NOTE: UNEDITED DOCUMENT
UNITED STATES OF AMERICA
PRESIDENTIAL ADVISORY COMMITTEE
ON GULF WAR VETERANS' ILLNESSES
PULIC MEETING
September 18, 1995
The Advisory Committee met in the Birch Room, Radisson Plaza Hotel,
101 South Tryon St., NC, at 9:20 a.m.,
Ms. Marguerite Knox presiding.
2
1 P R O C E E D I N G S
2 9:20 A.M.
3 MS. KNOX - Good morning, I'm sorry for the delay.
4 It's good to have you here. I'm Marguerite Knox and
5 I'll be the facilitator for today's meeting. I welcome
6 you to Charlotte, North Carolina for the first
7 subcommittee meeting of the Presidential Advisory
8 Committee on the Gulf War illnesses.
9 The first committee meeting was held in
10 Washington, D.C. on August the 14th and the 15th, and
11 at that time we decided that we would have focus groups
12 or subcommittees which would meet, and this is the
13 first one of those which we're proud to say is being
14 held in the Southeast.
15 We will have a couple of panels today that will
16 talk with us. We have Doctor Frances Murphy, Major
17 Edwin Matthews, and Colonel Kurt Kroenke, and
18 Lieutenant Colonel Patti Hamill, and Lieutenant Colonel
19 Karen Price who will speak to us concerning clinical
20 issues within the VA and the DOD.
21 The President's mandate to us is to help insure
22 that we're doing everything possible to identify why
23 veterans are ill, and if they're receiving the care
24 that they need from both DOD and the VA setting. And
25 so that's what we're going to look at today.
3
1 We've asked people who are going to testify this
2 afternoon or give public comments to talk about some of
3 those issues. Not all of those issues will be
4 discussed, but mostly that's what will be on the agenda
5 for the afternoon.
6 We're going to be in tight time schedule so I'll
7 ask you to stick to your times that you've been
8 allotted. I want to tell you a little bit about
9 myself.
10 I am a clinical assistant professor at the
11 University of South Carolina in Columbia, South
12 Carolina. I teach in the College of Nursing, I'm a
13 nurse practitioner in the Acute Care Practitioner
14 Tract. But, more importantly, for this committee I am
15 a Gulf War veteran myself. I served in Saudi Arabia in
16 King Coli Military City under the command of the 251st
17 evacuation hospital. I have continued my career as a
18 soldier and I'm presently still connected with the
19 300th Combat Support Hospital, which is located in
20 Columbia.
21 I'd like to introduce for the members of the
22 panel the staff members, Michael Kowalok and Holly
23 Gwin. Michael Kowalok is the research assistant, and
24 Holly Gwin is the deputy executive counselor. To my
25 left is Doctor Donald Custis, Doctor Elaine Larson, and
4
1 Doctor Joe Cassells, who is also a member of the staff.
2 Doctor Custis and Doctor Larson are members of the
3 Committee and we make up the subcommittee. So I'll let
4 them tell you a little bit about themselves, and we'll
5 begin.
6 DOCTOR CUSTIS - I am currently retired, and
7 previously was Chief Medical Director in the Veterans
8 Administration, and prior to that spent a career in the
9 United States Navy as a surgeon.
10 ELAINE LARSON - My name is Elaine Larson. I'm
11 the Dean at the School of Nursing at Georgetown
12 University, and my area of specialty is infectious
13 diseases and infection control.
14 JOSEPH CASSELLS - My name is Joe Cassells. I
15 spent 28 years in the Department of the Navy and
16 trained in internal medicine. I then spent six years
17 at the Institute of Medicine, and I have just recently
18 come onto the staff of this Commission.
19 HOLLY GWIN - I'm Holly Gwin. I am the Deputy
20 Director and Counsel for the Committee.
21 MICHAEL KOWALOK - I'm Michael Kowalok with the
22 Committee staff, and if you have any testimony this
23 afternoon I would be happy to accept it and later on
24 this morning.
25 MS. KNOX - Great. I would ask the panel members
5
1 now to come forward, and I'll let you introduce
2 yourselves.
3 DOCTOR MURPHY - I'm Doctor Frances Murphy. I
4 currently am the Director of the Environmental Agent
5 Service in the office of Public Health and
6 Environmental Hazards at VA. I previously served as an
7 Air Force neurologist, and I am an Air Force veteran.
8 DOCTOR MATTHEWS - My name is Doctor Edwin
9 Matthews. I am Staff Internist at Wilford Hall Medical
10 Center. I am one of the region's CCEP Program
11 directors as well as the director of newly formed
12 specialized care center in the Western Region.
13 DOCTOR KROENKE - I am Kurt Kroenke, the General
14 Internist and Director of the General Medicine Division
15 at the Uniform Services University, and have had a
16 research interest for about a decade in common physical
17 symptoms.
18 MS. KNOX - We are very pleased to have you all
19 here, and we thank you for coming and sharing this time
20 with. Doctor Murphy, I'm going to let you go first.
21 DOCTOR FRANCES MURPHY
_____________________
22 We're going to talk about some of the health care
23 programs this morning the VA has, and I'd like to start
24 with just a little bit of background so we start from
25 the same place and then talk about the wide variety of
6
1 health care programs the VA has, specifically for
2 Persian Gulf veterans.
3 I'd also like to tell you about VA eligibility
4 for health care. It is rather complex, and I'll try to
5 tell you about veterans' eligibility in general and
6 then priority care for Persian Gulf veterans, and a
7 little bit about some of our future directions for
8 these programs.
9 I think it's important to go over the chronology
10 of the Persian Gulf War. The Iraqis invaded Kuwait on
11 August 2nd, 1990, and the first Air Force planes
12 arrived later that week in the theatre of operations.
13 It wasn't until January, mid January, that the
14 air war began, and on February 20th, 1991 the oil well
15 fires were started in Kuwait as the Iraqis pulled out.
16 On the 24th of February the ground war began. It
17 was a short four-day war and there weren't as many
18 casualties as we initially had planned for, but there
19 was - - - But that doesn't seem to tell the whole
20 story. It certainly gives us a very narrow perspective
21 on some of the problems that Persian Gulf veterans have
22 had after this deployment.
23 I would also like to point out that the VA was
24 very pro-active in developing health care programs for
25 Persian Gulf veterans. A short two months after the
7
1 ground war ended the VA put in its first budget
2 proposal to start the Persian Gulf registry, and the
3 Office of Public Health and Environmental Hazards
4 recognized at that point with the oil well fires and
5 some of the other environmental concerns we could
6 potentially need to provide specialized health care for
7 Persian Gulf veterans and begin planning for it, as
8 early as April of 1991.
9 I want to just briefly talk about the composition
10 of the troops that were in the Persian Gulf. There
11 were almost 697 troops deployed to the Persian Gulf
12 theatre of operations, and there were several
13 differences about this deployment.
14 First of all, it was the largest deployment of
15 women to a wartime situation. Seven percent of the
16 troops in the Gulf were women, and about 17 percent of
17 the troops deployed were in the Reserves or the
18 National Guard. There was a large contingent from
19 Reserve and National Guard as opposed to active duty.
20 The mean age of the troops, all the troops in the
21 theatre of operations was actually 28, however the
22 Reserve and Guard had an older contingent, and we can
23 see that the age range was much older in both the
24 Reserve and Guard and in active duty, about thirty to
25 thirty-two years as opposed to twenty-seven years in
8
1 active forces. In addition, the Guard and Reserves had
2 a larger number of women deployed.
3 And so of those 697,000 troops who were deployed
4 to the theatre of operations, now in 1995 almost half
5 are eligible for VA care. The others are still
6 eligible for military care and will be cared for by the
7 active forces. About a third of the individuals who
8 are eligible for VA care have actually accessed VA
9 through outpatient care. We've treated more than
10 155,000 individuals on an outpatient basis. That's
11 unique veterans.
12 And, in addition, about 14,000 have come in for
13 admission to VA medical centers for evaluation of their
14 problems. So we provide a large amount of health care
15 to Persian Gulf veterans.
16 We have a number of different mechanisms that we
17 can provide health care to Persian Gulf veterans. We
18 have the Specialized Persian Gulf Registry and the
19 Persian Gulf Referral Center programs. I'd like to
20 talk at length about those during the next portion of
21 my presentation, but first I think it is important to
22 understand which veterans are eligible for care in the
23 VA, because the eligibility of veterans is actually a
24 relatively complex issue. In fact, to be eligible for
25 VA health care and benefits you have to have served in
9
1 the military for 181 days or more. And then only
2 certain veterans are actually eligible for health care
3 within the VA, the Department of Veterans' Affairs.
4 Laws were passed by Congress which made several
5 changes in veterans' eligibility for VA medical care,
6 to insure that VA medical care is provided to service
7 connected veterans and to lower income veterans. Those
8 non-service connected veterans with higher income will
9 have health care provided on a space available or
10 resource available basis, and will be charged a co-
11 payment for their care.
12 VA eligibility for hospital and nursing home care
13 are dealt with under separate eligibility rules from
14 those for outpatient care. So it gets relatively
15 complicated. There are some veterans who may be
16 eligible for inpatient care but not for outpatient
17 visits, and we need to sort of walk each veteran
18 through what their eligibility is.
19 Now, the laws related to VA hospital and nursing
20 home eligibility are Public Law 99-272, The Veterans
21 Health Care Amendment of 1986, and Public Law 101-508,
22 which is the Omnibus Budget Reconciliation Act of 1990.
23 It provided that hospital care shall be furnished
24 to certain veterans while nursing home care may be
25 provided to the extent that resources and facilities
10
1 are available. Now, all of those veterans who VA has a
2 mandate to provide inpatient care, the category
3 includes service connected veterans, former POW's, and
4 notably Persian Gulf veterans. And that's what
5 priority care means. It's priority to have this
6 special eligibility. They do not have to go through
7 the same income or means testing that other veterans
8 do. So any Persian Gulf veteran who may have been
9 exposed to an environmental hazard, and presumably that
10 condition is related - - - Has a condition related to
11 that exposure, can be given treatment as an inpatient
12 or an outpatient under the current VA eligibility
13 rules. Other veterans, who are not service connected
14 or who do not fall into the other mandatory categories
15 have to undergo a means test, and if their income is
16 above a certain level - and that level changes every
17 year - then they may not be eligible in all medical
18 centers, only on a space availability and resource
19 availability basis.
20 In addition, non-service connected veterans have
21 a pharmacy co-payment and that service connection is
22 very important, because priority care does not extend
23 to the pharmacy co-pay. Persian Gulf veterans have
24 been charged for pharmacy co-payments.
25 I'd like to spend one minute talking about one of
11
1 our specialized medical care programs before I move on.
2 The VA does have a program to look at depleted uranium.
3 That depleted uranium program is run at the Baltimore
4 VA Medical Center. It's a medical surveillance program
5 for 35 service members exposed to friendly fire who
6 have retained depleted uranium shrapnel.
7 All 22 members who have retained depleted uranium
8 shrapnel have undergone a thorough medical evaluation,
9 including urine uranium determination and a thorough
10 physical examination, and I'm pleased to report that at
11 least early in our surveillance no kidney toxicity or
12 other adverse outcomes have been identified during that
13 program.
14 In addition to that special program, VA has its
15 Persian Gulf Registry Health Examination Program. Now,
16 the Persian Gulf Registry Health Examination Program is
17 a specialized health care program for Persian Gulf
18 veterans, and let's stress health care. This is not a
19 research project. It was not designed to give any
20 definitive results. It was first initiated in August
21 of 1992.
22 Now, the planning, as I said, began back in April
23 of 1991 with the first budget proposal, but was
24 actually initiated at medical centers nationwide on
25 August of 1992. In initiating that, a Persian Gulf
12
1 physician and an administrative coordinator was
2 designated at each VA medical center and outpatient
3 clinic. So there is a point of contact. Veterans can
4 contact the Persian Gulf coordinator at each medical
5 center to get an appointment for this voluntary free
6 health examination.
7 More than 51,000 veterans have been examined
8 under this special program. It involves having a
9 history, a medical history, taken, getting some basic
10 laboratory screening tests including the CBC,
11 chemistry, urinalysis and previously a chest x-ray, and
12 getting a physical examination by a VA physician.
13 Of the individuals who have been examined there
14 has been a wide spectrum of clinical diagnoses, but
15 more than 14 percent of those who have accessed the
16 Persian Gulf Registry Examination Program have actually
17 come in with no health complaints. They have been
18 asymptomatic. They simply wanted to get on the
19 registry and also to have their questions answered by a
20 VA health care professional.
21 Many of these veterans have concerns because of
22 the extensive media coverage and because of some of the
23 exposures that they themselves have identified as a
24 concern during their Persian Gulf service. We've seen
25 a wide range of medical complaints. I've listed here
13
1 the top ten complaints for you; fatigue, skin rash,
2 headache and muscle and joint pain, memory loss,
3 breathlessness, sleep disturbances, GI disturbances,
4 including diarrhea and cough, have consistently over
5 the past three years remained at the top of this list.
6 We've seen, as I said, a wide variety of clinical
7 diagnoses - and I give this to you just for comparison
8 with what my DOD colleagues are going to present - and
9 see that musculoskeletal and connective tissue diseases
10 are at the top of the list, but this isn't a big
11 surprise because, in fact, over the years that's been
12 the most common reason for military members to apply
13 for service-connected disability. Again, there may be
14 joint injuries, low back pain, etcetera.
15 In addition, we've seen a whole range of other
16 conventional medical diagnoses. All of this data was
17 previously given to you during the first meeting of the
18 Presidential Advisory Committee, so this is just a
19 review.
20 But one of the things that the veterans have been
21 particularly concerned about is they had a perception
22 that there was an increased number of cancers being
23 diagnosed among individuals who were deployed to the
24 Persian Gulf theatre of operations.
25 Of those veterans who have participated in the
14
1 Persian Gulf Registry 140 individuals have had a
2 diagnosis - - - a cancer diagnosis. And of the
3 inpatients - - - Remember there were 14,000 inpatient
4 admissions of Persian Gulf veterans, 441 were for
5 diagnosis of cancer.
6 They cluster in the diagnostic categories that
7 I've listed, with the most - - - Again, the cancers,
8 the testicular and lymphoid cancers, being common in
9 the age group we're talking about, and so far while we
10 don't consider this again a definitive result, there
11 don't appear to be any increase incidence of rates of
12 cancers in this population.
13 In addition, when we look at the first 36,000
14 health examinations that have been done in Persian Gulf
15 veterans, about 76 percent of those have had a
16 diagnosis given and they're common conventional medical
17 diagnoses that don't appear to cluster in any
18 particular disease category.
19 However, 24 percent have symptoms but no
20 diagnoses, and these are the ones that we've looked at
21 as potentially being indicative of an unexplained
22 illness.
23 Now, when the initial Persian Gulf Registry was
24 designed back in 1992, we didn't think to ask the
25 question of the physicians, do you believe this
15
1 individual has an unexplained illness? So what we've
2 done is try to estimate that from veterans who have
3 reported symptoms but the physician has not given a
4 diagnosis, and that totals 24 percent in our current
5 database.
6 What we've done in the interim is revise the
7 Registry, and we've expanded the number of exposure
8 questions that we ask. Remember, initially were
9 focused on the oil well fires. We've now come to
10 realize that there's a wide range of exposures that we
11 need to be concerned about and certainly the veterans
12 are concerned about.
13 We've also included a larger number of
14 reproductive health questions to try to address the
15 issues, not only of birth defects but also of
16 infertility and miscarriage, etcetera. Initially the
17 listed diagnoses and symptoms were only reported for
18 three symptoms and three diagnoses and we've expanded
19 those to ten, and we can handwrite in more if need be.
20 We've noticed that many of these veterans have multi
21 system complaints and so we've allowed for increased
22 reporting of symptoms and of diagnoses.
23 We've also at the end of phase 1 given the
24 physicians the opportunity to tell us whether they feel
25 that these veterans have unexplained illness so instead
16
1 of having an estimate we'll have a physician's
2 determination of that. And the expanded and revised
3 Registry also has a phase 2, which is consistent with
4 DOD, CCEP program phase 2 and the uniform case
5 assessment protocol for those individuals that are
6 difficult to diagnose or unexplained illness.
7 The exposures that we've included as specific
8 questions on the registry are listed here and on the
9 next line. So you can see that there are a wide range
10 of concerns among Persian Gulf veterans, and we're
11 trying elicit those concerns by allowing them to self
12 report these on the registry.
13 The issue of unexplained illness has been a
14 concern among VA health care providers, and I'm looking
15 at the information that we have for our registry
16 database. It appears that the symptoms of the
17 individuals with unexplained illness are not localized
18 to one organ system. These individuals have no
19 consistent physical examination findings and no
20 consistent laboratory abnormalities have yet been
21 identified.
22 In addition, on looking at the exposures that are
23 reported in the individuals there doesn't seem to be
24 any particular exposure or any particular geographic
25 location that explain all of the illnesses that
17
1 veterans report to us. So I'm sorry, the multi-system
2 kind of symptom complex that doesn't appear to localize
3 either by geographic area that the veteran was deployed
4 to or by reported exposures, and we've not been able to
5 pin it down with a physical examination or laboratory
6 test at this point.
7 One of the ways that VA has chosen to deal with
8 this issue is to set up specialized referral centers,
9 and the VA Persian Gulf Referral Centers were actually
10 instituted at the same time as the registry, back in
11 August of 1992.
12 Initially three regional referral centers were
13 set up in Washington, D.C. and Houston, Texas and West
14 Los Angeles, and these centers were viewed as centers
15 where second opinions could be given for those
16 individuals where a diagnosis couldn't be made or the
17 diagnosis remained unclear after an evaluation at the
18 local medical center.
19 This was viewed as necessary because we have wide
20 range of medical facilities in the VA nationwide,
21 ranging from highly affiliated university affiliated
22 tertiary care medical centers down to small clinics,
23 and in some locations some of the very specialized
24 testing could not be done, or such specialty
25 consultations were not available. And this was a way
18
1 that VA could insure that each veteran who chose to
2 come to the referral center could get a thorough
3 uniform evaluation.
4 When these referral centers were initiated back
5 in 1992 we didn't have a very - - - We didn't have a
6 large amount of information on the unexplained
7 illnesses, and it was the staff at these referral
8 centers that ultimately developed uniform assessment
9 protocol for the unexplained illnesses, from their
10 experience with these veterans. And the protocol that
11 has been used, specifically at the DCVA was then
12 incorporated into the DOD-CCEP program when it was
13 instituted in 1994.
14 In addition, in June of this year a fourth
15 referral center was initiated in the Birmingham,
16 Alabama VA. This VA center, responsible for one of our
17 specialized Persian Gulf programs, and the expertise
18 there was felt to be very useful in instituting an
19 expanded Persian Gulf Referral Center. The idea was
20 that we would allow veterans from the Southeast to have
21 more ready access to a referral center and, in
22 addition, we will start to invite veterans, who have
23 previously been evaluated at the other referral centers
24 and have still had an unexplained or undiagnosed
25 illness, to come back for an annual follow-up
19
1 examination so that we can in fact develop some
2 understanding of the natural history or progression of
3 their illness.
4 In order to get into a Persian Gulf Referral
5 Center, the veteran needs to be referred by their local
6 VA physician. That local VA medical center physician
7 then calls the physician director at one of the
8 referral centers in their region, and talks with him
9 about the case and will fax the medical records that
10 have thus far been obtained, and in consultation with
11 the Persian Gulf Referral Center, the local physician
12 and a referral center director then develop a workup
13 for that veteran, and the veteran is admitted to one of
14 these referral centers. The referral center protocol
15 takes about ten working days to complete, so it is a
16 big time investment and a very comprehensive evaluation
17 that's performed at these centers.
18 So far, 250 individuals have gone through
19 referral center programs, and I've listed the total
20 number at each of the centers, and that actually is
21 updated as of August 31st.
22 All of these various protocols and programs have
23 been well coordinated with DOD and HHS. We have a
24 Persian Gulf Veterans Inter-Agency Coordinating Board,
25 which is composed of three working groups; the
20
1 Compensation Working Group, the Research Working Group
2 and the Clinical Working Group.
3 The Clinical Working Group has worked very hard
4 to insure comparability between the VA Persian Gulf
5 clinical programs and the DOD-CCEP program. The
6 Clinical Working Group meets approximately on a monthly
7 basis, sometimes more often when we are developing and
8 revising the protocols and sometimes a little bit less
9 frequently, depending on what other meetings are going
10 on, but a coordinating board does fill a very central
11 and useful role in allowing us to coordinate the
12 programs between VA and DOD.
13 Before I summarize, let me just give you a little
14 bit of insight into ways that veterans can find out
15 about these specialized programs. VA has tried to
16 develop a comprehensive outreach program so that every
17 Persian Gulf veteran not only understands what special
18 programs are available to them, but understands how to
19 access them easily through our nationwide health care
20 system.
21 We have a Persian Gulf newsletter - it's called
22 the Persian Gulf Review - and that's mailed out to
23 every veteran who is on the Persian Gulf registry.
24 Initially it was just the veterans who are on the
25 health registry, but I'm happy to announce that as of
21
1 this current issue it will be mailed out the 191,000
2 veterans who have accessed health care, either through
3 their Persian Gulf Registry Health Examination Program,
4 through outpatient or inpatient care in the VA who have
5 applied for any benefit through the Veterans' Benefits
6 Administration, or who have come in through the DOD-
7 CCEP program. So we are reaching out to a large number
8 of veterans and telling them about these specialized
9 programs.
10 In addition, we've developed a number of
11 brochures and other printed materials to let veterans
12 know about these programs, and also have posters around
13 at our Vet centers and our medical centers.
14 In addition, in February of 1992 we instituted a
15 Persian Gulf Veterans Help Line. It's a toll-free
16 telephone number, and the number is 1-800-PGW-VETS.
17 Veterans can call into the help line and information,
18 up-to-date information, either by having it mailed out
19 in printed form or listening to a computerized
20 telephone message or, if they choose, during normal
21 business hours Monday through Friday they can speak to
22 an operator and have their individual questions
23 answered, and those range from how do I get a Persian
24 Gulf Registry examination - they can get the name and
25 the phone number of their local Persian Gulf
22
1 coordinator to schedule that examination - or if the
2 have an individual health question the operator will
3 fax a message back to their local medical center, and a
4 health care provider will contact them to answer their
5 questions. So we feel it's a very big and central part
6 of our outreach program to Persian Gulf veterans.
7 In addition, VA has instituted a computerized
8 bulletin board, and the number for that is 1-800-US1-
9 VETS. And there is a wide variety of information about
10 VA programs in general but also about Persian Gulf
11 specific programs, and a large number of veterans have
12 found that accessing that has provided them very useful
13 information. We also have public service announcements
14 on radio and TV to tell Persian Gulf veterans about
15 these various programs.
16 In summary, what I'd like to finish up with is
17 the fact that we do have a broad range of health care
18 programs for Persian Gulf veterans, and so far of the
19 51,000 veterans that we have examined through our
20 registry health examination program, only a small
21 percentage have had unexplained illnesses.
22 The majority have readily explainable
23 conventional medical diagnoses. Of those with
24 unexplained illnesses we've thus far not been able find
25 evidence of a single syndrome or a single exposure that
23
1 appears to explain all of these illnesses.
2 We don't feel that this question will be
3 answered, however, by the registry programs. It's our
4 epidemiologic research and our other specialized
5 research that will in fact give definitive answers to
6 these very perplexing and complex questions.
7 And I'd like to let the Committee know that VA is
8 committed to a coordinated and comprehensive clinical
9 care program and research effort to answer these
10 questions, and that no particular cause and no
11 particular avenue has been closed off.
12 At this point we're looking at all causes and all
13 explanations for the health concerns of the Persian
14 Gulf veterans, and we look forward to having your input
15 for any improvements that might be made in these
16 programs. Thank you.
17 MS. KNOX - Thank you, Doctor Murphy. Would the
18 panel like to address any questions at this time?
19 DOCTOR LARSON - I just want to get some of the
20 timings straight here. The war ended on 2-28-91.
21 DR. MURPHY - That's correct.
22 DOCTOR LARSON - The Registry started eighteen
23 months later, 8-92, August '92. The comprehensive
24 clinical evaluation program started in June of '94. Is
25 that correct?
24
1 DR. MURPHY - The DOD program, yes.
2 DOCTOR LARSON - At what point were the two
3 protocols for evaluating the vets between the DOD and
4 the VA coordinated?
5 DR. MURPHY - Actually a representative from the
6 Army Surgeon General's office sat in on our initial
7 planning meetings for the protocol for the registry
8 health examination. DOD, however, did not institute
9 its own program until 1994, and was really beginning in
10 late April or May of 1994 that VA-DOD came to an
11 agreement on the use of the uniform case assessment
12 protocol for both VA's registry and for the CCEP
13 program.
14 DOCTOR LARSON - All this is '94.
15 DR. MURPHY - That's correct - - - I'm sorry,
16 excuse me, began in April of 1994 and initiated in June
17 of 1994.
18 DOCTOR LARSON - In this copy that you sent us,
19 dated August 8, 1995, for the - - -
20 DR. MUPRHY - That's the revised.
21 DOCTOR LARSON - Okay, it's the revised. Under
22 eligibility criteria on page 21, it does say that
23 veterans are eligible to serve who served on active
24 military duty in Southwest Asia between August 2, 1990
25 and the official termination date to be established.
25
1 DR. MURPHY - Yes, and that's something that's
2 very important to recognize. In fact, there has been
3 no close date to the Persian Gulf era. Individuals who
4 are being deployed on active duty to the Persian Gulf
5 even today are eligible to come for these Persian Gulf
6 Registry examinations and, in fact, one of our staff
7 members in the Office of Public Health and
8 Environmental Hazards as a Navy reservist who was
9 deployed in June to the Persian Gulf, and would be
10 eligible to come in for these special programs. So it
11 is not just those veterans who were deployed during
12 Operation Desert Shield and Desert Storm, but
13 individuals who are being deployed currently.
14 DOCTOR LARSON - Okay, but they had to have been
15 in the geographic region, not deployed but somewhere
16 else.
17 DR. MURPHY - In the Congressionally defined
18 theatre of operations.
19 DOCTOR LARSON - In terms of the hot-lines, you
20 said this first one started in February of '92, a toll-
21 free number.
22 DR. MURPHY - The hot-line actually began in
23 February of 1995, this year.
24 DOCTOR LARSON - Okay. The toll-free number in
25 February of '92.
26
1 DR. MURPHY - I must have mis-spoke.
2 DOCTOR LARSON - All right. I was taking notes.
3 You said February of '92. So '95 - - -
4 DR. MURPHY - February 1995.
5 DOCTOR LARSON - That's four years after the war,
6 okay. Then the bulletin board that you talked about,
7 the publication, when did that start?
8 DR. MURPHY - Also in 1995.
9 DOCTOR LARSON - The newsletter, when did that
10 start?
11 DR. MURPHY - In, I believe, February of 1993 is
12 the first issue.
13 DOCTOR LARSON - And so the newsletter was in '93
14 for all of the Gulf War veterans - - -
15 DR. MURPHY - For registry participants.
16 DOCTOR LARSON - Oh, just those 51,000.
17 DR. MURPHY - Initially it was for anybody who had
18 come in for the specialized registry health
19 examination, because those were the individuals that we
20 had readily available addresses on. We've now expanded
21 that to include not only the 51,000 who have currently
22 gone through the health examination program, we've gone
23 out to the IRS and gotten addresses for anyone who came
24 in for inpatient care, outpatient care, or DOD care, or
25 applying to VA for benefits. So that's 191,000
27
1 individuals that we'll be mailing the newsletter to.
2 DOCTOR LARSON - So between February of '95, when
3 the hot-line was started - - - Well, from the end of
4 the war to February of '95 how did people find out
5 about the registry and then the CCEP? That's not - - -
6 How did the people - - - What was their information
7 source?
8 DR. MURPHY - By a number of mechanisms. It was
9 VA officials speaking to the print and TV media, radio
10 media about the program; also through information that
11 went out from the veterans service organizations and,
12 in addition, there were numerous local outreach efforts
13 from the VA medical centers to the reserve units that
14 they served, informing people about these special
15 programs and asking them to come to VA for the
16 specialized examinations.
17 DOCTOR LARSON - I did speak to some fairly high-
18 ranking veterans in between our meetings and was told
19 that they tried early on to call the hot-line but
20 couldn't get through. They called numerous times. I
21 called a couple of weeks ago and got through on the
22 first ring, but I'm just wondering if maybe there were
23 more people calling in the beginning and it was harder
24 to get through or - - -
25 DR. MURPHY - Were they calling the VA or the DOD
28
1 hot-line?
