+ + + + +



+ + + + +


+ + + + +


+ + + + +


+ + + + +

The meeting convened at the Ambassador West Hotel, 1300 North State Parkway, at the hour of 9:00 o'clock a.m.

2 I-N-D-E-X


Mr. Burnett 4

Mrs. Burnett 13

Mr. Samuel Ramos 23

Mr. Nick Kresch 30

Ms. Laura Olah 36

Mr. Troy Albuck 51

Ms. Marguerite Barrett 72

Mr. Terry Reese 78

Ms. Kathi Kelly 84

Ms. Penny Pierce 89

Mr. Chris Kornkven 100

Ms. Christine Eismann 108

Lieutenant Colonel Robert Ryczak 114

Dr. Timothy Gerrity 126

Dr. Duelfer 163

Mr. Igor Mitrohkin 176

Colonel David Schreier 217

Mr. Jack Ross 222

Ms. Patricia Campbell 267

Mr. Tom McDaniels 273

3 1 P-R-O-C-E-E-D-I-N-G-S

2 (9:06 a.m.)

3 MR. GABRIEL: As the designated Federal

4 Official for this Advisory Committee, I_d like to call

5 this meeting to order and turn it over to Dr. Lashof.

6 DR. LASHOF: Thank you very much. I_d

7 like to welcome the Committee and the audience to this

8 meeting of the Presidential Advisory Committee. And

9 as is our custom in all of our meetings, we begin with

10 public comment and I think all of the come-in people

11 who_ve asked to come in are here except for the very

12 first person. Sylvia Roberts is not here at the

13 moment. So we will proceed down the line and save the

14 last spot for her, in case she does come.

15 So, if I can ask Tom Burnett to come

16 forward. Our ground rules are five minutes for

17 presentation and five minutes for questions from the

18 panel.

19 As I understand, Mr. Burnett, you_re going

20 to speak and your wife will speak, so that we have two

21 time slots for you.

22 MR. BURNETT: That is correct, thank you.

4 1 DR. LASHOF: Okay. You may proceed.

2 MR. BURNETT: Good morning. I wish to

3 thank all of you for the opportunity to speak today.

4 I am here to tell you about the current health

5 problems that my son, Scott Burnett, is experiencing.

6 Scott is now 29 years old. He served in

7 the 101st Airborne Division of the U.S. Army from May

8 1988 to May 1992. He was deployed to the Gulf in

9 September of 1990. Upon Scott_s return from the Gulf,

10 we noticed many changes in him. He was very nervous,

11 got frustrated easily and had less energy. He

12 suffered from intestinal problems, headaches, muscle

13 and joint pains, shortness of breath, eye problems and

14 night sweats.

15 In October of 1995, Scott was diagnosed

16 with double pneumonia at one of our local clinics. He

17 was admitted to McLaren Hospital in Flint, Michigan,

18 and he was sent from there to the University of

19 Michigan Hospital in Ann Arbor for a heart transplant.

20 He had only between 10 and 20 percent use of his

21 heart. The doctors at the U of M Hospital then

22 decided to use regular heart medications to stabilize

5 1 Scott and to evaluate him later for a heart

2 transplant.

3 We told the doctors and nurses that our

4 son had been in the Gulf War. While they were

5 sympathetic to the situation, nobody seemed to have

6 any answers. We were told that most likely a virus

7 had attacked his heart, causing cardiomyopathy and

8 leading to congestive heart failure. One doctor said

9 that he would be interested in knowing what

10 investigational drugs and vaccines were given to Scott

11 prior to and during his stay in the Gulf. That led us

12 on an almost impossible fact-finding journey. There

13 has been at the least exhausting.

14 We were put in tough with Dr. Garth L.

15 Nicholson at the University of Texas M. B. Anderson

16 Cancer Center in Houston, Texas. Dr. Nicholson told

17 us that there are a large number of members of the

18 101st Airborne Division who were stationed at Base

19 Eagle and Base Echo who were deployed into Iraq who

20 are now very ill. Our son was deployed from one of

21 those bases. However, Dr. Nicholson had no way of

22 knowing this at the onset of our conversation.

6 1 Dr. Nicholson suggested Scott was infected

2 with micoplasma fermentens incognitus and that this

3 organism attacked his heart. He states that there had

4 been many other cases where organisms has attacked the

5 heart also. He also states that the organism can be

6 destroyed with proper antibiotic treatment and that

7 then the heart can heal itself.

8 The soldiers could have been infected with

9 this organism in several ways. Mainly blow back from

10 bombings, scud attacks, vaccine contamination or

11 biological and chemical mine fields in Southern Iraq.

12 After careful deliberations, Scott_s doctors placed

13 him on Doxycyclene on December 22, 1995. His blood

14 samples were sent to Dr. Nicholson for testing. Just

15 last Thursday, we received a tentative positive result

16 from the preliminary tests. We will receive the final

17 results in two to three weeks.

18 The medical tests performed on Scott in

19 January after about a month of taking Doxycyclene

20 confirmed that his heart function had increased to 39

21 percent. He was advised to continue with the

22 antibiotic treatment by the doctors at the U of M at

7 1 Ann Arbor. Scott continues to improve. He remains on

2 antibody treatment at this time. He relapses when the

3 antibiotics are discontinued. He takes several heart

4 medications daily. He sees several doctors on a

5 regular basis. He is starting to regain control of

6 his life. There are several problems with his blood.

7 Excuse me.

8 DR. LASHOF: That_s all right. Take your

9 time.

10 MR. BURNETT: His immune system and of

11 course, his heart. He has within the past several

12 weeks gone back to his job on a trial basis. He gets

13 very tired each day but is very happy to be able to

14 work. I have some tough questions for which I need

15 answers. I feel that this is the place to start

16 asking. My first question to the Committee is what is

17 going to happen after your meetings are completed?

18 Veterans and their families need help from people such

19 as you who have the expertise, the compassion and the

20 experience to run interference and beg for answers.

21 My toughest question is why hasn_t

22 something been done to notify these veterans of the

8 1 problems that they may possibly experience. The

2 Senate, the DOD, the DUE, the National Institute of

3 Health and other agencies have known for years of

4 problems such as mycoplasma fermentens incognitus,

5 biological and chemical warfare, heart problems,

6 cancers, birth defects and many other problems.

7 Senator Richard Shelby reported to

8 Congress in 1994 on the Persian Gulf Syndrome. I am

9 making a direct quote from that report. _This is a

10 serious public health issue. I have been contacted by

11 thousands of veterans throughout the United States

12 and, regrettably, I have received reports of many

13 young men and women who have after initially

14 experiencing these symptoms died from cancers or

15 unexplained heart failures._ End of quote.

16 Senator Donald Reigle of Michigan also

17 reported much information related to the health

18 consequences of the Gulf War in his report to the

19 Senate in 1994. Not much reporting has been done to

20 the vets involved. The Rockefeller Report reports

21 abnormal heart problems with these innoculations. Had

22 my son, Scott, been aware of the problems that had


1 been known to exist for several years, he would have

2 sought more aggressive treatment prior to his

3 pneumonia and would have not had the problems that he

4 has today.

5 I believe that with today_s technology it

6 would not be difficult for the government to contact

7 each of the 700,000 vets involved. After all, we

8 receive a Form 1040 each year and that goes out to

9 millions. And I_m sure we all get those.

10 I have read reports from the May 1st and

11 May 2nd meeting of 1996 of this Committee. I have a

12 question concerning Dr. Russell_s statements

13 concerning mycoplasma fermentens incognitus and the

14 vaccines given to the soldiers. Is it possible for me

15 to receive a copy of that investigation?

16 I question the time frames discussed for

17 research into the Gulf War illnesses. As you are

18 aware, many vets are sick and need help now.

19 Thousands have already died. We do not have three to

20 five years to research. Perhaps more people need to

21 work at this task and perhaps those who need help in

22 the Middle East could help us now at least


1 financially.

2 I have been in contact with the mother of

3 a young Gulf War veteran from our immediate area.

4 This young man supposedly died from a rare brain

5 disease. He, like my son, was the picture of health

6 before going to the Gulf. What is the probability of

7 two healthy young men from the same area who went to

8 the Gulf could both get serious rare illnesses.

9 I have talked to numerous Gulf vets who

10 have had serious pneumonias during the past two years.

11 What is the probability of a young 20 or 30 year old

12 getting pneumonia?

13 In conclusion, we do not know for sure

14 whether mycoplasma fermentens incognitus caused

15 Scott_s illnesses or whether it was a result of the

16 Pyridogistigmine Bromide, the vaccines he was given,

17 the desert sand, the chemical, biological or

18 environmental exposures, or a combination of all of

19 these factors.

20 However, we are totally convinced that his

21 illness is a direct result of something that happened

22 to him during that Gulf War experience. As for

11 1 Dr. Nicholson, he was the only person who gave us much

2 hope where my son_s health was concerned. Although we

3 cannot prove or disprove his theory, it seems to me

4 that he is on to something. He deserves to be

5 listened to and we have the obligation to listen to

6 him.

7 In the past, we have been able to resolve

8 most or all of our own problems. But this is an

9 uphill battle all the way. We, as well as the rest of

10 the country, need your help in resolving this Gulf War

11 Syndrome, as it is called. There are countless others

12 who need your help just as we do. We need medical

13 results and we need it soon. I thank you.

14 DR. LASHOF: Let me ask whether you would

15 prefer for Mrs. Burnett to speak next and then our,

16 save questions, or should we have the questions first?

17 MR. BURNETT: She is going to defer her

18 time to someone else who needs it. I understand that

19 there are some people here who want to speak, some

20 veterans that don_t have a time slot. So we will

21 yield any time that we have left to them.

22 DR. LASHOF: All right. Well, then let us

12 1 proceed with questions from the panel. Are there --

2 any of the members have questions for Mr. Burnett?

3 MS. KNOX: I have one.

4 DR. LASHOF: Marguerite?

5 MS. KNOX: You mentioned that his heart

6 function had improved to 39 percent.

7 MR. BURNETT: That is correct. In the

8 beginning, in November, his ejection fraction was

9 between 10 and 20 percent. After going on the

10 Doxycyclene starting December 22, 1995, he was gaining

11 weight and the doctors thought he was taking on fluid

12 and going back into heart failure. He collapsed in my

13 arms. We had to take him back, excuse me. We had to

14 take him back to the University. At that time they

15 found out that he was dehydrated simply because they

16 had been giving him more and stronger diuretics

17 because they thought that this weight gain was fluids.

18 At that point in time they found out that his ejection

19 fraction had improved to the 39 percent from the 10 to

20 20 percent.

21 They advised us to continue the

22 Doxycyclene. They did not expect my son to improve at

13 1 all. They sent him home to die. And I want you

2 people to ask me questions. Any, please, anything

3 that you want to. We have so much information. All_s

4 we have been doing for the past nine months is reading

5 and praying. Any questions at all. I_m sure there

6 must be some. We have medical people there. And I_m

7 sure that they know what I_m talking about when I tell

8 them what cardiomyopathy with congestive heart failure

9 is nothing more than a label to put on something that

10 they don_t know what it is.

11 DR. LASHOF: Could you describe what his

12 responsibilities were in the Gulf and what he feels he

13 was exposed to there?

14 MR. BURNETT: He was connected with the

15 Air Assault of 101st Airborne.

16 MRS. BURNETT: He was a ground soldier.

17 He went over to the Gulf at the onset in September.

18 He was with the 101st Airborne. They were in the

19 desert most of the time. Before the ground war, they

20 went up into Iraq and they were primed and ready to

21 take Basra. It never happened because the war ended

22 the day before their mission was supposed to take

14 1 place. But somewhere, somehow while he was in the

2 Gulf, I mean, he said the chemical detectors went off

3 all the time.

4 They were stationed right in the desert.

5 He never saw a building, a bathroom, fresh water, for

6 seven months. So, it could -- he said that, you know,

7 even the ground, the sand could have been contaminated

8 or he just doesn_t know exactly what happened to him.

9 But, he was the picture of health before he left.

10 MR. BURNETT: There is nothing in our

11 family history. We have searched both sides of our

12 family. There is nothing that would dictate that he

13 would have to have come down with this disease, which

14 is not a hereditary disease anyway.

15 MRS. BURNETT: He said one night he was on

16 guard duty. And he was out by himself. He said there

17 were not too many others around. He was walking. And

18 he said he heard a tremendous blast, but he never knew

19 what it was. He said it just scared him to death. He

20 said, Mom, I just fell to the ground. I don_t know

21 what it was.

22 We don_t know if it was that incident or,

15 1 we just don_t know.

2 MR. EWING: Was he ill at all while he was

3 in the Gulf?

4 MRS. BURNETT: He wrote -- his letters

5 would come back to me. Sometimes they took a month.

6 And there were times when he had diarrhea, but not

7 often. When he came back from the Gulf, he was one of

8 the first to go. So, consequently, he was one of the

9 first to come back. On our way home from Fort

10 Campbell, that was the first day, the second day that

11 we had seen him. In his truck on the way home, I was

12 riding with him. He just totally lost it. I mean, he

13 just, for no reason at all, just totally lost control

14 of himself and just went spastic, like, just green.

15 And every time just the least frustration.

16 From that time on, and he tries so hard to control his

17 emotions. He can_t. It_s been that way ever since he

18 came back. He_s been, ever since he came back from

19 the Gulf, pushing himself. He was a go-getter. He

20 was the one of our three children that when we ask a

21 question and when we needed something done, Scott was

22 the one. The other two are beautiful kids, willing to

16 1 help, but it was always, oh, no, why me, you know.

2 Scott was always, yeah. Ever since he came back,

3 instead of saying something to the effect, I can_t do

4 that, I don_t feel up to it, he_d just get,

5 physically, or not physically, just get belligerent or

6 frustrated, frustrated more than anything.

7 After he went into the hospital, I went to

8 his home. And he has his own house. He lives by

9 himself. I found probably 12 bottles of vitamins,

10 rejuvenating vitamins, vitamins for senior citizens,

11 all of these different kinds of complexes. But he

12 never told us exactly. We knew something was wrong,

13 but he never admitted, he never in his mind, I_m

14 young, I_m tough, I_m strong. I should be able to do

15 this. And he pushed and pushed and pushed.

16 In October he got so sick he called me, I

17 have to go to the doctor, Mom, I can_t. There_s

18 something wrong with me. And that was it. That was

19 the beginning of the end, you know.

20 MR. BURNETT: One thing we have also been

21 told. Almost every place that we have, government

22 agency, that we have talked to was that my son was the

17 1 only one that they have heard of with cardiomyopathy

2 with congestive heart failure or heart problems of any

3 kind. We have learned, just in the past couple of

4 days, that there are literally hundreds and hundreds

5 of these cases. That just doesn_t jive with us. And

6 I think his improvement is -- at the University of

7 Michigan they claim that he only had a 30 percent

8 chance of improving on his own.

9 MRS. BURNETT: And that was just, they

10 expected some minor improvement. The doctors are

11 flabbergasted. They do not know. They look at Scott

12 and they_ll stand there and they_ll shake their head.

13 They don_t believe what_s happened. They don_t know

14 why he got sick. They don_t know why he_s getting

15 better.

16 The cardiologist is the head of the

17 Cardiac Unit at Ann Arbor. It was such a strange case

18 that, according to my son, and we were there all the

19 time, but sometimes the doctors would come in while we

20 weren_t right in his room. He said, Mom, they_re

21 actually fighting over me. They all want to take care

22 of me. And Dr. Nichols is the one that ended up with

18 1 him.

2 MR. BURNETT: This is Dr. Nichols from

3 Ann Arbor, not to be confused with Nicholson at

4 M. B. Anderson.

5 DR. TAYLOR: Andrea Kidd Taylor. Did your

6 son receive all of the required vaccines? Yes.


8 (Everyone talking at once.)

9 MS. TAYLOR: The other question I had, you

10 mentioned there were others with cardiomyopathy. Do

11 you have a written list, or where did you find your

12 information regarding the others that you know of with

13 cardiomyopathies?

14 MR. BURNETT: I_m sorry, ma_am?

15 DR. TAYLOR: You mentioned that there are

16 hundreds with cardiomyopathies of veterans who served

17 in the Gulf.

18 MR. BURNETT: This Senator Shelby report

19 and just last night I talked to some -- we just met a

20 couple of veterans here. And they tell me that there

21 are literally hundreds of these type of cases.

22 They_re able to apparently talk to these people

19 1 through computers or whatever. We have a computer

2 person in our family, but it_s not myself.

3 DR. TAYLOR: The reason I ask that is

4 because maybe our staff would like that information if

5 you could, if someone could get that information.

6 MRS. BURNETT: Senator Shelby_s report is

7 one document that we_ve taken this information from.

8 MR. BURNETT: That was a direct quote.

9 MRS. BURNETT: That was a direct quote.

10 I spoke to someone in his office and the lady that we

11 talked to said that he absolutely will verify

12 everything that_s in that report, but I have

13 information at home that we received from the Veterans

14 Administration, the DOD, the National Institute of

15 Health. Numerous other agencies and every one of them

16 mentions heart problems.

17 Our son had no heart problem, no history

18 of a heart problem, nothing. We were told just

19 recently, one day last week in fact, there was no

20 viral cardiomyopathy. The tests concluded that there

21 was not a virus that attacked his heart and that_s

22 what we were initially told, the possibility of virus


1 attacked his heart. But for whatever reason the

2 doctors neglected to --

3 MR. BURNETT: To tell us.

4 MRS. BURNETT: -- tell us --

5 MR. BURNETT: It_s not a viral infection.

6 There is some sort of, or something different than a

7 virus. And that is the best information we have at

8 this point, quoting directly from an infectious

9 disease doctor that he is now seeing, who he has

10 started seeing about a month ago. That_s where we

11 found out that he has -- his immune system is way out

12 of whack.

13 Our infectious disease doctor made a

14 statement, I think it was more of a thought than a

15 statement to us, he was thinking out loud in other

16 words, that I think I_ve got you figured out, Scott.

17 MRS. BURNETT: But he didn_t tell us why.

18 MR. BURNETT: He didn_t tell us why. He

19 was going to take some more tests.

20 MRS. BURNETT: Our main problem with Scott

21 was concentrated on his heart. And of course you can

22 understand that. So, we went to cardiologists and an


1 internist since November, since his first admit to the

2 hospital in November. In April, and in March, Scott

3 was real sick. And we didn_t know, I mean, I was

4 getting to the point where I went to his internist

5 doctor and I told him, I said, I cannot sit here and

6 watch my son turn, take a turn for the worst after

7 he_s gotten so much better. I made an appointment

8 myself. I went to the doctor. I said you_ve got to

9 do something, you know, he_s going downhill again.

10 The doctor said, well, I_ll try to get him back into

11 Ann Arbor sooner. So, he did. But he put him on

12 another antibiotic. Within two weeks, Scott popped

13 back. He was back to feeling much better. Now, don_t

14 get me wrong, he_s not normal. He_s got a lot of

15 problems, but better than he was.

16 When we went to Ann Arbor, he was feeling

17 good. He did good on his stress test. I asked the

18 cardiologist, I said, Doctor, why was he so sick a

19 couple weeks ago and what caused that? The doctor

20 said, I don_t know, but it wasn_t his heart. His

21 heart is getting better. That told me that, well,

22 it_s time that we look somewhere else besides his

22 1 heart. We went to the infectious disease doctor at

2 that point.

3 And now, he still has the problem with his

4 heart, but we_re finding out all along, ever since

5 October when he first got sick, his blood tests are

6 way out of whack. None of the doctors, they kept

7 saying, well, he_s anemic. They didn_t do anything

8 about it. They didn_t check into it.

9 MR. BURNETT: He_s been anemic. They_ve

10 been knowing that since November.

11 MRS. BURNETT: Since October. Yeah, the

12 first part of November. But they were ignoring that

13 and concentrating on his heart. He takes nine

14 prescription medicines every day. He is working full

15 time. He_s just push, push, push, but since he

16 started back to work, emotionally he is so much better

17 off. He had nothing for seven months. He_s a young

18 man, 29 years old, he had no money, no income,

19 nothing. We paid, he does have a job with the State

20 of Michigan. He went through his -- but he_s only got

21 a year and a half on the job. He went through his

22 sick and vacation pay, paid his Blue Cross and --

23 1 MR. BURNETT: Left to his own devices, you

2 know. My wife is talking, number one, he would have

3 died.

4 MRS. BURNETT: Right.

5 DR. LASHOF: Thank you very much. I_m

6 afraid we_ll have to move on now.

7 MRS. BURNETT: Thank you.

8 MR. BURNETT: Thank you very much.

9 MRS. BURNETT: Thank you for listening.

10 DR. LASHOF: Samuel Ramos.

11 MR. RAMOS: Good morning, good people. I

12 would like to begin this morning by expressing my

13 appreciation to you for the invitation you extended to

14 me to be here today.

15 I will begin with sharing my service

16 history in the Armed Forces and medical history as it

17 relates, excuse me, as it relates to my service in

18 Vietnam and the Persian Gulf conflicts.

19 My service history is as follows. I

20 served a total of 11 years in the Army and National

21 Guard. While in the Army, I served in the Republic of

22 Vietnam during 1969 and 1970. My service was

24 1 honorable and I was privileged to receive the bronze

2 star. I felt I could offer my services to the United

3 States Armed Forces during the Persian Gulf conflict.

4 I voluntarily joined the National Guard and served in

5 the Persian Gulf from January 1991 through April of

6 1991.

7 I was deployed during the time to Dharan,

8 Saudi Arabia, and King Khalid Military City. Again,

9 my service was honorable and received a meritorious

10 service medal.

11 During my service in the Republic of

12 Vietnam I was exposed to Agent Orange. During my

13 service in Saudi Arabia, scud missiles were blown down

14 by Bakus. One scud missile was within 130 feet above

15 us.

16 The following is a combined analysis of

17 the health examinations completed, done at Washington,

18 D.C. VA Medical Center in June of 1995, United States

19 Air Force Medical Center at Wright Patterson Air Force

20 Base in Ohio in November of 1994. The final

21 diagnosis, all my joints are in deterioration,

22 mechanical low back pain, high frequency sensoral

25 1 hearing loss, a combination of tension-type and

2 migraine headaches, right greater than left carpal

3 tunnel syndrome, chest pain, possible secondary to

4 coronary spasm, major depression, recurrent severe

5 without psychotic features, post-traumatic stress

6 disorder, positional obstructive sleep apnea.

7 From Washington, D.C. VA Medical Center,

8 major depression, idiopathic cardiomyopathy, sleep

9 apnea, gastric ulcer with hylochodoctorpylary, high

10 frequency sensoral hearing loss moderate degree. The

11 diagnoses between the two government agencies concur

12 based on the foregoing information.

13 It is time that not only I but all

14 veterans receive the following. Recognition that our

15 honorable service resulted in medical problems which

16 to date have been denied, thereby resulting in

17 inferior treatment, besides outright denial of

18 officials that we have legitimate medical

19 complications. Two, unbiased medical detection to

20 treat our illness, besides exposure to all information

21 the government has regarding chemicals used by our

22 enemies in the Persian Gulf.

26 1 Three, financial assistance to compensate

2 us for loss of work and inability to work regularly

3 due to illnesses resulting from exposure to life-

4 threatening chemicals.

5 In conclusion, veterans have traditionally

6 waited too long for concise and accurate information

7 regarding service injuries. Compensation has come

8 often too little, too late. This is unlike our

9 attitudes of service when our country calls us to

10 serve. Good people, now is the time for you to act

11 and bring relief to the veterans who served this

12 country. You can give us recognition. We deserve the

13 medical attention our broken bodies need and the

14 financial compensation for us to allow our bodies to

15 rest and heal.

16 I have a letter here from my company

17 commander verifying the scud missiles that we had.

18 Two scud attacks appeared the first night in country

19 and continued five out of the seven nights we were at

20 Kobar Towers. The stress factor of the first week was

21 quite high for the entire unit. At times the scud

22 attacks were a little unnerving. The unit also

27 1 received several scud attacks while at KKMC. The

2 majority of these attacks came without warning. The

3 only warning was hearing the patriot missiles being

4 launched at scuds to intercept them. Usually the scud

5 attacks came at night and no more than two or three

6 scuds were in the attack. We did however receive a

7 severe scud attack that came within 300 yards of our

8 base camp. There were probably six or seven scuds in

9 this attack, and it came in the late afternoon.

10 That is all I have. Thank you.

11 MR. LASHOF: Thank you. Questions from

12 the panel? Elaine?

13 MS. LARSON: So, you_re receiving

14 disability now?

15 MR. RAMOS: No, ma_am. The only thing I_m

16 receiving is 10 percent disability for PTSD. And that

17 was from my, term from Vietnam. I_ve been having

18 problems with the VA trying to receive disability. I

19 have filed for disability in 1991. And yet, to this

20 date, I have not received no answers. I_ve written to

21 my congressman, senators, and nothing has been done.

22 MS. LARSON: You_ve received no answers at

28 1 all.

2 MR. RAMOS: I have received -- the only

3 thing that they tell me is that they have written to

4 the VA and they_re waiting from the VA, answers.

5 MS. LARSON: So you_ve not even been given

6 a denial?

7 MR. RAMOS: I have been receiving a lot of

8 denials, even though, with the medical proofs that I

9 have, I still receive denials. Why, I do not know.

10 MS. LARSON: But your claim is still

11 pending, it_s still open?

12 MR. RAMOS: Yes, ma_am.

13 DR. LASHOF: But did you say that you are

14 receiving disability from your period in Vietnam?

15 MR. RAMOS: Yes, ma_am, which is 10

16 percent.

17 DR. LASHOF: When did you start on that

18 disability?

19 MR. RAMOS: Right after I got back from

20 the Persian Gulf in _91.

21 DR. LASHOF: But it was from Vietnam? It

22 was after Vietnam. Yes, it was after I got back from

29 1 the Persian Gulf. You were not disabled when you went

2 to the Persian Gulf?

3 MR. RAMOS: No, ma_am.

4 DR. LASHOF: How would you compare your

5 experiences in Vietnam with the Persian Gulf, in terms

6 of exposure, stress?

7 MR. RAMOS: From Vietnam, the experiences

8 that I had there were traumatic, a lot worse than what

9 there was in Saudi. But the scud missiles were very

10 unnerving. Not knowing what kind of chemicals they

11 had in there, all the alarms went off when the scud

12 missiles came in, and but, I cannot understand why we

13 have all this sophisticated equipment for detecting

14 and yet, the government denies there was no chemicals

15 used.

16 DR. LASHOF: Did you have any acute

17 illnesses while you were in the Gulf?

18 MR. RAMOS: No, ma_am.

19 DR. LASHOF: Any other questions. If not,

20 thank you very much, Mr. Ramos.

21 MR. RAMOS: Thank you.

22 Nick Kresch?

30 1 MR. KRESCH: Good morning. My name is

2 Nick Kresch. I_m a Persian Gulf veteran. I_m afraid

3 to speak out for fear of losing my service-connected

4 benefits. But I don_t want to let any other veterans

5 go through what I_ve experienced.

6 On December 28, 1990, my ship, the

7 Theodore Roosevelt, was deployed in the Persian Gulf.

8 I was a Master at Arms and responsible for escorting

9 prisoners back to the United States. On January 19th,

10 we arrived at Abu Dabi Airport. On January 20th, we

11 witnessed an air burst, a ring blew and heard the

12 alarms. The following morning I experienced nausea,

13 headaches, tightness in my chest, muscle pain, joint

14 pain, and excessive perspiration. I arrived home

15 January 29th. On February 4th, my children became

16 ill. On February 11th, they were taken to the

17 emergency room and treated for pneumonia. My children

18 and my wife have had many unexplained illnesses and

19 infections.

20 I have been in and out of many hospitals

21 and have many extensive work-ups and experienced very

22 painful testing, but was never tested for biological


1 warfare or chemical sensitivity. The VA and DOD made

2 me their guinea pig. They told me I was the only one

3 having these kinds of problems and said they were

4 stress-related and it would go away. They turned me

5 away from Wadsworth VA, Veterans Hospital, because I

6 could not buff floors for room and board. I was in a

7 wheelchair. My brown hair fell out and returned

8 white. I had rectal bleeding, fibromyalgia,

9 headaches, memory loss, muscles spasms, night sweats,

10 blood in the urine, fever, bleeding gums, and had lost

11 45 pounds.

12 The Veterans Administration had me on the

13 following medications: Morphine, Methadone, Percoset,

14 Demerol, Darvon, Merinol, Vicodin, muscle relaxers.

15 I lost my family, my friends, my good standing with

16 the community, my freedom and even my self-esteem.

17 I was disrespected, humiliated, lied to

18 and harassed by General Blanks_ staff. Treatment of

19 active duty personnel was intolerable at Walter Reed

20 Hospital. People with the same symptoms as I were

21 held in psychiatric ward. Furthermore, while

22 attending a congressional hearing in Washington, my


1 illness worsened. I went to the VA and was told that

2 the only bed that were open were in the psychiatric

3 ward. When I threatened to call the press, they found

4 an empty ward in the Persian Gulf Referral Center.

5 My family and I have stood in welfare

6 lines, food lines and public housing lines. We were

7 denied by VA and Social Security and given red tape

8 runaround for many years. My wife has been seen at

9 Cook County Hospital with similar symptoms for the

10 last three years because she is uninsurable and the

11 state spend down amount is $2,378 per month. All the

12 wives and children deserve the benefit of the doubt

13 and they desperately need the medical insurance.

14 I_ve seen death, physical pain and

15 emotional suffering belittled by the very organization

16 that was supposed to support them, the Veterans

17 Administration.

18 Please ask me any questions, because it

19 was very difficult to put all the horrors of five

20 years into five minutes.

21 DR. LASHOF: Marguerite?

22 MS. KNOX: Now, you mentioned that you

33 1 were fearful of losing your service connection, do you

2 receive VA compensation now?

3 MR. KRESCH: Right now we receive 60

4 percent due to the Gulf War Syndrome and 10 percent

5 due to the broken ankle and was given an

6 unemployability rating. And so we_re, with the VA,

7 even though I_m not able to, it_s their determination

8 what happens. They, you know, it_s not permanent. I

9 mean, this could be taken away just as fast as it was

10 given to me, you know. And we had to wait three years

11 to get that.

12 MS. KNOX: Being in the Navy, did you

13 receive Anthrax from the Botchlanim vaccine and did

14 you take BE tablets?

15 MR. KRESCH: In the Navy, I was on an

16 aircraft carrier and nobody told us what we had. We

17 stood in line. We didn_t get the pills, you know, we

18 were on the ship so we didn_t need them. So, no, we

19 didn_t take the pills.

20 MS. KNOX: And you were on the ship the

21 entire time?

22 MR. KRESCH: I was just going over there,

34 1 I was on land for three days, and that was my extent.

2 MS. KNOX: And where were you when you

3 were on land?

4 MR. KRESCH: I was in the United Arab

5 Emirate and Abu Dabi Airport.

6 DR. LASHOF: So, you didn_t have exposure

7 to sand and fuel, or any of the other exposures that

8 we_ve --

9 MR. KRESCH: No. I was there three days

10 and I left January 21st, before the oil well fires,

11 you know, I wasn_t in the desert. Before any major

12 activities occurred and I was well behind the lines.

13 DR. LASHOF: Are you on medication now?

14 MR. KRESCH: Right now I_m just on muscle

15 relaxers. But, all the other drugs that I was on I

16 had grown addicted to them and am currently going

17 through Alcoholics Anonymous and Narcotics Anonymous

18 to get off that.

19 MS. LARSON: Mr. Kresch, how are your

20 children now?

21 MR. KRESCH: I have two children --

22 MS. LARSON: How are they? They were ill

35 1 when you returned.

2 MR. KRESCH: Right.

3 MS. LARSON: How long were they ill and

4 how are they now?

5 MR. KRESCH: Well, the oldest one is nine

6 now and she_s having problems breathing. They_ve

7 always had infections. I mean, if one would get the

8 flu or a sickness, all of us would get it. It was

9 over and over again, as well as my spouse. And the

10 pediatricians just didn_t know what to do. So, with

11 the baby, we don_t, you know, know what -- we went

12 through the registry. They said the baby had heart

13 palpitations. And the older one had asthma real bad.

14 And so if that answers your question.

15 DR. TAYLOR: These illnesses were all

16 diagnosed after you returned, the asthma and some of

17 the other symptoms that your children are

18 experiencing?

19 MR. KRESCH: Yes. Yeah, because they were

20 born both before the war. The baby was diagnosed just

21 a few weeks ago.

22 DR. TAYLOR: You mentioned, one more thing

36 1 I wanted to ask you about. You_re receiving 60

2 percent disability due to Gulf War Veterans Syndrome,

3 did they give you another diagnosis for receiving the

4 compensation?

5 MR. KRESCH: They gave me the diagnosis

6 of, let_s see, environmental hazards, it wasn_t for --

7 everything on my paperwork says Gulf War Syndrome, but

8 as far as the VA side of the pension compensation,

9 they made it very bland. They didn_t say Gulf War

10 Syndrome, because that would indicate, you know, this

11 was service-connected, you know, for this disorder.

12 For the group of symptoms, the whole group of

13 symptoms. They didn_t break it down to each one,

14 well, he_s got fibromyalgia. He_s got rectal

15 bleeding, blood in the urine, they didn_t break it

16 down like that. They just said, well, here_s 60

17 percent for all of them.

18 DR. LASHOF: Okay. Thank you very much.

19 Next person is Laura Olah.

20 MS. OLAH: Good morning. I want to thank

21 the members of the Presidential Advisory Committee and

22 its Chairperson, Dr. Lashof, for the opportunity to

37 1 offer testimony and recommendations.

2 I am here today on behalf of the Depleted

3 Uranium Network of the Military Toxics Project. The

4 national network of people working near or living at

5 the Depleted Uranium Development manufacturing and

6 testing sites, atomic veterans and Persian Gulf War

7 veterans. And as Executive Director of Citizens for

8 Safe Water on Badger, a community-based group

9 responding to Wisconsin_s Military Toxics, to appeal

10 for the immediate testing and treatment of U.S.

11 soldiers exposed to depleted uranium.

12 Depleted uranium, or D.U., used

13 extensively in weaponry by the U.S. military forces

14 during the Persian Gulf War was used for its superior

15 density. D.U. ammunition was armor-piercing and

16 Abrhams tanks and Bradley fighting vehicles were

17 reinforced with D.U. Remarkably, while the U.S. Army

18 acknowledges firing at least 14,000 rounds or 40 tons

19 of D.U. ammunition in Kuwait and Southern Iraq,

20 American and Allied soldiers were not told they had

21 radioactive bullets in their arsenal. And moreover,

22 were not aware of the hazards and precautions required

38 1 when dealing with D.U. and D.U. contaminated vehicles.

2 When D.U. munitions smash into tanks or

3 other objects, they partially burn, producing uranium

4 oxide dust which is chemically toxic and radioactive.

5 As much as 70 percent of a D.U. penetrator can be

6 aerosolized when it strikes a tank. On penetrating a

7 tank or armored vehicle, a D.U. shell bursts into

8 flames and all but liquefies, searing through the

9 armor like a white hot phosphorescent flare. The heat

10 of the shell causes any diesel vapors in the tank to

11 explode and the crew inside is burned alive. Wind

12 blown particles readily lodge in lung tissue, exposing

13 the host to a growing toxic dose of alpha radiation

14 and capable of inducing cancer and other deadly

15 illnesses. A single microscopic particle of D.U.

