthenia, although it�s not clear to me what causes it. That may be clear to experts, but it�s not clear to me and we have a treatment for myasthenia.
The problem with ALS doesn�t necessarily appear to be at the neuromuscular junction. It appears to be a serious problem with the nerve so that the nerve deteriorates to the point that it doesn�t tell the muscle to do anything.
Now, the issue -- ALS is a very difficult problem. We don�t know what causes ALS, and we have no treatment, no real effective treatment for ALS. The issue of ALS has come up with regards to possible exposures that may have occurred in the Gulf. I personally looked at these preliminary data starting from March of 1999 through the summer of 1999.
What we found when we looked at the preliminary data with ALS is that the rate appeared to be low and not increased among Gulf War veterans. We looked at the available data we have on the entire Gulf War cohort, and there did not appear to be any increase in death associated with ALS.
Troublesome, however, was that when we looked at these data, there seemed to be a shift among patients developing ALS at a younger age than we would have expected. Now, that raises some uncertainty. Is that important or not? I actually don�t know. You may recall that Lou Gehrig died of ALS at the age of 38 as a young man.
What we have done with help from DoD and also with expert epidemiological help from the CDC is we just announced last week a major national study that is a case finding study trying to find all Gulf War veterans who might have ALS, regardless of whether they were deployed or not, regardless of whether they use VA for medical care, the military or private medical care. That is a project that has literally just been initiated.
This case finding effort will probably go on for about a year. We have solicited and received help from the ALS Association. We are contacting the veterans service groups, and we will contact the professional societies like the American Academy of Neurology who care for these veterans to try to identify all the patients who have it so that we can see what the rates are and then also get some information about possible exposures.
If the rate is not increased and it turns out that the age distribution is not so unusual once we get all the identified patients who have ALS, then we will stop. If anything is remiss or inconclusive, then we will continue with a national study trying to look at cause.
SECRETARY BROWN: Are any of these studies right here, of the 19, do they attempt to determine if any of BP or -- PB could create a disease that mimics ALS or that they are not. I read your announcement, but your announcement also said that you�re not going to get into research, if I remember correctly.
DR. FEUSSNER: Oh, no. The announcement -- I�m sorry, Mr. Secretary. The announcement announced the research effort.
SECRETARY BROWN: No. I�m talking about -- it announced the research effort to identify, not the research effort to determine the etiology or the cause and effect relationship.
DR. FEUSSNER: Well, the -- I regret if the information was not as precise as it might have been.
SENATOR RUDMAN: Well, why don�t you tell us what it is doing? That will be a lot easier.
DR. FEUSSNER: Yes. The goal is to identify the cases, and then there will be specific questions asked about exposures and for all of the patients who are alive, we will invite them to have a comprehensive examination wherever they would like, either at a VA ALS center or a non-VA center.
We wanted to make clear in the announcement that this was not a study looking at treatment. We didn�t want patients with ALS to think that we�re initiating a treatment trial.
SENATOR RUDMAN: Thank you very much.
DR. FEUSSNER: Thank you, sir.
SENATOR RUDMAN: We�re going to take a short break here for about five or ten minutes, and then we�ll proceed with the panel.
SENATOR RUDMAN: If we could all be seated, please. We have Dr. Rostker, Admiral Mayo, Captain Mazzella, Dr. Brown, Dr. Claypool, and Dr. Mazzuchi. And we�re starting a little bit late but we have a little flexibility in the schedule so I�d like you to get through your presentations and Dr. Rostker, we�ll call on you.
DR. ROSTKER: Mr. Chairman, I think we have provided you my testimony, answers to specific questions and then a revised schedule. Let me move through my testimony quickly and then I�ll be pleased to take any questions that you have.
SENATOR RUDMAN: Now, will each of our witnesses this morning be testifying briefly?
DR. ROSTKER: That�s my understanding.
SENATOR RUDMAN: I believe that�s correct.
DR. MAZZUCHI: You did not ask any questions of Health Affairs so we do not have a prepared statement. We�ll be happy to answer any questions.
DR. ROSTKER: The centerpiece of my testimony is the draft charter which we have provided to the Board for a new office which this draft charter has been widely coordinated within DoD, although I note it has not been forwarded to Secretary Cohen for his final approval.
For the past four years, my office has been committed to doing everything possible to understand what happened during the Gulf War and to respond to questions and concerns of veterans. As we move forward, I believe it is imperative that the lessons we have learned are used to address the needs and concerns of the servicemen associated with deployments, not just Gulf War deployments.
While we have taken numerous lessons away from our exhaustive investigations, perhaps the ultimate lesson to be learned is that the Department of Defense is not well structured to deal with non-traditional issues that seem to arise after every deployment. As importantly, we have learned that we must stay connected to service members and veterans less we risk damaging the trust they have in our leadership.
In the last few months, I have shared with you and with other members of the Board the need for continued organization that would outreach investigate issues of deployment health. I�ve talked with leaders from the major veterans and military service organizations and asked for their thoughts as we consider the future, and I�ve also provided their input to the Board. I�ve also discussed our vision for the future at a recent meeting of the Gulf War Illness Interagency Working Group.
In your interim and your special reports, you discuss the need for and provided some thoughts on the new organization. The new organization will be a strong voice on behalf of servicemen and will ensure that the lessons learned from past operations are applied to future deployments, redeployments and post-deployment activities.
We will build on and expand the work of OSAGWI, becoming a permanent part of the Department of Defense. Additionally, the new organization will continue to work with veterans and military service organizations and importantly individual Gulf War veterans. We remain as committee as ever to help veterans of the Gulf War and to address the many health issues that unfortunately remain.
Special Assistant for Deployment Matters will operate under the direction of the Secretary of Defense and be responsible for independent reviews of deployment matters as they pertain to the health of the force. Placement as a special assistant to the Secretary of Defense ensures the independence and objectivity of the special assistant.
This relationship also ensures the effectiveness of the special assistant in reviewing the broad range of issues and providing a basis for actions essential to meeting the challenges of today�s defense management and defense environment.
I�d like to share with you some of the comments that we received during the coordination process. One I think highlighted the general consensus and it was, I quote, "we understand the need for and fully support the concept of institutionalizing this organization at the highest levels of the department." The Joint Staff also endorsed the importance of ensuring coordination of OSAGWI�s role in improving relations and developing trust with veterans, helping guide for us health protection policy and doctrine based upon lessons learned.
Within the Department, the Office of the Special assistant for deployment methods, the acronym, interestingly enough, comes out as OSAGWI, will be responsible for accounting to the DoD leadership, Congress, the Executive Branch, veterans and the American people for health issues as they arise during deployments and on the battlefield.
The office roles will be proactive in developing and ensuring the implementation of lessons learned and conducting outreach to the total force, veterans and military, service organizations, individual veterans and the public. OSAGWI will monitor and report on deployment matters and related activities including aspects of doctrine, policy, readiness, medical research, again, as it pertains to the health of the force. This will be done in coordination with other DoD components having deployment policy oversight and execution responsibility.
And I really want to stress this. This is the eyes and ears of the Secretary. We in no way take away from other DoD components, which are charged with actually managing the deployment. We need to be respectful of their roles and their missions and of their responsibilities. At the same time, we need to be in a position to work with them to ensure that we have the full interests and the full ability to view the health of the force as it pertains to the deployments.
In addition to initiating and coordinating actions within the Department to ensure implementation of lessons learned, we will provide a single focal point for actions or for interactions with other government agencies. This will provide the best avenue for the exchange of information between DoD, Department of Veterans Affairs, Department of Health and Human Services and the veterans -- and the military and veterans coordinating board.
We are reminded daily of the challenges faced by our own forces deployed around the globe, protecting our national interest in peacekeeping and humanitarian missions. The Department has a responsibility and an obligation to protect the health and welfare of the men and women we routinely put in harm�s way. It is a commitment we must take seriously. It is not one that we can pass to another agency.
The Office of the Special Assistant for Deployment Matters, building on the lessons learned and the commitments made by OSAGWI, is uniquely positioned to represent veterans and service members. I made a commitment nearly four years ago to our Gulf War veterans and we believe we must continue that legacy to all veterans, past, present and future.
I request your continued support for our efforts and the establishment of the new office for the special Assistant for Deployment Matters and I�d be pleased to respond to any questions that you may have.
SENATOR RUDMAN: Thank you, Dr. Rostker. I may go down the panel but before I do, just one quick question for you. How will this be established? Will it be established within DoD or by the Secretary or will this require legislation?
DR. ROSTKER: No, this would be established within DoD by the Secretary. It�s my understanding it would not require legislation.
SENATOR RUDMAN: Why don�t I ask each member of the panel just to make a few remarks from their particular perspective, whether they have prepared remarks or not? Admiral Mayo.
RADMIRAL MAYO: I agree with the follow-on organization, as does the Joint Staff, as you�ll hear in my prepared statement. We see as important the outreach mainly with the veterans, it�s a very important part and until our force health protection plan that we�re just now embarking on is complete, this serves as a help, if I could say it in those words, or another pair of eyes and hands to assist us in accomplishing our mission.
SENATOR RUDMAN: And you don�t see any conflict here between the traditional people within the CINC staff that do these sorts of things and the Joint Staff?
RADMIRAL MAYO: No, I�ll try to explain that in my statement but we don�t see this. There may be a little bit of overlap, but we don�t see this as a hindrance or any way where folks are impinging on things.
SENATOR RUDMAN: Well, why don�t you go ahead with your statement?
RADMIRAL MAYO: Because part of the concept and the way we see it is not on an ongoing day-to-day basis. It�s part of a -- you can use the word oversight or looking at incidents after they�ve occurred and so forth.
Could I have the first slide, please?
Good morning, Senator Rudman and Secretary Brown and distinguished Board members. I�m pleased to have the opportunity to discuss the force health protection and the Joint Staff position on a follow-on organization to the Office of the Special Assistant for Gulf War Illnesses.
You can go to the next slide.
In our view, OSAGWI has played an integral role in improving relations and developing trust with veterans and helped to guide force health protections policy and doctrine development based upon lessons learned. We want to ensure the continuation of these efforts.
After considering inputs from the combatant commands and services, we concur in the proposed charter for the Office of the Special Assistant for Deployment Matters. We support the concept of a temporary follow-on organization to the OSAGWI. In the following charts, I will briefly present the information you requested as outlined on this chart.
Two primary joint publications outline processes and responsibilities related to deployments. From Joint Pub 3-35, the significant responsibilities of the chairman of the Joint Chiefs of Staff and the Joint Staff responsibilities include preparation and review of joint plans and conform to policy and guidance from the President and the Secretary of Defense, advising the Secretary of Defense on critical deficiencies and strengths in force capabilities including manpower, identified during preparation and review of the operating plans, and assesses the effect of noted deficiencies and strengths on meeting national security objectives, policies and strategic plans and that would also include force health protection as essential to that advice.
In addition, the Joint Staff oversees activities of the combatant commands and reviews the plans and programs of the combatant commanders to determine their adequacy, consistency, acceptability, and feasibility for performance of assigned missions.
Further, the Joint Staff develops, implements, monitors and assesses joint education and training programs to improve deployment and redeployment planning and execution and ensures that deployment and redeployment planning and execution is assessed during all joint force operations as well as chairman of the Joint Chiefs of Staff and the combatant commands sponsored joint exercises.
Relatedly the supported CINCs establish predeployment standards. These predeployment standards outline basic command responsibilities, policies, training and equipment requirements necessary to prepare supporting personnel for the tactical, environmental and/or medical conditions in the field.
Joint Publication 5-0 gives the chairman responsibility to monitor and assess readiness of U.S. military forces to fight and meet demands of the national military strategy. The chairman�s readiness system supports the chairman of the Joint Chiefs of Staff in meeting the responsibility.
Joint operating plans are the foundation for this chairman�s readiness system, providing standards against which readiness is measured. The joint monthly readiness review is a forum available to the CINCs to identify any force health protection shortfalls or deficiencies.
According to the charter for the SADM, responsibility for policy, oversight, execution of deployment activities remains with those DoD components that have responsibility for deployment issues, including the Joint Staff and the CINCs. We see the new organization as complementing what the Joint Staff does.
Many lessons were learned from the Gulf War. In fact, these lessons were key drivers in the development of our force health protection strategy. As you are aware, poor documentation and record keeping were significant issues but not unique to Operation Desert Storm. It had always been there.
There was no comprehensive health surveillance nor environmental assessments. The predeployment and redeployment and garrison cycles were all separate incidents, not connected medically. In fact, health care was episodic care rather than comprehensive longitudinal, which is essential for addressing health maintenance and prevention.
Early improvements examples include the use of our forward laboratories in Somalia in 1994. Comprehensive health surveillance including disease, non-battle injury and environmental surveillance started in Bosnia, in our ongoing efforts in Kosovo. We know more about the soil and the air and the environment in Bosnia than we do about many parts of the United States.
Joint Staff memorandum "Deployment Health Surveillance and Readiness" of December �98 float from the 1997 DoD directive and instruction on joint medical surveillance and established standard requirements for all deployments. It became effective in February of 1999. Kosovo was the first major operation requiring compliance with this policy. Pre- and post-deployment health assessments and recording of all healthcare as well as any potential hazardous exposures are ongoing.
I personally visited Kosovo with the Assistant Secretary of Defense for Health Affairs, Dr. Bailey, last August. I was quite impressed with what I saw there. Data was being collected in the composite health care system which is the computer-based system that is in effect now in the Army field hospital, our cache that was there, and they transmitted this data to Germany be included in the database that�s resident here in Washington, D.C.
In addition to establishing standardized procedures, we�re working on improvements in several areas, most notably those listed on this chart. We recognize the value of medical record keeping for both prospective and retrospective uses. These data are obviously essential to any effort to assess health risks or reconstruct reported events.
Having the central repository in the defense medical surveillance system supported by a robust information management applications at all levels will get us where we need to go. Many of these changes in record keeping are still labor-intensive and will be until we have the computerized medical record, worldwide connectivity and database integration, especially with the personnel systems and also a change in our business practices.
Appropriate command emphasis and a culture shift, a major culture shift on everyone�s part are critical to the full success of force health protection.
Deployment oversight occurs through several mechanisms. In addition to plan reviews previously mentioned, compliance with the JCS memorandum includes periodic reporting requirements for data such as disease non-battle injury rates. We have found that having standard language written into all the CJCS directed deployment orders specifying compliance with these requirements has been of great value.
In fact, on the recent deployments, even though they were for less than 30 days, where we sent troops into Mozambique and Venezuela, this was a standard part of the deployment. To collect a predeployment samples; do the predeployment assessment as well as the post-deployment assessment.
Oversight does occur at many levels, before and during deployments, including the JTF staff, military components, the CINCs, the Joint Staff and the Office of Secretary of Defense. Established situation reporting, after action reporting and the joint uniform lessons learned system are there to close the loop. Lessons learned and current deployments are both discussed at our semi-annual CINC surgeons� conferences.
Periodic DoD reviews of deployment activities related to force health protection are conducted by the Joint Preventive Medicine Policy Group and the Joint Environmental Surveillance Working Group formerly chartered by ASD(HA) in 1997 but in existence on an ad hoc basis before that. That group makes policy recommendations to support and improve our force health protection programs.
Notable among these are DoD force immunization policies including immunization documentation and tracking, recommended improvements to the Armed Forces medical intelligence centers, medical environmental disease intelligence countermeasures, it�s called MEDIC, which is widely used throughout the preventive medicine community, development of proposed redeployment clinical guidelines and joint consensus on environmental contaminants of interest and recommended short-term exposure guidelines.
We are excited about the opportunities presented by the standup of the interagency Military and Veterans Health Coordinating Board. I will be very actively involved myself as the designated chair of the deployment health-working group. The SADM will be a key player in Dodd�s efforts in this regard. I am confident that the interchange between DoD, VA, HHS, through this forum will pay great dividends to making our life cycle approach to force health protection a reality.
Finally, our recently-released force health protection vision document has identified several critical success factors including information management and information technology solutions that we will be actively pursuing with the services during the coming year�s budget cycles.
For the future, continued standardization and inter-operability will be the key. Besides other partners within our own government, we are sharing ideas with our NATO allies through alliance medical committees.
As you know, some OSD oversight is already in place by law. USD for Policy, Personnel and Readiness or even Science and Technology, as examples, combined with deployment oversight by the Joint Chiefs or the Joint Staff, the CINCs and the services; we have a fairly comprehensive network established.
The establishment of the SADM represents an interim solution supplementing and complementing other efforts. You might say an extra set of eyes, if you will, to ensure that forced health protection is optimal.
Collaboration with appropriate elements within the Department of Defense, particularly the Joint Staff and combatant commands, the assistant secretary of defense for health affairs, DoD centers for deployment health, and the military and veterans health ordaining board would eliminate unnecessary duplication of effort and allow optimal use of resources to meet these needs. We see the outreach program with the superior veterans advocacy as the most critical function of a follow-on organization.
As our force health protection programs mature and lessons learned that impact force health are institutionalized in future deployment processes, the need for such an organization may be reduced or even eliminated. Formal periodic review of the charter to assess performance, cost and benefits and relevancy of mission and functions would facilitate appropriate resource allocation decision-making.
You can be confident that protecting the health of service members, their families and our veterans remain the highest priority.
I�d be glad to answer any questions.
SENATOR RUDMAN: We�ll go right down the panel; do it that way. Captain Mazzella?
CAPT MAZZELLA: Good morning, Senator Rudman, Secretary Brown, members of the panel, the Board.
HHS has just some brief remarks to make and then we�ll be glad to answer some questions. We had no organized testimony per se. But as an introduction, we�d like to restate our position is one of support for the principally involved Departments of Defense and Veterans Affairs.
Historically, HHS has provided subject matter experts to support the efforts of both the Departments of Defense and VA. For example, at one point the PAC had asked for -- the Presidential Advisory Commission had asked for members from the Agency for Toxic Substances and Disease Registry to participate in the Research Working Group and, of course, we participated in that.
Another example was mentioned to you this morning when the Department of Veterans Affairs had requested our CDC, Centers for Disease Control and Prevention, to provide them with epidemiological experts to help them with their ALS studies.
The Department expects to continue to provide this scientific expertise to its partners and we look forward to the continued collaboration with DoD and VA on these matters pertaining to military service members, veterans and their families.
And that�s all we have for right now.
SENATOR RUDMAN: All right. Thank you very much. Dr. Brown?
DR. BROWN: Thank you. Honorable Chairman, Vice Chairman and members of the Presidential Special Oversight Board, I�m honored by your invitation to appear before you today and tell you about some of Vans activities directed towards improving our understanding and treatment of Gulf War veterans illnesses. As you know, this is the third opportunity I�ve had to appear before this Board.
In your letter of invitation, you asked us four questions, all focusing on how the Department of Veterans Affairs coordinates with other federal agencies with our respective programs directed at military and veterans health. I�d like to be able to tell you today that all the federal agencies do a perfect job in seamlessly coordinating our activities relative to veterans health. You might be skeptical about such a claim.
Nevertheless, I can tell you that the events since the Gulf War in 1991 have led to a new spirit of interagency cooperation, which I believe is to the benefit of all American veterans. Moreover, now that we all see how to do it better, I think that the processes put into place from these efforts will continue to function for the foreseeable future.
Before I address your four specific questions about interagency coordination, I�d like to make some general comments about the broad range of the Department of Veteran Affairs programs that focus on Gulf War veterans health.
As you know, the Department of Veterans Affairs is the lead federal agency for fulfilling this nation�s responsibilities to American veterans. To meet this responsibility, the VA has an integrated program that offers high quality medical care services throughout the nation.
It offers appropriate disability compensation to veterans. It offers outreach and education programs directed at veterans and VA health care providers and it supports scientific research directed at basic and applied medical issues for veterans.
For example, more than 78,000 Gulf War veterans have received our Gulf War health registry examination. About 280,000 Gulf War veterans have been seen at VA outpatient clinics and more than 26,000 Gulf War veterans have received medical care as inpatients at VA health care facilities. I just want to make the point, we don�t need to wait for research to be able to treat veterans, of course.
As of January 15 of this year, the VA has processed approximately 159,000 claims filed by Gulf War veterans for service-connected illnesses, of which approximately 138,000 were granted.