2 DOCTOR LARSON - Both. I called both, and I
3 talked to vets - - -
4 DR. MURPHY - We actually have statistics that I
5 can provide for you on the number of calls that were
6 actually dropped and how long each caller waited. We
7 do keep those statistics, and I've been impressed that
8 in fact a very small percentage actually drop off after
9 waiting on the line to speak to an operator, and many,
10 many people have accessed that hot-line number. It's
11 more than 80,000 individuals who have called in in the
12 first six months.
13 DOCTOR LARSON - In the first six months, even
14 four years after the war.
15 DR. MURPHY - Yes.
16 DOCTOR LARSON - My last question. At what point
17 - - - What was the date of the time when you changed
18 the form so that there is now the ability to record
19 more multi-system symptoms?
20 DR. MURPHY - That's the revised registry exam you
21 have in your hand, and it was published in August of
22 1995. Now, those histories were always recorded in the
23 consolidated health record before this, but now we will
24 be computerizing that information so that it will be
25 readily accessible and comparable to the DOD
29
1 information.
2 DOCTOR LARSON - Well, I asked because at the
3 first hearing we were told that multiple symptoms it
4 was not possible to record those or at least it wasn't
5 in the computer.
6 DOCTOR MURPHY - Initially just three symptoms and
7 three diagnoses.
8 MS. KNOX - Doctor Custis, do you have a question?
9 DOCTOR CUSTIS - Yes. Doctor Murphy, do you have
10 any mechanism for quality control?
11 DOCTOR MURPHY - In fact, we've just initiated an
12 effort to provide quality management for the Persian
13 Gulf Registry Health Examination Program. We developed
14 a self-assessment tool for each medical center that is
15 being sent out by directive from central office. Each
16 medical center will sample - - - Do a 10 percent sample
17 of the registry examinations they've done, looking at
18 various aspects of the program, including completeness
19 of the examination, recording of the result, follow-up
20 of any abnormal results and whether further evaluation
21 was done for common symptomatology. That initial data
22 should be available in early 1996.
23 In addition, we do quality control through an
24 evaluation of the code sheets, and how many rejected
25 code sheets we get with incomplete information. And
30
1 that effort has been ongoing since the institution of
2 the registry examination program.
3 For the Referral Center Program, we have twice
4 yearly meetings where we provide updated information to
5 the referral center directors, and also talk about
6 particular issues of concern that either we have in
7 central office about the referral center programs or
8 they have about their implementation of those programs.
9 So there is lot of information now and quality control
10 going on.
11 In addition, VA held a Persian Gulf veterans - -
12 - An update on health consequences of the service in
13 the Persian Gulf. It was a CME conference for VA
14 physicians who are providing registry examinations. We
15 held that in Baltimore on July 18th through 20th, 1995
16 and during that two and a half day conference we gave
17 everybody an update on the latest from the registry,
18 the referral centers, what's known about exposures, and
19 the latest information from the research that's going
20 on. And that, I think, provides a large measure of
21 quality assurance, by making sure that our physicians
22 who are doing these exams have the latest information
23 available to them. And we have applied to have an
24 national training program, which is a training program
25 that will go on on an annual basis, and I understand if
31
1 our budget holds we will be holding annual meetings of
2 that type for our physicians.
3 DOCTOR CASSELLS - Can you give me some estimate
4 of the time lag between initial contact with the
5 registry and the initial examination, and then to the
6 referral center, although I recognize that that
7 requires some commitment of time.
8 DOCTOR MURPHY - The referral - - - The time
9 between initial request and obtaining a registry
10 examination on average is 30 days or less, and that's a
11 new standard that had been implemented last year, a
12 performance standard for VA outpatient care.
13 We do monitor that with bi-monthly reports from
14 each of the medical centers in our office, and the way
15 that's done is we ask them when their next available
16 appointment is, and if we get an answer back that it's
17 more than thirty days, the Persian Gulf coordinator
18 will get a call from our registry coordinator in the
19 Office of Public Health and Environmental Hazards,
20 asking them to explain what the delay is and why it has
21 occurred, and also to outline a plan for improvement.
22 We do again monitor that on a frequent basis.
23 Now, there is some variation in the request for
24 these examinations. If there is a program on 60
25 Minutes or on one of the national media shows of if
32
1 there is a local program or a lot of press or something
2 else, some new information that comes out, the number
3 of requests for registry examinations may skyrocket in
4 a particular location and, consequently, it's a little
5 bit difficult for the local medical centers to keep a
6 consistency, but on the average I think what we've seen
7 is that most of the medical centers have been keeping
8 under that thirty day deadline.
9 Initially, when the program was first initiated
10 in 1992, obviously in starting up a new program you
11 have to designate new people with a new program and it
12 may take a little bit longer to do the examinations,
13 and I think the delays were somewhat longer back the
14 early registry days in 1992 and really '93, but I think
15 currently we do pretty well.
16 For the referral centers, in general if the
17 referral is completed between the local physician and
18 the referral center director, the admission can be done
19 within the month. Some of the delay is because there
20 are numerous specialized examinations, like sleep
21 studies, GI consults and endoscopies and pulmonary
22 function tests that need to be prescheduled, and so we
23 do that in order to decrease the length of stay and
24 increase the efficiency for the veteran.
25 In some cases, veterans are requested that their
33
1 admission be delayed so that they can accomplish the
2 Persian Gulf Referral Center admission at a time that's
3 most convenient for them, either for personal reasons
4 or because of taking two weeks off of work. It is a
5 big commitment for these veterans to go through the
6 program.
7 MS. KNOX - Doctor Murphy, I have a question. I
8 think during the war didn't Congress mandate that the
9 time spent for eligibility was 120 days instead of 181?
10 Lieutenant Colonel Matthews, you might be able to
11 answer that. I think it was changed for the Persian
12 Gulf.
13 DOCTOR MATTHEWS - I think you're correct on that.
14 DOCTOR MURPHY - We'll check on that for you.
15 MS. KNOX - Doctor Matthews, if you would like to
16 proceed.
17 LIEUTENANT COLONEL MATTHEWS
___________________________
18 Good morning ladies and gentlemen. It is my
19 honor and privilege to speak before you today on behalf
20 of the Department of Defense's Clinical Comprehensive
21 Evaluation Program. As noted, I am the Director of the
22 Region 6 CCEP program as well as also the Director of
23 the Western Region Specialized Care Center.
24 I plan to day to outline the Department of
25 Defense's Clinical Comprehensive Evaluation Program
34
1 beginning with how Persian Gulf veterans gain entry
2 into the program, detail the two clinical phases, and
3 then briefly discuss the Specialized Care Centers, and
4 close with specific comments on the program.
5 The DOD established the clinical program June
6 7th, 1994, and this was in response to the veterans'
7 concerns about potential health effects from the
8 deployment of Operations Desert Shield and Storm. Our
9 program too is a clinical and not designed as a
10 research program.
11 The CCEP program is designed as an indepth
12 medical program to investigate the nature of the
13 Persian Gulf Veteran's illnesses and provide
14 appropriate medical care.
15 The DOD program, as annotated by Doctor Murphy,
16 has been closely coordinated with the Department of
17 Veterans Affairs and is very similar to their
18 comprehensive clinical evaluation. Eligible DOD
19 participants include those on active duty, their
20 dependents, both spouses and children, retirees,
21 reservists, and this includes full-time Ready Reserve
22 and individual Ready Reserve, and certain Secretarial
23 Designees. We also have opened a program now to
24 certain DOD civilians that were deployed during the
25 Operation Desert Shield and Storm.
35
1 Our time frame that we have placed basically from
2 the period of August 1, 1990 through July 31, 1991 and
3 anywhere in that theatre of operations those are
4 eligible. How do you gain entry into our program?
5 Entry into our program is basically by two means; one,
6 you can call our Department of Defense's hotline out in
7 Monterey, the 1-800-796-9699 number, or the other
8 mechanism is to walk into a local medical treatment
9 facility.
10 A majority of our entrants come through the
11 hotline number. Currently we're receiving close to 200
12 calls per week on the hotline. We have to date
13 received - - - We have 26,000 members in our registry,
14 of which approximately 18,000 have received clinical
15 evaluations.
16 The CCEP program is a two-tiered clinical
17 evaluation. The first phase is conducted at the local
18 medical treatment facility by a designated CCEP
19 physician, and this a physician who is either board-
20 certified in family practice or internal medicine. The
21 examination in content and quality is equal to
22 admission inpatient's workup.
23 The phase I evaluation is a comprehensive
24 evaluation that begins with a fairly extensive history.
25 It's probably given to you as our protocol. We have
36
1 several questionnaires that the patient fills out.
2 This is directed under the clinician's supervision. It
3 begins with a symptom questionnaire where certain
4 specific questions annotated, as noted up there;
5 fatigue, headache, joint, etcetera. The most common
6 ones have been reported by the VA. We also ask
7 questions on exposure. This relates to tobacco, oil
8 fire smoke, petrochemicals, several other ones. We
9 also began in response to queries on reproductive
10 history, and this began in January of 1994 - - - Of
11 '95. I'm sorry. This is in regards to infertility,
12 miscarriages and stillbirths. This, I must indicate,
13 is all self-reported by these individuals.
14 We also do a very comprehensive physical with
15 attention focused on the patient's symptoms and health
16 concerns. Routine labs are obtained, and this includes
17 complete blood county, serum chemistries and
18 urinalysis, a chest x-ray also.
19 Specialized consults are also accomplished and
20 this may be done either localized or regionally if
21 needed. Approximately in our region about 30 to 40
22 percent of our participants have obtained consults,
23 roughly ranging from 1 to 3, and this varies from
24 Dermatology, Neurology, Gastroenterology and Psychiatry
25 and Psychology.
37
1 Due to the large number of our CCEP participants,
2 we have given them priority medical care to obtain
3 their consults and medical appointments. At our
4 facility, if we receive a consult from any of the
5 local MTF's, we get them scheduled within five days.
6 When a participant calls into your system they're
7 contacted within two weeks by the local facility, and
8 the local facility has thirty days to complete the
9 complete medical evaluation. This was recently
10 implemented about two months ago.
11 The CCEP evaluation program emphasizes continuous
12 primary care. The local primary provider maintains
13 responsibility for patient evaluation throughout the
14 whole process.
15 After completing the phase I, and if clinically
16 indicated, they are referred to one of the phase II
17 regional medical centers, which there are 15, and this
18 is through contacting the region and relaying the
19 medical information records and such.
20 Phase II is fairly comprehensive, and I will go
21 into further detail on this. At each of the regional
22 medical centers we have internal an medicine specialist
23 that goes through, reviews their whole medical history,
24 does another complete physical examination and repeats
25 their history, also obtains designated laboratory
38
1 studies. I have listed some of those for completeness
2 sake. As you can see, we are looking for inflammatory
3 diseases, rheumatoid factors, and a liver function
4 test. We look at muscle enzyme tests, we look at
5 hepatitis, we look for syphilis, we do thyroid function
6 studies, we do vitamin assessments, B12, Folic, as well
7 as repeating some of the other examinations.
8 We also have required consultations. These are,
9 one in infectious disease, and the other is in
10 psychiatry, and the others are directed at symptoms
11 specific. If they have not seen a dentist before
12 coming to our facility, if there's no one-year visit,
13 we obtain that also.
14 For instance, at Wilford Hall we have instituted
15 a fairly aggressive medical evaluation process. If
16 someone comes into our facility - I'll give one example
17 - their complaint is diarrhea, our GI department has
18 worked with us in developing extensive protocol
19 evaluating this. They will go through stool studies to
20 look for infectious, inflammatory type causes. We will
21 do types of testing looking for fat intolerance. We
22 will do endoscopies. We have done biopsies of upper
23 and lower scopes on these individuals. We don't stop
24 with just the routine evaluations. We've been very
25 comprehensive in our scope.
39
1 One of the other areas that we have been fairly
2 aggressive in looking at is the common complaint of
3 fatigue, and those results have actually been fairly
4 interesting. We have found a significant number of
5 those individuals presenting with complaints at our
6 facility in Region 6 with sleep disorders, and at our
7 facility each of us interviews them, does a
8 comprehensive interview, then if appropriate sent down
9 to the pulmonary department where they interview and
10 answer the questionnaires, and then if necessary
11 undergoes the sleep studies, and from those we have
12 found approximately about 40 percent of our individuals
13 out of the 300 have been diagnosed with some type of
14 sleep disorder, and this has been obstructive sleep
15 apnea and also for some insomniacs. Most of these are
16 readily treatable, and the individuals that we have got
17 on treatment have seen remarkable improvements, and
18 it's one of those areas where I feel we've really made
19 a lot of advance.
20 We also have been fairly aggressive looking at
21 individuals complaining about memory complaints.
22 Either the individual sees a psychologist or a
23 psychiatric, and we do computerized testing, neuro-
24 cognitive testing, on these individuals trying to
25 assess that.
40
1 To date out of the 263 individuals we've
2 evaluated we have not seen any evidence of any
3 neurologically based as a result of their loss of
4 memory, but will continue to evaluate and look at our
5 data.
6 I just recently was contacted Friday by a
7 neurologist. Another common trait in the system is
8 muscle aches and joint aches. We have done now 21
9 individuals through a protocol looking for especially
10 the muscle aches. We've done specialized EMG,
11 electronic myography, specialized nerve-fiber tests,
12 single fiber tests. We've done muscle biopsies, we've
13 looked at muscle enzymes, we've looked at cellular
14 functions, myocardia, and to date, August 21, this is
15 coordinated with the Health-Science Center in San
16 Antonio. We have not found any evidence of any
17 etiology for the muscle complaints.
18 We also look at psychosocial issues besides
19 investigating possible medical causes, and each phase
20 II participant is also wee by a social worker - and
21 here one of my favorite social workers has given them a
22 little pamphlet on some of the benefits they can get
23 from VA and other agencies to help them out. And they
24 also see a Psychologist in phase II.
25 This has been very helpful for helping us as far
41
1 as understanding how the veterans are coping in their
2 work and home environments, and also helping relate
3 with their families has been a real benefit.
4 The other thing we have implemented too in our
5 institution is that we sit down with the individual at
6 the end of consultations in phase II and we detail all
7 of the results. We go through all the laboratories
8 that have been obtained, we go through all the
9 radiographic studies that have been obtained on these
10 individuals. We also go through the different
11 consultants that have been visited and formulate a
12 treatment regimen for these individuals. This has been
13 one of the gold mines, I think, looking at it because a
14 lot of these veterans have not had time with another
15 practitioner to talk about what's going on in their
16 lives and medically what is happening; and we can
17 explain to these individuals the symptoms. We can say
18 what benefits they can get from our therapies and get
19 them on a lifestyle that will return them back to
20 normal function and to begin it.
21 The CCEP medical protocol underwent a revision in
22 January 17th, 1995. At that time almost 85 percent of
23 our participants were continued on to phase II, and
24 then underwent exhaustive laboratory and extensive
25 medical studies. A number of these labs and studies
42
1 would not have been routinely obtained; however, we
2 wanted to have it broad as possible so we did not miss
3 the unexpected or unusual.
4 Review of our protocol failed to reveal any
5 unusual medical conditions being overlooked. We had
6 two meetings of the CCEP regional directors as well as
7 coordination with the Institute of Medicine and the
8 Department of Veteran Affairs, and our protocol was
9 revised to reflect a clinically directed evaluation.
10 Now, as a result, only approximately 5 to 10
11 percent of our participants move from phase I to phase
12 II, and the review of now one year later reveals these
13 common medical problems are still continuing with very
14 few unusual conditions, but we not needing our
15 extensive labs that we were doing before. Before we
16 were doing EEG's on everybody that was coming up to
17 phase II; we were doing specific MRI's of the head on
18 anyone with a headache as such, and we revised that now
19 to be more of a clinically directed protocol that you
20 would see in a normal practice.
21 The DOD also have now steppedforward and
22 established a Specialized Care Center at Walter Reed.
23 It was started in March of this year, and a second one
24 is currently being formed at my facility, at Wilford
25 Hall. A limited number of patients have been found to
43
1 be suffering from chronic debilitating symptoms, such
2 as fibromyalgia or chronic fatigue that typically don't
3 respond to general medical regimens.
4 A multi-disciplinary team of health providers
5 from various specialties, behavioral health
6 psychologists, a rehabilitative medicine specialist,
7 physical and occupational therapists comprise the staff
8 at the specialized care centers.
9 The treatment is designed as a multi-disciplinary
10 pain clinic protocol, which have shown effectiveness in
11 treating such disorders. In fact, I talked with the
12 specialist that was at the Baltimore Regional in
13 chronic fatigue and fibromyalgia, and they proved very
14 supportive of our programs.
15 Walter Reed Army Medical Center has treated
16 almost thirty patients to date. A significant of them
17 have been returned to full duty status. A number of
18 psychosocial issues have been also identified at Walter
19 Reed Army Medical, and these have been addressed
20 through counseling sessions.
21 Now, I will discuss a little bit some of our
22 findings, but I'll be very brief on that. I think that
23 this will be presented in later presentations.
24 Our phase I and phase II evaluations have again
25 found common medical diagnoses that you would see in a
44
1 primary care setting among the 300 participants we have
2 evaluated, and these are similar to those that are
3 reported in the recent DOD 2020 report.
4 Our most primary diagnosis category that we've
5 found was psychological. About - - - a little over a
6 quarter of our patients presented with this diagnosis.
7 The principal categories in this was depression, both
8 minor and major, adjustment disorders and traumatic
9 stress disorders.
10 If you look at relatives in any diagnosis,
11 including the primary, a psychological diagnosis was
12 then 44 percent of our participants. If you look at
13 the CCEP 10,000 report, which has been made available
14 to you, approximately one-fifth of the patients in our
15 studies have a primary diagnosis of psychological, and
16 if you look at any diagnoses it's 37 percent.
17 Wilford Hall reflects a tertiary medical care
18 center, and about 85 percent of our evaluations have
19 been phase II. Fifteen percent have been phase I. In
20 the CCEP's report it's just the opposite. Eighty-
21 three percent of those are phase I and 17 percent are
22 phase II.
23 Musculoskeletal conditions, as I mentioned, have
24 been very common at our institution. If you look at
25 primary diagnoses it's 14 percent. If any diagnosis,
45
1 58 percent of them have had some type of
2 musculoskeletals. If you break that into categories,
3 three categories that are consistent with the majority
4 are mechanical back strain, pain in joints and muscles.
5 Other common characteristics we have seen include
6 neurologic, which the principal one is migraine
7 headaches; dermatology, which we found things such as
8 fungal foot infections; hair losses, male pattern
9 baldness and some folliculitis.
10 We also have in the gastroenterology department,
11 despite our aggressive evaluations, we have revealed
12 basically common diagnoses; such as, irritative bowel,
13 gastro-esophagal reflux disease and hemorrhoids. We
14 have not found any - - -I found one case of gerinyisis,
15 and that's it among all of our stool samples.
16 In the sleep department I've outlined that.
17 Again that's been a very productive department for us
18 in helping these veterans with obstructive sleep apnea
19 and chronic insomniacs. We've actually also began an
20 intervention for insomniacs where they go through a
21 behavioral health psychology to help them learn the
22 proper sleep hygiene and such, and that's been great.
23 We have seen relatively very few spouses and
24 children in our department at Wilford Hall and
25 nationwide in the CDEP program. Nationwide we've only
46
1 seen 131 spouses in our program and 81 children. If
2 you look at the 81 spouses, their diagnoses are similar
3 to those reported in my CCEP report, and those for the
4 children seem to be seeing what you see in pediatric
5 department, but I think caution has to be really
6 exercised with this. We have such a small core of
7 these people, and to make any comparisons should not at
8 this time be done. Again - - -
9 MS. KNOX - I've given you twenty minutes. I want
10 to be sure that Colonel Kroenke has his fifteen
11 minutes.
12 DOCTOR MATTHEWS - Okay, I'm just finishing right
13 now. Most of CCEP participants have expressed genuine
14 concerns about their health and ongoing symptoms, and
15 upon reviewing their diagnosis and treatment plan most
16 of them are expressing a high degree of satisfaction.
17 At Wilford Hall we have a 96 percent satisfaction rate.
18 I will address one issue before closing right now
19 for quality control. Twenty-five percent of the
20 records from the local medical treatment facilities are
21 reviewed, and we at regional medical centers also get
22 together with them, met four times over last year.
23 Again, I think the DOD - - - In my twelve years
24 in the Air Force I have not seen such commitment for
25 the services towards providing medical care like this
47
1 in a timely fashion. It's certainly been a pleasure
2 for me to work in this area. We are committed to
3 taking care of those individuals that returned from the
4 Gulf and their spouses and family members, and the
5 other thing is from this we can hope to take this
6 information and help others in the future.
7 MS. KNOX - Thank you, Lieutenant Colonel
8 Matthews. I'm going to let Colonel Kroenke go ahead.
9 COLONEL KURT KROENKE
10 I just have a couple of overheads. Most of mine will
11 be talking directly to you. I appreciate the
12 opportunity. My presentation will be slightly
13 different. It's to look at the problems we deal with
14 the symptoms in general as we look at medical practice.
15 By way of background, I am a general internist
16 who has had a research interest for about a decade in
17 common physical symptoms. We have conducted studies,
18 respective studies, on several specific symptoms, like
19 chronic fatigue, dizziness, and abdominal pain, as well
20 as a series of studies on physical symptoms as they
21 present to clinicians in general.
22 We've done some of these studies in our
23 outpatient clinics at two military medical centers.
24 One of them is at Brooke at San Antonio, and now at
25 Walter Reed. We have done other in collaboration with
48
1 civilian primary care clinics.
2 Our aims have been to better understand the
3 frequency of common various physical symptoms, the
4 yield or value of diagnostic testing, the causes of
5 symptoms, including how frequently we were unable to
6 pin down an exact cause, and the outcome, namely how
7 long it takes symptoms to generally get better.
8 What I'm presenting today are just the few
9 lessons we've learned about physical symptoms in
10 general, since in that unexplained illness group that
11 Doctor Murphy has presented our Gulf War Veterans have
12 experienced a variety of different symptoms. I hope to
13 provide some context for what primary care physicians
14 in general struggle with in evaluating patients with
15 physical symptoms which may not be well understood.
16 Now, it's important to emphasize that I'm talking
17 about studies in outpatient medical clinics. Some
18 military and some civilian, and we and you have to be
19 cautious in generalizing these findings to Persian Gulf
20 Veterans. And, in fact, my purpose is not to tell you
21 that what we've found in other primary care outpatients
22 will directly apply to the Veterans who are currently
23 suffering from a variety of symptoms. But my aim is to
24 point at that the failure to identify an exact
25 explanation for physical symptoms is a common dilemma
49
1 throughout medical practice, and I will address three
2 primary issues, symptoms in general, unexplained
3 symptoms, and symptom syndromes.
4 Now physical symptoms account for over half of
5 all outpatient visits in the United States, physical
6 symptoms rather than specific diseases, of which a
7 proportion are specific diseases, but an estimated
8 400,000,000 clinic visits in the United States each
9 year.
10 Now, in the first overhead what I show here is
11 the four most common symptoms in Veterans evaluated in
12 the Department of Defense's CCEP but, as you recall
13 from Doctor Murphy's presentation, were also the most
14 common symptoms in their registry, and what I've shown
15 is studies in the general population, to the white bar
16 and the middle bar of each is in clinics, patients
17 presenting to medical clinics, and the other is a
18 community survey, a large community survey, of these
19 symptoms and two clinic populations, primary care
20 clinics and one community population, and you can see
21 that the range of these four symptoms - fatigue, joint
22 pain, headaches, sleep complaints - range is anywhere
23 from 20 to 50 or 60 percent, and so on various surveys
24 on inpatients presenting these are quite common.
25 Also using the national and medical care survey,
50
1 which is a random sample of the United States, not
2 shown on this slide, these symptoms are also very
3 common in clinic patients. Fatigue was estimated to
4 account for 7 million visits in the United States each
5 year; headaches 9.6 million; joint pain 17 million; and
6 a complaint not shown on this slide but very common in
7 the registry patients is skin rashes, 14 million.
8 Now, the second item I just wanted to mention is
9 what about unexplained symptoms, symptoms we don't do
10 too well in pinning down a cause. And what we found
11 from the series of studies is that about one in three
12 patients presenting with physical complaints we were
13 unable to write a precise, specific disease label; for
14 example, if a patient presents with abdominal pain in
15 primary care, an exact physical cause such as peptic
16 ulcer or gallstones or hiatal hernia with reflux will
17 be can detect in some of the patients, but about one-
18 quarter to one-third will have normal physical exam in
19 diagnostic testing and have diagnosis of abdominal pain
20 but not a precise physical cause. The same can be true
21 with chest pain in which angina or reflux or
22 costochondritis will explain well over half of the
23 cases, but again about a third to a fourth will have a
24 normal evaluation for physical cause, and this is true
25 for most of the common symptoms you will look at.
51
1 In fact, if we can show you the second overhead.
2 This is from a study of four primary care clinics
3 looking at some representative symptoms and also that
4 large community based population study of four
5 communities in the United States, and you can see from
6 these representative symptoms that on average in the
7 clinic study about a quarter did not have an exact
8 physical explanation, in community study about similar
9 number. And this is true not only for the
10 representative symptoms I've put on for simplicity but
11 most other common symptoms.
12 Now, let me emphasize - this is important -
13 caution on the limitations of what we may conclude from
14 this for the Persian Gulf Veterans. First, the
15 majority of Veterans were men - approximately 90
16 percent or so - well over half of the individuals in
17 the studies I'm citing - because that's the way of
18 clinic populations and that's the way a community is -
19 about half or slightly more are women. For a variety
20 of reasons, not well understood, most symptoms are
21 about 10 percent more common in women than in men, and
22 we had 90 percent men in the Gulf War Veterans.
23 Also the average age of the Persian Gulf Veterans
24 was a little over 30 - 32, I believe, whereas the
25 average age in the studies I'm citing is 43 for the
52
1 community study and about 54 or 55 for the clinic
2 study. And so there's a difference of one or two
3 decades. When you look at studies of symptoms as
4 people get older, you would expect some of these
5 symptoms to be about five percent more common. There's
6 a slight increase with age.
7 And finally, the Persian Gulf Veterans were a
8 group presumably fit enough to be deployed into a
9 combat situation, whereas studies of clinic patients
10 presumably include some patients at least who may not
11 be so fit. So these are things where you may feel that
12 symptoms would be expected to be somewhat less common
13 in this age group.
14 Now, because of how often physicians in regular
15 practice are unable to precisely pinpoint the cause of
16 common physical symptoms, it's very important to draw
17 the distinction between an illness and a disease.
18 All patients experiencing symptoms severe enough
19 to seek medical attention have an illness. They have
20 physical discomfort causing suffering, concern and
21 worry, and at least some degree of impairment of each
22 one. However only in those instances where we can
23 pinpoint a precise cause; for example, coronary artery
24 disease causing chest pain, an ulcer causing stomach
25 pain, shortness of breath due to asthma, have we
53
1 identified a disease. And one of the limitations of
2 our current diagnostic coding systems, such as ICD-10,
3 is that they are diseased-based. This is fine when the
4 patient has a clear cut specific cause of a particular
5 symptom that can be readily identified by a current
6 medical means; however, when there are symptoms for
7 which the cause is not so clear-cut the physician must
8 use an ICD-10, a residual category called system
9 symptoms, signs and ill-defined disorders.
10 In clinical practice physicians may frequently
11 write in the chart simply the name of the symptom, back
12 pain, headache, dizziness. They may qualify it with a
13 phrase like idiopathic or etiology unknown. As our
14 studies indicate, this is at least a quarter to a third
15 of the times.
16 One other thing, it's common for many patients to
17 experience more than one symptom. Four studies that
18 we've been involved in and three we haven't - one from
19 the literature - show that on symptom checklists,
20 typical outpatients will endorse a median of four
21 symptoms as bothersome, with one-third noting as 0 to 1
22 symptoms, one-third 2 to 3 symptoms, and one-third 4 or
23 more symptoms. And, in fact, one of these studies
24 included 414 apparently healthy graduate students and
25 hospital staff in Philadelphia, published in The New
_______
54
1 England Journal some years ago, and in this group they
2 were predominantly male, 73 percent, and a young
3 population of less than thirty. So even in this
4 population a bit closer to our Persian Gulf Veterans,
5 many common symptoms were endorsed on symptom
6 checklists.
7 Now, part of this high level of symptom reporting
8 in surveys - and it must be mentioned that the primary
9 method for countings symptom in the registry was
10 symptom reports and checklists - is that symptoms are
11 common episodic experiences - fatigue, headaches, a
12 sore back or neck or shoulder, GI upset, trouble
13 sleeping - and that when given checklists persons, in
14 the community or clinics, will check all symptoms that
15 they have noticed to allow a physician or a clinician
16 to decide which symptoms may or may not be important.