16 lodged in the respiratory system is the radiological

17 equivalent of 50 X-rays and can subject lung tissue to

18 8,000 times the annual radiation dose permitted by

19 federal regulators for whole body exposure.

20 Military experts estimate that somewhere

21 between 300 and 800 tons of D.U. debris, mostly

22 particles and small fragments, are still scattered

39 1 around Gulf War battlefields. U.S. Army studies

2 confirm the radioactive properties of D.U. have the

3 greatest potential for health impacts when D.U. is

4 internalized. Equipment contaminated with D.U. oxides

5 becomes a source of contamination when the oxides are

6 resuspended, blown, washed or dislodged during

7 transit. In addition to recovery or maintenance

8 personnel, thousands of ground troops encountered and

9 entered contaminated vehicles and likely ingested or

10 inhaled depleted uranium particles.

11 Ingestion occurs primarily from hand to

12 mouth transfer or from D.U. contaminated water or

13 food, and once inside the body concentrates in the

14 kidneys, liver and bones. Inhalation can occur during

15 D.U. munitions testing, during a fire involving D.U.

16 emissions or armor and when D.U. particles are

17 resuspended by testing or fires. As far back as 1985,

18 Department of Energy tests from M28-9 rounds confirmed

19 D.U. ordinance under severe fire conditions remained

20 in the fire and oxidized to powder rather than being

21 ejected undamaged from the fire, facing significant

22 concerns that exposure to uranium oxides may

40 1 dramatically increase under these conditions.

2 One such fire ripped through the United

3 States ammunition depot in Motorpool on July 11, 1991,

4 setting off a change reaction of explosions at the

5 Black Horse base at Doha, about 12 miles west of

6 Kuwait City. American and British military, as well

7 as the United Nations forces, had bases near Doha.

8 The incident began with an electrical fire on a combat

9 vehicle carrying 155 millimeter howitzer shells. As

10 crew members fought to put out the fire, the vehicle

11 suddenly exploded, pelting soldiers with engine parts,

12 ammunition rounds, phosphorous rounds and shrapnel.

13 The walls of several warehouses used as barracks for

14 American and British soldiers were pierced with holes

15 from flying debris. Waves of explosions which

16 continued for more than four hours incinerated nearby

17 vehicles and tore the roof of the British Headquarters

18 building. One by one, ammunition vehicles, munitions

19 dumps and ammunition storage containers blew up.

20 According to newspaper reports, at least 50 Americans

21 and six Britains were wounded. One American soldier

22 suffered serious brain damage when shrapnel shattered

41 1 his skull. Three other soldiers underwent surgery for

2 abdominal wounds. Six British soldiers from the

3 nearby Saint Georges Lions camp were slightly wounded.

4 As many as 660 D.U. rounds, or the

5 equivalent of 7,062 pounds of D.U., may have been

6 burned in the fire and at least four Abrhams tanks

7 were destroyed. The accident caused the loss of

8 nearly 40 million dollars_ worth of vehicles and

9 ammunition, as well as the loss of several lives

10 during the clean-up operation of scattered munitions.

11 In the end the fires were left to burn out by

12 themselves. Within days DOE, or explosive safety

13 personnel returned to Black Horse Base to begin

14 identifying and clearing out unexploded ordinance and

15 munitions followed by G Troop and other soldiers

16 detailed to clean the area. Nearly 3,000 troops were

17 at the Black Horse Base at the time of the fires.

18 These troops were from the 11th Armored Calvary

19 Regiment, including G Troop Second, First, Third and

20 Fourth Squadrons and the Combat Service Support

21 Squadron.

22 Sadly, the death toll from this fire is


1 still unknown as among the ashes was depleted uranium.

2 Soldiers were again exposed as they returned for

3 clean-up detail, not knowing the risks of D.U.

4 contamination, approached D.U. armored M1-A1 tanks,

5 carried debris and shrapnel with their bare hands and

6 inhaled the toxic dust from the fires and explosions.

7 There is also a significant concern that soldiers

8 stationed at Camp Doha after the fire were exposed to

9 residual depleted uranium, as even today Camp Doha

10 remains an active base.

11 It is now, now that we do know the dangers

12 and the harm, that we can no longer turn away. And

13 for these reasons we respectfully request that here

14 today the Committee and in particular its Chairperson,

15 Dr. Joyce Lashof, make a modest yet earnest commitment

16 to begin testing of those known to have been exposed

17 to D.U. Beginning with the soldiers at the Black

18 Horse Base near Doha, Kuwait. We appeal to you for

19 funding to support in vivo monitoring, or whole body

20 counts, a testing method that has effectively been

21 used to determine the levels of radioactive material

22 in lungs and other organs of workers at D.U.


1 manufacturing facilities and in Gulf War soldiers who

2 were wounded by friendly fire and carried D.U.

3 shrapnel.

4 We also respectfully request a meeting of

5 the Committee specifically dedicated to investigating

6 the potential health effects of D.U. exposure. And

7 here today, Dr. Lashof, we must respond because now we

8 do know the truth. Thank you. Do you have any

9 questions?

10 DR. LASHOF: Questions? Elaine?

11 MS. LARSON: Do you have an estimate of

12 how many people were exposed to D.U. in this fire and

13 in other areas in the Gulf?

14 MS. OLAH: Well, because there have been

15 -- first of all, the military hasn_t even acknowledged

16 that it_s a problem. Any of their internal reports,

17 that was one thing I wanted to bring to your

18 attention. You should also have a copy of the Army

19 Environmental Policy Institute_s report on depleted

20 uranium, which until recently they denied even

21 existed. So that I don_t know. I do know from my

22 research that at least 3,000 soldiers were at Camp

44 1 Doha at the time of the fire. Beyond that I don_t

2 know.

3 Have you guys done anything specifically

4 on D.U.? I mean, I_m not the first person that_s come

5 and talked to you about this. I guess I_m looking --

6 only you get to ask questions.

7 DR. LASHOF: No. Staff have been

8 investigating D.U. and it is on our agenda sometime

9 tomorrow for a report on what they have learned about

10 the D.U. So, it is on the agenda. Therefore,

11 continue to explore this and report to the Committee

12 and others have brought it to our attention.

13 MS. OLAH: Okay. Are you --

14 DR. LASHOF: So, we_re not ignoring it.

15 MS. OLAH: No. No. That_s not what I

16 meant to say. Are you willing to dedicate a meeting

17 to the D.U. issue?

18 DR. LASHOF: I can_t respond to that right

19 now. We will have to review what the staff have done,

20 what questions yet remain and what the rest of our

21 schedule is on a number of other issues we have to

22 look into before our work is completed.

45 1 MS. OLAH: All right. I guess I would

2 also encourage you, I understand there_s open spots

3 and there are veterans here that would like to speak

4 and that we should fill those.

5 DR. LASHOF: Well, we_ll see if we have

6 any open spots. The only open spot we had was one

7 person who hadn_t shown yet, and we_ll move along.

8 We_ll take one more before the break.

9 Kimberly Martin. Is Kimberly here?

10 MS. MARTIN: Good morning Committee

11 members and thank you for letting me have the

12 opportunity to speak to you today. I appreciate your

13 time.

14 My name is Kim Martin. I am a wife of a

15 permanently disabled Persian Gulf veteran. I myself

16 suffer from many different medical problems and

17 symptoms which are very parallel to my husband_s. I

18 spent the complete month of June in Walter Reed Army

19 Medical Center last year under orders from the

20 Secretary of the Army in the care of Major General

21 Ronald Blank and his staff.

22 I was given one free year medical care,

46 1 but they chose to stop seeing me after June. Why, I_m

2 really not sure. I was also given an appointment to

3 be seen by the Department of Veterans Affairs. That

4 was just as big of a disappointment as Walter Reed

5 was.

6 I_ve been diagnosed by private doctors as

7 having chronic fatigue syndrome, insomnia and severe

8 headaches. Walter Reed diagnosed me with somatization

9 disorder and PTSD. I am not and never have been or

10 served in the military. I_m not a veteran and I never

11 was. Only a few doctors at Walter Reed knew that. In

12 1994 to 1995, several bone scans were done. Test

13 results showed focal area of thinning, involving the

14 outer table of the skull just posterior to the vertex.

15 The overlying soft tissue also appeared depressed in

16 this area. This likely corresponds to the indentation

17 which has been detected clinically. Although the

18 erosion of the outer table appears fairly smooth, my

19 breasts are riddled from lumps. I suffer from

20 gynecological difficulties like burning semen after

21 intercourse. I have to sit in a cold bath to relieve

22 the burning, stinging pain. I have talked to many

47 1 wives with the same burning sensation. I am currently

2 taking high estrogen birth control pills to control my

3 hormones and bloating in the abdomen area.

4 Laparoscopy surgery was performed at Walter Reed to

5 lance a cyst on my left ovary and detach and realign

6 my right ovary. My problems have been compared to

7 early menopause, as one doctor put it.

8 My body is not physically the same as it

9 was before my husband returned from the Gulf. Our

10 son, Devon, was born May 1992. After almost dying at

11 birth, four years later he is currently exhibiting

12 symptoms of difficulty breathing, hyperactivity,

13 rashes, painful muscles, high temperatures and swollen

14 lymph nodes all the time. He also seems to have a

15 speech impairment problem. Our six year old daughter

16 is perfectly healthy.

17 After receiving a call about a new program

18 for spouses and children the VA started, I immediately

19 called for an appointment. I was given an appointment

20 on June 7, 1996. I was unable to keep the appointment

21 because of where I was to be tested is over four hours

22 away in Detroit, Michigan. It makes no sense

48 1 whatsoever to drive over, excuse me, it makes no sense

2 whatsoever to drive that far and take that much time

3 for what? It was made absolutely clear that no matter

4 what I was diagnosed with or how severe my medical

5 problems could be I would not be treated. The results

6 of these tests would only be added to my husband_s

7 registry code sheets. I ask you, what good is that.

8 How does that address my medical concerns? I have

9 talked to other veteran spouses that were told to

10 drive as far as eight hours away. How does the VA

11 expect wives who are taking care of sick family

12 members to drive four to eight hours away, leaving

13 them home alone?

14 Talking with other spouses, one thing we

15 have in common is there are medical universities

16 within the range of one hour to two hour drive. For

17 example, I live near a total of three miles from the

18 University of Notre Dame and two hours from Michigan

19 State University. I realize these are not in the 33

20 locations the VA established, but why can_t the 171 VA

21 medical centers across the country find a location

22 near them for us to go to? Why does it have to be

49 1 universities? Why not an ordinary private practice or

2 medical clinics located in our home towns? If the

3 information the VA is looking for is so important to

4 them, why make it so difficult for us to help them get

5 it?

6 Since April 1, 1996, the VA has tested 672

7 spouses and children. They expected to test about

8 4,800, spending $2 million to do it. Their goals

9 cannot possibly be met without compromise. It seems

10 that once again the VA is so close but yet so far.

11 This is salt added to injury in the wake

12 of all we have endured in the past five years and will

13 endure for many more to come. My hopes are that my

14 testimony speaks for all the wives who could not be

15 here today, and will be heeded in the thought and deep

16 consideration. We have already sacrificed more than

17 one can ask for in a lifetime. We need our strength

18 to take care of our loved ones.

19 DR. LASHOF: Thank you very much.

20 Questions?

21 MS. KNOX: I have one. Did the VA offer

22 any travel pay for you?

50 1 MS. MARTIN: No, ma_am, they did not.

2 MS. KNOX: Is your husband on disability

3 or is he working now?

4 MS. MARTIN: No, my husband has been, was

5 rated and judicated in 1993, excuse me, I_m sorry,

6 that_s wrong. August of _94 he was judicated. He

7 suffers from multiple chemical sensitivity, temporal

8 lobe brain damage, cholitis, gastritis, inflammatory

9 bowel disease, Rider_s Syndrome. There_s tests still

10 pending. We_ve had semen testing done. Nobody can

11 explain why the levels in it are out of range. He is

12 above average.

13 MS. KNOX: He was diagnosed by Walter Reed

14 Army Medical Center?

15 MS. MARTIN: I was diagnosed by Walter

16 Reed Army Medical Facility. Brian was diagnosed by

17 Dr. Francis Murphy in Washington, D.C., at the VA

18 Clinic there.

19 DR. LASHOF: Any other questions for

20 Ms. Martin?

21 If not, thank you very much. And I_ll

22 think we_ll take our break now.

51 1 MS. MARTIN: Thank you.

2 DR. LASHOF: And we will resume at 10:30.

3 We will resume at 10:30.

4 (Whereupon a short recess was taken.)

5 DR. LASHOF: I think we are ready to

6 resume.

7 Troy Albuck? I gather you just arrived.

8 MR. ALBUCK: I did. Thank you.

9 DR. LASHOF: All right. You may begin.

10 MR. ALBUCK: Okay. A few years ago, I

11 began a round of testifying because, not only did I

12 get sick after fighting Iraq, but my family began to

13 have some significant health problems as well. We

14 testified in _93 before the House VA Subcommittee for

15 Oversight and Investigation, the Institute of

16 Medicine, the Illinois General Assembly a few times,

17 and then in _94 before the National Institute of

18 Health and a full Senate VA Committee. I stopped

19 after that because there were some clearly negative

20 repercussions that I was receiving from providing

21 testimony about Gulf War Syndrome.

22 Recently, though, I read a newspaper

52 1 article in the Chicago Tribune about what they were

2 calling Bunker 73, and after looking at the article

3 and getting in touch with some contacts I have from

4 where I used to work, which was the Defense

5 Intelligence Analysis Center when I was an enlisted

6 man, I determined that as an officer in the 82nd

7 Airborne Division leading paratroopers in the war

8 against Iraq, I had captured, led the infantry assault

9 and captured the bunker that was being mentioned.

10 The article went on to say that the U.N.

11 had gone back to that location in the fall of _91,

12 determined that Bunker 73 had contained shells, the

13 shell fragments left behind after demolishing them,

14 showed signs of mustard gas and Sarin. It had been my

15 contention after capturing the ammo depot, looking in

16 the bunker and reporting to my commander that these

17 artillery shells look an awful lot like the kind that

18 we would put a binary chemical agent into or leaflets

19 or tactical nuclear weapons, and I really think we

20 ought to make this bunker off limits because I don_t

21 want to know what_s inside of it.

22 I was told that, you know, the 37th


1 Engineer is coming in. They_re going to rig the whole

2 place for demo. I said, well, I_m not certain that

3 that_s a good idea given what might be in these

4 shells. Well, if there_s any chemicals in there, the

5 reply from my lieutenant commander was, they_ll be

6 burned up in the explosion. Again I stated, I_m not

7 certain that it works that way. It turns out that

8 mustard gas and Sarin aren_t flammable and what we

9 probably did was take those shells, full of whatever

10 the agent was, and just make them into smaller pieces

11 of the same agent.

12 After the demolitions were set to go, my

13 infantry unit was withdrawn to blocking positions

14 about three, yeah, three kilometers, which is a little

15 under two miles outside of the depot to prevent people

16 from going in while it was exploding. We had to move

17 another kilometer further out because we were

18 receiving indirect fire from the secondary explosions

19 from inside the depot. You have to understand that

20 this depot was fairly sizable. The reason I led the

21 infantry assault was I had a mounted unit. WE were on

22 humvees with 55 caliber machine guns, automatic


1 grenade launchers and anti-tank guided missile

2 systems. We were uniquely suited to taking terrain in

3 big gulps like that. The depot itself was three or

4 four kilometers on one side and four or five

5 kilometers on the other side, sort of a rectangle.

6 The large earthern berm or read out all the way around

7 it on the top were anti-aircraft machine guns and

8 inside were dozens upon dozens of bunkers filled with

9 various types of ammunition including the bunker that

10 I spoke of.

11 Outside that position in our blocking

12 positions, the shells that were exploding for about

13 96 straight hours after the beginning of the

14 demolition were raining down on top of us to such a

15 high degree that one of my humvees sustained damage

16 including a flat tire. A lot of the soldiers in my

17 platoon took small shrapnel wounds. So I took it upon

18 myself to move a little bit further away and then

19 report my position to the chain of command.

20 When we went to testify before the

21 National Institute of Health, I spoke to the purported

22 Chief of Intelligence for the Middle East, from the

55 1 Defense Intelligence Analysis Center, a man named

2 Dennis Ross, whose first overhead and first bullet

3 said, the Iraqis had no intention to use chemical or

4 biological munitions at any time during Desert Shield

5 or Desert Storm.

6 And of course, I went to the hallway to

7 seriously question Dennis Ross face to face about this

8 because I had been on the ground, unlike Dennis Ross,

9 and had seen these rounds right there ready to go.

10 And could not get anything other than that_s the way

11 it is kind of response about his overhead.

12 Two years later, I_m talking about the

13 same exact issue. I_m saying the same exact

14 sentences. I_m looking at the same puzzled stares and

15 disbelief. And seeing the same old soldiers out in

16 the lobby of the different hotel talking about the

17 same things. We know what we saw. I mean, I_m just

18 a grunt, but I wasn_t born last night. I was there.

19 I saw it. It was on the ground. I questioned it.

20 And when I got sick, I didn_t say that I knew that

21 that_s what it was from, because again, I_m just a

22 grunt. I_m not a doctor. It_s not up to me to figure

56 1 out what kind of rifle shot the bullet. I just raise

2 my hand when I_m wounded. And I knew that I was sick

3 and that my family was sick. And since nobody could

4 figure it out, I had to really look seriously at my

5 service in the Gulf War.

6 Unfortunately, I hadn_t gotten anyone else

7 who can help me in this, like the Department of

8 Veterans Affairs, all their doctors, and the Gulf War

9 Registry and all their computer files, and all the

10 congressmen that I have spoken to and the boards that

11 I_ve testified before to respond and really do

12 something about this. Just say, yeah, you know what,

13 until we can figure this out 100 percent, we have to

14 treat the wounded.

15 I really want for the Department of

16 Defense to pull the shadow on this.

17 DR. LASHOF: Thank you very much.

18 You became ill at one point?

19 MR. ALBUCK: It was about 18 months from

20 my return to Conus. Initially just slowing down and

21 started to mark it up to old age. But as the symptoms

22 began to pile up, it wasn_t a plausible explanation.

57 1 I was covered with red lesions from head to toe, sort

2 of a bullseye shape, red lesion. And I began to swell

3 up to the point where my lips split open and were

4 bleeding because I guess you can only swell up so far.

5 The right half of my tongue swelled up fairly

6 severely. It was swelling my throat shut and my ears

7 and my eyes. And finally when my airway was being

8 restricted by the swelling, I went to the emergency

9 room.

10 I saw my family doctor the next day in the

11 hospital, and he said to me that, you know, he_d only

12 practiced medicine for 40 years and he had never seen

13 anything like that. And maybe I should go to the VA

14 because he thought that I picked it up in the jungle.

15 I previously had been in combat in Panama when we

16 parachuted in to catch Noriega. And he was

17 immediately confused, puzzled, dumbfounded and very

18 eager for me to see someone that might know what that

19 was. And his thoughts were that someone in the VA

20 Hospital might. I went to the North Chicago VA. I

21 spent about two months on a ward there. They really

22 were confused. I began to bleed out of a lot of

58 1 places in my body. Had pretty severe joint pain and

2 muscle aches and couldn_t really walk or move much

3 anymore. Sleep pattern disappeared almost entirely.

4 And had a very difficult time digesting any food or

5 water.

6 They decided to Medivac me to Houston

7 which at the time was the Gulf War Syndrome Specialty

8 Center, but I never really got anything more than

9 Motrin there either. So, you know, no answers were

10 forthcoming. Lots of tests, lots of procedures, but

11 no answers at all. And then Congressman Evans asked

12 me to come out and testify before the House

13 Subcommittee, the VA Subcommittee for Oversight and

14 Investigations which I agreed to do.

15 And that started a round of testimony and

16 hearings and that sort of thing, but never really got

17 anything going for that either. My son was born with

18 a lot of the same symptoms, the same identical red

19 lesions from head to toe, respiratory difficulties,

20 about eight weeks premature, underdeveloped lungs,

21 cranial hemorrhage, bleeding ulcers, calcium deposits

22 on the kidneys. The cranial hemorrhage prevented echo

59 1 so the ventilators eventually blew his lungs apart.

2 So the left lung had to be removed from the lingula

3 up. Lower lobe on the right was totally destroyed.

4 About a dozen pneumothorax, 20 blood transfusions,

5 three cardiac arrests, ran through his entire lifetime

6 limit of medical insurance in 88 days. And the

7 neonatologists who were all very good and the neonatal

8 nurses who were fantastic kept them alive, stood

9 around scratching their heads a lot and didn_t want me

10 in there in their ward because I was covered with red

11 spots and they didn_t know what it was.

12 DR. LASHOF: What is your health now?

13 MR. ALBUCK: I_m in fairly good shape. I

14 still get the red lesions from time to time and feel

15 a little slower than I used to. I think I shouldn_t

16 feel as slow as I do. But, I_ve been working hard to

17 drink a lot of water and not combine foods and not eat

18 much processed stuff and really concentrate on that

19 and exercise a lot. And right now I_m ranked number

20 one on the eligibility list for the Oak Brook Fire

21 Department. So, out of the 612 guys that went to do

22 that, I rose to the top. I tend to be a very average

60 1 individual who just tries real hard. So, I think I_m

2 going to fight through it. My son is fighting through

3 it. He_s disabled, but they_d said he_d be deaf,

4 blind, fail to flourish and probably die within a

5 year. He walks, talks, sees, hears and is doing great

6 in his special education program.

7 DR. LASHOF: I_m glad to hear that. Any

8 other questions? Elaine?

9 MS. LARSON: You said that there were

10 negative repercussions from your testimony. Can you

11 elaborate on that please?

12 MR. ALBUCK: Yes, ma_am. A couple days

13 after we returned from Washington, another family that

14 had been to some of the hearings with us called me and

15 said that their car had been burned and that the

16 incendiaries were placed on the cardboard box that had

17 all the paperwork from the various places that we

18 went, both with the testimonies that we took and the

19 paperwork that we received at the various hearings.

20 And that they were very scared by that, felt it was a

21 message and that they were not going to be available,

22 you know, for us to call anymore because they were

61 1 going to move.

2 The next day I was bringing my son home

3 from physical therapy and he always came home

4 exhausted so I put him right in his crib, went

5 downstairs where I had a computer and fax machine, and

6 kind of did business. And there were a couple guys in

7 my basement and they took me at gunpoint out of my

8 house, through the back door, through the woods, put

9 me in the trunk of their sedan, taped me up, drove me

10 to a cornfield and stabbed me in the back, which

11 punctured my right kidney, and left me in the

12 cornfield. I walked out through a swamp, went to the

13 hospital, the Lake County Sheriff_s Department was

14 very interested for about six hours. The FBI called

15 and said pack up and go home, and they did. And at

16 that point, I went to my house, packed up my family

17 and I left, too.

18 I haven_t spoken to anyone about this for

19 about two years.

20 DR. LASHOF: There was no further followup

21 by any law enforcement?

22 MR. ALBUCK: The only thing I saw was a

62 1 news article in my local paper. The interview was

2 given by the FBI who were never on the scene and they

3 said that obviously I was suffering from post-

4 traumatic stress disorder, which a lot of veterans do,

5 and that it was a very sad thing how we end up.

6 DR. CUSTIS: You seem to have a propensity

7 for being at the wrong place at the wrong time.

8 MR. ALBUCK: Yes, sir.

9 DR. CUSTIS: Are you under any

10 compensation now for --

11 MR. ALBUCK: No, sir. I filed a claim.

12 DR. CUSTIS: Where does it stand?

13 MR. ALBUCK: Well, they noted that I had

14 multiple chemical sensitivity, chronic fatigue

15 syndrome, hives and a bunch of other things that I

16 can_t even pronounce. And that is was obviously not

17 service-connected. And that was basically the end of

18 it. If you don_t, you know, if you cannot

19 service-connect your illnesses then the VA, you know,

20 is not liable.

21 DR. CUSTIS: What time frame was it that

22 you applied for compensation?

63 1 MR. ALBUCK: I went into the hospital, you

2 know, the VA hospital, about 18 months after I got

3 back from the Gulf War. I actually applied for

4 compensation right on, you know, the end of the two

5 year threshold. There_s a two year threshold where,

6 you know, if you get sick, up to two years --

7 DR. CUSTIS: It was within the two year

8 threshold?

9 MR. ALBUCK: I don_t remember exactly, you

10 know, whether I was either on or after, I believe I

11 was after, because if I were before, they should have

12 had to help me out. But, all this other stuff started

13 to come up at the same time. I really just dropped

14 the whole thing and hid my family as best I could.

15 Some of my old soldiers and old commanders really, you

16 know, extended themselves to help us out. And so we

17 kept my family in hiding for about a year and a half.

18 About six months ago, I went back into the work force.

19 I_m a preschool teacher, so I can take my two sons, my

20 three and a half year old who is disabled, my one and

21 a half year old to work with me, so that they_re close

22 to me all the time. It_s a very secure facility


1 because the executives from a major corporation_s

2 children are the ones that are taught there.

3 DR. TAYLOR: You mentioned that your

4 symptoms recur? Are they occurring more often or less

5 and are you receiving, or have you received ever any

6 kind of treatment?

7 MR. ALBUCK: Well, they just kind of limp

8 along, you know. Some days are better than others.

9 Treatment, you know, I_ve gone back to my family

10 doctor on occasion and we_ve tried various different

11 medications for allergic reactions to reduce reactions

12 that, you know, those sorts of medicines. I don_t

13 even know all the terms for them. But nothing really

14 seemed to have a direct effect on this. Any time I

15 had symptoms and there was something they wanted to

16 try, you know, if they knew what it was, if it was

17 just hives, then this would clear it up. None of that

18 stuff never seemed to work the way they had thought it

19 would. So I always felt like it was, you know, it was

20 fairly resistant to the doctor_s attempts to, you

21 know, to clear it up.

22 DR. TAYLOR: I just wanted to clarify one


1 other thing. You were in Conus in Iraq, or where

2 were you located during the times that you felt that

3 you were exposed to chemical agents?

4 MR. ALBUCK: Well, if I am clear on

5 everything, Bunker 73 is within a large ammo depot.

6 I led the infantry assault that initially cleared,

7 secured, inspected and then protected that depot

8 complex. I led an anti-tank platoon, a mounted

9 platoon, and I was attached to a rifle company because

10 they were all on trucks and they wanted some people

11 with weapons on their vehicles to lead them around.

12 So that was what my platoon_s job was was to, you

13 know, lead the way for this team, it_s called a

14 company team when they change platoons around, and

15 they took a rifle platoon away and an anti-tank

16 platoon in, it becomes a company team. My element was

17 a mounted element, you know, uniquely suited for

18 crossing the forward edge of the battle area, which,

19 in our location, Highway 8. We crossed a small canal

20 in the Euphrates River Valley, and then out into this

21 depot just short of the Euphrates and this depot

22 splits right in between this canal and the actual

66 1 Euphrates River, and is also paralleled by Highway 8

2 in Iraq. It_s just southeast of T_Lil Air Base and

3 also southeast of An Nasaria, which is a larger Iraqi

4 city or town.

5 DR. LASHOF: When you identified the items

6 in Bunker 73, oh, any other members of your group

7 identify them with you and did you write up a

8 description in a formal report to your commanding

9 officers?

10 MR. ALBUCK: No. No, I didn_t write

11 anything up. It was simply, you know, the tempo of

12 operations was fairly quick. You know, we got the

13 fragmentary order to secure this ammo depot over the

14 radio. The company commander called officers in to

15 him. He said, okay, here, you need to go to this

16 spot, and I looked at my map, said, well, it_s not

17 tactically sound, but the only route is to go over

18 this canal bridge. That_s the only way we_re going to

19 get these vehicles in there short of, you know,

20 walking all you guys through all this stuff, and, you

21 know, bringing the vehicles up on the road separately,

22 which would take an awfully long time. We_re just

67 1 going to do a movement to contact straight up this

2 high speed avenue of approach and right into the ammo

3 depot, which, you know, in all of our training, isn_t

4 tactically sound, but we had pretty much control of

5 every combat that we entered in Iraq up to that point.

6 When we arrived on the northeast side of

7 the canal bridge, there were some Iraqi individuals in

8 uniform and many that were not in uniform and they

9 appeared to be fighting each other. What we worked

10 out after capturing some of the uniformed individuals

11 and thrashing the rest, kind of sending them on their

12 way, was that they were the guards and administrative

13 staff who had kind of hung around the depot and some

14 looters. And we did find a significant number of

15 looters inside the depot. And the only reason we

16 really cleared them out was because we were going to

17 blow it all up and we didn_t want to, you know, have

18 them get hurt. But then we helped them carry a lot of

19 the small arms ammunition and some of the AK weapons

20 out into the desert. We conducted an AK-47 basic

21 rifle marksmanship because they were conducting a

22 surgency against the authorities that were left in the

68 1 area. And we certainly wanted to help them out with

2 that as best we could. And we gave them, you know,

3 plenty of bullets, a little bit of instruction on how

4 to use the rifles and pointed them in the direction of

5 enemy units and then cleared everyone out of the depot

6 to our radius and then the 37th Engineers was brought

7 in with trailer loads of explosives which they placed

8 at all the bunkers.

9 The complete explosion lasted about 96

10 hours. It began exploding and just kept on with

11 secondary explosions and things coming out of the

12 bunkers, artillery shells, that sort of thing, for a

13 few days. It was quite impressive.

14 DR. LASHOF: We will be hearing more on

15 that.

16 MS. LARSON: I have a question.

17 DR. LASHOF: Yeah. Elaine?

18 MS. LARSON: Would you feel comfortable

19 giving us the name of the chain of command that you

20 reported that information to?

21 MR. ALBUCK: I don_t see why not. The

22 team company commander was Captain Cooper.

69 1 MS. LARSON: Do you have a first name?

2 MR. ALBUCK: First initial was A. It was

3 like 15 letters long and it was Hawaiian. And I

4 really couldn_t even get close to pronouncing it or

5 remembering how it was spelled. But that should get

6 you pretty close. I know his father was a general,

7 maybe a brigadeer or a major general.

8 MS. LARSON: The second thing, has your

9 spouse been ill as well?

10 MR. ALBUCK: She has -- I_ve been out of

11 contact with her since my younger son was about two

12 months old. So, I just have the two boys myself and

13 I really haven_t had any contact with her at all. She

14 was really traumatized by the, you know, the set of

15 events and so, you know, you can hardly blame her for

16 having a difficult time processing all that.

17 MS. LARSON: What led you to believe that

18 the stabbing related to your testimony and do you feel

19 safe now?

20 MR. ALBUCK: It was pretty clear by the

21 incident what it involved. I also was amazed at the

22 difficulty I had at trying to get information on what

70 1 exactly had happened. And I am at the wrong place a

2 lot of the time, but I also am pretty good at getting

3 around things. And I happen to know somebody in the

4 Israeli Council General_s office in Chicago. And I

5 went downtown and I talked to them for a while. And

6 they told me that they cannot help me in this country.

7 But ultimately some information appeared on my

8 windshield one day, under my windshield wiper. And it

9 led me directly to the folks that were involved.

10 It turns out that one of them was an

11 individual who carries cash from here to the Middle

12 East. And in January, after I was attacked, I placed

13 a call, after I was following one of the guys around

14 and he had a trunkful of cash, and he left O_Hare for

15 Lebanon and the Massad picked him up in Israel and a

16 Chicago man was picked up with $250,000 in cash and

17 placed in custody in Israel. So, it was just a really

18 involved and backwards thing that I knew exactly what

19 the guy looked like. When the Israelis helped me out,

20 that_s exactly who it was. I followed him around

21 until he did something bad and then I made sure he got

22 caught doing it.

71 1 MS. LARSON: I_m trying to understand if

2 there is something important or relevant to the work

3 of this Committee --

4 MR. ALBUCK: Other than -- I can guaranty

5 you that the information is going to be slow in

6 coming. You know, we were there at the NIH. We had

7 our information. We knew exactly what we were talking

8 about. And there_s the Department of Defense saying

9 the exact opposite. And there_s the Defense

10 Intelligence Analysis Center, Chief of Intelligence

11 for the Middle East, first lie, first bullet, no

12 possibility that these guys could be sick from that.

13 It_s just, you know, either it_s an

14 extreme case of the right hand not knowing what the

15 left is doing, you know, just some sort of, you know,

16 monumental ineptness, or it_s got, you know, the only

17 other explanation is that there_s just some real

18 disinformation or delaying and downplaying,

19 diminishing of the truth that it_s causing this to

20 happen, where people who are on the ground have vastly

21 different reports of what they encountered from the

22 Department of Defense reports was encountered by us.

72 1 And, you know, it_s hard for me to say because, you

2 know, I was really in this thing. And I was there,

3 you know, there for the duration. And now I have to

4 say stuff that I really wouldn_t want to have to have

5 ever said.

6 DR. LASHOF: I_m afraid we have to move

7 on, but we will be looking further into the

8 circumstances of Bunker 73 and certainly want to be in

9 contact with you further to get additional

10 information.

11 MR. ALBUCK: Thank you for your time.

12 DR. LASHOF: Thank you. Marguerite

13 Barrett?

14 MS. BARRETT: Thank you for giving me the

15 opportunity to speak to you this morning. My name is

16 Marguerite Barrett, and I_m here on behalf of my

17 husband David who is currently a patient at the VA

18 Hospital in Marion, Indiana, and could not be here

19 himself.

20 My husband served in Jedda, Saudi Arabia,

21 for six months and it was shortly after his discharge

22 in August of 1992 that his troubles began. Attachment

73 1 A is a list of the symptoms he has been experiencing

2 since he has been home. It is due to these symptoms

3 that he has been unemployable for the last two and a

4 half years.

5 The last four years have not been easy for

6 David. Instead of going to movies, spending time with

7 friends and spending time with his daughter, who is

8 now four years old, he has been spending his time

9 going from VA Hospital to VA Hospital, trying to find

10 someone who will listen to him so he can find out

11 exactly what is wrong with him. He has had four

12 hospitalizations in the last two and a half years and

13 he is finally at a facility who is taking him

14 seriously.

15 This hospitalization has occurred as a

16 result of the negligent care he received at Lakeside

17 VA Hospital here in Chicago. Attachment B is the

18 letter I wrote to Lakeside_s Director, Mr. Joseph

19 Moore. And Attachment C is the written response I

20 received from my letter. In Attachment C, Mr. Moore

21 states that both David and I were fully aware of the

22 care that was given during this stay. I had asked the

74 1 staff to please keep me informed of things as they

2 occurred, but no one ever called me. And every time

3 I called to see how my husband was, I was treated as

4 if I was overbearing, annoying and had no right to the

5 information that I was seeking. I am not sure exactly

6 what David was told because throughout the entire stay

7 he was kept in a drug-induced stupor. Prior to the

8 Lakeside admission, my husband had problems with his

9 short term memory. The drug-induced stupor caused a

10 complete loss of all of his short term memory.