As I have described at previous briefings before this Board, the VA was pleased to be able to implement Public Law 103-446, signed by the President on November 2, 1994, giving VA the authority to compensate any Gulf War veteran suffering from a chronic disability from an undiagnosed illness or combination of undiagnosed illnesses.
The Administration strongly endorsed this legislation and Secretary Jesse Brown had sent letters to all 535 members of Congress urging their support. Based on this law, as of January 2000, VA has granted service connection to about 3,000 Gulf War veterans with undiagnosed medical conditions.
VA also offers substantial outreach and educational activities for Gulf War veterans. For example, in early 1995, VA established the Gulf War Information Center Helpline or 1-800-PGW-VETS. By the beginning of this year, the VA hotline had received over 300,000 calls. This outreach program offers callers the opportunity to obtain information about medical care, about the Gulf War registry, about medical research involving exposure to environmental hazards and about disability compensation benefits that they may be entitled to. It�s available to veterans twenty-four hours a day, seven days a week.
VA also publishes a quarterly Gulf War newsletter on health and compensation issues of interest to veterans and their families with a circulation of about 400,000 copies nationally.
These are just a few examples of Vans initiatives directed at Gulf War veterans. VA takes these responsibilities for Gulf War veterans very seriously. In fact, taking care of veterans is our primary mission.
We also note that the Department of Defense has many similar initiates focusing on active duty and reservist Gulf War veterans service members. Many of these programs mirror some of the programs I�ve just described. We also appreciate that in order to offer the best quality services to American veterans often requires that VA effectively coordinate with other federal agencies, in particular Department of Defense and Department of Health and Human Services.
One example of interagency coordination that you may be familiar with is the effort that took place in May of 1999 in response to problems experienced by certain U.S. service members who had received a medical retirement following a diagnosis of ALS. Some of these service members reported difficulties gaining timely access to veterans benefits from the VA following separation from military service.
As you know, ALS is a very serious disease and given the rapid and debilitating effects of ALS, this was precisely the point of transition -- it was precisely the point when veterans and their families needed benefits the most. Discussions between members of the interagency compensation and pensions working group of the Persian Gulf Coordinating Board led to changes in Vans procedures in order to provide service members access to VA benefits in a timely manner and as appropriate to the care required by these individuals. In this example, coordination was key to quickly providing veterans access to the benefits that they deserved and needed.
I think one of the most outstanding examples recently in -- or the last half decade, since the Gulf War, of interagency coordination on Gulf War veterans health issues is the activities of the Coordinating Board�s Research Working Group. These activities were discussed quite fully by Dr. Feussner at the previous seating.
Dr. Feussner as the chair of this group described their activities in coordinating research, identifying knowledge gaps, and dissemination of research results. Over the last half decade, as Dr. Feussner mentioned, this group has coordinated a federal interagency research effort that today involves more than 145 distinct research projects at a cost of about $151 million.
There are many similar examples that one could point to where veterans and military personnel today receive better services as a result of interagency coordination in such areas as uniform clinical care and basic and applied research on military and veterans health.
My point here is -- in bringing up these examples is that I think each agency has certain clear-cut core responsibilities that are unique to that agency�s mission and the constituents that they must serve. But each agency also has other responsibilities that can be significantly enhanced through interagency coordination.
Over the last decade since the end of the Gulf War, a primary focus for such coordination in research, clinical care and other areas, has been the Persian Gulf Veterans Coordinating Board. As you�ve heard at previous meeting of this Committee, the President established the Persian Gulf Veterans Health Coordinating Board in January 1994 to provide direction and coordination within the Executive Branch of the federal government on health issues related to Gulf War veterans.
Recently the new Military and Veterans Health Coordinating Board was established, based, I believe, largely on the successful model and example established by the earlier coordinating board and their activities. Headed by the secretaries of DoD, HHS and VA, the coordinating board has provided and will undoubtedly continue to provide the institutional framework required for consistent and effective interagency coordination of these types of activities.
Now, I�ll turn to the four specific questions that you asked of us. Your first question was -- you asked how will the Department of Veteran Affairs coordinate Gulf War-related activities with the proposed OSAGWI follow-on organization.
As I mentioned, VA has many Gulf War-related initiatives that address the clinical research and outreach needs of Gulf War veterans. Many of these activities have required significant coordination with other federal agencies, in particular, the Department of Defense, including OSAGWI, and the Department of Health and Human Services. Persian Gulf Veterans Coordinating Board and its successor organization, the Military and Veterans Health Coordinating Board, has provided an invaluable forum for ongoing discussions between the various relevant agencies that participate in these activities.
No one is yet certain about the forum of an OSAGWI follow-on organization but regardless of the outcome of ongoing discussions, we expect that the Coordinating Board will continue its past missions in this area.
Your second question was does any overlap in function or responsibility exist between the OSAGWI follow-on organization and other agencies responsible for Gulf War health issues, to include the Department of Veteran Affairs? If so, what should be done to minimize redundancy?
And I think based on our experience dealing with Gulf War veterans health issues over the last decade, I do not see that there is unnecessary redundancy between the various programs that focus on Gulf War veterans health issues offered by the various federal agencies involved.
As you�ve heard, each agency conducts a broad range of programs that reflect our unique constituency and missions. I also believe that it may be misleading to try and identify or eliminate possible redundancies in efforts put forward by the various agencies involved. Again, each agency brings its own unique perspective, expertise, constituent base and a sense of mission to this problem.
The responsibilities for certain issues will clearly fall to a single agency. For example, when it comes to the analysis of after action reports of military activities during the Gulf War, DoD clearly has the lead. VA, on the other hand, has the lead, I think, on issues such as determining what medical treatments and compensation may be appropriate for Gulf War veterans.
Nevertheless, we fully acknowledge the value of interagency cooperation on many federal activities relating to Gulf War veterans health such as in setting our national military and veterans health research agenda and establishing other national policies that affect military and veterans health.
Your third question was what agency should be responsible, if any, for integrating past, current and future medical research to determine the causes of undiagnosed symptoms that are referred to as Gulf War illnesses.
Again, I think that to answer this question about which institution should coordinate Gulf War health issues in the future, we should begin by looking at who has carried out this mission in the past. I believe that the Research Working Group of the Coordinating Board has done an outstanding job in initiating new medical and scientific research and in integrating existing research that focuses on Gulf War illnesses. I think that it�s reasonable to expect that this group will continue to fulfill this mission into the foreseeable future.
And your fourth and last question was is there any value in conducting further town hall meetings on Gulf War issues. If so, what department or agency should sponsor these meetings?
I think each of the federal agencies that have taken an active role in addressing Gulf War veterans health has established its own outreach and educational initiatives that meet its own agenda. The Department of Defense has developed the town hall meeting format, which I understand they consider to be an effective outreach mechanism. In fact, VA has supported this activity by providing VA representatives at nearly all of the town hall meetings to be there to address veterans specific questions about VA benefits and the VA Gulf War veterans health examination registry.
We appreciate this forum as an opportunity for VA representative to speak to Gulf War veterans. VA has a number of outreach initiatives as well, including our hotline and Gulf War veterans newsletter that I mentioned earlier.
I think that my answer to this question is consistent with my earlier points and that is that ultimately the evaluation and review of the DoD town hall meeting as an outreach activity is an issue for DoD itself to determine.
In conclusion, as I mentioned at the beginning of my remarks, we all no recognize the value in coordinating federal activities on military and veterans health. I think that we have made enormous improvements in such coordination since the Gulf War, and I think that the coordinating board has played an important role as a forum for this coordination and I think that the Department of Veteran Affairs looks forward to continuing this collaboration with the coordinating board.
Thank you very much and I�d be happy to answer any questions.
SENATOR RUDMAN: Thank you, Dr. Brown. Dr. Claypool.
DR. CLAYPOOL: Senator Rudman, Secretary Brown, Admiral Steinman, Dr. Cam, CSM Moore, I am Bob Claypool. I am currently dual-headed as the executive director of both the Persian Gulf Veteran Coordinating Board and the Military and Veterans Health Coordinating Board. I will attempt to weave into my prepared testimony or statement answers to the questions that I was asked by the Board and there -- we had three questions which essentially mirror those of the Veterans Affairs office in terms of integrating research, providing Persian Gulf follow-up and for redundancy of application.
SENATOR RUDMAN: Before you get into your prepared statement, Dr. Claypool, you�re dual-hatted now. When will one of those organizations essentially evaporate so you�d only have to wear one hat?
DR. CLAYPOOL: Right.
SENATOR RUDMAN: When is that?
DR. CLAYPOOL: Yes, sir. Let me -- I do address that.
SENATOR RUDMAN: Will you talk about that?
DR. CLAYPOOL: Yes, sir.
SENATOR RUDMAN: All right. Thank you.
DR. CLAYPOOL: The Military and Veterans Health Coordinating Board, which is built upon the successful foundation of the Persian Gulf Veterans Coordinating Board as identified by Dr. Brown, is chartered and chaired by the secretaries of Veteran Affairs, Department of Defense, and Health and Human Services. It�s supported by a small full-time staff of me plus five other individuals, supplied by the three departments.
Furthermore, the charter identifies the top health official in each agency as the principal alternate member of the Board who provides frequent guidance to the director and staff through senior personnel who may have been designated as liaisons of the Board. These top health officials are, as you know, Dr. Tom Garthwaite, the deputy undersecretary of health for Veterans Affairs, Dr. Sue Bailey, assistant secretary of defense, Health Affairs, and Dr. David Satcher, assistant secretary of health for Health and Human Services.
Dr. Mark Brown from the Veterans Affairs, Dr. John Mazzuchi from Defense and Capt Peter Mazzella from Health and Human Services, who are here with me on this panel, are the personnel chosen by their health leaders as the liaison individuals with the Board.
As I mentioned, the Military and Veterans Health Coordinating Board is built upon the foundation of the Persian Gulf Board. It has the same board co-chairs, it is supported by the same full-time staff, but the Military and Veterans Health Coordinating Board has a broader mission, which focuses on the health of the men and women who serve in the U.S. Armed Forces and their families. It also encompasses their total careers beginning with recruitment into the military, throughout their entire length of service, be it active, reserve or guard, and continues through and into their life as a veteran.
Its coordinating effort is supported by three working groups, the deployment of health, health risk communication and research. We are currently in a proposal phase in which we are examining and coordinating with all stakeholders the prospect of continuing the work of the Persian Gulf Veterans Coordinating Board within the construct of the Military and Veterans Health Coordinating Board.
As I mentioned above, the chairs are the same. The offices are co-located and both boards are supported by the same staff. Today --
SENATOR RUDMAN: Well, really it�s the same group, isn�t it, with a different charter?
DR. CLAYPOOL: To that -- yes, sir.
SENATOR RUDMAN: I would think that whoever is doing all this ought to try to, you know, formally establish it as a subcommittee of or whatever, I mean, just to clear up the lines.
DR. CLAYPOOL: To that end, sir, that�s why we have -- that�s what we are in the process of proposing. We have met with veterans service organization, we have met with members of both the Armed Services and veterans committees on the Hill to broach this as a proposal and our follow-on plan is to go ahead and have more detailed discussions with the veteran service organizations to make sure that we capture their trust and confidence in making sure that nothing is dropped in the gap as we make this transition but that is our proposal.
SENATOR RUDMAN: Well, I think that the reason I ask that is as we write our final report, you know, I think we�re going to have a lot to say about the follow-on organization, what we�ve done over the last 18 months -- it seems like longer than that -- but I think we would like to have some comment about what you do because that will be a very important part of the follow-on.
So we would like you to keep us posted on what�s going on, particular with the Hill, to see whether or not people up there are in favor of what you want to -- I would think they would be. They tend to like to streamline organizations rather than duplicate.
DR. CLAYPOOL: The preliminary information that we�ve gotten back from these two groups that we�ve pinged, to use a Navy term, really has been favorable.
SENATOR RUDMAN: All right.
DR. CLAYPOOL: The real shoulder to the wheel work of the Military and Veterans Health Coordinating Board is accomplished by the three working groups I mentioned. The deployment health working group, as Admiral Mayo mentioned, is chaired by him and it focuses on force health protection and medical surveillance.
The charter of the MVHCB calls for the deployment health working group to provide recommendations to the Board to ensure that lessons learned from competent operations and other deployments and research findings are translated into effective preparation for future operations.
It will also take up issues from the Persian Gulf Veterans Coordinating Board with our work group and address coordination matters regarding disability and compensation. So the functionality of the Persian Gulf era in part will be accomplished by the deployment health working group.
The health risk communications working group provides recommendations and coordination for the health risk communication efforts of Department of Veterans Affairs, DoD and HHS for military members, veterans, deployed civilians and their families. It focuses on information before, during and after deployments. It also coordinates interagency activities to provide health care providers with up-to-date guidance on health effects from deployment and battlefield risks.
The third important work group -- and by the way, that health risk communication working group is chaired by Brigadier General Lester Martinez, who is also the commander of the Army�s -- United States Army Center for Health Promotion and Preventive Medicine up in Aberdeen.
The third work group, the military and veterans health Research Working Group is chaired by Dr. Jack Feussner who provided earlier testimony and I was unable to savor this. As was done in the past, the Persian Gulf Veterans Coordinating Board will continue to be responsible for integrating the past, current and future medical research for integrating and examining the cause and examining treatments with the undiagnosed symptoms referred to as Gulf War illnesses.
We�ve formed an executive steering committee that consists of the chairs of these working groups, of Admiral Mayo, Dr. Feussner, General Martinez and myself, to form a steering committee for the working groups to ensure, number one, that any kind of gaps are identified and can be plugged, number two, any duplication or redundancies identified can be addressed.
In this brief sketch, I�ve tried to capture the essence of the board as a true interagency effort, which is based upon three dynamic interactive collaborative work groups. Personnel from the follow-on organization will contribute their considerable expertise as DoD participants on all three of these work groups.
Within each of these agencies, the Military and Veterans Health Coordinating Board staff and the work groups have established and will continue to establish functional links to support specific work group goals. And so the board and the work groups also will work closely with the follow-on organization just as they have done, for example, within HHS, utilizing the CDC, within the Department Veterans Affairs, including research and development expertise, and also within DoD, for instance, as with the Center for Health Promotion and Preventive Medicine.
Just such an interactive collaborative process coordinated through the board is the best assurance to both identify the gaps in the work that is needed to be accomplished and to avoid unnecessary duplicative efforts.
I will provide you a copy of my text and that concludes my statement.
SENATOR RUDMAN: Thank you, Dr. Claypool. Dr. Mazzuchi?
DR. MAZZUCHI: I don�t have any prepared statement, but I would like to address the relationship between the follow-on organizations and Health Affairs, as we see it, as we discussed with Dr. Rostker during the coordination of that process. Just I think it might help clarify something for the Committee.
We have worked with OSAGWI very closely for the past four years and basically the way that we have divided up the labor is that Health Affairs is responsible, working with the director for defense research and engineering, to help plan and charter the research of the Department of Defense, to answer question about A, the Persian Gulf and now about deployment health, and we work very closely with the Research Working Group with Dr. Feussner. I�m a member of that group with Dr. Feussner.
We also work clinically to set up the CCEP, our comprehensive clinical evaluation program, very similar to the VA registry, and are working with the VA to develop a practice guideline for deployment health. And those matters will remain with Health Affairs.
The OSAGWI office and the follow-on organization primarily works with identifying what happened on the battlefield and doing outreach with military members and veterans groups. And it is through those outreach meetings that we have gotten both better understanding of the veterans� concerns and pressure from the veterans to do research in particular areas.
I think for instant, pyridostigmine bromide, the RAND report clearly said that we could not set that issue aside as settled as a non-cause and that�s why we have continuing research. I think there�s been both synergy and tremendous cooperation between the two offices and I think as the OSAGWI moves into its follow-on organization, I expect the pattern that we�ve already established for the Persian Gulf will be the same pattern we�ll follow for all other deployments, especially in terms of getting a clearer picture of what actually happened on the battlefield because that will have a tremendous influence on how we do both some of our clinical work as well to identify research needs and particularly research priorities.
SENATOR RUDMAN: Thank you. Let me start out with a question for Dr. Brown. I believe I understood you to say that there were about 155,000 or that number, approximately, of claims, and 138,000 had been granted.
DR. BROWN: Right.
SENATOR RUDMAN: Claims for treatment, claims for disability? I mean, what kind of claims? Both kinds?
DR. BROWN: Compensation benefits.
SENATOR RUDMAN: Compensation benefits.
DR. BROWN: Pensions. Right.
SENATOR RUDMAN: 138,000. How many people served in the Gulf War and what was the population of the Gulf War?
DR. BROWN: About approximately 700,000 individuals.
SENATOR RUDMAN: Right. So this percentage-wise would be what, 20 percent of that?
DR. BROWN: I think it�s slightly less than that. It is high. It�s -- I understand that it�s somewhat higher than veterans from other specific conflicts.
SENATOR RUDMAN: Well, that was my next question. I mean, that looks to be -- if your number is right of 138,000, there�s 700,000 people who served, that was the population; so 140,000 would be 20 percent. Say it�s 18 to 20 percent. Do you have any idea what the numbers were for Korea, for Vietnam, for World War II?
DR. BROWN: I think I do have that information. I could provide it for you; it was significantly lower.
SENATOR RUDMAN: Was it significantly lower?
DR. BROWN: Several percentage points lower. Obviously lower. You do see a difference.
SENATOR RUDMAN: That was a startling number to me; that was a huge number.
DR. BROWN: I can�t explain why it is that way. Perhaps it�s because we�re being more efficient and doing our job better and trying to contact more veterans, but I have no obvious explanation, except to just point to the data itself that we do compensate Gulf War veterans at a higher rate than veterans from previous conflicts.
SENATOR RUDMAN: Do you keep that data as to the unit that the individuals served in, regular forces versus reserve or guard forces?
DR. BROWN: We do have it. We do that.
SENATOR RUDMAN: Could you supply that to us also?
DR. BROWN: I could provide that; sure.
SENATOR RUDMAN: I�d like to know, and I think the Board would like to know, what percentage of the compensation grants went to people who were serving as regular forces vis-à-vis those who were called up as reserve or guard forces.
DR. BROWN: The information is broken out along a variety of axis and I�m sure that that�s one of them. It�s broken out by branch of service and versus type of duty and I�d be happy to --
SENATOR RUDMAN: This government loves to keep statistics. I would be totally shocked if it didn�t keep this one.
DR. BROWN: Well, I guess the other issue is the questions do come up so --
SENATOR RUDMAN: We�ve got platoons of -- divisions of people to keep statistics on, wings or whatever you want to call them.
Dr. Rostker, let me ask you a question. We understand the charter; I think we have a good handle on what�s going on. This has been very helpful this morning, but let me give you a kind of a hypothetical and tell me what�s going to happen.
Before I do that, let me just draw back. You�ve got a large organization over there supported by a large budget for consultants, that�s been going on for the last four years. When will that end?
DR. ROSTKER: We submitted to the Board and are working through a program to publish the reports that the Board has asked us to publish. That�s really the guiding -- the pacing event. We�ve created a minimum baseline organization on the assumption that there is no active deployment that requires an extraordinary effort, on the assumption that we would continue, for example, a deployment newsletter and a web page, but it would be on a much less frequently updated period. And that would be a core of around a dozen or so government employees and a number of contractors that would maintain the Administrative systems and the computer systems and provide some ability to monitor ongoing activities.
Our ability to transition into that organization will very much be determined by how fast we can complete the work we have promised you, your review of that work and our final publication of the material related to the Gulf War.
SENATOR RUDMAN: Is there a good chance that we�ll get that done this year?
DR. ROSTKER: We hope to get almost all of the Gulf War work done this year. That is our goal, and we make frequent reports to the Board as to how we�re doing. But my expectation is we will close out the various reports we�ve talked to you and bring the organization down.
There has been already natural attrition. The investigative directorate is about a quarter smaller than it was when we last met from natural attrition, and we�re not moving to replace those individuals. That has an impact on the amount of work that we will get done between now and September.
SENATOR RUDMAN: Now, the special Assistant for Deployment Matters; how large an organization would that person have? How many people would they have in that organization, right within their organization in normal time before any augmentation that might be necessary in case of a large deployment?
