[mission slide]
I am Colonel Edward Koenigsberg, Director of the Persian Gulf War Veterans' Illnesses Investigation Team which is under the direction of the Assistant Secretary of Defense for Health Affairs. Your committee has requested that the Team present testimony discussing the personnel assigned to the Team and the procedures/processes we use in our investigations. We have also provided you material on the 54 cases we have initiated to date. A few files are single incident investigations, while others are a series of incidents that all relate to the same possible cause of illness. We also have case files containing information relating to a particular theory provided by veterans or scientists. Material in one case file may be cross referenced with other files since many theories and incidents are not mutually exclusive. Your staff has requested we discuss certain case files to illustrate our procedures and that we give you updates on case files of specific interest. We are, however, prepared to respond to questions relating to any case file provided to you. I will be assisted by Lieutenant Edward Moldenhauer, a Navy Pharmacist with prior experience as an Army military intelligence analyst.
We would like to point out that although there are teams within the Department of Defense involved in the clinical and research aspects of Persian Gulf illnesses, we are the only team dedicated to the actual overall investigation, coordination and analysis of information on this issue. Therefore, in addition to our primary mission, we have many additional responsibilities which we listed in the packet we provided.
As requested, we have also provided written testimony outlining the resources allocated to our investigation effort. These resources not only include the monetary aspects of our operation but also our staff.
A biographical sketch for each staff member has been provided. As you can see on this slide, the Team's composition is a mix of highly talented and diverse individuals.
[investigative procedures slide 1 of 3]
Before discussing the case files of the Team's investigations, I would like to discuss the general procedures we use for conducting our investigations. The Team initiates a case file based upon information we receive which may have a relationship to Persian Gulf Veterans' Illnesses. This information may come from eyewitnesses to an event, a health care provider theory, testimonies to various committees, or from other cases being investigated. In most instances, we do not take the recollection or theory of one individual and regard it as factual until we are able to substantiate it by several sources. These sources, such as additional interviews, literature research, expert consultation, or physical evidence, allow the Team to reconstruct an incident or clarify a theory.
[investigative procedures slide 2 of 3]
Once we have compiled enough preliminary information to feel comfortable in addressing the issue, the Team, as a group, discusses the item and runs it through a "logic test". This test simply stated allows the Team to determine if the item truly has relevance to Persian Gulf Veterans' Illnesses, a filter if you will. We also determine if the item falls within our area of expertise and whether we can expect results from further efforts of investigation. This process is similar to that of an Institutional Review Board. If the item brought to our attention falls outside the Team's scope or expertise, we relay this item to other more suitable experts for review or analysis. Within the Department of Defense, there exists a wide spectrum of medical, scientific and operational experts to consider such proposals. An example of this would be the proposal for a long-term epidemiologic study.
As you can see, the Team dedicates a significant amount of preliminary investigative time to a proposal prior to it actually becoming a formal case file. During an investigation itself, we use telephonic interviews, personal visits, literature research, consultation with experts in government agencies and civilian institutions, and any other DoD asset required to resolve an issue. When a case file has reached the point where the Team feels it is unlikely to obtain additional information, we still maintain the file as open but no longer consider it active.
[investigative procedures slide 3 of 3]
At that point we prepare an interim report for GulfLink. We do review all case files on a regular basis to determine if new information has become available. There is always the possibility of new information surfacing prior to our scheduled termination date of June 1997. We continually monitor testimonies and theories presented at Congressional hearings, scientific meetings, and PAC panel meetings for new information. Also, we continue to monitor the operational and medical records undergoing declassification. The scheduled completion date for records processing is not until December 1996. It is intuitive that as June 1997 approaches we must compile a final summary report on our investigative efforts. In the interim, we will continue to generate reports and testimonies concerning our efforts, which, when applicable, are released for public examination and review. We also meet regularly with the Assistant Secretary of Defense for Health Affairs and additional members of his staff who are working in other areas relating to Persian Gulf illnesses. We provide these individuals with information assisting them in their particular efforts.
In addition to a final report, our Team has an electronic archive system which is being constructed. This archive will house the collection of our computerized investigation case management system, other supportive data bases, and the document repository of Persian Gulf War Veterans' Illnesses health-related documents. This amassing of data will conclude the summer of 1997.