11 It has been said that joining the military

12 will make you a more responsible person. From all

13 that I_ve seen and everything my husband has been

14 through, the military takes independent and

15 responsible people and reduces them to shells of their

16 former selves left to be cared for by their families.

17 Our situation has gotten so severe that I have had to

18 take charge of our household and am in the process of

19 being made power of attorney over David_s legal,

20 financial and medical affairs.

21 Despite all of this the VA feels that our

22 situation does not warrant an increase in my husband_s


1 30 percent disability. How sick does an unemployable

2 veteran have to be before assistance can be granted to

3 help take care of his or her family? And what does it

4 take for a veteran to be treated with the respect that

5 they deserve? Thank you.

6 DR. LASHOF: Thank you. Any questions

7 this Committee would like to direct?

8 What is your husband being treated for now

9 in the hospital in Marion?

10 MS. BARRETT: For the longest time when he

11 was going to the different VA Hospitals all they were

12 addressing was the depression that he was going

13 through and they were just trying to treat him with

14 the drugs. He is just now, after almost four years,

15 just now getting a physical, as far as trying to

16 address the physical symptoms that he_s been going

17 through.

18 When he came home from Saudi Arabia, my

19 husband weighed 150 pounds and he is six foot two. He

20 is now down to about a little under 130 pounds and he

21 has not been able to maintain any weight whatsoever,

22 no matter what he eats.


1 DR. LASHOF: Can you tell us anymore about

2 the treatment he is actually receiving now?

3 MS. BARRETT: While he was at Lakeside, he

4 was given medication. He asked for therapy. He was

5 not given any therapy. They were talking about

6 putting him through a PTSD program. He has yet to be

7 put through one. He has been asked to be put through

8 a stress treatment program. They_re just now talking

9 about putting him through one. While he was in

10 Lakeside, he was given medications that clashed with

11 each other and caused him to get into a very violent

12 state. Since we took him down to Marion VA, in

13 24 hours his total demeanor has changed and he_s never

14 had any experience of any violence before he was taken

15 to Lakeside. At Lakeside, the only response they had

16 to his violent rage was to strap him down. I mean,

17 they didn_t try to figure out if it was a clash in the

18 medications he was given or anything like that. He_s

19 just now being checked. They_re just now checking to

20 see if he can be put into a stress treatment program

21 and a PTSD program.

22 DR. LASHOF: Thank you.

77 1 MR. CROSS: Is the disability he_s

2 getting, is that for his medical symptoms or his

3 psychological symptoms?

4 MS. BARRETT: I think it_s for his

5 psychological symptoms. This is just now the first

6 time anybody has listened to his physical symptoms.

7 Before they just gave him drugs. But now, he_s just

8 now -- they_re just now starting to listen to his

9 physical symptoms and being willing to give him a

10 complete physical.

11 MR. CROSS: And he is at a VA Hospital

12 now?

13 MS. BARRETT: Marion, Indiana.

14 MR. CROSS: How far is it a drive for you

15 from where you live to there?

16 MS. BARRETT: Two and a half hours.

17 MS. KNOX: You_ve had a child since the

18 Gulf War. Is that child healthy?

19 MS. BARRETT: So far, yes. And his

20 daughter from his previous marriage has been,

21 thankfully, very healthy.

22 DR. CUSTIS: Where is your home base?

78 1 MS. BARRETT: Mishawaka, Indiana.

2 DR. CUSTIS: How did you wind up in

3 Marion?

4 MS. BARRETT: Because when my husband was

5 stationed at Grissom Air Force Base, that was the

6 closest VA facility. And after he was discharged from

7 Grissom Air Force Base, he had married somebody who

8 lived close to there and that_s where he lived. So

9 when he moved back up to Mishawaka, he continued the

10 treatment there at Marion because that was the only

11 facility where the doctors knew him and knew his case

12 history.

13 DR. LASHOF: Thank you very much. I

14 appreciate your coming. Terry Reese?

15 MS. REESE: First of all, I would like to

16 thank the Committee for letting me speak on today and

17 thank the other Gulf War veterans and their families

18 for the support that they_ve given us.

19 I just want to start out by saying that

20 there_s not a day that goes by that I don_t stop

21 wondering when is this all going to end and why did it

22 begin? Is it worth it? The people said that history

79 1 tends to repeat itself. And if it_s true, why can_t

2 we utilize the experiences from the past as a stepping

3 stone for the future. Everyone remembers the big deal

4 with the Agent Orange incident and how long the

5 process took for us to rectify the problems with that.

6 And the U.S. is spending billions and billions on

7 machinery, weapons and chemicals. Why can_t we demand

8 that the women and the families that put their lives

9 on the line day in and day out get the support that is

10 needed for them? There_s been reports of babies being

11 born with defects, muscles and nerve abnormalities,

12 arthritis, skin rashes, hair loss, chronic fatigue,

13 weight losses, headaches, and many, many more symptoms

14 that people have been coming up with, and still there

15 is no answer. There has to be something.

16 And I never felt more angry than when I

17 was being seen by a physician and I was told that

18 everything I was going through was normal. That was

19 when I was 25. I don_t know too many 25 year olds

20 that wasn_t in the Gulf War that are going through

21 these things that I_m going through so I don_t know

22 how it could be normal.

80 1 When I was told that they could not find

2 what was wrong with my muscles and nerves, I had two

3 abnormal EMGs that was done, physical medicine, at

4 Fitzsimmons in _93 out in Denver, Colorado, and they

5 told me to follow it up with the VA once I was out of

6 the military after active duty, it seems like a slap

7 in the face to me if they cannot deal with the issues

8 while I was on active duty. What_s the purpose?

9 Just, excuse me. Just think if I was to wait to join

10 the military after the Gulf War, I wouldn_t have to

11 deal with these issues either.

12 I think this is very sad that a lot of

13 people are going through the things that they_re going

14 through and we cannot get the support from the VA_s or

15 the active military from the Department of Defense.

16 Now, I_m currently going through the process of going

17 to the VA in Battle Creek and it_s pretty much the

18 same thing. I have to travel two and a half hours to

19 go see a doctor for 15 minutes in one day. And I have

20 a family and a wife and two children to support. And

21 it_s really hard. And I just don_t know what to do

22 anymore. There_s days that I don_t know if I_m coming

81 1 or going. Short term memory loss, and stuff like

2 that. I live in Niles, Michigan, and I grew up there

3 all my life up until I was 18 when I joined the

4 military. I left in 1987. And I just moved back

5 there currently in January, and it seems really weird

6 when you wake up from day to day and you can_t

7 remember the places that you grew up at or the faces

8 that look familiar but you can_t remember the names.

9 And that_s all I have to say. I_ll take your

10 questions now.

11 DR. LASHOF: Any questions on anything the

12 Committee has for Mr. Reese?

13 MS. LARSON: What did you do in the Gulf

14 War and how long after the war did your symptoms

15 start?

16 MR. REESE: When I was in the Gulf War, I

17 was with the 24th Infantry Division. I was working as

18 a 31 Kilo, which is communications. We used to run

19 telephone lines and stuff like that. And we would go

20 out and do long distance radio checks and

21 communications with the radios.

22 When I shortly returned, it was in, I

82 1 think January of _92 that I started noticing problems

2 with my skin. I had went to a physician when I was

3 down in San Antonio going through an AIT course down

4 there. And my skin was really dry and it was like

5 cracking in spots real bad. Anytime I moved my arms

6 and stuff like that, the skin would just open up and

7 it would start bleeding sometimes. The only thing

8 that really worked for that, they gave me some steroid

9 cream, it_s called a west pore. And I used that for

10 like about eight months. And my skin is really

11 irritating now. I can_t use anything that has alcohol

12 in it as far as like regular lotions and stuff like

13 that. I_ve been using a Eucerin lotion and I can_t

14 use any cologne or anything. If I just put it just on

15 my hands, it just makes my eyes start watering and

16 it_s very irritating.

17 MS. LARSON: It was about a year after?

18 MR. REESE: Right. Somewhere within six

19 months to a year after I had came back. I started

20 noticing that and I had real bad cases of diarrhea and

21 stuff like that. They said I might have a lactose

22 tolerance problem, but they can_t really figure it

83 1 out. They can_t pinpoint what it is.

2 DR. LASHOF: Any other questions?

3 DR. TAYLOR: Are you working now?

4 MR. REESE: I_m currently working as a

5 home car, as part of a nursing association. And I do

6 that part time. I work about maybe 16 to 20 hours a

7 week. But whenever I go to work, if I work like an

8 eight hour day and I come home, it_s like my body goes

9 through a complete shutdown and I can sleep from like

10 10 to 12 hours and I wake up and I_m still tired that

11 whole day. And I never was like that before. I used

12 to play basketball and baseball, everything like that.

13 If I get out on the court and try to play basketball

14 now, I run up and down the court two or three times

15 and I_m dead dog tired. I just can_t do it anymore.

16 MR. CROSS: Are you presently getting

17 compensation at all from the VA?

18 MR. REESE: No. When I got out of the

19 military, at first I had moved down to Florida and I

20 was down there for about four months. And I started

21 the process down in Pinellas County. And things got

22 a little hard, so I moved back up here so I could be

84 1 with my family and get support from them.

2 And I_m currently trying to get the

3 process going with Battle Creek, but I_m still waiting

4 on the records to come from the Florida station.

5 DR. LASHOF: Okay. Thank you very much.

6 We appreciate it.

7 MR. REESE: Thank you.

8 DR. LASHOF: Kathi Kelly.

9 MS. KELLY: I_d like particularly to thank

10 Mr. Miles Ewing for allowing me to testify today. I

11 don_t have any record of United States military

12 service. I was a civilian in Iraq during the Gulf

13 War. I went to Iraq. I flew into Baghdad on one of

14 the last civilian planes that went into Baghdad. And

15 from January 15th until the 29th of 1991, I was in a

16 camp on the border between Saudi Arabia and Iraq on

17 the Iraqi side. And so, like so many of you, I saw

18 the bombers going overhead. I heard many, many, many

19 explosions. But perhaps, unlike you, when I was

20 evacuated to Baghdad on January 31st until February

21 4th and staying in a very well fortified bombing

22 shelter, I was in the underground area huddled

85 1 together with parents and their children. And I held

2 children in my arms. I played with them in the

3 daytime but sometimes held them at night. And I saw

4 their parents, themselves shaking with fear, and

5 trying to soothe the children and say things would be

6 all right when there was certainly no guaranty for

7 that.

8 I was then evacuated to Amman, Jordan. I

9 spent some time in mid February in a refugee camp just

10 outside of Iraq. And there I most clearly remember

11 sharing just the tiniest portions of food with very

12 hungry and very frightened displaced children. And

13 then again, in March of 1991, I returned to Iraq and

14 I went to the Ammaria shelter, the site of the bombing

15 there.

16 And so today it_s very clear, I hope, that

17 the competency and the composition of this Commission

18 says that all of you are willing to say to the people

19 here that something did happen during the Gulf War,

20 that these people were there and that they did sick.

21 And hopefully, the intent now is to say that nobody_s

22 asking questions to try and see, well, who_s to blame


1 and are we responsible to do something about it, but

2 rather to acknowledge that the government of the

3 United States has the resources to do something about

4 has happened. And that when a government chooses to

5 go into a war, that government is by all means

6 responsible for the consequences of that warfare.

7 And it certainly is my hope that the agony

8 and the frustration and the panic and the pain and the

9 fear that all of you have felt will begin to be

10 redressed and in some measure you can be compensated

11 and be restored to happiness and health.

12 I mainly speak to you, the Gulf War

13 veterans, and I ask you out of that space of real

14 terror and unhappiness that you_ve experienced that

15 you might extend a hand of friendship to the Iraqi

16 children, to the Iraqi families, to the Iraqi

17 civilians. For them the war has simply never stopped.

18 It_s been an ongoing war. A most terrible warfare

19 comprised of economic sanctions.

20 I went back to Iraq in March of 1996. And

21 again, held children in my arms, and I_m really

22 certain that the baby I held for 15 minutes didn_t


1 survive that day. And that is one of 567,000 children

2 who have died since the imposition of sanctions in

3 August of 1990.

4 Those children bear no responsibility for

5 their government. Children under five, like our own

6 children, simply cannot control their governing

7 forces. And yet, because of the terrible corrective

8 punishment, they_ve been called upon to pay the price.

9 And they paid a very terrible price. Children

10 continue to suffer from malnutrition, stunted growth,

11 starvation. The death rate continues, as high as

12 10,000 per month.

13 We recognize that our government has

14 responsibility for the Gulf War veterans, I don_t

15 think that any of us is thinking people can simply

16 say, well, it_s Saddam Hussein_s fault. His

17 government bears responsibility for the people who

18 suffer there. And as we recognize that each of these

19 people has a right to decent and complete medical

20 treatment, mustn_t we also recognize that the people

21 in Iraq today, because of the sanctions, can_t get

22 medicines, can_t get spare parts to repair the

88 1 equipment that they once had, and that civilian people

2 continue to pay a terrible price.

3 And Dr. Custis, you said that, and

4 Mr. Arbuck perhaps said that the propensity to be in

5 the wrong place at the wrong time. Surely we can_t

6 say that a whole nation of children are in the wrong

7 place at the wrong time. And so I simply beg of you

8 to keep in your commissions here, and in your

9 professional competency, a recognition that there are

10 in fact many different veterans of that war. And that

11 they suffer most atrociously. And may we all be

12 haunted by those questions. Thank you for your

13 attention.

14 DR. LASHOF: Thank you. In what capacity

15 had you gone to Iraq originally and returned?

16 MS. KELLY: Dr. Lashof, I was part of the

17 international group called the Gulf Peace Keeping.

18 I_m afraid we couldn_t have been more irrelevant in

19 terms of stopping the war. We hadn_t anticipated that

20 it would be an air war initially, and we were on the

21 ground in a bordering camp between Saudi Arabia and

22 Iraq. And we reconstituted ourselves after evacuation

89 1 to try to ride along the roads that were being bombed.

2 By bringing in medical relief supplies, which were

3 very paltry, we mainly hoped that we might safeguard

4 the roads so that people who were refugees and needed

5 to flee, or people who were bringing in humanitarian

6 relief might be able to travel with some measure of

7 safety on those roads.

8 DR. LASHOF: Thank you very much. Are

9 there any questions that any member of the Committee

10 has?

11 MS. KNOX: Have you had any illness

12 yourself since having been present in the Gulf?

13 MS. KELLY: No.

14 DR. LASHOF: Thank you very much. We

15 appreciate you coming forward.

16 Penny Pierce.

17 MS. PIERCE: And I, as well, thank you for

18 the opportunity to speak today. I_m speaking as a

19 scientist who completed several studies of women who

20 served in Desert Storm.

21 And as you_ve heard in previous testimony,

22 the Gulf War posed unique threats on our fighting

90 1 forces, but I_m here today to remind all of us that a

2 large majority of those fighting forces were women.

3 Yet, there_s been a lack of attention to assessing if

4 there are long term outcomes of toxic exposure common

5 to the combat scenario that may pose particular and

6 specific threats to women_s health.

7 Since the end of the war, there have been

8 increasing concerns about the possible health effects

9 for both men and women, and yet there_s been little

10 systematic research devoted particularly to the women

11 who were deployed at this time in unprecedented

12 numbers. To my knowledge the two studies I_ve

13 conducted to date with my collaborator, Dr. Vinniker,

14 at the Institute for Social Research at the Institute

15 of Michigan are the only randomized studies focusing

16 solely on the health effects of service in the theater

17 on women_s health. These studies were conducted with

18 the support of the Tri-Service Nursing Research

19 Program and we_re most grateful to them for their

20 continued support.

21 In the first study we selected from the

22 Data Manpower Center tapes of all people who served

91 1 during that time. A stratified randomized sample of

2 525 women from both active guard and reserve forces.

3 We had a group that were deployed to the Gulf and a

4 comparison group that were deployed during the same

5 time but deployed elsewhere. We also conducted a

6 followup study two years later. The initial study was

7 done in 1991 to _93 and our followup study was in

8 September of _94 to August of _95.

9 We again measured the health status of

10 this same sample of women. In this followup study we

11 were looking to see if the physical health findings

12 that were reported in the first year of the study were

13 limited to that initial time of readjustment or if

14 they did continue for an additional period of time.

15 It_s important that you know that in the

16 first study we asked the respondents to report all

17 conditions or symptoms for which they had sought

18 medical services during their entire career, which

19 was an average of about ten years for this group. And

20 results comparing the ratings of both their general

21 health as well as gender specific health problems

22 indicated there were absolutely no differences between

92 1 those deployed to the Gulf and those deployed

2 elsewhere on any of these baseline symptoms.

3 Therefore, the women that were deployed to the theater

4 and those deployed elsewhere were equivalent in terms

5 of their prior physical health.

6 When we analyzed problems based on the

7 length of time in the theater, we found very

8 significant findings. By the way, the average length

9 of time was about 120 days in theater. Among the

10 general health problems, there were significant

11 differences in the first survey in reports of skin

12 rashes between women who did not deploy to the theater

13 and women who were in the theater over 120 days. So,

14 there_s some indication that the length of exposure is

15 important.

16 There were significant differences in

17 findings of depression between those deployed

18 elsewhere and those deployed less than 120 days in the

19 Gulf. Unintentional weight loss was another symptom

20 that was significantly different between these two

21 groups. And reports of the frequency of insomnia was

22 also significantly different. Headaches was another

93 1 symptom that was also significantly different in these

2 two groups.

3 Health problems in general were higher for

4 those that had served in the Persian Gulf region and

5 ratings were highest among those that reported they

6 were no longer in the military, and presumably some

7 had left the military due to health reasons.

8 When we conducted the followup survey two

9 years after the first and four years after the war, we

10 found a different display of symptoms with the

11 exception of skin rashes, which did persist among

12 those who had served in the theater. Remember the

13 first year survey reported depression, unintentional

14 weight loss and insomnia. These were no longer

15 statistically significant. However, the reports of

16 cough and respiratory problems did persist in this

17 four year period. Also, reports of memory problems

18 persisted and for some they worsened.

19 So, returning again to the initial survey,

20 there were no differences in the two groups on gender

21 specific health issues which reported reproductive

22 issues as well as gynecologic issues in these women.

94 1 However, when the same group was measured two years

2 later, again there are striking differences between

3 those deployed to the Gulf and those that were

4 deployed elsewhere. We found significant differences

5 in reports of lumps and cysts in the breast and

6 findings of abnormal pap smears, which were actually

7 a two and a half fold increase over the two year

8 previous findings.

9 In summary, these results indicate to us

10 as scientists that there is sufficient evidence to

11 warrant further study of the group of general health

12 symptoms that include rashes, depression, cough,

13 fatigue, unintentional weight loss, insomnia,

14 headaches and memory problems. Within our group, it_s

15 a small group, it_s clustered in about 8 percent, if

16 you look at those who report these as severe problems.

17 We need to look much more closely for other

18 explanations for the vague configuration of symptoms,

19 despite the fact that they do not fit into existing

20 diagnostic categories.

21 We need vigilant followup and care of

22 those that are no longer in the military, since it

95 1 appears that poor health following the Gulf War may

2 have been a contributing factor to their leaving the

3 military and perhaps they_re in the VA system, but I_m

4 pessimistic about that.

5 The incidence of gender specific health

6 problems in particular warrants further attention.

7 And points directly at some of the unique health care

8 needs of military women. Specifically, we need

9 rigorous followup on the significant findings

10 concerning these changes in breast lumps that have

11 occurred over time as well as cervical alterations

12 that are reflected in this two and a half fold

13 increase among women who served in the Persian Gulf.

14 We need to know if there are gynecological

15 reproductive problems that pose a risk to future

16 generations.

17 The opportunity to study health

18 consequences of Persian Gulf women in a timely fashion

19 meets a very long and critical need. I_ve offered for

20 you several priorities. First, I think we should

21 commit the needed resources to establish, if nothing

22 else, the prevalence of these health problems among

96 1 Gulf War veteran women and men alike in very well

2 defined epidemiologic studies.

3 Second, we need to document and monitor

4 the health effects of occupational and environmental

5 stressors that are typically found in combat, to

6 better understand the effects of these on gender,

7 menstrual cycle, reproductive capability, and perhaps

8 the interaction of these factors on the health and

9 well being of American women who serve their country

10 in uniform.

11 The third priority acknowledges that women

12 play a key role in the military readiness of this

13 country, and keeping them healthy is as vital to our

14 nation_s defense as any other member. And it_s time,

15 particularly given findings of scientific studies like

16 this one and hopefully others, that this attention

17 will be given to better pre-deployment health

18 screening of women, improved gender specific health

19 care to women in deployed locations and better

20 surveillance and treatment of health problems in the

21 post-deployment period. Thank you very much for your

22 time and attention this morning.


1 DR. LASHOF: Thank you very much. Have

2 you submitted to staff the data from your paper?

3 MS. PIERCE: I believe Miles has the

4 paper.

5 DR. LASHOF: Okay. Thank you. Other

6 questions?

7 MS. LARSON: Has this study been

8 published?

9 MS. PIERCE: The papers are in review

10 right now. I_ve offered a pre-publication draft of

11 papers.

12 DR. LANDRIGAN: Was your sample a national

13 sample?

14 MS. PIERCE: It was drawn from the

15 database provided by the DMDC, randomized, stratified,

16 according to active duty guard and reserve, those that

17 were deployed to the Gulf, those deployed elsewhere

18 and also on parental status. So, it was like a three

19 by nine.

20 DR. LANDRIGAN: And what was your response

21 rate from each of those groups?

22 MS. PIERCE: The first was very high. It


1 was around 93 percent. By year four, because of the

2 movement, in part, of this population, it was 87, 88

3 percent. Very high response rate.

4 DR. LANDRIGAN: And when you calculate

5 those rates, your denominator is the full 525?

6 MS. PIERCE: Right. You have --

7 DR. LANDRIGAN: Was it questionnaires on?

8 MS. PIERCE: We started with the telephone

9 interviews with the Institute of Social Research. So

10 women were contacted personally. There were a series

11 of questionnaires in each round of surveys and one

12 went to their significant other that also reported on

13 health effects.

14 DR. LANDRIGAN: Thank you.

15 MS. PIERCE: Mm-hmm.

16 DR. BALDESCHWIELER: Did I understand that

17 there were 525 in each branch of the study?

18 MS. PIERCE: No. That was total. That

19 was just a sample size based on the measures we were

20 using.

21 DR. BALDESCHWIELER: And do you have some

22 sense of the consequence which you have significant

99 1 finding with respect to breast lumps, for example?

2 MS. PIERCE: I can give that to you.

3 MR. EWING: Staff has all the tables done.

4 And we_ll make them available to the whole Committee.

5 MR. CROSS: In this questionnaire, were

6 there any questions about care or services offered by

7 the VA, whether it was positive, negative, in terms of

8 these women?

9 MS. PIERCE: Yes. Actually one of the

10 things I was interested in as a nurse-scientist was if

11 people sought care for some of these symptoms. And if

12 they did, where did they go and what was their

13 satisfaction with the care they received.

14 It_s difficult to disentangle because of

15 the large number of guard and reservists. Those

16 people reported that they went to a civilian doctor.

17 And the highest satisfaction was with the civilian,

18 next was with active duty and the lowest satisfaction

19 rate is with the military, with the VA, excuse me.

20 But that_s in part because they_re small numbers, too.

21 It seems that people, particularly women,

22 are not using VA facilities.

100 1 DR. LASHOF: Any other questions? If not,

2 thank you very much. We appreciate your testimony.

3 Chris Kornkven had asked to present again.

4 We have five minutes left, Chris, and you can have

5 that. Even though you have presented in the past, I_d

6 appreciate it if you would limit yourself to five

7 minutes.

8 MR. KORNKVEN: Thank you, Dr. Lashof. I

9 also understand others have provided testimony in the

10 past more than once. I appreciate the opportunity.

11 My testimony today will provide a single

12 person_s perspective in seeking health care from the

13 Department of Veterans Affairs. I have been seeking

14 treatment at the Oklahoma City VA Agency since early

15 1992. And stopped seeking treatment from the VA

16 medical system in February, 1996. During this period,

17 the following items have been discovered and were

18 reported to the VA.

19 I have reported blinding headaches for

20 more than a year with only offers of aspirin.

21 Eventually, an MRI was reluctantly performed in which

22 a nasal mass was discovered. There has been

101 1 absolutely no treatment to date. I have reported

2 memory loss since returning from the Gulf. This has

3 been dismissed as a result of stress with no other

4 attempts at finding the cause or other treatment.

5 I have reported skin problems since

6 returning. After a skin sample was taken of many

7 brown spots that have been appearing, I was told,

8 _It_s not skin cancer yet._ And I could _come back as

9 needed._ There has been no further treatment to date.

10 I have reported problems breathing and

11 have had instances of pneumonia and bronchitis since

12 returning. I have been questioned by VA doctors about

13 whether I have ever had surgery on my chest with no

14 explanation. Other than antibiotics for the pneumonia

15 or bronchitis, the only other attempts at treatment

16 have been frequent chest X-rays.

17 I have reported intestinal problems that

18 include diarrhea for more than a year before a strange

19 type of bacteria was found. I was given a two week

20 course of antibiotics in which the symptoms receded

21 somewhat. When the symptoms returned worse than

22 before, I reported this to the VA for more than

102 1 another year. During this time I also reported having

2 rectal bleeding. I was eventually given an

3 appointment in which the bleeding was described as

4 hemorrhoids after no examination.

5 When the doctor found no evidence of this

6 in my medical records, he continued to dismiss the

7 problem until I insisted something be done. By the

8 time I left Oklahoma months later, a followup still

9 had not been performed. This bleeding continues.

10 I have reported joint pain for many months

11 and have been given a followup to see a rheumatologist

12 in 1994. To date I have yet to see a rheumatologist,

13 and the joint pain has been dismissed as fibromyalgia.

14 No other treatment other than Motrin has been given.

15 I have reported my wife and I having a

16 miscarriage in which the fetus had to be surgically

17 removed. And my semen burning her. There have been

18 no attempts at finding the cause of either other than

19 mysterious questions asked by some doctor from the

20 Houston VAMC.

21 Other blood and urine samples have shown

22 glaring abnormalities with no attempts to discover the

103 1 problem. I have been told of these abnormalities

2 months after the sample was taken. I have requested

3 over several months that a urine test for depleted

4 uranium be performed. After many excuses and attempts

5 to ignore this, I finally was successful after

6 requesting congressional help. After waiting the

7 period needed for the results, I began inquiring about

8 them from the Chief of Staff. Three months went by

9 during which I was told they had called the Baltimore

10 facility performing the test, left messages, but

11 Baltimore would not return their phone calls.

12 I called the Baltimore facility, spoke

13 with the doctor overseeing the testing and had him fax

14 the results. During the conversation I was told, _I

15 had a higher D.U. count than those carrying around

16 fragments in them._ I was also told there was nothing

17 for me to worry about and that I probably got it from

18 the drinking water where I live. I believe the

19 Environmental Protection Agency would be interested in

20 hearing that one.

21 I understand D.U. contamination may cause

22 kidney problems. I have been questioning for many

104 1 months as to whether this may be the cause of the

2 urine abnormalities, but they have been unanswered.

3 I also question if this may cause liver problems, and

4 the only response I_ve ever received is a question of

5 whether I_ve ever had an ultrasound of my stomach,

6 since it has been painful to the touch since I have

7 returned.

8 I have reported chest pains since

9 returning and instances of my heart racing as high as

10 160 beats per minute with no activity. After going

11 through tests with results varying from _no problem_

12 to not being able to start a test due to abnormalities

13 showing, I was given an appointment with a

14 cardiologist. After the initial examination in which

15 problems were discovered, I was given followup.

16 Unfortunately, this followup was scheduled for a year

17 after the initial visit. Several attempts to correct

18 this were ignored until once again I requested the

19 help of my congressman. When the appointment was held

20 after a couple of failed attempts, I was told the

21 heart problem I was having was due to an abnormal

22 heart valve.

105 1 After many physicals and no heart problems

2 prior to the Gulf, I was surprised to hear this. I

3 was also told this type of problem was hereditary,

4 nicely avoiding the VA_s rating guidelines. Many

5 types of treatment at this facility consisted of

6 providing a quick prescription for whatever the

7 reported problem may be. The number of prescriptions

8 that I have been given totaled 27 at one point. I

9 began wondering about the interaction of all these

10 medications and requested over several months through

11 the Chief of Staff an appointment with the pharmacist.

12 I eventually had this appointment for my

13 own doing with no attempts by the Chief of Staff.

14 During this appointment I was told two of the

15 medications I was given interacted, causing heart

16 arrhythmias and _some people have died from it._ To

17 date my insurance has been billed more than $35,000

18 for these appointments with the VA, ranging from a few

19 minutes to half an hour. Most were with medical

20 students. I have little wonder why claims are denied

21 once a veteran reports having medical insurance.

22 Due to problems in obtaining treatment, I

106 1 have contacted the Persian Gulf Veterans doctor, the

2 patient advocate, the Assistant Chief of Staff, the

3 Chief of Ambulatory Care, the Chief of Staff, the

4 congressional liaison, and finally, the Director of

5 the Oklahoma City VAMC. Since problems continued in

6 obtaining treatment or appointments, I have contacted

7 six different members of Congress to include three

8 congressional committees. The problems continue.

9 I then contacted the VA Inspector

10 General_s office which opened an investigation. This

11 resulted in the Inspector General_s office requesting

12 a response from the Director of the Oklahoma City VA.

13 The Director provided excuses for each of the problems

14 I had identified. After two months of waiting for

15 results, I called the Inspector General_s office and

16 was told they were satisfied with the Director_s

17 response and refused to investigate further.

18 Due to the publicly shown support of the

19 Gulf War veterans by First Lady Hillary Clinton and

20 the continued gross negligence with no resolution, I

21 contacted the First Lady_s office with some of the

22 issues that I had raised. The result was her office

107 1 referring her problem back to the same VA staffers

2 that had been the cause of all of the problems in the

3 first place.

4 I have thought of filing an SF-95 claim

5 for the damages with the VA, but I_ve given up, secure

6 in the knowledge that it would end up in months of red

7 tape. I can no longer jeopardize my health by seeking

8 treatment through the VA medical system. And so have

9 given up any further attempts at seeking treatment for

10 these problems from them. Thank you.

11 DR. LASHOF: Are you seeking treatment in

12 the private medical sector?

13 MR. KORNKVEN: No, ma_am, I am not because

14 I have a wife and an 18 month old little boy. My

15 little boy is showing problems. I cannot jeopardize

16 my health care insurance by myself seeking treatment.

17 DR. LASHOF: Thank you. Any other

18 questions? Okay. Thank you very much.

19 MR. KORNKVEN: I appreciate the

20 opportunity.

21 DR. LASHOF: Okay. Because of weather

22 conditions in New York, Mr. Duelfer, who was to


1 present at this point, has not been able to get here

2 yet. He_s still trying. He may be in the air by now.

3 So we_re going to move to what was originally

4 scheduled for 1:45. That is Christine Eismann,

5 Lieutenant Colonel Robert Ryczak and Dr. Timothy

6 Gerrity. If they_ll come forward now, they will

7 present reports on the research funded by DOD through

8 the 1995 Broad Agency Announcement. I want to thank

9 the three of you for being able to rearrange your

10 schedule and come on at this point. Will help us get

11 through what we have to get through.

12 Ms. Eismann, you wish to start?

13 MS. EISMANN: Yes. Good morning.

14 DR. LASHOFF: Thank you very much.

15 MS. EISMANN: Good morning. My name is

16 Christine Eismann. I_m here representing the

17 Department of Defense. I work in the office of the

18 Director of Defense Research and Engineering and have

19 responsibility for oversight of all DOD biomedical

20 science and technology programs. I also served as a

21 DOD representative on the Selection Subcommittee of

22 the Persian Gulf Veterans Coordinating Board_s


1 Research Working Group.

2 Today, in reference to your questions

3 concerning new research being funded through the DOD

4 Broad Agency Announcement. I_d like to comment

5 briefly on the planning and execution of these DOD

6 funded studies as an introduction to some of the more

7 detailed presentations that will follow.

8 Since the emergence of Persian Gulf War

9 illnesses, which I_ll shorten to PGI, and the

10 establishment of the Persian Gulf Veterans

11 Coordinating Board in 1994, the Departments of

12 Defense, Veterans Affairs and Health and Human

13 Services have worked diligently to try to answer

14 questions concerning the etiologies of medical

15 problems arising from military service during the

16 Persian Gulf War.

17 Throughout this process the Departments

18 have maintained several guardian principles for

19 management of PGI research efforts. The first of

20 these is a commitment to approaching the problem of

21 PGI in a well organized, coordinated and cooperative

22 fashion across the federal agencies. Part of this

110 1 effort, which is managed through the Persian Gulf

2 Veterans Coordinating Board, is to centralize all

3 available information and expert opinion concerning

4 PGI to identify gaps in our knowledge concerning PGI

5 and to utilize these data to identify and then pursue

6 new paths for research investigation.

7 Resources are limited. So we must focus

8 our attention on the most likely causes of PGI as

9 supported by evolving scientific data and yet we have

10 striven during our activities to err on the side of

11 inclusion where reasonable doubt remains concerning

12 the potential etiologies of PGI.

13 Our second guiding principle is a

14 commitment to securing the very best research

15 performers_ hypotheses and experimental designs from

16 all possible sources including the federal, civilian,

17 national and international communities. This

18 commitment follows an appreciation at all levels

19 within the Departments of our responsibilities, both

20 to achieve an optimal investment of taxpayer dollars

21 and also to assist our military veterans to secure

22 diagnoses and treatments for the disabilities and

111 1 illnesses they_re suffering following their service

2 during the Persian Gulf War.

3 It_s with these principles in mind that

4 the Departments planned and executed a PGI research

5 strategy supported with FY _95 funds appropriated to

6 the DOD. Please recall that Public Law 103-337

7 required the Secretary of Defense to conduct PGI

8 studies in coordination with the Secretaries of VA and

9 HHS specifically in areas of epidemiology,

10 pyridostigmine bromide and clinical research. The FY

11 _95 Appropriations Conference report contained

12 $5 million for PGI research within the cooperative DOD

13 VA medical research program account and provided

14 guidance that these funds should be used to support

15 competitively awarded and independent PGI research

16 efforts.

17 The Deputy Secretary of Defense later

18 directed that additional funds be provided for PGI

19 studies. VA agreed with utilization of additional

20 funds from the cooperative DOD VA medical research

21 program account and the available funding for PGI

22 research was increased to $7.3 million. The VA, as

112 1 lead agency for PGI research, guided the efforts of

2 the Selection Subcommittee in creating a sound

3 investment strategy for PGI funds. The Selection

4 Subcommittee utilized the August 1995 working plan for

5 research on Persian Gulf Veterans illnesses, which

6 identified research gaps and questions yet to be

7 answered concerning PGI.

8 This plan itself was based on previously

9 documented expert opinions from the Institute of

10 Medicine, the Defense Science Board Task Force and the

11 NIH Technology Assessment Workshop. Early on the

12 evaluation process, the Selection Subcommittee reached

13 consensus concerning areas that required additional

14 investment to round out the national portfolio of PGI

15 research relative to ongoing studies and complete

16 research efforts.