DR. ROSTKER: In terms of government employees --
SENATOR RUDMAN: Well, I�m going to try it both ways. First government employees.
DR. ROSTKER: Between 12 and 14.
SENATOR RUDMAN: And how about contractor employees?
DR. ROSTKER: We think the additional contractors would be around 20 to maintain public affairs, the investigative arms, lessons learned, computer systems. In this day and age you just don�t go out and plug in an electric typewriter, unfortunately. We�re all tied to computer networks.
SENATOR RUDMAN: Right.
DR. ROSTKER: And then an Administration section.
SENATOR RUDMAN: That will be a lot less than what we have --
DR. ROSTKER: It�s about --
SENATOR RUDMAN: It�s got to be maybe a fifth.
DR. ROSTKER: -- a quarter?
SENATOR RUDMAN: A quarter? I was going to say -- I said a fifth. A quarter. Because, you know, one of the things that we�ve been concerned about is that, you know -- we�re not being critical; we�re just concerned about it -- is that, you know, after ten years, we�re spending enormous sums, at least in my mind, enormous sums of money on consultants.
DR. ROSTKER: In my mind also.
SENATOR RUDMAN: And I was hoping we might be able to get that down and, you know, for obvious reasons. And let me get to my hypothetical question here because I want to see how things work, because everybody here has got legitimately a piece of the puzzle on action if not the puzzle on organization.
Let�s assume that in the next two or three years there�s a major deployment to some part of the world involving large numbers of U.S. ground forces, some air and naval. There is a conflict which lasts some weeks or months. It is settled. The troops are brought back. Some are discharged, reserve and guard units are then sent back with appreciation for what they did and sometime in the next year suddenly everybody starts getting sick and there are all kinds of problems that nobody ever thought about. Even though the special search and deployment was out there with the CINCs trying to get all the information, something was in the air over there; who knows?
Okay. Tell me what happens at that point. How -- I mean, because there are a lot of folks involved here. I�d like to get a -- kind of tell us what�s going to happen because, you know, you can read charters and you can listen to statements but I�m always the kind of guy who likes to know, you know, how does it work. Tell us how it works.
DR. ROSTKER: Let me first talk about coordination across the departments. Because of the Military and Veterans Coordinating Board, we will have uniquely an organization in which we can talk about this problem in real time, and I�m sure that board would facilitate the creation of a health registry that would be better coordinated than the last one, ensuring that the data flows even more perfectly than in the past between the Department of Defense and the Department of Veterans Affairs as people come out of service.
So I think that there would be a major issue there.
SENATOR RUDMAN: How about all the funding for all the research that people might want to do to find out -- where would that come from?
DR. ROSTKER: The funding --
SENATOR RUDMAN: Well, it all comes from the Congress, but which agency would it come to and who would execute it?
DR. ROSTKER: The funding has largely been, I believe, through the Department of Defense, with significant contributions by the Department of Veterans Affairs. But importantly, the vehicle for the allocation of those funds has been largely through the coordinating board and it would continue to be so.
SENATOR RUDMAN: Well, this is only my view but -- obviously we�ll hear from others on the panel but, you know, as you�re developing this and as you�re working on it, you know, when something happens, you know, you grab the life preservers and that�s what happened here. You go back four or five years and go -- people grab for what the instrumentalities were that were there and you made them work as best you could. They didn�t work too well at the beginning but they certainly, in my view, work very well as you get along.
As you look back on it, you know, if someone were to say to me where should the Congress put this block of money and decide how to best -- I would not say DoD. I would not say the VA. I would not say HHS. I would say give it to the NIH with specific earmarking for what you want them to find out. They�re an outfit with worldwide reputation. Why would you do that or would you do that? Or should we say something about that before we leave this whole subject this year?
DR. ROSTKER: I think that�s why HHS is on the Working Group, on the coordinating group, but I think you also cannot leave the various departments that have ongoing responsibilities -- you can�t leave them out of the process.
SENATOR RUDMAN: No, I didn�t suggest that; no.
DR. ROSTKER: Let me give you --
SENATOR RUDMAN: You have a role, but I�m talking about the major research it seems to me ought to come out of the -- that part of the government that does peer review medical research day in and day out.
DR. ROSTKER: I�m going to let my physician colleagues comment on that, but let me just highlight the role and the issues for the Department of Defense.
If you were to tell me that this hypothetical deployment was the last time we would ever be deployed --
SENATOR RUDMAN: Which we obviously couldn�t.
DR. ROSTKER: -- which we obviously couldn�t -- then if you could tell me that, then I could say well, then this is an issue for the Department of Veterans Affairs. But importantly, it is not the last time, and the critical aspect of deployment medicine, of what we would find in Gulf War or in a future deployment, is how does it react to what is the appropriate role for the department to learn those lessons and ensure that it addresses the policies, procedures, equipment that we have in the future.
And that�s why it is very important that the Department of Defense stay tied to and have an important impact on the kinds of research that is being done because we need to internalize those lessons back into the department. We are vitally interested, for example, in the whole issue of PB because PB is the only prophylactic that can be used against certain types of nerve agent.
So it�s not just an academic interest. It�s not just an interest in terms of those who may have been exposed at a point in time, but it�s an interest to ensure that we understand the effects of, in this particular case, PB, on our ongoing chemical doctrine and our ongoing chemical procedures.
Now, within the Department, given your hypothetical deployment, I would hope that we would be able to fully draw on the information that is going to be available because of improvements in our medical records information that will be available through improvements in the unit record keeping. But to the extent that that is not perfect, the unique capability demonstrated by OSAGWI over the last four years is its ability to reconstruct a "what happened on the battlefield." If the events repeat themselves, and we have veterans who are concerned that they may have been exposed, that is really the unique thing that OSAGWI brings to the table.
And I would point out to you, for example, that the Canadians have an unexplained illness situation. They�ve created a new board, they have gone to examine a incident that has occurred in Kosovo -- excuse me -- in Croatia where --
SENATOR RUDMAN: Yes. We want to hear about that.
DR. ROSTKER: -- where soldiers believe they may have been exposed to chemicals at an industrial site. That�s the kind of thing that the new organization would be in a unique position.
And then the last thing is to be able to deal with veterans service organizations and individual veterans to provide them the information uniquely from the Department. Now, we recognize the importance of the VA having outreach, but uniquely, the Department of Defense has to be held accountable or is accountable to its veterans and to its service members about what happened on the battlefield and that needs to be communicated. We take veterans concerns seriously and our obligations to provide answers to questions that veterans are asking.
SENATOR RUDMAN: I don�t think there�s any question, Dr. Rostker, that we hold the DoD accountable for that sort of thing. My point is that, where possible, research about what happened ought to be sponsored by other organizations, not to keep DoD out of it> I�m not suggesting that at the moment, but I think DoD has enormous responsibilities to find out a lot of things about that deployment but when it comes to the medical side of it, with all due respect to Health Affairs, I still believe that we�ve got places in this government which tend to be very good at that.
DR. ROSTKER: Largely that�s why we have the coordinating board representing the three departments.
SENATOR RUDMAN: And I hope -- and I�m going to call on you in a moment, Captain, but I just hope, speaking for this Board -- I know I speak for this Board -- that the mistakes that were made early on, on this are well learned and that the result of all of this is that, should we ever have to face this again, that there is truly a method to move forward that not only is more efficient but makes the veterans feel that people care about them and they�re looking out for them. That�s been one of the major problems.
CAPT MAZZELLA: Thank you, sir. Yes, NIH is probably one of the premier biomedical research facilities in the world. And as such, we�ve been supportive of the efforts of both the Department of Defense and Department of Veterans Affairs. We have a long, long history of working with both of the Departments. In fact, through all the federal government, we�ve kind of crafted ourselves as the science expert, if you will, the independent science expert.
And we believe that, you know, we will be assistive and supportive to both VA and DoD in their efforts but as such, they are the primary care givers to both veterans and to war fighters. Our department doesn�t have the kind of war fighting expertise that is so required when treating military people. I remember Dr. Claypool saying just a little bit ago that for sucking chest wounds you couldn�t find a better example.
Also, it�s true, too, with the unique experiences of war fighters and veterans and their families, our Department, while it does address all of the health needs of the American people, we do believe that war fighters and veterans are very -- experience specific things that the general public does not experience and that�s why there are departments, for instance, the Veterans Administration -- the Department of Veterans Affairs, rather and the Department of Defense, to address those issues.
And that�s why we�ve been supportive, just going back to the geriatric -- what�s the --
DR. BROWN: The GRECC.
CAPT MAZZELLA: The GRECC; yes. We�re involved with the GRECC, we�re involved -- we�re supportive and collaborate with the VA in much of their intensive research when folks come to us. In fact, when the Oversight Board came to us we supplied you with a specialist as well. And that�s how we perceive our role; as supportive. We�ll help you with the empirical science and then allow the department that do have those tasks and responsibilities to kind of take them over. And in this way, really, our effectiveness is enhanced because what we�re doing is we�re providing the empirical data as opposed to controlling the research.
SENATOR RUDMAN: Captain, I don�t disagree with a word you said but let me come back to where I�m coming from. There are lists here of research grants that have been given out and I�m sure they�ve been given out on all the right bases. I know they have been because that�s the way the VA and DoD have operated.
Having said that, we had a major health problem in this country, whether it be from a military deployment or some other place, if somebody asked me where would I have the most confidence that a group of people in one organization would know where the best expertise is in the world to address that problem and to find the people to do that research, I would say NIH. And that�s not based on, you know, some rumor. That�s based on the long experience I�ve had with NIH and a position of appropriating funds for NIH.
CAPT MAZZELLA: I understand, sir.
SENATOR RUDMAN: So I repeat that I�m not saying VA or DoD ought not to, but I would think that as this Board goes out of existence, and this goes into the future, and these other institutions stay in place, that people keep in mind that we do have a resource that if you have to peer review $250 million worth of money to find out the answer to a question, there is a place in this country that has a track record of doing it better than anybody else. And I just want to stand on that statement today and I hope it�s heard.
CAPT MAZZELLA: I understand that, sir. There�s no disagreement.
DR. BROWN: I would just make two points. First of all, as someone who has followed the activities of the Research Working Group now for some years, I think you need to give them a little more credit. I think that the difficulty actually that they face in trying to identify the right research and the right researchers has been in trying to get the academic community, the research community, to take these issues on.
As Captain Mazzella pointed out, many of these research issues are really quite unique to health effects that involve military and veteran population. So the difficulty has been getting the best qualified people to respond to that, and I think that they�ve done an outstanding job in identifying those individuals.
And I suspect that if you had gone -- we could go back in time and have the NIH take care of that, that you would have come up with essentially the same research topics and the same researchers.
And the second point I would make is that you asked me how would we -- I think it�s a really good question; how would we do it better if we -- you know, the next conflict, how would -- you know, we talk about the lessons learned, we talk about how we�ve learned from our mistakes in the past and as somebody who I believe is innately optimistic, I like to think that we can, we can learn as individuals, we can learn as a government.
And I think a lot of time and effort, as I�m sure you know, has been spent in examining what went wrong, what we could have done better in thinking about the Gulf War from the periods of recruitment of an individual service member to the training of that service member to what happens to them on the battlefield and the whole program now aimed at force health protection to what happens to that individual when they�re discharged and eventually enter the VA health care system.
The types of mistakes, I guess, that we did then and how we can do better, a lot of attention has been paid to that and I think that we�re trying to make a very conscious effort of trying to rectify those mistakes in anticipating the next conflict and trying to avoid some of the pitfalls that we fell into.
SENATOR RUDMAN: All right. Do you any questions of the panel at all? Admiral or --
SECRETARY BROWN: I do.
SENATOR RUDMAN: All right.
SECRETARY BROWN: Dr. Rostker, you had mentioned a couple times in your proposed organization the importance of communicating directly with the VSOs and the veterans community; outreach effort. Can you describe, at least from your vision at this point, how that would look once this proposed organization has been implemented?
DR. ROSTKER: Well, we�ve had probably five means of interacting with veterans. First a very active 800 phone number where veterans -- individual veterans can call in. And what particularly we pride ourselves on is that we provide continuity of contact so that a veteran is assigned a veterans contact manager, just a word we invented, so that they�re not going from person to person and that we�re able to provide them information and in a few cases we�re able to actually facilitate their contacts with the government. And we say the government because we have referred to other agencies where appropriate.
We maintain, if you will, an award-winning web site where a great deal of information is made available about Gulf War issues and we would see that being extended to deployment and deployment-related matters. We follow that up with a newsletter for those who might not have a web page and we see doing that on somewhat of a scale back basis.
We are responsive to all service organizations to provide speakers and to provide displays at conventions and other gatherings and that would -- we�ve already started to move, over the last year-and-a-half, from just being -- talking about the Gulf to talking about force deployment issues because we think that is the broader context.
And then finally the town hall meetings. I think with the smaller organization we absolutely cannot do the kind of town hall meetings we have done in the past, and I share the chairman�s concern. Every month we do an outreach program, and I -- it reinvigorated by the town hall meetings. I think the last two were just perfect examples.
First of all, the town hall meetings are not just town hall meetings. They are a week of presentations to active duty troops and troop leadership groups in a given area, culminated by a town hall meeting that is open to the public.
The last two, one was at San Antonio and the other was at Norfolk, Norfolk just being a week ago. The San Antonio meeting was really a throwback to earlier town hall meetings in the sense that I heard rumor and innuendo and concerns that frankly I hadn�t heard for two years.
But what was different was I was able to say to people who were concerned that they may have been gassed at a given location that we had taken their concern seriously, that we had published extensively on it and give us at least the opportunity to see -- for them to see what we have done and why we drew different conclusions. And I think that was very effective.
This last town hall meeting at Norfolk was completely the opposite. It was concerned people who had concerns about what happened in the Gulf, questions about in generic terms, their own health, for example. A staff sergeant in the Marine Corps Reserves worried about whether it was safe to have children, and we were able to give some comfort in talking about the research that had gone one.
Now, is that cost-effective? I don�t know but I felt good about being able to talk to one veteran and helping him over a personal crisis built around his wife�s pregnancy. We�re going to cut back because of the resources and the number of people that we�re able to get to, but we want to be able to preserve that opportunity to deal with veterans, veterans groups and being responsive.
Town hall is as much a symbol of the Department�s willingness to come out from behind the Potomac and meet any group, any place in the United States and talk about what we do, than is the event itself. And the press we get from that event is much greater than the people who actually come out to the meetings.
American people are very skeptical of their government today, and they�re very skeptical of the fact that people they see are hiding, as I said, behind the Potomac. We�re very proud of the fact that we will go out, meet with organizations, talk about what we�re doing. That won�t change even if we cut back on the town hall meetings.
SECRETARY BROWN: I don�t disagree very much with anything that you said, but I would encourage you as you cut back on the infrastructure of the whole organization that you increase the communication and the relationships with the veterans organizations.
DR. ROSTKER: Yes, sir.
SECRETARY BROWN: I think that�s very, very important. It�s absolutely key to any successful endeavor here and I would encourage that. I want to say that for the record.
I also want to say for the record I do agree with Capt Mazzella and Dr. Brown with respect to that the VA should maintain some control over the research efforts. And I kind of look at it maybe a little bit differently in the sense that I recognize that, to a large degree, health care and research in this country is an economic decision.
And too often -- and by that I mean if there are not enough people sick in one area then there are questions being asked whether or not we should invest in that particular type of research. We shouldn�t be asking those questions when it comes down to the health of our service people who did what we asked them to do and they may be sick as a result of it, so we should not hesitate to go ahead and do what is necessary.
And I think those decisions probably can be best handled by the DoD and the VA and of course with the support, because we get a lot of money from NIH to help us in our research, so we want to continue that.
Dr. Brown, I�m a little confused on some of your numbers here. You talked about 159,000 claims that were filed by veterans Gulf service-connected. So what you�re basically saying here -- first of all, is there anyone from VBA here?
DR. BROWN: I�m from VHA.
SECRETARY BROWN: Yeah, but I�m talking about VBA. You got these numbers from VBA, right?
DR. BROWN: That�s correct.
SECRETARY BROWN: Well, I would ask just for the record that you go back and submit for the record the resource data on these numbers.
Secondly, when we talk about Persian Gulf and we talk about service connection for Persian Gulf veterans, this number here I think is misleading in the sense that you have 159,000 of them, 138,000 were granted. Well, those grants were for many different things. I�m talking about for the gunshot wounds. I think there were a number of them that were wounded there. For those who for whatever reason incurred diseases or injuries, to include on -- while on annual leave or whatever. That�s what we�re talking about here. We�re talking about service connecting for diabetes, heart disease, all types of things.
SENATOR RUDMAN: Isn�t that true -- I thought that�s true for all wars.
SECRETARY BROWN: Yes, it�s --
SENATOR RUDMAN: That�s my understanding and, you know, I commanded a rifle company once and I got a lot of friends of mine who got service connection in Korea. They were on a motorcycle on duty, and they got hurt. So that�s true; the statistics would be kept the same for all wars, wouldn�t they?
DR. BROWN: Well, Secretary Brown --
SECRETARY BROWN: Well, let --
SENATOR RUDMAN: If they�re not, I�d sure like to know about it.
SECRETARY BROWN: Well, I think as a general -- if I had to just answer you yes or no, the answer would be yes. But let me tell you the difference here. The difference between World War II and Korea is that during World War II and Korea, the primary emphasis were on traumatic-type injuries; I�m talking about people that received gunshot wounds and that type of stuff.
Subsequent to Korea, to include Vietnam, the emphasis kind of changed a little bit. Certainly we had many of us who were wounded but also that was an enlightenment that took place throughout the country, primarily through the inferences of the veterans organizations that in fact educated the servicemen.
The average claim, if you look back historically for a World War II and a Korean War veteran, was probably three issues. They�d say, I want service connection for my gunshot wound, I maybe want service connection for a nervous condition, combat fatigue. That was the kind of -- that was kind of it.
During Vietnam, you had an explosion of knowledge about VA benefits and so you had these folks, particularly the veterans organizations and I�m happy I was one of them, when I opened up a claim, I�m looking at everything, to include the lives of the guys, our cholesterol was high, I want to know whether or not that was an indication of heart disease; I�m looking at all the X-rays to see if they were calcifications on the abdominal aorta, and I filed for all of that. So all of a sudden the claims went from three to eleven. And so that�s what�s happening. That�s continuing to increase because of this here massive amount of information. So that�s why you see these numbers here.
DR. BROWN: I suspect that that�s correct and I would just add to that that I would be happy to provide you with a list of the types of claims that come through. And I think your point is well taken. The injuries tend to be a wide variety of muscle and bone injuries that you might associate with a population like this, an active population. The top service-connected conditions tend to -- you know, the first one on the list is knee injury.
SENATOR RUDMAN: Well, I think what the vice chairman is saying is that the compensation within the VA for service-connected injuries, and let�s say Vietnam and the Gulf War, are probably much higher than they were pro rata in World War II and Korea. Having said that, there are a lot of people who do get service-connected as opposed to combat-incurred. I�d just like to know the most accurate statistics there are available on those four conflicts just for our information to look at. I don�t think you could draw any conclusions.
I think the Secretary is very correct, from my own observations, that the VSOs have been far more aggressive in pursuing claims post-Vietnam than they were probably post-World War II and post-Korea. That�s a decision they made and obviously it�s worked, but I would like the numbers, please.
DR. BROWN: We�d be happy to provide those.
SECRETARY BROWN: Dr. Brown, also you mentioned here -- we talk about Public Law 103-446. You mentioned, based on this, and this has to do with undiagnosed medical conditions, there were 3,000 claims granted.
DR. BROWN: That�s correct.
SECRETARY BROWN: That�s out of how many filed?
DR. BROWN: I think the number is about 11,000, but I could get you that as well.
SECRETARY BROWN: So 11,000 filed and 3,000 were granted. You think that�s --
DR. BROWN: Those are the approximate numbers; yes.
SECRETARY BROWN: Okay. Now, let�s go down here to the bad part. I�m not picking on you, but I know more about what you had to say than anything about anyone else.