17 In fact, studies have shown that concern or worry
18 about what a physical symptom means or signifies is a
19 powerful determinant of seeking health care, and the
20 potential or perceived seriousness of a symptom; for
21 example - Can this chest pain be my heart? Can this
22 dizziness or headache be a problem with circulation or
23 signify a warning of a stroke? Could my abdominal pain
24 be a sign of cancer or an ulcer - is as much of a
25 reason to report symptoms to a health care provider as
55
1 the actual severity of the symptom.
2 Now, extensive research has revealed that it's
3 important to inquire about the possibility of
4 depression or anxiety disorders in patients with
5 multiple or unexplained physical symptoms. Many
6 studies have documented that these conditions are
7 common - about one in four patients in primary care -
8 and in fact at least half the patients who report
9 multiple or unexplained symptoms in primary care. In
10 fact, in the study of 1000 patients presents presenting
11 to primary care clinics, who are given a 15-symptom
12 checklist, those who report 0 to 1 symptoms or 2 to 3
13 symptoms or 4 to 5 or 6 to 8 or 9 or more, you can show
14 that there's an increased likelihood of them having a
15 co-existing diagnosable anxiety or depression as well.
16 Now, a word of caution here must be mentioned.
17 Just because depression and anxiety frequently coexist
18 in patients with unexplained or multiple symptom, of
19 course, doesn't mean that they cause the symptoms.
20 It's likely that in some patients with persistent
21 unexplained symptoms could lead to feelings of
22 depression or anxiety when we haven't found a cause or
23 a specific treatment. It's also possible depression or
24 anxiety can lower the tolerance in common physical
25 symptoms, or that the neurotransmitter balances we know
56
1 exist in depression and anxiety do cause changes in
2 energy, sleep, pain thresholds, and gastrointestinal
3 function. Whether a cause or a consequence, however,
4 in primary care there is evidence that treatment of the
5 coexisting depression or anxiety that might develop can
6 lead to improvement in some of the physical symptoms as
7 well.
8 Finally, let me comment briefly on my third issue
9 of symptom syndromes, which are illnesses manifested
10 solely by combinations of symptoms with normal findings
11 on physical examination and laboratory testing, and yet
12 for which research has yet to reveal an exact cause.
13 Now, these syndromes are common for anyone who
14 practices in primary care, the irritable bowel
15 syndrome, fibromyalgia, chronic fatigue syndrome,
16 premenstrual syndrome, tension headache, and other
17 conditions.
18 In fact, the overlap of specific symptoms can be
19 considerable. What I've shown here is the percent of
20 patients with four disorders that have each of these
21 symptoms, and on the left are Veterans, are Gulf War
22 Veterans on the DOD evaluation; in the middle are two
23 common physical symptom syndromes in primary care,
24 chronic fatigue syndrome and fibromyalgia; and on the
25 right is the physical symptoms experienced by patients
57
1 with depression, and you can see that fatigue,
2 myalgias, headaches, memory complaints, sleep
3 complaints are quite common, usually 40 to 50 percent
4 or more in these various types of six syndromes.
5 Let me close by saying once again that I cannot
6 delineate for you the cause of symptoms experienced by
7 Veterans evaluated in the CCEP. I can show you that
8 these symptoms are quite prevalent in medical practice
9 in general, and that the frustration of being able to
10 find an exact cause is true of about one-third to one-
11 quarter of the time. What I have summarized briefly is
12 that actually our scientific understanding of symptoms
13 in other medical settings is in fact imperfect, and
14 that indeed the amount of research on symptoms has been
15 far less than the many studies conducted of well-
16 defined diseases, such as heart disease, diabetes,
17 cancer, AIDS, and many others.
18 I thank you for the opportunity to summarize a
19 little bit of this research, and we'll be happy to
20 answer any questions.
21 MS. KNOX - Thank you so much. You've all done a
22 very good job of presenting your information, and I
23 would open questions to the panel once again.
24 MS. LARSON - One of the big purposes of today is
25 to look not just at the symptoms but at the access to
58
1 care and issues about timeliness and so forth, so I'm
2 going to address my questions primarily to those
3 issues.
4 First, the VA eligibility is still open-ended,
5 but the DOD eligibility is August 1st to July 31st,
6 1991. That's very different and, in fact, it seems
7 like the opposite of what you think it might be. Why
8 is that?
9 DOCTOR MATTHEWS - What we wanted to do is try to
10 confine our group to those that were deployed in that
11 region for the purposes of looking at their health care
12 concerns.
13 DOCTOR LARSON - Sure, I understand that, but we
14 just heard how coordinated your efforts were, and yet
15 something as basic as eligibility for care is totally
16 different. Okay, next question.
17 DOCTOR MATTHEWS - They're all eligible for care,
18 but we're just defining this certain time frame for
19 them to enter.
20 DOCTOR KROENKE - That's an important distinction
21 because anybody on active duty military for any health
22 problems have unlimited access to care and doesn't have
23 the special requirements that the VA would have, so
24 it's just as part as this Gulf War - -
25 DOCTOR LARSON - Okay, but it has to do with
59
1 priority cases.
2 DOCTOR KROENKE - Active duty has first priority
3 in the military.
4 DOCTOR LARSON - With the VA it's just an issue of
5 priority then.
6 DOCTOR MURPHY - It's really a special
7 eligibility. They don't have to go through the means
8 testing and they're eligible for the registry and
9 referral center program.
10 DOCTOR LARSON - Prior to the CCEP implementation
11 in June of '94, were there any formal mechanisms for
12 looking at - - - For examining Gulf War Veterans, or
13 did they just go through the regular - - -
14 DOCTOR MATTHEWS - In regard to their duty?
15 DOCTOR LARSON - Yes.
16 DOCTOR MATTHEWS - We had a Persian Gulf War
17 Registry that was actually formed, approximately one
18 year earlier, and that was a kind of in effect. We had
19 a very limited number of patients. These were all
20 identified at individual treatment centers and reported
21 to our headquarters through our infectious departments,
22 but that was just a very limited scope, just restricted
23 to the practitioners reporting cases that they thought
24 might be referable to the deployment in the Persian
25 Gulf.
60
1 DOCTOR LARSON - So the Registry health exam of
2 the VA started in August of '92, but the formal
3 evaluation within DOD started in approximately June of
4 '93.
5 DOCTOR MATTHEWS - Yes - - - June of '94.
6 DOCTOR LARSON - Well, June of '93 in the Registry
7 with small groups.
8 DOCTOR MATTHEWS - Yes, it was very limited in
9 scope with very limited knowledge, mostly amongst
10 regional medical centers and such, especially in the
11 Air Force, and our program really started June 7th,
12 1994.
13 DOCTOR LARSON - And prior to that, people who had
14 symptoms just went through the regular - - -
15 DOCTOR MATTHEWS - The regular medical care
16 system.
17 DOCTOR LARSON - Now, you have 26,000 in your
18 registry. Eighteen thousand of them have been
19 evaluated.
20 DOCTOR MATTHEWS - (Indicating)
21 DOCTOR LARSON - And what about the other 18,000?
22 DOCTOR MATTHEWS - That would be 8,000.
23 DOCTOR LARSON - What about the other 8,000?
24 DOCTOR MATTHEWS - We have approximately about
25 6,000 of those are people that have just called in to
61
1 be on the registry, but have declined further
2 evaluation. There is a number of individuals that have
3 said yes I would like to be on the registry but I
4 cannot come in at this time to be evaluated. There's
5 approximately another 2,000 that are undergoing
6 evaluations at this time and have had their evaluation.
7 DOCTOR LARSON - Great. So now the mean time to
8 evaluation over the past few months is less than thirty
9 days.
10 DOCTOR MATTHEWS - Yes, that has recently been
11 implemented to help expedite the process.
12 DOCTOR LARSON - What was it before then?
13 DOCTOR MATTHEWS - I can't tell you. I can get
14 that information and what time frame it was, but we
15 were encountering difficulties of getting people
16 through the system. A number of people would come into
17 our process and complete part of it, then for different
18 reasons not elect to continue, and so we have elected
19 to go ahead and implement this thirty-day time frame to
20 give the regional medical centers and MTS to accomplish
21 it faster and also relay this information to the
22 participants.
23 DOCTOR LARSON - Now, you didn't just say that the
24 time - - - The problem was that people didn't elect to
25 continue, that's the reason - - -
62
1 DOCTOR MATTHEWS - Yes. Most of that was what we
2 have encountered in our region is that most of the
3 individuals coming in, once they get identified, saying
4 well I can't come in right now because of something
5 going on socially or a job. And what we are trying to
6 convey to them is that we want them to get that done in
7 a fast manner, and by having this thirty-day deadline
8 has helped.
9 DOCTOR LARSON - Let me just clarify that again.
10 You're saying that the reason why there might have been
11 longer delays before was because the Veterans - - - I'm
12 sorry, the active duty chose not to continue?
13 DOCTOR MATTHEWS - Active duty and we also have
14 some Reservists in here that come in, chose not to come
15 in.
16 DOCTOR LARSON - And were active duty personnel
17 given time off if they requested an exam? Are there
18 any anecdotal stories or otherwise of people not having
19 an easy time getting access?
20 DOCTOR MATTHEWS - I can comment for that. Most
21 cases there has been no problems for them getting time
22 off. You know, there has been a few cases that people
23 have had troubles getting into our system from work;
24 however, those are being addressed.
25 DOCTOR LARSON - And then when did you say the
63
1 reproductive history questions were asked?
2 DOCTOR MATTHEWS - That began right around
3 February of this year.
4 DOCTOR LARSON - I have no other questions.
5 MS. KNOX - Doctor Cassells?
6 DOCTOR CASSELLS - Yes. I would like to explore
7 that time gap between '92 and '94 again, starting with
8 the programs. Doctor Murphy said that there was a
9 representative from the Surgeon General of the Army's
10 Office at the meeting when they were planning their
11 initial registry examination. What is the reason for
12 the time delay between the VA starting their official
13 procedures and DOD starting theirs, even the informal
14 one in 1993. Do you know?
15 DOCTOR MATTHEWS - I personally can't comment on
16 that, I can inquire and see if I can an answer.
17 DOCTOR CASSELLS - You mentioned - - - Doctor
18 Kroenke, you mentioned the gender breakdown in the
19 overall outpatient visits that you were quoting there.
20 Doctor Murphy in the 24 percent undiagnosed category
21 that you have in your registry, what is the gender
22 breakdown there?
23 DOCTOR MURPHY - We do break down some of our
24 registry numbers by gender, and there are some
25 categories of symptoms that occur at a higher rate in
64
1 women than they do in men, specifically fatigue and
2 headaches. But again, those are more common complaints
3 that women have in general when they present to primary
4 care clinic, and it was only 2 or 3 percent difference.
5 In addition, I believe the unexplained illness category
6 was about 2 percent higher in women, but again I didn't
7 come prepared with those specifics and I can get them
8 to you.
9 DOCTOR CASSELLS - Doctor Matthews, you said that
10 in phase 1 of the CCEP program that the initial contact
11 required a board certified family practitioner or
12 internal medicine?
13 DOCTOR - Board eligible or board certified.
14 DOCTOR CASSELLS - Board eligible or board
15 certified, does that also mean house staff in those
16 hospitals where you have graduate and education
17 programs?
18 DOCTOR MATTHEWS - No.
19 MS. KNOX - Doctor Custis, did you have any
20 questions?
21 DOCTOR CUSTIS - Doctor Kroenke, your research on
22 symptomatology, do you have any research on the
23 incidents of onset. Is there any symptomatology in the
24 immediate versus delayed onsets or is there a wide
25 range of onset?
65
1 DOCTOR KROENKE - Yes. Most of the studies
2 unfortunately are prevalence studies, and I think
3 you're asking the question about incidents, and
4 particularly is there difference between those who have
5 acute onset of symptoms versus delayed onset. I'm not
6 aware of literature on delayed onset, because in most
7 of our people who are coming in with symptoms and in
8 terms of having had some kind of potential exposure
9 several years and then coming in with a symptom like
10 what exists for the Persian Gulf Veterans who now some
11 years after. I'm not familiar with comparable data in
12 the literature.
13 DOCTOR CUSTIS - In viewing the material, I got
14 the impression it's very common to have some degree of
15 delay in the onset symptoms, that the immediate onset
16 is kind of rare. Is that a false impression.
17 DOCTOR KROENKE - What I mean is a symptom is
18 present as immediately as the person experiences it.
19 Do you mean more of a gradual, kind of gradual onset?
20 DOCTOR CUSTIS - I'm talking about their leaving
21 the theatre, and then when they develop symptomatology.
22 DOCTOR KROENKE - There's not really a comparable
23 sort of phenomenon. It's a very - - - I mean in the
24 studies, the symptom studies, because when people come
25 in with symptoms they have them. They may have them
66
1 for different degrees of time. I'm sorry, I may be off
2 track.
3 DOCTOR CUSTIS - I think I was confusing you. By
4 onset, I mean on in terms of when they leave the
5 Persian Gulf and when they develop the symptomatology.
6 Is there any commonality in that?
7 DOCTOR KROENKE - You mean some who had them
8 immediately and some who may develop them a year or two
9 later?
10 DOCTOR CUSTIS - Right.
11 DOCTOR KROENKE - Actually all I've been able - -
12 - The data I looked at was that that was reported from
13 the registry. Do either of you have information on how
14 many had delayed onset versus immediate onset?
15 DOCTOR MATTHEWS - This has been very hard data to
16 try to acquire for us. We're now four years out from
17 the deployment, but I've been interested in trying to
18 obtain some kind of idea when the onset of the symptoms
19 came on for these Veterans now reporting to our
20 program, and so I've been asking this question; and
21 approximately two-thirds of our participants, about
22 300, are reporting the onset of symptoms within one-
23 year time frame of their deployment. Approximately
24 one-third of these came on fairly immediately after
25 about one - - - Within three months of returning back
67
1 from their deployment. The rest of them, the 66
2 percent, are one year from what I've seen so far, but
3 two-thirds of them are reporting onset symptoms within
4 one year. Be it that this data is very objective and
5 it's all by self-reports and so you would have to
6 analyze it from that standpoint.
7 DOCTOR MURPHY - I think one of the ways that
8 we're to get further clarification on that issue,
9 Doctor Custis, is through the National Persian Gulf
10 Survey that is about to kick off next month. We're not
11 only asking about symptoms that had their onset or were
12 present within the last year, but also when their onset
13 was, was it during the Gulf, before the Gulf, or after
14 their Gulf service, and that will be a random survey of
15 15,000 Gulf Veterans and 15,000 people who were on
16 inactive duty at the time but not deployed to the
17 theatre of operations. And I think we will have a much
18 better understanding of onset of symptoms after that
19 survey.
20 MS. KNOX - Doctor Matthews, I have a question for
21 you. I found that very interesting that you said 40
22 percent, I think, have been diagnosed with sleep
23 disorders. Help me understand. My experience with
24 sleep disorders and sleep apnea is usually caused by
25 obesity and maybe the utilization of alcoholic
68
1 beverages. Knowing that most active duty soldiers are
2 physically fit, what type of obstructive disorders have
3 they been diagnosed with, as you mentioned?
4 DOCTOR - That's an interesting comment, because I
5 was too was under the impression, and I think most
6 clinicians are - - - sleep disorders, I think, are
7 fairly under-diagnosed in the general medical
8 community, but from our analysis of the individuals
9 that have gone through us, if you look at the body mass
10 index that is a major obesity, our individuals that
11 have diagnosed with obstructive sleep apnea are just
12 slightly above the high norms values are at 27-25.
13 Ours is just around 28-26, and so these individuals are
14 not obese by clinical standards, and so I think for
15 that reason are not being diagnosed. We also have a
16 fair number of individuals coming through that have
17 been diagnosed with chronic insomniacs, and these also
18 respond to therapies through different behavior, health
19 and such.
20 MS. KNOX - So what are the obstructive disorders?
21 Are they asthma or COPD or sinusitis?
22 DOCTOR MATTHEWS - No. They are actually
23 physiologic. The obstructive sleep apneas are
24 physiologic obstructions, and actually can be in some
25 cases - - - We usually attempt to try continuous
69
1 positive airway pressure where it physically forces the
2 pharynx from falling back, or else they undergo surgery
3 to remove the physical obstruction. And there is a
4 group of sleep disorders that are secondary to other
5 medical causes, such as reflux or COPD, but we found a
6 very few minority of those. Most of these are a
7 physical obstruction.
8 MS. KNOX - From the uvea - - -
9 DOCTOR MATTHEWS - From the uvea as opposed the
10 pharynx area.
11 MS. KNOX - I find that very interesting. I think
12 in your DOD study of the 10,000 veterans that you
13 looked at you had no reports of sinusitis or allergies.
14 DOCTOR MATTHEWS - There are actually - - - If you
15 look at that, I think that part of it comes in analysis
16 as ICD9 coding, and that has been one of the ones we've
17 used for trying to report our illnesses, but if you're
18 trying to look at individual sinusitis or allergic
19 rhinitis or chronic sinusitis we do see some of that.
20 We have at our region - I'm just looking through our
21 data approximately 25 - - - Almost 25 percent of our
22 patients have had some type of a ears, nose or throat
23 related type disorder, most of these like allergic, but
24 again we're in the Southwest Region and there's a lot
25 of floods through Texas and such, so it's hard to say
70
1 whether this is an increased prevalence or not.
2 MS. KNOX - Did anyone have any other questions?
3 DOCTOR LARSON - When did your hotline start?
4 DOCTOR MATTHEWS - Our hotline actually began in
5 June. I don't have the exact date but I can get it to
6 you. I believe it was June 27th, 1994.
7 DOCTOR LARSON - And let me just clarify again.
8 Between the end of the war and two months ago you have
9 no idea what the mean waiting time was.
10 DOCTOR MATTHEWS - Waiting time for entry into the
11 DOD program?
12 DOCTOR LARSON - Yes.
13 DOCTOR MATTHEWS - We have actually had a minimal
14 waiting time, although I'm not sure if the data is
15 available. I can check on that for you to see. Since
16 we've begun one year ago, I can specifically comment on
17 our region. Most of the waiting times have been very,
18 very small. A couple - - - We've got a fairly couple
19 of large Army medical centers in our region. Fort
20 Hood, which is probably the largest army medical center
21 in the nation, has reported 5,000 individuals there.
22 They've mainly experienced the largest waiting time
23 period. For all the Air Force and Navy and Marine,
24 there have been very, very small waiting times.
25 DOCTOR LARSON - Why do you think it was three
71
1 years between the end of the war and when and when
2 these hotlines were first started?
3 DOCTOR MATTHEWS - I can't comment on that. I can
4 check with the DOD responses.
5 DOCTOR MURPHY - Maybe I can comment from VA's
6 standpoint. We have a system nationwide of delivering
7 health care to Veterans in general. We had 172 medical
8 centers until this year when we consolidated some of
9 them under single management, and now there are 158
10 nationwide, and it was very easy access the Persian
11 Gulf Registry.
12 We had a coordinator designated at each medical
13 center who would make appointments and get Veterans
14 into the system. In fact, we don't use our hotline or
15 help line as an access point for any of our health care
16 programs. They're given a number of the individual at
17 the local medical center who can help them through the
18 system and get them hooked up with their local health
19 care system.
20 So that really is not viewed as a mechanism to
21 get them accessed to health care. It's simply an
22 information and an outreach vehicle.
23 DOCTOR LARSON - That's very helpful. Then this
24 last question may be a little subjective, but I'm going
25 to ask it anyway because I think it's important.
72
1 Nobody likes to be perceived as having a psychological
2 problem because it's perceived as either not real or
3 malingering or it's dismissed in some way, and we all
4 have psychological problems that could be diagnosed. I
5 guess my question is, to what extent do you think that
6 the manner in which the care is provided might give the
7 impression to people that their problem is perceived as
8 psychological and hence perhaps less important?
9 DOCTOR MATTHEWS - I think that's very important,
10 and that's one thing that we've tried to be sensitive
11 to in our region is that gray area. I think what has
12 to be realized that these individuals were subjected to
13 tremendous stressors while they were deployed. There
14 has been tremendous media exposure since their
15 deployment, and these people have real medical
16 conditions going on and these medical conditions have
17 for these individuals, a very little number of
18 individuals but very debilitating. But for the most
19 part does cause some interference in their lives, and
20 from our standpoint that is what we've attempted to
21 address and to try to - - - We may not have the answers
22 why these medical conditions exist, but we've at least
23 tried to help them deal with their medical problems and
24 help them get back to a normal life as much as
25 possible, and that's another thing for the specialized
73
1 care center project.
2 MS. KNOX - Go ahead, Doctor Cassells.
3 DOCTOR CASSELLS - I just want to follow up on
4 that question. We had some indication in earlier
5 conversations that perhaps we might be getting an under
6 sampling in the DOD program as a result of concerns
7 about career, either because of appearing to be ill
8 anyway or building on Doctor Larson's question about
9 the possible stigma of having psychological diagnosis
10 attached. Do you have any indication that that is in
11 fact taking place?
12 DOCTOR MATTHEWS - I can't say I have absolute
13 evidence of that. There are reports that has gone on.
14 I'm not aware of exact cases, but one thing we've tried
15 to emphasize to the different services is that to
16 endorse this project, to try to get them into our
17 program without any stigma. Of course, you will have
18 to be aware that so far individuals that are like
19 pilots and individuals that are in certain - - - Like
20 the Marines and such, there is a certain personal
21 feeling that something may be checked against them,
22 something like that, but I have not seen it.
23 DOCTOR MURPHY - Madame Chairman, if I could
24 provide a point of clarification.
25 MS. KNOX - Okay.
74
1 DOCTOR MURPHY - You asked a question about my
2 statement about a minimum of 181 days for eligibility
3 for care. I'm going to introduce to you Mr. Kent
4 Somonis. He's the Chief of the Medical Administration
5 Service and at the VAMC in Columbia, and is our expert
6 on eligibility. Most physicians don't get into the
7 nitty-gritty of that, and in fact I stand corrected.
8 It is 120 days minimum for eligibility for care at the
9 current time, except for some service-connected
10 conditions.
11 MS. KNOX - I wanted to ask to, Doctor Murphy, you
12 mentioned that Veterans can still walk into the VA
13 center and report their DE214 and they can receive an
14 exam. And I know Veterans from our unit who are still
15 doing that up until 1995, five years after deployment.
16 What is DOD and the VA system doing as far as
17 looking at the main date that Congress has set if you
18 didn't report the illness within two years or have
19 symptoms that the VA knows about as not considered
20 connected? What is the use to continue doing exams if
21 it's not - - - If it's already mandated that it cannot
22 be connected?
23 DOCTOR MURPHY - First of all, let me clarify a
24 couple of points. The VA is divided actually in three
25 separate administrations, Veterans Health Care and
75
1 Veterans Health Administration provides medical care.
2 Veterans Benefits Administration provides compensation,
3 pension and other benefits to Veterans, and then we
4 also have a national cemetery system so they're three
5 separate administrations. You have to separate
6 eligibility for health care from compensation.
7 The time limit that you're referring to is a two-
8 year limit for disability compensation under the new
9 Undiagnosed Illness Regulation, which is specific only
10 to Persian Gulf Veterans. Now, what that regulations
11 says, for compensation - - - Again for service
12 connected compensation, not for medical care - - - Is
13 that any Persian Gulf Veteran who is 10 percent or more
14 disabled and has a chronic disability, defined as six
15 months or more of disability, can receive compensation
16 if their illness or their disability actually manifests
17 within six months - - - Excuse me, within two years
18 after leaving the Gulf Theatre of Operations. So at
19 the time they left the Gulf that clock starts, not the
20 time period for Desert Shield/Desert Storm. But that's
21 compensation. They're still eligible for medical care
22 under this priority care legislation irrespective of
23 service connection.
24 MS. KNOX - So if they have a long-term disability
25 that's picked up on their exit physical at the VA, are
76
1 they eligible to come for care for that? Do they meet
2 the regs for service connection? They don't, do they?
3 DOCTOR MURPHY - Again, there are two sets of
4 regulations that apply to Persian Gulf Veterans. There
5 are the routine compensation regulations and the
6 compensation regulations for undiagnosed illness.
7 Normally for a Veteran to be service connected for a
8 disability, they need to have a disease, a diagnosable
9 disease, or an injury that occurred or was exacerbated
10 by their military service, meaning in most cases it had
11 to manifest itself while they were on active duty.
12 In some chronic conditions there is a one-year
13 presumptive period, but let's put that aside. But that
14 has to be a diagnosed disease. The special set of
15 regulations that apply only to Persian Gulf Veterans,
16 not any other era Veteran, comes under the special
17 regulation.
18 So it is a very unique and groundbreaking
19 compensation regulation for undiagnosed illness. We
20 were not in the past able to compensate Veterans of the
21 Persian Gulf when we were not able to give them a
22 diagnosis, and since this became a real issue we had
23 legislation enacted in November, Public Law 103446 that
24 essentially said we're going to put that aside if
25 they're chronically disabled or 10 percent or more
77
1 within two years after their Persian Gulf service and
2 they had an undiagnosed illness, we can still
3 compensate those Persian Gulf Veterans. So I think
4 we've gone extra mile with that program.
5 MS. KNOX - Well, just let me clarify once again.
6 I have an example of a Veteran who like two and a half
7 years post Desert Storm had her exit physical of the VA
8 medical center and was diagnosed with lung cancer. She
9 did not have any symptoms of that lung cancer other
10 than shortness of breath, and that was the symptom that
11 she presented with to the VA, but because she didn't
12 report any symptoms within the time she was on active
13 duty and within the one year of service, she has not
14 received any compensation or been quoted as being
15 eligible for care, and knowing the ecological system
16 that Veterans were exposed to, in particular
17 environmental toxins, as concerning that people are not
18 compensated for a neoplasia in that time area.
19 DOCTOR MURPHY - Again, with diagnosed illness of
20 that type, we have to fulfill all other requirements of
21 the usual compensation regulations, and I believe we
22 have a Veterans Benefits and somebody from the regional
23 office in the audience. Maybe we can take down an
24 individual's name and Social Security number and look
25 at the specifics for you, but if that individual is a
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1 Persian Gulf Veteran and feels that their condition of
2 lung cancer is due to an exposure that occurred in the
3 Gulf, and a physician is willing to write in the
4 medical record that they think that that is possible,
5 then they can receive health care.
6 MS. KNOX - So the health care can be granted?
7 DOCTOR MURPHY - It can be granted and should be
8 granted.
9 MS. KNOX - We started a little late so I've held
10 this over a little late. Are there anymore questions?
11 Thank you so much. We would like to take a fifteen
12 minute break, and we'll report back at about 11:30 and
13 start again.
14 WHEREUPON - a recess was taken.
15 MS. KNOX - We're going to hear from the second
16 panel. We're going to look at pre-deployment physicals
17 that were provided from both DOD and the VA, and I
18 would like to introduce Lieutenant Colonel Patty Hamill
19 from the Department of Defense, and also Lieutenant
20 Colonel Karen Price, who is a member of the 300th
21 Combat Support Hospital in South Carolina. If you
22 would like to add something, we don't really know your
23 background, and I would appreciate that.
24 LIEUTENANT COLONEL PATRICIA HAMILL
__________________________________
25 Hi, I'm Lieutenant Colonel Patty Hamill, and
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1 currently I'm assigned to the Office of the Assistant
2 Secretary of Defense for Reserve Affairs, and I'm in a
3 position as the Director of Medical Programs and
4 Medical Readiness, and I've been there about three
5 years. We work all Reserve programs that would impact
6 medicals for the recruiting end, all the way through
7 the medical fitness of the force as a whole.
8 During Desert Storm - - - I'm on active duty as a
9 Reserve officer. I'm an active Guard/Reserve officer
10 in the Army Reserve. During Desert Storm I was
11 assigned to Forces Command, which was the Army
12 Mobilization Coordinator for Army Forces, and worked
13 with a number of the pre-mobilization requirements as
14 well as reviewing units pre-deployment to make sure
15 that we had the right skill mix and those kind of
16 issues back then.
17 Thank you for the opportunity to address this
18 Committee. I will address three primary areas. The
19 first is the policies government the medical assessment
20 of the Ready Reserve at the time of Desert Storm and
21 the implementation of these policies during Desert
22 Storm.
23 Second, I'll talk about the polices governing
24 demobilization of Reserve because it sort of links, and
25 I thought you might want to at least have some
80
1 knowledge of what was done with official policy
2 matters, and finally talk about what the impact of the
3 Desert Storm experience had on those mobilization
4 policies, both pre-mobile and demobile.