[investigative obstacles slide]
Obstacles to our investigative efforts revolve around three primary issues. First is the inability to locate individuals for interview purposes. The Defense Manpower Data Center, Monterey, California maintains a data base of service member's last known addresses. This address is current at the time of the member's discharge from active duty or separation from the reserves or national guard. If the service member has remained on active duty or is a drilling reservist or guardsman, they are considerably easier to locate and contact. Nevertheless, you can imagine the time spent to locate a veteran who separated immediately after returning from the Persian Gulf War. The second difficulty is the determination of unit locations during the war. During our investigation of a particular incident, the identification of all units, their location during a specific time period and subsequently all the personnel assigned to those units is very time consuming. Once the Environmental Support Group (ESG) data base becomes available, this part of our investigation should be accomplished more rapidly. Our last obstacle deals with the lag time associated with the declassification and digitization of Persian Gulf War Illnesses related documents. Until all record processing is accomplished in December 1996, our investigations remain incomplete. It would be a disservice if we closed a case file and the last piece of paper digitized contained key information relating to Persian Gulf War illnesses. Therefore, our investigative efforts will continue until proper analysis of all digitized documents is accomplished. At this time I will turn the testimony over to Lieutenant Moldenhauer.
As stated in previous testimonies, the Team does not focus its efforts strictly on chemical warfare issues. Our case files do, however, appear to be skewed in the direction of chemical warfare issues. This is due to the sensitivity of this topic. Our charter is to investigate any plausible theory relating to Persian Gulf Veterans' Illnesses and to guarantee we do not overlook any possible cause. Many of our case files interrelate and some also provide supportive information to overall subject area reviews. In order to efficiently discuss our case files, they are arbitrarily separated into general file categories. The Team bases its investigations on the information identified to date, realizing that new data may be added. For your assistance, a list of acronyms used throughout our case file summary sheets has been provided. I will now address several of our representative files.
[investigative case file categories slide]
This first slide illustrates the diverse subject matter investigated by the Team. These categories are for administrative and presentation purposes.
Your staff has requested we discuss the thallium toxicology case file. We identified the thallium exposure theory during a review of the declassified intelligence information released on GulfLink. A civilian physician employed by the Kuwaiti government from 1978 to 1983, recalls a use of thallium rat poisons sometime during 1980 or 1981. He recalls the hospitalization of many Kuwaiti civilians having the same symptoms as Persian Gulf War veterans. He proposed that thallium residue in the soil was dispersed into the atmosphere during the extensive military operations in Kuwait. In a review of the medical and toxicological literature (OSHA, EPA, Poisindex, ATSDR), thallium exposure does produce some symptoms similar to those seen in Persian Gulf veterans. These symptoms, such as fatigue, mood changes, pain in the legs or arms, hair loss, and peripheral neuropathy, may occur some time after exposure and last for months or years. The Team consulted members of the Armed Forces Pest Management Board to determine if U.S. forces used thallium rat poisons during Operation Desert Shield/Storm. The Pest Management Board stated that U.S. Forces used only anticoagulant-based, not thallium-based rodenticides. Thallium was an item of interest during Operation Vigilant Warrior '94. CENTCOMs Problem Definition and Assessment (PDA) Team, comprised of infectious disease, epidemiology, laboratory and environmental and occupational health experts, conducted soil and air sampling and discussed the issue with the Kuwaiti Ministry of Health. The U.S. Army Center for Health Promotion and Preventive Medicine performed the soil sample analyses and found no thallium present. The Kuwaiti Ministry of Health stated that thallium rodenticides were not used. We are investigating the possible Saudi Arabian use of thallium rodenticides, even though the soil samples tested were negative. Although the symptoms of Persian Gulf illnesses mimic that of thallium exposure, we are unable to substantiate the claims of thallium use or presence in Kuwait prior to or during Operation Desert Shield/Storm. Therefore, current evidence does not support the theory that thallium is an underlying cause of veterans' illnesses.
[depleted uranium slide 1of 2]
I will now discuss depleted uranium as a representative environmental health-related case file. Depleted uranium (DU) is a recognized hazard in today's modern battlefield. I am sure the Committee realizes the importance of this matter, as evident by the numerous veterans testimonies and reports in the media. The issue of DU relates to the possible contamination by heavy metal uranium dust and the associated radiation. DU is present in the armor penetrating munitions used by coalition forces. In order to understand the dynamics of DU munitions, we consulted weapons experts and research specialists at the Armed Forces Radiobiological Research Institute (AFRRI). The Team reviewed medical literature to educate ourselves on the heavy metal and radiological effects of DU. There exist several detailed technical reports produced by AFRRI, the U.S. Army Environmental Policy Institute, the Government Accounting Office and USACHPPM each discussing the hazards associated with DU. We reviewed Congressional testimony specific to DU, as well as the Institute of Medicine's Health Consequences of Service During the Persian Gulf War report. We have reviewed CENTCOMs PDA Team report on residual DU findings and their discussion of the issue with the Kuwaiti Ministry of Health. Eyewitnesses, identified through various testimonies and our 1-800 Incident Reporting Hotline, have been interviewed.