DR. BROWN: Well, I enjoy the chance to talk to you, certainly.
SECRETARY BROWN: Here you talk about -- and I�d like for you to just describe to me the process that you are able to accelerate for a catastrophically disabled veteran or a veteran that has a condition that has been diagnosed fatal, such as ALS.
DR. BROWN: Right.
SECRETARY BROWN: Tell me how -- describe how he gets through or she gets through the process faster than the veteran who was just let�s say shot.
DR. ROSTKER: Well, the veteran who is shot I think would have -- would be presumably in an ER facility but the issue here --
SECRETARY BROWN: Say that again?
DR. ROSTKER: A veteran who is -- oh; you mean a veteran -- after separation and they were injured in such a way. I see.
Well, the story with -- this particular story that I used to illustrate coordination between DoD and VA started with the observation, the complaint that veterans -- there aren�t very many Gulf War veterans who contracted ALS, who�ve been diagnosed as ALS but nevertheless it�s some number. And the condition is very serious. It�s at least a fairly rapid and untreatable and irreversible injury, motor muscle -- loss of motor muscle control, as I�m sure you know.
And the concern was that there�s inevitably, because we�re slightly bureaucratic, there�s an inevitable delay if somebody -- an individual separates from the Department of Defense and ceases to be active duty where they would have access to all the medical care that an active duty service member has and they become a veteran, there�s an inevitable transition time, a delay.
And so that effort was -- and the problems with these particular individuals, they can�t afford a delay in medical care; their care is immediate. They need it today.
That program was developed to try and deal -- to try and direct that transition time to try and put it ideally to zero so that somebody transitioning would not lose any -- they�d be able to go from their -- from a VA -- from DoD medical care and the next day they could report to their Department of Veteran Affairs Medical Center and get care for their problems.
SECRETARY BROWN: Yeah, but I want you to describe it. I mean, I�m very familiar with it, but I want you to describe -- okay. A fellow is diagnosed with ALS and he or she goes through the physical evaluation board and they�re probably military retired. Now, at that point, a claim for VA benefits has to be filed, 526.
DR. BROWN: Right.
SECRETARY BROWN: And once that is filed, they get the medical records, they adjudicate the claim, service connection is established and as a result of that, the veteran is entitled to compensation, educational benefits, hospitalization and so forth.
Now, that�s the normal process. Now, tell me what you do or what you are talking about that shortens that process that will allow this veteran to get pay and to get medical care close to his date of discharge.
SENATOR RUDMAN: Before you answer, can I ask a question?
DR. BROWN: Yes.
SECRETARY BROWN: Yes.
SENATOR RUDMAN: If somebody gets ALS and they happen to be in the service, are they automatically entitled to be service-connected?
SECRETARY BROWN: Yes.
DR. BROWN: Yes.
SENATOR RUDMAN: Automatically.
SECRETARY BROWN: Yes.
SENATOR RUDMAN: If you get ALS.
SECRETARY BROWN: Yes.
SENATOR RUDMAN: You mean, if you served in the Armed Forces -- I served in the Armed -- if I get ALS next week, then it�s automatically deemed service-connected?
SECRETARY BROWN: No, no, no.
SENATOR RUDMAN: That�s my question.
SECRETARY BROWN: You have to be in the service. You�re not in the service now.
SENATOR RUDMAN: Right. That�s what I thought.
SENATOR RUDMAN: Jesse, I was trying to follow your question. You�re talking about people in the service, sure. But I mean, if someone was in the service and now they�re out of the service --
SECRETARY BROWN: Oh, no.
SENATOR RUDMAN: You�re talking about veterans, you know, and I didn�t understand your presentation. I�m glad it�s been straightened out. Essentially someone who has been out of the service for 15 or 20 years and gets ALS --
SECRETARY BROWN: No.
SENATOR RUDMAN: Well, of course, if they�re a service member, if there�s available space, they�re entitled to medical treatment.
DR. BROWN: Sure. And I�m talking about that transition, that difficulty in transition.
SENATOR RUDMAN: All right. Thank you very much because you weren�t too clear about that and I was starting to wonder if I had understood everybody.
DR. BROWN: I appreciate your interruption --
SENATOR RUDMAN: Thank you. All right.
DR. BROWN: -- because I think -- I have to level with you. I don�t know what the answer of the specific details of how that�s handled. I�d be happy to find out exactly what is done. I assume what we�re talking about here is basically a paperwork exercise to figure out -- to produce a mechanism so that that new veteran with those immediate medical needs is taken care of, that there�s no loss of benefits, no loss of access to medical care. But I have to apologize. The exact details on how that�s handled I�m not familiar with. I�d be happy to
SECRETARY BROWN: The point that I want to make, and then I�ll want to hear from Dr. Rostker, is this. When you find out, what you ought to tell them to do is to establish that as an institutional policy so all veterans will be able to get their benefits as quickly as possible after their discharge.
DR. BROWN: Well, we do have a transition assistance program and a disabled transition assistance program, which we are --
SECRETARY BROWN: As you know, Doctor, that�s totally different. The transition assistance program is primarily while the veteran is still in the military. They kind of talk him and walk him through the process. I�m talking about when the guy gets out, he files his claim for severed connection, and he doesn�t get paid until six months or a year later. And what you just described to us is that you want to make sure he gets paid maybe within weeks after he gets out, simply because of the gravity of his condition. Is that correct?
DR. BROWN: That�s correct.
SECRETARY BROWN: Okay. And so I would like to know how you were able to shorten that process which distinguishes fatally disabled -- or fatally disabled people from just a normal veteran who maybe --
DR. BROWN: Your point is why don�t we offer it to all veterans, and I don�t know.
SENATOR RUDMAN: You�ll supply it for the record.
SECRETARY BROWN: Dr. Rostker wanted to --
DR. ROSTKER: I think I can help you a little --
SENATOR RUDMAN: And then I want to move on and let Admiral Steinman -- see if we can stay on our schedule, more or less.
DR. ROSTKER: I think I can help you a little bit with ALS because my office was intimately involved in the discussions about ALS as we�ve been responding to concerns from several families that had ALS.
Unfortunately, the internal DoD process did not categorize ALS as a permanent disability. It was in normal parlance a temporary disability, and it hassled the families to go back and have to reassert the fact that this was no improvement in the serviceman�s condition.
This is the normal way a person is processed out. He may be ill, he may have certain symptoms; they do declare it as a temporary disability. He�s separated, he has to come back and show that he has in fact not progressed in his treatment.
What we�ve done is, under the diagnosis of ALS, it is considered immediately permanent, that there is no chance of recovery, and we take the burden off the family from having to come back a second time and reassert. It�s an insult to the family, given the diagnosis of ALS, and so we brought our Administrative procedures in line with the reality of what we know about ALS.
SECRETARY BROWN: Okay; see, Doctor, that�s in the military. What you just have described is that you no longer put them on the TDRL, you put them on the PDRL.
DR. ROSTKER: That�s right.
SECRETARY BROWN: But that�s different from what Dr. Brown is talking about.
DR. ROSTKER: It was part of the whole process of working with VA to facilitate the transfer. From the family�s point of view, it became a more direct permanent transfer to the VA.
DR. BROWN: The exercise was to create a seamless transition.
SECRETARY BROWN: Okay. I don�t agree with that. I mean, I don�t agree with the logic here. We must go on, but let me make one statement. The logic doesn�t follow. If a -- if we�re talking about an ALS case, you�re right. Normally they would probably put the guy on the TDRL and with the expectation within five years he has to come back, and they will then put him on the PDRL but even though he�ll be dead in three years, probably.
So what you have said, we�re going to put him on the PDRL right now.
DR. ROSTKER: That�s right.
SECRETARY BROWN: You�re finished with him at that point. Once you put him on the PDRL, he is -- you discharge him and then you send him to the VA and the Vans responsibility, say okay, fill out this here 526 and then from that we�re going to get you compensation, we�re going to get you medical care and the education benefits.
DR. BROWN: Yes, sir.
SECRETARY BROWN: Now, tell me how what you did shortened the time --
DR. ROSTKER: I didn�t say it shortened the time. It moved the hassle and complaints that the family members had. They were insulted by the fact that we were putting them on the temporary list, they were concerned about the fact that they�d have to come back and rejustify as if the service member might somehow improve or that their benefits would be questioned because they weren�t on the permanent list, and what we try to do is hear from -- respond to the service member�s family and provide them with a bit of expedited comfort by recognizing, given the diagnosis of ALS, that they were not going to get better and to treat them accordingly.
SENATOR RUDMAN: Thank you. Admiral, do you have any questions at all for the panel?
RADM STEINMAN: Yes, sir. I�ve got three, hopefully brief.
SENATOR RUDMAN: And we�d like to keep the answers brief, unless you can�t.
RADM STEINMAN: Regarding the proposed focus of the OSAGWI on the health and fitness of deployed forces, if approved, it seems to me there�ll be three governmental entities dealing with health issues; Health Affairs, MVHCB and the SADM. How are the issues of health for the forces going to be parsed out between those three entities?
DR. ROSTKER: From my point of view, first of all, the special assistant works directly for the secretary of defense and is a form of oversight. It is not to take away from the statutory, in-line responsibility for the number of organizations, but it is the eyes and ears of the secretary just as the IG is a form of eyes and ears of the secretary and hopefully will be another vote at the council to press for these issues.
The uniqueness of OSAGWI has proven to be the case narratives and our ability to inform the community as best we can what happened on the battlefield, and I think that will continue to be the unique contribution that we will make.
From the Defense Department�s point of view, the additional contribution is in the risk communication area, the communication area of Secretary Brown. If we would have the deployment that the Chairman talked about and a veteran or a veterans organization wanted to contact the Department, who does he call, the Joint Staff? The Joint Staff is engaged in today�s military operation.
They need to have -- know that there�s somebody there at the highest levels of the department that they can call and can work through the bureaucracy to get them answers, and that�s the role that I would perceive that we have played and we would continue to play in the future.
DR. CLAYPOOL: The Board�s responsibility on that would be to coordinate the efforts between the various agencies, specifically DoD and what you�re talking about obviously has significant impact on the Veterans Affairs organization as well, so that the Board would ensure that that ability to provide that oversight is coordinated so that there is a seamless addressing of that issue. In that respect, we would coordinate, advise, those kinds of words.
RADMIRAL MAYO: I see the Board also doing -- it goes back to the question that Secretary Brown asked of Dr. Brown, having to do with -- you know, from the point of let�s say transfer of an individual to the VA.
This Board can help cut through a lot of that red tape and establish the procedures, what the mechanisms are, so that the DoD discharge criteria medically corresponds to the VA so it can be an automatic. That gets into our effective handoff of people when they retire or get out of the military and are now at the ready. So this group can help facilitate that even more than it has in the past.
SECRETARY BROWN: Mr. Chairman, for those of you who don�t know it, Dr. Brown and I are brothers.
SENATOR RUDMAN: I figured, Jesse.
RADM STEINMAN: An unrelated question. In our discussions with VSOs and individual veterans, there seems to be great concern about Gulf War-specific issues being diluted in any follow-on organization. Will the follow-on organization have an identifiable entity so that the public and the veterans can say this is the people who are still looking at the Gulf War issues?
DR. ROSTKER: Well, the whole organization will continue to look at the Gulf. I think the ultimate respect to the veterans is that, as I said in my testimony, the ultimate lesson learned from the Gulf War is that we need to do this for their brethren in the future.
How silly if we were to say well, we�re only interested in the Gulf War and then close it down and not learn that lesson. So we have a passion to continue the Gulf War, but we have to expand that horizon to today�s soldiers and tomorrow�s deployment.
RADM STEINMAN: Does someone on the panel want to comment on it?
DR. CLAYPOOL: Well, as I indicated, at least from the standpoint of the Board�s standpoint, I totally agree with you. That�s a concern that we have, that we make sure that the Gulf War veterans issues are addressed. Thus far, talking to VSOs on one occasion and talking to members of Congress, there hasn�t been a great deal of concern about the ability of the Board not to be able to provide that.
Within the construct of the MVHCB, the Research Working Group will continue to carry the banner for the Gulf War issues and some of the specific issues will be tracked as Persian Gulf veteran issues.
SENATOR RUDMAN: Anything else?
RADM STEINMAN: No, sir.
SENATOR RUDMAN: Is that it?
RADM STEINMAN: Yes, sir.
SENATOR RUDMAN: Dr. Cam.
DR. CAM: Yes. I want to thank Dr. Rostker and the panelists for having put together the draft on the follow-on organization. I believe there is a need for one, and I want it to be very strong and effective. For that reason, I have three questions for Dr. Rostker.
You have mentioned in the past OSAGWI is not responsible for health matters but in this follow-on organization, it�s very heavily driven by health issues. Do you think of -- and some of these functions I see Health Affairs are doing it with the deployment health service center. Are you thinking of removing some of those functions from Health Affairs and putting it into the new organization?
DR. ROSTKER: No, and the applicable word here is it pertains to the health of the force. For example, we are very interested in the whole issue of equipment and false alarms and chemical doctrine because it pertains to the health of the force.
I�m not very interested in whether the 82nd Airborne Division should go before the 4th Infantry Division in the deployment schedule because that doesn�t relate to the health of the force, and my brother here on the Joint Staff would take great exception if I showed much interest in that.
So we settled on the term as it relates to the health of the force to remind us that we�re interested in the individuals but there is no compromise over the full range of issues that we could address. And everything that you have seen us comment on in the last four years is fair game for the new organization.
DR. CAM: My second question is can you tell me more about your risk communication program? Has it been effective? Please give us some very specific examples dealing with risk communication because I feel your office could be a little more aggressive in this area.
DR. ROSTKER: Well, I�d be very interested in talking to you. On the technical side, we have -- and we�re proud of it -- won now twice, government awards for the quality of our web site. I think we�ve been very aggressive in our -- in the town hall meetings and in our servicing and being available for individual veterans but I�d -- I�m always open to suggestions on how we can improve our risk communication.
DR CAM: My third question is you have mentioned in your proposal that the follow-on organization would ensure the development and implementation of force health issues and so forth.
It really conveys the idea of enforcement. How would this be accomplished? Because what I�m concerned is that we would have another organization -- another OSAGWI with a different title, and I feel at this point there�s really a need for you to refocus and really sharpen the mission and have an organization that is very proactive in dealing with deployment issue and also it should have the ability to respond to crises very quickly. And so my point is, you know, I want to see -- I mean, do you feel that the follow-on organization will have what it takes to integrate all the lessons learned and --
DR. ROSTKER: That�s why -- yes. And I believe it will. We want to follow the model of OSAGWI which has allowed us to expand much more quickly than we might have if we didn�t use contractors but at the same time have the key functions manned by government. So I think we can expand very quickly.
Let me just say that allocating scarce resources in the Defense Department is more of an art than a science, and it�s done through personal contacts and cajoling. It�s done by working with the senior leadership, the undersecretaries, the deputy secretary and ultimately the secretary. And the fact that this organization would continue to have unfettered access to that level is important.
We have, I think, made some progress, for example, in depleted uranium training, reinforced no more than three weeks ago by a letter from Secretary Hamre to the service secretaries pointedly reinforcing the lessons of this office and saying I endorse what Dr. Rostker has written you, and I want you to carry it forth. That�s the kind of collegial interactions that I believe make progress.
And the alternative is to give us a budget and then we will not have the ability to interact with -- if we try to do it ourselves it really will be duplicative and our best progress is working with the services and the Joint Staff and changing the way others in the Defense Department do.
DR. CAM: Can I have a question for Dr. --
SENATOR RUDMAN: Yeah. If you could keep it short, Dr. Cam, we�re running a little late.
DR. CAM: I understand that DoD has done an agency-wide assessment of the granting process for DoD research. Do you have the findings?
DR. MAZZUCHI: No, that would be -- we�d have to get that for you. That would be from the defense research and engineering. We actually do not have responsibility for research. Our responsibility comes in the form of co-chairing the Armed Services Biomedical Research Evaluation and Management Committee but the research itself is conducted under the auspices of the director for research and engineering.
I�ll see what I can get from them for you.
DR. CAM: Yeah. I want to take this opportunity to express the importance of building an in-house research capability. I agree that NIH is the first name that pops in your mind when it comes to excellence of research but in terms of research for DoD and the VA and the HHS, I feel that it�s -- you need to have -- those agencies have such specialized mission that it�s very important for those agencies to build its own in-house capability.
I mean, if I had a magic wand with Congress I would definitely give more money for DoD and the VA to dedicate for training for research scientists because those people already working there; they�re familiar with the mission, they�re committed to the mission. And it�s such a specialized research, it would be very difficult to ask anybody else to do that type.
I could relate to what you mentioned, the difficulty in finding people just interested in that kind of research. So I feel really bad that DoD has been battered about the poor quality of research. It probably depends -- you just don�t have the credential and the right resources to do what is asked of you and the outsourcing -- I feel there is over reliance on outsourcing.
So my point is there is a need to invest -- a long-term investment. If that had been done 10 years or 15 years ago, you know, we wouldn�t be in that position now. But it should be something to focus on the ability of training the in-house specialists. I�m not talking about a big group but just a small cadre of scientists who would --
DR. BROWN: I would argue that the Department and the Veterans Affairs, some of the research that we do really is on the cutting edge. I think --
DR. CAM: No, I didn�t mean to put down what that means; yeah.
DR. BROWN: -- so if you look at, say, research on prosthetics, research on geriatrics, I think we do the best medical research available.
DR. CAM: But that combines the specialized mission of the VA as well. That�s what I meant to say.
And another point that I wanted to address is there is a need really to get input from the VSO community in terms of research need. I�m not talking about them sitting at the table and dealing with the details of the protocol, but it�s important to get the concept, what needs to be done in research needs because that would give like a guidance for DoD and the VA to plan long-term research.
SENATOR RUDMAN: Well, I want to thank all of you. It�s been instructive. Obviously we�re going to continue to be in touch with you on all of these issues before our final report to the President and the Secretary is issued, and we hope to help you in getting through the remaining things that we�re talking about so perhaps we can in fact have it lined up and have a transition started.
During this meeting this morning I was handed a note which I�m delighted to announce that Admiral Paul Busick has now been officially appointed and is now officially a member of this Board.
SENATOR RUDMAN: And I want to talk a little bit -- I�m not going to applaud the Admiral because the Admiral asked me to do this on behalf of the President, and I unfortunately could not resist his entreaties. But seriously, he has been a key member of the Administration.
When he retired from the Coast Guard he worked for the National Security Council, handled a multitude of interagency matters, worked on this matter for a long time, was instrumental in putting together the idea of how to deal with this and with this Board and helped constitute the Board.
And so when we had the sad passing of Admiral Zumwalt, I recommended to the White House that I couldn�t think of anybody more qualified to help us finish than Admiral Busick. He is now a member, will sit with us this afternoon.
Welcome to you. I understand you�re now in North Carolina as president and executive director of the state�s global transport authority. Well, we�ll give you something a little less global to deal with, and you can sit with us for the rest of the year. So Admiral, we�re delighted to have you join us officially.
Thank you all. We�ll reconvene at about 1:30.
SENATOR RUDMAN: I�d like to ask the people in the back of the room either to cease conversation or come in and be seated or go down to the second floor, whatever you�d like.
We�re delighted to welcome Mr. Jeff Whitehead who represents the Canadian Armed Forces. He�s going to talk about health problems in the Canadian forces in Croatia.
Mr. Whitehead, thank you for coming before our panel.
MR. WHITEHEAD: Thank you.
Could I have the first slide?
First of all, what I�m going to tell you about is basically what happened in Croatia. We had a board of inquiry which just finished in January of this year, and basically we had some soldiers that came back from Croatia, from their U.N. tour back in �93 to �95, complaining of some illnesses and we had a board of inquiry which looked into this and I was the medical advisor to that group.
I�d like to point -- to start out by saying that I�m not an expert on the Gulf War by any means, okay? I�ve been with the Department of National Defense for less than a year. But I was asked to be the medical advisor because of the fact that I have military experience as a medical officer, also because I�m a civilian, and finally because I have training in public health, epidemiology and environmental health.
Could I have the next slide, please?