17 We further agreed that the FY _95 funds

18 should be used to support multiple worthy research

19 efforts rather than one or two large studies because

20 there were so many yet unanswered questions regarding

21 PGI. The DOD retained responsibility for managing

22 this new PGI research program. The U.S. Army Medical

113 1 Research and Material Command managed the development

2 and publication of the DOD Broad Agency Announcement

3 and all aspects of the external peer review proposals.

4 Following this peer review, the Army

5 provided the Selection Subcommittee a prioritized list

6 of proposals judged to have high scientific merit with

7 associated relevant scores and funding requests. The

8 Selection Subcommittee respected the prioritization of

9 research proposals developed through the peer review

10 process and altered the order of funding only where

11 proposals required an unacceptable level of funding or

12 were considered to be of low relevance to the

13 investment strategy for PGI.

14 This investment strategy resulting from

15 the efforts of the Selection Subcommittee and the

16 independent peer review process included 12 proposals

17 that fully met the direction of Public Law 103-337.

18 The proposals are all of high scientific quality and

19 in our view contribute to a balance overall portfolio

20 of PGI research. This concludes my statement.

21 DR. LASHOF: Thank you very much. I think

22 we_ll move through and hear the presentations by

114 1 Lieutenant Colonel Ryczak and Dr. Gerrity and then

2 open it up for questions.

3 MS. EISMANN: Thank you.

4 DR. LASHOF: Lieutenant Colonel?

5 MR. RYCZAK: Good morning. I_m Lieutenant

6 Colonel Robert Ryczak, a U.S. Army Science and

7 Technology staff officer at the headquarters of the

8 U.S. Army Medical Research and Material Command, which

9 is a subordinate command of the Army Medical Command.

10 I am here to address your request for a

11 briefing on the new research being funded through the

12 auspices of the Department of Defense_s Broad Agency

13 Announcement in response to the congressional mandate

14 of Public Law 103-337, Section 722.

15 The first part of your request was for

16 descriptions of the research studies funded

17 specifically in response to the special mandate of the

18 public law. Twelve studies have been funded. Funding

19 for these studies totals $7.301 million. I have

20 previously provided the Committee a copy of each of

21 the twelve proposals_ protocols. I have also

22 submitted to you for this meeting an information sheet

115 1 on each of the twelve funded studies. In each of

2 those sheets I have provided the study title, the name

3 and institution of the principal investigator, the

4 funds awarded, the period of performance and a short

5 description of the study_s objectives.

6 The first study, Feasibility of

7 Investigating Whether There is a Relationship Between

8 Birth Defects and Service in the Gulf, funded at

9 $427,000, will attempt to identify all children born

10 to Gulf War veterans living in California and to

11 determine if congenital birth defects diagnosed during

12 the first year of life can be identified as well.

13 The second study, a Controlled

14 Epidemiological and Clinical Study Into the Effect of

15 Gulf War Service on Servicemen and Women of the United

16 Kingdom Armed Forces, funded at $865,187, addresses

17 the prevalence of unexplained illnesses, including

18 chronic fatigue-like symptoms in members of the United

19 Kingdom Armed Forces who were deployed to the Persian

20 Gulf and who have served or are serving in Bosnia.

21 Since virtually no data exists on the prevalence of

22 symptoms and illnesses among other Coalition Forces or

116 1 among indigenous populations, this study is important

2 in helping assess the results of prevalence studies

3 among U.S. Persian Gulf veterans.

4 The third study, Epidemiological Studies

5 of Persian Gulf Illnesses Persian Gulf Women_s Health

6 Linkage Study, funded at $778,704, will address the

7 effects of Gulf War service on military women_s

8 health. The studies will compare the incidence,

9 prevalence and risk of illnesses and general health

10 outcomes of women deployed in the Gulf War theater of

11 operations with Gulf War era women who were not

12 deployed to the Gulf.

13 The fourth study, the effects of

14 Pyridostigmine in Flinders Line Rats Differing in

15 Colanergic Sensitivity, funded at $354,089, will study

16 the possibility that some of the individuals reporting

17 adverse reactions to pyridostigmine may have had

18 predisposing genetic conditions that made them more

19 sensitive to pyridostigmine and contributed to

20 symptoms of multiple chemical sensitivity after

21 exposure to pyridostigmine.

22 The fifth study, Neurobehavioral and

117 1 Immunilogical Toxicity to Pyridostigmine, Permethrin

2 and DEET in Male and Female Rats, funded at $933,947,

3 is a multidisciplinary study using male and female

4 rats to examine any neurobehavioral toxicity and

5 immune response alterations after exposure to

6 pyridostigmine bromide, permethrin and DEET either

7 alone or in combinations. Human lymphocyte cells will

8 also be studied for inhibition of immune response as

9 a result of exposures to these two materials.

10 The sixth study, Disregulation of the

11 Stress Response in the Persian Gulf Syndrome, funded

12 at $970,578, will test the hypothesis that

13 abnormalities in some of the neurohormones important

14 in human response to stress are at least partly

15 responsible for some of the unexplained symptoms

16 suffered by some Gulf War veterans as well as symptoms

17 in other conditions, such as chronic fatigue syndrome,

18 fibromyalgia, somatoform disorder and multiple

19 chemical sensitivity.

20 The seventh study, Neuropsychological

21 Functioning in Persian Gulf War Veterans, funded at

22 $353,428, will study whether Gulf War veterans show

118 1 cognitive impairments suggestive of central nervous

2 system damage at a greater rate than do veterans who

3 were not deployed to the Gulf.

4 The eighth study, Fatigue and Persian Gulf

5 Syndrome Physiologic Mechanisms, funded at $553,698,

6 addresses the symptom of abnormal fatigue in Gulf War

7 veterans. The study will examine the possibility that

8 mechanisms used by muscle cells to use oxygen and

9 produce energy for work may be impaired in patients

10 suffering abnormal muscle fatigue and the inability to

11 exercise.

12 The ninth study, Psychological and

13 Neurobiological Consequences of the Gulf War

14 Experience, funded at $264,000, will continue to

15 follow the course of symptoms of post-traumatic stress

16 disorder in a population of Gulf War veterans. This

17 study of how such symptoms, as well as memory

18 function, change over time in the veterans will lead

19 to a better understanding of PTSD and the elements of

20 risk that would cause and continue PTSD symptoms over

21 time.

22 The tenth study, Evaluation of Muscle


1 Function in Persian Gulf Veterans, funded at $906,248,

2 address the causes of ongoing chronic fatigue and

3 muscle weakness in Gulf War veterans with unexplained

4 illnesses. The study will be a comprehensive

5 multidisciplinary approach to evaluate abnormalities

6 in skeletal muscle function in Gulf War veterans.

7 The eleventh study, Characterization of

8 Emission from Heaters Burning Leaded Diesel Fuel in

9 Unvented Tents, funded at $282,861, will provide

10 detailed information on pollutants produced in

11 unvented tents from heaters that burn leaded diesel

12 fuels. This information is needed to assess potential

13 exposure of service personnel who served in the Gulf

14 War.

15 The final study, Diagnostic Antigens of

16 Leishmania Tropica, funded at $611,594, will attempt

17 to develop a sensitive method to diagnosis

18 leishmaniasis, a tropical disease in military

19 personnel.

20 The second part of your request was for a

21 description of how these studies address the

22 congressional mandate of Section 722 of Public Law


1 103-337 and the two modifications to the three

2 requests for proposals published in the Commerce

3 Business Daily soliciting proposals for this research.

4 Section 722 directed the Departments of

5 Defense, Veterans Affairs and Health and Human

6 Services to conduct studies and administer grants for

7 studies to determine the nature and causes of Gulf War

8 veterans_ illnesses and appropriate treatment of those

9 illnesses. The three Departments approved the

10 language in the three requests for proposals for this

11 research initiative. The three requests for proposals

12 specifically included the public law_s description of

13 the nature of the studies to be conducted and funded

14 by the three Departments.

15 An interagency selection subcommittee

16 representing the three Departments recommended the

17 twelve studies for funding. The Department of

18 Veterans Affairs is conducting one of the studies.

19 The Department of Energy is also conducting a study.

20 Ten of the twelve studies are being administered

21 through grants. The public law directed that the

22 studies be undertaken by the three Departments include

121 1 at a minimum three specific types.

2 The first type was to be epidemiological

3 studies on the incidence, prevalence and nature of the

4 illnesses and symptoms and risk factors associated

5 with the symptoms or illnesses. Three of the funded

6 studies are this type. One epidemiological study

7 addresses birth defects. Another examines the

8 illnesses and symptoms experienced by veterans of one

9 of our coalition partners and the third focuses on

10 military women.

11 The second type was to determine the

12 health consequences of use of pyridostigmine bromide

13 alone or in combination with exposure to pesticides,

14 environmental toxins and other hazardous substances.

15 One of the twelve funded studies examines

16 pyridostigmine alone in rats. A second looks at the

17 effects of pyridostigmine alone and in combination

18 with permethrin and DEET in rats as well as effects on

19 human immune response cells.

20 The third type directed by the public law

21 was to be clinical and other studies on the causes,

22 possible transmission and treatment of Persian Gulf

122 1 related illnesses. The remaining seven funded studies

2 are in this category. Five studies addressed the

3 causes of unexplained symptoms of stress, cognitive

4 impairments, abnormal fatigue, post-traumatic stress

5 disorder and memory function and chronic fatigue and

6 muscle weakness.

7 The sixth study concerns the possible

8 exposure of veterans to airborne contaminants from the

9 burning leaded diesel fuel in heaters in unvented

10 tents.

11 The seventh study focuses on developing

12 sensitive and accurate ways to quickly diagnosis

13 leishmaniasis. The individuals covered in these

14 studies are all drawn from Gulf War veterans, Gulf War

15 era veterans who did not deploy or their spouses and

16 children. These research populations were among those

17 specified in Section 722 of the public law.

18 The research working plan developed by the

19 Research Working Group of the Interagency Persian Gulf

20 Veterans Coordinating Board was one of the resources

21 used by the scientific peer reviewers in assessing the

22 relevance of submitted proposals. The Interagency

123 1 Selection Subcommittee used the research working plan

2 in their selection process. This was done so that all

3 twelve funded studies would be consistent with the

4 coordinated plan of studies directed by the public

5 law.

6 As prescribed in modification one to the

7 three requests for proposals, both federal and non-

8 federal proposals were subjected to the same

9 independent scientific peer review. All proposals,

10 federal and non-federal, went through the evaluation

11 and selection process as a single set of proposals.

12 However, modification one stated that a minimum of $5

13 million was to be reserved for non-federal proposals

14 only. Both federal and non-federal institutions could

15 compete for any remaining funds. This was to comply

16 with the intent of Congress stated in the FY _95

17 Defense Appropriations Conference Report 103-747 that

18 $5 million within the cooperative DOD VA medical

19 research program element be competitively awarded for

20 independent research on Gulf War Syndrome.

21 Of the $7,301,334 awarded, $6,754,447 or

22 92-1/2 percent were awarded to non-federal

124 1 institutions. Ten of the twelve awardees were non-

2 federal. Modification two to the three requests for

3 proposals identified several special interest areas.

4 These areas were symptoms, illnesses in Coalition

5 Forces and indigenous populations compared to

6 appropriate control populations.

7 The identification of potential risk

8 factors associated with the Persian Gulf deployment.

9 The effective validation of self-reported symptoms,

10 particularly the issues of recall and selection bias.

11 The ecology and epidemiology of leishmania species and

12 the development of an effective diagnostic or

13 screening test and treatment regimen for

14 leishmaniasis.

15 One of the twelve awards was for an

16 epidemiological study within one of the Coalition

17 Forces. Another study was to develop diagnostic or

18 screening tests for leishmania species.

19 The third part of your request was for a

20 list of study topics which were rated 1.5 or better on

21 scientific merit but were not selected for funding.

22 There was one such proposal. The topic was a multiple

125 1 project international cooperative study of U.S. and

2 the coalition partner veterans to estimate the

3 prevalence and incidence of illnesses and symptoms to

4 undertake clinical, neurophysiological research to

5 improve case definitions for further epidemiological

6 studies to conduct binational case control studies of

7 the relationships of risk factors and illnesses and

8 symptoms to study in animals the effects of

9 pyridostigmine and bromide components of

10 pyridostigmine bromide in concert with risk factors

11 identified in the epidemiological portion of this

12 effort. The proposed cost of this program proposal

13 was $7.128 million.

14 The fourth and final part of your request

15 was the identification of the source of funding for

16 this research and a list of the amounts provided in

17 each of the awards. All $7.301 million awarded came

18 from the FY _95 congressional appropriation for the

19 cooperative DOD VA medical research program element in

20 the DOD budget. I have earlier in my presentation

21 listed the dollar amounts for each of the twelve

22 awards. These figures are also on the one page

126 1 information sheets on each of the twelve studies.

2 This concludes my presentation.

3 DR. LASHOF: Thank you very much,

4 Lieutenant Colonel. Dr. Gerrity, you can proceed.

5 DR. GERRITY: I have one overhead that I_m

6 going to need in my presentation. Miles?

7 Good morning. My name is Timothy Gerrity

8 and I_m the Deputy Director of Medical Research

9 Service in the Office of Research and Development in

10 the Department of Veterans Affairs, the lead agency

11 for coordination of research on Persian Gulf veterans

12 illnesses.

13 Ms. Eismann and Colonel Ryczak have given

14 you an excellent account of the origin and results of

15 the Department of Defense_s Broad Agency Announcement

16 of 1995 soliciting proposals for research on Persian

17 Gulf veterans illnesses. I_m here today to discuss

18 the range of selected research projects and the

19 thought processes that went into their selection.

20 I was a member of the Selection

21 Subcommittee of the Research Working Group of the

22 Persian Gulf War Veterans Coordinating Board that made

127 1 the final selection and recommendation to DOD of

2 research proposals for funding. I will frame my

3 remarks within the context of the August 5, 1995

4 working plan for research, DOD_s mandate contained in

5 Public Law 103-337 as presented by Ms. Eismann, and

6 other areas of consideration.

7 I will also address research gaps that may

8 currently exist as they have been identified by the

9 Research Working Group.

10 The areas of inquiry that the working plan

11 for research identified in August of 1995 as having

12 significant gaps in knowledge at that time were, one,

13 information on the prevalence of symptoms, illnesses

14 and/or diseases within other Coalition Forces. Two,

15 information on the symptoms, illnesses and/or diseases

16 within the indigenous populations within the Persian

17 Gulf area, including Saudi Arabia and Kuwait. Three,

18 information on the prevalence of reverse productive

19 outcomes among Persian Gulf veterans and their

20 spouses. Four, simple and sensitive tests for

21 L. tropica infection that could lead to quantitative

22 prevalence of L. tropica infection among Persian Gulf

128 1 veterans. And five, information on the long term

2 cause-specific mortality among Persian Gulf veterans.

3 Funding for research to fill these gaps

4 was identified by VA and DOD from the Cooperative DOD

5 VA Medical Research Program contained in the 1995

6 Defense Appropriation Bill. Besides these specific

7 areas, Public Law 103-337 directed the DOD focus

8 research in the areas of epidemiology, clinical

9 research and research on the health effects of

10 pyridostigmine bromide alone and in combination with

11 other substances.

12 Congress further intended that $5 million

13 from the DOD VA program should be devoted to

14 externally peer reviewed research by non-federal

15 researchers. DOD and VA also identified an additional

16 $2.3 million from the DOD VA program to fund research

17 by either federal or non-federal investigators.

18 In order to ensure that the best and most

19 appropriate research was funded, a two-step process of

20 review was used. The first step involved the

21 scientific peer review of 111 submitted proposals.

22 The second step involved the Selection Subcommittee of

129 1 the Research Working Group. The purpose of the

2 Selection Subcommittee was to provide a secondary

3 examination of research proposals for relevance after

4 their review for scientific merit.

5 The Subcommittee met four times beginning

6 in December 1995 and concluding its work on January

7 24, 1996. The reviewed submissions that that

8 Subcommittee received for secondary review include

9 only the abstracts of the proposals, review summary

10 statements redacted of identifiers of specific

11 investigators and institutions, priority scores for

12 science and relevance and an indication of whether the

13 proposal was from a federal or non-federal

14 investigator.

15 The Subcommittee agreed in advance that it

16 should not rereview proposals for scientific merit.

17 The Selection Subcommittee had to arrive at research

18 priorities satisfying both science and policy

19 requirements. To accomplish this, the Subcommittee

20 established the following guiding principles.

21 One, fund research of high scientific

22 merit as judged by DOD_s Merit Review Panels.


1 Two, fulfill the requirements of the law

2 requiring the DOD to fund certain categories of

3 research, epidemiology, clinical research and research

4 on pyridostigmine bromide.

5 Three, fill gaps identified in a working

6 plan for research on Persian Gulf veterans illnesses.

7 Four, avoid unnecessary duplication of

8 other ongoing research.

9 And five, allow as broad an approach as

10 possible.

11 The Subcommittee also agreed in advance

12 that a few very large projects, each consuming large

13 portions of the allocated budgets, should not be

14 selected over a greater number of smaller, high

15 quality projects, thereby ensuring a diversity of

16 topics and approaches. Prior to receipt of abstracts

17 and summary statements, the Subcommittee used these

18 principles to arrive at a consensus on the areas which

19 the Subcommittee felt should be emphasized. These

20 areas encompassed all gaps identified by the working

21 plan for research along with research on PB alone and

22 in combination with other compounds in response to


1 Public Law 103-337.

2 It was felt that other than the need to

3 identify meritorious PB research, the mandate of

4 Public Law 103-337 was probably broad enough to

5 encompass the gaps identified by the working plan for

6 research. And that the only concern would be the

7 extent to which meritorious research on PB could be

8 identified.

9 The Subcommittee did not set out to fund

10 any one identified area of research emphasis at a

11 predetermined funding level. Such an approach could

12 have led to funding scientifically inferior work at

13 the expense of meritorious research that was relevant

14 but not necessarily in areas of identified emphasis.

15 Instead, the Subcommittee considered first

16 and foremost scientific merit, starting at the top of

17 the list, and selecting projects in descending order

18 as they were judged to fit the defined research needs.

19 The availability of research funds exceeded the total

20 value of meritorious research projects specifically

21 addressing identified areas of emphasis, and by

22 identified areas of emphasis, I am referring to the

132 1 working plan for Persian Gulf research.

2 Therefore, it was decided to fund

3 meritorious research projects that, although not

4 identified as being in identified areas of emphasis,

5 were nonetheless highly relevant to Persian Gulf

6 veterans_ illnesses. In most cases, this led to the

7 selection of projects that would complement the

8 existing research portfolio.

9 If I could have the overhead projector

10 now. The table which you see up there, with apologies

11 for the size of the print, lists all twelve projects

12 that were selected by the Selection Subcommittee and

13 they_re identified by project names. What identified

14 areas of emphasis within the working plan for Persian

15 Gulf research that a project may have satisfied. And

16 the lastly the selection of rationale as one

17 incorporated both the requirements of law as well as

18 the requirements of science and policy.

19 Among the projects falling in identified

20 areas of emphasis, Project One is a study focusing on

21 the prevalence of symptoms and illnesses in a

22 population of women Persian Gulf veterans compared to

133 1 a non-deployed group of women Persian Gulf era

2 veterans. In addition to assessing overall health

3 status, reproductive health will be a major component

4 of this project.

5 Project Six is an epidemiological

6 investigation of the health of servicemen and women

7 that were part of the United Kingdom Coalition Forces.

8 This study will allow comparison to the prevalence of

9 symptoms and illnesses in U.S. Persian Gulf veterans

10 with a non-U.S. cohort that served in the Persian Gulf

11 with U.S. forces. It will also augment research

12 conducted in response to a British Medical Research

13 Council solicitation for proposals that was recently

14 announced.

15 Project Seven is directed at developing

16 diagnostic antigens of L. tropica. This research

17 augments other ongoing research and will help to

18 achieve the goal of a simple and sensitive diagnostic

19 test for L. tropica infection.

20 Project Eight is a study of the

21 feasibility of investigating possible relationships

22 between Persian Gulf service and adverse birth

134 1 outcomes. This project will capitalize on the largest

2 state birth defects registry in the State of

3 California.

4 As the table shows, three of the five

5 specific areas of inquiry identified by the working

6 plan for research were captured by the BAA, although

7 Public Law 103-337 was satisfied in virtually all

8 cases.

9 The projects selected that are not in

10 identified areas of emphasis but are in areas of

11 ongoing research bring in deep strengths to the

12 ongoing research portfolio.

13 Projects Two and Nine expand the current

14 repertoire of research on pyridostigmine bromide.

15 Project Three brings new clinical research

16 questioning whether an adverse endocrine response to

17 stress may be responsible for some of the symptoms of

18 Persian Gulf veterans.

19 Projects Four and Five investigate

20 physiological and biochemical mechanisms of muscle

21 fatigue bringing state of the art magnetic resonance

22 imaging technology to bear on this problem.

135 1 Project Ten augments the ongoing studies

2 of the Fort Devens Reunion Cohort by the Boston VA

3 Environmental Hazards Research Center by allowing the

4 inclusion of two new study groups, a treatment-seeking

5 group and a non-deployed group.

6 Project Eleven is a continuation of a

7 longitudinal study of Persian Gulf veterans for the

8 progression of post-traumatic stress disorder.

9 Lastly, Project Twelve is a study to

10 characterize emissions from heaters in unvented tents.

11 There is only one ongoing DOD study that is attempting

12 simulations of tent exposures. Because of the

13 strength of the reviews of Project Twelve, it was felt

14 by the Subcommittee that it would provide valuable

15 information augmenting the DOD study.

16 Two areas of inquiry identified in the

17 working plan for research will not be addressed by the

18 current round of DOD VA funding. Namely, epidemiology

19 of indigenous populations and long-term mortality of

20 Persian Gulf veterans. There were no scientifically

21 meritorious submissions addressing these issues.

22 Studies of indigenous populations would be fraught

136 1 with many difficulties, particularly in the ability to

2 draw generalizable conclusions. It is therefore

3 understandable that meritorious proposals were not

4 identified.

5 Consistent with VA_s continuous

6 involvement in mortality studies of other veteran

7 cohorts, VA is committed to the study of the long-term

8 mortality of Persian Gulf veterans through repeated

9 studies at regular appropriate intervals. VA has

10 already completed a mortality study that has been

11 reported to this Committee.

12 The question now is what, if any,

13 additional research is needed. DOD and VA are making

14 additional funds available that will allow funding of

15 up to another three projects from the BAA list of

16 meritorious proposals. These are to be announced

17 shortly. These projects will, if funded, cover

18 topical areas similar to the other twelve projects.

19 At the present time, the Research Working

20 Group does not consider funding through a targeted

21 solicitation of additional research in the areas

22 already covered by ongoing research warranted. The

137 1 Research Working Group does, however, encourage

2 researchers to submit research proposals to

3 investigator-initiated merit review programs available

4 through DOD, VA and HHS.

5 This method of funding research is a

6 mainstay of the biomedical research community and

7 should be relied upon to support highly meritorious

8 research in important areas of concern for human

9 health.

10 The recent announcement by DOD that an

11 Iraqi munitions bunker probably containing chemical

12 weapons was detonated by U.S. forces shortly after the

13 conclusion of the conflict raises concern the previous

14 assumptions of the absence of chemical weapons

15 exposure are incorrect. Ongoing research relative to

16 chemical weapons exposure and effect includes

17 epidemiology studies that have the potential for

18 identifying chemical weapons exposure as a risk

19 factor.

20 For example, the Portland Environmental

21 Hazards Center is stratifying its population sample of

22 deployed veterans according to whether deployment was

138 1 during Desert Shield alone, Desert Storm alone, Desert

2 Clean-Up alone, or a combination of these. This

3 stratification by time in conjunction with troop unit

4 location should help identify illness clusters that

5 could relate to a potential chemical weapons exposure.

6 In addition, researchers at Portland are

7 also working to identify DNA adducts in skin

8 epithelium which could be markers of exposure for

9 mustard. And lastly, researchers at VA Medical Center

10 in Boston have established informal ties with

11 investigators in Japan at the Saint Lukes Hospital

12 that it_s seen victims of the tragic Sarin exposure of

13 one year ago. And this could be important in

14 comparing responses.

15 In the 1995 working plan for research,

16 further research on chemical weapons exposure and

17 effect beyond what was ongoing was not recommended.

18 Because of the new evidence, the Research Working

19 Group has now altered its position on this topic. VA

20 and DOD have committed to spending at least $3 million

21 from the DOD VA Cooperative Research Program on

22 additional research focused on the health effects of

139 1 low level chemical weapons exposure.

2 Because of the urgent nature of this

3 issue, VA and DOD are pursuing three paths for funding

4 new research. First, VA and DOD will attempt to

5 identify ongoing research related to issues of low

6 level chemical weapons exposure that could be enhanced

7 to conduct additional research. Second, the Research

8 Working Group Selection Subcommittee will examine

9 proposals submitted to the last BAA that were

10 meritorious but not selected due to the perceived lack

11 of relevance at that time.

12 An attempt will be made to identify

13 projects within this category that are focused on

14 issues relating to low level chemical weapons

15 exposure.

16 Lastly, DOD will issue a focused request

17 for applications for new research proposals. The

18 Research Working Group will assist DOD in the

19 development of the language of this RFA.

20 In closing, I want to say that the process

21 by which new research on Persian Gulf veterans_

22 illnesses was obtained represents the delicate balance

140 1 that exists between the need to sponsor so-called

2 directed or targeted research and the awareness that

3 some of the best biomedical science springs from

4 researchers on initiative. Because of this natural

5 tension, the Selection Subcommittee sought to respect

6 primarily the peer review process while at the same

7 time it followed the aforementioned guidelines.

8 The Research Working Group believes that

9 the projects selected encompass the best science that

10 can be brought to bear on the subject of Persian Gulf

11 veterans_ illnesses. Additional research on low level

12 chemical weapons exposure and health effects is now

13 being vigorously sought by DOD and VA. I_m confident

14 that the ongoing research, along with newly funded

15 projects, will lead to some answers as well as

16 stimulate new research questions. This concludes my

17 prepared remarks.

18 MR. HAMBURG: At the same time you point

19 out that recent developments made the question of low

20 level exposure to chemical antigens more salient than

21 it had been before. And so you_re trying to find some

22 way to stimulate new research that otherwise would not


1 have been done. My question is whether, in a related

2 fashion, there_s some important research gaps, some

3 matters of concern to Persian Gulf illness, that did

4 not elicit any proposals or, at any rate, proposals of

5 adequate scientific quality so that you are not going

6 down a particular line of inquiry for want of adequate

7 proposals. Is there some way which you_re thinking

8 about stimulating work in important research gap areas

9 that may now be missing?

10 DR. GERRITY: As I stated in my prepared

11 remarks, one of the areas identified in the research

12 working plan as a research gap was data on the

13 prevalence of symptoms and illnesses in indigenous

14 populations. At least at this time it_s perceived

15 that that could be a very difficult undertaking. The

16 results of which, if they would have any specific

17 validity to the populations themselves, there might be

18 a difficulty in generalizing those, hence the risk of

19 investing large sums of money might not be advised.

20 However, we had stated this in the

21 modification number three to the BAA that this was of

22 interest and we received no submissions, at least


1 within the scientific meritorious range that addressed

2 this problem. However, I think if we saw something in

3 that area come to us, we would certainly want to

4 examine that in terms of its approach, should another

5 funding opportunity arise.

6 Right now, neither the Department of

7 Defense nor the Department of Veterans Affairs have

8 identified funds beyond what we want to direct toward

9 the issue of chemical weapons, toward any additional

10 research. However, the Research Working Group itself

11 is engaged in an ongoing discussion of research issues

12 particularly. Now, we_re in a situation where

13 research findings are beginning to be made available.

14 And as these findings become available, these may

15 affect our thought processes and could potentially

16 lead us to seek additional research.

17 MR. CAPLAN: I was wondering, since the

18 time frame for many of these projects is going to

19 extend out over years to complete, what thought has

20 been given in the Research Working Group to either

21 interim reports or monitoring of research as it goes

22 along so that important findings or findings of great

143 1 concern to veterans would be available, at least in a

2 timely manner. Is there any monitoring committee or

3 oversight charged with interim or ongoing monitoring

4 of results?

5 DR. GERRITY: I would place that

6 responsibility within the domain of the Research

7 Working Group to conduct that. We have a database of

8 research projects that are ongoing that are funded by

9 the federal government. Unfortunately, it only

10 reflects those research projects which were funded by

11 the federal government. We don_t have the capability

12 of going beyond that in any sort of accurate way.

13 However, we_re made aware of research that is being

14 done in the private sector. I would argue that the

15 vast majority of credible meritorious research

16 projects are being funded by the federal government,

17 although not necessarily being conducted by federal

18 researchers.

19 This database is of great use to us in

20 monitoring interim progress. Again, you know, we try

21 to exercise caution as we look at that vis-a-vis

22 respecting a scientist_s right to avoid prepublication

144 1 of their data and thereby jeopardizing the publication

2 of peer review literature.

3 But, you know, we feel that this is right

4 now a good mechanism by which to proceed.

5 DR. LASHOF: Elaine?

6 MS. LARSON: I want to followup on that

7 with a comment first and then two short questions.

8 Again, the data will not be available on any of these

9 studies for at least seven years post-war. Be that as

10 it may, some of us are going to feel compelled to say

11 what was said at the first meeting. And that is that

12 there are certain things that can_t be studied after

13 a certain amount of time because the data aren_t

14 available. You mentioned recall bias and all kinds of

15 bias. And in the future, one would hope that it will

16 not only be possible to get better information but

17 even cheaper to do it as it_s going along and not

18 start four or five years after.

19 Anyway, enough about that. Two questions.

20 First of all, this Committee has not heard much

21 testimony at all, if I recall, that leishmaniasis has

22 been a major issue here. And yet, we_ve heard

145 1 testimony at three or four of our Committee meetings

2 about this mycoplasma. And I_m wondering why

3 leishmaniasis, it_ll be great to have a good rapid

4 diagnosis test, but why that_s a priority when it

5 really, as far as I know, isn_t a major issue that we

6 don_t understand in this war and yet mycoplasma keeps

7 coming up. So that_s one question.

8 Second is, what_s the relationship of this

9 women_s health linkage study with the work just

10 presented by Dr. Pierce, or is there any linkage at

11 all? Two different funders, but it sounds like

12 perhaps this is a bigger study. What_s the

13 relationship and is there coordination between these?

14 DR. GERRITY: I_d like to answer your

15 initial comment and I think you will find general

16 agreement that, within both DOD and VA, that we could

17 do a much better job of providing databases and

18 forming databases that could help prevent some of

19 these problems that lead to time lags in getting

20 research results in the future. And VA and DOD are

21 cooperating right now in terms of trying to establish

22 better linkage between the two departments in this

146 1 arena.

2 Moving, though, to your specific

3 questions. L. tropica. That_s not, in our perception

4 of the Research Working Group, that has been an issue

5 which has risen and fallen in interest. One of the

6 things that we look at in looking at the selection

7 process, you might argue is an intuitive approach,

8 too, and that isn_t articulated explicitly anywhere.

9 And that is where can you take advantage of

10 opportunities to learn something that would have the

11 potential of having value, particularly because the

12 quality of the research is high enough to satisfy

13 that.

14 And I think in the case of the selection

15 of the particular L. tropica study that was the case.

16 It was a very highly scientific meritorious proposal.

17 We_re hoping that it will be able to link up with some

18 research that is going both at the Portland VA

19 Environmental Hazards Research Center as well as

20 research on L. tropica antigens at Walter Reed. I

21 think that there would be general agreement that if we

22 could identify a reliable serum antigen test, that it

147 1 would be valuable to apply it because I think that

2 amongst some members of the community of concern for

3 this, there still is some question about whether one

4 might not be looking at some low level infection or

5 occult infection.

6 And in addition, and in the broader sense,

7 I think, we have to be concerned about infection by

8 L. tropica in veterans because, as we are becoming

9 aware as our World War II veteran population ages, and

10 enters into health conditions that reduce their immune

11 status, that L. tropica infections that occurred due

12 to service in the Middle East back in the 1940's

13 during World War II are now turning into active

14 opportunistic infections and so, I think that, you

15 know, in a sense that although it_s not necessarily a

16 burning issue right now, I think it_s important

17 research.

18 One other question. The women_s health

19 linkage. The Research Working Group is right now

20 beginning to work at bringing the various federally

21 funded investigators together to link them up so that

22 they can where appropriate take advantage of targets

148 1 of opportunity to work together to ensure that where

2 appropriate they are looking and asking some similar

3 questions. One has to be very cautious in that

4 because we value the independence of researchers as

5 well and we don_t want to homogenize their research

6 efforts either, but we do recognize the value of

7 bringing different groups together. Nothing has been

8 done right now linking the women_s health linkage

9 study to that of Dr. Pierce, but I would anticipate

10 that efforts will be made along that.

11 MS. LARSON: I just have to followup with

12 one more thing about leishmaniasis. Are you implying

13 that there may be vets who are infected who are not

14 currently diagnosed and that you_re looking for

15 something that_s more sensitive and specific or just

16 faster? I_m pushing on this because I don_t -- I see

17 why it would be useful to use this opportunity, but I

18 am not sure what, anyway, I_m not sure if you_re

19 looking to diagnose more cases.

20 DR. GERRITY: Well, the answer to that

21 question is yes. Because there is some thinking

22 within the parisitology community that there could be

149 1 a very mild form of this L. tropic leishmaniasis, that

2 has not been diagnosed. In large part because

3 positive diagnosis is so difficult to do. The risks

4 attendant with that diagnosis, you know, involving a

5 bone marrow sample, often are not, merit is given the

6 cases that are being presented.

7 DR. LASHOF: John?

8 DR. BALDESCHWIELER: Let me go back to

9 Elaine_s question on the mycoplasma. We_ve heard

10 considerable comment on that. And as far as we know,

11 there_s only one investigator who has hypothesized

12 this as a cause of the symptoms we_re seeing. Are we

13 getting any proposals from other investigators or is

14 there any attempt to broaden this?

15 DR. GERRITY: We were certainly going to

16 have a process open to credible proposals involving

17 mycoplasma. Indeed, I think we would have welcomed

18 it. We didn_t see those.

19 MS. LARSON: Did you see any, credible or

20 not? You said credible proposals. Were there any

21 proposals on mycoplasma?

22 DR. GERRITY: I_m hesitating. The reason

150 1 why I_m hesitating is because I don_t want to venture

2 into areas of confidentiality.


4 DR. GERRITY: When it comes to identifying

5 research, you know, research that was not funded.

6 MR. RYCZAK: Yes, there were proposals

7 that addressed mycoplasma, but none of them were high

8 enough to get the funding that was only able to fund

9 about 10 percent of the proposals. Fifty-five of the

10 proposals submitted were considered to be of

11 scientific merit, and they added up to over $68

12 million. And when you only have a $5 million pot, we

13 just didn_t get that far down the list.

14 DR. LASHOF: John?

15 DR. BALDESCHWIELER: Let me ask also about

16 the proposal entitled _Disregulation of Stress

17 Response._ Do we have abstracts of these proposals?

18 Can you tell us roughly the hypothesis that_s going to

19 be explored in this proposal?