[depleted uranium slide 2of 2]
The net result of our investigative effort is that current literature and research do not indicate that DU is a likely cause of Persian Gulf illnesses. It is evident that many soldiers were around vehicles destroyed by DU munitions without taking proper protective measures. Additional research is definitely required. The Baltimore VA is currently following approximately thirty veterans with imbedded DU fragments and the Boston VA is following approximately twenty-five veterans of the U.S. Army 144th Maintenance Company. The latter unit was responsible for the recovery of DU contaminated vehicles and may have been exposed to breathable DU dust. To date, no evidence has been found to connect DU exposure to physiologic changes in these patients. The Team will continue our monitoring of the research efforts of these two study groups.
The Team's file category labeled Medical Policy and Clinical Issues deals with health care provider theories. The Committee staff requested that we discuss two of these case files: mycoplasma and delayed neurotoxicity. The mycoplasma case file being investigated by the Team is multi-faceted. Mycoplasma, a microorganism, has been proposed as an infectious disease in Persian Gulf veterans. Also presented was a theory that mycoplasma were intentionally genetically manipulated, thus implying an offensive weapon technology. Finally, it has been proposed that mycoplasma was a contaminant in the vaccinations given to U.S. forces. In order to effectively investigate each of these theories, this case file was divided into several facets.
Mycoplasma species cause human disease, usually in patients with severely compromised immune systems. Many of the symptoms exhibited in a mycoplasma infection are similar to those associated with Persian Gulf illnesses. Mycoplasma are difficult organisms to identify and the illnesses are difficult to treat. Mycoplasma are an endemic organism in southwest Asia. The Team consulted with medical experts at the National Naval Medical Center, the Armed Forces Institute of Pathology, the National Institutes of Health, the Centers for Disease Control, the Veterans' Administration, medical personnel at the U.S. Embassy Kuwait and the academic research community.
We presented the issue of genetic manipulation to these same experts. There is no evidence supporting the possibility of genetic manipulation of mycoplasma. Experts at the U.S. Army Medical Research and Material Command, the Armed Forces Medical Intelligence Center and one prior technical director of the U.S. Army Biological Weapons Laboratories (disestablished in 1969), all located at Fort Detrick, Maryland, addressed the issue of possible mycoplasma weaponization. These experts and the intelligence information reviewed identify no known BW research on mycoplasma being done world-wide nor had the U.S. ever done any BW research on mycoplasma. Additionally, the experts state that the technical capability to genetically engineer this organism does not exist today.
Presidential Advisory Committee staffers testified, at the June 1996 meeting, on the issue of mycoplasma vaccine contamination. Their testimony stated that this contamination is not possible due to the techniques used in vaccine preparation. The available evidence agrees with this assessment. We also consulted the U.S. Army Medical Research Institute for Infectious Disease (USAMRIID) to answer the question, "Did Fort Detrick supply vaccine precursors to manufacturers?". USAMRIID states that no anthrax or botulinum toxoid precursors were ever provided to vaccine manufacturers.
After all literature reviews and expert consultations, there does not exist enough substantial evidence to support any theory linking mycoplasma to Persian Gulf illnesses. We also find no evidence to suggest that the mycoplasma described is the result of biological warfare research. Since mycoplasma is endemic in the area, medical research should continue.
[delayed neurotoxicity slide 1 of 2]
The issue of delayed neurotoxicity is being investigated as a result of the work being done at the University of Texas. The theory behind delayed neurotoxicity, more precisely identified as organophosphate-induced delayed neurotoxity, relates to "low level" exposures to organophosphate insecticides and/or chemical warfare nerve agents. This "low level" exposure is theorized as being able to produce chronic neurological symptoms similar to those exhibited in Persian Gulf veterans. The University of Texas study also attempts to link this "low level" exposure and concomitant use of pyridostigmine bromide. We have done an extensive review of the medical literature and available operational data. The Team also studied the Armed Forces Epidemiological Board literature review and report of information on this subject. We have reviewed the CCEP data and consulted with experts within the Department of Defense, federal government and academic research community.
[delayed neurotoxicity slide 2 of 2]
Based on our investigation and the review performed by the Armed Forces Epidemiological Board, current research on this topic concurs with the findings reported on by Presidential Advisory Committee staffers at the June 1996 meeting: there is no current evidence supporting the existence of chronic illnesses derived from exposure to "low level" organophosphate agents and that further research is required. The Team will continue to monitor the progress of ongoing research efforts in this area.