So what I�m going to go through over the next 20 minutes is basically a background on Croatia, what happened there, the origins of the health concerns, the establishment and the conduct of the board of inquiry, the natures of the illness, the findings and conclusions, and finally the recommendations.
Just to give a little background, because if you�re like me, you probably can�t keep track of all the Balkan conflicts. The Republic of Croatia declared independence of June of �91. The fighting started almost immediately between what became the Croatian military and ethnic Serbs, backed by the Yugoslav Army, and then finally the UN was able to achieve a cease-fire in January of �92, and that was followed by the establishment of a full peacekeeping force which became known as the United Nations Protection Force or UNPROFOR.
There were 16 countries involved initially, and Canada provided an infantry battalion, a combat engineer regiment, and the RCMP--the Royal Canadian Mounted Police--also went to help out the police in terms of training and weapons confiscation.
This was known as Operation Harmony. The Canadian units were initially in Sector West and then in July of '93 they moved down to Sector South, which was an area which was a little more militarily active. But I would say in general it was quite an active deployment.
There was a lack of trust between the Croats and the Serbs and also with the UN. Both sides felt that -- in fact that the UN was taking sides with the others and such that the Canadians were often on the receiving end of direct and indirect fire.
That probably peaked during the Medak pocket operation, which was a Croatian offensive in September of '93 in which they captured three Serb villages and then, after a cease-fire was declared, they pulled back but in the process, of course, burned down the villages and murdered any Serb civilians who hadn�t already fled.
So I think the message I�m trying to get to here was that this was not peacekeeping as in Cyprus, you know, which many people compared to -- they said it was much like a holiday going to Cyprus for many of these rotations. This was pretty much warlike conditions.
As you may know, the whole UN thing in Croatia came to an end in �95 when the Croatian government decided to not extend the mandate and I�d say built up their military at that time, and then they were able to push the Serbs out later that year, and then the UN was withdrawn. So really the period of time we�re looking at is from �93 to �95 is when the Canadians were in Sector South.
Next slide, please.
So when did the health problems show up? Well, the first indication was not till April of �98 when the CO of Roto 2, which was involved in the Medak pocket, had a number of people that served under him came to him and said, well, you know, they had health problems and they had gone to Veterans Affairs Canada. In fact, they had been released from the military and Veterans Affairs Canada was saying that this was not related to their time in Croatia.
And the concern centered around red soil and PCBs. Those were the only environmental concerns. This is quite different from the Gulf, okay? And the red soil was some soil which was located near an aluminum oxide plant, and some people felt was bauxite. And this was used to fill a lot of sand bags, and they did do a lot of sand bag filling because they were shelled.
RADM STEINMAN: When you say concerns, whose concerns were they, the veterans concerns or the commanders?
MR. WHITEHEAD: Yes, it was the people that were there.
RADM STEINMAN: The veterans concerns. Okay.
MR. WHITEHEAD: Yes; exactly.
And so they had filled a lot of sand bags with this red soil, and they were also concerned about PCBs because next to this aluminum oxide plant was some transformers which had been destroyed in the fighting, and they were leaking an oily substance into the ground.
So in fact, soil tests were done in �94 and �95 and they -- well, I shouldn�t say soil -- soil samples were taken, and they were loaded onto a UN helicopter which went off to Zagreb and never heard from again, and no one could find out what happened to these. And so one of the medical officers which was serving with the infantry battalion finally got very frustrated and had a note put on all the medical charts saying these people have been exposed to PCBs and bauxite.
Now, what happened later on is that someone decided well, that wasn�t quite accurate and had those taken off the charts and that created quite an uproar because by now this was in the press. And so in fact another board of inquiry was set up, quite separate from this one, to look at the sequence of events after that. And then to top it off, which is the bottom line, at least one Croatian veteran claims there was a plan to poison some of the senior leadership within one of the infantry battalions, and so then there was a criminal investigation set up. So it was quite complicated.
Next slide please.
So I think it was the end of July, beginning of August of 1999, they set up this board of inquiry which was -- and the terms of reference are stated up there and I�ll just read the note -- to investigate whether Canadian forces members serving the Canadian contingent United Nations Protection Force and assigned to the area of operations commonly referred to as sector south during the period �93 to �95 were exposed to environmental contaminants in quantities sufficient enough to pose a health hazard during the course of their duties.
And then they went on to other -- the terms of reference went on quite a bit but again, referring only to this area with the red soil and PCBs. On the next slide you�ll see that the -- they did, though, leave this very broad opening for the Board and said in addition, the BOI may make findings and recommendations on any other relevant matter arising from its inquiry.
And in fact, this Board spent a lot of its time in this area as it churned that the environmental concerns were not -- they weren�t finding any smoking gun.
Next slide, please.
I just want to -- just a few brief words on who was on the board. It had six members and four of those six had PCB experience. Colonel Joe Sharpe, the president, was actually an Air Force navigator with no PCB experience, so he really came in with no preconceived ideas, but he had done a lot of boards of inquiry, and he was a very good communicator.
We had some people representing the reserves because some of these rotations, 30 percent were reserve members. See Mike Spellen there, second from the bottom, was the company sergeant major of Delta Company in Roto 2, and so he was in the thick of it, and I think he was very helpful to the board and, as with any cluster investigation, I think it�s important that you involve the community, as you know.
So he was on the phone many times to people to get them -- you know, people become quite cynical about things like this and he would talk them into coming in and testifying before the board, and I think he was a very valuable member of that board.
Inspector Reg Bonvie is a member of the RCMP, and he sort of gave a link to the criminal investigations.
Now, how did the process work? Well, the testimony was taken in Ottawa from over 90 witnesses, and I�d have to say it was emotionally draining to hear what these people had suffered and also in terms of how they had been treated by the Department, both DND and Veterans Affairs.
But the board also traveled quite widely because they wanted to contact all -- get in contact with as many regular force members and reserve force members, and so they went across the country both to explain the process and in fact also to discuss the recommendations, which they discussed with everyone before they even sent them up the chain of command.
They did plan to visit Croatia, but the Croatian government turned them down, although earlier in the summer they had allowed a new group to go in just to cut soil samples.
Now we come to the point about how did we collect the data on the health problems, and there they ran into problems right from the beginning. One suggestion was why don�t we just examine everyone who went to Croatia and see what we come up with. And it became very clear, many people said well, no we�re not -- you know, you�re not going to find anything because there were concerns about medical confidentiality and there were concerns that it would affect their career.
And so we said, okay, let�s try a more informal process and see, you know, if we -- at least we can get an idea of what�s going on and we can take it from there and decide from there if we�re going to do a more sophisticated study.
And so what they did is they asked people to voluntarily call into what we call the center for retired mem -- no -- for injured members and retired members and their families, which we call The Center, for short, obviously, which is a DND/Veterans Affairs creation, which is -- actually cuts red tape for people that have been injured in duty and it�s run by a social worker.
So what people did they called in this number, and they were asked if they would like to give their name to the BOI and if they did, a staff member from the BOI would give them a call and then take down on a form what their symptoms were, what illnesses they have had and also what exposures they felt they had. And that�s the way the system worked. Not perfect, but it was a very difficult time in terms of -- there was a lot of -- I�d have to say a loss of faith in senior leadership within the Canadian forces at that time.
We�ll go on to the next slide, please, and we�ll look at the symptoms. And here you can see, these are the symptoms that were recorded by that method and this is from 203 Croatia veterans. I should mention there were about 9,000 Canadians served in Croatia; about four percent called up with their problems. Many of these didn�t have health problems, but of the ones that had health problems, you�ll see these are what they had.
And you can see that -- I think the thing that is quite striking about that is out of 203 people, these people are having multiple symptoms, and these people are suffering quite a bit. It�s not just one or two symptoms each; obviously they have quite a few.
And if we go on to the next slide, please, we�ll look at what diagnoses were actually -- they talked about. The little plus at the bottom is to remind myself that there were two rare conditions as well. There was the eosinifilica phaseatis and a ragdomiolysis.
But all of these, there was really only one case of each, some there were two, but none of the rare conditions were there two, much less than what some people would say if you�re going to do a cluster investigation into chronic disease you should have five of at least something, you know, if it�s not a rapid increase or if it�s not a really rare disease. So it was not suspicious that we were looking at a worrisome picture at this point.
What the board found more confusing, though, is that people were -- a lot of people who came forward had these symptoms and yet were nowhere near the red soil. And what�s more is we even had people calling up and saying, look, I wasn�t on that deployment but I�ve got those symptoms. I wasn�t even in Croatia; I was somewhere else.
And so it was quite confusing to the board around mid-October when they were starting to see these and they weren�t sure what was happening. And then a number of toxicologists and occupational health specialists said well, look, PCBs and bauxite aren�t exactly known for their human health effects. They don�t usually cause this sort of thing, that�s for sure. And so it was quite a confusing picture but it became clearer as they got further into the testimony right through into November.
Next slide, please.
Let�s talk about the findings because -- and this is what came up in the testimony. So first of all the soil samples, this -- these were the ones that were done in August of 99. They were taken from 45 sites; 10 sites were inaccessible to mines that Croatians couldn�t even get into them at that point. And as you can see, they�re analyzed for a number of things.
The only things which were elevated were in the bauxite. The red soil was definitely bauxite, and there were six inorganic compounds were elevated in the bauxite compared to what you would find in usual soil, you know, one of them being aluminum obviously.
So they did hire an environmental consulting firm with expertise in soil toxicology, and they did not -- and they also did some modeling, see if they felt these people were exposed enough, if they were filling sand bags for six days a week all day, and they found no evidence of potential health risk.
And I should mention that the police investigation that was going on at this time found the original results from the soil samples from �94 and �95 in Zagreb, and they were also -- they agreed with these results so there had been no change over that period of time.
Can I have the next slide, please?
Another finding -- if the red soil wasn�t common to everyone, one thing that was common to everyone was the stress on this rotation; and I�d like to just talk briefly about this, the high frequency of deployment.
The rule in the Canadian force is that you have to have 12 months between deployment. The fact is that many of these people, they have to go on three-month pre-deployment training away from home when they get back, and they�ve also got career courses so many of these people were spending hardly any time at home. Marriages were falling apart and so on, so this was very difficult for them.
The exposure to atrocities in combat and I�m sure you -- I guess you would expect that in wall but the way it was called up was somewhat inadequate, it was felt, in that for example the Medak pocket operation happened two weeks before Roto 2 was finished, and so these people who were being shelled and shot at and then were loading dead bodies on the backs of trucks, they were sent back to Canada, and the reserve members, within two or three days, were sent back to their own units. So you could have someone in small town Saskatchewan two weeks after being through some of this awful stuff, and there�s really no follow-up with these people at all, you know, as to how they were coping.
The lack of defensive storage. Well, the UN supply system just couldn�t provide things like sand bags and lumber when they were being shelled. It was just -- you know, some of the stories were just hopeless.
I won�t go into the rest but let�s just say it was a very stressful deployment.
Next slide, please.
Another finding was that DND and Veterans Affairs Canada did not have a well-coordinated system for care and treatment of sick and injured soldiers. There were gaps in the social safety net in terms of their long-term disability insurance as well as the pension benefits, and these are the people that were going in the press because they were falling through the cracks.
In the Canadian forces there is an appalling lack of knowledge about mental illness, but I don�t think that�s any worse than, let�s say, the Canadian population in general. But I think what is worse is the next thing, and that�s the harmful attitudes towards mental illness and we found that at all levels. Commanders could -- they could understand that someone with a broken leg couldn�t do the job, but they couldn�t understand that someone with depression or post-traumatic stress disorder also could not do the job.
Another important finding is this one. The symptoms described by Croatian veterans are not unique to that operation. And we had a historian from the Royal Military College in Kingston come in, Dr. Allan English, who went back to the 1700s right up through the American Civil War to the present and pointed out that you often see people with multiple unexplained symptoms after any combat and that we in fact should have expected this to happen.
Dr. Charles Engel, from Walter Reed, I believe has spoken here. He talked about his experience with patients with medically undiagnosed physical symptoms, and Dr. Tim Cook from the Canadian forces spoke on foundational somatic syndromes and how he felt many of the people he saw had this and that they were -- and that their symptoms were quite similar to what�s seen in civilian practices for a number of other entities.
Next slide, another finding.
Now, I think someone has spoken to you previously about the Goss-Gilroy study of Gulf War veterans we had done in 1997. In a control group -- that included Croatian veterans in a control group. And in fact, the subgroup analysis showed no difference in the number of somatic complaints compared to other deployments and that was in 1997, two years after they had returned.
But I should note that the rate of somatic complaints in our control group was higher than the general Canadian population, which you would not expect to see because generally you have a so-called healthy worker effect in which you�ve got a screened population. They should feel healthier than the average Canadian. In fact, these people were feeling worse at that time, and that�s the general Canadian force population.
Another presentation discussed, well, what if we did a study -- and they point out that a study of symptoms currently would be problematic given the rise from extensive media coverage, and I think everyone is well aware of that because that�s happened in the Gulf War case.
Next slide, please?
I�m going to go very quickly through these conclusions because they follow very directly from the findings, and I�ll just read them out because they�re virtually verbatim.
There�s no scientific proof that the soil in Croatia contained contaminants in sufficient quantities to cause serious health hazards to CF members. The board was unable to rule out environmental contaminants entirely as a possible cause of at least some of the symptoms. And this latter point really is the fact that we couldn�t really rule out transient water or air contamination; it was five years after the fact. What can you do at that point? But I should point out that that Area Sector South was not a highly industrialized area of Croatia; very rural.
Next slide, please
Many veterans suffered from a range of symptoms that resulted directly from their service in Croatia. It is highly probable that at least some of these symptoms result from the very high level of chronic stress experienced during the operation and treatment can be provided to alleviate many of the symptoms of illness provided with the proper acknowledgment of the relationship between the service and the symptom, which was something that Veterans Affairs Canada was having trouble with.
The system in place to care for those suffering from stress-related injury was and is insufficient. Progress has been made in raising awareness about the health affects associated with service in high intensity operations and continued vigilance is necessary to ensure proper care is provided.
And in fact, we have set up some operational trauma and stress support centers which are sort of based on the community method of mental health, clinic model, which are co-located with our post-deployment centers to actually address this problem.
The next slide?
Department of National Defense and Veterans Affairs Canada are both responsible and accountable on behalf of all Canadians for providing proper care for injured soldiers and adequate support to all military personnel.
This conclusion is really pointing to the fact that there was too much finger-pointing going on between DND and BAC. And this may be a problem in the States, too. I don�t know. But the real problem here was people were falling through the cracks, and we weren�t looking after them and, you know, let�s start working together. And that is starting to occur in Canada.
This leads us to the final conclusion. DND can reduce the frequency and severity of casualties by decreasing the impact of a number of stressors. Scientific study is needed to determine the frequency to which individuals can be deployed and unnecessary stressors, such as unavailability of clean water, absence of advanced surgical care and inadequate equipment, must be countered.
And those are, again -- there were many stressors. In fact, when I -- when -- at the time that I joined the board I said well, what is our exposure here and they gave me a list of 22 stressors, basically, and that�s what we were looking at.
Next slide, please, for the recommendations. And I�ll go very quickly through these.
There were 33 recommendations. I�ve shortened them down, but their focus can be summarized as follows. Improved care of the injured, increase awareness of the limitations of the social safety net. We actually hoped to improve the social safety net, but we realized we could not do that within the time frames given to the board. Improve environmental monitoring on deployments much like the U.S. forces have already done.
Second slide, please; next slide.
Improve predeployment and post-deployment medical assessments to include risk factors and signs of stress-induced illness. Conduct ongoing periodic health surveys of CF members and create electronic health record. That�s so that we can follow these people over time and make sure that nothing more serious does develop and also we would like to pick these things up early in the future. And then correct unnecessary stressors such as supply surges, inadequate staffing of operations.
I want to comment a little on studies, and this is what you�ll be looking at. And the board did recommend studies looking at means of decreasing operational stress. I�d like to point out, though, that they did not recommend further study with respect to examining a link between environmental exposure and illness based on the totality of the evidence.
And if you can go the next slide, please.
And that -- I summarize that -- and this is more my perception of -- because -- just from listening to the discussions, I was not a member of the board but I think it was on this basis. First of all, the spatial temporal cluster lacked a clear boundary both in terms of the exposure and in terms of the outcome and it became very difficult to decide where you draw the line.
The centers were not in keeping with bauxite and PCB toxicity, and the soil exposure was negative as well. And this board was given a very definite mandate in terms of looking at those two environment risk factors. It was not to go looking for other ones elsewhere, and nothing had been raised either.
There was a clear environmental exposure stress. Did we have to look any further? We knew that -- it�s well known that stress can cause many of these symptoms. There was the historical evidence presented by the historian. There was also the known limited utility of investigations after the wide media exposure.
And the last one -- the next slide, please?
So what�s in the future? Well, the final report was presented in January of 2000, and the feedback both I would say from within the military and from the general public has been very positive towards this report, and I think it was mainly because it was very critical of how both departments had acted towards these people. They had -- these people have suffered a lot and they are being treated very poorly. In fact, Colonel Sharpe said they had been humiliated.
A monitoring office is being established to ensure compliance with the recommendations and implementation is well underway at this time.
And that�s my presentation; I�ll answer any questions.
SENATOR RUDMAN: Thank you very much, Dr. Whitehead. We appreciate it. Striking similarities with totally different circumstances, and I think that�s one of the reasons we wanted the testimony to us today and for others to hear.
Any questions from the panel at all?
RADM STEINMAN: I have some. These findings were similar to the Goss-Gilroy study, were they not, with Gulf War illness and Gulf War veterans?
MR. WHITEHEAD: Yeah -- well, yeah, although of course Goss-Gilroy was a very comprehensive study, and here we didn�t do a detailed study but definitely the symptoms were similar. I guess we felt it was quite striking that the control group was fine at that time in �97, which included Croatia veterans and which was interesting. So we feel that probably some of the illnesses has been created by the exposure in the media; that�s one thing.
But we also have a problem. The Canadian Force is -- the fact that we have more complaints among the regular Canadian Forces population so we�ve got a problem and the question is that due to illness? You know, is it due to physical illness or is it due to mental illness? We�re not sure; we don�t know at this point and that�s something we have to work on.
RADM STEINMAN: The -- what type of -- just going down some risk factors that would be parallel between Croatia and the Gulf War. What kind of immunizations were given to the troops before they deployed?
MR. WHITEHEAD: Nothing additional.
RADM STEINMAN: No immunizations.
MR. WHITEHEAD: No.
RADM STEINMAN: No PB, obviously.
MR. WHITEHEAD: No.
RADM STEINMAN: No exposure to chemical or biological agents over there that you know of?
MR. WHITEHEAD: No, no.
RADM STEINMAN: No depleted uranium, obviously, oil or fires. So how about infectious diseases? Were there any unusual infectious diseases the troops were exposed to or screened for?
MR. WHITEHEAD: No. Well, not that we�re aware of.
RADM STEINMAN: Okay.
MR. WHITEHEAD: It was a very -- the climate there was one side of the mountains was freezing and the other side was quite warm, so it was not all that atypical from Canada.
RADM STEINMAN: So you had a response of 203 symptomatic veterans out of 9,000 deployed. How many asymptomatic veterans responded?
MR. WHITEHEAD: Roughly four percent called in and so I think --
RADM STEINMAN: So that�s 369.
MR. WHITEHEAD: -- yeah. And some of these people had not been called back at the time I pulled these figures together so there are at least 50 -- 50 people called in who were feeling quite well and were just worried about what was going on.
RADM STEINMAN: So the symptom complexes you show were from the 203 --
MR. WHITEHEAD: That�s right.
RADM STEINMAN: -- symptomatic representatives.
MR. WHITEHEAD: That�s right. Yes.
RADM STEINMAN: Thank you.
SECRETARY BROWN: When you conducted your survey -- you talked about the people called in -- did you confirm -- have within your survey structure a criteria that you confirmed that they actually had the complaints and there were no real physical or pathological justifications for those complaints?
MR. WHITEHEAD: No, no. That was one of the understandings that we would not be pulling their records. However, people were encouraged to see their medical officer to discuss their problems and if they weren�t satisfied with that, then they were referred to one of the post-deployment clinics where they could be seen by an internal medicine specialist.