20 DR. GERRITY: I would do it at great risk

21 of not doing justice to that hypothesis, since that

22 does not fall within an area of my scientific

151 1 expertise. I, you know, I mean, very generally, it is

2 hypothesizing that, having given that caveat, it is

3 hypothesizing there are individuals who possess, who

4 have abnormal neurohormonal response to stress and

5 that this could potentially account for the

6 development of symptoms that often result in diagnoses

7 of chronic fatigue syndrome, fibromyalgia and chemical

8 sensitivities. And that is the principal hypothesis

9 that is being addressed by that research project

10 that_s being done at Georgetown University.

11 MS. KNOX: Mr. Gerrity, I have a couple of

12 questions. One is concerning the gap of research

13 that_s related to the mortality studies. I don_t

14 think veterans feel comfortable with the mortality

15 study that the VA has given to the Committee. Are

16 there any other research studies or proposals that

17 have been offered that deal with veterans who maybe

18 have died in private institutions as well?

19 DR. GERRITY: Well, okay. At the risk of,

20 no, let me go back. The answer is no.

21 MS. KNOX: The second question that I

22 have, go ahead.


1 DR. LASHOF: Just so as not to confuse

2 anyone, the mortality study that was presented to us

3 wasn_t limited to deaths at VA hospitals, was it?

4 DR. GERRITY: That is absolutely correct.

5 That is the area that I wanted to touch on.

6 DR. LASHOF: It was a VA --

7 DR. GERRITY: It was all inclusive because

8 it went into the Social Security death records, state

9 death records, the VA_s own death records. It is

10 estimated, you know, that its capture of deaths is in

11 the upper 90 percent of all deaths.

12 DR. LASHOF: Yeah. You used the National

13 Death Index.

14 DR. GERRITY: National Death Index, yes.

15 So, I mean, it was inclusive. It would include people

16 who died in private hospitals.

17 MS. KNOX: The second question. The study

18 that you have, that the VA_s provided for spouses to

19 come to VA institutions, do you foresee that there

20 will be any travel pay allotted to spouses and

21 children?

22 DR. GERRITY: I_m probably the wrong


1 person to have that question addressed to, because I_m

2 not familiar with what legislative authority VA has to

3 do that. So, I will demur that, but I can have the

4 appropriate people at VA get an answer to that

5 question back to you.

6 MS. KNOX: Okay.

7 DR. LASHOF: Phil?

8 DR. LANDRIGAN: I_d like to start off by

9 joining with Dr. Hamburg in saying I think you_ve done

10 a good, credible job of organizing the peer review

11 process here. It_s very parallel, of course, to

12 what_s done at the National Institutes of Health, and

13 I think you_ve made a diligent effort to pull in good

14 science.

15 Let me ask you a couple of questions.

16 Now, first of all, you said that for the future you

17 would hope that you could organize studies and get

18 science rolling sooner after deployment of troops than

19 was the case here. Clearly one of the fundamental

20 building blocks to achieving that goal would be to

21 have good accurate registries in place in future

22 deployments of who went where when, what units they

154 1 were with, what was their baseline health status.

2 Take the specific case of Bosnia. We_ve

3 got troops that have gone over there recently. Do

4 these building blocks exist for that deployment?

5 DR. GERRITY: Currently what is in place

6 is, and again, I want to hesitate that I can_t really

7 speak for DOD, but I will tell you what DOD and the VA

8 have discussed and what is in place by policy put in

9 by the Assistant Secretary of Defense for Health

10 Affairs, Stephen Joseph, is that there will be pre and

11 post-deployment health evaluations. And I think that

12 it has to be clear that that does not necessarily

13 include physical exams on every individual, but it

14 does involve the administration of health

15 questionnaires, both pre and post-deployment.

16 DR. LANDRIGAN: Were those in fact done

17 pre-deployment to Bosnia?

18 DR. GERRITY: I_ll demur on the answer

19 since I don_t know. I mean, I have assumed that they

20 have been, but I can_t speak authoritatively.

21 DR. LANDRIGAN: And the followup question

22 is whether the database is computerized because,

155 1 again, one of the problems we gathered from previous

2 testimony before this Committee, that one of the

3 problems with tracking back to the people that were in

4 the Persian Gulf is that the records were neither

5 centralized nor often computerized. And it_s awfully

6 difficult under those circumstances to reconstruct a

7 cohort.

8 DR. GERRITY: Yeah. As I understand it,

9 my colleagues at DOD can really speak better to this,

10 but DOD has projects in place that are looking toward

11 the future in terms of the computerization of their

12 databases for deployed troops, including their health

13 records, and constructing them in such a way that they

14 will then be able to be transferred over to the --

15 DR. LANDRIGAN: That_s good. And I

16 understand that Bosnia is a bit peripheral to the

17 Persian Gulf, but on the other hand, we_re putting in

18 a lot of time on this Committee and we_d like to see

19 that some of the lessons are carried into the future,

20 the procedures that have been suggested.

21 DR. GERRITY: I have some definite

22 agreement on that assessment.

156 1 DR. LANDRIGAN: Now, let me ask you a

2 particular question about the studies that you hope to

3 get going in the next round of people who might have

4 been exposed to CW agents. It strikes me that the

5 scientific problem that you have here is that the

6 number of people who may have been exposed to those

7 agents is only a fraction of the 700,000 or so members

8 of the DOD who were in the Gulf region. And

9 therefore, if you_re really going to get human studies

10 underway of good statistical power that are able to

11 examine health effects in this fractional group,

12 you_re going to have to have a recruitment strategy

13 that somehow enables you to come up with an enriched

14 sample. It_s fine to mine the cohort at Portland, for

15 example, and see if you can pick people up, but my

16 guess is that in any one VA the number of people who

17 will have had that exposure is not going to be very

18 large.

19 And I wonder if this, you might want to

20 give some thought to this, I don_t have the answer as

21 to how you might do it. But in putting out this RFA,

22 you might want to specifically encourage people to

157 1 come forward with strategies for national recruitment

2 of persons who may have been heavily exposed. I think

3 if you_re going to do clinical and epidemiologic

4 studies of the effects of these agents, that_s a

5 necessity.

6 DR. GERRITY: Yeah. There are two issues.

7 One is the specific one of the individuals who were at

8 the detonation of Bunker 73. The much broader issue

9 is one has to suggest that there is always the

10 possibility that this could be a broader issue, so,

11 you know, one still wants to look at the larger cohort

12 of 670,000 deployed troops.

13 Now, what is going on right now --

14 DR. LANDRIGAN: I think it_s fine to do

15 that, but Sutter_s Law applies.

16 DR. GERRITY: Exactly, no. No, well, let

17 me just tell you some specifics that I didn_t go into

18 in my testimony, actually because some of these

19 specifics arose subsequent to the submission of my

20 written statements.

21 Both DOD and VA are matching the

22 individuals within the 37th and 307th which were there

158 1 with the records on the VA health registry and the

2 DOD_s CCEP, with the understanding that this is not a

3 research tool. One cannot pose research questions to

4 it. However, you could certainly be, I think we owe

5 it to look at that to determine whether or not there

6 would be sentinel events that would come out of

7 looking at, for example, in the extreme, are all, you

8 know, are all on the registry or are none on the

9 registry. I think that_s very important. That_s

10 going on right now, and we expect to have results

11 within, actually, the next couple of weeks on that.

12 The other is to look at what other data

13 can be mined on those identified individuals. And we

14 have some preliminary data, for example, from the

15 Naval Health Research Center where they have gone and

16 taken, not just the 37th, but they_ve gone out into

17 the 82nd Airborne, it was, although not home or close

18 in, they were around the area of the detonation and

19 looked at the hospitalization records, basically

20 looking at them as a subset of the DOD hospitalization

21 study that the Naval Health Research Center did.

22 They found that overall there is a

159 1 difference between those who were in the 82nd and

2 those who weren_t in terms of hospitalizations.

3 However, when one goes down into ICD non-specific

4 discharge diagnoses, it ends up being accounted for by

5 musculoskeletal injuries and overall injuries which

6 would be intuitively consistent with the fact that the

7 82nd Airborne is an airborne contingent that is likely

8 to experience physical injuries.

9 None of the other ICD-9 categories showed

10 any difference. Again, I_ll caution that it_s, you

11 know, this is a quick look that I think we needed to

12 take to see whether or not, you know, something showed

13 itself. Nothing there did, but we_re not going to

14 stop there. I_ve asked again to try to get an

15 immediate response on this. Each of the Environmental

16 Hazard Research Centers that the VA has as being, if

17 you will now, VA_s environmental hazards experts that

18 we have brought on board. We_ve asked them to put

19 together some pre-proposals and some ideas for

20 conducting epidemiology amongst those particular

21 cohorts, and we_re going to be looking at those.

22 Those are amongst our real short term responses to

160 1 this situation.

2 DR. TAYLOR: I_m wondering, will your

3 chemical research be the same as before the peer

4 review process as well for submitting your proposals

5 regarding chemical warfare?

6 DR. GERRITY: In answer to the long-term

7 issue of an RFA, that would be a competitive peer

8 reviewed RFA. If we felt that we needed to get

9 something off the ground in the short term, we would

10 look at doing, if you will, instead of prospective,

11 more retrospective peer review. But definitely, we

12 will not launch anything that has not undergone

13 scientific external peer review.

14 DR. TAYLOR: And given the urgency now of,

15 there_s a lot of concern that there was chemical

16 warfare exposure. How soon do you see any of these

17 projects taking place or?

18 DR. GERRITY: Well, I think you_ll just

19 have to see it evolve over the next, you know, several

20 weeks to months. I think that, you know, as you know,

21 we have operated under the assumption with respect to

22 our health research agenda that there were no

161 1 exposures. That situation has, the face of that

2 situation has changed. We feel that we owe it to the

3 Persian Gulf veterans to address it vigorously with a

4 research response.

5 MR. CUSTIS: I have nothing.

6 DR. LASHOF: Let me come back to the issue

7 of the mycoplasma question. I gather there were none

8 of high enough scientific merit in this connection to

9 rise above the group to get into the funding. But

10 let_s get back to this issue of targeted versus going

11 for the best that_s submitted. Would you consider

12 that research on the mycoplasma hypothesis deserves a

13 targeted specific RFA in view of the fact that many

14 veterans are now being treated by their physicians

15 based on this theory of which there has been really no

16 solid decent research. And we do the veterans a

17 disservice if we continue to have that theory out

18 there. People being treated based on it, and yet we

19 have no good data that tells us it_s right or wrong.

20 DR. GERRITY: I would generally agree with

21 that statement. And I think this is something that I

22 want to take back with me to the Research Working

162 1 Group for a discussion. I, too, am concerned that

2 there are treatments being given that have no support

3 in adequate clinical science being done.

4 DR. LASHOF: We_d like a further report on

5 that.

6 DR. GERRITY: Yeah.

7 DR. LASHOF: Yeah. Marguerite?

8 MS. KNOX: Just clarify for me again, when

9 Phil asked about pre-deployment evaluations done on

10 soldiers to Bosnia. You said that yes, they were

11 having pre-deployment evaluations but they may not

12 necessarily be physical exams. Is that correct?

13 DR. GERRITY: Correct.

14 MS. KNOX: And so that still does not

15 adhere to the recommendation that we made in our

16 interim report. If we continue to send soldiers

17 abroad without giving them a physical exam prior to

18 and after, we cannot do an epidemiological study. So,

19 I think that that really needs to be addressed.

20 DR. LASHOF: Okay. I think that we_ll

21 have to break now for lunch. Thank you very much. I

22 think this has been a very worthwhile session. And we


1 will resume. We_re going to have to cut lunch short

2 because -- has arrived, I gather. And so we will have

3 to resume promptly at 1:45.

4 (Whereupon a recess was taken.)

5 DR. LASHOF: We_re ready to resume our

6 session. And I_m very pleased that Dr. Duelfer was

7 able to get out of New York and get here. And he is

8 accompanied by Igor Mitrohkin, correct? And they are

9 from the United Nations Special Commission and will

10 proceed to discuss their findings.

11 DR. DUELFER: Thank you very much. And I

12 apologize for the delay and the disruption to your

13 schedule. I wanted to begin with a few brief comments

14 on the background, what the Commission is and what

15 it_s tasks are. And then I will turn to our

16 understanding of what Iraq had in its inventory and in

17 its possession with respect to chemical weapons and

18 with respect to biological weapons. I will then

19 discuss our destruction activities in Iraq, and that_s

20 an activity which in fact we_re rather proud of. Then

21 I will turn to the specific questions related to the

22 area and the depot of Khamissiyah, where we have had


1 three inspections. And then finally, I have a video

2 that we_ve put together with some segments of our

3 activities in these areas, and I will ask Igor to

4 narrate that.

5 So, let me begin by stating, first of all,

6 that the Special Commission was created by the

7 resolution which ended the Gulf War, the cease fire

8 resolution known as Number 687. And among other

9 requirements, it required Iraq to rid itself of its

10 weapons of mass destruction. It created this Special

11 Commission to render harmless, destroy or remove all

12 of the agents and associated materials that were part

13 of the Iraqi weapons of mass destruction program.

14 This is chemical weapons, biological weapons and

15 ballistic missiles with a range greater than 150

16 kilometers.

17 I_ll just mention that in the nuclear

18 area, the International Atomic Energy Agency had

19 primary responsibility for removing the Iraqi nuclear

20 program. The slide, you know, basically is an excerpt

21 from that resolution. There are a lot of other

22 requirements on Iraq. The Commission, however, is

165 1 strictly focused on the weapons of mass destruction.

2 What Iraq had. The next line. What I am

3 going to tell you is a mix of what the Iraqis have

4 told us and what the Commission believes. And when

5 I_m telling you something that the Commission

6 believes, I will try to separate that. Because our

7 experience with the Iraqis has not been one of -- we

8 don_t have a lot of confidence in what they tell us.

9 And that_s been part of the problem why it_s taken us

10 so long to get to the bottom of what in fact they were

11 doing.

12 In the period between 1981 and 1991, Iraq

13 produced about 4,000 tons of chemical weapons agents

14 and approximately 100,000 chemical munitions. During

15 the period 1987 to 1991, Iraq produced around 30,000

16 liters of biological weapons agents, that_s

17 concentrated agents, and more than 200 biological

18 weapons munitions. You can see from this that the

19 biological weapons program began later. That_s why

20 the starting point that I mentioned is 1987 to 1991.

21 In January 1991, after the beginning of

22 the Gulf War, both chemical and biological weapons

166 1 were deployed to over a dozen different sites in Iraq.

2 And these are indicated on this chart. According to

3 Iraq_s declaration, most recent declaration that is,

4 in June 1996, most of these sites, as you can see on

5 the chart, were located in the central part of Iraq

6 and only two locations were in the southern area of

7 Iraq, namely, Nassiriyah and Khamissiyah ammunition

8 depots.

9 Iraq has told us that they deployed 6,240

10 artillery shells with mustard agent in them at the

11 Nassiriyah ammunition depot and 2,160 rockets with

12 Sarin were declared to be stored at the Khamissiyah

13 ammunition depot. At the time of the war, Iraq_s

14 chemical weapons arsenal consisted of about 30,000

15 filled munitions. And these included all sorts of

16 munitions, that is to say warheads for ballistic

17 missiles, the Al-Hussein scud warheads, aviation

18 bombs, artillery shells and various types of 122

19 millimeter rockets.

20 Now, some of these munitions were dual

21 capable in the sense that they were both for chemical

22 and biological. In this case, I_m pointing

167 1 specifically to the missile, the scud missile

2 warheads. They were to be used with both biology and

3 chemical agents, not at the same time obviously, but

4 for either one.

5 The BW arsenal, per se, was smaller

6 according to the Iraqi declaration. They had roughly

7 200 aviation bombs and 25 warheads for ballistic

8 missiles. That_s the next line. These are the

9 warheads for the Al-Hussein -- I use the term Al-

10 Hussein and scud interchangeably. Al-Hussein is the

11 Iraqi-built scud missile.

12 Let me turn to the destruction activities

13 that we_ve conducted in Iraq. In order to fulfill the

14 requirements of this Resolution 687, the Commission

15 had to conduct and build facilities for the

16 destruction of all these agents and munitions. Our

17 approach was to require Iraq to bring to its main

18 chemical weapons facility, Muthanna Estate

19 Establishment, all of the munitions and agents that

20 they had in the country. That was our goal. And at

21 that location, we would build a destruction facility

22 which would serve this purpose.

168 1 This slide shows an incineration unit

2 which the Iraqis constructed specifically for the

3 purpose of destroying mustard agent. In addition to

4 that, we had, there was already existent a hydraulysis

5 unit which had been used in the production of chemical

6 agents and it was modified for the destruction, by

7 hydraulysis, of nerve agent.

8 Next slide. That_s the hydraulysis unit.

9 Now, that was the procedure which we established, and

10 in fact, which we accomplished. We had a chemical

11 destruction group operating at Muthanna from 1992, the

12 summer of 1992, until the summer of 1994. They

13 destroyed roughly 28,000 munitions, 480,000 liters of

14 live agent, 1.8 million liters of precursor chemicals,

15 liquid form, and also one million kilograms of solid

16 precursor material.

17 The one exception to this pattern of

18 destruction on the part of the Commission was at

19 Khamissiyah. In 1991, when we did our initial survey

20 of where Iraq had agent and munitions, our team went

21 to Khamissiyah and found that the condition of the

22 munitions there was so fragile, that they were so

169 1 damaged, that they did not want to remove those

2 munitions to Muthanna Estate Establishment for

3 destruction. What they found, and this is in October

4 of 1991, was approximately 463 122-millimeter rockets

5 with chemical, these were the chemical versions.

6 Later, let me go to the next slide. Wait.

7 I_m sorry. No, stay with that one. I_m sorry. In

8 February and March of 1992, we sent a special mission

9 to that area to destroy those munitions and agent at

10 that location so as not to risk moving them the 500

11 kilometers to the Muthanna Estate Establishment. Now,

12 I_m going to be discussing three locations, and I, if

13 you get confused, I apologize, but just bear in mind

14 there are going to be three locations around

15 Khamissiyah. One of them is the depot, and that_s

16 where the Iraqis stored the 122-millimeter rockets

17 initially. Then I_m going to discuss a second area

18 which is variously described as a pit or open area.

19 That is an open area where they moved some of the 122-

20 millimeter rockets. A third location is going to be

21 a location not far from Khamissiyah, but it_s also an

22 open area and it_s the area where they moved mustard

170 1 artillery rounds.

2 Now, those mustard artillery rounds were

3 in fact in good condition when we found them, and

4 those were moved back to Muthanna Estate Establishment

5 for destruction. We developed with a team of experts

6 a procedure for the destruction of these munitions at

7 Khamissiyah which involved both the explosion of the

8 rocket as well as at the same time the incineration of

9 the agent. What we did was dig out these pits, as you

10 can see there, filled half rounds of these 55-gallon

11 drums with diesel fuel mixed with a little benzene.

12 The rockets were laid across them, usually about 20 at

13 a time, or some number about like that. The rockets

14 were opened with plastic explosives, small amount, I

15 guess, perhaps a detonation cord. And at the same

16 time the explosion went off, the diesel fuel and

17 benzene ignited and burned the agent. We took a lot

18 of precautions with respect to personal protection,

19 with respect to setting up clean zones, testing the

20 weather, the wind and so forth. Before the

21 destruction activity was taking place, we had a

22 helicopter in place which, you know, launched and did

171 1 a visual survey of the area to make sure there was no

2 wind in the area. And in this process we destroyed

3 the rockets which we found at Khamissiyah.

4 One other point I want to mention which

5 drives a lot of our work. And that is that our

6 responsibility is to assure the Security Council, the

7 U.N., that all Iraqi munitions and agents have been

8 destroyed or accounted for. Accounting for this stuff

9 is a very difficult problem because even when we know

10 how many things were brought into Iraq, and we know

11 how many things we destroyed in Iraq, there is an

12 uncertainty because Iraq claims to have destroyed a

13 large number themselves. They claim that in 1991,

14 after the war, they, through unilateral action,

15 destroyed a large amount of their weapons of mass

16 destruction, particularly munitions in the chemical

17 area and also biology area. They claim that they

18 destroyed all their biology agent and a large number

19 of their chemical munitions. We have inspected

20 locations where they claim to have done this, and we

21 have not found that their claims are inconsistent with

22 other information we have, but we_re not able to

172 1 verify it.

2 That uncertainty in our ability to conduct

3 an accounting has driven a lot of our work. And that

4 uncertainty caused us to send yet another inspection

5 mission to Khamissiyah this past spring. And here

6 again, I mentioned that Igor was the Chief Inspector

7 at this inspection. But again, now turning strictly

8 to the area of Khamissiyah.

9 In October 1991, we sent our first

10 inspection to that area and we found 300 122-

11 millimeter rockets at the depot. Now, there_s three

12 locations again. I don_t know if you can see it.

13 There_s the arrow pointing straight down, that_s the

14 depot. Then there_s also an open storage area, below

15 and to the right, that spot. Now, in between those

16 two locations are where we found all the

17 122-millimeter rockets. Some of them were at the

18 depot and some were at what is known as Bunker 73.

19 The rest were found at the open storage area.

20 These contain Sarin, a mixture of G

21 agents. The rockets which were on there each had two

22 plastic containers which contained this agent. The

173 1 bunker, when it was investigated in October _91, was

2 found to be completely destroyed. There were rockets

3 dispersed all over the area. There was a lot of

4 unexploded ordinants. An exact accounting was

5 impossible at that time. And again, for safety

6 reasons, due to the condition of the munitions, due to

7 the condition of the bunker area, we decided not to

8 conduct the full scale investigation of that until the

9 following spring.

10 In October of 1991, our inspectors also

11 went, if we go back to the previous. We also went to

12 the third spot which I mentioned, where that star is,

13 just below the -- that_s the location of the 155

14 millimeter mustard rounds. And those in October 1991

15 were found to be in good condition. They were

16 subsequently shipped back to Muthanna for destruction

17 there. They had been moved to that site, according to

18 the Iraqis, from the Nassiriyah ammunition depot,

19 which is 20 kilometers northwest of Khamissiyah.

20 Now, the following spring we sent a team

21 to destroy the 122 millimeter rockets in that area, in

22 February to March _92. They conducted the demolition,


1 as you saw in that photograph, roughly 463 rockets

2 were destroyed and then we asked the Iraqis to

3 continue some investigation in the area if they could

4 find others.

5 Now, in spring of this year, again, to

6 assure ourselves on the accounting of the munitions,

7 we had yet another inspection of the area and Iraq

8 described in greater detail their version of the

9 events surrounding the movement of the munitions to

10 Khamissiyah. They told us that they had moved 2,160

11 chemical rockets with GB and GF just before the

12 beginning of the war, that is in the period between 10

13 to 15 January, 1991. They moved them from Muthanna

14 Estate Establishment to the Khamissiyah depot, where

15 they were put into Bunker 73. Now, these were rockets

16 with the warheads attached. And as soon as you do

17 that, you know, it means they_re prepared for use.

18 Unfortunately, the rockets also began to leak quickly,

19 the Iraqis found. And they claim that they began

20 moving them when they found the leaking ones to an

21 open area. And that was the reason why they moved

22 down to that second open storage area. By the time of


1 the Iraqi retreat, which was early March _91, they

2 state that they moved approximately 1,100 rockets to

3 that open storage area. So, roughly there_s 1,000 at

4 the open storage area and 1,000 in Bunker 73.

5 They say that they were roughly intact at

6 the time of their retreat. They also state that when

7 they returned to the site after Coalition Forces had

8 withdrawn, that they found that Bunker 73 had been

9 destroyed and they also found that some of the rockets

10 located in the open area had been destroyed as well.

11 So, with respect to Khamissiyah, I would say, you

12 know, that roughly there were 2,000 122 millimeter

13 rockets filled with G agent. We have destroyed 463 of

14 them, but our numbers were all subject to some leveled

15 uncertainty. I think, you know, both -- even the

16 Iraqis given those numbers are subject to some

17 uncertainty.

18 Let me just comment that, and in all of

19 our discussions at all levels with the Iraqis, they

20 have stated that they never used either chemical

21 weapons or biological weapons. That, you know, they

22 were simply just not used. And we have seen no

176 1 evidence, by the way, that would contradict that.

2 And let me just leave my statement as it

3 is. I_ll ask Igor if he has anything to add at this

4 point. We have a short video which he will narrate

5 which gives a little bit better flavor of our

6 activities.

7 MR. MITROHKIN: Thank you. I will just

8 give the reasons for our last inspection in the area

9 of Khamissiyah before as I became Executive Chairman.

10 And the one reason was to control the counting of

11 these weapons provided by the Iraqi side. And the

12 other reason was to confirm particular type of 122-

13 millimeter chemical warheads which Iraq stored at this

14 particular site.

15 And if we will come back to our slides, we

16 need to show three more slides. Yeah. So, we go

17 there. As a result of this mission, the result was to

18 rid them of these type of weapons and we_ve got some

19 evidence and now we can prove that indeed the same

20 type of chemical weapons have been stored in both

21 ammunition depot and the open area. This is how

22 Bunker 73 looks like now. The Iraqis backfilled this

177 1 area with soil because of the severe construction

2 activities being built around this area.

3 Next slide please. But even now from what

4 remains of 122-millimeter chemical warheads and the

5 regional footprints in this area. And next slide

6 please. And even found some strong evidence of the

7 chemical origin of these weapons. You can see a

8 plastic container and residue covered with plastic.

9 This construction has been used only for GW

10 application by the Iraqis. Thank you very much.

11 MR. DUELFER: We can go through a video

12 very quickly.

13 DR. LASHOF: Please do, yeah. Okay.

14 Yeah.

15 MR. MITROHKIN: I will give you some

16 comment concerning this.

17 MS. LARSON: While we_re switching the

18 plugs, could you just elaborate on how the Iraqis said

19 the scuds were destroyed or the rockets were

20 destroyed. By whom and how?

21 MR. DUELFER: They claim that they

22 destroyed them unilaterally in 1991, excuse me, 1992.

178 1 But again, you know, we have still some uncertainty

2 about the accounting for those, and that_s one of the

3 greater problems of our work right now, to assure that

4 they still do not have new inventory of some of these,

5 both missiles and warheads.

6 DR. BALDESCHWIELER: Question also. Is

7 there any evidence of contamination of the ground

8 surrounding this area?

9 MR. DUELFER: At Khamissiyah?


11 MR. MITROHKIN: In May 1996 there was no

12 evidence. In _91, yes. There were a lot of evidence

13 and we had eight, ten buses leading on camps and was

14 a serious contamination. In February, March _92,

15 there was a serious contamination, too, especially

16 when we conducted the transportation of munitions from

17 one area, open area, to the destruction site, several

18 missiles leaked heavily and we even put them into the

19 plastic sleeves, in order to prevent contamination.

20 DR. BALDESCHWIELER: Both mustard and the

21 GB?

22 MR. MITROHKIN: No, only GB because, as

179 1 Mr. Duelfer mentioned, all mustard 155 millimeter

2 shells were in good condition. They were not leaked

3 and they were transported to the Muthanna Estate

4 Establishment where they had been filled for the

5 destruction purpose.

6 DR. BALDESCHWIELER: In your last

7 inspection, did you try to disturb the soil and see if

8 you could get a positive reading from elements of soil

9 that were shaded from sunlight?

10 MR. MITROHKIN: Yes, sir. We used the

11 standard equipment including cams and also some French

12 equipment designed not only for military application

13 but also for the civilian chemical industries which

14 allows to identify subproducts or single elements.

15 And both types of equipment didn_t give us any

16 reading.

17 DR. LASHOF: We_re going to go ahead with

18 the videotape and then we_ll take more questions.

19 MR. DUELFER: Let me just point out. Igor

20 was at each of our inspections to Khamissiyah, in

21 October _91 and the spring of _92 as well as the last

22 one.

180 1 DR. LANDRIGAN: Igor, could you move

2 closer. We_re having a little difficulty hearing you.

3 MR. MITROHKIN: Okay. This is Khamissiyah

4 ammunition depot in February _92. This is Bunker 73.

5 The remains of Bunker 73. You can see a lot of

6 122-millimeter missiles in the area around, the

7 surrounding area, and also in the bunker.

8 At that time the Commission didn_t know

9 exactly the type of these weapons and we were not able

10 to confirm that the same 122-millimeter rockets were

11 stored in the open area outside the facility.

12 This is the open area, which is located

13 about three kilometers to the southeast of the bunker.

14 This is the Iraqi workers trying to put chemical

15 rockets, especially those of them which were leaked,

16 into plastic sleeves. It_s also February _92.

17 The first inspection in October _91 found

18 approximately 300 missiles. By the second inspection

19 sent to Iraq to destroy rockets fond before identified

20 more rockets. When the inspection team decided to

21 leave the site after the destruction of 300 rockets,

22 the search for other remaining munitions was carried

181 1 out. And we found more munitions under the bank,

2 under the soil. We used a land mine detector. This

3 is the British piece of equipment. Worked very good.

4 MR. DUELFER: That_s Igor holding it.

5 MR. MITROHKIN: Yeah, that_s me. I was

6 the safety officer for this mission.

7 MR. DUELFER: Safety always comes first.

8 MR. MITROHKIN: But when identified some

9 metal pieces we were not sure that those were chemical

10 rockets, and we asked the Iraqis to check it. A lot

11 of metal fragments were identified in this area. We

12 put yellow flags, according to our procedure. It was

13 the more informational approach. And this is the

14 example of the Iraqis trying to get it out. And

15 indeed, a lot of chemical rockets were taken out of

16 the bank.

17 DR. LANDRIGAN: Now, were these fused?

18 MR. MITROHKIN: Yeah. No, no, no. Sorry.

19 The rockets were completely, I would say, prepared for

20 use, but without fuses, of course, because fuses

21 according --

22 DR. LANDRIGAN: First they discharge the

182 1 propellant?

2 MR. MITROHKIN: Yeah. Warheads were

3 attached, cables connected, because the assembling

4 procedure includes not only the installment of booster

5 tubes but also the connection of cables.

6 This was a real live chemical rocket.

7 MR. DUELFER: We had absolutely zero

8 injuries during our entire destruction process, by the

9 way.

10 MR. MITROHKIN: But the duration, of

11 course, was quite dangerous. And of course, being

12 responsible for carrying out of such operation we

13 tried to arrange our own decontamination procedures

14 which applied also for the Iraqi personnel involved.

15 When we found the evidence that a lot of rockets were

16 still under the bank, we decided to continue the

17 collection of rockets. And we used water, the

18 simplest way. Okay, next.

19 As I mentioned, we didn_t believe to the

20 Iraqi, to the effectiveness of the Iraqi

21 decontamination procedures and all decontamination

22 activities were carried out by the Commission_s

183 1 personnel. In this particular case, we might use a

2 Swedish personnel. Okay, next please.

3 All the rockets found in this area were

4 transported by the Iraqi site under the Commission_s

5 supervision to another site. This is the destruction

6 site. Stop here please. The pit and we transported

7 rockets using regular trucks.

8 We destroyed not more than 40 rockets for

9 a single demolition because we calculated the quantity

10 of agents to be destroyed, the purity of agents, and

11 we took into account the particular location, because

12 in back the Basra Highway was located about five miles

13 to the south of this place. This is the destruction

14 pit, barrels. The procedure was extremely primitive

15 indeed. We use the plastic explosives basically only

16 quarts in order to open the munition. And after the

17 opening, the agent itself was burned.

18 All operations with explosives were

19 carried out by the Commission personnel only, because

20 we also didn_t trust the Iraqi side of this. Stop

21 here. Of course, the area was secured. We used also

22 helicopter, this is the German. And then demolition.

184 1

2 And this is the area of Bunker 73 in May

3 _96, a couple weeks ago. The area was backfilled with

4 soil, but even after that several chemical rockets or

5 their components were found in the footprints. This

6 is the engine. There were rockets around.

7 This is the inspection team.

8 DR. BALDESCHWIELER: Was there any

9 evidence of unburned agent in the aerosol form from

10 the explosion?

11 MR. MITROHKIN: No, sir. The, again,

12 equipment was used but no any readings. The most

13 important for us was to find an evidence of the

14 chemical origin of these weapons, and we found it.

15 MR. TURNER: What is that?

16 MR. MITROHKIN: You see, this is the

17 plastic container inside the warhead. This is also,

18 but it_s better to take the next, yeah, plastic

19 container. This is an indication of the chemical

20 nature of this warhead and also the booster tube is

21 probably ballistic.

22 DR. TAYLOR: And you say that there_s no


1 evidence of contamination now in the soil there, in

2 1996?

3 MR. MITROHKIN: Yes, because the agent

4 used by the Iraqis in order to fill these weapons was

5 not stable. It was a makeshift Sarin and Cyclosarin.

6 The normal stability could not be more than a couple

7 days, under several circumstances. If, for example,

8 it was steel inside the warhead, maybe a couple years,

9 but not more than two years in any case. This is the

10 plastic container again.

11 We also checked other buildings

12 surrounding Bunker 73. All of them destroyed, but we

13 checked this in order to verify are there any remains

14 of chemical warheads or chemical rockets, or any other

15 122-millimeter rockets. We checked about 20 bunkers

16 around or remains of these bunkers and no any evidence

17 of 122-millimeter chemical rockets. Only in Bunker

18 73. Who_s next?

19 Then we visit again the open area. The

20 landscape of this area has changed indeed. This is

21 the open area. Even now several rockets are still

22 existing because when the inspection team left Iraq in


1 March 1992 it was an understanding that more munitions

2 were still under the bank and the Iraqis were guided

3 to continue the situation, according to the

4 declaration. They indeed conducted during several

5 months the digging of this area. And when we visited

6 this site in May _96, we found that the whole bank

7 disappeared because of the digging.

8 What_s interesting that we can confirm

9 that this the same type of chemical 122-millimeter

10 rockets which was found in Bunker 73. Thank you.

11 That_s it.

12 MR. DUELFER: That_s our presentation.

13 DR. LASHOF: Thank you very much. I don_t

14 have questions for either Mr. Duelfer or for Igor.

15 John? Please.

16 DR. BALDESCHWIELER: In your central

17 demilitarization area, back at the, where you took

18 grounds to be demilitarized. How did you deal with

19 the assembled rockets and shells? How did you drain

20 the agent from those?

21 MR. MITROHKIN: Basically taking into

22 account that there were no fuses installed. The

187 1 munitions were transported from the open area to the

2 destruction area without any disassembly. The

3 probability of the explosion, according to our

4 calculation, the probability of the non-authorized, I

5 would say, explosion was not high indeed. And we

6 didn_t disassemble any complete rockets.

7 DR. BALDESCHWIELER: In the central

8 facility, where you showed a picture of incinerator?

9 MR. MITROHKIN: You mean in Muthanna

10 Estate Establishment?

11 DR. BALDESCHWIELER: Yes. How did you

12 drain the agent from the munitions before

13 incineration?

14 MR. MITROHKIN: Normal procedures for most

15 of Iraq_s munition we simply open the filling plug.

16 If no filling plug, were drilled manually.

17 MR. DUELFER: Some of the mustard rounds,

18 the artillery rounds, were opened explosively, with

19 just a small amount of plastic explosive.

20 DR. BALDESCHWIELER: In the incinerator

21 itself?

