The Persian Gulf Veterans Coordinating Board Action Plan
with Respect to the Findings and Recommendations
of the Presidential Advisory Committee
on Gulf War Veterans' Illnesses Final Report

The Persian Gulf Veterans Coordinating Board comprised of the Secretaries of Defense (DoD), Health and Human Services (DHHS), and Veterans Affairs (VA) greatly appreciates the effort, thought and constructive recommendations provided by the Presidential Advisory Committee on Gulf War Veterans' Illnesses in its final report.

Like the Presidential Advisory Committee, the three Departments recognize that the issues surrounding Gulf War veterans' illnesses are complex. Since the end of the Gulf War, concerns have been raised as to whether there is a relationship between the illnesses (diagnosed and undiagnosed) being experienced by some Gulf War veterans and their family members and a variety of possible hazardous exposures during service, including chemical warfare agents. We share these concerns and are taking concrete steps to determine the causes of these illnesses and to provide care for veterans who are ill.

The Presidential Advisory Committee's "Final Report" provides a number of important findings and valuable recommendations. This plan outlines the Departments' actions, including those already partially or fully implemented, taken in response to the findings and recommendations of the Presidential Advisory Committee in their "Final Report." This Action Plan is a dynamic document which will need to be revisited and adjusted as information becomes available and we learn more. Furthermore, in the upcoming weeks, the three Departments and the Persian Gulf Veterans Coordinating Board will develop specific timelines for the actions proposed.

The plan addresses actions to be taken in the areas of outreach, medical and clinical issues, research, coordination, investigations, and chemical and biological weapons. These actions include:

• Initiation of a Presidential Review Directive pursuant to which the National Science and Technology Council will create an interagency plan to address health preparedness for, and readjustment of, veterans and their families after future conflicts and peacekeeping missions.
• The Persian Gulf Veterans Coordinating Board's Clinical Working Group will develop a comprehensive risk communication plan. Government and non-government risk communication experts will be engaged to assist in development and implementation of the plan.
• VA Transition Assistance Program briefings for service members separating from active duty will emphasize the VA programs and services available to Gulf War veterans and their families.
• VA will ensure that its outreach to the Latino populations provides information on Gulf War-related programs. A Spanish language information pamphlet and federal veterans benefits guide are being produced.
• Re-evaluation and enhancement of the Persian Gulf Veterans Coordinating Board will include the addition of new members to the existing Clinical, Research, and Compensation Working Groups. Further, a Deployment Planning Working Group will be established to make recommendations for interagency activities, and to monitor pre-deployment, deployment, and post-deployment medical surveillance programs.
• The Food and Drug Administration is preparing regulations that will solicit public and expert comment on any rule that permits waiver of informed consent for use of investigational products in military exigencies.
• Deployment health surveillance programs will be carried out involving pre-deployment health screening and education, deployment operational, environmental, and medical surveillance, and post-deployment health surveillance and risk communication.
• DoD is developing enhanced orientation and training procedures to inform service personnel about the health risks, benefits and proper use of military medical countermeasures to chemical and biological warfare agents.
• Military medical record keeping will be given particular priority by DoD officials at the highest levels. Computerized medical records, meditags, and compatible information systems are under development.
• Continuing medical education programs for health care providers in VA and DoD will be enhanced to ensure up-to-date patient education and delivery of high quality health care.
• DoD is developing a Directive on Combat Stress that will set forth policy, improve stress reduction and management programs, and involve military leadership in stress management and unit cohesion programs.
• DHHS will engage in a special effort designed specifically to impact the stigmatization of stress-associated and other mental health conditions.
• DoD has established the Office of the Special Assistant for Gulf War Illnesses, which is responsible for investigation of reported Gulf War-related incidents that may have health consequences. This effort involves case management and release of investigation narratives, and outreach to veterans and Military Coalition organizations. Recent activities include initiation of a Khamisiyah survey to collect information from veterans who were there and to encourage them to participate in the health registries.
• Service members who may have been exposed at Khamisiyah and other sites will be notified and any needed evaluation and care provided; moreover, appropriate research will be conducted.
• Research activities are a key component of the government's response. Related initiatives include:
  
  • The Persian Gulf Veterans Coordinating Board has encouraged Public Advisory Committees be established for all large epidemiologic studies;
    
• Federal research requests for proposals include:
  
  • the possible long-term health effects of chemical and other hazards (including subclinical exposure to chemical warfare nerve agents);
    
  • studies of combined exposures to pyridostigmine bromide, pesticides and other agents;
    
  • epidemiologic feasibility studies on Khamisiyah veterans and other groups possibly exposed to low-level chemical agents; and
    
  • research on stress-related disorders.
    
• Development of a strategic plan for research into the potential health consequences of exposure to chemical and other hazards, including low-levels of chemical warfare agents; and
• Support for long-term mortality studies and cancer registries.

The Persian Gulf Veterans Coordinating Board has engaged in a comprehensive, coordinated effort to respond to the health concerns of Gulf War veterans. DoD, DHHS and VA are committed to finding answers to Gulf War illnesses and look forward to working with the Presidential Advisory Committee on Gulf War Veterans' Illnesses to achieve this goal. Our veterans and their families deserve no less.

Last updated 7/14/97. TLJ