5 First, the polices governing the medical
6 assessment of the Ready Reserve, both routinely and
7 pre-deployment. For your benefit - - - I know some of
8 your aren't military background, but the Ready Reserves
9 includes the service members that belong to the unit
10 type structure; in other words, the people that - - -
11 The weekend warriors, as we call them, the people that
12 drill on weekends and serve to expand the active
13 deployment force at the time of mobilization, and also
14 the individual Ready Reserve, which are people who
15 don't belong to units and don't drill on a regular
16 basis, but are available for call should they be needed
17 in specific specialty areas, and then also the
18 individual mobilization of MT's, which are not units
19 but individuals who drill with the active duty
20 installations or have certain skill that we need within
21 the various service components, that help round out the
22 capability of the total force. So when I talk Ready
23 Reserve, I'm talking about the whole gamut of those
24 elements as what the policy applied to when I'm talking
25 about the various policies.
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1 The physical standards for Reserve forces are the
2 same as they are for the active duty force. Periodic
3 physical exams are required by Title 10 US Code, are
4 performed to ensure continued compliance with the
5 established physical standards.
6 At the time of Operation Desert Storm Ready
7 Reserve members were examined every four years, and
8 that's contained within Title 10, that requirement.
9 Also this is the Navy, the Army, the Air Force, Marine
10 Corps. All the services require as a minimum a
11 physical every four years, and then each of the service
12 secretaries also required specific members of their
13 forces to have physicals more frequently; fliers,
14 divers, various specialties. People over 40 had
15 increased frequencies in some of the services. So
16 there were service variances throughout the various
17 service components.
18 Members were also required by law, Title 10
19 again, to submit an annual certificate of physical
20 condition, whereby they certified their physical
21 condition on an annual basis. This annual certificate
22 was developed by each service and was completed in
23 according to the service policies.
24 The Navy and Marine Corps Ready Reserve members
25 signed a statement - - - Filled out a form and signed a
82
1 statement indicating any change in their health status
2 since their last physicals - - - Since their last
3 statement or their last physical exam, whichever one
4 was more current.
5 The Army had no formal policy implementing this
6 legal requirement, although some commanders on an
7 individual basis required their members during their
8 annual record review to document their current health
9 status as a statement on their record review.
10 The Air Force monitored the physical condition of
11 their members on a monthly basis and, therefore, did
12 not implement the requirement since on a monthly basis
13 they were assessing the physical status of their
14 members.
15 At the time of movement to an overseas location
16 or a deployment, each member undergoes a final medical
17 screening, again in accordance with the service
18 specific policies. Each service; in other words Navy,
19 Marine Corps - - - And when I talk about service the
20 policies between the Guard and Reserves were no
21 different. Nor was there a significant difference
22 between the Active and the Reserve population. In
23 other words, the movement to overseas locations
24 consistent to space of the service you belong to. So
25 whether you are Army, Guard, Ready Reserve your
83
1 screening practice was the same as your active
2 component members. You were going to get on the same
3 airplane with these, so it was very consistent. The
4 same thing was true with the Air Guard and the Air
5 Reserve. And the policies do not differ. They might
6 be recorded in different service regulations because of
7 the way service regulations go, but when you compare
8 the policies between the Air Guard and the Air Reserve,
9 they were very consistent. Army Guard and Army
10 Reserve, they almost dovetailed.
11 Each service required a medical exam before
12 deployment in support of Operation Desert Storm. The
13 specific requirement at the time of the call to active
14 duty and movement to an overseas location varied among
15 the services.
16 The Army required all members to undergo a
17 preparation for overseas movement, which included
18 review of immunizations, HIV status, and validation of
19 medical and dental status. The Army modified the
20 requirement in October of 1990. Members then were
21 required to complete a health history which was
22 reviewed by a medical provider to determine if
23 additional assessment was required. In other words, as
24 they went through the line and while they were waiting
25 in line they would complete a health history, and that
84
1 was turned in and it was reviewed by a provider and if
2 there was anything questionable on that health history
3 those members were pulled out of the line, referred for
4 direct interview by that provider who made the decision
5 if a follow-up evaluation was required.
6 If additional assessment was required, the
7 members were referred to the appropriate provider,
8 appointments were scheduled and follow-up evaluation
9 completed pre-deployment. The Navy required Commanders
10 to ensure that their members met physical standards.
11 Upon mobilization members reported for duty at a Naval
12 Reserve Center where medical records were reviewed by
13 medical department personnel. At this time the member
14 also signed that annual statement certifying that their
15 current health status and if there had been any changes
16 in their health status. If a medical facility was
17 nearby, immunizations were updated. Otherwise, upon
18 arrival at the mobilization site, immunizations were
19 updated, and the member's dental and HIV status was
20 reviewed and documented. Like the Army, members were
21 referred to an appropriate provider when problems were
22 identified.
23 The Air Force regulations at the time of Desert
24 Storm required a physical examination in addition to
25 record screening and health questionnaire of the other
85
1 Services. In most instances this requirement was
2 waived for members who had a recent periodic physical
3 exam. Mobilization processing or deployment processing
4 included updated immunization and review of member's
5 HIV and dental status. Thus, you can see that we had
6 policies that people were to meeting during the
7 peacetime. We monitored those during the peacetime
8 period with the annual certification as well as the
9 every four-year physical, and then immediate pre-
10 deployment we screened individuals to see if there were
11 any significant problems which would impair their
12 ability to do their jobs in the theatre of operations.
13 Next, the policies governing demobilization of
14 Reserve members: Title 10 of the US code requires
15 members of the Army and Air National Guard to be
16 examined as to physical fitness immediately prior to
17 departure from federal service. In order to ensure
18 uniform treatment with respect to medical separation
19 procedures for the members of the Ready Reserve who had
20 been order to active duty in support of Operation
21 Desert Shield and Desert Storm, the Department of
22 Defense directed that each member of the Ready Reserve
23 who was released from active duty must comply with
24 requirements for a separation physical exam established
25 in accordance with Service directives.
86
1 So the department, even before we started moving
2 people back from the theatre of operation, the
3 Department of Defense mandated that all reserve members
4 will be physically evaluated prior to separation. The
5 Army broadened this requirement to encompass both
6 Active and Reserve members and published specific
7 guidance detailing the components of the post-
8 deployment physical exam.
9 The Air Force authorized a separation exam if a
10 member requested it, or if the medical record indicated
11 a need for it. If the member's previous physical exam
12 was less than five years old, the scope of the exam
13 consisted of a detailed medical history with a physical
14 exam directed only at problems identified.
15 For Naval and Marine Corps reservists being
16 returned to a drill status, the medical record was
17 reviewed and the Reservists were asked if there were
18 any changes in their health. If no changes in health
19 status, the member signed a statement indicating no
20 change in their health status since last exam and then
21 was released from active duty. For members separating
22 from military service of the Navy or Marine Corps a
23 complete physical exam was completed before the member
24 was separated.
25 Finally, the impact of Desert Storm on medical
87
1 mobilization policies: The experience of Desert Storm
2 has led to improvements in the mobilization process as
3 well as our monitoring of the medical status of the
4 Reserve force during peacetime. While the routine
5 pre-deployment screening processes proved to be
6 effective in identifying members with significant
7 medical problems before deployment, the system could be
8 improved.
9 Thus, since Desert Storm many mobilization and
10 deployment policies have been modified. The frequency
11 of routine physical exams is now five years with
12 increased emphasis on the annual certificate of
13 physical fitness. The Department of Defense is
14 completing a rewrite of both the accession and
15 retention physical standards policies and separation
16 review procedures for members who do not meet physical
17 standards.
18 In addition, the Department has also developed a
19 standardized report of medical assessment which will be
20 used at time of separation or retirement. The Navy has
21 eliminated the Reserve medical examination waiver
22 policy and now requires all members to maintain current
23 exams in a complete format, and to sign their necessary
24 medical condition form annually. And the Army has
25 modified its mobilization guidance to formally reflect
88
1 the changes it implemented during Desert Storm as well
2 as it's developed a certificate of physical condition
3 statement which is being implemented now for all
4 members on an annual basis. Thank you for your
5 attention and for allowing me to present.
6 MS. KNOX - Lieutenant Colonel Price, we'll let
7 you go ahead.
8 LIEUTENANT COLONEL KAREN PRICE
9 I'm Karen Price, and I'm a family nurse
10 practitioner in Columbia, South Carolina. At the time
11 of Operation Desert Storm I was with the 251st EVAC
12 Hospital in Columbia, which is now the 300 Combat
13 Support Hospital in Columbia.
14 And my reflections or observations would be a
15 collection of observations from those in my unit and
16 other reservists from my community about their
17 experiences in the pre-deployment physicals.
18 And many of my observations are going to parallel
19 with Colonel Hamill's, although we didn't talk before
20 this. But my observations of the pre-deployment
21 physicals that consisted primarily of screening
22 processes, which I will elaborate upon.
23 First of all, we did do a Standard Form 93, which
24 in essence is the health history form that is required
25 for our periodic physicals for retention and also the
89
1 health history form that you do for an induction. We
2 did fill that out. It consisted of a series of about
3 100 questions; yes/no, or don't know. And those health
4 forms were reviewed by a provider and positive answers
5 were reviewed and you were interviewed if there were
6 problematic things that came up on that health history.
7 We underwent a visual screening, which consisted
8 of an acuity as well as an assessment for color
9 blindness, and if service members wore contacts they
10 were fitted for glasses, and corrective lenses for gas
11 masks.
12 We also underwent a dental screening. If our
13 records were deficient in panographic x-rays that were
14 done and if there were any dental emergencies that
15 needed to be handled prior to deployment, those
16 procedures were also done as well.
17 Immunization status was reviewed and
18 immunizations were administered at the deployment
19 station. We were blood typed if our records were
20 deficient in that area. HIV testing, which is required
21 every two years, if they were delinquent in that that
22 was also done at the same time. There were other lab
23 and diagnostic tests which were performed, but that
24 based on a service member's self-disclosure and the
25 need for such.
90
1 If there were service members who were on
2 prescription meds at the time, the prescriptions were
3 rewritten for a period of six months. I would liken
4 the screening process to the screening process that
5 takes place prior to our retention physical. There was
6 not a requirement for a one-to-one physical exam with a
7 health care provider, and that is the difference
8 between our retention physical every five years, that
9 after you do these screening processes then you would
10 have a physical exam and an assessment by a health care
11 provider which might be a physician or a nurse
12 practitioner.
13 And we also did have a APFT test administered
14 prior to deployment, which is not really a part of the
15 health screening but it was administered prior to
16 deployment. I think that the depth or extent of the
17 screening varied from mobilization to mobilization
18 station, and that was primarily based on availability
19 of personnel and equipment and resources, and also the
20 relationship to the time frame that we had to deploy to
21 Desert Storm; ie, in December. Our process went very
22 quickly and we were went from mobilization station for
23 Desert Storm in a period of about ten days.
24 MS. KNOX - Thank you very much. Are there
25 questions from the Committee panel? Doctor Cassells.
91
1 DOCTOR CASSELLS - Colonel Hamill, I have a couple
2 of questions. Number one, what kind of quality control
3 do you have in the Reserves and the Guard on the four-
4 year physical examination and the annual certification
5 review?
6 LT. COL. HAMILL - It's been fairly inconsistent
7 throughout the Services; however, as a result of Desert
8 Storm it's significantly different now. The Navy in
9 particular had a policy whereby they would say facility
10 not available and would waive the physical exam. As
11 Colonel Price said, there was a requirement in the Army
12 to have a physical pre-deployment. That's essentially
13 true with the Navy and the Air Force as well. The
14 currency of the physical was a routine monitoring
15 procedure that was done during peacetime, and would not
16 impact the member's ability to deploy. And I don't
17 think it ever will hold it as being a reason for non-
18 deployment because that would sure be a positive
19 indicator for people not staying current to in order to
20 circumvent a possible deployment, but the procedures
21 for maintaining the orce as we get smaller and smaller
22 and smaller, the looks of the quality of the Force are
23 getting much tighter. So in the Navy a year ago they
24 changed the facility not available procedure. All
25 members must have a current physical exam and they're
92
1 referred to local MTF or to a civilian contract that
2 are established within each region so they can it done,
3 and then their physicals are being maintained current,
4 and the Commanders themselves are being held
5 accountable, and the currency of those physical exams
6 can be documented.
7 In the Army, in the Army Reserve and the Army
8 Guard, in particular in the Army Guard, last - - - two
9 years ago Congress passed Title 11, which is the
10 fitness of the Guard for deployment, and there were two
11 sections that dealt with medical and dental readiness
12 that as a result of that, if members are not medically
13 fit they have to be transferred to a non-deployables
14 account until such time as they're rendered fit.
15 So, as a result of that requirement, people have
16 moved much more aggressively forward. In addition,
17 they added early qualification for separation.
18 Frequently the reason for Reserve members not
19 completing physical exams were that if it rendered the
20 individual unfit the individual would lose all
21 benefits, because if you didn't have 20 qualifying
22 years you had no review process because most of the
23 conditions were then service-connected.
24 Last year they added to the separation benefits
25 an early qualification for retirement as a result at 15
93
1 years. So if a member has a medical condition that's
2 nonservice connected, the individual can apply for
3 early qualification if they have medical - - - I mean
4 if they have 15 qualifying years, and that's helped
5 significantly with members identifying out front their
6 medical conditions as well as the willingness of the
7 Commanders to take their neighbor and force them
8 through the medical system for evaluation. And that
9 seems to have had an excellent result.
10 In the Army Reserve they're initiating a test on
11 physical exams whereby you would have some quality
12 control. It's an Army Guard and the Army Reserve test
13 where we would use the physical exam entry sites annex
14 stations as well as the DOD-MEB, the DOD Medical
15 Evaluation Boards, which do outline Service School and
16 Service Academy physicals throughout the United
17 States, use those as the test process to do all the
18 Reserve physical exams, which would take it out of the
19 local area and put it into a non-service aligned
20 element so that we would have better consistency
21 between the physicals.
22 Right now the physicals can be provided by local
23 unit, civilian contract, another service component in
24 an active duty facility, and it's been very difficult
25 to get those done. So people are looking aggressively
94
1 at the result of the study that's going to start in
2 March to see how using the facilities, the accession
3 facilities, would work, and they've got it all
4 established in time frames and everything else, and
5 it's much more cost effective there as well. Using
6 those facilities drops the cost down to almost 50
7 percent of what the cost would be if the individual
8 units started providing the services.
9 The Air Force does the best job, and I think the
10 reason is is their co-location. Most of the Reserve
11 units are co-located with a medical facility. In
12 addition, those that aren't co-located all have medical
13 elements so that they all have a doctor sign because of
14 flying involvement, so that they tend to stay much more
15 current and they're monitored much more closely because
16 of that alignment. So that while there isn't a formal
17 place for people to check in, each of the local
18 commands that monitors various services, all do track
19 that as a mobilization criteria for retention in the
20 Force.
21 DOCTOR LARSON - In addition to the regular NCIP
22 recommendations for immunizations for the US, what did
23 all the troops get in terms of immunization?
24 LT. COL. HAMILL - I would have to go back to - -
25 - There was specific criteria that were published by
95
1 the Department as required pre-deployment, and that
2 went out to each of the sites and that was based on the
3 theatre of operations and what the view was that
4 members did require, and that was theatre-based so I
5 can get that back to you.
6 DOCTOR LARSON - Yes, I think we need to get that.
7 And what kinds of special preparation for health care
8 for the troops were given before they went out; for
9 example, discussions about physical environmental
10 hazards, psychological hazards, any kind of eduction,
11 both going in and then going out at the end? It's a
12 little bit different than what you were asked to talk
13 about.
14 LT. COL. PRICE - We did have several sessions
15 that were presented about heat, about the cultural
16 changes or the cultural differences prior to
17 deployment, but I don't recall that we had any of that
18 post-deployment.
19 DOCTOR LARSON - Anything about things that
20 occurred frequently in - - - Things such as Post-
21 traumatic Stress Syndrome?
22 LT. COL. PRICE - I don't recall that post-
23 deployment. After we returned to our units, after we
24 were demobilized now there were opportunities presented
25 and individuals came in and spoke about that when we
96
1 got back to our home stations.
2 DOCTOR LARSON - Because that's a predictable
3 event.
4 LT. COL. PRICE - Correct. And we did have - - -
5 DOCTOR LARSON - One last question. You said
6 people were getting their medications for six months.
7 I assume there were some things that screened people
8 out. For example, did you have people with serious
9 allergies or asthma going in, because there wasn't any
10 coming out, right?
11 LT. COL. HAMILL - Right.
12 DOCTOR MURPHY - So I'm assuming they were
13 screened out.
14 LT. COL. HAMILL - They were screened out. There
15 were certain prerequisites. If you were pregnant you
16 did not deploy; if you had asthma that needed to be
17 treated with medications you did not deploy; if you had
18 - - - And asthma was a real tough one. I mean I just
19 remember because lots of people as they're standing in
20 that line that they need acute intervention to survive,
21 so they usually referred those people over for a
22 pulmonary evaluation rather than just take the word of
23 the individual unless they provided some civilian
24 health documentation, because that was really - - -
25 They could just use it once people realized that it was
97
1 a discriminator. Insulin dependent diabetics were also
2 prohibited from deploying, and then each of the
3 services had specifics, and I can try to do a specific
4 - - - Other than that, almost everybody was mobilized,
5 and then those people with those conditions were just
6 referred away from deployment.
7 The second and third trimester women were not
8 retained, they were returned, and first trimester women
9 were mobilized but did not deploy.
10 DOCTOR CUSTIS - I would imagine that the post-
11 deployment physical examination didn't occur very
12 often. Is that - - -
13 LT. COL. HAMILL - Looking backwards, sir, it
14 didn't happen in the Navy hardly at all; it did not
15 happen in the Air Force, since it was a requirement,
16 unless the individual asked for it. Statistically in
17 the Army most of the people say that the majority did
18 experience one.
19 Now, we did have some problems because of time
20 constraints. We were getting pressure from Congress
21 within 72 hours of people returning to the base, that
22 they wanted them off active duty and back to their
23 homes. And when you start bringing in huge shiploads
24 of folks into various installations trying to process
25 people that quickly became problematic.
98
1 The Army issued formal guidance that the majority
2 of the physical is to be done in theatre once the
3 ground war had ceased. There was a time lag there, so
4 a number of those procedures were initiated in the
5 theatre and then completed when they returned to the
6 States.
7 There's onesies and twosies where people fell
8 through the cracks, and it's consistent that the Army
9 is pretty comfortable that the majority of their assets
10 were physicalled before separation.
11 DOCTOR CUSTIS - Don't you think that this is a
12 subject for DOD to take to Congress themselves and
13 require it of all Services?
14 LT. COL. HAMILL - Yes, sir. DOD has established
15 a - - - Well, the policy for Desert Storm was a
16 requirement that all Veterans be physicalled, and it's
17 written - - - And I can get you a copy of that if you
18 want to see. There is a requirement the DOD put out -
19 - - And I forget, I've got it in here. It may have
20 been April of '91 that mandated that all Reservists on
21 active duty upon mobilization for Desert Storm would
22 undergo a separation exam.
23 DOCTOR CUSTIS - Reservists only?
24 LT. COL. HAMILL - Reservists only except for the
25 Army. The Army is the only that expanded it. Now,
99
1 there's already service policies within the Department
2 that say the individual has the option of requesting a
3 physical prior to separation from active duty. So as
4 long as the member - - - Now, the Department has also
5 developed a standardized separation physical exam for -
6 - - Not a physical exam, Report of Medical Assessment
7 form, which is a screening form that all members will
8 go through on their way out the door, and very similar
9 to the pre-deployment screening. There's a series of
10 questions. It's a two-sided form that has to be
11 reviewed by the provider. Anything that causes the
12 provider to question how sick the individual will cause
13 retention and referral into evaluation system.
14 A number of people that did undergo screening
15 didn't acknowledge health problems because literally
16 they wanted to go home, and I think the educational
17 process is probably going to be more important that you
18 need to stay and extra day to make sure that you've
19 properly documented rather than just get home and then
20 try to come backwards and correct it, because that's
21 the hardest problem. People did not want to stay, but
22 I think they can address very more acutely than - - -
23 Everything we are hearing was that nobody wanted to
24 stay that extra day to go through a physical exam no
25 matter how quick it was going to go, and the Navy in
100
1 particular had a lot of pressure just to let their
2 people out the door.
3 LT. COL. PRICE - I'd like to comment on just one
4 thing you said. I think that there were a lot of
5 emotions come into play when we were returning home,
6 and I think that perhaps it wasn't always that we
7 didn't want a physical exam, but I think we had pause
8 to think about it later perhaps. Some of these
9 symptoms just didn't come to mind when we were trying
10 to get home.
11 MS. KNOX - Can either one of you speak to the
12 problems that maybe you saw during the time of the war
13 that were really related to pre-existing conditions?
14 LT. COL. PRICE - I can. In the first four to six
15 weeks that we were there, when it was primarily the air
16 war, we saw predominantly our own troops in the King
17 Coli Military City Hospital, and there were a lot of
18 service members with, I would say - Call them diseases
19 of lifestyle, that perhaps getting into the theatre of
20 operations and having incredible stresses that they
21 hadn't been presented with before, their physical
22 symptoms did manifest themselves. We had a fair degree
23 of service members with chest pain and angina, high
24 blood pressure. We did screen someone, I remember
25 specifically, that did have diabetes that probably
101
1 shouldn't have been there, probably fell through the
2 cracks, and maybe didn't disclose it on the self form.
3 But we did have a fair number of diseases of lifestyle
4 that did show up and manifest themselves in the
5 theatre.
6 MS. KNOX - Now, members who were diabetics who
7 were on hypoglycemic agents, they were allowed to
8 deploy, were they not?
9 LT. COL. PRICE - Correct.
10 MS. KNOX - Any further questions? Doctor
11 Cassells?
12 DOCTOR CASSELLS - Two others. I understand the
13 individuals' desire to get home quickly, and you said
14 that there was pressure particularly in the Navy to
15 demobilize their Reserves.
16 LT. COL. HAMILL - Well, there was Congressional
17 pressure.
18 DOCTOR CASSELLS - To demobilize as quickly as
19 possible?
20 LT. COL. HAMILL - Yes, sir.
21 DOCTOR CASSELLS - Is there any relationship to
22 that pressure to demobilize in the 120 service
23 requirement?
24 LT. COL. HAMILL - No, sir. There wasn't at the
25 time. The biggest push was Congress wanted their
102
1 constituents back home, and that anything that would
2 slow their process down was viewed as delaying - - -
3 getting the troops home, and we had to get the troops
4 home. And I think if you go back and read all the
5 literature that the group from Pennsylvania - - - The
6 bunker that blew up, they made them - - - Even though,
7 if you'll check, the military said they weren't ready
8 to go home because they did not accomplish some of the
9 decompression they wanted to do with the troops, they
10 were forced to release the people home and then had to
11 try to reconstruct and get support structures
12 established. So there was an awful lot of pressure at
13 the time. I think that once we realized what was
14 happening Stateside they started doing most of the
15 physicals in theatre and that helped a great deal. The
16 biggest problem with that was linking the field
17 physical exam to the Stateside health records so that
18 there was good documentation. It becomes problematic
19 then, because marrying out those two separate sets of
20 files did cause some problems in the area when they
21 went back to validate how many physical exams were
22 done.
23 The Army did send out letters to a large number
24 of its population, predominantly individual Ready
25 Reservists, questioning whether they had completed
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1 their separation physical exam. About 700 replied that
2 they had not received one, and those individuals were
3 given the opportunity to come back in for a physical
4 exam, so I don't think it was linked to the time frame
5 at all. I mean I think that time frame was established
6 in order to give a credit to the members because the
7 war lasted that length of time.
8 Most of the Reserves stayed later than that. I
9 mean I'm just looking at numbers trying to figure out
10 if you ask a numbers question, but Doctor Murphy had
11 most of them, but if you looked at that the Reservists
12 did not start re-deploying until the March-April time
13 frame anyhow and most had gone over there by December,
14 so 120 days was pretty well covered with the pre-mob
15 processing and those kind of things.
16 DOCTOR CUSTIS - Finally, I would like to know if
17 there's any difference - - - You said you handled the
18 Guard and the Reserve units exactly the same way as far
19 as deployment was concerned. What is the difference in
20 mobilization procedures for the Reserve versus the
21 Guard?
22 LT. COL. HAMILL - Well, I can talked to the Army,
23 and I think the areas are very close, but I since I can
24 personally address the Army we'll do it from that
25 standpoint. Upon mobilization, the difference between
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1 the Guard and the Reserve were the Reserve were already
2 federalized. They're federal troops. The Guard are
3 state troops, and we have to go through the state
4 governor for permission - it's an automatic grant if
5 they're required to be federalized. But until they
6 arrive at their mob site - - - In other words, until
7 they arrive at the first station. So, in other words,
8 the time between home station and mob site they're
9 still state activities.
10 The minute they walk onto that federal
11 installation at the mob they become federalized and
12 there is no difference. So the biggest difference
13 would be notification procedures as far as the chain it
14 goes through and who cuts the orders and how they move
15 to home stations.
16 By virtue of there being a federal order of
17 active duty, even the home station criteria for what
18 they do at each home station is exactly the same. And
19 then when you get to the active duty installation in
20 the Army the policies are the same whether it be Guard,
21 Reserve or Active, and it didn't make any difference.
22 In the Army that was what the published policies were
23 at the time.
24 Now, I can tell you that sometimes that
25 installation varies slightly, but that was an
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1 individual installation Commander's area more so than
2 any official position of the various services. And I'm
3 pretty sure in talking to the Air Force that that
4 applies as well, once they get federalized it's
5 consistent and they go to their mobility point and the
6 mobility processing is exactly the same, whether they
7 be Guard or Reserve or Active.
8 DOCTOR LARSON - Doctor Hamill, you touched on
9 something that may explain some differences in
10 testimony that we've had in the past, and that is about
11 documentation. Some people have testified that their
12 immunizations, for example, were never recorded on
13 their permanent record, and others have copies of where
14 they were recorded. Do you think that was sort of site
15 specific or can you give us any sense of what
16 proportion of the documentation that was actually done
17 so that it's on permanent record?
18 LT. COL. HAMILL - The official policy is when you
19 report to the mob site as a Reservist you take your
20 official file as well as your medical file. But
21 because of the problems, they can't go in the same car,
22 and they have to be in a separate vehicle, you can't
23 hand carry them. So when people showed up at sites as
24 we were mobilizing people to different mob stations,
25 you could have the records going to installation "A"
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1 and the bodies going to installation "B."
2 And then those records were stored, and if you
3 couldn't get the record you didn't not process the
4 individual. What you did is you initiated a temporary
5 record and you documented what went on with the
6 individual, and then that went into record storage. So
7 I think in looking back - and again this is my
8 experiences when I was on a non-official duty position
9 - But in hearing the phone calls and it is linking of
10 the two files got very problematic because in many
11 instances because of the desire to reprocess people
12 home more quickly, we didn't even bring people back
13 home through the same station that they deployed out
14 of.
15 Now, we aggressively tried to do that, but if it
16 meant we could get somebody home two weeks earlier, we
17 would change the station and try to move the files to
18 where they actually could get rehooked up with their
19 unit and move home. Individuals in particular - - -
20 And there were a lot of individuals or cells of
21 individuals that when - - - It got much more difficult
22 because the ownership of those files became very
23 confused. And the theatre, you didn't take health
24 records to the theatre with you, so anything that was
25 done in the theatre had to come back and be married up
107
1 with the file, and I think in the effort I think it was
2 very difficult to keep those as tight as it should have
3 been to make sure that we completely married up all the
4 files. And I don't think anybody could give you a
5 percentage rate. I know that the policy in all the
6 services was to fully document what was done. I mean
7 in every one - - - If you read any of the service
8 messages, you know, record all immunizations on this
9 form, but some people had their individual shot record,
10 other people had their health record, both of which are
11 considered shot records to the military, so it just
12 depended which installation you were at, which forms
13 they might have used. If you didn't have the shot
14 record they would start a little yellow form - and we
15 were joking - most of the people were over-immunized on
16 departure because they couldn't provide that sheet of
17 paper to prove that they had be immunized previously.
18 DOCTOR LARSON - That's very helpful. That
19 explains some of the diversions that we've heard and it
20 makes it difficult to follow some potential exposures,
21 for example, when the documentation may be - - - One
22 last question. The 700 people who reported that they
23 did not receive a physical at the end of their time,
24 what was the time lag between their offer to get a
25 physical?
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1 LT. COL. HAMILL - I'll have to look it up for
2 you, but it was a formal letter that went out after - -
3 -
4 DOCTOR LARSON - Was it a month or a year or four
5 years?
6 LT. COL. HAMILL - No, it was short term. I mean
7 within 6 months.