22 MR. DUELFER: No. No, no, no.

188 1 DR. BALDESCHWIELER: Outside the

2 incinerator?

3 MR. MITROHKIN: Yes. We established a

4 special area for DOD operations not far from the

5 incineration unit and some operations were carried out

6 there.

7 DR. BALDESCHWIELER: But some of the

8 munitions have a drain plug?


10 DR. BALDESCHWIELER: I assume some of the

11 rockets did not?

12 MR. MITROHKIN: Basically all munitions

13 had filling plug, with the exception of 122-millimeter

14 rockets and 155-millimeter shells. But with 155-

15 millimeter shells it was easy because there was a

16 possibility to take out the booster tube from those,

17 and most of them were stored also by the Iraqis

18 without boosters. This made the situation easier.

19 All aerial bombs, they had the filling plug. Even a

20 Hussein chemical warhead also had the filling plug

21 because it was the special aluminum container inside

22 the warhead and this container had the filling plug.

189 1 The warhead was fixed in the vertical position, the

2 filling plug was opened and the chemical agent was

3 liquidated from the filling hole.

4 DR. LASHOF: Elaine?

5 MS. LARSON: You did not destroy any

6 biologic agents; is that correct?


8 MS. LARSON: So, the information about

9 biologic agents was just what was reported by the

10 Iraqis, and you assume -- they reported that they

11 destroyed the toxins?

12 MR. DUELFER: That_s correct. That_s one

13 of the difficulties we have now is to verify their

14 statements and their claims. Now, there_s, you know,

15 secondary evidence which we can endeavor to collect

16 through interviews of personnel, through, you know,

17 knowledge about fermenter capacity and so on and so

18 forth, and knowledge about the time they were

19 operating, you know. We can try to test elements of

20 their description to see if they_re, you know, they_re

21 consistent with other facts that we know.

22 But the short answer is, we never

190 1 destroyed any Iraqi agent. They claim they did that

2 all themselves. And we haven_t seen such --

3 MS. LARSON: Are you aware of any

4 information that would lead you to believe that CBW

5 agents were in fact used?

6 MR. DUELFER: We have seen no evidence at

7 all that it had been used. The Iraqis have said they

8 deployed it, though. I mean, they deployed it before

9 the war, and out into, you know, various locations.

10 DR. LASHOF: Art?

11 MR. CAPLAN: I just want to go back to

12 your first visit to this depot, Bunker 73. When you

13 got there, you said they had moved some of the armed

14 missiles and then realized they were leaking so they

15 took them to the open pit. When you first got there,

16 and were looking for contamination, what sort of

17 radius did you look around in? I_m trying to get a

18 feel for what level of contamination and what distance

19 you were able to detect the presence of these agents

20 that might have leaked or that they might have

21 distributed by trying to destroy some of these weapons

22 there at that particular location?

191 1 MR. MITROHKIN: During our first visit, we

2 used only the chemical agent monitoring system, the

3 well-known cams, the British equipment. And the

4 equipment was used only when we had the evidence of

5 potential chemical weapons, munitions. Without this

6 evidence, of course, the area itself was not checked.

7 MR. CAPLAN: You made no general survey?

8 MR. MITROHKIN: No, sir. When 122-

9 millimeter chemical rockets or rockets supposed to be

10 chemical weapons were found. After that we carried

11 out the, I would say, search of this area. But also

12 it had been very limited. The area was covered with

13 unexploded ordinants and the, even movement in this

14 area was restricted. That_s why we didn_t visit all

15 of the bunkers in this area. The open area wasn_t

16 rated much better because in the open area we even had

17 an accident. Being not familiar with this type of

18 weapons, we tried to take samples of agents from

19 chemical warheads. And during the drilling, the agent

20 makeshift, Sarin and Cyclosarin, under the high

21 pressure inside the munition was pushed and about two

22 liters of the agent leaked through the seal used by

192 1 our DOD expert.

2 Taking into account that we liberated the

3 special safety standards and for this particular

4 duration only the rubber protection seal could be used

5 because the German protection seal which normally is

6 used for the destruction of chemical munitions from

7 World War II in the specialized facility, but only the

8 regular protection seal. And only this fact saved us.

9 MR. CAPLAN: One other question. How long

10 would it take to fuse one of these ready-to-go rockets

11 and fire it?

12 MR. MITROHKIN: If the fuses are

13 calibrated, it means if this is a proximity fuse and

14 the timing is installed already, is the standard

15 operation that doesn_t take more than couple seconds

16 per rocket. And if the personnel is trained, it_s not

17 a problem. Could be done very quickly.

18 DR. LASHOF: Elaine?

19 MS. LARSON: I_m just curious why they had

20 produced all of these agents and deployed them and

21 then didn_t use them. When were they going to use

22 them then? I mean, what were they waiting for?

193 1 MR. DUELFER: Iraq has long experience in

2 this area. And in our discussions with them they have

3 explained that, you know, in the war with Iran in fact

4 they felt that these weapons saved their country in a

5 sense, because they had enormous attacks on Iranians

6 and, you know, they had experience that led them to

7 believe that these weapons were useful. However, they

8 also have told us that in the case of the Gulf War,

9 that they were deterred from using them in that case.

10 We_ve gotten actually somewhat mixed

11 explanations. On the one hand they will say that

12 their possession of these weapons deterred the

13 Coalition Forces from attacks on them in Baghdad,

14 either directly or with other weapons of mass

15 destruction. On the other hand, they say that perhaps

16 they were deterred from using them because others

17 might have used such weapons. So, you know, it_s a

18 question of deterrence, I suppose, that they_re

19 fundamentally saying.

20 DR. LASHOF: Okay. Marguerite?

21 MS. KNOX: Yeah. I have a couple of

22 questions. Can you clarify for us what the difference

194 1 in the findings in 1992 versus 1996? I know you said

2 you left instruction with Iraq to destroy the rest of

3 those missiles. What were the differences in the

4 findings when you returned in 1996?

5 MR. MITROHKIN: Yes, indeed. I will start

6 with the second part of the question. We found that

7 Iraq did conduct the operations according to the

8 guidelines received from the Special Commission. We

9 found the rockets under the bank, because the open

10 area was located in a distance approximately 30 feet

11 from Kamal. All this bank is not existing now. The

12 Iraqis digged it out, trying to verify remaining

13 rockets. And what did we see in particular? A couple

14 complete rockets even in May _96, at least according

15 to our understanding, confirms that at least some

16 activities were carried out in this area by the

17 Iraqis. And the Iraqis also didn_t deny that there

18 was a possibility of more rockets under the bank of

19 Kamal.

20 Concerning the first part of the question,

21 what_s the difference between findings. In _91, of

22 course, the Special Commission was not familiar with

195 1 the system of chemical weapons produced and procured

2 by Iraq. For example, in _91, the Commission thought

3 that it was only one type of 122-millimeter chemical

4 rockets produced by the Iraqis. A couple years later,

5 we found that Iraq produced in total about five types,

6 five different types of 122-millimeter chemical

7 rockets.

8 MS. KNOX: And can you name those?

9 MR. MITROHKIN: Basically, there are

10 technological differences and the differences in

11 construction. Looking from outside, you will never

12 recognize the difference. For example, how many

13 containers, what material was used for the containers

14 and for the warhead, what was the range of missiles,

15 and several issues like this. And we tried in _96 to

16 confirm that warheads found and rockets found in

17 Bunker 73 completely adequate to rockets found in the

18 open area, because we didn_t believe the Iraqis that

19 1,100 rockets were moved when they found that they

20 were leaking in Bunker 73. We_re being suspicious in

21 this respect because they are the Iraqis.

22 Why you found that they_re leaking only


1 after the transportation, not during the

2 transportation, if you have leaking weapons, that_s

3 very strange that you found this only after putting

4 them into the bunker.

5 MS. KNOX: Right.

6 MR. MITROHKIN: This was our concern. And

7 taking this into account, we had a feeling that maybe

8 there were different types of chemical 122-millimeter

9 rockets in the bunker and in the open area. And

10 that_s why we need to collect some information

11 concerning the construction of this type of chemical

12 weapons, and what did we find? Basically the

13 confirmation of two plastic containers in warheads,

14 inside Bunker 73, and two plastic containers in

15 warheads in the open area, which is the confirmation

16 of the same type of weapons.

17 MS. KNOX: Right. If you were suspicious

18 in _91 and you returned in 92, why did you wait four

19 years to return in 1996?

20 MR. MITROHKIN: There are several reasons

21 for this. One of the reasons is related to the level

22 of our investigation. Before 1995, Iraq completely


1 denied any deployment of chemical weapons to any

2 military facilities. Before _95, the Iraqi refusal

3 line was that chemical weapons have never been

4 deployed to the Minister of Defense, which was the

5 main concern for us because we found this illogical,

6 that the weapons produced was not designated to be

7 used by the Minister of Defense. And even this

8 information, which has been provided by the Iraqis

9 concerning the location of chemical weapons, this

10 information was requested to be provided by Iraq in

11 1991. Finally it was provided first time only in _95.

12 In the latest of our declarations there were several

13 modifications of this latest declarations. And I

14 could not say that the situation is clarified

15 completely now.

16 DR. LASHOF: Okay. Phil, go ahead.

17 DR. LANDRIGAN: Do you have information

18 that you could produce maps of areas of contamination.

19 Perhaps not fully quantitative, but at least

20 qualitative or semi-quantitative. I_m thinking that

21 the generation of that sort of map would help define

22 focus areas for subsequent epidemiologic studies.

198 1 MR. MITROHKIN: Of course we can do this.

2 But I must say from the beginning that we didn_t find

3 any large areas of contamination with G agent because

4 of the nature of this CW agent. The contamination was

5 very limited and basically it was the radius of dense

6 feets around particular warheads. But not more. For

7 example, after the demolition, we, of course, checked

8 the, not only potential distances of contamination,

9 but practical distances. And the distance was not

10 more than about 800 meters.

11 DR. LANDRIGAN: Do you have reason to

12 think that there were areas in southern Iraq, apart

13 from this area that you_ve been describing, the

14 general area, where also there might have been

15 contamination with this agents, or was it restricted

16 to this one area?

17 MR. MITROHKIN: In central Iraq?

18 DR. LANDRIGAN: Southern, mainly in

19 southern. I_m thinking mainly in southern.

20 MR. MITROHKIN: We have no any other

21 evidence that there were other contaminated areas in

22 southern Iraq. In central Iraq, there were

199 1 contaminations in the area around the Mohammadia

2 storage facility, was the primary storage area located

3 not far from the Muthanna Estate Establishment. In

4 central Iraq, in the area was contaminated indeed, but

5 not more than for couple square kilometers.

6 DR. LANDRIGAN: Yeah. Thanks.

7 MR. MITROHKIN: And of course around the

8 Muthanna Estate Establishment was contaminated

9 heavily, because agents in bulks were destroyed there

10 during the war.

11 DR. TAYLOR: I guess the question I have

12 about the contamination again. So none of these

13 chemicals can remain airborne for any specific length

14 of time? They can_t become airborne.


16 DR. TAYLOR: No?


18 DR. TAYLOR: Only the -- I_m a little

19 confused still. The contamination again, only

20 specific areas when that small section that you were

21 talking about?

22 MR. MITROHKIN: Right. Because this agent

200 1 would be vaporized immediately, being put on the

2 ground. And this is the reason of this agent, this G

3 agent, it_s not persistent agent. It was not designed

4 for the contamination of the area. It was designed

5 for the inhalation exposure. And that_s why it_s

6 difficult to believe that this agent can create any

7 contaminations or any long scale contaminations.

8 Only if the source of contamination is

9 still available, like leaking munition, there is a

10 possibility of some contamination. But again, the

11 agent itself was not persistent.

12 DR. TAYLOR: It_s not persistent.

13 DR. CUSTIS: Not to belabor the question,

14 we have been briefed on the opinion that Sarin

15 specifically does get into the explosive cloud and

16 that winds will disperse those particles and it would

17 be contradictory as to the direction and distance of

18 that dispersion. You_re saying none of this is true?

19 MR. DUELFER: Let me just throw -- our

20 responsibilities are strictly to find munitions in

21 Iraq and get rid of them. I mean, we_re not appearing

22 before you as experts on the effects of these agents.

201 1 So I_m a little bit -- I want to caution, you know,

2 what we say with respect to contamination, those sorts

3 of things, that is not -- our expertise and why we are

4 here is to tell you what we have found in Iraq. So,

5 I mean, I just -- don_t take us as experts on

6 dispersion or inhalation or any of those sorts of

7 things. Igor Mitrohkin happens to know a great deal

8 about that, and because he was a safety officer on a

9 lot of our destruction activities, you know, has

10 intimate knowledge of these things. But, you know,

11 our role is we are a U.N. body charged with certain

12 activities under the resolution. So, if we offer

13 opinions on these types of things, they are opinions

14 only. Forgive me for sounding a bit bureaucratic.

15 I_ll turn to Igor to answer your question.

16 DR. LASHOF: You may answer, Igor, any way

17 you want. There_s no independent -- individual or

18 whatever.

19 Let me try a few and then I_ll get back

20 and give us a round because we_re going to run short.

21 I_d like to review a little bit the time table here.

22 As I understand it, our forces went in in March of _91

202 1 and blew up the rockets and things that were in Bunker

2 73. At that time, assuming that none of them were,

3 they didn_t contain rockets with chemical weapons.

4 You went in October of _91, several months

5 after we had been in, and found evidence that they had

6 obtained chemical weapons. Is this correct? And at

7 that time you did notify our government of that

8 finding, our DOD, that you think that they might have

9 blown up some weapons that had contained chemicals?

10 MR. DUELFER: We make regular reports to

11 the Security Council, who are our bosses, as it were,

12 public reports that are official U.N. documents, that

13 describe our activities. And we have described what

14 we found at Khamissiyah ever since we first made that

15 inspection in October _91. I mean, this is, you know,

16 it_s common knowledge that we in fact were rather

17 pleased with ourselves of destroying the weapons at

18 Khamissiyah in the spring of _92. And that was our

19 first chemical weapons destruction activity.

20 DR. LASHOF: And so, and then you have

21 similar reports for your other visits in _95 and of

22 course we know you_ve reported in _96?

203 1 MR. DUELFER: Yes.

2 DR. LASHOF: That_s your routine all the

3 time. So that our government was informed, obviously,

4 all along the way. And what I gather you_re telling

5 us is that in _95 you were more convinced that there

6 were more weapons there than you might have thought

7 there were in _92. But in _92 you were convinced that

8 there were chemical weapons?

9 MR. DUELFER: Oh, absolutely. We knew in

10 October _91 that there were chemical weapons there.

11 DR. LASHOF: Yeah. I mean, in October _91

12 that there were chemical weapons. But this question,

13 if that_s not in your realm to answer I_ll understand,

14 what were the things you saw in _91 that enabled you

15 to determine that there were chemical weapons and yet

16 our government had gone in earlier in _91 and blown it

17 up, thinking there were no chemical weapons.

18 MR. MITROHKIN: If I may, I have one

19 comment. In _91, we didn_t establish the fact that

20 the weapons, the chemical weapons stored in the area

21 of Khamissiyah ammunition depot was destroyed by the

22 Coalition Forces. We are not able to make this

204 1 assessment even now. If representatives of other

2 institutions, U.S. governmental agencies, have more

3 information, they will admit this to you, I am sure.

4 But we are not able to prove this fact. We can tell

5 you only what Iraq admitted with this respect. Being

6 asked to provide explanations, how the weapons were

7 destroyed, they provided us in May _96 these

8 explanations. In October _91, Iraq was not able to

9 explain how the weapons were destroyed. The

10 explanation provided to the Special Commission was

11 very general, that the weapons were destroyed during

12 the war, but how it was destroyed in particular, no

13 explanations were presented by the Iraqis.

14 Even now when Iraq admitted during this

15 inspection with the Chief Inspector that the weapons

16 were destroyed by Coalition Forces, as the Chief

17 Inspector, I cannot prove this or I cannot disprove

18 this. I can tell you only what I was told by the

19 Iraqis.

20 MR. DUELFER: I think part of your

21 question is how did we know that there were chemical

22 weapons in October _91 and if the Coalition Forces

205 1 were there in March, why didn_t they know. One

2 important factor is the Iraqis did not mark a

3 conventional munition any differently from the

4 chemical munition. When we went there in _91, they

5 were already dissected as it were. And so you can

6 readily determine and see that they were chemical

7 agents and munitions.

8 DR. LASHOF: You mean because they were

9 partially destroyed?

10 MR. DUELFER: They were intact.

11 DR. LASHOF: If they were intact, you

12 could have told.

13 MR. DUELFER: The regular chemical

14 detectors, as I understand it, I_m not the expert, but

15 regular chemical detectors would not be able to

16 determine a conventional rocket from a non-

17 conventional one.

18 DR. LASHOF: I see. Go on.

19 MR. MITROHKIN: One more comment. What

20 Mr. Duelfer just mentioned, this is very important.

21 The Iraqi practice, practice, was not to mark chemical

22 munitions as a special weapons, as chemical munitions

206 1 or any other munitions other than conventional

2 munitions. This was the idea, this was the mentality

3 and this was the practice. Chemical weapons were not

4 marked and had not any marking system which could be

5 used in order to identify that this is a chemical

6 munition and this is a conventional munition. And

7 they tried to produce munitions, basically, using as

8 much as forcible empty casings from conventional

9 weapons. It_s all private speculation, but, for

10 example, it was the problem for the Special Commission

11 because the Special Commission undertook several

12 additional steps in order to identify the origin of

13 the weapons.

14 For example, the drilled menu in

15 munitions, because there was not any other

16 possibility. The regular military detection equipment

17 doesn_t work in this case, because even the munition

18 in good condition, chemical munition, if it_s not

19 marked and if empty casings from conventional weapons

20 is used, there is only one way to drill munition and

21 to take sample. And this is what the field workers

22 did in two years.


1 DR. BALDESCHWIELER: But they must have

2 some numbering system.

3 MR. MITROHKIN: No. And this was, again,

4 this was the Iraqi idea to cover chemical weapons

5 under the conventional weapons purposes.

6 DR. BALDESCHWIELER: But how would they

7 know themselves?

8 MR. MITROHKIN: In this respect we had

9 several accidents. For example, when at first I found

10 a Hussein chemical warhead, and this was shown in

11 photo and slide, I also was the member of this

12 inspection team. I was Deputy Chief Inspector. The

13 Iraqis tried to assure us that the warhead held only

14 one component of the Iraqi binary system. And all of

15 us commissions experts and the Iraqis were standing

16 around the warhead without any protection equipment.

17 The warhead was open because the Iraqis were

18 absolutely assured that this was empty warheads from

19 the one component.

20 Finally, we found that this particular

21 piece was found with G agent. The Iraqis were

22 surprised, we had been surprised and since that, we


1 have been under procedures established by the

2 Chairman. Each Iraq_s declaration should be

3 challenged. We have this experience.

4 MR. CAPLAN: So that does mean, though,

5 that it would be relatively easy for them to make a

6 mistake, fused a missile and shoot it in error,

7 perhaps, speculatively?

8 MR. MITROHKIN: I cannot give you any

9 response in this particular respect. But logically

10 you are right.

11 MR. TURNER: I have two questions about

12 Khamissiyah specifically, which I think are

13 clarifications. In Bunker 73, the U.N. has only found

14 evidence of rocket casings that are consistent with

15 Sarin and Cyclosarin nerve agents; is that correct?

16 MR. MITROHKIN: Yes, sir.

17 MR. TURNER: You found no evidence of

18 mustard rounds in Bunker 73?

19 MR. MITROHKIN: No. And we have no

20 evidence that these types of weapons, 122-millimeter

21 rockets, have ever been filled with mustard, only with

22 G agent.

209 1 MR. TURNER: The second area I_d like to

2 clarify about Khamissiyah is, if I understood your

3 testimony correctly, Mr. Duelfer, there is a

4 suggestion by the Iraqis that not only were Sarin and

5 Cyclosarin filled rockets at Bunker 73 destroyed

6 during the war, but also some in the site of the open

7 pit; is that correct?

8 MR. DUELFER: That_s correct. That_s what

9 the Iraqis have told us.

10 MR. TURNER: And you have nothing to

11 verify the latter part?

12 MR. DUELFER: We have no reason to believe

13 it or disbelieve it.

14 MR. TURNER: Okay. If you could put up

15 the map again, Mr. Ewing, of Iraq? Mr. Duelfer, if

16 you could indicate the other sites where the U.N.

17 found damaged chemical warfare munitions in Iraq on

18 the map when Miles gets it up, I think that would be

19 very helpful for the Committee.

20 MR. DUELFER: One location, Mohammedia,

21 which is, I can_t find the end of this. There, yeah.

22 MR. TURNER: That_s Mohammedia?

210 1 MR. DUELFER: There.

2 MR. TURNER: So they_re both central Iraqi

3 sites?

4 MR. DUELFER: That_s correct.

5 MR. TURNER: Can you give us some idea of

6 the quantity and type of chemical munition that was

7 found at Al-Muthanna?

8 MR. MITROHKIN: In Mohammedia --

9 MR. TURNER: Mohammedia, that_s fine.

10 MR. MITROHKIN: Mohammedia, we had several

11 hundred dumps filled with mustard that were destroyed.

12 Some of them had already leaked. Also, not more than

13 ten aviation bombs filled with G agent, also a mixture

14 of Sarin and Cyclosarin. A lot of empty 122-

15 millimeter casings and several thousand of mortar

16 bombs filled with CS were there.

17 MR. TURNER: That_s what you found.

18 According to the Iraqi declarations, at Mohammedia,

19 how much in some kind of quantitative term of mustard

20 agent was destroyed during the war?

21 MR. MITROHKIN: In total, let me calculate

22 this. Let_s take 200 aerial bombs, 60 liters in each,

211 1 couple times, not more.

2 MR. TURNER: You were going to talk about

3 Al-Muthanna also. I_m sorry, at Mohammedia, you also

4 had some Sarin-filled aerial bombs?


6 MR. TURNER: And my information is three

7 metric tons. Does that sound in the correct area?

8 MR. MITROHKIN: Couple tons. Yeah, couple

9 tons.

10 MR. TURNER: At Al-Muthanna, again, the

11 same kind of question. What can you tell us about

12 what the Iraqis had indicated is the quantity of

13 chemical munitions that may have been destroyed there

14 during the war?

15 MR. MITROHKIN: In general, in Muthanna,

16 in Muthanna, several thousand 122-millimeter rockets

17 stored in the bunker area of the Muthanna Estate

18 Establishment.

19 MR. TURNER: So those are the same kind of

20 Sarin, Cyclosarin rockets were destroyed at

21 Khamissiyah were the type --

22 MR. MITROHKIN: Same type, different kind.

212 1 Also, maybe you have this information that the

2 Muthanna Estate Establishment was consisted of

3 different areas and it was a huge storage area in the

4 Muthanna Estate Establishment with underground

5 bunkers. During the war when the facility was

6 destroyed, they stored 122-millimeter rockets, 155-

7 millimeter shells, also aviation bombs, including

8 different calibers. And heavy contaminated those who

9 were in the -- I believe the production facilities

10 located in the Muthanna Estate Establishment, because

11 the production was carried out also in January. The

12 day before the destruction the facility had produced

13 chemical weapons. And as a result of the destruction,

14 the area was heavily contaminated.

15 And also, stocks of agents in bulks.

16 Mainly in mustard.

17 MR. TURNER: What information does the

18 U.N. have on the quantity of agent that may have been

19 released around there? Can you give us any kind of

20 idea with respect to nerve agent or mustard agent?

21 MR. MITROHKIN: Several tons of mustard.

22 MR. TURNER: And this is at Al-Muthanna.

213 1 MR. MITROHKIN: Yes. Basically bulk

2 agents.

3 MR. TURNER: Bulk agents were released

4 there, presumably during the air war.


6 MR. TURNER: Just kind of a final point to

7 clarify. The testing that you described doing for

8 contamination. Now, that is conducted when you_re

9 there, obviously, which is several months after the

10 end of the war. So that, if I understood your

11 testimony again correctly, or your comments here

12 today, correctly, the likelihood of finding evidence

13 of Sarin after that kind of passage of time is pretty

14 remote; is that correct?


16 DR. LASHOF: If they_re urgent, we_re way

17 over time. But, just on important issues.

18 MR. CAPLAN: Just one last question which

19 has come up in our hearings frequently, and I_m just

20 curious to have an opinion about it. In your view,

21 were the chemical and biological weapons, well, you

22 didn_t find any biological weapons. The chemical

214 1 weapons you found, is it your view that the Iraqis had

2 ample capacity to manufacture these that nothing came

3 from outside the country, the source of the actual

4 chemical weapons?

5 MR. MITROHKIN: This is a most complicated

6 question addressed to us. If you consider chemical

7 weapons as a system including agents, precursor

8 chemicals, equipment required for their production,

9 filling technology, empty casings of munitions,

10 components of these munitions, parts of the components

11 of munitions, of course Iraq was not able to create CW

12 arsenal on its own. Several components, including

13 precursor chemicals, key pieces of equipment,

14 basically dual use equipment, had been procured by

15 Iraq from the outside.

16 We have no evidence that Iraq imported

17 chemical weapons itself as a final product, either CW

18 agents or CW munitions. But we have evidence that

19 some empty casings supposed to be used later for CW

20 purposes have been exported by Iraq. The same is

21 related to minor precursor chemicals and equipment,

22 but not to chemical weapons itself as a final product.

215 1 DR. LASHOF: One more, John.

2 DR. BALDESCHWIELER: Let me come back to

3 the question of lot numbers and serial numbers. In

4 their manufacture, did the Iraqis have any system of

5 identifying lots and serial numbers on individual

6 munitions?

7 MR. MITROHKIN: Depending on type of

8 munitions. For some munitions they had serial

9 numbers. For example, Al-Hussein missiles.

10 Al-Hussein missile was a strategic weapons for Iraq.

11 It was, it delivered the most sufficient range. After

12 the modification, regular munitions had 300

13 kilometers. Al-Hussein had 600 kilometers. Because

14 they had the serial numbers for the missile itself and

15 for its particular components, for engine, for the

16 warhead, but not for the piece of chemical weapons.

17 And without any knowledge, it was not possible to

18 differentiate, for example, the chemical missile and

19 the conventional missile. Both of them had serial

20 numbers, but only some Iraqi responsible agencies had

21 lists of numbers that applied to chemical weapons and

22 to conventional weapons. And no special marking

216 1 system. Of course, not any instructions or menus,

2 like in other countries that processed chemical

3 weapons by the regular procedure that a short menu was

4 even put on the box. This is not the case for Iraq.

5 DR. BALDESCHWIELER: Could you follow a

6 forensic trail. For example, if you found a munition,

7 could you establish where it had been assembled, for

8 example, and, you know, where the individual parts,

9 for example, had been produced?

10 MR. MITROHKIN: Yes. We did this

11 individually for each particular type of chemical

12 weapons. But this was a long investigation for each

13 type. It took more than one year. For this

14 particular type found in Khamissiyah, it took us three

15 years to establish and to finalize the investigation

16 from the beginning to the end, who produced, how many

17 were produced, who assembled this, what was procured,

18 what was produced, indigenously, where it was filled,

19 and so.

20 DR. LASHOF: Okay. Thank you very very

21 much. We do appreciate your coming down. It_s been

22 very helpful. We_re going to proceed directly to the

217 1 presentation concerning compensation from the Persian

2 Gulf Coordinating Board_s Compensation Working Group.

3 Colonel David Schreier and Mr. Jack Ross.

4 Colonel Schreier, are you going to start,

5 or is Mr. Ross going to start?

6 MR. SCHREIER: No, I will start. Good

7 afternoon. As was said, I am Colonel David Schreier.

8 And I am the Principal Director for Military Personnel

9 Policy within the Office of the Assistant Secretary of

10 Defense to enforce management policy. Now, we_ve had

11 policy oversight and responsibility for the DOD

12 Disability Evaluation System since August of 1995.

13 And prior to that time, the Assistant Secretary of

14 Defense for Health Affairs had this responsibility.

15 This afternoon I_d like to speak with you

16 for a few moments about the DOD Disability Evaluation

17 System. I_ll detail the mission of our system in

18 comparison with the Department of Veterans Affairs

19 Disability System. The components of our system and

20 the procedures we employ to adjudicate a case in a

21 manner that is fair and equitable for both the

22 Department and the affected member.


1 And finally, I want to provide a picture

2 of the levels of appeal built into this system to

3 ensure that this is fair and equitable. Next slide

4 please.

5 Many times there is confusion about the

6 roles and missions of the DOD and the Department of

7 Veterans Affairs Disability Systems. While they are

8 similar and use the same standard for rating

9 disabilities, each system has a different character

10 and charter that is mandated by statute.

11 The purpose of the DOD System is to

12 determine the service member_s medical fitness for

13 duty and, if the member is found to be unfit for duty,

14 to compensate the member for a shortened military

15 career. The DVA System, however, has a different

16 charter. The DVA_s purpose is to determine if the

17 disability is service connected and, if it is,

18 compensate the member for the loss of civilian earning

19 capacity.

20 Further, the law prohibits DOD from

21 evaluating members for disability after they have left

22 the service. Once a member is separated, disability


1 evaluation and compensation comes to the Department of

2 Veterans Affairs. Next slide please.

3 The DOD Disability Evaluation System

4 consists of two major components. The Medical

5 Evaluation Board, or MEB, and the Physical Evaluation

6 Board, or PEB. The MEB is composed of three medical

7 doctors. Their role is to decide if a diagnosed

8 medical condition fails to meet medical retention

9 standards. If so, they refer the member to the

10 Physical Evaluation Board, which will decide if the

11 member is fit for duty.

12 The PEB consists of two line officers and

13 one medical officer. Their job is to determine

14 fitness for duty. And there are two types of PEB_s.

15 The first is the informal PEB. This is the initial

16 review of a case referred by the MEB. The member is

17 not present at an informal PEB. Once the informal PEB

18 makes a fitness determination, the member can either

19 accept their findings or request a formal Physical

20 Evaluation Board.

21 The formal PEB is the first level of

22 appeal and satisfies the requirement for a full and

220 1 fair hearing as mandated by law. The member may

2 appear in person before the formal PEB, have Counsel

3 present and present new evidence or documentation.

4 The formal PEB is not bound by the informal PEB and

5 makes its own fitness determination. Next slide

6 please.

7 This is a graphic depiction of the

8 Disability Evaluation System process. It starts with

9 identification of a medical condition that may impair

10 a member_s ability to perform his or her duties. For

11 reservists, this has to be a condition that is a

12 result of performing military duty. The MEB then

13 determines if the condition meets medical retention

14 standards. If it doesn_t, the member is referred to

15 the Physical Evaluation Board.

16 The PEB is responsible for determining

17 fitness for duty. As I said before, the member_s case

18 file goes before the informal PEB. If the member does

19 not concur with the findings of the informal PEB, he

20 or she can request a formal Physical Evaluation Board.

21 If a member is determined fit by the PEB,

22 the member returns to work. If determined unfit, the

221 1 member is assigned a disability rating and, based on

2 the rating and years in service, either separated or

3 retired.

4 Members separated from the service for

5 disability are entitled to the full range of

6 transition benefits afforded to other separating

7 members. Next slide please, Alex.

8 The last item I_d like to discuss is the

9 appeals process. As mentioned, there are several

10 levels of appeal and automatic review to ensure fair

11 and equitable treatment for both the member and the

12 government. The formal PEB is the first level of

13 appeal. If a member disagrees with the formal PEB,

14 the member can appeal to the Service Disability Agency

15 as indicated. Beyond that, the Service Secretary is

16 the approving authority for all disability separations

17 or retirements, and the member may appeal to the

18 Service Secretary.

19 Finally, even after separation or

20 retirement, the member may appeal the case to the

21 Service Board for Correction of Military Records and

22 to the courts.

222 1 The DES is, in our opinion, a well thought

2 out system and processes over 26,000 members each

3 year. The bottom line is that we have a system with

4 multiple levels of appeal and review to protect the

5 interests of the member and to help ensure we do the

6 right thing by our people. Thank you very much.

7 DR. LASHOF: I think maybe we_ll take --

8 go ahead and hear the GAO presentation. And then take

9 questions.

10 MR. ROSS: Good afternoon. My name is

11 Jack Ross. I am the Acting Director of the Department

12 of Veterans Affairs Compensation and Pension Service.

13 I am pleased to be here today to speak to you about

14 VA_s Compensation Program for Persian Gulf Veterans

15 Suffering from Undiagnosed Illnesses. Although

16 undiagnosed illnesses will be the focus of my remarks,

17 I would like to provide as background some discussion

18 of compensation issues in general.

19 Compensation is a benefit paid to a

20 veteran for service-connected disability. Various

21 forms of compensation have existed since colonial

22 times. The aim of this compensation has always been

223 1 to provide an amount that would help a disabled

2 veteran maintain an adequate standard of living.

3 Currently, compensation is intended to replace income

4 lost due to a disabled veteran_s decreased earning

5 power.

6 Under 38 United States Code 1110, we have

7 authority to compensate for disabilities that arise

8 from diseases or personal injuries incurred in or

9 aggravated by the line of duty during active military,

10 naval or air service. By line of duty, we mean that

11 a disability must not either be the result of the

12 veteran_s own wilful misconduct or the result of drug

13 or alcohol abuse. A veteran must have been released

14 from active duty under other than dishonorable

15 circumstances. It is VA_s policy to grant service

16 connection for any condition that can be attributed to

17 service, no matter how long after service the

18 condition became manifest.

19 Service connection may be granted in one

20 of three ways. First, direct service connection.

21 Generally, direct service connection is granted for

22 chronic conditions that are documented from service

224 1 medical records. However, direct service connection

2 may be granted for a disability that does not appear

3 until long after service if the evidence supports the

4 conclusion that it is related to an incident occurring

5 on active duty.

6 Secondly, the service connection can be

7 granted through aggravation. If a medical condition

8 that pre-existed service becomes worse during service

9 beyond what would be normally expected, we may

10 establish service connection for this worsening of the

11 condition.

12 Lastly, presumptive service connection.

13 For some chronic diseases, the statute and regulations

14 provide presumptive periods. A disease first

15 appearing during a presumptive period is considered to

16 be related to service unless there is affirmative

17 evidence to the contrary.

18 Most presumptive periods are one year

19 following release from active duty. VA evaluates

20 disabilities according to the Schedule for Rating

21 Disabilities which is Part 4 of Title 38 Code of

22 Federal Regulations. Evaluations are made in ten

225 1 percent increments from zero percent to 100 percent.

2 Evaluations of more than one disability are taken

3 together to determine the combined valuation, which is

4 reached not by adding the individual percentages but

5 by applying a combined ratings table found in 38 CFR

6 4.25.

7 The rating schedule was designed to assess

8 as far as is possible the average impairments

9 resulting from the disability in civilian occupations.

10 We are currently revising the rating schedule

11 systematically to incorporate needed clarifications

12 and ensure that it takes into account the latest

13 scientific and medical knowledge available.

14 As I stated earlier, 38 United States

15 Code 1110 authorizes us to compensate for disabilities

16 that arise from diseases or personal injuries. The

17 accepted definition of disease includes the notion

18 that it is manifested by a characteristic set of

19 symptoms and signs whose etiology, pathology and

20 prognosis may be known or unknown.