["low level" chemical exposure slide]
To shift gears slightly, the following slides address several case file updates requested by members of your staff. As mentioned earlier in our testimony, there are times when case files are grouped together, all relating to one issue, in this case "Low Level" Chemical Exposure. The case files shown build upon or are supportive of each other. For today's testimony, I will update the chemical and biological warfare facilities and target destruction, the Czech/French detections and the 37th Engineer Battalion: Khamisiyah Ammunition Depot case files.
As we have testified in the past, we are examining the possibility of low level chemical agent exposure from several perspectives. We are examining the possibility that chemical agents were released as fallout from coalition bombing of Iraqi chemical production and storage facilities or by ground force destruction of chemical munitions sites. We are continuing to work closely with CIA in this effort. Air targeting and battle damage assessments of suspected chemical facilities have been compared to post-war UNSCOM inspections of these suspected sites. As CIA previously reported to you, munitions or bulk chemical agents at only three sites were destroyed by coalition forces. These sites are Muhammidiyat and Al Muthanna during the air war and Khamisiyah.
[CBW target destruction slide]
Satellite imagery has been analyzed and since these sites were bombed repeatedly, our efforts are now being placed on identifying the exact day the designated chemical bunkers were destroyed. The Air Force is analyzing over 4000 hours worth of archived aircraft cockpit/gun camera video and attempting to tie this to the UNSCOM data which describes the specific chemical containing bunkers. This is an extensive effort and we plan to keep the Committee updated as to the status of the video analysis. Determining the exact day and time will allow CIA to further refine their modeling of downwind hazards.
[Czech/French detections slide 1 of 2]
[Czech/French detections slide 2 of 2]
As stated in prior testimony, based upon the information available at this time, the available evidence indicates that the Czech detections of 19 and 24 January 1991 are credible. The other Czech and French reports are unsubstantiated, although they cannot be discounted. The reported mustard agent detection of 24 January 1991 still remains unresolved in the absence of any evidence of an attack. Our report on the Czech/French detections is complete and will be released on GulfLink soon.
[37th Engineer Battalion: Khamisiyah ammo depot slide 1 of 2]
Efforts to solidify information on the units located at the Khamisiyah ammunition depot are still ongoing. Through our interview of eyewitnesses and operational unit logs, we have been able to ascertain many of the additional units in the immediate area. CIA has modeled exposure limits for this site. A worst case analysis indicates that a potential agent release from bunker 73 would result in an area of approximately 25 kilometers in a general east-by-northeasterly direction not meeting the safe level of continuous human exposure for 72-hours. After identifying the units who were directly involved in the demolition operation at Khamisiyah, we have contacted over 60 members of the 37th Engineering Battalion and traveled to Fort Bragg, North Carolina to interview key personnel still on active duty. We have enlisted the efforts of an Army Explosive Ordnance Disposal (EOD) specialist who is currently assisting in the analysis of operational records and unit logs of the various EOD teams deployed to the Persian Gulf. This addition of an EOD specialist may also aid in the possible identification of other ammunition storage sites which may have also contained chemical munitions. This case file investigation on EOD activities will be fruitful in clarifying the question of whether or not there are other "Khamisiyahs" existing in the theater of operation.
[37th Engineer Battalion: Khamisiyah ammo depot slide 2 of 2]
We will continue to investigate circumstances surrounding the pit area destruction to determine a more detailed description of the pit and the number of missiles destroyed there on 10 March 1991. This information is important for modeling any agent release during the demolition operations at that site. We will then attempt to identify units which may have been exposed on 10 March 1991. We hope to have this resolved by the end of August.
As you can see, the actual procedures required for each case file are unique to that case. Medical hypotheses, toxicological and conditional investigations require significant reviews of the medical literature. Incident or event investigations, such as Khamisiyah, require substantial resources dedicated to review intelligence and operational records, as well as identifying, locating and interviewing eyewitnesses. Team members have traveled to obtain information on a first hand basis; to Kuwait, to individual units and to technical experts in the fields being investigated. We consult the subject matter authorities, both within the Department of Defense and the civilian sector, to assist us with their expertise or to analyze information and samples.
The Persian Gulf War Veterans' Illnesses Investigation Team is striving to fulfill its mission of identifying the underlying causes associated with the veterans' illnesses. We have tried not to become focused on any one specific issue. If we did, we might miss an opportunity to discover a new and valuable piece of information. This piece of information might be the key to solving the puzzle of Persian Gulf War veterans illnesses. Thank you for this opportunity to present the Team's efforts to date.
[personnel slide]
[thallium exposure slide]
[mycoplasma slide 1 of 2]
[mycoplasma slide 2 of 2]
[CBW facilities slide]