8 DOCTOR LARSON - Fine.
9 MS. KNOX - You mentioned in your paper, for Naval
10 and Marine Corps Reservists being returned to drill
11 status, the medical record was reviewed, the Reservist
12 was asked if there were any changes in their health,
13 and if there were not they were asked to sign a
14 statement to that effect. If they had changes later
15 were those addressed, or because they had signed a
16 statement they were not?
17 LT. COL. HAMILL - In the Navy once you sign a
18 statement and depart, it's considered that when you
19 departed you were fit. Now, if you can show a direct
20 linkage of the problems you're experiencing to your
21 military service, the Navy for its service issues
22 something called a Notice of Eligibility, and what that
23 is is an authorization to receive health care, health
24 care and pay, pay only. It varies on the individual
25 situation, but if the individual says that - - - You
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1 know, if they have a condition that they thought was
2 related to service but they can't prove it to the
3 person that issues that Notice of Eligibility, they
4 would have a great deal of difficulty, and the Sea Bees
5 were that group that were trying to document, and the
6 Navy has cleaned up its procedures and policies
7 significantly since Desert Storm, and that isn't as
8 much of a problem now as it was right after Desert
9 Storm. But it would have been hard for those troops to
10 say it was service-connected, unless they could
11 directly link it.
12 MS. KNOX - What about the physical exam that's
13 required for Guard and Reservists every five years.
14 Can either one of you address the diagnostics that are
15 done in that physical exam? Is there a routine CBC or
16 Chem 7? What are those that are performed?
17 LT. COL. PRICE - There's not a routine CBC or
18 Chem 7. They do cholesterol and blood glucose
19 screenings as well as a urine dip, and the rest of the
20 screening process is similar to the - - - Well, it's
21 the dental screening, the official screening, hearing,
22 blood pressure, vital signs, a health history, height
23 and weight, and basically that's the extent of the
24 screening. And then the actual physical exam does take
25 place, and for over 40 then it's a more extensive exam,
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1 an EKG, inter-ocular pressure. They do a
2 cardiovascular risk, forum screening to give them a
3 cardiovascular risk. And then if they fail that
4 screening then that requires a more extensive test
5 that's usually done by the civilian physician. And
6 then take it back through medical review, evaluation
7 review.
8 MS. KNOX - So do you think it's fair to say that
9 if on the exit physical, on the chest x-ray if they
10 found or made a diagnosis, the burden of proof lies on
11 the Veteran's shoulder to show that that was not
12 present prior to deployment?
13 LT. COL. HAMILL - They don't do routine chest x-
14 rays on physical exam anymore. So it would be only
15 based on symptomatology during the physical exam
16 portion. They used to do routine chest x-rays as part
17 of your routine exam, but they're not doing that
18 anymore. The way it's going right is the burden of
19 proof would be on the individual to show that because
20 of the short-term length of the call to active duty
21 that that did not exist prior to service. The prior to
22 service issue gets to be real difficult because most of
23 the conditions probably were lifestyle issues that they
24 weren't aware of, so it's really hard to define when
25 the onset or if the condition had been aggravated. In
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1 trying to clearly document the interfaces, it's really
2 tough to do.
3 MS. KNOX - I don't have any further questions.
4 Does anyone else?
5 DOCTOR LARSON - I just want to be real clear on
6 this, about the documentation. It's totally
7 understandable that during conflicts you've records
8 going every which way and you're not carrying your
9 little record around with you. That's crazy, but what
10 were the efforts made by the services to link up those
11 records after the war was over?
12 LT. COL. HAMILL - My understanding is - and I
13 didn't experience this first hand, because I wasn't at
14 an installation. But my understanding in all the
15 services when I asked these questions this week was
16 that the records went into a storage facility and they
17 went into - - - You know, they identified what the
18 service center was and then they tried to identify the
19 primary source, and when people move to different
20 installations they know that if the individual came
21 into - - - Went out of Fort Bragg but came back through
22 Fort Jackson, Fort Jackson would contact Fort Bragg to
23 forward the records so they could be merged, documented
24 and forwarded out. So they do try to do it. I think
25 the biggest problem might be scope, and if you had a
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1 box of 200 records that got buried someplace with 5,000
2 other boxes, I think at some point they probably will
3 be married up.
4 Unfortunately, I think where they'll be married
5 up is the National Record Center in St. Louis, which
6 they're working on it, but that's going to take awhile,
7 and eventually they will be married up. I mean history
8 shows that somehow they all end up in the same folder,
9 but there are boxes - - - There are warehouses full of
10 boxes at that location, so if a member leaves, if they
11 can't figure out where they get forwarded there because
12 that's where all post-military records go.
13 MS. KNOX - So once again, for any illness that a
14 veteran or soldier saw while they were in country or in
15 theatre, if they had an illness that they received care
16 for they may not have record of that and the burden of
17 proof lies on their shoulder.
18 LT. COL. HAMILL - Well, each of the services that
19 if they were seen in an inpatient facility or an
20 outpatient clinic where records are maintained, the
21 services have maintained those. So the member should
22 go through the service to see if they can get back if
23 they can remember the name of the facility. None of
24 those are destroyed because they're just like real
25 records. So I was trying to get to where they're
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1 stored to link it, because those are like inpatient
2 records and outpatient. It's like inpatient records,
3 and people have linked them. I mean I know of
4 situations where people were seen for a specific
5 condition and knew the approximate time frame, and they
6 were able to get to the facility that saw them in the
7 theatre, and were able to pull the box that it was in
8 and come up with the 600 document or whatever.
9 MS. KNOX - Just one question about the
10 vaccinations that Elaine made, do you know what
11 vaccinations the soldiers who are deployed to Saudi
12 Arabia now are receiving?
13 LT. COL. HAMILL - I don't.
14 MS. KNOX - Any other questions? Thank you so
15 much. We're going to take an hour and a half for
16 lunch, and we'll come back to hear public testimony
17 from the Veterans at two o'clock. At two o'clock we
18 will reconvene.
19 WHEREUPON - A lunch recess was taken.
20 MS. KNOX - I would like to go ahead and
21 reconvene, if we could. It's two o'clock. I want to
22 thank everyone for coming today.
23 We've had some very interesting panelists this
24 morning, and they given some insight into some of the
25 clinical issues regarding Veterans' care and also DOD
114
1 care.
2 We're going to have the public testimony this
3 afternoon. I want to thank each one of you for coming.
4 I know that some of you have traveled far distances,
5 and we are most interested in hearing what you have to
6 tell us.
7 Before we start, I need to set some ground rules.
8 We have several speakers today, and we want to give
9 everyone the opportunity to share their story. So we
10 will give each speaker ten minutes. If you have not
11 completed your talk at five minutes, realize that you
12 are moving in onto your time for questions. So if you
13 choose to spend your ten minutes talking, the panel
14 will not have time to ask you questions, so each person
15 will be afforded ten minutes.
16 There are some people who are on the agenda that
17 have not arrived yet. Those people, if they come in
18 late, we will try and add them at the end. We're going
19 to go ahead and start with Robbin Adams.
20 ROBBIN ADAMS
____________
21 My name is Robbin Adams, and I'm the spouse of a
22 Persian Gulf Veteran who served ten months in various
23 locations in the Gulf. He moved locations every two
24 weeks for the first six months, according to what he
25 told me upon his return to the United States.
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1 First, let me state that my husband served his
2 country for twenty years with over half of that time in
3 the chemical, nuclear a biological warfare.
4 When my husband went to the Gulf I expected some
5 medical problems upon return, but figured we could
6 still have a good life. I didn't expect my husband to
7 return home and eventually be unable to function on his
8 own, where he could share the enjoyment of sons getting
9 married or becoming fathers.
10 When my husband first started getting notably ill
11 to the point where he was unable to maintain
12 employment, I tried to take my husband to the nearest
13 military installation, which was Pope Air Force Base or
14 Fort Bragg.
15 I was informed that it would take three or four
16 months for my husband to see a doctor since he was
17 retired military and not active duty. I was also
18 informed that at that time he was not eligible for any
19 type of Persian Gulf registry, that the registry was
20 being done strictly on active duty members.
21 At this time I contacted the Salisbury Veterans
22 Medical Center, and I finally got my husband in for
23 treatment. His illness was not taken serious at the
24 beginning. After several calls and conversations with
25 various Salisbury Medical Center personnel, the
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1 attitude changed.
2 My husband is currently receiving medical care
3 from the Salisbury Veterans Medical Center and is under
4 the care of Doctor David Catsin, Chief of Medical
5 Service.
6 My husband has been receiving excellent care
7 since May of '94 through Salisbury Medical Center.
8 Doctor Catsin has been treating each symptom as it
9 arises, even though some of the tests do not show my
10 husband has a memory loss and memory confusion. Doctor
11 Catsin has spent time with him and has observed the
12 problems and made a note of it.
13 All I need to do is call Doctor Catsin's office
14 when there's a problem and I'm not sure how to handle
15 it, and he's readily available to help. I truly
16 appreciate Doctor Catsin's help and his medical
17 expertise in caring for my husband.
18 The Salisbury Medical Center also has a Persian
19 Gulf support program, and it's handled by Doctor
20 Blanche Williams and Doctor Mary Frew. These two
21 doctors have been very instrumental in helping the
22 Medical Center approve the care for Persian Gulf
23 Veterans.
24 During our various support meetings, problems
25 have been discussed concerning medical appointments,
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1 care received, registry exams, etcetera, and these
2 doctors have taken the problems to management to
3 improve it. They have assisted Veterans when problems
4 have risen, getting them appointments with different
5 medical specialists. They have assisted in getting
6 their medical records current and complete when they've
7 gone to visit other VA medical facilities.
8 Both Doctor Williams and Doctor Frew have been
9 very vital in helping Veterans and their families
10 handle the multitude of symptoms. I feel that the VA
11 could help Persian Gulf Veterans more if the Department
12 of Defense would tell what the soldiers were exposed to
13 while serving in the Gulf.
14 The Salisbury Medical Center has a good medical
15 exam program in place for the registry and have
16 appointed someone to assist Veterans when there are
17 problems with the tests. I have gone through the DOD
18 Persian Gulf Registry as a dependent, and I consider
19 that registry a complete joke and insult to the
20 Veterans, the military members and their families. The
21 doctors do not take any serious, nor do they appear to
22 believe the person.
23 The physical reminds me of an assembly line for
24 entrance into the military. There are several parts to
25 the exam. I received the physical part of the test,
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1 which is truly a joke, touch your toes, walk heel to
2 heel across the room, and then it had blood work, I
3 never received results, and then four months later I
4 took the psychological exam and still have not heard
5 anything.
6 It's been five months since the psychological
7 exam, and I'm having symptoms that my husband is
8 having, but I still have not heard anything even though
9 it was noted on the exam.
10 What concerns me is that as a seasoned military
11 wife I am used to dealing with the Department of
12 Defense and all the games that they are playing. What
13 about the families that are not used to dealing with
14 the government, what do they do? Do the spouses
15 believe that the illness is in the Veteran's mind, like
16 the military wants you to believe? What about the
17 young Veterans, will they live to enjoy life at all?
18 I hold the Department of Defense responsible for
19 taking care of the Veterans, military members and their
20 families, and Reservists. Every war has casualties,
21 but it should not be at the hand of our own government.
22 The government should not turn their backs on the
23 veterans. The veterans served their country when
24 called upon. Now they are calling up their country to
25 assist them in their medical care and find a cure for
119
1 their medical problems.
2 I do not want to watch my husband slowly die
3 because our own government is not willing to stand up
4 and tell what truly happened in the Persian Gulf, and I
5 am watching that daily. I know that a lot of stuff
6 becomes classified just to save the government from
7 further monetary claims or embarrassment, but it's the
8 responsibility of this country to support the Veterans
9 who served their country and placed their lives in
10 danger.
11 I implore this Committee to find a cure to stop
12 all these medical problems from getting worse and
13 possibly to save lives. Thank you for allowing me to
14 speak.
15 MS. KNOX - Thank you very much. Are there any
16 questions from the Committee Panel?
17 DOCTOR CASSELLS - Mrs. Adams, during your
18 statement you said that when your husband went to the
19 Gulf you expected some medical problems upon his
20 return. What did you mean by that?
21 MS. ADAMS - Anytime you go into a war area you're
22 always exposed to odd things, maybe the country you're
23 living in is not what you're adjusted to at home. Viet
24 Nam, for instance, was totally different, country and
25 living conditions. You expect them to pick up some
120
1 type of illness when they're in a foreign country. In
2 traveling the military we're accustomed to my husband
3 coming home from different areas with a flu or stomach
4 virus or something like that. You get that wherever
5 you go. We didn't expect it to be major.
6 DOCTOR LARSON - Thank you, Mrs. Adams. Is your
7 husband still in active duty?
8 MS. ADAMS - No, ma'am, he retired two months
9 after returning from the Persian Gulf.
10 DOCTOR LARSON - And that's why you were able to
11 get to the VA?
12 MS. ADAMS - Yes, ma'am.
13 DOCTOR LARSON - Otherwise that would have been
14 available to him.
15 MS. ADAMS - Probably not.
16 DOCTOR LARSON - And you're saying you are
17 suffering from the same symptoms? Do you feel that he
18 has something contagious?
19 MS. ADAMS - Sometimes I do, I'm not positive. My
20 doctor can't connect it, but I do feel some of it is -
21 joint pains and swelling of the muscles. I've
22 recently been diagnosed with a liver dysfunction and
23 they cannot find out why, and they're still running
24 tests for that. So I'm not positive. I have three
25 grandchildren, my husband is not allowed to hold, hug
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1 or kiss because we are not sure it is not contagious,
2 and their doctors have advised that they not be held by
3 him until we know.
4 MS. KNOX - Is it your impression that as a
5 retired military serviceman that you can get treatment
6 at either the DOD facility or the VA medical centers?
7 MS. ADAMS - Yes, ma'am.
8 MS. KNOX - But you're stating that you did not
9 feel that you got satisfactory care from a DOD
10 facility. Is that correct?
11 MS. ADAMS - That's correct. When I tried to take
12 my husband over there they told us because he was
13 retired they didn't have appointments available. Pope
14 Air Force Base did not know anything about a registry.
15 Fort Bragg told me it would take three to six months or
16 more to even get him there to see a doctor, let alone
17 the registry.
18 MS. KNOX - Thank you so much. We appreciate your
19 testifying. The next speaker is Mike Ange. Has he
20 checked in yet? No? Let's go on to Mrs. Joy Chavez.
21 JOY CHAVEZ
__________
22 Hello. My name is Joy Chavez. My husband was
23 with the 354 Tactical Fighter Wing at King Phite
24 International Airport in Saudi.
25 John returned home with many symptoms. He went
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1 to Myrtle Beach Air Force Base and was told it was just
2 a cold. Well, the cold only became worse.
3 He continues to have the memory loss, the swollen
4 lymph nodes and fatigue, rashes, severe headaches and
5 joint pain.
6 April the 28th, 1994 John saw a neurologist at
7 the VA in Columbia, South Carolina. The doctors stated
8 that the majority of these men need to seek psychiatric
9 help. Then he stated that my husband was depressed due
10 to the war. We did not agree with him. He then stated
11 that the oil fires was my husband's problem, and then
12 my husband answered back to the doctor stating that it
13 was series of vaccines, nerve agent pep pills and the
14 scud attacks near his unit.
15 The doctor then sent us to the lab. My husband
16 fainted after the nurse had withdrawn five tubes of
17 blood. One tube with a purple top busted, and blood
18 went all over the table. They then placed another top
19 on it and sent it out, even though it had been exposed
20 to the air for sometime. The nurse wanted more blood.
21 I said no.
22 As we were leaving the VA a male nurse said that
23 they see seven Gulf War Vets a day, and that all want
24 compensation and don't forget to pick up your coffee
25 money, travel pay. We said no thank you. We just want
123
1 medical help.
2 July 1st, 1994 a letter was sent to us from the
3 VA. It stated the results of our examination and
4 laboratory tests indicate that you have headache and
5 sinus congestion. After we received this letter, I
6 called the environmental physician that had diagnosed
7 John with this. He stated to me that he had just taken
8 the neurologist's diagnosis and that he does not see
9 the patients himself. We did not know what to do after
10 this. We started to seek help from a private doctor
11 because we had not gotten help from the VA for my
12 husband. Three private doctors have diagnosed John
13 with Gulf War Syndrome, and yet the VA still does not
14 recognize this.
15 November the 8th of '94 my husband became worse.
16 Our doctor was out of town, and we had nowhere to turn.
17 So we went to the VA in Salisbury, North Carolina for
18 help. There John saw an internist and she called a
19 surgeon in. He said that he would not touch John. He
20 stated that there are lumps pressing into the carotid
21 artery and to hope that it did not spread to the
22 kidneys or any other major organ. He said it was also
23 neuralgia arteritis. He prescribed Motrin. The pain
24 was so bad at times that for the next two months my
25 husband had to sleep in a recliner chair to elevate his
124
1 head and to ease the pain. Our private doctors don't
2 know what to do for us, so who do we turn to? The VA
3 is simply not there for Veterans.
4 In June 1995 John received a medical discharge
5 from the military with no benefits, and was told to
6 follow up with the VA for the benefits. September 1995
7 we received his denial from the VA. This is very
8 unethical of the VA. We can understand problems with
9 funding; however, this is not a problem with funding.
10 I've talked to many, many Veterans every day. There
11 are many cancers, tumors, connective tissue problems,
12 Sarcoidosis, lymphomas, heart problems, neuralgia,
13 neurological problem, respiratory, burning semen during
14 intercourse. And there's many other problems going on,
15 families of Veterans are now sick, and many more - - -
16 There's suicides, divorces, and for God's sake our
17 children are born deformed and sick.
18 So many Veterans had died. How many more must
19 die? This is a problem of the VA turning their backs
20 to us. I am so sick. I had an MRI with a possible
21 angiomas was on the blood vein in my face. My
22 neurologist stated to me that I had to have been
23 exposed to a toxin or a chemical. They do not know if
24 the possible angiomas are benign or not. The only way
25 I could have been exposed to any chemical or toxin was
125
1 when my husband returned from the war with his uniforms
2 and whatever else he had been exposed to.
3 As of August '95 my sedimentation rate was 40 a
4 positive ANA. September '95 the Washington Post
5 reported that two attorneys had destroyed records of
6 Veterans from the Veterans Board of Appeals, from
7 August of 1990 to February of 1994. Aren't these Gulf
8 War Veterans? Why is it just during these days? And
9 the Board of the Veterans Appeals is made up more than
10 two people. So why would just two people have those
11 records in hand?
12 The report also stated that the attorneys were
13 sentenced to 15 months in prison. Yet it stated her
14 reason was due to a personality disorder. It seems to
15 strange that she would not be sentenced to a mental
16 health facility, and who examined her, the VA?
17 It also stated that 77 Veterans have died waiting
18 on their claim. What will they come up with next? I
19 hope a better one than that. It's time to stop this
20 unethical and horrible behavior from the VA, which
21 should never ever have occurred in the first place.
22 VA and DOD may never answer to the Veterans,
23 their families or to the President of great country for
24 this cover-up; however, you will have to answer to God.
25 God help you all. Thank you.
126
1 MS. KNOX - Any questions from the Committee
2 Panel? Thank you very much. Richard Minor? Pam
3 Perry?
4 PAM PERRY
5 My name is Pam Perry. You'll have to forgive me,
6 I forgot my glasses. I am a wife of a Gulf War
7 Veteran, Larry C. Perry, a retired Navy Seabee. He was
8 in Saudi Arabia for six months.
9 We met once before he went to the Gulf. We were
10 pen pals. I met him again on April 29th, 1991. After
11 dating Larry for about a month, I noticed that I was
12 feeling tired and short of breath. I had aches and
13 pains like the flu. I have always been healthy all my
14 life, so I just brushed this off as the flu.
15 I continued to date Larry, and tried to convince
16 him that I was a healthy person. At the same time I
17 did not realize that he was sick also. Later on my
18 blood pressure went crazy. I was placed on three pills
19 a day. I then ended up with bronchial asthma. As time
20 went I had difficulty thinking, concentration, memory
21 loss, chest pain, headache, swelling glands, numbness
22 in my arms and legs. My legs hurt like a toothache. I
23 had hair loss, joint pain, kidney and bladder infection
24 and yeast infection.
25 Doctor Hyman treats me New Orleans for sixteen
127
1 days. He said that my symptoms were due acute
2 streptococcus - that was a bacteria, he said - and that
3 the hypertension and cardiac arrythmia was probably
4 related to the bacterial infection.
5 September the 22nd, 1993 I had a malignant breast
6 tumor removed. I have been tested and told that I have
7 peripheral neuropathy in both legs and arms, chronic
8 fatigue, hypoglycemia. Findings on an MRI show a
9 possible aneurism. I have vasciless, I have a yeast
10 infection in my throat.
11 There was no significant - - - There was a
12 significant level of impairment on a memory function
13 test performed by Doctor Graffagnions from the Duke
14 Hospital in Durham. My PAP smear shows cancer cells.
15 It was quite a few cells.
16 My husband is having to take shots for
17 testosterone, because of his problem that started when
18 he returned from the Gulf. Every time he has an
19 illness it's not long I too have the same symptoms;
20 thyroid, EDV virus, infection, to nerve damage. How
21 does this happen? I think you should start with
22 research into semen testing. There may be an answer
23 there.
24 I have some other problems too I'd like to you if
25 you have time in private, but I'd like to also add that
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1 my husband has been sick, and I have asked the
2 Salisbury Hospital to do some tests on him that his
3 private doctor has already done, and that was the nerve
4 conduction test.
5 I've asked the Salisbury VA to do a field vision
6 blindness and also to follow up on a PTSZ2 that he was
7 told that needed to be done, and it took them a year to
8 get to Birmingham, Alabama, and we have not yet - - -
9 Doctor Catsin has not yet got the results from those
10 tests, and I'm not throwing off on Doctor Catsin.
11 Doctor Catsin is a good doctor, but he still has not
12 got the results from those tests yet.
13 According to the Social Security Board, my
14 husband is unemployable and disabled, and has been
15 since May the 13th of 1991, and he was diagnosed with
16 the fatigue, the headaches, the depression, memory
17 loss, anxiety, mental confusion. Doctor Catsin, Doctor
18 Hyman, the North Carolina Department of Human
19 Resources, Doctor Bachelor, Doctor Prince, Doctor
20 Graffagnions - from the Durham VA, they all say he's
21 unemployable because of these symptoms. I thank you
22 very much for listening to me.
23 MS. KNOX - Thank you, Mrs. Perry. Any questions?
24 DOCTOR CUSTIS - You mentioned several hospitals,
25 namely Birmingham, Salisbury, Durham. Are they all VA
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1 hospital or are some of these private hospitals?
2 MS. PERRY - The VA Hospital in Alabama is a VA
3 Hospital and the Salisbury VA, but Durham was Duke,
4 Duke Hospital.
5 DOCTOR CUSTIS - Was he at the VA Hospital in
6 Durham?
7 MS. ADAMS - Me or my husband?
8 MS. KNOX - Anymore questions? Have they given
9 you any reason as to why the results are not back from
10 the phase 2 testing, which were received in Birmingham?
11 MS. ADAMS - No, he has not.
12 MS. KNOX - But he has requested those records and
13 he just has not received them yet.
14 MS. ADAMS - Right. And that was done in March of
15 1995.
16 MS. KNOX - March of '95.
17 MS. ADAMS - (Indicating)
18 MS. KNOX - Thank you so much. We appreciate your
19 coming. The next person that we have is Bill Simmons.
20 BILL SIMMONS
____________
21 Good afternoon. My name is Bill Simmons,
22 formerly 1st Lieutenant, Columbia 251st Evacuation
23 Hospital. I arrived back in the country, of course,
24 May 6, I believe, of 1991, and I've been experiencing
25 all sorts of symptoms from, in my opinion, the Gulf
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1 War.
2 First of all, I guess I should pause for a
3 second, first getting onto God, President Clinton for
4 creating this Committee, distinguished Committee
5 members, guest spectators, my fellow Gulf War Veterans
6 and their families. It is indeed a pleasure to be able
7 to participate today. I can only hope and pray for
8 everyone who are suffering that one day we will all be
9 healed.
10 First of all, my statement is going to consist of
11 a poem, first of all, that I've written over the past
12 couple of days, and the title of the poem is "'Tis My
13 Eyes to See," and this talks about some of our accounts
14 from the Gulf War and also some of the symptoms, and
15 this is not some fairy tale so I really hope this
16 country takes the Veterans very serious. We have some
17 serious problems. "'Tis My Eyes to See."
18 'Tis my eyes to see not the America I once knew.
19 "Tis my eyes to see "Gulf War" Veterans and their
20 families suffering mysterious diseases that could
21 possibly be cured if not for the love of money.
22 "Tis my eyes to see "Gulf War" Veterans divorced
23 due to symptoms that mimic sexually transmitted
24 diseases.
25 'Tis my eyes to see "Gulf War" Veterans
131
1 developing cancer.
2 'Tis my eyes to see denial of proper medical
3 attention for "Gulf War" Veterans.
4 'Tis my eyes to see my deceased Brother-In-Law
5 tell me that he loved me before going forward
6 into Kuwait and Iraq - I wondered, what is that the did
7 not tell me?
8 'Tis my eyes to see medical professionals telling
9 me "why did you wait to me back home to the US before
10 getting sick?"
11 'Tis my eyes to see medical professionals looking
12 at me in the waiting area for medical attention and the
13 professionals grab their briefcases, shut their doors
14 and go home.
15 'Tis my eyes to me wanting medical attention for
16 "strep A" and having to another part of the state of
17 South Carolina for proper medical attention.
18 'Tis my eyes to see me urinating frequently which
19 may indicate prostate cancer. - I do have a degree in
20 biology, so I do some of my own investigations.-
21 'Tis my eyes to see my backache, rashes, joint
22 pains, and medical professional probably not knowing
23 what is wrong and they sure will offer no help.
24 'Tis my eyes to see my wife sick and almost dead
25 or died, shall I say, and no one would tell me what was
132
1 wrong with her.
2 'Tis my eyes to see the unprecedent of harassment
3 of our African American Gulf War Veterans at previous
4 employment.
5 'Tis my eyes to see an African American Gulf War
6 Veteran pregnant harassed at her employment.
7 'Tis my eyes to see African American Soldiers
8 discriminated against and denied opportunities while
9 wearing the same uniform as their colleagues.
10 'Tis my eyes to see what has happened to the
11 America I once knew.
12 'Tis my eyes to see will God spare America.
13 Other comments, first of all, I would like to say
14 at that point I have written some of the stuff of what
15 I wanted to say. Right now I'm very disappointed.
16 I've gotten over the anger at the irresponsible humans
17 that probably don't care about Veterans anyway.
18 When our unit was about to land in the States I
19 had severe ear pains. Approximately 1992 is when I
20 developed a rash in my and my hand. As time
21 progressed, it spread over my hands, fingers, legs,
22 armpits and arms. I was told this rash is eczema, but
23 I had my doubts.
24 Later over time, I developed aches, muscle pains
25 and joint pains, backaches, unexplained sweating,
133
1 infections, etcetera. I did not know exactly what was
2 wrong, but I was fine before I went to the Gulf War.
3 My wife has had and still has problems, but I
4 won't go into her history. I pray that my son will be
5 all right because I know something is not right.
6 I went to the VA and have seen doctors on several
7 occasions for help, but nothing seemed to permanently
8 help my situation. When it's cloudy I'm at my worse.
9 I will not give up until medical justice is served.
10 Respectfully, William J. Simmons, Senior.
11 And also since I do have the opportunity, and
12 since I may or may not be compensated in my first
13 impairment to Gulf War Syndrome, I really don't care
14 about compensation, I want to be cured. But now, since
15 nobody seems to really care, I wrote my own version of
16 a fictional story of a drama, based on a true story,
17 and it's called Operation Desert Shield/Storm Through
18 the Eyes of a Black Lieutenant. So if you want to find
19 some more truth - truths, I'll say - you can buy that
20 for ten dollars ($10.00) from me, or nine dollars
21 ($9.00) from the book store. I would like to thank you
22 for your time. Are there any questions?
23 MS. KNOX - Any questions from the Panel? Doctor
24 Cassells.
25 DOCTOR CASSELLS - Mr. Simmons, would you go into
134
1 a little more depth about the harassment that you are
2 experiencing at your previous employment and also the
3 harassment that your wife has been through as well?
4 MR. SIMMONS - Well, I'll put it this way. Some
5 of you may know me quite well. I trust you're all
6 humans, the way I want to be treated. So I was having
7 some problems in my unit because I believe in treating
8 all humans the same way. But after I got back from the
9 Gulf, and this is based on my opinion too, I got
10 promoted to an exempt position, and I noticed that I
11 was being harassed and mistreated. So I wondered why
12 all of this was happening.