21 After the return of U.S. Forces from the

22 Persian Gulf, many veterans began exhibiting symptoms

226 1 that could not be attributed to a known clinical

2 diagnosis. They often have combinations of non-

3 specific symptoms that do not fit a single case

4 definition. There have been concerns that these

5 illnesses were caused by various chemical exposures or

6 other environmental hazards in the Persian Gulf.

7 Since these widely varying symptoms cannot

8 be attributed to the characteristic signs or symptoms

9 of known diseases, we are unable to pay compensation

10 for them under the usual statutory authorities.

11 Therefore, we strongly supported legislation giving us

12 that authority. Public Law 103-446 authorized us to

13 pay compensation to Persian Gulf veterans with chronic

14 disabilities resulting from undiagnosed illnesses that

15 appeared either during active duty in the Persian Gulf

16 or to a degree of ten percent or more within a

17 presumptive period thereafter.

18 On February 3, 1995, we published 38 Code

19 of Federal Regulations 3.317 to implement the criteria

20 for establishing service connection for undiagnosed

21 illnesses. Significant features of the regulation

22 include a two-year presumptive period following

227 1 service in the Persian Gulf, a definition of chronic

2 disability as one that has existed for at least six

3 months, a requirement that there be objective signs of

4 chronic disabilities resulting from undiagnosed

5 illnesses, and a requirement that a disability may not

6 be attributable to a known clinical diagnosis.

7 The two-year presumptive period. The one

8 year period established for most chronic diseases

9 seemed insufficient to meet the special circumstances

10 of Persian Gulf veterans. Many of them did not begin

11 to document their undiagnosed illnesses until an

12 examination was held in conjunction with VA_s Persian

13 Gulf Health Registry. The Registry, however, did not

14 begin full operation until November 1992, well over a

15 year after the first veterans began returning from the

16 Gulf. Therefore, we determined on two years as an

17 adequate period allowing all veterans of the

18 hostilities an opportunity to document their

19 illnesses.

20 Definition of a chronic disability. So

21 long as we are dealing with a known disease whose

22 clinical course is familiar, chronicity may generally

228 1 be determined from observing the various

2 manifestations of the disease. This process, however,

3 is not appropriate for dealing with an undiagnosed

4 illness whose clinical course cannot be predicted.

5 Therefore, we adopted six months as an objective

6 standard for determining chronicity. It is a period

7 commonly accepted within the medical community for

8 distinguishing chronic conditions from acute

9 conditions.

10 Since some illnesses have intermittent

11 episodes of improvement and worsening, any undiagnosed

12 illness presenting such fluctuations over a six month

13 period will be considered chronic.

14 Objective indications of chronic

15 disabilities. Objective indications allow us to

16 determine the existence of a disability, when it first

17 appeared and the degree of impairment it produces.

18 Objective indications include both signs in the

19 medical sense of evidence perceptible to an examining

20 physician and non-medical indicators. Non-medical

21 indicators would include such things as time lost from

22 work, evidence that a veteran has sought medical


1 treatment for his or her symptoms, changes in the

2 veteran_s physical appearance and changes in the

3 veteran_s mental or emotional attitude. The

4 importance of non-medical indicators cannot be

5 discounted. Where an undiagnosed illness manifests

6 itself solely through symptoms which cannot be

7 verified medically, non-medical indicators assume a

8 proportionately greater importance. Non-medical

9 indicators are provided to us in the form of lay

10 statements. A lay statement may be submitted by any

11 person who is able to establish that he or she is

12 reporting observations that are based on personal

13 experience.

14 Disability not attributable to a known

15 clinical diagnosis. Public Law 103-446 governs only

16 compensation based on illnesses that cannot be

17 attributed to a known clinical diagnosis. Once a

18 diagnosis is obtained, we cannot consider entitlement

19 under that law. However, as in any case we will

20 consider entitlement under all other statutory and

21 regulatory provisions.

22 At 38 Code of Federal Regulations 3.317,


1 Subparagraph B, we have listed 13 signs or symptoms

2 that may be manifestations of undiagnosed illnesses.

3 This list represents the signs and symptoms most

4 frequently encountered in over 17,000 examinations in

5 VA_s Persian Gulf Health Registry. The 13 signs and

6 symptoms are broad categories encompassing a number of

7 different complaints. The list is not exclusive. We

8 will consider any sign or symptom as a possible

9 manifestation of an undiagnosed illness. We evaluate

10 the degree of disability resulting from an undiagnosed

11 illness by using criteria contained in the Rating

12 Schedule. We apply the criteria for a disease or

13 injury that produces a similar type of disability. We

14 evaluate different types of disabilities as

15 manifestations of either a single illness or more than

16 one illness, whichever is to the veteran_s advantage.

17 Because of concerns about the possible

18 role of environmental hazards in causing the

19 unexplained illnesses in Persian Gulf veterans, we

20 centralized Persian Gulf compensation claims based on

21 environmental hazards in the Louisville Regional

22 Office beginning December of 1992. In October of

231 1 1994, we redistributed these claims to four regional

2 offices known as Area Processing Offices, or APO_s.

3 The APO_s are located in Louisville, Nashville,

4 Phoenix and Philadelphia.

5 Persian Gulf claims based on undiagnosed

6 illnesses are also now centralized at the four APO_s.

7 The authority granted by Public Law 103-446 has

8 presented a unique set of challenges. Prior to that

9 statute we established service connection for

10 diagnosable diseases with well-defined clinical

11 courses. Under Public Law 103-446 we may now

12 establish service connection for disabilities

13 resulting from unexplained illnesses whose clinical

14 courses cannot be predicted and whose manifestations

15 may be entirely symptomatic.

16 Furthermore, some of the illnesses have

17 appeared only after the veteran_s service in the

18 Persian Gulf, delaying the veteran_s efforts to seek

19 medical assistance and consequently documentation of

20 illness. A decision to grant service connection is a

21 bi-parthied process. First we determine that the

22 claimed disability is related to service. Once the

232 1 relationship to service is established, we determine

2 the degree of disability according to the Rating

3 Schedule.

4 In making these determinations, we

5 routinely rely on such evidence as service medical

6 records, VA examination records, or records of VA

7 hospitalization or outpatient treatment, medical

8 records from private physicians or hospitals and

9 occasionally lay statements. To set a simple case

10 history, a veteran claims compensation for a stomach

11 condition. A review of military medical records,

12 which we routinely obtain, discloses several episodes

13 of complaints of and treatment for stomach problems.

14 No diagnosis is given in the service. Examination at

15 VA medical facility discloses that the veteran

16 currently has a duodenal ulcer. After a review of the

17 entire evidence of record, the Rating Board at the VA

18 regional office of jurisdiction determines that the

19 veteran_s current ulcer condition is related to a

20 stomach problems in service. Grant service connection

21 and assigns the appropriate degree of disability as

22 provided in the Rating Schedule.

233 1 The point to be brought out is that we

2 have an established diagnosis, duodenal ulcer, and a

3 well documented medical history of complaints from

4 service medical records and VA examinations, allowing

5 us to determine service connection. If the medical

6 records had contained a diagnosis of duodenal ulcer,

7 the grant of service connection would have been an

8 even simpler decision.

9 However, this case history would become

10 somewhat more complex if the service medical records

11 disclosed no complaints or treatments for a stomach

12 disorder. However, let us assume that some medical

13 evidence, whether from VA or private sources, reveal

14 that the ulcer appeared within one year following the

15 veteran_s separation from active duty. Duodenal ulcer

16 is one of the chronic diseases for which service

17 connection may be presumed provided they appear to a

18 degree of ten percent or more within one year after

19 service. Therefore, in this situation we may

20 determine service connection on a presumptive basis.

21 We can increase the complexity of the case

22 history still further by assuming that the service

234 1 medical records disclose a single complaint of stomach

2 disorder for which the examining physician could

3 establish no diagnosis. A year and a half after

4 separation from service the veteran claims

5 compensation for a stomach disorder. VA medical

6 examination discloses no verifiable signs of a G.I.

7 disorder and the examining physician is unable to

8 provide a diagnosis, but does record the veteran_s

9 history of stomach problems. There is no other

10 medical evidence for consideration. In a situation

11 such as this, with complaints of stomach problems

12 during and after service but no underlying diagnosis

13 to explain them and no history of chronicity to link

14 them as manifestations of the same illness, service

15 connection would be denied under normal criteria.

16 However, with the advent of Public Law

17 103-446 it may now be possible to grant service

18 connection for this undiagnosed stomach ailment in the

19 case of Persian Gulf War veteran. The situation as

20 set out includes a complaint recorded in service

21 medical records, given the two-year presumptive period

22 for undiagnosed illnesses, an indication of such

235 1 complaint in service medical records is not necessary.

2 We have adjudicated compensation claims

3 for all types of conditions for over 80,000 Persian

4 Gulf veterans and have granted benefits to 25,000 of

5 these claims. As of June 28, 1996, we had reviewed

6 the claims of slightly more than 11,000 Persian Gulf

7 veterans for entitlement to compensation based on

8 either exposure to environmental hazards or

9 undiagnosed illnesses. The claims of 10,348 have been

10 reviewed under both sets of criteria. To date we have

11 granted compensation to 1,324 veterans for

12 disabilities claimed to have resulted from exposure to

13 environmental hazards or undiagnosed illnesses. Of

14 these, 532 veterans are receiving compensation for

15 undiagnosed illnesses. The remainder receive

16 compensation for disabilities due to environmental

17 hazards.

18 Although there have been proportionately

19 few grants of compensation for undiagnosed illnesses,

20 reviews by both the General Accounting Office and VA

21 indicate that we have awarded compensation for

22 diagnosed condition for as many as 40 to 60 percent of

236 1 the over 11,000 veterans claiming these types of

2 conditions. Nonetheless, in response to concerns over

3 the low number of grants of service connection for

4 undiagnosed illnesses, the Compensation and Pension

5 Service recently undertook a review of a sample of 468

6 cases in which undiagnosed illnesses were found not to

7 be service connected.

8 A review disclosed errors of coding in the

9 tracking system we used to monitor these cases. The

10 miscoding had no effect on the outcomes of the cases.

11 Our review also disclosed several instances of

12 incomplete development for evidence and failure to

13 obtain current medical and lay information, which

14 could affect the outcome of a claim. On the basis of

15 our findings, we are undertaking a second adjudication

16 of the over 11,000 cases in the tracking system to

17 correct problems of development, adjudication and

18 coding. We also have published more detailed

19 instructions to our field offices emphasizing proper

20 development and adjudication of these cases and

21 specific instructions for coding.

22 In response to concerns about the adequacy

237 1 of the two-year presumptive period, the Secretary has

2 asked us to conduct a further review of Persian Gulf

3 undiagnosed illness cases. He has specifically

4 requested an analysis of our experiences with these

5 cases, the medical and scientific information

6 supporting an extension of the presumptive period

7 beyond two years and the basis justifying the cutoff

8 point for whatever extended period might seem

9 appropriate.

10 Upon completion of the analysis, the

11 Secretary will decide how next to proceed. This

12 concludes my statement. Thank you.

13 DR. LASHOF: Thank you very much, Mr.

14 Ross. Questions from the panel?

15 DR. TAYLOR: I have one question of

16 Mr. Ross. Regarding the disabilities, compensation

17 received due to environmental hazards, how are you

18 defining environmental hazards? What are those, the

19 ones where the cases have been reviewed and approved?

20 MR. ROSS: Environmental hazards could be

21 anything. It could be exposure to benzene, it could

22 be exposure to the oil fires in the Gulf where they

238 1 experienced breathing problems shortly thereafter, any

2 of those types of disabilities.

3 DR. TAYLOR: And so you had 700 cases that

4 have been approved and they_re receiving compensation?

5 MR. ROSS: A little over 800, ma_am. Yes,

6 ma_am.

7 DR. CUSTIS: A number of years ago the

8 American Medical Association was critical of the VA

9 for being too generous in their rating schedule and

10 arguing that it should be more in keeping with

11 industrial compensation. Does that argument still go

12 on?

13 MR. ROSS: I_m not familiar with that

14 argument, sir. I couldn_t address that.

15 MS. NISHIMI: Mr. Ross? I understand that

16 you_ve consolidated the undiagnosed illness claims in

17 four offices, I believe you said. But, as I am sure

18 you are aware, the American Legion opposes the

19 consolidation and recommends that it go back to the

20 field offices. Is VA considering the Legion_s

21 viewpoint and where do the whole thing just stand?

22 MR. ROSS: There are two schools of

239 1 thought with regard to centralization. Centralization

2 focuses the issue. It allows a certain degree of

3 specialization for the very unique type of claims.

4 And that school of thought tends to support the

5 centralized four processing offices.

6 The other school of thought tends to

7 indicate that you are a little closer to the problem

8 with regard to the individual representatives, if in

9 fact you maintain jurisdiction in the regional office.

10 However, I would point out this. That the initial

11 adjudication for undiagnosed illnesses, although it is

12 processed at one of the four processing offices, if an

13 individual disagrees with that claim, jurisdiction

14 then reverts back to the regional office of

15 jurisdiction for the hearing officer_s review of the

16 case. So, in that sense, at least the individual is

17 afforded the opportunity at the regional office level

18 to have their claim reconsidered.

19 DR. LASHOF: As I understand it, the

20 Coordinating Board, as the Working Compensation Group

21 is a subgroup of the Coordinating Board, which is

22 trying to coordinate, because they_re the VA. Is that


1 an active group and what are the kinds of issues that

2 come before the Working Group?

3 MR. ROSS: Doctor, I_m sort of new at

4 this. I_ve only been on board now for about three

5 weeks, and I_m not familiar with how the subgroups are

6 actually structured.

7 DR. LASHOF: Do you know, Colonel Schreier?

8 MR. SCHREIER: I_m afraid I don_t.

9 DR. LASHOF: Okay. We_ll have to go back

10 to someone else and try to find out.

11 We_ve heard a lot of testimony from

12 veterans who feel that they_ve been waiting a very

13 long time, a year, two years, to find out whether or

14 not their claims are going to be approved or not. Do

15 you have data on how long it usually takes you from

16 the time the claim is filed til the time action is

17 taken one way or the other?

18 MR. ROSS: Yes, we do. There is a very

19 common misimpression among veterans throughout the

20 country that their claim takes two or three years for

21 initial processing, when in fact on average right now

22 claims are taking about 151 days, initial claims.


1 What a veteran tends to think in terms of his or her

2 claim is from the date he first files an application

3 to its completely adjudicated through all of the

4 appeals processes. So in fact a veteran may well file

5 a claim with one of the four, the area processing

6 offices, and have a determination made within, say,

7 six months. But then they are dissatisfied for one

8 reason or another and they want to appeal that case.

9 Then it may stay in the hopper for a hearing officer

10 for another three or four months, and then if the

11 veteran remains dissatisfied, it could go to the Board

12 of Veterans Appeals where the case may await call-up

13 and final decision for another year to two years.

14 DR. LASHOF: Do you think that_s a

15 reasonable length of time for a veteran, say someone

16 has totally disabled, has no income, to take two years

17 before he can get a final reading?

18 MR. ROSS: If we are talking about each

19 segment, Doctor, if we_re talking about the 150 days,

20 I don_t think that is a reasonable period of time. We

21 have set a goal for ourselves of 102 days as a

22 reasonable period, and we are moving toward that goal.

242 1 Two to three years ago we were well in the area of

2 over 200 days to process original claims. And as I

3 just mentioned, we are now down to 151 and our goal is

4 102 days.

5 The other areas, in terms of appeals,

6 there are areas that we don_t have any control over.

7 There are requirements of the law that give the

8 veteran a year to file an appeal, and our clock never

9 stops ticking. The veteran has one year, and many of

10 them wait six months before they file their appeal.

11 Service organizations or attorneys who represent

12 veterans, they also have certain provisions under law

13 in which they have time to develop their evidence, and

14 we have no control over that. Yet we are charged with

15 the time lengths.

16 We also have periods that are mandated by

17 due process that we have to allow.

18 DR. LASHOF: Well, I understand that. And

19 obviously, it_s to the veteran_s advantage to have

20 time during which he has time to file. So, let me ask

21 the question another way. Assume that he_s turned

22 down and he files immediately for an appeal, from the

243 1 time he files for the appeal, how long does it take

2 before it_s heard and action taken before he_s ready

3 to file the next appeal?

4 MR. ROSS: If in fact he is filing or

5 perfecting his appeal to the Board of Veterans Appeals

6 in Washington, D.C., the Board of Veterans Appeals,

7 the most recent data that I have heard from them is

8 that they are reviewing the cases complete from start

9 to finish within 90 days.

10 However, if in fact the veteran has a

11 service representative, depending on the service

12 organization, it ranges anywhere from 120 days up to

13 396 days that the service organizations are holding

14 cases for review.

15 DR. LASHOF: The service organization

16 being the reason for the long delay rather than --

17 MR. ROSS: It_s the veteran_s

18 representative. Yes, ma_am.

19 DR. LASHOF: I see. Don?

20 DR. CUSTIS: This all reminds me, what

21 loss of FTE are you going to be visited with?

22 MR. ROSS: In each of the next two fiscal

244 1 years, it looks like we will lose at least 400 people

2 in each of the next two fiscal years.

3 DR. CUSTIS: How is this going to impact

4 the time lengths?

5 MR. ROSS: Obviously, with fewer FTE_s to

6 process the cases, our case load could turn around and

7 go the other way. Time lengths could in fact

8 increase, rather than decrease as it has been. We are

9 hoping that technology will at least stem the tide to

10 some degree.

11 MR. MCDANIELS: You state in your

12 statement that you published more detailed

13 instructions emphasizing proper development and

14 adjudication of cases. This is including obtaining

15 lay evidence?

16 MR. ROSS: Yes, sir, it is.

17 MR. MCDANIELS: Why do you suspect it_s

18 difficult to obtain lay evidence? It seems like lay

19 evidence would be something quite easy to provide, if

20 you were a veteran?

21 MR. ROSS: You know, that was surprising

22 to me when I initially read those findings where we

245 1 had developed from veterans lay statements and they

2 were not provided. I don_t know why lay statements

3 aren_t provided in every instance.

4 MR. MCDANIELS: But the applications for

5 disability compensation, they ask for or they state

6 that lay evidence is acceptable?

7 MR. ROSS: Yes. I will expand on that a

8 little bit. In the traditional sense of what

9 credibility is attached to lay statements, the

10 specific regulations which apply to undiagnosed

11 illnesses give far greater weight to lay statements

12 for those types of disabilities than any other

13 disability we_ve ever considered in the past. It_s a

14 separate category, if you will. And as this evolves

15 we are learning bit by bit the necessary steps that we

16 have to take to elicit information from veterans and

17 veterans and their representatives are also going

18 through that same learning curve.

19 DR. LASHOF: Okay. John?

20 DR. BALDESCHWIELER: If I can come back to

21 the 151 days, or the 102 days, if you can achieve

22 that, is that an issue of cueing basically or is it,

246 1 I mean, what literally goes on if it takes that long?

2 MR. ROSS: Actually, if you look to the

3 case, there are certain time frames within that that

4 we actually have no control over. First of all, when

5 we get a claim in, we have to request the veteran_s

6 military records. And typically that can take

7 anywhere from a week to a month, you know, on average.

8 So there_s 30 days that we really can_t act on. Then

9 in other instances we have to go back to the veteran,

10 say, for the lay statement or for private medical

11 records or for evidence that he or she may have, and

12 we have to give them 60 days to provide that

13 information before we can act on the claim. So

14 there_s another 60 days that we have no control over.

15 And I would say in a, normally you_ve got

16 a 60 to 70 day window in there that you_ve got no

17 control over whatsoever, that you cannot completely

18 adjudicate the claim. It_s not like an insurance

19 claim where one bit of evidence goes in and it_s acted

20 upon. There are two or three things that have to

21 occur. We have to get the veteran_s military records,

22 we have to get him a current examination, and we have

247 1 to develop evidence that he or she may have.

2 DR. BALDESCHWIELER: Are you adequately

3 staffed to handle the backlog, or there must be a

4 significant backlog?

5 MR. ROSS: The backlogs are all going down

6 at present time, sir.

7 DR. BALDESCHWIELER: Because that must

8 vary enormously with time. That is, following the

9 Gulf War, presumably you have a large pulse of claims.

10 MR. ROSS: Any time that there is an armed

11 conflict of that magnitude, our work load rises and

12 our staff does not rise correspondingly. And it takes

13 a while for us to get it manageable again, get it

14 under control, but our backlogs and our timeliness,

15 our backlogs have been going down for the past year,

16 year and a half, and our timeliness has been steadily

17 improving.

18 DR. LASHOF: Thank you. David?

19 MR. HAMBURG: We heard a lot at this

20 Commission about the burst of new research on Persian

21 Gulf illnesses and there_s also an intensification of

22 clinical experience over those problems. Could you

248 1 tell us more about how the compensation system takes

2 into account the changes in research and clinical

3 experiences. How does it update itself in light of

4 new information?

5 MR. ROSS: In terms of undiagnosed

6 illnesses, right now all we need is a statement from

7 a physician in essence that says Persian Gulf Syndrome

8 or Persian Gulf Symptom, or undiagnosed illness, any

9 of those kinds of things. That would, in conjunction

10 with the veteran_s medical history during service and

11 the associated lay statements and what his current

12 condition is, would allow us from an adjudicative

13 standpoint to grant the benefit.

14 If, for instance, say tomorrow, this is

15 just a hypothetical situation, it was disclosed that

16 the Sarin that was found in the chemical weapons did

17 in fact cause a specific type of disability or

18 disabilities, the minute that that medical knowledge

19 was made available to us, we could then grant, not on

20 the basis of an undiagnosed illness, but on the basis

21 of a known diagnosable entity.

22 DR. LASHOF: Art? Go ahead.

249 1 MR. CAPLAN: Just two questions for

2 Mr. Ross. When someone appeals a decision, do they

3 have to forego all the benefits that they might have

4 been awarded while they_re appealing?

5 MR. ROSS: Oh, no. Oh, no. That_s --

6 MR. CAPLAN: So those continue?

7 MR. ROSS: There_s absolutely no loss.

8 MR. CAPLAN: And my other question for you

9 is, do you need a representative or an attorney to

10 work the system, or another way to put it is, how user

11 friendly is this? I mean, people have come before us

12 and said they_re lugging around documents trying to

13 find signatures. Occasionally we see evidence of

14 failure to move forward with claims because people

15 don_t get the medical evidence or statements that they

16 need in. Could I go to a web site and be told how to

17 take this claim forward myself? Is it something you

18 would claim to be user friendly?

19 MR. ROSS: I would say that, given all of

20 the avenues that are available to veterans today, I

21 know when I got out of the service I was as green as

22 could possibly be. That was back during the Vietnam

250 1 era. There were county veteran service officers to

2 help me. There were national service organizations

3 like the American Legion, DAV, people like that there

4 to help me, and they were almost waiting in line

5 literally when I was discharged.

6 There are a number of avenues to pursue.

7 The VA itself is not adversarial in the initial claims

8 process. If you went into any VA regional office and

9 said, I want to file a claim, they would assist you in

10 filing the basic claim. After a decision is made,

11 that environment changes somewhat.

12 DR. LASHOF: Okay. Marguerite?

13 MS. KNOX: Yeah. I just have one question

14 for the Colonel. We_ve had several testimonies from

15 active duty soldiers who have been hesitant to go and

16 have their CCEP because they are afraid that they may

17 be medically retired and lose their benefits that they

18 would get if they retired from the military after 20

19 years. Can you talk about, say they got 50 percent

20 medical disability, what would they really get, and I

21 know it would depend on rank, but what are the other

22 benefits that they_re losing as to why they do not do


1 that?

2 MR. SCHREIER: Off the top of my head, I_m

3 not sure what they would be losing. I mean, they and

4 their family members continue to have access to the

5 military medical system. They continue to have access

6 to commissaries and exchanges. They have the full

7 range of transition benefits that any separating

8 service member has access to.

9 MS. KNOX: So those would be life-long

10 benefits?

11 MR. SCHREIER: Well, some of the

12 transition benefits have an expiration date associated

13 with them, because they are meant to assist the

14 individual in transitioning back to civilian life.

15 But yes, the commissary, exchange, military medical

16 system, at least up until the time that they_re age 65

17 and come under Medicare, then that takes over. They

18 are losing, generally speaking, when we speak of a

19 military member retiring at 50 percent of their basic

20 pay, that_s closer to about a third of their actual

21 income because of the other allowances that they

22 receive for housing and subsistence and anything else


1 that may be in the total pay package.

2 MS. KNOX: So about two-thirds of their

3 salary is what they_re losing?

4 MR. SCHREIER: I would think that would be

5 the predominant thing that is causing them concern and

6 perhaps also the fact that it_s a significant life

7 change, going from an environment where they are, if

8 they_re concerned about it, apparently an environment

9 where they feel relatively comfortable into a

10 different environment.

11 MR. CROSS: Colonel, I think there_s two

12 other issues that they lose if they raise their hand,

13 because I know, I_ve had active duty veterans, you

14 know, raise a concern. If they get into this process

15 where they seek medical retirement or medical

16 evaluation, let_s say, they_re instantly stricken off

17 of any promotion lists.

18 MR. SCHREIER: That_s not true.

19 MR. CROSS: Now, in my experience they

20 are. And also, reenlistments are jeopardized because

21 they_re in a medical hold status. So that_s the fear,

22 to me, because obviously you want to get promoted, so

253 1 obviously you make more money. And on the other hand,

2 to stay in for 20 years you have to reenlist to

3 continue your career. So, those are two areas that I

4 sense that there are a concern about.

5 MR. SCHREIER: I will agree that the

6 individual is probably going to, well, it comes back

7 to the same thing. They feel threatened that there_s

8 going to be a change in the environment. I think,

9 though, that I will dispute the fact of being removed

10 from the promotion list. I think that is bad

11 information that you have been given. There may be an

12 extraordinary case where that occurred, but I can for

13 the life of me not imagine how that would have

14 occurred. But I_ll take it that if someone told you

15 it happened, it happened. In that case, I_d be

16 interested in knowing the specifics. The individuals

17 that are being evaluated and would be coming up on an

18 enlistment point typically what will occur is that the

19 individual can continue there on a current enlistment.

20 They can be extended until there is some resolution of

21 the case, whether or not they are medically qualified

22 to reenlist. So it_s not that we have an individual

254 1 who perhaps has 11 years_ service, is coming up at the

2 end of the 12 year enlistment that would carry him to

3 12 years, we_re not going to throw them out the door

4 at the 12-year point if they_re undergoing some

5 medical assessment. But nonetheless, you_ve got an

6 individual that feels threatened that their livelihood

7 is at risk.

8 MR. CROSS: Now, also, out of that 26,000

9 figure that you processed last year, are those claims

10 that are still in that group? Are there claims for

11 Gulf War Syndrome requesting retirement based on that?

12 MR. SCHREIER: I_ll say yes, but I_m going

13 to quibble on terminology. An individual doesn_t

14 request retirement through the Disability Evaluation

15 System. An individual comes to the medical community

16 through their local medical treatment facility and

17 reports a condition, or a supervisor or commander asks

18 them to go because of some problem that they detect.

19 And if the medical community then

20 documents that they have a medical condition, it_s

21 three doctors who recommend that he be evaluated for

22 continued service through the Physical Evaluation

255 1 Board. The individual, of course, can present them

2 with information that would help them along the way,

3 but the individual does not request medical

4 retirement. That_s solely based upon the medical

5 condition that they have and an assessment on their

6 ability to perform military duties.

7 DR. LANDRIGAN: Question for Mr. Ross.

8 Mr. Ross, to what extent does the VA consider

9 compensable psychological diagnoses, post-traumatic

10 stress disorder and the like?

11 MR. ROSS: If we_re talking about a

12 diagnosis, a diagnosable condition such as post-

13 traumatic stress, that can be evaluated anywhere from

14 zero percent to 100 percent based upon the degree of

15 impairment in the individual case, but that_s a

16 diagnosable condition. You could have an undiagnosed

17 illness just as well, which could fall into that

18 category, but there would not be an associate

19 diagnosis.

20 DR. LANDRIGAN: Are you implying that in

21 the latter case it would not be compensable?

22 MR. ROSS: No, we are being compensable in

256 1 the latter case. Yes, sir.

2 DR. LASHOF: Okay. Thank you very much.

3 Appreciate it. We_re running a half hour behind time.

4 I suggest we skip the break but takes five minutes to

5 stand up and stretch and just take a five minute break

6 in that place.

7 (Whereupon a recess was taken.)

8 DR. LASHOF: Can I get our Committee to

9 resume?

10 Okay. I think we_re almost all here. I

11 think we_ll resume and the first item now is an update

12 or a review of our meeting on reproductive health,

13 which was held in Seattle on June 17th and 18th. All

14 of you have a fairly detailed summary of our meeting.

15 It was really an excellent one, and I must say it was

16 a really crash course in biology, enteretology and all

17 aspects of reproduction and development embryology.

18 The briefing material was extremely thorough, and we

19 had a very extensive panel of experts in the various

20 areas. And we looked at biologic plausibility, we

21 looked at reproductive toxicology, we looked at the

22 epidemiology and the research on infertility and

257 1 subfertility and fetal loss and birth defects. We

2 looked at the federal research on evaluating the rates

3 of congenital anomalies and what data we are trying to

4 get. We assessed reproductive health in special

5 populations. We dealt with the problems of diagnosing

6 and defining syndromes and determining their

7 prevalence. And we dealt with the genetics referral,

8 both the VA and DOD.

9 I don_t want to go through the findings on

10 all of them. They_re detailed in your book and we_ll

11 be discussing them again tomorrow when we do the

12 review of risk factors. But I just want to make a few

13 points and then sort of open it for questions and let

14 you all ask questions about anything that you read in

15 here that isn_t clear or that you want further

16 additional information on or want us to look at.

17 One key issue clearly is the biological

18 plausibility of birth defects due to abnormal sperm

19 because of exposure of the veteran or soldier in the

20 Gulf after his return. I mean, going through the

21 biology of spermatogenesis, it appears that unless

22 conception occurred within 60 to 90 days upon return

258 1 it would be highly unlikely for there to be any birth

2 defect in the offspring due to exposure to the male

3 while he was abroad, as sperm turn over within 60 to

4 90 days. That, I think, is an extremely important

5 factor.

6 We also looked at the toxicology and we

7 looked at what studies have been done on the various

8 toxic substances they were exposed to and what is

9 known about any of those causing birth defects, and so

10 far there_s no evidence that any of the chemicals have

11 been known to do so.

12 I don_t want to detail all the others.

13 But those I thought were two critical issues. We did

14 review the various epidemiologic studies that are

15 still going on. And, as you heard earlier today,

16 there_s a new study that_s being funded to also look

17 at the incidence of birth defects.

18 One important point in the diagnosis in

19 defining syndromes that I thought was extremely

20 important that we did hear testimony about. How the

21 variation in diagnosis and how when the birth defects

22 or syndromes are reported as occurring in a certain

259 1 number, when one goes ahead and goes back and has the

2 children examined by experts in the field, one finds

3 a lot of misdiagnoses so that it_s often difficult to

4 accept statements that have not followed up with a

5 detailed diagnosis by a pediatric specialist in

6 congenital defects.

7 I think those are the major points that I

8 wanted to raise. And let me just open it up for you

9 to ask questions of myself or Kathy, or Marguerite.

10 Do you want to add anything to my very brief summary?

11 You were at the meeting.

12 MS. KNOX: No. I think it_s important,

13 like you said, that there is a study that came out

14 today from DOD that_s going to fund research

15 concerning that, and I think that it_s notable. Also

16 money is going to be funded from the Shea Bill, is

17 that correct, on, is that right, Robyn?

18 MS. NISHIMI: The Byrd Amendment. That

19 would depend, obviously, if that language is retained

20 through the legislative process. It_s encouraging,

21 though.

22 MS. LARSON: I_ve got a question. The two

260 1 studies that are reported about Golden Harr Syndrome.

2 One of them the conclusion is, or it looks like it

3 might be that there isn_t enough of the sample size to

4 tell, even with 75,000 infants, or, you know, infants

5 being studied. And the second one is in the process

6 somewhere. Is that an answerable question given these

7 two studies? I can_t tell from reading and I wasn_t

8 there so, it_s on page four.

9 DR. LASHOF: Kathy, do you want to tackle

10 that one?

11 MS. HANNA: Thanks. The study that_s

12 being done by the CDC, in cooperation with the Naval

13 Health Research Center, is taking, let me just explain

14 briefly what the study is. They reviewed 75,000

15 records that came from the Defense Manpower Data

16 Center of reported births and used IDC codes to try

17 and classify very inclusively any case that might be

18 Golden Harr. And Golden Harr is a very broad spectrum

19 syndrome, and so any clinical aspect that fell within

20 the Golden Harr category was included. So they were

21 very inclusive. They then sent those cases, they

22 collected detailed medical records on those cases, and

261 1 sent them to the CDC, blinded, for clinical

2 dysmorphalogists and geneticists at CDC to review the

3 records and validate the diagnosis as to whether it

4 was Golden Harr or not.

5 They did that without any knowledge of

6 whether these children were born to Gulf War veterans

7 or not. And their study design would require many

8 more cases. I think they reviewed 360 cases

9 altogether that were not Golden Harr but had been

10 originally diagnosed as Golden Harr, but after they

11 reviewed the records, they excluded many of those

12 cases.

13 They would have to get many more records

14 before they would feel comfortable that they had a

15 powerful enough statistical sample to rule out any

16 differences, but within their confidence intervals

17 right now, they are ruling out that there_s any

18 increased incidence in Golden Harr.

19 MS. LARSON: What_s the incidence about in

20 the general population?

21 MS. HANNA: That_s a good question, too.

22 It_s very difficult syndrome to diagnosis, and so


1 depending on when the diagnosis was made, when the

2 study was done, and what the population was, the

3 literature reports Golden Harr as being anywhere from

4 one in 2,500 births to one in 25,000 births. And that

5 big difference is due to the difficulty in diagnosing

6 it and the fact that it is quite often misdiagnosed.

7 The more, I think, conservative estimates

8 are that it_s probably in the range of one in 15,000

9 to 20,000 validated Golden Harrs.

10 MS. LARSON: Well, out of the 75,000 you_d

11 only get 30 cases at the most, and then you split

12 those into two groups, and you_ve got the little

13 statistics?

14 MS. HANNA: Right. That_s the big problem

15 with that study.

16 MS. LARSON: And what_s the status of the

17 Dr. Aaronetta study? Where is she on that? That_s

18 the first one from San Diego?

19 DR. LASHOF: Yeah. Yeah.

20 MS. HANNA: Yes. They_re still collecting

21 cases. You mean, on the Golden Harr study?

22 MS. LARSON: Yeah, on birth defects, yeah.


1 They_re in the middle of this epidemiological study

2 which sounds very useful to answer the --

3 MS. HANNA: Right. I would expect that

4 they would have preliminary data by September that

5 they_ll be able to report to the Committee.

6 The other study that you were referring

7 to, the Golden Harr study, has been done. It_s

8 records that have been collected by the Association of

9 Birth Defect Children and they -- it_s a self-reported

10 questionnaire. The questionnaire is sent out to their

11 mailing list, which is basically families of children

12 with birth defects. And these individuals fill out

13 the questionnaire and send it back and then it is

14 coded as to whether it_s Golden Harr or not.