SECRETARY BROWN: So what you have here -- I�m just trying to understand -- you have drawn conclusions based purely upon what was told to you.
MR. WHITEHEAD: Exactly.
SECRETARY BROWN: Thank you.
SENATOR RUDMAN: Dr. Cam?
DR. CAM: Yes. What lesson learned from the Gulf War have you used in applying to the Croatia experience?
MR. WHITEHEAD: Lesson learned? On a conscious basis? Well, I think one was probably in that -- you know, understanding the -- probably one thing -- one reason why we did not launch into a long study, there were a number of reasons, you know, because one of -- that was suggested; why don�t we do another sort of Goss-Gilroy-type study and I think we realized that cluster investigations in situations like this rarely will find any answers.
And in fact, we looked at the research -- if you look back to -- I often refer to Ken Rothmans presentation to the cluster busters conference back in the late �80s in which he discussed the limitations of cluster investigations, and that�s published in the American Journal in 1990.
And I think we learned from that and when you read a lot of the Gulf War studies, they often say at the end, you know, we have to stop doing these retrospective studies because there is so much bias because people -- you actually get people thinking about these illnesses and then you may actually -- you�re getting recall bias.
And so perhaps that�s one thing that we learned, we kept that in the back of our minds as we were seeing these cases come forward. I can�t say that consciously I�ve thought well, what have we learned.
SENATOR RUDMAN: I want to thank you very much for coming before us.
I�d call on the Veterans Service Organization panel number one from the American Legion, AMVETS, National Vietnam and Gulf War Veterans Coalition. I believe that will be Lisa Spahr, David Woodbury and Denise Nichols.
MR GAYTAN: I apologize, sir. Our executive director, Mr. Woodbury, couldn�t make it today.
SENATOR RUDMAN: All right; well, that�s fine, too. You�re certainly welcome here.
MR GAYTAN: Thank you.
SENATOR RUDMAN: Well, I think we�ll ask you to -- if you have statements, and I have some of them here you have given me, you want to either read them in total if they�re not too long or summarize, whatever you�d like to do. We�ll start with you, Ms. Nichols. If you�ll all identify yourselves for the record and who you represent.
MS. NICHOLS: Okay. I�m Denise Nichols with the National Vietnam and Gulf War Veterans Coalition, and I did serve in the Gulf War as a nurse so I have some vested interest to find answers for myself and others. I think I�ll stick to my reading, and then there�s a couple of things that came up this morning that I have to talk to vets that are here that would like to bring up.
SENATOR RUDMAN: All right. Fine.
MS. NICHOLS: The Gulf War veterans that are here today and those that I�ve talked to in preparing testimony are disturbed that DoD continues to disregard the truth. The foundation of national security is protecting the health of all citizens. We swore to defend our country against all enemies, foreign and domestic. We are dismayed that ten years has passed without the full truth, responsibility and accountability and holding to these same foundations in relationship to Gulf War veterans.
It has been verified that chemical biological logs were deliberately destroyed, and that�s by GAO and Seymour Hersh documentation. Fox vehicle chemical detection tapes were confiscated in theater, never to be seen again, and that soldiers were exposed to oil fires, chemicals, DU during the war and would warrant medical care. This was in theater by your ARCENT team that was there, preventative med.
The documentation of all these instance and more were made by theater medical staff and many of these staff members have attempted over the years to communicate this to the PAC, OSAGWI, IOM and Congress, but OSAGWI and other agencies seem to arrogantly continue to delay, deny and outright disregard the truth.
When will the truth be told, and will those individuals that knowingly obscure the truth be held accountable for their willingful and known violation of U.S. laws, military orders and written directives? We feel until this occurs that nothing of value, such as adequate medical diagnosing and treatment and compensation will be obtained. We ask how this can continue to occur, that actual documentation that was done in theater has not been evaluated and why those key team members have not been brought forward to testify and be part of this process.
Our first demand is that the synergistic relationship of multiple vaccinations and medications given prior to and during deployment and while in theater be evaluated along with those environmental hazards the troops encountered for untoward effect on the immunological and neurological system.
And I�m very specific of how that should be done of reviewing, and one of the things that has not been mentioned is the troops, a great number of them, were given oral polio vaccine and those are made up of live viruses that may have had an effect that hasn�t been evaluated. And then you combine that with the other vaccines and environmental exposures. We feel that should be done by independent non-governmental commission, and I name specific in my written testimony of who should do that, and I feel this needs to be done immediately.
Second, that the Army preventative med team from ARCENT during the war take over the investigation or provide an oversight to what has already been done and this investigation should be led by retired Major General Don Edwards who served with us in theater and then served as the staff member up on the Hill on Congress.
Third, we recommend that an independent judiciary committee be appointed to investigate individual accountability for abandoning the ill veterans.
Fourth, our laws, regulations and directives must be immediately implemented and enforced and sadly, we do not feel that that is occurring. Fifth, government grants and funds be made available immediately for independent researcher and doctors. Name just a couple would be Dr. Urnovitz--Howard Urnovitz, Dr. Bill Baumschweiger --
SENATOR RUDMAN: Let me just interrupt you right there. You certainly are not by that statement indicating that the government hasn�t already put out millions of dollars to independent research.
MS. NICHOLS: I have reviewed the list--I got it from Kelly--that you were provided this morning. There are doctors and independent physicians and researchers that I have been communicating with, Dr. Vinh Cam, as I find them, that are interested and have been testing handfuls of vets and are finding things.
SENATOR RUDMAN: Oh, I understand that. No, that wasn�t my question. My question is you would agree there has been a lot of research done already.
MS. NICHOLS: I would agree that there has been a lot of research done already.
SENATOR RUDMAN: But what you don�t -- you�re not happy with is that certain people that you think should get these grants haven�t got these grants.
MS. NICHOLS: That�s true, sir.
SENATOR RUDMAN: And I understand that. A lot of people are unhappy with who gets grants, not only here, but in lots of places.
MS. NICHOLS: Well, there�s also one that dates back quite a while in Dr. Boone, William Boone, North Carolina, that was asked by Senator Rockefeller�s staff to take a look at the burning semen problem. He looked, he found things. It was a very small sample size, but there is something there that has not been followed up on and it could be a key --
SENATOR RUDMAN: Let�s go ahead. I think the problem -- I would just tell you here the problem is no matter how much money, my experience is, you allocate, whether it be in a veterans field or any other field for research, when you give it out, there are always people unhappy and people happy. The people that are unhappy are the people that didn�t get the money. The people who are happy are the people who did get the money, and I don�t know how we solve that problem.
MS. NICHOLS: Well, I --
SENATOR RUDMAN: I mean, we certainly can�t let some unqualified panel decide who�s going to get the money. We�re unqualified to make that decision. That�s made by peer groups of very good people who have no axe to grind except to find the truth. So I want to point out to you on your point number five, it�s my belief that we�ve done a lot of that already. Have we done enough? I can�t answer that question. But why don�t you go right ahead? I just did want to pick you up with that point.
DR. CAM: Just --
SENATOR RUDMAN: No, I would like for her to continue -- well, go ahead, Dr. Cam.
DR. CAM: No, because that point relevant -- one of the doctors you mentioned, Dr. Vojdani, did get the grant from the VA. Were you aware of that?
MS. NICHOLS: Yes. And that was one I brought to you. But there are --
SENATOR RUDMAN: But we don�t influence those grants. I want you to make sure that you understand that.
MS. NICHOLS: I understand that.
SENATOR RUDMAN: We don�t influence those grants.
MS. NICHOLS: I understand there is a separate process.
SENATOR RUDMAN: Okay; so long as you knew.
MS. NICHOLS: And I�m not talking about a great number here. I would say there�s maybe five to ten that I have found that need to be followed up and, maybe I should say, followed up from having been refused before to see what can be done and if there is legitimate concerns.
SENATOR RUDMAN: Okay.
MS. NICHOLS: Now, sixth, that was the follow-on to that is independent funds be made available for testing and treatment. Now, this goes to a problem that one of the vets here today wanted me to be sure and cover with you all is that the toxic cycling testing and treatment that�s being done -- we want to complement that that�s being done.
But when vets are sick and they request that testing and are denied it at their local VA because they�re not part of that project but they are very ill, like one of our vets here has had a liver transplant. He requested that testing and was turned down. The same thing with the neurological testing and the spec scans.
These are documented ill people that are seeking care and seeking answers and when they ask how do I get about getting this testing, they are turned down. So that�s why I�m saying independent funding of that.
Seventh, an independent non-governmental medical commission to be established and I�m very specific who should be picked out to do this, but I�m utilizing people that served in theater with us that are also affected, and to provide a review on the medical. And what I�m saying here, and I think I mentioned it this morning with some of the staff of the Board, is that there is no oversight onto the medical. We�ve had oversight on OSAGWI but there�s not oversight with the problems that we�re having with VA with the medical research. It�s a separate --
SENATOR RUDMAN: There is oversight, ma'am. It�s called the United States Congress.
MS. NICHOLS: Well, that�s true, and we keep going back to them but --
SENATOR RUDMAN: You got a problem -- you got a problem, I could guarantee you that this will -- your number seven will never happen. This government is not going to establish independent doctors to oversee government doctors but if you�ve got a problem with government doctors at the VA or any other place, there are a lot of people on the Hill would like to hear your story and that�s where you ought to go.
MS. NICHOLS: Well, that we do. We�ve lost a lot of Gulf War vets, and I turned over one of the names of a early death to ALS to the person that testified to you earlier today, and we find those that have not received compensation and these are deaths. So there needs to be some follow-up with the veterans that have died already that have not received death benefits or compensation.
The other thing is there is no follow-up being done on the deaths by autopsy report of these veterans to see if there�s clues there that could be obtained and maybe it�s a missing clue that we need. Tenth, we still have veterans that are within the system for claims compensation problems that have been dragged out. Like to have an action hotline to that so that we get that resolved.
Okay. We�re all here to take care of the vets, get them taken care of. So I feel that the system has responded a lot but we still have problems out there. We�re still finding people -- and I�m diverting a little bit here -- but we�re still finding people that are getting out of the service that know nothing about the CCEP program, of the evaluations, the phase one, two and three. We�re still finding vets that are ill that do not know about the registry.
So there�s newsletters going out, there�s a web site but they still don�t have answers and I�d like to give an example of the town hall meeting down in Colorado Springs. There was quite a bit of publicity. The public affairs person there did a lot of work. I mean, the word was out in Denver and throughout the state, which was different from other OSAGWI town hall meetings. We had roughly 250 people that showed up at that base theater.
The difference was the publicity was out there. We had someone that was directed concerned at the base that did a good job and brought the people in and there was a lot of questions, a lot of frustrations, because they�re not being cared for. And some of them were still active duty and some were out and veterans. So there is still a problem. It�s not resolved.
The other thing is that we have big concerns because we do have the people in the active duty that have received the vaccinations that are coming out, the mandatory anthrax vaccination. That needs to be looked at. Why are those people getting sick? And they are. Is there a combination -- is there something we�re missing, like the polio vaccine? Did they receive that? Was there effect there?
The other thing is a lot of decisions are made based on economics and a lot of policy decisions that are made that still need to be evaluated at the higher levels. And the other two items is that we continue to use depleted uranium. They are already reporting sickness in the Italian forces that were used in Kosovo. They�ve already had some deaths.
And I think that as a leader of the free world, that we need to look at that depleted uranium and provide at least medical care recommendations to those other citizens living in the environmentally impacted areas because if we don�t do that and we -- and ignore this problem, we continue to have health problems developing just like we used DU in Saudi, we used it over in Kosovo. There�s no reports of health -- illness over there and the only factor I can see over there is the depleted uranium usage.
And the other -- the last thing is we still have not had an apology to the Gulf War vets or their family members, especially the veterans that have died, for the sacrifice that was made by them and I think that needs to be done. I think that the President needs to say something special to those families that have died of Gulf War illness, whether it�s related or not, an apology, we�re sad that it took so long, that the lessons learned that we�re talking about today -- there just needs to be that strong statement.
I think that I pick up the points that were added to my comments today as I went through my testimony to you. What hit all of us as we sat and ate lunch is there seems to be a disconnect. We hear beautiful things from the people that were here this morning but when you take it out to the normal field, like my hospital, VA Hospital in Denver, there�s a disconnect. There is a disconnect; it�s not happening.
On the claims -- you asked about the claims number and that there was only 3,000 for undiagnosed illness. What�s happening out in Colorado is they�re not even being put in for undiagnosed illness. The service organization put them in for PTSD or any other reason that they may find in the chart but they don�t look and say these symptoms match with the undiagnosed illness; we need to put that into the claim.
So you may only have 3,000 but I�m saying there�s more than that, and it�s a problem with the disconnect of that not being applied to the veterans across the board when they put in their claims. And that�s something that needs to be looked at and followed up with.
The other thing was the publicity of meetings. We appreciate all the work that�s going on but like I pointed out with the OSAGWI, when there was a meeting out in Seattle, the meeting location was changed. There wasn�t a great number of veterans there. When we checked with the veterans in that area, there was no newspaper coverage beforehand to alert them that this was going to happen, to be there to be able to testify. And so you may have a beautiful web site, beautiful newsletters, but a lot of the veterans are still disconnected out there and we pick them up, somehow they find us. Somehow I still get phone numbers, and I don�t have a web site. I get phone calls asking for help. So we still have a disconnect and I don�t know how many thousands are out there.
Thank you for your attention and your consideration.
SENATOR RUDMAN: All right, Ms. Nichols. Peter Gaytan?
MR GAYTAN: Yes, sir. My name is Peter Gaytan. I�m national legislative director for AMVETS. Senator Rudman, Secretary Brown, members of the Board, I appreciate the opportunity to appear before you this afternoon to present AMVETS views and recommendations regarding the functions and responsibilities of a follow-on organization to the office of special assistant for Gulf War illness.
On November 12, 1996, the Special Assistant for Gulf War Illnesses was established to coordinate all aspects of DoD programs related to Gulf War illnesses. In addition to coordination efforts with DoD, OSAGWI was tasked with investigating possible causes for Gulf War illness, providing outreach to veterans of the Gulf War, and determining lessons learned from the Gulf War.
AMVETS applauds the accomplishments of OSAGWI since its inception, and we recognize the importance of continuing their efforts into the future with a follow-on organization.
Although more than $121 million has been spent between the Department of Veterans Affairs, Health and Human Services and DoD since 1997 for research and investigation into Gulf War illnesses, no real conclusions have been reached. Results of research and investigation activities are developing slowly and basic questions regarding the causes, course of development and treatment of Gulf War illnesses remain unanswered.
Meanwhile, Gulf War veterans continue to suffer from a wide array of undiagnosed symptoms and unexplained health problems. AMVETS supports the formation of a follow-on organization that will continue the effective outreach efforts of OSAGWI and will provide real answers to sick and disabled Gulf War veterans.
It is our hope that the follow-on organization will serve as a primary contact for all matters affecting military personnel who are sick as a result of their service in the Gulf War. Additionally, we feel that this organization should be independent of DoD, VA and HHS. We recommend the easy and open exchange of information between these three departments and the follow-on organization to prevent the duplication of efforts and to expedite the process and ultimately serve the veterans.
This new organization must operate under the OSAGWI promise to leave no stone unturned. The follow-on organization must direct its resources towered determining a cause of illness through scientific and medical research and providing effective medical treatment for those veterans diagnosed with the illness.
While OSAGWI accomplished its goal of reaching out to the veterans and educating them on the possibilities of exposure during their time in the Gulf, the follow-on organization must accomplish the goal of properly diagnosing sick and disabled veterans and ensuring that they receive the treatment they need and deserve.
As I mentioned earlier, AMVETS applauds OSAGWI�s efforts in the past three years and we look forward to working with the members of this Board and the follow-on organization to ensure that the needs of Gulf War veterans are met.
Thank you for the opportunity to present our views.
MS. SPAHR: Good afternoon. I�m Lisa Spahr with the American Legion. I�d like to thank the distinguished Board members for this opportunity to share our views on what a follow-on organization for OSAGWI should look like and what the responsibilities should be.
The two topics I�m going to briefly discuss today are outreach and credibility. I�ve had the pleasure of attending a few town hall meetings with the Office of the Special Assistant for Gulf War Illnesses, and each evening Dr. Rostker opens the meeting by announcing three questions they�re going to attempt to answer. One is why am I sick; the second is, do you care, directed at the OSAGWI team; and the third, why should I trust you?
And those questions are very important because they�re seen at each and every town hall meeting, and I just want to say that they continue today. Those questions continue to need answers and for that reason I�m very pleased that most of us accept that a follow-on organization is necessary and essential.
I think that -- Denise commented on this and I will agree that many people aren�t aware of the CCEP, the Comprehensive Clinical Evaluation Program and the VA registry. Further, they�re not aware that their family members can sign up and have the same examinations. And I think until we -- and collectively I say we, meaning the veterans service organizations, DoD and VA -- until we collectively do a little bit better at getting the word out, this work remains to be done.
Further, until adequate training and maintenance of records is consistently conducted and followed and the deployments of today and in the future our work continues to need -- need to be done. The follow-on organization needs to be masterful at conducting outreach and risk communication. We�re all living in an age of information and technology. More than ever I believe men and women are becoming skeptical of military affairs. Few of us working in the veterans services can go one day without having someone reference Agent Orange in relation to what they�re seeing with Gulf War illnesses.
A more recent and highly publicized example with military distrust is the anthrax vaccination program. Therefore, again, the follow-on organization needs to make outreach a number one priority.
I believe that service members need and deserve to have a place where they can call if they suspect policy is not being followed or they suspect that they have been exposed to hazardous materials and with saying certainly they�ve already gone to their superiors and attempted to go through those channels first. These concerns need to be addressed by someone who takes them seriously and will attempt to help them find resolution to these particular issues that they may have.
OSAGWI has and continues to make outreach a top priority. To date, they�ve held 30 town hall meetings, and they�ve responded to more than 24,000 telephone calls, e-mails and letters. I encourage you to be sure that this follow-on organization is willing and capable to address this volume of concern.
With that being said, I now turn to what the organization might look like. Many people use the term independent, and I think we all like to believe or know that independent organizations can do work because they�re held in higher credibility or may be held with higher credibility. However, I find it hard to locate such an independent group that could conduct this work.
We want an organization who can create lessons learned as well as see that they be implemented. That�s going to require DoD involvement. As I mentioned, outreach must be carried on. That can require, but also will involve VA, HHS, VSOs and veterans at large. Investigations need to be carried out when suspicious events are discovered. That�s going to require DoD involvement.
Duty seems to be the common thread among the responsibilities that I�d like to see in this follow-on organization, but I think it�s still ideal that some way, the group should include representatives of various organizations who can capture more of what I call the veterans advocate role and that�s for a credibility issue.
Perhaps these individuals could be brought in on a periodic basis to oversee or work with the follow-on organization. Perhaps they could be involved through the monthly round table discussions just as Dr. Rostker currently hosts, or possibly they would be an outside organization entirely, one such as yours, that could carry on that level of independent involvement or supervision.
These options are simply suggestions that may need further thought and development. However, credibility needs to be a key factor in developing such an organization.
After I put my thoughts down on paper, I continued to ask people around me what they thought and what they would say if they were here. And as Admiral Steinman had mentioned, a repeated concern I was hearing was that Gulf War issues, Gulf War illness is being swept under the rug. And I think that people are saying that for two reasons. They�re seeing OSAGWI being downscaled, and they�re seeing it become more of a deployment health matter organization, and they�re afraid that that in turn means less attention will be given to Gulf War issues.
But secondly, as you heard today, the Military Health Veterans Coordinating Board and the Persian Gulf Veterans Coordinating Board kind of joining together, they�ve really been doing the same functions and they�re going to become one. So I think that with both of those going on, veterans are concerned that their issues may not receive the adequate and appropriate attention that they do now being with these two organizations specifically focusing on Gulf War issues.
So I hope that the follow-on organization can attempt to dispel the idea that the Gulf War veterans are going to be ignored.
I just want to say one further thing, if I may. I�ve heard today a number of people saying that working relationships with the VSOs are important and I couldn�t agree more, coming from a VSO. I�ve been very happy to attend each of the monthly round tables with Dr. Rostker and we enjoy and appreciate being well informed of their ongoing work.