13 So, in my opinion, I think there were some
14 individuals in there who contacted my employment, and
15 my wife was harassed and there was nothing done about
16 it, but I intend to make sure there will be something
17 done about it.
18 I'm going to sing one last song, and I think
19 that's going to be it for me today, and it's everyone's
20 favorite. It's the Battle Hymn of the Republic.
21 (REPORTER'S NOTE: MR. SIMMONS SINGS THE
22 BATTLE HYMN OF THE REPUBLIC)
23 MS. KNOX - I want to commend you. I know the
24 service that you served while you were in Desert Storm,
25 and I think you need to be thanked for that service. I
135
1 am concerned about any specific problems that you've
2 encountered at the VA system. Can you touch on that
3 before you go?
4 MR. SIMMONS - Yes. The first occasion that I
5 went to a VA hospitals, and I was going through quite
6 frequently, and he looked out of his office and I
7 stated I had an appointment, and he saw me. He knew I
8 was there because I was going there very frequently
9 with all these itches in my hands and stuff, and he
10 leaves and goes home then. He just basically don't
11 care about me. And then the next incident was another
12 VA hospital. Of course, there's only two that are
13 close by. But the doctor he told me that, why did you
14 wait to get sick once you came back to the United
15 States. I mean to me that's ludicrous. I won't stand
16 for that type behavior.
17 MS. KNOX - Were you able to receive a phase 2
18 evaluation?
19 MR. SIMMONS - Not to my knowledge, no, ma'am.
20 MS. KNOX - Any questions?
21 DOCTOR CUSTIS - Will you identify the VA
22 hospitals?
23 MR. SIMMONS - Sure. I guess it's what I have to
24 do. I have cancer too, I don't know. Augusta and
25 Columbia.
136
1 MS. KNOX - What type of cancer do you have?
2 Could you share that with us?
3 MR. SIMMONS - Well, they never said that I had
4 the cancer. I'm only assuming that I may. I haven't
5 have any type of test to say that I have cancer. When
6 you see so many people suffering from cancer who went
7 to the Gulf War, all you can think is you've basically
8 got the same problems they have.
9 MS. KNOX - Thank you very much. Our next speaker
10 is Paul Sullivan.
11 PAUL SULLIVAN
_____________
12 Good afternoon. On behalf of the members of the
13 Gulf War Veterans in Georgia, I wish to thank the
14 Presidential Advisory Committee for this opportunity to
15 discuss the issues of chemical weapons and health care.
16 We are here to present evidence regarding
17 chemical warfare agent exposures during the Gulf War.
18 This evidence was obtained by the Gulf War Veterans of
19 Georgia using the Freedom of Information Act, FOIA, and
20 the records cited here are public documents. We ask
21 the Panel to independently obtain these documents and
22 review the information cited here.
23 Our testimony begins with the strong belief that
24 chemical and biological warfare agent exposure is an
25 essential component toward understanding illnesses
137
1 affecting as many 75,000 previously healthy Veterans of
2 the Gulf War who now claim they are ill.
3 We are here to discuss the "C-word" - chemical
4 warfare agents. Just as Mark Furman said he never
5 spoke the "N-word," our government has issued several
6 statements saying it knows nothing about the "C-word" -
7 chemical agents.
8 Let's start at the beginning. On May 25, 1994,
9 William Perry, the Secretary of Defense, and General
10 John Shalikashvili, the Chairman of the Joint Chiefs of
11 Staff, wrote an official statement to soldiers that
12 claimed that, there is no information, classified or
13 unclassified, that indicates chemical or biological
14 weapons were used in the Persian Gulf.
15 Let's carefully review Perry's statement. Let's
16 unpack some of the words. He used the phrase
17 indicates. This is very low standard of evidence. In
18 essence, these two top military leaders stated for the
19 record that there was no "C-word" - no chemicals. The
20 official statement also states that there is no
21 classified or unclassified evidence regarding chemical
22 weapons usage. This quote says there are no hidden
23 reports, and that the government has reviewed all the
24 documents in its possession and found use of the "C-
25 word" - chemical weapons. I'm referring, of course, to
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1 the Ladenberger report that said that there was no
2 chemicals found, none present whatsoever.
3 Ladies and gentlemen of the Panel, we are here to
4 tell you that these two men have lied; either that or
5 they are so incompetent that they were unaware of the
6 thousand of pages of government documents describing
7 chemical warfare agent usage during the Gulf War and
8 the liberation of Kuwait in 1991.
9 The lies and incompetence are now costing lives,
10 American lives, Veteran lives. The evidence of record
11 show that government documents are replete with the use
12 of the "C-word."
13 The most convincing evidence of this comes from a
14 memo written by Major General Ronald Blanck, MD, the
15 Commander of Walter Reed Army Medical Center. On
16 January 18, 1994, Doctor Blanck wrote: Conclusions:
17 Clearly, chemical warfare agents were detected and
18 confirmed - - This is a two-star Army general writing
19 this in 1994. He added, Therefore, the presumption of
20 their presence must be made. It cannot be ruled that
21 the chemical warfare agents could have contributed to
22 the illnesses in susceptible individuals. This is the
23 number 1 doctor at Walter Reed Army Medical Center.
24 He's also been a de facto Army point person on this
25 issue.
139
1 Thus, the Army is on record as saying chemicals
2 were present and those chemicals may have injured
3 Veterans of the Gulf War. The Blanck memo is a rather
4 high level of evidence that, at a minimum, indicates
5 chemicals were present, detected, and confirmed on the
6 battlefield.
7 And there is additional evidence. In March 1991,
8 the United States Army Private First Class David Fisher
9 was diagnosed with chemical warfare agent exposure by
10 US Arm Colonel Michael Dunn, MD. Colonel Dunn wrote, I
11 conclude the PFC Fisher's skin injury was caused by
12 exposure to liquid mustard chemical warfare agent.
13 This document is convincing and is strong evidence that
14 goes well beyond a mere indication that a Veteran was
15 injured by chemical warfare agents.
16 Doctor Stephen Joseph, who spoke on behalf of the
17 Department of the Defense at the first meeting of the
18 Presidential Advisory Committee last month, stated that
19 a later review of the facts show that PFC Fisher was
20 not injured by chemical weapons.
21 However - and please pay close attention - the
22 Department of Defense never released a medical doctor's
23 report contradicting Doctor Dunn's medical diagnosis.
24 Here is something Doctor Joseph did not tell the Panel.
25 Doctor Dunn, the former Commander of the United States
140
1 Army Medical Research Institute for Chemical Defense,
2 has not retracted his diagnosis of PFC Fisher.
3 What we have is these medical professions saying
4 that chemicals are present, and another medical
5 professional, an MD both of them - saying that somebody
6 was injured somewhere. This is in direct contradiction
7 to what Secretary Perry and General Shalikashvili said
8 in their statement.
9 According to the Hartford Courant newspaper, PFC
10 Fisher maintains that wooden crates marked with skulls
11 and crossbones were present in the Iraqi bunker located
12 inside of Kuwait where he was injured.
13 Unfortunately, this is only the tip of the
14 iceberg. Here is why General Blanck's memo and Colonel
15 Dunn's diagnosis are relevant. The Department of
16 Defense and the Department of Veterans Affairs refuse
17 to evaluate, test, or treat Veterans of the Gulf War
18 for chemical or biological warfare agent exposure.
19 Let me elaborate on that. Today, Doctor Fran
20 Murphy stated that the VA is only taking information
21 about chemical exposures. That's a significant
22 difference than actually evaluating, testing and
23 possibly treating someone for chemical warfare agent
24 exposure and injury. There's a very huge gulf between
25 what they're saying and what they're doing.
141
1 The VA will not consider chemical exposure as a
2 possible cause for a Veteran's illness, both during
3 medical exams and during the claims process. Veterans
4 have been refused treatment for chemical injury. As
5 evidence of this refusal of the VA to accept a chemical
6 diagnosis, Private First Class Fisher, the Arms soldier
7 injury by mustard gas and diagnosed by Doctor Dunn, VA
8 Regions Office. This was last year. PFC Fisher told
9 the Gulf War Veterans of Georgia that he was turned
10 away by VA employees who told him that, since the DOD
11 said chemical warfare agents were not used, he could
12 not have been injured by them, that he was not even
13 allowed to file a claim. They wouldn't let him do
14 that.
15 On the one hand, we have - - -
16 MS. KNOX - Mr. Sullivan, you're eight minutes
17 into your talk. I have decided if you want to use the
18 next two minutes to finish reading it, we'll have your
19 written testimony, or if you want to allow the Panel to
20 ask you questions.
21 MR. SULLIVAN - I have a couple of wrap-ups and,
22 if I may since some people were absent, if I could have
23 a few additional minutes, I'd appreciate it.
24 MS. KNOX - Okay.
25 MR. SULLIVAN - I want to tie this in on why the
142
1 chemicals are relevant to the treatment.
2 MS. KNOX - Okay.
3 MR. SULLIVAN - As I said we have the Department
4 of Defense issuing an official statement saying there's
5 no "C-word." And on the other hand the DOD's own
6 internal documents verify the presence of chemicals as
7 well as chemical injury.
8 This issue of chemical exposure gains an
9 importance because - - - And becomes more sinister in
10 light of the evidence showing that the Department of
11 Defense has suppressed and destroyed chemical incident
12 reports. As described earlier, Secretary Perry said
13 there was no classified or unclassified documentation
14 indicating chemical warfare agent usage. The Gulf War
15 Veterans of Georgia have documents showing the DOD is
16 covering up chemical incident reports by refusing to
17 release operations logs kept during the war.
18 I'm going to read a quote from a two-star
19 General. He granted our FOIA request for chemical
20 logs, and then he refused to grant all of the logs for
21 the whole war saying that they were still classified.
22 He gave us 11 pages covering five days of 47 or 48 day
23 war. In addition to classified records, there is
24 evidence that NBC logs, or nuclear, biological or
25 chemical logs, have been destroyed.
143
1 On March 13, 1995 Mr. Anthony Stepleton, an aid
2 to Army General Denis Reimer, who is now the Army Chief
3 of Staff, wrote the Gulf War Veterans of Georgia and
4 stated that, many routine duty logs - some may have
5 included NBC entries - were destroyed as a matter of
6 routine prior to re-deployment.
7 In addition, the Force Com memo stated further
8 that the US Army's First Calvary Division's nuclear,
9 biological and chemical logs were destroyed.
10 I'll wrap up here real quickly by saying,
11 remember the 1984 novel by George Orville, where the
12 guy sat there in the room and all he did was change the
13 newspaper entries to conform with what the government
14 wanted said.
15 Well, what we have here is a systematic approach
16 by the government to refuse to release documents and in
17 some cases to destroy documents, which it makes it very
18 difficult for physicians at the DOD and the VA to
19 understand what the Veterans may or may not have been
20 exposed to.
21 Let me conclude by saying that we would like the
22 Presidential Panel to consider some of our demands, as
23 Veterans. The first is that the Department of Defense
24 and the Department of Veterans Affairs must now begin
25 considering chemical and biological warfare agent
144
1 exposure and injury as a possible cause for illness.
2 Not merely to report it but to evaluate and treat for
3 it.
4 Second, the Department of Defense must come clean
5 and release the records and protect the records as soon
6 as possible, so that we can know what's going on, both
7 for the health of the Veterans and for posterity.
8 Let me quickly say one thing. You've probably
9 all seen Dear Abby, one of all of our favorite people.
10 She wrote Gulf War Veterans look for guide, and the
11 Gulf War Veterans of Georgia, in cooperation with the
12 Gulf War Veterans of Massachusetts and the National
13 Veterans Legal Services Project, has come up with a
14 self-help guide on how to deal with the VA and the DOD
15 because of the monstrosity of the bureaucracy that's
16 faced by some of these folks.
17 I want to let you know that we're trying to do
18 things to help ourselves out. Not only just looking to
19 the government to help us out, we're trying to help
20 each other out. That's why we formed our organization.
21 I also have with me any of the documents that I
22 cited in the presentation if anybody wants to take a
23 look at them. I have abbreviated my presentation for
24 you, and you all have copies of my testimony and I'll
25 be happy to answer any questions.
145
1 MS. KNOX - Any questions from the Panel?
2 DOCTOR CUSTIS - Mr. Sullivan, would you identify
3 the VA Regional Office that Mr. Fisher - - - Where is
4 it?
5 MR. SULLIVIAN - On page 3.
6 DOCTOR CUSTIS - Is just says VA Regional Office.
7 Where?
8 MR. SULLIVAN - Mr. Fisher advised me that he was
9 living in New Mexico. I don't know the name of the
10 specific office that he visited. I do know that he
11 lives in New Mexico.
12 DOCTOR CUSTIS - And, the documents that you're
13 holding there, are those the documents you refer to as
14 showing DOD's covering up?
15 MR. SULLIVAN - Yes. If you would like to see
16 some
17 of them - - -
18 DOCTOR CUSTIS - May we have a copy?
19 MR. SULLIVAN - Certainly. Right here, for
20 example, is the memo from Department of the Army
21 Headquarters, United States Army Forces Command, and it
22 says in here - - -
23 DOCTOR CUSTIS - Well, for the sake of time, why
24 don't you just give us a copy of it.
25 MR. SULLIVAN - Well, sir, I'll send it to Mr.
146
1 Kowalok of the professional staff.
2 MS. KNOX - Just out of curiosity, could you share
3 with us which days the DOD gave you for the classified
4 material. Do you know that right off?
5 MR. SULLIVAN - Yes, ma'am. They started the 18th
6 of January, and it's spotty for about a 11 pages, a day
7 here, a day here.
8 MS. KNOX - So it's not consecutive days.
9 MR. SULLIVAN - Not consecutive days. We don't
10 get entire days. It says see further entry. Well, we
11 don't have the next page, and such like that. For the
12 record, we've also sent copies of our newsletter that's
13 titled The Phoenix, which is published by the Gulf War
14 Veterans of Georgia every month and sent to Gulf War
15 Veteran groups around the Country and ask that it be
16 included as part of our testimony. It lists the
17 address and the location of the documents cited, and in
18 some cases as with the diagnosis of Private Fisher, the
19 entire report is published in The Phoenix. So if
___________
20 anybody wants to read that, we wanted to make sure that
21 everybody saw the entire report. The Department of
22 Defense when we released this said that we had
23 selectively quoted from the diagnosis, so we printed
24 the entire thing, and there is not one word that doubts
25 that it's a chemical warfare agent incident. In fact,
147
1 the soldier was examined by a medic who referred him to
2 two physician's assistants who had recently graduated
3 from chemical warfare medical training. Then it was
4 referred on to a Major Duclaw, who diagnosed the
5 solider with chemical warfare exposure, and then it was
6 referred on to Colonel Dunn.
7 All of those folks diagnosed the soldier with
8 chemical warfare agent exposure. It's not like we had
9 one rogue captain running. This was a very thoroughly
10 documented exposure, and the Department of Defense has
11 not retracted it.
12 MS. KNOX - Any other questions from the Panel?
13 I've given you twenty minutes I've taken off yp other
14 veteran's time. So let's go on to the next one.
15 MR. SULLIVAN - Thank you.
16 MS. KNOX - Thank you so much for your time.
17 Brian Atkinson.
18 BRIAN ATKINSON
______________
19 Good afternoon. On behalf of the members of the
20 Gulf War Veterans of Georgia, I wish to thank the
21 Presidential Advisory Committee for the opportunity to
22 present testimony regarding sub-standard health care
23 services at the Department of Veteran Affairs Medical
24 Center in Atlanta, Georgia.
25 Veterans of the Gulf War were making complaints
148
1 to the VAMC about problems with medical care. As a
2 result, Mr. Bruce Martin, the patient representative at
3 the VAMC, agreed to meet with approximately 15 Veterans
4 of the Gulf War on June 16th, 1994 to listen to our
5 concerns about sub-standard treatment at the VAMC.
6 Most of those present were members of the Gulf
7 War Veterans of Georgia. Also present was Mr. Bruce
8 Rooney, the head of the Persian Gulf Registry and the
9 Persian Gulf Family Support Group at the VAMC.
10 During the three hour meeting Veterans cited
11 complaints regarding long waits for doctors, long waits
12 to schedule appoints, lost medical records, lost claims
13 records, denials for medical treatment, rude staff
14 members, and refusals by physicians to list symptoms or
15 to request relevant tests. Veterans at the meeting
16 claimed the problems were system-wide and not isolated
17 incidents.
18 A report written by Mr. Martin is added to our
19 testimony to supplement what we believe is a systemic
20 problem within the VA to respond adequately to a
21 crisis, namely the illness affecting as many as 75,000
22 Veterans of the Gulf War. Mr. Martin's report
23 documents in extensive detail, how the VA is keenly
24 aware of their inability to resolve the issues of large
25 numbers of ill Gulf War Veterans.
149
1 Our only added comment to the report is that Mr.
2 Larry R. Deal, the Director the VMAC, has refused to
3 make any changes in policy in order to correct these
4 self-admitted systemic problems. Mr. Deal prefers to
5 address each case at one time.
6 Unless an effort is made to address the core
7 cause of the problems, all the VA does is tread water,
8 the problem of continuing or keep themselves
9 indefinite. In their defense, we should add that
10 VAMC Atlanta continued funding for the Persian Gulf
11 Family Support Program. The Persian Gulf Family
12 Support Program has enrolled more than 2,000 Veterans
13 in Atlanta on the VA's Persian Gulf Registry. Mr.
14 Rooney was presented with a certificate of appreciation
15 for his work on behalf of the Veterans and the Gulf War
16 Veterans of Georgia.
17 An example of substandard medical treatment is
18 how the VAMC treated Paul Sullivan, one of our members.
19 On his first visit to the VA - he was seen in July 1992
20 - he waited 12 hours before he seen medical personnel.
21 He waited 19 months to obtain his first appointment for
22 medical problems related to the Gulf War.
23 According to an internal VAMC memo, Sullivan was
24 denied for his respiratory ailments by Doctor Ronald
25 Gephardt on February 3rd, 1994. His claim for service
150
1 connection was filed in July 1992, and has not yet
2 finished a review process by the VA Regional Office.
3 There is also substandard treatment within the
4 Department of Defense. Several of our members of the
5 Gulf War Veterans of Georgia remain on active duty and
6 they have shared the stories with us. One heartfelt
7 example of how the DOD mistreats Veterans occurred
8 early this year.
9 An active duty Army soldier who is a member of
10 the Gulf War Veterans of Georgia, claims he is ill from
11 the Gulf War. At his request, we're not using his name
12 in order to protect his career.
13 The soldier claims his spouse has suffered at
14 least one miscarriage after the war. The spouse of the
15 soldier claimed the fetus of subsequent post-war
16 pregnancy was given a five percent chance of survival
17 at three months gestations. The Department of the Army
18 refused to grant this woman the surgery needed to
19 terminate the pregnancy.
20 In essence the Army forced this woman to carry an
21 unviable fetus to term, knowing that once the baby was
22 born the baby would perish. The child was born with
23 massive defects and died shortly after birth. The
24 Veteran believes the deformities are related to his
25 participation in combat during the Gulf War and his
151
1 exposure to environmental toxins. The parents were
2 grief-stricken and the Army did nothing to help.
3 This is one example of how the Army has shown
4 little regard for the health and welfare of Veterans
5 who served in the Gulf War.
6 The Presidential Advisory Committee on Gulf War
7 Veterans illnesses demand that the DOD and the VA
8 perform a long-term epidemiological study on the health
9 effects of war on Veterans and their families. Thank
10 you.
11 MS. KNOX - Thank you very much. Are there any
12 questions from the Panel?
13 DOCTOR LARSON - Mr. Atkinson, did you also seek
14 help from either the DOD or the VA system after the
15 war. Did you have symptoms for which you sought help?
16 MR. ATKINSON - I did.
17 DOCTOR LARSON - How long did you have to wait?
18 MR. ATKINSON - I waited eight hours to be seen.
19 I was told I had an appointment at 9:00 a.m. I didn't
20 get to see a doctor until about 5:00 or 5:30 in the
21 afternoon. They came in, they poked around on my
22 stomach, didn't take any blood tests, no urine samples,
23 nothing.
24 DOCTOR LARSON - So you were in a waiting room all
25 day. You had to get an excuse from work and stay in
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1 the waiting room.
2 MR. ATKINSON - Oh, this happens every day, ever
3 day in Atlanta. That's just a basic case.
4 DOCTOR LARSON - It is not related to the Gulf
5 War, just - - -
6 MR. ATKINSON - No, that is. I just showed up for
7 the Persian Gulf Registry, feeling as though I was
8 having problems, problems at home, problems with my
9 joints and I had - - - Even my medical record is
10 showing past problems with my joints, and they're still
11 denying me treatment, saying that well this was
12 diagnosed as tendonitis, even though it was problems
13 with nerves.
14 DOCTOR LARSON - Let's do one thing at a time.
15 First before denying treatment, I'm just trying to
16 establish sort of the norm for a waiting period. Mr.
17 Sullivan waited 12 hours, presumably in a waiting room
18 or something. That's a long time. That's longer than
19 most people work in a day. And you waited eight hours
20 so are you saying that it's the norm, it was or is?
21 Which, first of all, it was the norm that you waited
22 eight to twelve hours before being seen by any health
23 care professional or before getting through the system
24 to a physician?
25 MR. ATKINSON - Well, at this point I can't say as
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1 far as whether or not people are getting in sooner than
2 five hours or four hours, because it's going to vary,
3 depending on the day. If you show up on a Monday
4 morning you can pretty much guarantee you're going to
5 sit there for six to eight hours.
6 DOCTOR LARSON - And so you're saying that even
7 today the average waiting period is at least four to
8 six hours, even with an appointment.
9 MR. ATKINSON - Yes.
10 DOCTOR LARSON - And that's in the VA system or
11 DOD or both?
12 MR. ATKINSON - That is in the VA. That is VAMC.
13 DOCTOR LARSON - Do you have any experience for
14 either yourself or with other that you've talked to
15 about how long the active duty people are waiting to be
16 seen? Let's say they have an appointment at 10:00 A.M.
17 MR. ATKINSON - Well, as far as the DOD, if an
18 active duty soldier goes in to his medical unit with a
19 problem, they are seen promptly, about an hour, because
20 they want to get the soldier back into duty to perform.
21 If they are diagnosed with a problem or says that this
22 person is having problems, they will immediately put
23 them on profile. Once they put them on profile, if
24 their problems continue, they will then seek to look
25 for a medical discharge or look at the soldier and say
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1 well he's malingering, okay, he's just avoiding duty,
2 and this is an every day occurrence. This is why I'm
3 saying we do not want to release any kind of names of
4 any of our active duty members because this has been
5 known to come back at the soldiers.
6 DOCTOR LARSON - I'm trying to get a sense of two
7 things. The first thing is whether the waiting
8 problems are specific to the Persian Gulf issue, or
9 whether they are, as you pointed out, some of the
10 systemic problems with the delivery system.
11 MR. ATKINSON - The waiting problem is VA-wide.
12 Whether you're a Gulf War Veteran, whether you're a
13 Viet Nam Veteran, it doesn't matter. You walk in that
14 hospital, if you have an appointment you are going to
15 sit there for five hours minimum.
16 MS. KNOX - Any other questions? I wanted to ask,
17 how far do you travel to the nearest VA from Decatur,
18 Georgia?
19 MR. ATKINSON - From Decatur it's about a - - -
20 About a ten minute drive from Decatur. For myself, I
21 just recently moved to Woodstock, which is now a one-
22 hour drive.
23 MS. KNOX - Thank you very much, Mr. Atkinson.
24 The next person that we have speaking is Donna Morris.
25 I would like to add that we will take a break, a twenty
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1 minute break after Ms. Morris.
2 DONNA MORRIS
3 Hi. Thank you for hearing me today. I'm a
4 mother of a Gulf Vet. All that my son ever wanted to
5 do from the time he was a little boy was be in the
6 military. He comes from a family of serving men,
7 and he served and served proudly. We still love this
8 country and we still love what it's supposed to stand
9 for, but these boys from the Gulf are prisoners of war
10 in the system. Things are not going the way they're
11 supposed to go for them.
12 My son left in September of '90 and he came home
13 in April of '91. Almost right after - I'd say a month
14 after - - - He went into the Green for Gold Program,
15 which was the Army released him into because he was
16 going to be an officer. So when he started into this
17 program at Appalachian State he started having problems
18 right away. He left for the Gulf very, very health,
19 very physically fit. He had always been into some type
20 of a military program in physical fitness. He had
21 perfect teeth, perfect muscles, and as soon as he
22 started in this program he started having chest pain,
23 dizziness, and just could not do the program. So he
24 lost that program. He lost being in the military
25 because of this.
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1 He then went and registered at Johnson City VA,
2 and he had a very, very brief examination. He was
3 called back from Doctor Bennett and told him to come
4 back with a stool specimen because they had found
5 something, which they told him at that time was
6 microsporidia. He then also registered when he moved
7 at Winston-Salem, North Carolina, and he had another
8 brief exam where they didn't do very much. He had a
9 letter from Regional Headquarters, from VA Regional
10 Headquarters that stated anything that he felt was
11 related to exposure to biological agents that he was to
12 be treated for - - - Salisbury VA absolutely refused to
13 treat him for anything, dental work or anything.
14 We're talking about months, years that my son has
15 been going back and forth and back and forth and
16 getting sicker and sicker and sicker and, as a mother,
17 it's terrifying. It breaks my heart.
18 There's a microbiologist who actually showed me
19 under the microscope the microsporidia. The doctor,
20 Doctor Bennett at Johnson City, he was taken off of
21 working for Gulf War Vets and got a Congressman
22 involved so that he could work - because he is a Gulf
23 War Vet - so that he could work on it again. The lady,
24 Carol, who is assistant there in the lab who provided
25 us with the pictures that son provided you with at the
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1 last hearing, she is no longer allowed to work with the
2 Gulf vets because she gave us those pictures of my
3 son's body, his own body. He's not allowed to have
4 that. They're not allowed to say that. They have to
5 keep separate logs because they're not allowed to use
6 that terminology.
7 Mr. Gotaris was going to come here today to
8 speak, and he was forbidden to come and speak. He's
9 heartbroken because he has worked on this so hard and
10 wants to help these boys so much, and he gets spirit
11 memos on how everybody should help everybody else, but
12 when he tries to do that he's stopped by his superiors.
13 There were neurological tests done on my son that
14 show slow response. Nothing has been done to follow
15 that up. He had a breathing test done that showed that
16 he that he takes in oxygen but it is not going into
17 blood properly. This is all at the VA. Nothing, not
18 even another appointment has been made for months after
19 that.
20 He was on a treadmill test that he insisted that
21 he have because part of his problem was that he started
22 having these chest pains. He got off the treadmill
23 test, and directly as soon as he got off - I was there
24 with him - he told the doctor, let's do it now, I'm
25 having it now, let's do it now, and the doctor looked
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1 at him and said well you're on the treadmill, it's
2 probably not your heart. He didn't listen to his
3 heart, he walked out of the room.
4 There is nothing that will be accomplished as
5 long as the people are fighting to prove that there's
6 nothing wrong and there is something wrong. All this
7 energy needs of the VA needs to put into finding the
8 problem and curing these boys. There are cures out
9 there. We keep hearing there's cures out there. I
10 don't want to lose my son. I don't want my son to get
11 sicker, and I've been through this - - - I called the
12 hotline. I was told he will get help. That was months
13 and months and months ago.
14 I went to the Patient Advisor and Assistant at
15 Johnson City, and she said oh well they'll eventually
16 did something about Agent Orange. I'm sure they'll
17 eventually do something about this. And I said well if
18 you had a child would that satisfy you that they'll
19 eventually do something about this. I was told by the
20 microbiologist that this could and probably would if
21 not treated cause blindness and death.
22 Now, as a mother, that's what I'm facing. So why
23 is nobody doing anything to cure these boys? I mean
24 they gave and they gave willingly. They weren't forced
25 to go over there. They served their country with a
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1 glad heart, and I'm not sure if I've left anything out
2 or not. I really appreciate your time in listening to
3 me, and I appreciate what you're trying to do. Thank
4 you.
5 MS. KNOX - Any question from the Panel?
6 DOCTOR LARSON - Mr. Gotaris was forbidden to
7 speak. Could you elaborate on that, and who is Mr.
8 Gotaris and who forbid him to speak about what?
9 MS. MORRIS - Mr. Gotaris is the microbiologist
10 that's at the Johnson City VA, and I may be losing him
11 his job telling you this. I don't know. But he is the
12 one who had - - - Well, actually he and Doctor Bennett
13 will say yes, this is what this is, and the Infectious
14 Disease at the same VA downstairs will say no, it
15 doesn't exist, and Doctor Bennett actually the pictures
16 for Mr. Gotaris to show the microsporidia down there
17 and said look, this is what it looks like, here it is
18 in the textbook and here is a picture of it. It's in
19 their body, here it is. He was coming today to bring
20 pictures, to bring his findings - - - He should get a
21 Nobel Prize. He's been working so hard on this, and he
22 went to his superior and said - and he was going to
23 spend his own money and he was going to take his own
24 time off and the VA wasn't paying for this to be done.