15 The problem there is the denominator.

16 Although they do have reported cases of Golden Harr,

17 it_s not clear what their entire population is, in

18 terms of their denominator. And they_re also going

19 to, they_re also continuing to collect data and they

20 have said that they will report that to us as

21 available.

22 DR. LASHOF: I think the other problem

264 1 with that report was that, you know, these are self-

2 reported cases on Golden Harr and given the difficulty

3 on the diagnosis, I mean, obviously not self-reported

4 by the child but the parents have given that diagnosis

5 and submitted it.

6 MS. HANNA: There_s 3,000 birth defects.

7 Thirteen were Golden Harr.

8 DR. LASHOF: All right. And that sounds

9 so high and doesn_t fit.

10 MS. HANNA: The denominator is birth

11 defects, so it_s actually very low. In that 3,000

12 cases of birth defects, 13 of those were Golden Harr.

13 DR. LASHOF: Yeah. And 270 involved Gulf

14 War. Of the 3,000 cases, only 270 involved Gulf War

15 veterans, and of those 270, they_re saying it_s Golden

16 Harr, 13 had Golden Harr.

17 MS. HANNA: They_re saying 13 of the 270.

18 MS. LARSON: Okay.

19 MS. HANNA: The problem is --

20 DR. LASHOF: That_s just out of line.

21 MS. HANNA: Right. The problem is that

22 they actively solicited surveys from Gulf War families

265 1 that believed that they had a child that had been born

2 with Golden Harr. So, there are problems with this

3 sample, but we_re trying to follow up with them and

4 get additional data.

5 The other thing I_d like to add about the

6 Golden Harr and tie it into the biological

7 plausibility is that I think we heard fairly

8 convincing testimony in Seattle that if an agent were

9 a mutagen, it_s very unlikely that it would be site

10 specific, meaning that it would be very unlikely that

11 it would produce one type of anomaly. It_s more

12 likely that it would result in pre-implantation loss.

13 It_s more likely it would result in an infertility or

14 transient infertility or subfertility. So, the

15 biological argument having to do with whether an

16 exposure could create that specific of a mutation that

17 would create one specific syndrome is very hard to

18 prove.

19 MS. LARSON: Well, what_s the potential

20 for causing some permanent change, genetic change

21 somehow, in the sperm or whatever. I mean, I can see

22 the turnover of the sperm is every 60 to 90 days,

266 1 right?

2 DR. LASHOF: Right.

3 MS. LARSON: But is there such a case as

4 something that totally changes the sperm from then on?

5 DR. LASHOF: Not according to any of the

6 biologists who reported to us in Seattle. That would

7 have to be the sperm cell that was damaged and they

8 had not, Ray said that that had not occurred, and they

9 had no evidence that it could occur.

10 MS. LARSON: Ever you mean? So that means

11 that the cases that occurred a year after, well, you

12 know, a year and a half after --

13 DR. LASHOF: Any time, even 90 days after

14 they return from the Gulf would be --

15 MS. LARSON: For males.

16 DR. LASHOF: For males. I mean, female

17 was exposed while she was over there. Because the ova

18 are there for a long time, and the risk could be

19 affected, but not the male.

20 Okay. Any other questions on that? No?

21 Let_s move on to the next item on our agenda, which is

22 the Gulf Family Support Program. Patricia Campbell

267 1 from the Medical Center at North Little Rock? Go

2 ahead and proceed. Sorry. Little distracted up here.

3 MS. CAMPBELL: I_m very honored to be able

4 to share this information with you about our Persian

5 Gulf Program. Arkansas, as many other states, had a

6 large number of National Guard and reserve personnel

7 activated during the Persian Gulf War. In

8 anticipation of the social impact of the military

9 operations, the Department of Veterans Affairs Medical

10 Center and Social Affairs in Little Rock applied for

11 and received a grant of $95,000 for a pilot project to

12 provide mental health services to veterans of

13 Operation Desert Shield, Desert Storm and their

14 families in the spring of 1991.

15 The overall goal of the program, which was

16 operational from June through September 1991, was to

17 assist veterans and their families coping with the

18 stress and consequences of war. This goal was

19 accomplished using a multitude of services, most

20 important of which was outreach, counseling and

21 referral services and advocacy.

22 The outcomes of this pilot project set the

268 1 stage for the development and implementation of the

2 Persian Gulf War Family Support Program which funded

3 32 sites in 26 states selected for the Persian Gulf

4 War Family Support Program established by Public Law

5 102-405 October 9 of 1992. This law authorized the

6 Secretary of Veterans Affairs to provide marriage and

7 family counseling to veterans awarded a campaign medal

8 for active duty service during the Persian Gulf War,

9 veterans who were members of reserve components called

10 or ordered to active duty during the war, and their

11 spouses and children.

12 Additionally, all other medical centers

13 were mandated to provide counseling services within

14 their existing social work mission without funding.

15 Ten million dollars was appropriated for fiscal years

16 1993 and 1994 to carry out this program. With the

17 submission of a bound report no later than July 1,

18 1994.

19 Experience has shown us that 10 to 20

20 percent of the Persian Gulf veterans have had

21 difficulties upon return to their families, but only

22 one to two percent sought treatment. Therefore, the

269 1 program considered outreach and access to services to

2 be a critical issue in its implementation.

3 Program planning began in February of 1992

4 based on the legislative proposal and services were

5 initiated in September 1992. Training was provided to

6 78 staff members to ensure the staff had a clear

7 understanding of the services to be provided and our

8 reporting system.

9 The training centered on developing

10 effective working relationships with community

11 agencies, creating outreach goals and strategies,

12 developing assessment and treatment goals, using

13 therapies based on the need of the clients and

14 providing marriage and family counseling services to

15 veterans and their families.

16 Staff were instructed to use a strict

17 perspective in providing services and to develop an

18 aggressive outreach program. They were offered

19 several outreach and implementation strategies which

20 had been found to be successful with other programs.

21 Coordinators and other staff members were encouraged

22 to adapt the strategies to fit the constraints and

270 1 opportunities of their particular service settings.

2 A critical component of this program was

3 that family members could be provided services whether

4 or not the veteran requested them. Outreach efforts

5 were concentrated on two target populations. Family

6 support groups and community networks were contacted

7 to ensure that all eligible persons were aware of the

8 availability of these services.

9 Briefings were presented to National Guard

10 and reserve units which had personnel activated during

11 the war. During unit briefings, staff described the

12 program, the type of problems that some veterans and

13 their families were facing, and they encouraged

14 persons to contact Persian Gulf staff if they had

15 concerns.

16 Outreach efforts at briefings included the

17 collection of information from veterans in attendance

18 to expedite their enrollment in the program. Our

19 staff worked irregular tours of duty in order to be

20 accessible to the veterans and family members taking

21 advantage of the program services and to attend the

22 monthly drills of each unit.

271 1 The coordinators conducted psychosocial

2 assessments and utilized the multi-problem screening

3 inventory to ascertain the level of functioning of the

4 client. A strict perspective was utilized in

5 providing counseling, reviewing and building on the

6 strength of the family.

7 Interim and final MPSI_s were also given

8 to measure progress. With the emergence and increase

9 in the number and the types of physical symptoms being

10 reported, staff began to refer veterans to the

11 evaluation or triage clinics at their medical centers.

12 Family members were referred to their local physician

13 for physical symptoms they encountered.

14 The establishment of the Persian Gulf

15 Registry in 1992 provided more specialized and focused

16 evaluation and treatment. The development of the

17 Centers of Excellence also provided another

18 opportunity for veterans to be evaluated and to

19 receive even more and enhanced medical treatment.

20 Dr. Robert Roswell, who_s the Chief of

21 Staff at Birmingham Alabama VA, also provided his

22 medical expertise to some of the funded sites as well

272 1 as other medical centers. He assisted in the

2 diagnosis and treatment of veterans and assisted with

3 referrals to local physicians.

4 The funding of the program was not

5 continued beyond September 30, 1994. However, some

6 medical centers have retained the counseling component

7 of the program and incorporated it with other duties

8 of the coordinators. For example, East Orange, New

9 Jersey; Washington, D.C.; Hines VA, here in Chicago;

10 Birmingham, Alabama; Little Rock and Decatur. We

11 would normally say it_s Atlanta, Georgia.

12 The medical center in Columbia, South

13 Carolina, has also maintained some of the outreach

14 activities, for which the coordinator continues to

15 return to the National Guard and reserve units

16 occasionally to conduct presentations and workshops.

17 While in reviewing our final report there

18 appears to be a decline in the number of requests for

19 services from Persian Gulf veterans, we must remember

20 that number one, family members are no longer eligible

21 for services. Two, veterans must meet all eligibility

22 criteria for service. Three, veterans were told that


1 the program no longer exists. Therefore, they do not

2 ask for services that have been terminated.

3 The program was considered a success and

4 could easily be replicated in other areas. It is the

5 first time that the Department of Veterans Affairs was

6 proactive on a national level in identifying persons

7 eligible for and making services available to them.

8 Secondly, counseling services were

9 provided to family members, whether or not the veteran

10 chose to request services. And thirdly, there was a

11 notable improvement in the family_s level of

12 functioning, which may be attributable to the

13 existence of the family_s strict approach to

14 counseling. And I thank you.

15 DR. LASHOF: Thank you very much. We

16 appreciate the very brief summary of a fairly

17 extensive project. Are there questions that the panel

18 would like to address to Ms. Campbell? Tom?

19 MR. MCDANIELS: Thanks again for coming.

20 Could you tell us that when you were conducting

21 outreach in your region, did you feel you had

22 saturated all the veterans as far as getting


1 information out to them? Did you feel that you had

2 saturated the region?

3 MS. CAMPBELL: For our area in Arkansas,

4 because we initially had the pilot project, we were

5 able to reach more of the veterans that were

6 activated. However, when the nationally funded

7 program was implemented, we were only able to fund

8 sites that had veterans in a close proximity of about

9 50 miles or so with 4,000 or more veterans being

10 activated. So they did limit the national program.

11 MR. MCDANIELS: Do you feel that most of

12 the veterans in your region knew about the Persian

13 Gulf Health Registry Program?

14 MS. CAMPBELL: One of the things that our

15 program tried to do was make sure that we worked very

16 closely with Medical Administration Service, with the

17 Department of, let_s see, Veterans Benefits

18 Administration, I_m sorry, I_m getting my acronyms

19 mixed. And with all community agencies to make sure

20 that we were able to share as much information as we

21 possibly could.

22 Sometimes what we would do is we would

275 1 send out information about the Persian Gulf War Family

2 Support Program, but then when we had an opportunity

3 to present or to speak to a group, we would then make

4 them aware of the other services that were available.

5 The other thing that our staff also did

6 was that, the titles were program coordinators, but

7 what they honestly did was provide case management

8 services. Because a lot of times someone would come

9 in saying that they do have a psychosocial problem,

10 but then they would start mentioning their medical

11 problem as well.

12 Our goal as social workers is to make sure

13 that we take care of the whole person. Therefore, we

14 would tell them about what services were available.

15 And we would also help walk them through the system

16 and help make sure they got the paperwork completed

17 correctly, that they knew when their appointments

18 were, and that we did everything that we could to help

19 them know that those services were available.

20 DR. LASHOF: The program ended in _94 and

21 it basically ran for two years; is that correct?

22 MS. CAMPBELL: Yes, it did.

276 1 DR. LASHOF: Did you feel that that was an

2 adequate length of time for a program like this? Or

3 did you feel that there was a lot of need that you

4 hadn_t been able to meet at that point?

5 MS. CAMPBELL: I believe that there were

6 a lot of needs that we were not able to completely get

7 addressed. But it was based on funding for the

8 program. I have concerns about programs that are

9 implemented and then they stop and then they_re

10 reimplemented and stopped. And that_s just because

11 when you_re providing services or counseling to a

12 person, you don_t want to, we call it open them up or

13 get them talking, and then not be able to complete

14 that process. And in some cases that_s what happened.

15 And that_s why -- the sites that I said that had

16 continued their counseling component are still in

17 operation.

18 MS. NISHIMI: Were there any other needs,

19 you said --

20 MS. CAMPBELL: I think, and I would like

21 to see programs of this type work closer with the

22 Persian Gulf Registry, or let them be integrally

277 1 connected to make sure that as veterans are going

2 through the system that they have someone they can

3 contact when they don_t really understand the process

4 or they don_t know what the process is. Because

5 sometimes when you have a lot of people coming in, we

6 may fail to tell them everything that has to be done.

7 And may not really explain to them the time limits

8 that it would take or what they can look for in

9 treatment.

10 MR. MCDANIELS: But there still are

11 Persian Gulf coordinators at each VA Medical Center

12 who are supposed to do that?

13 MS. CAMPBELL: No, not --

14 MR. MCDANIELS: Not the social workers but

15 as far as attached to the environmental health side of

16 the house?

17 MS. CAMPBELL: Most facilities are trying

18 to do that. We do, in cases where they do not have a

19 person assigned to the Registry, then they just

20 contact the Social Work Office and they send someone

21 down. But there_s not someone assigned in all cases.

22 DR. LASHOF: Well, I guess one of the

278 1 issues is, if it_s a transition service, and it_s

2 designed to help, as it says, the transition from the

3 military into the civilian, how long should one try to

4 plan for that, if it_s a transition service you don_t

5 expect that type of service to get into long term

6 therapy for those who need continual counseling or

7 psychological help over a long period. What would be

8 an adequate time for transition?

9 MS. CAMPBELL: One thing in my remarks I

10 did not explain to you that in March of _93, it became

11 questionable whether or not the program was going to

12 be continued past September of _93, and that had an

13 impact on the program as far as some staff members

14 were temporary staff and they found other jobs, they

15 were replaced, veterans were starting to be told that

16 the possibility of this program not existing past that

17 time also, I think, had a negative impact on it. So,

18 some veterans were starting to be referred to other

19 agencies, or to other groups to try to make sure that

20 was done.

21 And I, you know, two years I think would

22 be enough if we knew for sure that this is the time

279 1 limit, and we could say in the very beginning, this is

2 how long we will be here for. Not that we_re here and

3 we_re not going to be here, or I_m not sure if we_re

4 going to be here. But if we can say for sure that for

5 this period of time you can count on us to be here.

6 We will provide these services for you.

7 DR. LASHOF: Do you think, from your

8 experience, that that is an adequate enough length of

9 time for transition services, or would you think it

10 needs to be longer?

11 MS. CAMPBELL: I think for the majority of

12 veterans and their families, it probably will be,

13 because, in our report we determined that I think 62

14 percent of the veterans and 70 percent of their family

15 members were age 35 and under, and, you know, I think

16 it_s because they_re so integrated in their

17 communities at that age, they have an ability to

18 rebound from, you know, whatever is happening.

19 There are others that may need continued

20 treatment, but in that case I think I would be looking

21 at long term, you know, psychiatric care or counseling

22 services, and they would fall into a different

280 1 category for me.

2 DR. LASHOF: That_s the distinction I was

3 trying to make. Thank you. Marguerite?

4 MS. KNOX: For future counseling, do you

5 not think that that transition or counseling should

6 have been started earlier than when it did for the

7 Gulf War?

8 MS. CAMPBELL: I think it would have been

9 very good for the veterans and their families as well,

10 because, by the time our program started in September,

11 veterans were coming home, they were already having

12 problems, there was an increase in the divorce rate in

13 Arkansas that was very noticeable. But I think this

14 is a program that would be easily replicated so if

15 there was another conflict such as this or another

16 war, then we could implement it a lot earlier and

17 prepare the families for the veterans_ return.

18 MS. KNOX: So maybe in our recommendations

19 that would be something that we would need to address,

20 that it would be for this type of program to be

21 implemented at an earlier stage than what it was for

22 this conflict?

281 1 MS. CAMPBELL: I believe that would be

2 very good. It would also give the family members a

3 chance to begin their adjustment process to having

4 this person come back in their home all of a sudden.

5 DR. LASHOF: David?

6 MR. HAMBURG: If I understood you

7 correctly, you said that some of the counseling

8 services imbedded in the Family Support Program were

9 continued in some places after the program itself

10 ended. Could you say a word about the conditions that

11 would foster such counseling services, and more

12 generally, whether family oriented counseling services

13 at the present time are reasonably available to

14 veterans?

15 MS. CAMPBELL: I think what affected that

16 continuation basically was the support of the

17 management of the Medical Center, that they believed

18 in the program, that a need was demonstrated, and I

19 would have to be honest to say also, we had varying

20 results from different funded sites based on the

21 commitment of that medical center.

22 DR. LASHOF: Elaine?

282 1 MS. LARSON: You said that the program was

2 considered a success. What measures of success were

3 used to evaluate the program?

4 MS. CAMPBELL: The multipurpose screening

5 inventory, multiproblem screening inventory, I_m

6 sorry, was developed by Dr. Walter Houston out in

7 Tucson, Arizona. And that looks at the functioning

8 level of a person and their psychosocial adjustment.

9 It specifically addresses certain problem areas such

10 as anger, problems with your partner, problems with

11 your family, unemployment, drug abuse, alcohol abuse.

12 And when the client first begins counseling, he would

13 be given, he or she would be given that MPSI. Then in

14 the middle of treatment we would give it again and

15 measure the levels of discomfort, so to speak, I

16 guess, and there was an improvement, a continued

17 improvement in them.

18 MS. LARSON: And that wasn_t given to any

19 vets who did not have the service?

20 MS. CAMPBELL: No. That was not.

21 MS. LARSON: Okay. Do you have any idea

22 how many family members used the services without

283 1 involvement of the veteran?

2 MS. CAMPBELL: I think I can find that

3 right here.

4 MS. LARSON: I_m just wondering if

5 sometimes problems were identified via a family member

6 and got the veteran into the system somehow.

7 MS. CAMPBELL: What I would think about,

8 to put it, because I don_t see it here immediately.

9 I think about approximately 20 percent of the family

10 members came in on their own initially, and we tried

11 to include the veteran if he was willing to come in.

12 If not, the counseling would continue with just the

13 spouse or the children.

14 DR. LASHOF: Thank you very much.

15 Appreciate it.

16 Okay. That will wrap up the day. No, not

17 yet. Tom is going to talk about outreach and give us

18 our staff briefing on outreach, where we stand, what

19 we know and what we_ve yet to learn.

20 MR. MCDANIELS: Today I_m presenting

21 information about outreach efforts associated with

22 special government sponsored readjustment programs.


1 Specific populations of Gulf War veterans and military

2 broadcasts. This briefing will focus on these outreach

3 elements, and after summarizing each I will present

4 staff findings and suggestions for possible Committee

5 recommendations.

6 Immediately following the Gulf War, VA_s

7 Vet Centers and Persian Gulf Family Support Program

8 provided services to assist Gulf War veterans and

9 their families in the post-conflict readjustment

10 process. Staff with these programs performed a

11 significant amount of outreach about the readjustment

12 services available to the veteran population. As

13 illness began to be reported and clinical procedures

14 were established to evaluate Gulf War veterans, the

15 outreach aspects of Vet Centers and the Family Support

16 Program continued to educate the public.

17 For the Vet Center and Family Support

18 Program, I will present suggestions for possible

19 Committee findings and recommendations after

20 summarizing both of them. Next slide please.

21 Vet Centers provide readjustment and

22 psychosocial services to all veterans of conflicts.


1 There are 196 centers, each staffed by a team leader,

2 two or three counselors and an office manager. Vet

3 Centers are located away from the local VA medical

4 center, although it administrative supports the Vet

5 Center with supplies, personnel, fiscal processing and

6 other logistical services.

7 The Vet Center provides the medical center

8 a consultation referral information and expertise in

9 the area of providing psychosocial services to post-

10 conflict veterans. Next slide please.

11 Since they were established in 1979, Vet

12 Centers have developed a working relationship with the

13 veterans community, veterans service organizations,

14 local VA medical personnel, local military bases and

15 guard and reserve units. Through this community

16 network, Vet Centers are able to provide outreach and

17 did so immediately following the Gulf War. Next slide

18 please.

19 More than 69,000 Gulf War clients have

20 visited Vet Centers since May 1991. Gulf War veterans

21 comprise the largest percentage of the post-Vietnam

22 era group of clients during this period. Now, I_d

286 1 like to briefly touch on the Family Support Program,

2 some outreach aspects. This is the same program that

3 Ms. Campbell just spoke about.

4 Public Law 102-405, oh, next slide please.

5 Public Law 102-405 directed that VA provide

6 readjustment assistance to Gulf War veterans, and VA

7 established the Family Support Program on October 1,

8 1992. Again, there was $10 million appropriated for

9 each of the fiscal years, _93 and _94, and it was

10 designated at 36 sites around the country. Next slide

11 please.

12 Initially, the program provided services

13 to assist veterans with readjustment difficulties.

14 But in response to concerns about emerging illnesses

15 among Gulf War veterans, coordinators conducted

16 regional Gulf War illness related outreach and

17 enrolled clients into VA_s Persian Gulf Health

18 Registry, which began evaluating patients in November

19 of 1992.

20 Community outreach was a major component

21 of the Family Support Program. Coordinators prepared

22 briefings which included registering veterans into the

287 1 Family Support Program, referral into the VA Health

2 Registry, informing veterans and VA medical staff of

3 policies relating to Gulf War veterans, providing case

4 management and providing general information on Gulf

5 War environmental hazards and exposures. Coordinators

6 also developed networks with the veterans community.

7 Coordinators at the 36 sites closely monitored the

8 services provided for the program_s initial two-year

9 period.

10 Some stats here. More than 2,800 outreach

11 briefings were conducted for approximately 70,000

12 persons and approximately 22,000 Family Support

13 Program outpatient visits were made by the veterans

14 and family members nationwide. Funding for the

15 program ended October 1, 1994. Some VA medical

16 centers continue to fund aspects of it, incorporating

17 them into the facility_s general budget.

18 Staff have made the following findings.

19 The first finding. In their geographic areas, Vet

20 Center staffs have established working relationships

21 with the veterans community, veteran service

22 organizations, local, municipal and state veterans

288 1 liaison offices, in-region guard and reserve units,

2 community social services organizations, local VA

3 medical center personnel, and military establishments.

4 These relationships enable Vet Centers to

5 provide education and outreach to local communities

6 about issues in clinical programs concerning Gulf War

7 veterans, and it appears that a significant amount of

8 Gulf War veterans used their services.

9 The second finding. The outreach

10 initiative of VA_s Persian Gulf Family Support Program

11 was an effective method of communicating information

12 about Gulf War veterans_ illnesses. In particular,

13 they established government clinical programs to

14 veterans, reservists, National Guard and local

15 communities. The outreach components used trained,

16 knowledgeable personnel in the field to establish a

17 communications network with the community and deliver

18 specific information directly to the target

19 population.

20 And based on those two findings, staff

21 suggests that the Committee recommend, given the

22 effectiveness of Vet Centers and the Persian Gulf

289 1 Family Support Program, DOD and VA should consider

2 these examples of field-based outreach when developing

3 education and awareness campaigns for active duty

4 service members, reserve and guard personnel and

5 veterans. Broader, less specific, outreach methods,

6 such as hotlines and public service announcements,

7 should be viewed as an important supplement but not

8 replacement.

9 Do you want to discuss the finding?

10 DR. LASHOF: Are there questions? Art?

11 MR. CAPLAN: One issue that came up in the

12 earlier discussion comes up here, too. You might want

13 to also, since this is still relatively new, call for

14 some systematic evaluation so that the Vet Centers, we

15 heard that some did well, some didn_t, according to

16 some measures, but it would be useful probably to

17 evaluate them and make sure that whatever was working

18 well was picked up correctly and that client

19 satisfaction was taken into account and feedback

20 there. So, I wouldn_t just go with what was tried,

21 even though I don_t have any reason to doubt that it

22 was good, but we need to make sure that we_re on top

290 1 of it as an outreach experiment.

2 MR. MCDANIELS: I also want to point out

3 that with these readjustment programs, the outreach

4 component is significant, but it is only one part of

5 it. And I_m trying to extract just the outreach

6 component of the whole readjustment program as well.

7 Okay. Now, I_ll discuss the Transition

8 Assistance Program. The National Defense

9 Authorization Act of 1991 authorized DOD, VA and the

10 Department of Labor to provide comprehensive

11 transition assistance for service members separating

12 from active duty. The Department has developed a

13 memorandum of understanding that established the

14 three-day Transition Assistance Program workshop and

15 assigned each department responsibilities for its

16 implementation.

17 Department of Labor coordinates the

18 execution. Department of Defense arranges the

19 participation of service members and provides

20 logistical support. And VA presents veterans benefits

21 information. TAP Workshops continue to be held

22 periodically at major U.S. military institutions in

291 1 the United States and overseas, and service members

2 are directed to attend within a 180 day period before

3 separation.

4 TAP_s main objective is to prevent and

5 reduce long-term unemployment problems among veterans

6 by educating them about goal setting, decision making,

7 labor market information and job search techniques.

8 However, informing veterans about VA benefits is also

9 a high priority set forth in the memorandum of

10 understanding between the three departments. Staff

11 have made the following finding about the VA briefing

12 section of the Transition Assistance Program.

13 The finding is, 90 percent of separating

14 active duty service members attend Transition

15 Assistance Program Workshop briefings conducted

16 jointly by the Departments of Defense, Labor and

17 Veterans Affairs. VA benefits briefings during the

18 TAP Workshop could be an effective method of outreach

19 about DOD and VA programs for evaluating Gulf War

20 veterans_ illnesses. Yet, there is no evidence their

21 clinical programs ever receive mention.

22 Staff suggests the Committee recommend VA

292 1 should direct its TAP Workshop benefits counselors to

2 specifically mention DOD and VA programs related to

3 Gulf War veterans_ illnesses.

4 DR. LASHOF: Any questions for Tom? I

5 guess not. You_re selling us.

6 MR. MCDANIELS: Okay. Now, I_ll discuss

7 outreach to women veterans. More than 40,000 women

8 served in the Kuwaiti theater of operation. Cognizant

9 of the increased role of women in the Armed Forces and

10 specific medical needs they could have, Congress

11 authorized new and expanded services for women

12 veterans in VA medical centers and Vet Centers in the

13 Women_s Veterans Health Program Act of 1992. Every VA

14 medical center has a women veterans coordinator who,

15 in addition to coordinating clinical services, also is

16 responsible for outreach to the female veterans

17 population.

18 Vet Centers provide outreach about

19 specific VA programs for women and building referral

20 networks for non-VA medical and social services.

21 Staff have made the following finding about outreach

22 to women veterans.

293 1 The finding is, through the initiatives of

2 the Women Veterans Health Programs, VA has implemented

3 a range of efforts to inform women veterans about

4 available health services. Based on this finding

5 staff suggests the Committee recommend VA should

6 ensure that its initiatives under the Women Veterans

7 Health Programs specifically provide information about

8 Gulf War related programs.

9 The brief history on this is that I_ve

10 seen different outreach components target for women

11 and they do attempt to bring women in, or the focus is

12 to bring women into the VA medical centers. It_s just

13 that I haven_t seen it specifically targeted for

14 bringing them in for the VA Persian Gulf Health

15 Registry. And the coordinators of this program, in

16 addition to the next finding, which will about Latino

17 veterans, they do a lot of outreach that_s not

18 literature, that_s based on making contact with the

19 community. So, I can_t say or suggest that they

20 haven_t been mentioning these programs, but in the

21 written literature it_s not obvious that they_re

22 trying to get the veterans in for Persian Gulf health

294 1 exams. So, the idea here is to instruct them to

2 specifically mention that.

3 DR. LASHOF: Any questions. Art?

4 MR. CAPLAN: I don_t know if this makes

5 sense to do it here or not, but one of the issues that

6 has been around for a while is the underrepresentation

7 of women in research, in addition to letting people

8 know about Gulf War Health Registry. There may be the

9 ability to let them know about research projects or

10 studies that they could be eligible for, too. That_s

11 part of that coordinating.

12 DR. LASHOF: Do you want to go on?


14 DR. LASHOF: Any other questions? The

15 advantage of being on at the end of the day.

16 MR. MCDANIELS: I suppose so. Now, I_ll

17 briefly discuss --

18 DR. LASHOF: We_ll think about it over

19 night and get you tomorrow.

20 MR. MCDANIELS: Now, I_ll briefly discuss

21 outreach to Latino veterans. New Mexico, Texas,

22 California and Illinois, as well as the metropolitan


1 areas of Boston, New York City, Chicago and Milwaukee

2 have large Latino veterans communities. Vet Centers

3 in these regions typically have a Spanish-speaking

4 staff member who, in addition to bridging potential

5 language difficulties, also can address cultural

6 barriers that could make Latino veterans and families

7 more comfortable in the Vet Center setting.

8 VA outreach unique to this population

9 includes establishing relations with Latino veterans

10 service organizations and Spanish language media for

11 publicizing VA programs and acting as a liaison with

12 other veterans service organizations and VA personnel

13 for assistance in filing disability compensation

14 claims.

15 The staff have made the following finding

16 about outreach to Latino veterans. The finding is, in

17 regions with significant Latino populations, Vet

18 Centers and VA medical centers attend to delivering

19 bilingual cross-cultural outreach in service centers.

20 And based on that finding, staff suggests the

21 Committee recommend VA should ensure that its outreach

22 to Latino population specifically provides information


1 about Gulf War related programs.

2 DR. TAYLOR: I have a question about that.

3 DR. LASHOF: Sure. Sure.

4 DR. TAYLOR: Is any of the written

5 material in Spanish?


7 DR. TAYLOR: Okay. So they do have it in

8 their own language.

9 MR. MCDANIELS: But again, it_s, the

10 written literature that I_ve seen does not

11 specifically target the clinical programs for Gulf War

12 veterans. It_s targeted for Spanish-speaking

13 veterans, getting them to, or alluring them to the

14 fact that the VA center is there and the types of

15 services they provide. But again, it_s not Gulf War

16 specific.

17 DR. LASHOF: Okay. Moving right along?

18 MR. MCDANIELS: Okay. I will now talk

19 about the outreach through the military media. The

20 American Forces Information Service and its

21 broadcasting arm, the Armed Forces Radio and

22 Television Service, which is AFRTS, comprise the bulk

297 1 of DOD_s internal information services. AFIS oversees

2 the European and Pacific editions of the Stars and

3 Stripes newspapers and the approximately 1,100

4 military funded newspapers in the U.S. and overseas.

5 AFRTS delivers radio and television

6 programming for service members overseas and aboard

7 ships. AFIS has produced several media products

8 pertaining to Gulf War veterans illnesses. Since

9 early 1992, Stars and Stripes has printed 118 stories

10 with headlines related to Gulf War veterans illnesses.

11 The coverage appears to be similar to the civilian

12 media sporadically covering topics as issues evolve.

13 Circulation for the papers is 75,000

14 worldwide, with readership estimates at 175,000.

15 Since early 1994, AFRTS has broadcast 19 television

16 and 43 radio spots on Gulf War related illnesses.

17 AFRTS estimates one million people are stationed

18 overseas and aboard ships. Although a few print

19 stories and broadcast spots communicate how to

20 register for either the DOD or VA clinical programs,

21 most are general news stories on research efforts and

22 exposures that possibly could have adverse health

298 1 effects.

2 AFIS also produces an internal information

3 plan, a collection of single-page briefs with topics

4 of interest to military personnel, such as voter

5 registration, drug and alcohol abuse, equal

6 opportunity and military benefits. The plan is

7 distributed to public affairs officers at all units

8 throughout the military, and they are encouraged to

9 disseminate this information to service members.

10 In 1996, a Persian Gulf illness brief

11 explaining DOD_s comprehensive Clinical Evaluation

12 Program was added to the plan, but DOD_s telephone

13 hotline is not listed. The staff have made the

14 following findings about DOD_s internal information

15 media.

16 Finding, while newspaper articles and

17 television and radio broadcasts disseminated by DOD_s

18 American Forces Information Service provide adequate

19 media coverage of Gulf War illness related issues, few

20 of the media products performed the outreach functions

21 of publicizing government sponsored Gulf War veterans

22 clinical programs and methods of referral into them.

299 1 The next finding is, although produced

2 this year, DOD_s 1996 internal information plan of

3 Persian Gulf illnesses describes DOD_s CCEP, it fails

4 to provide the most basic information on how to

5 register for it.

6 And the two recommendations based on these

7 findings. Staff suggests the Committee recommend, as

8 with other outreach efforts and as noted in the

9 interim report, it is difficult to evaluate the

10 effectiveness of AFRTS and AFIS health communication

11 outreach.

12 And the Committee_s recommendation for

13 refined performance measures also applies here.

14 Likewise, DOD and VA officials using media products

15 for outreach initiatives should be aware of the

16 difficulty in enumerating the actual readership and

17 viewership figures and concern how effectively the

18 message saturates the targeted population.

19 Staff suggests the Committee recommend DOD

20 should reissue its internal information plan on Gulf

21 War related illness and make a special effort to note

22 that the revision provide the toll free number and

300 1 that individuals are encouraged to register for the

2 Comprehensive Clinical Evaluation Program. It also

3 should take this opportunity to provide updated

4 information.

5 DR. LASHOF: Tom, can you tell us more

6 about what they really cover in terms of information

7 about what the government_s doing, like the funding of

8 epidemiologic studies, the research studies that are

9 going on, things about general defects and just all of

10 the things that we_ve been looking into and hearing

11 and learning about as part of this. How much of that

12 information does get out to the veterans, not only am

13 I concerned about the military media for the active

14 duty, but how do you get information about this out to

15 the general veterans other than their reading

16 misleading information in our public media?

17 MR. MCDANIELS: Right. You_re talking

18 other than through the military media?

19 DR. LASHOF: Yeah.

20 MR. MCDANIELS: That is --

21 DR. LASHOF: I_m thinking about both, what

22 the military media does and what else other than the

301 1 military media?

2 MR. MCDANIELS: From what I_ve seen,

3 again, it_s very similar to the civilian press. Just,

4 I would say, the hottest topics, the hottest

5 headlines, they will, like this Committee, for

6 example, they_ll run a story on that.

7 But they have not specifically run stories

8 on health consequences and health effects and risk

9 factors, as much as just general --

10 DR. LASHOF: Stories around what efforts

11 the government_s doing, what research efforts are

12 under way?

13 MR. MCDANIELS: There has been some of

14 that. There has been, but nothing in these areas is

15 significant. It_s just a story here or a story there.

16 DR. LASHOF: Do you think we could look a

17 little further and think through some recommendations

18 about what might be done to get more objective data

19 and information out to the veterans about what_s going

20 on?

21 MR. MCDANIELS: Yes. That is something we

22 -- that_s next on the list. It_s an ongoing thing.

302 1 But, yeah, this definitely, how to communicate better

2 to the veterans, both we_ll be looking at the

3 information itself and also the channels through which

4 it travels.

5 DR. LASHOF: Okay. Thanks. Other

6 questions? If not, I think we can recess for the day

7 and we will resume tomorrow morning at 8:30. We_re

8 going to try to start early and keep on time. I_ve

9 got a tough schedule tomorrow.

10 (Whereupon, the proceedings went off the

11 record at 5:11 p.m.)