But the one thing I�m very sad to report today is that if you�re trying to reach Gulf War veterans, veterans service organizations, although we are highly regarded, we don�t -- many of us, our membership doesn�t include that high number or majority of Gulf War veterans.
So they�re out there and we�re trying to locate them, and we�re trying to assist and I think OSAGWI�s efforts have done a fine job as well. But I�m afraid if you just work on keeping your relationship strong with the VSOs, you�re still not going to be reaching those Gulf War veterans who in fact do need that help and assistance.
DR. CAM: What is your specific recommendation in dealing with that?
MS. SPAHR: Well, you know, that�s the million dollar question, really. I would love to sit here and say we have a hundred thousand Persian Gulf veterans in our membership. The truth is that we don�t and we are attempting in many ways to reach out to them as well. People have different theories on why the Gulf War veterans aren�t seeking veterans service organizations to be a part of and to be a member of and you could ask each of us, and I�m sure we would have different answers.
MR GAYTAN: I would suggest a stronger outreach at the base level because that could be a way of transitioning into the civilian world when they�re leaving. Some of them aren�t aware of --
SENATOR RUDMAN: Is it possible also that some people would go into the Service, serve with great distinction, decorated, wounded, what-not, get out, don�t want another thing to do with the Army?
MR GAYTAN: Yes, sir.
SENATOR RUDMAN: Or any organization whatsoever that represents it, the Navy or the Air Force or anything else?
MR GAYTAN: Very much so.
SENATOR RUDMAN: And that�s legitimate, isn�t it?
MR GAYTAN: Yes, sir. But all we can do is provide the information, assume that they�re going to review it and they make their choice.
SENATOR RUDMAN: Doesn�t surprise me. Most people I served with didn�t want any part of anything. They just wanted home, so I don�t think we ought to make a big thing out of the fact that these organizations aren�t growing the way you might think they might grow. A lot of people don�t want to join them and this is America; you�re free to join, you�re free not to join.
I happen to belong to two VSOs but that was my own personal choice, but most of my friends didn�t. I think you ought to put that on the record here. It�s no surprise to me, particularly the American Legion, has not attracted a great many. And that�s true up in New Hampshire where I�m from. Very few Gulf War veterans have joined the Legion.
MS. NICHOLS: I just don�t want people to believe that reaching out to VSOs means reaching out to all of the Persian Gulf veterans because it in fact doesn�t.
SENATOR RUDMAN: I think that�s right. That�s a very important point
We�re just about out of time for this panel. Yes, Ms. Nichols.
MS. NICHOLS: One comment. You know, OSAGWI went around to bases. We really have not held like outreach at a VA hospital where those veterans are trying to get care and so as a follow-up, like I said, I think we need something focusing on VA as a follow-on to reach out to the veterans in those areas that may live in Denver or Grand Junction, if I use Colorado, that aren�t down by the base in Colorado Springs. And the VA Hospitals would be where you need to go out to do like what OSAGWI has done with the town hall meetings.
SENATOR RUDMAN: Thank you all very much. Any other questions here? Are we all set?
SECRETARY BROWN: Well, I�d just like to say I think she has a good idea. I�m going to ask the staff to recommend that.
All right. We�ll do that. I thank you all very much.
And we�re going to call the next panel up. The next panel will be from the Non-Commissioned Officers Association and the VFW. We have Dick Schneider and William Bradshaw.
Mr. Bradshaw, why don�t you go ahead?
MR. BRADSHAW: Thank you. First we�d like to thank you for inviting the VFW to be a part of this special and important Board hearing, and we thank the President for extending this panel through the end of the year. You know, we agree with the special assistant to the secretary of defense�s approach on the future of this Office of the Special Assistant for Gulf War Illnesses specifically in the transfer of responsibilities to agencies within the Department of Defense. We think that�s where it belongs.
But our real concerns focus on now the who is going to have the oversight and the scientific research projects under various government contracts. That�s what concerns us most now, who�s going to have that oversight.
And even though we realize that the charter of this panel is primarily focused towards the efforts and function of the special assistant for Gulf War illnesses, in our mind we see real potential for your panel, Mr. Chairman, for transitioning as a full oversight panel for all of the research projects now underway in the government. Primarily that means what is under the purview of the Department of Defense, Health and Human Services and the Department of Veterans Affairs.
We say that also realizing that current presumption periods for Gulf War undiagnosed illnesses has a delimiting date of December 31, 2001. However, we feel confident that with so much research going on, and obviously so much that will go on beyond the delimiting date, that legislation will soon occur.
We further think that that delimiting date should not be a factor in determining what it is that the new regime will do because we think that there�s great work that needs to be done, you�ve done great work in the past and we think that it should continue. Whether this panel�s future is at the end of the year or if it�s five years from now, we believe that you should press on in doing those things, that�s fight for Gulf War veterans.
Our veterans organizations are doing things to attract Gulf War veterans. They belong to us, and we�ve had a strategic plan, a brand new strategic plan that has to develop. What can you do for young veterans. I mean, I -- when I join things I want to know what can you do for me. I don�t necessarily want to go down to the club and drink and get drunk. I want to know what can you do for me.
And that�s some of the things I think that veterans organizations have to be cognizant of, is what is it I�m going to give you if you join our organization. And that�s what we look at today, is how do you attract the younger veteran because we need them and they need us and we can do great things together.
Thank you so much.
SENATOR RUDMAN: Thank you very much, Mr. Bradshaw.
MR. SCHNEIDER: Thank you, Senator Rudman, Mr. Secretary, distinguished members of the panel. I�ve got to warn you. I�ve got to warn you right up front that I�m proud to be an American, and I�m proud of this country and the fact that we put troops in harm�s way in �91, �92, and when we recognized some of the potential of what was going on in the Gulf, we unleashed the resources to go after the problem, to look at health concerns, to look at our military people and to raise the level of awareness for not only them but for their treatment and care. And I must warn you, I like what we did.
But I�m going to tell you something. 1993 I spoke for our association on Capitol Hill at the first Congressional testimony, and in 1993 I made the statement that DoD, Department of Veterans Affairs did not have the best record in the world because of secrets like mustard gas, like Agent Orange, like radiation poisoning. And I doubted in 1993 whether any organization within government could really capture and move out on an issue that affected the military people of the United States of America.
The development of OSAGWI four years later and its reign of four years has convinced me that my skepticism in 1993 was wrong. I think OSAGWI and its leadership, Dr. Bernard Rostker, that they came on board to do a job and they organized quickly and they went to the troops. I heard a briefing before and what was lacking in the briefing was going to the troops and talking with the troops and doing the evaluation and establishing registries and everything else that has become critical for the welfare of our people.
I think OSAGWI�s role is the health and welfare of troops put in harm�s way, and I think the successor organization which I�m here to address today is the continuation of that role to identify the causes and problems and factors that influenced the health deterioration of military people.
Yes, we need the public relations and yes, we need to disseminate all of that information. But primarily we need an organization and I believe and NCOA is strongly committed to the belief that that organization needs to be rooted within the Department of Defense.
We attended the briefing that Dr. Rostker gave on what he envisioned as a follow-on organization, which was the special Assistant for Deployment Matters, and I like the concept. Matter of fact, I found myself with having fault because I became very annoyed in that meeting when I realized that a comment was made that has great import.
And the comment was this: OSAGWI�s responsibility was the Persian Gulf War, the envisioned office is all deployments in the future as well as the concerns of the Persian Gulf War to carry through to fruition that research and that effort and that energy that can be used for the Persian Gulf veterans while concurrently planning to take care of future deployment and future people.
And I really regretted that we put troops in harm�s way since 1992 to now and we didn�t have an office that was concerned with the health and welfare, the physical well-being and the contaminants and the environmental concerns that would impact those troops.
And I like the concept of the deployment matters office. I like the concept that they�re going to be involved from day one. I like the concept that they�re going to be looking for the information and they�re going to be providing the ticklers that say we need to capture records, we need to do whatever it is that we learned in the Persian Gulf and make sure that it is applicable in the next excursion in which we are involved.
I think that we�re headed in the right direction. I think we started a little bit late for the Persian Gulf War, but we got there and I think we can be proud of the accomplishment of OSAGWI. And I would like to endorse 100 percent the follow-on mission within the Department of Defense because I believe it is the only place where the influence can be brought to bear, the dollars are available and the effort can be expanded to take care of our military people.
And we need to take care of them and we need the Department of Veterans Affairs to continue that process afterwards. And we need to work in unison. But we can do that. But we need to be within the Department of Defense, in my judgment.
I thank you for your time and I would say this, that if we have that office within DoD, the expectation of NCOA, and it�s in the statement that I�m willing to give for all of you, is that -- and I�ll read it because it is very simply stated.
After many, many orders, it comes down to these short orders. Let�s keep the divine -- the design functionally designed within DoD. Let�s keep the organization within DoD. Let�s functionally define it. Let�s not make it an issue that is going to be debated by military department as to the role of that group and whether they have a right to intrude on my military theater of operations. Let�s define the roles so that there is no gain.
Let�s not mix apples and oranges and obviously let�s not throw together government and non-governmental resources and attempt to go in a thousand different directions. Let�s remain committed and focused. Most importantly, let�s hold the chain of command responsible. Let�s hold the chain of command responsible.
And I would say that we ought to require that the Secretary of Defense, through the office for deployment matters, that they provide a report to Congress following any significant deployment and that that report identify health issues, matters and concerns affecting military people or if it cannot be presented immediately afterwards, at the time when it is apparent that they can present that information.
And lastly, oversight when necessary. I don�t know what your future role is going to be. I hope that --
SENATOR RUDMAN: We�re out of this at the end of the year.
MR. SCHNEIDER: I hope so. I hope so. But I�ll tell you this, Senator. I�ll tell you this. This organization, and I�m sure VFW and everybody else, if that new successor organization screws up or we think they�ve screwed up, we�re going to be in the halls of Congress, we�re going to be writing to the Executive Branch and there�ll be another group sitting in chairs like you�re sitting in today because we�re committed to America�s military people and we have to honor that commitment that we�ve made as a nation to those people. We put them in harm�s way; we take care of them.
Thank you very much, sir.
SENATOR RUDMAN: Thank you very much, Mr. Schneider, Mr. Bradshaw. Let me just point out really to both of you, you know, the history of how this Board was created was after the PAC, which you�re very familiar with, that presidential advisory commission came up with a number of very controversial--in some cases�recommendations, some that weren�t but certainly everybody believed one thing and that was there had to be continued oversight of the entire process. Where would it come from? The President thought it ought to be independent; we were created.
We will essentially -- we asked to extend our time because we wanted to follow through to make sure that we would have some recommendations on what we�ve been talking about today, namely the follow-on organization. I don�t think it�s practical, however, that any Presidential Advisory Commission, including this one, would be in a position of for instance making decisions on grants and things of that sort, number one because we don�t have the expertise and number two because once you start creating a large staff, it really ought not to be an advisory commission; it ought to be some sort of a body itself.
I have a lot of confidence that DoD and VA -- I think particularly with General Claypool�s organization which is eventually going to merge into one, I think we�ve got all of the tools in place to make sure that whenever we have this kind of a situation there�ll be people in place that, having learned what we learned from 1990 until today, will be in a position to make the kinds of decisions in outreach and research and in reaching out to veterans which, frankly, was not done very well early on.
But I really think that when you can let the traditional government organizations do their work, which is really what you�re saying, Mr. Schneider, you�re better off. Let the VA do the Vans work without a lot of oversight from a lot of other people within the Executive Branch, other than the President, and I might add the Congress, and obviously if we were to have a problem of this type again and this thing ever started out on the wrong foot, you�d have plenty of oversight.
But my sense is that what they�ve put in place, along with the other organizations that are in this city, stand a good chance of probably getting the job done; better than a good chance.
MR. SCHNEIDER: Senator Rudman, if I might make one last comment.
SENATOR RUDMAN: Sure.
MR. SCHNEIDER: I guess over the past couple of years since you all have been organized, I have sat in the room with you, I�ve listened to you, and I have had great respect for the questions that you have asked, and I think that what you have done is not try and dictate anything but to ask the right questions, cause action to happen.
SENATOR RUDMAN: Exactly. We have no authority to dictate anything to anyone. We have to lead by suggestion, and I must say that our dealings with OSAGWI -- I don�t know if you were here earlier this morning when I read the opening statement but we have really given them direction on a whole number of things, and they have followed that direction, although they have no statutory reason to have to but they have. So, you know, I think it�s been a positive experience for them.
MR. SCHNEIDER: Yes, sir.
SENATOR RUDMAN: Anybody have any questions for these two gentlemen before we move to the third panel?
SECRETARY BROWN: I would just simply like to say I thought their statements were outstanding, all of the panelists and I believe very strongly that the follow-on organization will work as long as it engages and keep engaged the VSOs. While we won�t be there, you�ll be there to make sure that it does what it�s supposed to do.
MR. BRADSHAW: Thank you. We�ll do that.
DR. CAM: I just want to thank the panelists for having been so encouraging for our work and that will help us to deal with this issue. Thanks a lot for your support.
SENATOR RUDMAN: Thank you both very much. I�ll call now the final panel from the Vietnam Veterans of America and the National Gulf War Resource Center, Mr. Bill Frasure and Mr. Keith Boylan.
Mr. Boylan, we�ll start with you.
MR. BOYLAN: Well, I don�t know where to start now.
SENATOR RUDMAN: The beginning is a good place.
MR. BOYLAN: Well, my name is Keith Boylan. I�m a Persian Gulf veteran. I served in the Persian Gulf with Second Armored Cav. I currently work out in California as a Persian Gulf outreach coordinator as well as a board member for the National Gulf War Resource Center.
I�d like to begin by thanking the Board for providing the National Gulf War Center the opportunity to provide a representative voice for Gulf War veterans here today. I think it�s a positive step for rebuilding the trust and good faith between veterans and the Department of Defense.
I�m going to go ahead and go through my testimony, but there�s several issues that were brought up earlier today throughout the meeting that I�d love to address with you as well and one is clearing up the ALS controversy and how a claim goes through. That�s a very -
SENATOR RUDMAN: You may either read your whole statement -- this statement will go into the record. If you want to read the whole thing, you�re free to do that too. If you want to paraphrase it, you�re free to do that, anything you�d like to. But the entire statement will be in the record as you have submitted it to us.
MR. BOYLAN: Well, essentially it goes to -- I�ll go ahead and do that, then. I prefer. I will go ahead and summarize it and take us back to essentially where the National Gulf War Resource Center is coming from. Although OSAGWI has invested extensive research funds, staff and time into their search for the answers surrounding Gulf War illness, veterans continue to view them as a pediment to the overall effort.
Unfortunately, much of this frustration was from early misguided attempts at research and veteran outreach, failed attempts that were unduly placed on OSAGWI�s shoulders. However, they repeated many of the same mistakes that their predecessors have, including immediately marginalizing some of the concerns of the veterans as well as not disclosing all the information in their possession, currently with the National Academy of Science and in the past with the Department of Veterans Affairs and Persian Gulf veterans.
In addition, the National Gulf War Resource Center feels they have wasted precious funds by conducting ineffective research as well as the misappropriation of some funds. Clearly OSAGWI had some significant hurdles to overcome when they were put in place. Our question is why didn�t they take this opportunity to address the concerns of the veterans at that point?
In November 1997, the U.S. Committee on Government Reform and Oversight, the Shays Report, stated Congress should create or designate an agency responsible for the coordination of all research into Gulf War illnesses and the allocation of all research funds. This recommendation continues to be the present belief of the National Gulf War Resource Center and in the presence of careful oversight, we feel that OSAGWI has continued to impute the search for answers.
SENATOR RUDMAN: Let me see if I understand what you just said. Are you saying that OSAGWI doesn�t want real research done in this area?
MR. BOYLAN: I don�t.
SENATOR RUDMAN: Then what are you saying? Because those words would seem to say that --
MR. BOYLAN: Well, real is a loaded word, sir.
SENATOR RUDMAN: -- what do you mean? I just don�t know what you mean.
MR. BOYLAN: Yeah; completely. That�s understandable. I just feel that much of their research has been incomplete, and I can go through and give you some examples of where that�s --
SENATOR RUDMAN: Go ahead.
MR. BOYLAN: Unfortunately, with depleted uranium, for instance, one of the -- it was specifically mandated that they do ingestion and inhalation studies which were not done. Recently, OSAGWI allocated $5 million to take on this issue. That�s valueless. But in the face of the past research they�ve done, recommendations they made from that point as far as research direction, as far as the way veterans seek treatment in the VA facilities, concerning future deployment issues, I think it�s a shame that two years past the fact, this is just beginning.
Their updated depleted uranium case narrative is due in August. Unfortunately, none of that information will be in that narrative, and I would hope that they would not continue to make definitive statements about the safety or non-safety of depleted uranium. It�s definitely the -- the jury is still out on that, without a doubt. And I�m -- and we�re not making any definitive statements one way or another about the safety of depleted uranium. However, there are some serious concerns that should be addressed.
SENATOR RUDMAN: And I understand they�re going to, Mr. Boylan, for a lot of reasons.
DR. CAM: Mr. Boylan, may I interrupt you just --
MR. BOYLAN: Sure.
DR. CAM: Were you aware that there is a DU study done by the Inhalation Toxicology lab in Albuquerque?
MR. BOYLAN: Yes. However, no information has been released about that research as well to this point.
DR. CAM: Okay.
MR. BOYLAN: So that goes back to statements being made one way or the other about its safety when there�s simply just not enough research available to make those type statements.
DR. CAM: I see.
MR. BOYLAN: The oil well fires is another example. In their analysis, once again, it was a big part of the investigation that they failed to address, and they had the information in their possession, it was readily accessible, and that�s the particular matter in the oil well fires.
Primarily the basis of their research on the oil well fires was based on gaseous emissions which to this point it�s pretty generally agreed that it�s of minimal if any cause -- minimal if any -- has anything to do with health effects that the Persian Gulf veterans suffered from. However, they do state that particulate matter poses a much significantly larger health effect; however, they didn�t address the information they have in their possession in their analysis.
Overall, I mean, back to the point of -- the point of this is that they�ve continued to destroy any credibility that they have with any Persian Gulf veterans. Every time they take a step forward, they release a research project that has gaping holes in it, and they immediately move three steps back. And any understanding they�ve built with the veteran community is immediately washed away once again.
Another point of contention with the research center is the availability and dissemination of information. OSAGWI has essentially become the clearing house for all FOIA inquiries around Gulf War illness. The central control of this information has made it nearly impossible for veterans to obtain information conducted on research which to this point, a lot of the information that you�ve reviewed and so forth has been from veterans accessing Freedom of Information Act requests, putting together narratives based on material that a lot of times the Department of Defense in the past, as early back as the late 50s, has conducted. However, when OSAGWI does their analysis, once again, this information is ignored.
But this central control of the information has created this bottleneck and in some cases it�s delayed responses up to three years. One recent response to a 1997 FOIA request by the research center, it was a request for OSAGWI�s document logs, shows that OSAGWI has a great deal of material in their possession that they haven�t provided in light of repeated requests.
Much of -- requests for information on the end notes for the OSAGWI narratives have also been rerouted and denied. When you look through their narratives they put together and you want to see where they came up with their figures and facts and try to get possession of the end notes, it�s impossible; the National Academy of Sciences has also reported the same problems because, as you know, they�ve been tasked with looking into the 31 toxins known to be in the Gulf and they�ve had their own difficulties around that.
Another -- a couple examples of this is the Doha fire in CENTCOM logs that go along while the fire raged. You can get them before; you can get them after. But while the fire is raging, those logs are unavailable, and it�s our opinion that there would be some vital information in those logs.
Selectively releasing and withholding substantial information not only violates federal law but it once again removes any credibility OSAGWI has gained. The resource center requested additional staff be assigned the task of expediting past FOIA requests that have been rerouted or denied. In addition, the research center proposes that the GAO conduct a review of OSAGWI�s policies towards fielding FOIA request and recommends investigation of any possible violations.