25 He was doing this. He could even stay with any Gulf
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1 Vets. I mean that was no problem, and he didn't think
2 it would be a problem, and his superior took it to his
3 superior, and his superior said absolutely not, you are
4 not to go there, you are not to speak, not even on your
5 own terms, not even as representing yourself. He could
6 not come here and speak, and everything that this man
7 has found, somebody is trying to push under the rug
8 when he needs to be patted on the back.
9 There are Veterans that were in the Guard there,
10 and the Marine Corps Reserve, they were so sick that
11 there are like there are like three families living
12 together because they can't afford to live apart
13 because the men are so sick. And it goes back to that
14 problem, Gulf War Vets cannot get medical insurance,
15 and they will tell you because they've been in the Gulf
16 War. So what do these guys do?
17 Our family has been devastated financially, and
18 we don't even care about that. We want him well. You
19 know, money doesn't mean anything. All the money lost,
20 that's just gone, it doesn't matter. His career, I
21 feel real bad about, but the main that as a mother that
22 I want is my son healthy again.
23 DOCTOR LARSON - Just one other question. We've
24 heard about many different kinds of symptoms from a
25 number of people. Is it your sense that all of these
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1 other people are suffering from the same infectious
2 disease or do you have any feeling about that?
3 MS. MORRIS - I don't have any knowledge about
4 some of the other things that I'm hearing about, but I
5 have a lot of knowledge about microsporidia, and I have
6 been told and shown that it will cause the joint pain,
7 it will cause the headache, it will cause all these - -
8 - A lot of these symptoms that these guys are having,
9 that it will cause that because it affects so many
10 organs in your body.
11 And the really strange thing about it is that it
12 is only seen - - - And it is exact with what's seen in
13 AIDS patients except that these Gulf Vets don't have a
14 compromised immune system like the other patients. So
15 it's very obvious something biological has gone on
16 somewhere.
17 MS. KNOX - Did you go to any of the VA Referral
18 Centers for your Phase 2 exam?
19 MS. MORRIS - No, ma'am. I have asked to go
20 several time, and been asking to go since I first
21 entered the VA system several times and flatly turned
22 down. I've been told now that I'm on a waiting list,
23 and have heard nothing further on that. My next
24 appointment is later this month, and hopefully I hear
25 something then.
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1 MS. KNOX - Thank you very much.
2 MS. MORRIS - One thing further I would like to
3 mention is that I've been to the VA with my dad and my
4 uncles. They both lost eyes, one in World War II, one
5 in Korea, and they are treated different. I've taken
6 both of them. There is a big difference. My dad can
7 have an appointment and go there and be out in an hour.
8 I go with him and we're there all day long.
9 MS. KNOX - Is your dad service connected?
10 MS. MORRIS - Yes.
11 MS. KNOX - I wanted to see if Richard Minor or
12 Mike Ange had come into the room yet. Okay. We'll
13 take a 20 minute break, and then we'll reconvene.
14 MS. KNOX - Jeffrey Saint Julian? How about
15 Timothy Easter? Kim Kenney? Kim, why don't you go
16 ahead and start.
17 KIM KENNEY
__________
18 Good afternoon, and thank you for the opportunity
19 to appear before the Presidential Advisory Committee
20 today. I'm Kim Kenney, Executive Director of The CFIDS
21 Association of America. The Association is the world's
22 largest and most active charitable organization
23 dedicated to conquering chronic fatigue and immune
24 dysfunction, or CFIDS, also known as chronic fatigue
25 syndrome or CFS.
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1 While we represent hundreds of thousands of
2 people with CFIDS, I wanted the Committee to know that
3 I myself do not have the illness. I feel fortunate for
4 that, and nor did serve in the Gulf War, but I wanted
5 to bring some similarities to the attention of the
6 Panel.
7 CFIDS is a serious disease of unknown origin or
8 cause. It devastates the lives of its sufferers.
9 CFIDS is a complex multi-systemic disorder
10 characterized by incapacitating fatigue neurological
11 and immunological abnormalities. Other specific
12 symptoms include impairment of short-term memory and
13 concentration, headaches, swollen glands, muscle pain
14 and weakness, and difficulty initiating or maintaining
15 sleep. These symptoms can be severely debilitating,
16 often remit and relapse without warning and can last
17 for many years.
18 Fatigue in this disease goes far beyond normal
19 tiredness. According to the case definition, published
20 in the December 15th, 1994 issue of the Annals of
21 Internal Medicine, the fatigue experienced by persons
22 with CFIDS resulted in substantial reduction of
23 occupational, educational, social and/or personal
24 activities.
25 Many persons with CFIDS are homebound and may
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1 spend 16 to 20 hours a day in bed, unable to perform
2 even the most basic self-care activities. And this
3 description of CFIDS sounds strikingly similar to the
4 illnesses described by thousands of Veterans who served
5 in the Gulf War. In fact, many Gulf War Vets are
6 receiving disability benefits today under the diagnosis
7 of Chronic Fatigue Syndrome, since there has been no
8 formal recognition of a Gulf War Syndrome by the
9 Veterans Administration or Social Security
10 Administration.
11 Doctor Benjamin Natelson of the New Jersey
12 Medical School has been award separate research grants
13 to study Chronic Fatigue Syndrome and the medical
14 complaints of those who served in the Gulf War. He
15 recently stated that he believes something in the Gulf
16 War environment put soldiers at greater risk for
17 chronic fatigue syndrome.
18 Doctors William Reeves and K. G. Caputo at the
19 Center for Disease Control of Environmental dDiseases,
20 have investigated a group of Gulf War Vets and found
21 their illnesses to be nearly identical to CFIDS.
22 Since reports of this CFIDS-like illness came to
23 national attention, the CFIDS Association of America
24 has followed the medical and policy developments that
25 so closely mirrored the experience of persons with
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1 CFIDS. Negative lab results lead physicians to believe
2 that the illness is merely psychological in origin.
3 Lack of recognition by military and medical
4 establishments often lead patients to believe they may
5 be crazy. Anger, depression and isolation result.
6 Applications for disability benefits are denied.
7 Interactions between patients and government officials
8 and physicians are polarized due to lack of
9 understanding and mistrust. New theories about the
10 true origin of the illness surface regularly. Cures
11 are promoted by doctors whose credentials and ethics
12 are impugned by the medical establishment.
13 And through all this, the patients become more
14 ill and more unsure that they will ever be taken
15 seriously. The problems with access to care within the
16 VA or the DOD medical systems also mirror those
17 experienced by persons with CFIDS, with private and
18 public medical establishments. Let us not repeat the
19 tragedy that person with CFIDS, and many other diseases
20 that at one time lacked credibility, have endured.
21 Much has been learned about CFIDS, particularly over
22 the last two years. Multi-disciplinary research has
23 essentially refuted earlier misconceptions that CFIDS
24 is a psychological illness. Instead it is now
25 considered a complex multi-systemic disorder and likely
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1 the result of a combination of genetic hosts and
2 environmental factors.
3 I would like to highlight just a few number of
4 findings from the past year that may be helpful to this
5 Panel as it continues to work. Researchers at Johns
6 Hopkins University have identified a strong link
7 between CFIDS and a documented physiologic abnormality
8 known as neurally mediated hypotension or vasovagal
9 syncope. This miscommunication between the heart and
10 the brain is diagnosed by the use of a three-stage tilt
11 table test. In a study due to be published in the
12 Journal of the American Medical Association later this
13 month, 95 percent of CFIDS patients tested had a
14 positive tilt test.
15 Further, treatment for neurally mediated
16 hypotension result in dramatic and substantial
17 improvement in a significant number of those patients
18 enrolled in the open trial. An application to conduct
19 a double blind crossover trial has been submitted to
20 the NIH. Second, scientists gathered at last week's
21 National Advisory Allergy and Infectious Diseases
22 Council of the NIH to review progress and future
23 direction in CFIDS research, and came to a consensus
24 the multi-disciplinary approach to CFIDS research
25 should be expanded, because abnormalities have been
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1 identified in virtually every body system studied. And
2 last, a researcher at the Medical College of Wisconsin
3 has isolated a novel retro virus, known as the JHK
4 virus, from a group of CFIDS patients. This study and
5 others led the NIAID Council to assert that the search
6 for infectious agents that might play a role in the
7 etiology of CFIDS is not over.
8 Despite many negative findings for known
9 pathogens, the Council members concluded that science
10 simply has not identified adequate means of uncovering
11 viruses that harbor in the brain or other organs.
12 These advancements and numerous others which I regret I
13 do not have time to share with you, give us strong
14 reason to believe that the investments made in CFIDS
15 research will bring rewards in terms of identification
16 of a definitive diagnostic marker, the cause of CFIDS
17 and effective treatment for the illness.
18 These advances should not be ignored by those
19 studying the illnesses suffered by Gulf War Veterans.
20 Instead, there should be a generous exchange of
21 findings between the two illnesses which Major General
22 Ronald Blanck of Walter Reed Army Hospital has
23 recognized as being similar to CFIDS in very many ways
24 in a key note address he gave in October 1994 at the
25 CFIDS Research Conference. Information gained about
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1 the origin, pathogenesis or treatment of Gulf War
2 syndrome that may prove beneficial to the study of
3 CFIDS should also be willingly shared.
4 The US Assistant Secretary for Health, Doctor
5 Philip Lee, chairs the Chronic Fatigue Center
6 Interagency Coordinating Committee that brings together
7 officials from NIH, CDC, Social Security Administration
8 and Food and Drug Administration.
9 I'm fortunate to serve as a consultant to that
10 Committee. The CFSICC provides an excellent vehicle
11 for the exchange of information between CFIDS
12 researchers and those studying Gulf War illnesses. We
13 urge this Presidential Committee to take advantage of
14 that opportunity, and also we strongly recommend that
15 Doctor WIlliam Reeves of the CDC, principal
16 investigator for CFS studies be called upon to brief
17 this Committee on his group's findings from the study
18 of Pennsylvania unit of Veterans.
19 We thank President Clinton for his wise decision
20 to assemble this independent Panel and for the outreach
21 it is conducting in communities like Charlotte.
22 The CFIDS Association stands ready to serve this
23 Advisory Committee to expedite the exchange of
24 information, and is also eager to serve the suffering
25 from Gulf War illnesses and their families with
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1 information and support that may allow them to better
2 cope with and manage their illness until effective
3 treatments are found. Thank you for your thoughtful
4 consideration of our recommendations.
5 MS. KNOX - Any questions? Thank you very much.
6 Some of you were late coming in, and I actually went
7 out of order. If we can start back with David
8 Fournier.
9 DAVID E. FOURNIER
10 I thank you very much for this opportunity to
11 speak to the board, and I'll start off by saying I'm a
12 retired Marine captain. I spend 24 years in the Marine
13 Corps, and I'm a Viet Nam Veteran, and then a Gulf War
14 Veteran. And since I returned in May of '91 I have
15 been going through a living hell. I have been sicker
16 than I've ever been in my life.
17 On the handout that I gave you is a list of the
18 symptoms that I've had to deal with in the last three
19 and a half years. It's on page 8. I'll just quickly
20 run down it: chronic fatigue, rashes, hair loss, night
21 sweating, hot and cold spells throughout the day,
22 seborrhea dermatitis, blurred vision, headaches, low-
23 grade fevers, joint pain, short-term memory loss,
24 degenerative disk disease, burning semen, burning
25 sweat, arthritic-like destruction of joints, diarrhea,
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1 stomach acid reflux nightly, ringing in my ears,
2 depression, malaise and mild obstructive pulmonary
3 disease. And most of those are still with me today.
4 Each morning when I get up, this is what I have
5 to look at. I take over 20 medications a day just to
6 make me operative from day to day, with all that's
7 going on with me, and this is depressing enough, when
8 you wake up and have to look at this and sort out all
9 your pills to take three times during the day.
10 First of all, I'll start off with my concerns
11 with the DOD study that I believe are your concerns
12 also. I participated in the phase 1 studies up in Port
13 Smith Naval Hospital in Virginia. I went up there on
14 July 13th through the 15th, 1994, and from the git-go I
15 was very upset. The Lieutenant Commander that was in
16 charge of the study took the time to tell me that this
17 was temporary assignment for him and he wasn't real
18 happy with it, he was anxious to get through with the
19 study and go on to bigger and better things, and from
20 there it went downhill.
21 The folks at internal medicine who headed the
22 study gave me a checklist to take with me and drop them
23 off at different departments to be examined in
24 different ways; audiology and x-ray and psychiatry and
25 so forth, and as I went around to each department and
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1 presented myself, I told them that I was part of the
2 DOD study. An aid looked at me with a question on her
3 face, amazement, and said well what are we supposed to
4 do. So I had to tell each one of them what they were
5 supposed to do, draw blood, a hearing test, x-rays of
6 check and maybe joints. I went to dental. The dental
7 officer asked me why I was there. I told him. He said
8 okay, have a seat in the chair. I did, and he said
9 what am I looking for, and I was amazed. I said well
10 it's my understanding some Gulf War vets have bleeding
11 gums so you might start there and see if I have any
12 bleeding gums. I knew I didn't. He said no, you look
13 fine in the mouth, so that was that.
14 The study, I felt, they didn't really put their
15 heart into it, and people who were involved in it
16 didn't really know what they were doing, they didn't
17 have the proper guidance, and it was just a paper
18 drill, if you will. They were going through the
19 motions. I also found out because I was retired I
20 drove myself up there, a four-hour drive up there from
21 Jacksonville, and I drove myself back. I stayed
22 overnight two nights. I paid for my own food and
23 lodging, and when I asked if there was any type of
24 reimbursement they said no, there wasn't because I was
25 retired and wasn't entitled, this was a voluntary thing
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1 on my part for the DOD study. So I went home real
2 disappointed. And it made me wonder, because if I as a
3 captain have to go up there, retired, and pay my own
4 way and pay my own lodging, what about all the other
5 Reservists, the young enlisted troops who are asked to
6 participate in this study. They don't have the money
7 and the resources to drive four or five or six hours to
8 someplace for the DOD study and pay it out of their own
9 pocket, pay their own lodging and pay their own meals
10 for three or four days to participate in this study.
11 So something needs to be done about that. If
12 they're on active duty they can get temporary duty
13 orders and they can get reimbursement and paid for by
14 the government, travel and lodging, but people who are
15 not on active duty cannot get that, so that's going to
16 hamper the DOD study quite a bit.
17 I received phone calls from the Fort Smith for
18 the phase 2 study later on in the year, but I had back
19 surgery the following month after I had been up there.
20 In August I had back surgery and I was laid up for six
21 months, so I used that as an excuse for not going back.
22 Then in March or April when they called me I told them
23 that I was very unhappy with phase 1 and that I was not
24 going to participate in phase 2 and come back up there.
25 And so they asked me to put it in writing and I did,
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1 they sent it to the - - - That's my feeling on the DOD
2 study. I guess either the wrong people were put in
3 charge or they didn't brief everyone or they didn't
4 really believe that it was a problem.
5 Secondly and more importantly, I think, is what
6 we're doing with the VA claims. I am currently on 100
7 percent disability from the VA, but it's not for
8 Persian Gulf related stuff, it's for symptoms that
9 they're able to put a handle on. I've got arthritis.
10 My right wrist is auto-fusing on me. All the cartilage
11 has been eaten away between the bones. It's in my left
12 wrist, too, in my right foot, and I feel it starting to
13 present now on the left hip and my knees. But that's
14 what the VA has given me my disability on. It's not
15 for any of the other symptoms, and I just recently got
16 a letter last week saying that they were decreasing
17 that percentage from 100 percent to 60 percent, so I
18 guess that means I'm getting better.
19 MS. KNOX - Did they tell you why that was?
20 MR. FOURNIER - No, just because they had another
21 look at the arthritic conditions, and they felt that it
22 wasn't deserving of 100 percent, even though it's
23 continuing and it's progressively destructive. I don't
24 know where they get their mind-set, but I guess when I
25 can't walk anymore then I'll be 100 percent.
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1 But the problem I see. I went to Winston-Salem
2 VA and had a Gulf War physical for the registry. They
3 wrote me back and said yes, you're a mess, it's good
4 that you're going to civilian doctors, sounds like they
5 have a good game plan, keep up the work, we have
6 nothing to offer you for therapy at this time. So
7 luckily for my wife, who has a good paying job and good
8 health plan, I'm able to go to civilian doctors on her
9 card, and I'm getting all my care right now, even
10 though I'm retired and entitled to military benefits
11 and all that stuff. Rather than fight with the system,
12 I'm just going to civilian doctors who are pro-active
13 rather than reactive, and they're giving me good care
14 and so forth. But right now the magic is the
15 medication. We have played with medication for three
16 years now and they've not always worked, and it just
17 seems right now we're on a good balance and a good mix,
18 a good diet here, and that seems to keep everything in
19 check. And I know when I miss my medicine because I
20 just turn into puppy doodoo, and it's not good.
21 But, anyways, back to the Persian Gulf claim,
22 because they decreased my - - - Or they're going to
23 decrease my disability rating in the next sixty days, I
24 thought well, because they came with a positive note on
25 the Persian Gulf physical and they said that this
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1 physical will serve as a basis for you to file a claim
2 in the future should you so desire, I did not file at
3 that time. I thought well, I'm getting 100 percent, no
4 need to file another claim for anything. But now I'm
5 at a point where I guess I do need to file it. But as
6 I was driving up here today I thought about it long and
7 hard, the forms that we have to fill out for that
8 thing, it's not difficult, it's just that you list the
9 doctors that you have seen, you list the facilities you
10 have been to, the dates that you've been treated, the
11 operations and all the different medications and
12 everything, and then the VA gets that and then they'll
13 turn around and contact these doctors and stuff, and
14 they say does this guy have Gulf War Syndrome. Well,
15 the doctors don't know what Gulf War Syndrome is
16 anymore than anybody else knows, and that's what's
17 going to happen when I file my letter, because all the
18 doctors I'm dealing with are chasing a solution within
19 their own realm.
20 The internal doctors - the internal medicine
21 doctors, the infectious disease doctors, they all have
22 a field of expertise within which they work, and
23 they're not microbiologists by trade, and they seldom
24 deal with the areas that they're not real familiar
25 with, and multi-chemical sensitivity is one that they
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1 just don't want to touch.
2 MS. KNOX - Mr. Fournier, your ten minutes are up
3 and I have a couple of questions myself, if you will
4 allow us to do that. Does anyone on the panel have
5 questions?
6 DOCTOR CUSTIS - Are you gainfully employed at the
7 present time?
8 MR. FOURNIER -I'm working part-time right now. I
9 work 32 hours a week, and it's a very difficult task
10 for me because my boss thinks I'm getting up at 8:00 in
11 the morning and working, but - - -
12 DOCTOR CUSTIS - Prior to your notification of
13 your reduction to 60 percent did you have the
14 compensation examination? Did you got to a VA?
15 MR. FOURNIER - Yes, I did. Yes, I did.
16 MS. KNOX - You said you were a retired captain
17 from the Marine Corps. You're eligibility lies in the
18 DOD facility only or can you go to the VA facility?
19 MR. FOURNIER - Oh, I can go to the VA, too.
20 MS. KNOX - So you have both options.
21 MR. FOURNIER - Yes.
22 MS. KNOX - But you've not been back for that.
23 You've decided to use civilian health care on your own.
24 MR. FOURNIER - Treatment only, yes, I'm getting
25 on the civilian side of the house. I'm going to the VA
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1 for the physicals that are required to establish
2 disabilities, to establish raises and percentages and
3 stuff.
4 MS. KNOX - Any other questions? Doctor Cassells?
5 DOCTOR CASSELLS - Mr. Fournier, in the chronology
6 that you gave us, it says here that you were retired
7 involuntarily with a 50 percent disability in 1993, and
8 then subsequently filed for disability with the VA, and
9 the VA came back at 100 percent. Was that for the same
10 disability or 50 percent plus other conditions? How
11 was that?
12 MR. FOURNIER - It was for the same disability.
13 The Marine Corps gave me 40 percent for an arthritic
14 condition and 10 percent for depression. Then the VA
15 turned around and gave 100 percent for arthritic
16 condition - - -
17 DOCTOR CASSELLS - The same combination.
18 MR. FOURNIER - Well, they gave me 100 percent for
19 the arthritic condition and 10 percent for depression
20 and 10 percent for skin condition, 10 percent for
21 something else, but they waive everything over 100
22 percent.
23 MS. KNOX - Thank you very much, Mr. Fournier. We
24 have your written statement, and we'll supply it to
25 each Committee member.
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1 MR. FOURNIER - Okay. If I could just re-
2 emphasize that one point. As we fill out the claims
3 forms for the VA with the doctor's references on there,
4 we need somehow to close that loop so that the VA
5 understands that this a claim for Persian Gulf-related
6 illnesses, and that the doctors they're talking to on
7 the outside were treating as internists and so forth,
8 and saying yes this fellow has got these symptoms, but
9 I can't say that he's got Persian Gulf illness because
10 I don't know what it is. And we need to close that
11 loop, which will strengthen that application on behalf
12 of the Veteran.
13 MS. KNOX - Okay. Thank you very much. I think
14 the next person on the list is Jeffrey St. Julian.
15 Jeffrey St. Julian? Timothy Easter is listed next.
16 TIMOTHY EASTER
______________
17 I come before you today knowing that I must speak
18 out on behalf of my sister's family. She is unable to
19 be here today due to her being held in Federal Prison
20 in Butner, North Carolina.
21 All of my life I have know Brinton Hamilton,
22 Junior, the Vet of which I speak, and his family. We
23 grew up in neighboring towns in Mississippi, and over
24 the years our families socialized often together. When
25 Brinton and Debra, my sister, started dating and
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1 married, our families celebrated their union.
2 My sister and Brinton started a family and were
3 happy together for many years. My sister and family
4 received many honors and awards through the bases that
5 they traveled through. She volunteered at every
6 opportunity. It wasn't until Brinton returned from
7 Desert Storm until we heard of any problems in their
8 marriage.
9 For sometime my sister was able to hide
10 disagreements and her bruises. Later, after trips to
11 the hospital and bones that had been broken, she was
12 unable to hide any longer. She sought counseling for
13 their marriage and Brinton went. He said at that
14 counseling that he believed from that trip to Saudi
15 that it had affected their relationship and his being
16 able to control his temper. He was unable to control
17 his temper also at work, and that was noted. What once
18 was a happy home, in a matter of months changed into a
19 house where my nieces spoke about not upsetting daddy
20 or else there would another problem.
21 Brinton also noticed and spoke with doctors about
22 other physical changes. He complained of high blood
23 pressure, that was monitored; he complained of joints
24 that were swelling, and problems with continuing his
25 work with the military because of that. He complained
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1 of numerous headaches, he also had gums that bled, but
2 he didn't really think much of that. The thing that
3 mainly he took note of in talking to Debra and myself
4 about is a rash.
5 He directly after Desert Storm was in a school in
6 August, Georgia. I lived in South Carolina, but they
7 would come visit, and he showed me a rash on his arm -
8 and I understand it was later on his stomach and then
9 on his thighs.
10 My brother-in-law's death was a result of one of
11 the episodes of family violence of which I spoke
12 earlier, in which Debra, my sister, tried to flee from
13 their home and Brinton jumped on the car. Later down
14 the road, a distance the road, he fell from the vehicle
15 as he attempted to get to her, inside the car driving.
16 The fall resulted in his death.
17 After suffering the loss of their father in June
18 of '94, my nieces and nephews have now lost their
19 mother. It is my hope that through my coming to speak
20 here, that you will use any power that you have in this
21 Committee to affect a change in these children's lives,
22 so that they can know that it wasn't their father
23 acting out in domestic violence that they were
24 witnessing, but rather than the Gulf Warn Syndrome
25 could have played a role in this.
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1 I would like to introduce now the children who
2 are with me, Cindy Hamilton Batener and her husband
3 Bill Batener, also in the military, their child
4 Brittany, who is named after Brinton, and then at
5 sixteen I have Brandy with me. The two younger were
6 not able to attend.
7 MS. KNOX - Any questions from the Panel? It's a
8 very moving story. Was your brother-in-law after his
9 death, was there an autopsy performed on his body?
10 MR. EASTER - Well, I asked for medical records.
11 My sister gave me everything that she had. In that
12 there's not an autopsy, so I'm sure they performed
13 something, an autopsy, since it was on federal base.
14 They were taking the case very seriously, and indeed it
15 resulted in her being brought to prison, so I'm sure
16 that one was performed. I am not privy to that
17 information. The information that my sister was given
18 when she requested medical records, she feels also had
19 been deleted, some items, is what she says because some
20 of the tests that he went through and she saw results
21 of don't seem to be there. There's some statements in
22 the medical record, from what I can determine, not
23 being a doctor, in reference to swelling of joints and
24 reference to other tests he had that mentioned, but I
25 don't know about the autopsy.
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1 MS. KNOX - Did he ever seek care at a VA medical
2 center?
3 MR. EASTER - Yes, he did. Well, he was active
4 duty so it would have been military installation
5 hospital.
6 MS. KNOX - Do you know if he was ever evaluated
7 for his bad temper or his outbursts of anger?
8 MR. EASTER - I mean at this time they were also
9 living in Texas and Kansas, a good distance away, so I
10 wasn't privy day to day. I do know that he had some
11 tests that he felt, because of his questioning on the
12 way to the hospital, and then complaining about these
13 things, but I'm not sure. There were some tests, but I
14 don't know what type.
15 DOCTOR LARSON - Mr. Easter, I think this is the
16 first we've heard volatility and anger being part of
17 the Gulf War Syndrome. You're suggesting that that is
18 - - - Are you aware of other people who had similar
19 kinds of - - -
20 MR. EASTER - I've done no research in this or
21 asked anyone else. This is just what Brinton felt had
22 played a role in his violence, and Debra also, because
23 it had not been previously in their relationship, and
24 it appeared directly after.
25 DOCTOR LARSON - What did he do during his time in
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1 Desert Storm. Do you know that?
2 MR. EASTER - No. As far as what his actual
3 duties were?
4 DOCTOR LARSON - Right what his MOS was during the
5 time of the war.
6 MR. EASTER - Cindy would know more about that per
7 se. All of it's jargon to me.
8 MRS. BATENER - He was communications.
9 DOCTOR LARSON - Communications?
10 MRS. BATENER - Yes.
11 MR. EASTER - Do you know where he was?
12 MRS. BATENER - A lot of times he wouldn't tell us
13 anything about it. And you asked if he had any
14 evaluations, he did have some, and they all came up
15 with scenarios that were kind of out there.
16 DOCTOR LARSON - Was he ever diagnosed as Post
17 Traumatic Stress Disorder or any psychiatric
18 evaluation, that you know of?
19 MRS. BATENER - They did give him a psychiatric
20 evaluation. Now, exactly how that resulted, I can't
21 say, but he did have one.
22 MS. KNOX - Thank you very much for your
23 testimony. We appreciate it. Mr. Jim Brown.
24 JIM BROWN
_________
25 I'm going to paraphrase this. A lot of the
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1 subjects that I was going to talk about today have
2 already been covered by the other Veterans pretty
3 adequately. If I can, I'd like to summarize the
4 speech.
5 My name is Jim Brown, and I'm a Persian Gulf War
6 Veteran. I served with the 514th Maintenance Company
7 from Fort Drum, New York, over in Saudi Arabia and - -
8 - During our training in the military, I had a lot of
9 instances to train with chemical alarms and chemical
10 agent detectors, things of that nature, since we were
11 basically light infantry, and never during that time
12 was I informed that we needed to distrust our
13 equipment. We were told that this is what we were
14 supposed to use to survive with, and it would keep us
15 alive if we paid attention to it and listened when it
16 went off.
17 DOD, however, now is telling us all that the over
18 14,000 alarms that went off repeatedly during the
19 course of the Gulf War were inaccurate, were wrong,
20 were false. That seems to be a bit of a problem
21 because those alarms are still in duty, they're still
22 being used, and they're still being deployed in the
23 world with our troops. Why? If they're that bad and
24 they're undependable, why are they still being used?
25 Secondly, at the Anniston Army Depot, around the
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1 first of August this year, there was a gas leak of
2 Sarin, a nerve agent, from an M-55 rocket warhead, that
3 was reported by Mr. Paul Sullivan in his Phoenix
4 newsletter.
5 When I check up on this, I found out that these
6 individuals had alarm sound, they reacted to it in
7 chemical suits, and they used an M-256 kit to determine
8 which nerve agent it was, to identify and confirm it
9 was there. This is the exact same methodology that we,
10 the Gulf War Veterans, were instructed on using over in
11 the war.