Another incident that DoD under reported depleted uranium exposures which adversely affected the research directions of Gulf War illness initially the VA facilities. They came out with a number that was very low on troops that could have possibly been in contaminated areas with DU. The number continued to grow until OSAGWI released a map detailing troop movement and DU use in the Gulf which displayed that nearly every combat troop in the Gulf went through a DU contaminated area at least once and most likely two or three times.
The Department of Veterans Affairs was not aware of the magnitude of this, and the Persian Gulf Registry exam initially didn�t reflect this. There was no DU test. Only since the revision of the VA Gulf War Registry has a DU test been added but unlike the rest of the exam, the burden is on the veteran to request this just for DU. Needless to say, out of the 150,000 veterans who have gone through that process, a tiny fraction have actually received a DU test.
At a public hearing on November 19, 1998, OSAGWI asked the Board for help and frankly you haven�t got this wrong before when the Department was incorrect in its conclusion that no troops were exposed to chemical agents, the Department cannot make the final determination of when the stones were too small to bother to turn over. This is a determination that this Board, in concert with the leaders of Congress and the veterans service organizations, must help us make. This is not an issue of cost for the Department of Defense; the resources are there. They will be there as long as necessary. This is an issue of getting it right and doing the best job for veterans.
It�s no longer a question of whether the stones are too small to turn over. We feel OSAGWI never intended to turn the stones over. Essentially they�ve set them spinning in place and provided no credible answers, no thorough investigation and that�s -- that�s --
SENATOR RUDMAN: Well, I have to interrupt you there and tell you on behalf of myself, and I think I speak for the entire board, we would category react -- contradict that, rebut that statement. That is too broad a statement.
MR. BOYLAN: Well, unfortunately --
SENATOR RUDMAN: I just want you to know our view. We have looked in detail at these investigative reports, and we have responded to that quote that you had, and we have told them there were some things we thought were a waste of the government�s money, better we do it in other places. But to say that they have not done a complete investigation, there, Mr. -- you do your own cause harm, Mr. Boylan, you make that kind of an overstatement.
MR. BOYLAN: And --
SENATOR RUDMAN: Proceed. I�m just giving you my view.
MR. BOYLAN: That cause, sir, would be promoting health benefits at a VA level; when a soldier walks in they can receive benefits. Now, by pushing off investigation of inhalation exposures, that�s an additional two years that ailing veteran is going to go without question. Now, I don�t understand how you can see that as a thorough investigation. Clearly there were shortcuts.
SENATOR RUDMAN: No. You -- listen to what I said, sir. What I said to you was that your statement that they have not done any thorough investigations is an overstatement.
MR. BOYLAN: And --
SENATOR RUDMAN: They have done a number of good investigations. There were some that we were very critical of, and I think you ought to state it that way on behalf of your organization.
MR. BOYLAN: And we appreciate that.
SENATOR RUDMAN: Good. Proceed.
MR. BOYLAN: Along the way, it�s had a unfortunate effect on the veterans' trust of the Department of Veterans Affairs as well. It�s initially drove almost an irreparable wedge between veterans and the access they�re receiving at the Department of Affairs (sic). Fortunately, the Department of Affairs (sic) has charted their own course from this point out, and they�ve gone in a really good direction, most recently with their discussion of doing ALS research. And we�d like to also thank the VFW for their efforts in promoting that.
It is our recommendation to eliminate OSAGWI with the assurance that the wealth of information in their possession is turned over to a successive research organization. We also recommend that there continue to be a DoD presence in the investigation. However, we feel this should be on the basis of a liaison which would effectively allow them to share the information in their possession as well as them to continue to learn -- lessons learned to be passed back to the DoD.
This will also ensure that their web site, which has been a big positive throughout this whole thing -- OSAGWI has maintained a very effective web site, the information is very up to date and it�s very thorough. Unfortunately, like I said before, some of the end notes listed are unavailable but that�s another issue.
We feel that -- I�ve heard your statements earlier about how you feel that the DoD and the Department of Veterans Affairs has to be involved in the research process, and I would agree.
However, the National Academy of Science through their effort so far recently recommended to create an agency independent of the DoD and DVA that would conduct research and it�s essentially what OSAGWI was talking about is a successive organization that not only is Gulf War only but future deployment and any war-related illness research.
And this would be -- this would be conducted as you mentioned by -- earlier -- by representatives from the International -- the Organization of Medicine, Health and Human Services, Centers for Disease Control, as well as independent researchers. They would be responsible for conducting research, focusing on the health of active, reserve and guard troops. This legislation will be introduced by Representative Baldwin later this year and the National Gulf War Resource Center supports that.
That�s more or less my testimony in a nutshell.
SENATOR RUDMAN: Thank you very much for summarizing; it saved some time. We have it in the record.
MR. FRASURE: Senator Rudman, thank you for having me here. My name is Bill Frasure. I work for the Vietnam Veterans of America. I am certainly not a Vietnam veteran. I�m a Gulf War veteran, and I hope that you all will carefully review the written testimony that I�ve submitted. Hopefully my comments will be brief here.
SENATOR RUDMAN: Your entire statement will go on the record as you have submitted it.
MR. FRASURE: Right. Thank you.
We see -- and when I say we, I mean VVA, the organization I work for -- we see OSAGWI as an abysmal failure on behalf of and for Gulf War veterans. Essentially it�s kind of like a car factory that�s been in business for, what, three years now and not one car has rolled off the assembly line.
It�s the year 2000 now and not one of you or anyone here in this room can tell me what are the causes of these undiagnosed Gulf War illnesses and also, still, there�s thousands of Gulf War veterans with these undiagnosed illnesses that are still ailing and still going without health care.
And we have -- this federal government has spent over -- we�ve heard different sums of money said here today in this room but it�s somewhere over $120 million. That�s a waste of taxpayers money. So our recommendation is that OSAGWI be immediately terminated. We would like to see it replaced with a National Institute of Military Medicine to fall under the aegis and be housed within the National Institute of Health.
We feel that this is a fair recommendation. We think a body such as this would still be responsible to Congress, to the American people and to veterans, yet it wouldn�t fall under the sort of public relations paranoia that seems to stall the efforts of OSAGWI.
We believe DoD and the VA should be fully cooperative with this Institute, and I�ll leave it at that. That�s it.
SENATOR RUDMAN: Thank you, Mr. Frasure; I appreciate it. We understand your frustration; $125 million spent, nobody knows what causes it.
I�m curious, Mr. Frasure. Any idea how much the Congress has spent to find out the cause of cancer in the last 20 years?
MR. FRASURE: No, I don�t.
SENATOR RUDMAN: I�ll tell you it�s in excess of $15 billion, and we don�t know any more about that than we know about Gulf War illness. The point I want to make to you is that I share your frustration; I�m a veteran myself. We sure would like to know what causes it, but I must say when this panel looks at the distinguished scientists in this country that have been given money to research this and they haven�t come up with an answer yet, that�s definitive. Then it�s very frustrating to everyone but that doesn�t mean you give up. That doesn�t mean that you say that they were wrong. What you essentially do is you try to find the best people you can in the world to research particular issues and see if they can find both a cause and a cure.
And of course, this panel was specifically prohibited from doing any scientific research --
MR. FRASURE: No. I understand that. I understand that you�re purely an oversight role. I understand that.
SENATOR RUDMAN: -- but even in the scientific area we�ve got, you know, some prohibition.
MR. FRASURE: Sure. Sure.
SENATOR RUDMAN: But we understand your frustration. I only want to make that point to you that this government has spent a lot of money and eventually you find cures. Polio killed a lot of people when I was a kid growing up; doesn�t kill anybody anymore. We found a cure. We found a vaccination; it doesn�t happen. So, you know, it will happen but it unfortunately won�t happen as quickly as many of us would like it to happen.
MR. BOYLAN: My only comment to that, sir, is that a lot of the individual independent researcher that come on board is pretty recent, and a lot of their research material isn�t back yet so hopefully they will shed some light on this issue. Unfortunately, the research that we�re looking at now is primarily sponsored by the Department of Defense and the people that you speak of aren�t part of those research efforts.
So I do -- I trust the elite research -- independent researchers in this country and I would expect them to produce the answers to this. Obviously we�re veterans; we�re not going to produce the answers to this. However, they�re starting to be involved now and we would hope that their actions due to past OSAGWI history -- I would hope their actions aren�t compromised due to past shortcomings and I would hope some of those same mistakes wouldn�t be repeated.
And I would like to see those independent researcher with this -- set off in the direction that you speak of, be not as connected with the Department of Defense and with the National Institute of Medicine or something of that nature.
SENATOR RUDMAN: Okay. Any comments, Admiral?
RADM BUSICK: No, sir.
SENATOR RUDMAN: Okay; I have two Admirals now.
RADM STEINMAN: I just have a question. It�s interesting listening to the veterans comments. We seem to have a polarization about OSAGWI. Some veterans organizations think OSAGWI has done a pretty good job; you guys think they�ve done a horrible job. To what do you account for this difference?
MR. BOYLAN: I would say the majority of the veterans organizations that feel a little better about the efforts of OSAGWI have made less effort into the Persian Gulf issues. Not to say their sincerity or their heart isn�t there but unfortunately their daily business doesn�t reflect that.
MR. FRASURE: I would associate myself with those comments. As a Gulf War veteran and having formerly worked for the VFW, I can say that there seems to be a -- and I believe many young veterans would agree with me -- seems to be an almost incestuous relationship between the major veterans organizations and the Pentagon and the VA.
Today major veterans organizations seem to have blinders on their eyes and are tunnel-visioned towards just kind of keeping the veterans� welfare state alive. So it�s just kind of a send out the check mentality. Any problem that requires real insight and an earnest hard effort seems to go by the wayside by the major veterans organizations.
They by and large fail young veterans today, and that�s why young veterans aren�t joining the Legion and the VFW, and I�ll say that publicly to anybody, any time.
SECRETARY BROWN: I�m not going to challenge you on that, but I want to ask you a question.
MR. FRASURE: Sure. Sure.
SECRETARY BROWN: Much has been talked about the young -- so-called young veteran not joining the major veterans organizations. The fact of the matter is that is not a new phenomenon. That happened right after WorLd War II. The veterans organizations were not able to get the Korean War veterans, they were not able to get the Vietnam veterans, by and large, nor were they able to get any subsequent veterans.
MR. FRASURE: Right; I understand that.
SECRETARY BROWN: So what you�re saying here is I think that there has to be another reason as opposed to saying -- and I�d like you to clarify that statement about keeping the check coming; I don�t understand what you mean by that. Tell me what you mean by that.
MR. FRASURE: Sure. It seems to me, in my opinion, from having worked in the veterans lobby for four years, that the main focus of the veterans lobby is keeping the disability check coming just for the sake of keeping the check coming and not returning that veteran, that disabled veteran, to a true level of self-sufficiency. It just seems as if there�s a veterans welfare state out there and --
MR. BOYLAN: I would concur. Maybe to touch on it a bit differently, among the Persian Gulf veterans that I associate with, they have an issue about the victimization of veterans.
SECRETARY BROWN: Who do you associate with, by the way?
MR. BOYLAN: I�m with Swords in San Francisco.
SECRETARY BROWN: Yeah. I know you guys are out of Frisco; right.
MR. BOYLAN: San Francisco.
SECRETARY BROWN: Tell me, what�s your membership out there?
MR. BOYLAN: We�re not a membership. We just have an organization that�s founded by some Vietnam veterans --
SECRETARY BROWN: How many members do you have in your organization?
MR. BOYLAN: It�s not a membership organization. It�s for homeless veterans in the five counties in the Bay Area. We provide employment services, legal services. We just got two buildings that will house another 120 homeless veterans. We have educational programs, substance abuse programs --
SECRETARY BROWN: Okay. Let me ask you another way. How many veterans do you reference?
MR. BOYLAN: With the National Gulf War Resource Center, quite a few, sir.
SECRETARY BROWN: Okay. Tell me about the National Gulf Resource Center (sic). How many are -- veterans are associated with --
MR. BOYLAN: Well, they have 65 grass roots organizations throughout the country that each have their individual membership so for me to give a number on that would be inaccurate. I mean, and I --
SECRETARY BROWN: Ball park it for me.
MR. BOYLAN: Pardon me?
SECRETARY BROWN: Ball park it for me.
MR. BOYLAN: I don�t know. It depends. At our conferences we may get several hundred. Last conference was a bit less, and we hope that�s due to the past legislation and they�re getting better treatment at the VA facilities. I don�t know. It depends on -- I mean, I don�t see the relevance of a number.
SECRETARY BROWN: Oh, you don�t?
MR. BOYLAN: I think there�s definitely a voice throughout the country that -- a representative voice from the various coalitions that work on veterans issues throughout the country. I think that�s significant. I don�t think each country -- I mean, the American Legion doesn�t necessarily -- although they have millions of members, doesn�t necessarily represent the voice of each of their members.
SECRETARY BROWN: Oh, yeah. But Bill here made a statement which I�m kind of offended by --
MR. FRASURE: No offense intended.
SECRETARY BROWN: It�s not personal; it�s a professional difference.
MR. FRASURE: Sure.
SECRETARY BROWN: Let�s make that clear.
MR. FRASURE: Okay.
SECRETARY BROWN: Is that the main purpose of the national organizations to keep the check coming. Well, that is -
MR. FRASURE: What do I mean by that? Let me try to give you another example.
SECRETARY BROWN: Well --
MR. FRASURE: Let�s take a look at rehab --
SECRETARY BROWN: -- let me finish and then you respond.
MR. FRASURE: Okay; that�s fair. Sure.
SECRETARY BROWN: First of all, most of these organizations� missions parallel that of the VA and the Vans mission, basically, even though they have two hundred and something thousand people and about a $40 billion budget, they really do basically three things; disability compensation for people that are injured or diseased while in the military. Would you disagree that that is a noble mission?
MR. FRASURE: Not at all. Not at all.
SECRETARY BROWN: To provide compensation -- I mean to provide health care to veterans that serve their country honorably. Would you disagree with that?
MR. FRASURE: Of course not.
SECRETARY BROWN: And then the last one of course if to bury the veterans with dignity.
MR. FRASURE: Of course not. Of course not.
MR. BOYLAN: Sir, unfortunately, we�re wasting time talking about a statement that he made when there�s very tangible things we could be discussing.
SECRETARY BROWN: Well, wait a minute. First of all --
MR. BOYLAN: I mean that have to do with the VA and the treatment of care, though, sir.
SECRETARY BROWN: First of all, Keith, I�m talking to him. I asked him a question, and there are two panelists here so let me finish my conversation with him.
So the point that I want to make is that as I see it, having been involved in that movement for the last 30 years, and so I guess I�m one of those guys who want to keep the check coming, and you�re right; that�s my -- I want to see those checks keep coming. I want to see the system the most rigorous system in the world. Nowhere in the entire world does a government compensate veterans for getting diabetes while they are there or compensate a veteran simply because he has a heart attack concurrent with his act of service.
Nowhere in the entire world does a veteran can get compensation 40 years after the fact. You take Agent Orange, for instance. We�re paying compensation any time the veteran develops non-Hodgkin�s lymphoma, soft-tissue sarcoma. There�s a whole list of things. And so I�m very proud of that and that�s the work of the veterans organizations, so I think that there is a role for everyone to play without creating this divide, this nasty thing that has been brought out of the box here.
So I would hate to see us begin to wedge -- develop a wedge between our individual efforts because everyone has a role to play. You have a role to play. I think the Legion, DAV, AMVETS, all of them have meaningful roles to play.
RADM BUSICK: Mr. Chairman, can I ask a question, and I obviously would like to address it to you.
SENATOR RUDMAN: Sure.
RADM BUSICK: This is obviously my first afternoon on the Board. I obviously was the guy who established the Board. And I thought that the role of the Board related specifically to the Presidential Advisory Commission�s concerns that the actions of the Department of the Defense were not credible and therefore could not be continued without oversight.
SENATOR RUDMAN: Correct.
RADM BUSICK: I don�t recall there being anything to do with the Department of Veterans Affairs or the work of the veterans service organizations or anything related to that.
SENATOR RUDMAN: That�s true, also.
RADM BUSICK: So I�m a little bit confused as to where we are in terms of what we�re trying to do here.
SENATOR RUDMAN: Where we are occasionally -- we occasionally get off course, we head for the rocks, I grab the helm and head back for the channel. We�re about to get back to the channel right now.
Everybody else is out of order. Dr. Cam, you have one question.
DR. CAM: I think it�s very important to clarify Mr. Boylan's statement. I want to direct your attention to the second page of your statement, paragraph three, and the last four sentences. You mentioned that preliminary result from AFRRI clearly document potential adverse health effects.
As clearly as I remember, they showed there was a deposit of DU pellets at certain hot spots but they never said there was any physiological impairment.
MR. BOYLAN: It showed that DU would --
DR. CAM: And I just wonder whether there is anybody in the audience who could address that.
AUDIENCE PARTICIPANT: This is study in the DU that was in rats?
DR. CAM: Yes.
SENATOR RUDMAN: Hold on a minute. We have a witness here, we have a commission here, you know. Go ahead. Do you want to respond to that
MR. BOYLAN: I would love to.
SENATOR RUDMAN: Go ahead and respond.
MR. BOYLAN: That report showed that DU contributed to the creation of oncogenes. It also showed that the DU transferred through the placenta into the uterus of the impregnated rats, it reduced the litter size, it reduced the birth rate. There was very significant findings in that research, and I would suggest to review it again because I don�t see how that would go unnoticed.
In addition, to the comment you made earlier at the VA and the compensation when we were talking about numbers of Persian Gulf veterans who have received compensation, I think it�s important to remember that those totals are only nine years after the war. They�ve already outnumbered all the other wars together, and it�s only ten years after the war. I think that�s very significant.
SECRETARY BROWN: What total?
MR. BOYLAN: The total of VA claims, when we were talking about the number of VA claims and were trying to determine how many were Persian Gulf-related.
SECRETARY BROWN: Oh, yes. That�s exactly right.
MR. BOYLAN: I think that�s a very significant factor.
SECRETARY BROWN: Absolutely. I agree with that.
MR. BOYLAN: In addition, Dr. Feussner earlier mentioned that with the Khamisiyah event, the hospital rates -- there were no research deaths and the hospitalization rates showed that troops who were in Khamisiyah have no -- do not have an increased hospitalization rate
I would say the research gap there is a hospitalization rate versus a claims rate. The House Committee on Government Reform released a report that showed that the hospitalization rates -- not the hospitalization rates but the claims rates of people who were involved in the Khamisiyah incident are four times more likely to file a claim and get it granted service-connected than the average veteran.
Now, understandably, that impairment may have came from the actual Khamisiyah explosion; maybe a vet was running away and tripped and broke his knee, as Dr. Brown talked about earlier. But at some level that�s another significant number, but I think those claims numbers -- and I agree with what you were saying -- but I think they are significant and I think that�s definitely an area to look into.
Also, when he spoke earlier about PB, he referred to it as a medicine. I would like to remind the Board that PB is an investigational drug that was passed in the eleventh hour labor by the FDA in order to be used in the Persian Gulf. Subsequently we�d be a lot farther along if they had followed the requirements of that waiver which meant that they had to probably annotate who received the PB pills and do medical follow-up, neither of which was done.
We would have a lot more answers about PB at this point if those things were accomplished. And this goes back to my point about OSAGWI and their --
SENATOR RUDMAN: We get your point about OSAGWI, Mr. Boylan and you�re out of turn, okay? You got more than enough time.
We�re going to meet again the fall of 2000 preparatory to winding up our entire project and submitting a report to the President, which of course will be published. And just exactly what form that hearing will take I�m not sure, but I�m working on it currently with the staff.
I want to take a moment to thank the staff of this group, a very small staff but very dedicated and devoted staff. We�re working with OSAGWI that has a huge staff and we have a very small group but I daresay they�ve kept up with what we�ve asked them to do, and I thank Mike Naylon and Roger Kaplan and the rest of the staff for that
And I would ask the members of the panel if they have any closing comments before I adjourn this hearing.
DR. CAM: I would like to say that the interaction has been very interesting and positive and I hope something good will come out of it and I thank you for being here.
SENATOR RUDMAN: Thank you all very much. We�re adjourned.
(The hearing was adjourned at 3:24 p.m.)
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