12 Why does the 14,000 plus alarms that we used were
13 inaccurate, were false and wrong, and yet Anniston Army
14 Depot seemed to have better equipment than we did or is
15 there something wrong here? That does not make sense,
16 and I think it needs to be looked into. Why is theirs
17 believed and why is our not?
18 Secondly, during the tragedy over in Japan the
19 agent Sarin again was detected in the subway.
20 Initially, the Japanese made a mistake, and they called
21 it a methyl-cyanidate, something close to one of the
22 chemical warfare agents, known as tabun. They later,
23 about an hour or so later, came back on the air and
24 said that they were mistaken, it was actually sarin.
25 The US believed them, and the next day their press
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1 secretary was on the air stating that we were going to
2 actually offer our expertise in equipment to aid them
3 with this tragedy.
4 For five years our expertise and all that of the
5 Coalition Nations has not been sufficient to save lives
6 of our own people. Why suddenly is it good enough for
7 another country but not for our own soldiers? I'd like
8 an answer from DOD on that.
9 There are also agents that were detected by other
10 Coalition Nations, such as the Czechoslovakian and
11 Israelis that the United States did not have the
12 capability of detecting one of nerve agents that's
13 known as GF. This is noted in the chemical logs that
14 were released by Centcoms down in Florida, and it seems
15 very odd that DOD can stand firmly on their statement
16 that GF was not detected and it was not confirmed by
17 the Coalition Nations, when they have absolutely no
18 ability to find out if that's true or not. They cannot
19 confirm it, they cannot deny it, they cannot tell if it
20 exists over there. They didn't field that equipment
21 over there because they thought no one would use GF.
22 Is that faulty intelligence on their part,
23 incompetence? This needs to be looked into also. GF
24 has not disappeared. It's still being used and
25 manufactured in the world. We need to update our
187
1 equipment, I would say.
2 Also, in the chemical logs why were there
3 specific entries in there that were whited out rather
4 than using black Magic Marker for the second release of
5 the 36 pages rather than the original 11 that Paul
6 Sullivan received. Why did they use White-Out on
7 specific portions of that, where GF was concerned, when
8 the Israeli police had detected and confirmed this
9 agent. This also needs to be asked the DOD. Why is
10 the DOD ignores its own teachings to its own soldiers.
11 They taught us how to look for these warfare agents;
12 they taught us how to survive in an environment such as
13 this. Why do they not depend on the soldiers when they
14 have actually been the ones to teach us? We teach
15 other nations how to do this. Why is suddenly no good.
16 It's not good enough save lives, but it's good enough
17 for other countries? I think that needs to be looked
18 into, also.
19 Since DOD cannot produce documentation to support
20 its claims that all of the alarms were false, and we
21 can produce Veterans with illnesses consistent with
22 exposures to chemical warfare agents, as per DOD's own
23 doctrine, as well as documentation that the agents were
24 detected and confirmed in many places, there's only one
25 position for us to take, the same one DOD has decided
188
1 to take with us, its own soldiers.
2 Until DOD can produce authentic documentation of
3 what happened during the war to support its claims, we
4 will have to say its statements are, and I quote using
5 their own words concerning us, anecdotal,
6 unsubstantiated, and unconfirmed, and this will stand
7 until they produce the documents needed to solve this
8 problem.
9 There are also detections of biological agents,
10 such as anthrax during the war. There are many UK
11 soldiers, United Kingdom soldiers, six specifically
12 mentioned in the chemical logs, that were checked, they
13 had blood tests done. The results of those blood tests
14 are not to be found. Why not? That needs to be
15 answered, also.
16 As stated earlier, at a VA in Tennessee, Johnson
17 City, there were Veterans examined for a biological
18 agent known as microsporidia. This is an agent that
19 was found in every fluid of the body and all body
20 tissues also. The CDC - The Director of the CDC,
21 Doctor David Satcher, talked to me specifically
22 concerning a blood ban on Persian Gulf War Veterans.
23 He told me specifically that if it was a chemical agent
24 alone, that would not be sufficient. Why he feels that
25 way he never really said. He did say if ever a
189
1 biological agent was detected in the blood of Persian
2 Gulf War Veterans he would institute himself a blood
3 ban on Persian Gulf War Veterans. Therefore, I think
4 that needs to be done. Somebody needs to contact him
5 and talk to him about this. If he can't do it, then we
6 need to find who can. We need to protect the blood
7 supply and make sure that it does not get contaminated
8 by unknown agents and organisms. If they don't have an
9 answer for us yet, let's err on the side of judgement
10 and save some lives. That's what we're supposed to be
11 in the business of.
12 There's also one other portion that concerns the
13 chemical agent detections during the war and some of
14 the things that were seen during the war. One of the
15 Veterans in the Gulf War Veterans of Carolinas happened
16 to be in King Fahad Military City on the 9th of January
17 19th, 1991. A scud incoming was knocked out of the
18 air, flew up over the camp, scattered many pieces of
19 that scud, all over. There were some that landed
20 between the tents and on the buildings. One of those
21 pieces was recovered by this Veteran and actually
22 brought to the United States. It's still in the
23 possession of that Veteran, and I have in my possession
24 a piece of that specific scud. It's not the entire
25 piece. The whole piece is approximately 6 inches
190
1 square.
2 When a person comes in contact with this piece of
3 metal their skin begins to redden and it begins to
4 blister immediately, and approximately one to five
5 minutes later a very large blister filled with pus and
6 water starts to form. It can grow to approximately the
7 size of my thumbnail before it will pop. This is
8 extremely consistent with chemical warfare agent
9 exposure. This has happened repeatedly through
10 people's reaction's to exactly what was on the scud,
11 and listening to DOD statements that it was nothing but
12 a dud. Why in the world would Saddam Hussein send duds
13 towards us? To try to goad us into turning his little
14 sandbox into a glass bowl? That was the statement that
15 President Bush made. We will retaliate and we'll
16 probably be nuked for it. That's a heck of a gamble
17 for somebody to say. Why would he send empty scuds
18 towards us? That doesn't make any sense.
19 MS. KNOX - Jim, you've had eight minutes. I
20 would like for the Committee to have an opportunity to
21 ask you questions.
22 MR. BROWN - Sure.
23 MS. KNOX - Are there any questions? I have one
24 myself. As you know I was at King Coli Military City,
25 and one of the things that's been confusing for us is
191
1 that, at no time did I hear the sound of a chemical
2 alarm, the sound of a horn, a signal three horns going
3 off that would signal a chemical alarm. However, how
4 we got our information was from the air raid siren. So
5 I've talked to several people, including the NBC
6 officer that was with my unit, and NBC enlisted folks
7 as well, and I've got mixed stories on that. And, in
8 fact, I was told that the air raid would sound in any
9 attempt of a incoming scud or a chemical that had been
10 detected, and the reason was because there could have
11 been anything on the warhead of that scud. However,
12 the day that this scud did go over our heads at King
13 Coli Military City and the Patriot intercepted it, the
14 alarm did not sound. For a big area like that, what
15 was the procedure that you know of?
16 MR. BROWN - For a large area like that, unless
17 there's an automatic alarm that actually was sounded
18 up there, there would have to be an individual that
19 heard the chemical alarm go off in response to an
20 explosion or something like that, and they would have
21 to suit up and go what they thought was a contaminated
22 area and use the M-256 kit, just like the one they used
23 at Anniston Depot and determine if there was an agent.
24 Unfortunately, DOD methodology that was put out into
25 the Gulf was keep taking tests until you get an all
192
1 clear. Report the all clear, and that is the only
2 thing that went into the reports. It's entirely
3 possible that the individual that was responsible for
4 actually making the report either had not gotten the M-
5 256 kit out correctly, didn't feel like going out and
6 checking it. There's many different reasons he might
7 not have done this.
8 MS. KNOX - Well, could the reason not be that
9 someone did actually do that, and because the compound
10 was so large that we didn't hear the horn, and then
11 they were told to sound the siren to activate - - -
12 MR. BROWN - That's entirely possible. There can
13 always be a delay in something like that where human
14 being are involved instead of automatic machinery. The
15 chemical agent monitor is a small portable ones were
16 automatic, but if they required a human response to
17 actually find out if it was a real detection and
18 exactly what the agent was after the fact where
19 something like platsun going off would be - - - I'd
20 have to say they'd have the chemical alarm sound first,
21 then the individual tests, then they sound the alarm.
22 MS. KNOX - You were trained as an NBC.
23 MR. BROWN - I trained more than this. I actually
24 taught the 35 people in my section up there at Fort
25 Drum.
193
1 MS. KNOX - Any questions?
2 DOCTOR LARSON - Do you yourself have symptoms of
3 Gulf War Syndrome?
4 MR. BROWN - Yes, ma'am.
5 DOCTOR LARSON - So that's the genesis of your
6 interest in finding the potential causes?
7 MR. BROWN - No, ma'am. I'd have to say that the
8 problem I had was before I had was before I ever I was
9 ever even deployed. The Tenth Military Intelligence
10 people that are at Fort Drum kind of hung around with
11 us. It was an interesting relationship, but they had
12 some information they shared with us, more or less,
13 watch your back, that kind of thing. We were
14 forewarned before we went over there to watch out for
15 certain things.
16 DOCTOR LARSON - What were you to watch out for?
17 MR. BROWN - Chemical agent alarms going off and
18 being disregarded, the United States not really backing
19 up the soldiers, and not being adequately prepared. We
20 were only issued one chemical suit to be able to go
21 over there, yet we had five decontamination kits given
22 to us. That's a little unusual.
23 DOCTOR LARSON - In your testimony you basically
24 listed all of the possible causes, six or seven. I
25 just wondered if you yourself had any problem about
194
1 whether - - - You listed insecticide, biological
2 agents, chemical warfare, infectious agents, failure of
3 the suitS, immunizations. If everything that I've
4 heard is listed in your testimony, what you're saying
5 is you think it's all of those things or - - -
6 MR. BROWN - Each one of those things has one
7 specific reaction on a human body, and physiologically
8 it will knock down your immune system to the point
9 where it will be open to any kind an opportunistic
10 infection.
11 DOCTOR LARSON - But you're not saying that each
12 one of those has one - - - One cause has one effect and
13 only one. Is that what you're saying?
14 MR. BROWN - Well, a chemical warfare agent being
15 organic phosphate and a pesticide being a low toxicity
16 organic phosphate, would react essentially the same,
17 just not with the same quickness or deadliness. They
18 will still affect your immune system to a less or
19 higher degree.
20 DOCTOR LARSON - But you're listing everything.
21 MR. BROWN - Yes.
22 Doctor Larson - Not just chemical agents, but - -
23 -
24 MR. BROWN - Alone or in combination they would
25 all have essentially the same effect.
195
1 DOCTOR LARSON - And infectious disease agents,
2 and the failure of the suits and the immunizations, and
3 so forth.
4 MR. BROWN - The failure of the suits would
5 actually precipitate the exposure to the lower level of
6 chemical agents that were in the area, which would
7 bottom out your immune system, therefore, allowing
8 opportunistic infections. So it's kind of like a
9 three-way dominoes effect.
10 MS. KNOX - Thank you very much, Jim
11 MR. BROWN - One more other question I did want to
12 ask. I was going to enter this into the record, and I
13 was also wondering if it would be entirely possible for
14 us to present this to DOD and get them to analyze it,
15 because they've been dragging their feet, literally and
16 figuratively, stating that they have no evidence, they
17 have no way to get a real answer. They have to come to
18 us and physically examine us first.
19 There should be a way to get somebody to do a GC
20 mass spectrometry on this piece of material and get an
21 answer, because this piece of material, not us, was
22 closer to whatever was in that scud. This will be your
23 answer. This is where we need to start.
24 MS. KNOX - Jim, I don't know if that's in the
25 authority of our Committee, but we will take that and
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1 see if we arrange that.
2 MR. BROWN - I really appreciate it. Thank you
3 very much.
4 DOCTOR LARSON - Could I ask you a questions about
5 - - - Is this your wife's testimony also?
6 MR. BROWN - Yes, it is.
7 DOCTOR LARSON - Is she here?
8 MR. BROWN - No, she's still in Missouri.
9 DOCTOR LARSON - Can I ask you something about
10 hers then.
11 MR. BROWN - You sure can.
12 DOCTOR LARSON - She says that women are
13 experiencing countless spontaneous abortions.
14 MR. BROWN - Yes.
15 DOCTOR LARSON - Do you have any documentation on
16 that? I realize that all women during their child-
17 bearing years, about two-thirds have a spontaneous
18 abortion at some point anyway which they may or may not
19 know about. I just wondered if it's more in - - -
20 MR. BROWN - Yes.
21 DOCTOR LARSON - It's more than two-thirds of
22 women.
23 MR. BROWN - The main thing that seems to be the
24 problem is it's not during the early periods of
25 gestation. It's actually into the second trimester of
197
1 time.
2 DOCTOR LARSON - If you have any data on that to
3 substantiate your wife's testimony, it would be very
4 helpful.
5 MR. BROWN - I can bring that to you.
6 MS. KNOX - I think the next speaker is Bruce
7 Rooney.
8 BRUCE ROONEY
9 Good afternoon. Thank you very much for allowing
10 me a couple of impromptu moments to speak to this
11 Committee.
12 I'm a Persian Gulf Family Support Program
13 Coordinator to the VA in Atlanta. You've already heard
14 that. I was just alluded to earlier. I'm not here to
15 refute or substantiate any claims that have already
16 been made by a couple of Veterans here. I'm also not
17 presenting myself as a spokesperson for the VA per se.
18 What I want to speak specifically about is a program
19 that was enacted in October of '92, and I may be
20 incorrect in quoting the specific - - - Or citing the
21 specific public law, but I think it was Public Law 102-
22 405, which established a Persian Gulf Family Support
23 Program, and the marriage and counseling component of
24 that program.
25 Initially there were 32 of these programs
198
1 established in VA's nationally, at this point which
2 you're looking at now - and I'm not talking about the
3 gray in my hair or my beard, as I'm a dinosaur. I'm
4 one of just probably two or three left nationally still
5 doing this program.
6 What we are doing or attempting to do is to get
7 Veterans into the program, into the VA medical center,
8 and be registered for the exam. That was not the
9 initial focus of our program. The initial focus of our
10 program was to deal with possible and to assess
11 possible readjustment issues that may present with
12 Veterans and family members, specifically family
13 relationships and sexual difficulties that may be
14 encountered, marital or couples relationship
15 difficulties, the opportunity to assess children
16 because of the fact that we're getting report of
17 behavioral and discipline problems, an increase in
18 alcohol and drug abuse by Veterans and family members.
19 We were to provide education of the normal and
20 expected responses to family members on the impact of
21 going to war, specifically dealing not only with the
22 National Guard and Reserve component, but the active
23 military component. Also to assess and identify
24 individual and family problems and to implement marital
25 and family counseling. Another very strong component
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1 of our program was the outreach, which had never been
2 done before.
3 Prior to the Persian Gulf era, National Guard and
4 Reservists did not have veteran status, if exclusively
5 that was their military experience. At this
6 opportunity we were given to go out to Reserve units
7 and National Guard units on the weekends during drill
8 times, talk to Veterans, appraise them of the program,
9 and sign them up for the Registry as well as meet with
10 family members.
11 Unfortunately, this program went by the wayside
12 due to funding, a lack of funding at this point. I am
13 carried under the local auspices of our hospital.
14 There may be one or two other programs like this still
15 in existence, but it's primarily a shared experience
16 now with the program leader doing perhaps one-third of
17 his time or her time devoted to Persian Gulf and other
18 duties delineated for the homeless programs that the
19 hospitals have established and other VA medical center
20 programs.
21 What I would like to implore, if at all possible,
22 is to expand the outreach that is very much necessary,
23 to say the least. At this point, outreach from a VA
24 standpoint consists of the issuance of a quarterly
25 Persian Gulf review and a hotline. While this is an
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1 excellent service, I'm afraid it's not reaching our
2 Veterans who need an active component of outreach,
3 which our program did provide at one time and,
4 unfortunately, has been decimated due to budgetary
5 restraints.
6 I have probably spoken and I'm not quite the same
7 - - - Nor the ogre that I've been presented by Mr.
8 Sullivan and Mr. Atkinson at this point; somewhere in
9 between, and I think the VA may fall somewhere in
10 between those two terms also. I'm very proud of the
11 work that we have done. I would be much more proud if
12 we could continue to do so. I think every Veteran, no
13 matter what era, should be given primary care - - - I'm
14 sorry, priority care.
15 I think basically I've been doing this for
16 eighteen years, the last three with the Persian Gulf
17 Veterans, and this is probably the proudest I've been
18 any VA venture prior to this.
19 Again, I thank everyone for the time. If there's
20 any questions, I'll gladly entertain those at this
21 point.
22 MS. KNOX - It's nice to hear something positive.
23 Any questions from the Panel? Thank you very much.
24 MR. ROONEY - Thank you very much.
25 MS. KNOX - I think the next person we have is
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1 Carol Roberts.
2 CAROL ROBERTS
3 Thank you for an opportunity to talk to the
4 Committee this afternoon. I'm here on behalf of my
5 son. My son served about - - - Served on the
6 Wisconsin, USS Wisconsin BB64, which was the flagship
7 of that fleet.
8 There were several ships in the Gulf area, but
9 this ship went all the way up and remained there for
10 quite a time.
11 I recall my son telling me about the middle of
12 the day how the sky turned pitch black and appeared as
13 it was midnight, and he talked about they were there
14 when the oil fields were set on fire, and numerous
15 things. But what I'm here to talk about is the
16 condition that my son returned to us. I first noticed
17 the change in him in August of '91. He was sitting in
18 the driveway. He was sent to do an errand and we were
19 sitting there waiting for him to return, and we made
20 the assumption that he was just tardy not returning.
21 And I happened to look out of the window and he was
22 sitting there in the car, and I went out and I asked
23 him where he had been and why he was sitting here, and
24 he was crying uncontrollably, and I asked him what's
25 the matter. He couldn't tell me what was wrong, it was
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1 just that I don't know. And even as of today he still
2 has those uncontrollable crying spells.
3 That's just the beginning of the problems. He
4 has chronic diarrhea, chronic diarrhea, the kind you
5 can never imagine. Not only is this embarrassing, it's
6 degrading to have to carry extra clothes that you would
7 carry for a toddler. He's been to the VA. The don't
8 seem to know what's wrong. He has headaches, severe
9 headaches. In fact, he was at the VA hospital and saw
10 the doctor, and they told him - and that was just this
11 month in September - oh, well, come back in January and
12 we're going to do a CAT scan on your head in January.
13 The meantime, he's taking 8 to 12 milligrams of
14 Motrin per day. He has mood swings. I don't know if
15 those people are still here, but I can understand about
16 what they were talking about, temper.
17 Before he went to the Service he was a real mild
18 mannered person. Now, you can look at him at a manner
19 that he doesn't want you to look at him, and he becomes
20 very angry. His mood swings - - - He's always at one
21 end of the spectrum, either very giddy or very
22 depressed.
23 He also has the rashes on his arms, on his
24 stomach, there's nothing that can be done. Memory
25 loss, and I'm not talking about someone who's an old
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1 man. You can look at him and tell he's relatively
2 young, and the impact on his life is devastating as
3 well as to the family. His body aches, his joints
4 swell, he can't sleep at night. He's on medicine to
5 make him sleep. It doesn't do any good, so what does
6 he do? He wants to double the dosage. Call the
7 doctor, oh, yes, as long as he doesn't do it too often,
8 yes, he can go on and take an extra pill. That's no
9 way to live.
10 His testicles became swollen and he had to be
11 hospitalized. It started off with severe stomach
12 pains; took him to the VA hospital - oh, maybe it's his
13 appendix. Let's see what it is. Excruciating pain,
14 just put him on a cot there and all the doctors have an
15 emergency, just stay there for a little while. I don't
16 know how many hours we stayed there. Eventually they
17 said well, he's gone for the night, we're going to have
18 to take you upstairs and we'll see in the morning;
19 remained at the hospital for five days, no one ever
20 told us what caused it. Eventually the swelling did go
21 down.
22 He's been diagnosed as having PTSD. He's always
23 depressed. He's on medication for that. Weight loss,
24 now obviously you can look at him and tell he's never
25 been a real large person or he's not large now, but
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1 it's unusual - - - It's not unusual for him to lose ten
2 pounds in one week. His weight goes up and down. The
3 VA hospital, he has different scenario for most people.
4 He has other service-related injuries. He served on
5 the Iowa and he was there when the explosion occurred
6 and he also has an eye injury, so he's receiving
7 compensation for some other injuries, nothing for the
8 Persian Gulf, and that is what seems to be affecting
9 him more. He has chest pains.
10 The young man can't keep a job. Since he's been
11 home he's had several jobs. One of them I can remember
12 distinctly, he would have to keep going to the bath
13 room. His employer wanted to know where are you, and
14 can you imagine telling him I have to keep going to the
15 bath room because I have diarrhea. He could no longer
16 do that job. He had another job. His arms hurt him so
17 bad he just couldn't keep the job, and when he does get
18 to sleep he sleeps for lengthy times. It's not a
19 normal sleep. And that's some of the major things
20 that's what's wrong with him.
21 The effect on the family, there is another - - -
22 He has a sibling in the household as well as my
23 husband, and we don't know what to expect one day to
24 the next. We never know if he's going to wake up and
25 he's okay. We never know what to say to him, what not
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1 to say to him. He's struggling, it's real hard for
2 him. He was doing real well in the Service. When he
3 was in high school he was in the Junior ROTC all the
4 time, planned for a military career and was excelling,
5 and now this has happened. I just want some answers.
6 Things have not been done, and I want to know why.
7 Thank you.
8 MS. KNOX - Thank you, Mrs. Roberts. Any
9 questions from the Panel? Doctor Cassells.
10 DOCTOR CASSELLS - I'd like to know, since you
11 were aboard the Iowa at the time of the gun turret
12 explosion, did you leave the Navy at the end of a
13 regular enlistment or did you leave as a result of
14 medical disability and disability retirement? What
15 exactly is your status?
16 MR. ROBERTS - I was released under general
17 honorable conditions. I re-enlisted in '92. I could
18 no longer take it, and I asked for out and they
19 wouldn't give me out, so I waited for 45 days and got
20 evaluated and got a discharge.
21 DOCTOR CASSELLS - So you're not medically
22 retired?
23 MR. ROBERTS - No, I did not.
24 MS. KNOX - Have you received an extensive
25 evaluation at the VA?
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1 MR. ROBERTS - Concerning the Persian Gulf?
2 MS. KNOX - Right.
3 MR. ROBERTS - Yes, I have. The results came back
4 negative.
5 MS. KNOX - So you did go through phase 2. Did
6 you?
7 MR. ROBERTS - I went to Winston-Salem, if you
8 want to call that phase 2. They just poked me; you
9 know, poked me here, poked me there. Let's take a
10 little blood, take a little x-rays, and came back
11 negative.
12 MS. KNOX - In your personal opinion, do you feel
13 like you're suffering from damages from the war that
14 were psychological or do you feel like they're actually
15 physical, or both?
16 MR. ROBERTS - They are physical. They are real.
17 I can testify they are real physical.
18 MS. KNOX - Well now, I don't want to diminish
19 that. I think for all of us who were in the war, I
20 think we all have psychological effects from that, so
21 I'll admit to that myself. Any other questions? Thank
22 you very much.
23 I want to see if Mike Ange has come into the room
24 yet. He obviously was not able to make it. How about
25 Richard Minor and St. Julian? No? Is there anyone
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1 else who had - - - If you would come forward.
2 TRAVIS MORRIS
3 I'm Travis Morris. I just wanted to speak very
4 briefly to you. I've already given you my statement.
5 I'd like to address just for a moment some of the
6 concerns about psychological evaluations and
7 depression. There's been a lot of talk today about
8 psychological evaluations and depression. I'd like to
9 talk a little bit about the psychology of people who
10 enlist in the military, as I know some of you in the
11 Panel already know many of the Veterans here now.
12 People that are drawn to military service tend to
13 be people who are a little bit different than other
14 people. They are very much perfectionists. They judge
15 themselves and other people different than the average
16 person would. Soldiers that are in lead units in the
17 Marines are particularly guilty of this. Their
18 physical ability and their ability to think quickly and
19 make quick judgments are one of their most prized
20 possessions, and they view this differently than a
21 civilian would.
22 One of the most admired qualities in a soldier,
23 that they admire in themselves and they admire in other
24 people and other soldiers, is their ability to what
25 call drive on, to continue with the mission no matter
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1 what physical pain or mental or emotional disability
2 you may be experiencing at the time.
3 Drill instructors implant this notion in young
4 recruits, soldiers sing cadences about it. In the end
5 soldiers drive on. You get blisters on your feet on
6 that old long road march. You just grit your teeth and
7 you drive on. If you have a good friend killed in
8 combat, a little bit of you dies too, but you drive on.
9 This is important to soldiers. This may not be
10 important to people who make a lot of money and live a
11 civilian world where physical ability doesn't mean a
12 lot, but physical ability and mental ability to make
13 snap decisions, sometimes lives depend on that for a
14 soldier.
15 The ability to make long ground marches and haul
16 the heaviest rocks, take the heavy gear, soldiers
17 admire that. Physical strength and intelligence, these
18 are things that soldiers really, really take to
19 themselves, and when soldiers make a mistake when their
20 physical ability is a little less than other people or
21 a little bit less than they expected of themselves,
22 they take it hard, take it real hard.
23 This has been the thing that has really been
24 robbed of Gulf War Veterans. Because of particular
25 chronic fatigue and memory loss, the ability to drive
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1 on and make quick decisions has been completely taken
2 away from us. The whole way we judge our lives and we
3 view ourselves, our self pride, all that is gone now.
4 We look in the mirror and we see a stranger. We
5 see people that we never wanted to become who are weak,
6 who are unable to perform physically. This is
7 devastating for Persian Gulf Veterans. The VA tells us
8 we're depressed. Yes, we're depressed. It's very
9 depressing when the way that you have lived your life
10 is completely turned upside down. This is true of
11 soldiers or other people with any other career, where
12 their whole life is totally changed. This has happened
13 to Persian Gulf Veterans. We want to be productive
14 members of society. We had a lot of pride in
15 ourselves, and all that is taken away. We can't react
16 as quickly as we used to; we can't run long miles;
17 we're not as fast as we were. It's as if we've aged 30
18 years, and our bodies have become painful and
19 arthritic, confusing shells of what they once were.
20 Our minds that once sharp are now slow and
21 forgetful, and men and women who were confident and
22 self-assured warriors are now irritable, unconfident
23 and shadows of our former selves.
24 So I just wanted to, I guess, go over that a
25 little. That's only part of the statement that I
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1 turned into you. But people want to talk about being
2 depressed - and the depression is there and I don't
3 deny it. The irritability is there. The anger and the
4 frustration, it's all there. Post traumatic stress is
5 very real. We all went through some traumatic
6 experiences. That's what happens in a war.
7 I just want to point out to the Committee, if you
8 don't already know this, and to the members of the VA
9 who are still here and to the Gulf War Veterans who,
10 I'm sure, know this, and to the families who may or may
11 not know this their loved one, this depression, this
12 irritability, it comes from being sick.
13 We are constantly reminded every day of traumatic
14 experiences in the Persian Gulf, so the first thought
15 we have when we wake up is about the pain that we're
16 experiencing from physical impairments that we have;
17 and the last thought we have before we go to bed is
18 about the Persian Gulf because we're still in pain.
19 So again, this has changed our lives, the
20 depression coming from the sickness, not the sickness
21 coming from the depression that some people like to
22 say, and that's the point I wanted to make. Thank you.
23 MS. KNOX - Thank you, Travis, very much. Any
24 comments from the Panel? I would like to close the
25 meeting now.
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1 I would tell you that the next full Committee
2 meeting is tentatively scheduled for October 18th and
3 19th, and this will be held in Arlington, Virginia.
4 Doctor Joyce Lashoff is the Chair of the Committee, and
5 I did not mention earlier that Robin - she is the
6 executor of the Executive Director of the Staff, and I
7 will say that they're working very hard to look at all
8 of the issues that you've discussed today, and we will
9 continue to do that.
10 We'll meet monthly as a subcommittee and then
11 every other month as a full committee. So please know
12 that we are doing our best to look at these issues and
13 bring you some answers.
14 MR. FOURNIER - Is there a schedule of your
15 itinerary for the next few months or year?
16 MS. KNOX - No, sir, there's not. Having twelve
17 members on the Committee, we're working towards that
18 but we've not reached those decisions yet. I call this
19 meeting adjourned.
20 WHEREUPON - Meeting was adjourned at 4:40 P.M.
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