Today, I would like to clear up any misconceptions concerning what I meant when I said that exposure to DU was not "medically significant" and what medical science has been telling us. But before I do that, I would like to reiterate another conclusion I spoke about in Washington; namely that the use of DU during the Gulf War undoubtedly saved thousands of American lives.

As I noted in March, the only soldiers on the battlefield who should have been most concerned about DU during the Gulf War were the Iraqi soldiers, not because it might have a long term effect on their health, but because their tanks and armored personnel carriers provided them no protection from our DU munitions. DU rounds ripped through their tanks and their guns were totally, and I mean totally, ineffective in penetrating American armor protected with DU shielding-- there were no instances in which the DU armor of our tanks was breached. DU did have an effect on the battlefield. Just ask any American tanker if he wants to face the Republican Guard in battle without every advantage we can provide him, including DU shielding and DU SABOT rounds.

Over the past several months it has become clear that there remains confusion about several issues concerning DU exposure and dose. There are two points that I want to make clear that may help to address this confusion:

• First, in assessing DU we need it is important to understand the distinction that medical toxicologists and environmental health experts make concerning the concepts of "exposure" and "dose." Or as medical science has long known, the dose makes the poison.e."

• Second, I would like to share with you the overwhelming consensus concerning DU by the medical review groups that have looked into the issue. This includes the medical surveillance of those soldiers taking part in the Department of Veterans Affairs (DVA) medical screening program since 1993.

On August 4^th, my offices recently published our first Environmental Exposure Report on Depleted Uranium in the Gulf. This report is available by calling my office (800-497-6261) or over the Internet (http://www.gulflink.health.mil). In the report we estimated the health risk from DU by using a health risk assessment methodology modeled on one developed by the National Academy of SciencesUS Environmental Protection Agency. It consists of four steps: Hazard Identification (Exposure), Toxicity Assessment, Dose Assessment, and Risk Characterization. Specifically, as applying this model to DU:

• Hazard Identification - who was exposed, and how? Which incidents warrant a full investigation?
• Dose Assessment - how much DU were the troops exposed to? What chemical or radiological doses do these intakes represent?
• Toxicity Assessment - what are the known medical effects of human exposure to DU? At what levels of exposure do these effects occur? How can the effects be mitigated?
• Risk Characterization - using validated toxicity and dose information, what medical effects can be anticipated? How serious are those effects? How can the effects be communicated to those affected?

Clearly, just because a person may have been exposed to a substance does not mean that he or she received a dose that will prove to have health effects. A dose is measured as quantity, frequency, and length of exposure. Not all doses are medically significant. We need to know the dose and toxicity of the substance to determine if a specific exposure/ or dose presents a medical risk. By way of comparison, let me use asbestos as an example. Many of you know that we are completely remodeling the Pentagon. One of the first tasks is to identify the asbestos before removeing it, which is a known cancer causing substance. If, during a visit to the Pentagon you were briefly exposed to asbestos dust you would not immediately assume you were going to get cancer. It would all depend upon the quantity, frequency, and length of exposure--or the dose you received over time. Nevertheless, we insist on strict environmental isolation limits to asbestos exposures and dosage to the ALARA level or the level that is "as low as reasonably achievable." DU is much the same. Here is what we know about DU:

First, in terms of Hazard Identification, we group the exposure during and after the Gulf War into three levels based on the activities of the soldiers involved, and the resulting potential for direct contact with DU dust. These three exposure levels provided a prioritized approach to describing and evaluating the potential exposures that occurred:

Level I � Soldiers are those in or near combat vehicles at the time these vehicles were struck by DU penetrators, or who entered vehicles immediately after they were struck by DU munitions. These soldiers could have been struck by DU fragments, inhaled or ingested significant amounts of DU dust, or had DU particles land on open wounds, burns, or other breaks in their skin.

Level II - Soldiers and a small number of DoD civilian employees are those who worked in and around vehicles containing DU fragments and dust. These soldiers may have inhaled DU dust stirred up during their activities on or inside the vehicles, transferred DU dust from hand to mouth, thus ingesting it, or spread contamination on their clothing.

Level III - An "all others" group whose exposures were largely incidental and very brief. This group includes individuals who entered DU-contaminated Iraqi equipment, troops downwind from burning Iraqi or US equipment struck by DU rounds, or personnel downwind from burning DU ammunition.

Second, in terms of Dose Assessment the US Army�s Center for Health Promotion and Preventive Medicine (CHPPM) has reviewed existing test data on DU exposures to develop dose estimates for Level I exposures. Level I exposures are being addressed first, because these veterans are expected to have received the highest exposures.

To estimate the intake, the amount of DU taken into the body by inhalation, CHPPM developed a "worst case" estimate which is twice as large as any exceeds known exposures in the Gulf. The maximum radiation dose for Level I individuals for this In other words, this "worst case" as it turned out is estimated was 0.96 rem. For comparison, the average radiation dose to a member of the US population from background radiation is 0.3 rem per year. In other words, the "worst case" is the same as living in the United States for about three years, and importantly, is less than one-fifth the annual dose limit allowed by the EPA Nuclear Regulatory Commission for industrial workers., which is 5 rems per year. The chemical exposure for heavy metal toxicity based on the same dose scenario was about 9 milligrams of soluble DU. For individuals near the tanks who did not enter the crew compartment, intakes of soluble DU are calculated to be much less, in the microgram range (14 micrograms). Most medical experts agree that DU�s heavy metal toxicity is the primary health concern, not DU�s radiological hazard. This point has drawn considerable attention in the third and fourth phases of our methodology: Toxicity Assessment and Risk Characterization. And this leads us to the next topic.

The Toxicity Assessment and Risk Characterization work continues on two fronts. Several organizations have reviewed the limited existing medical literature on DU and the much more voluminous literature on natural uranium. In addition, the VA has been monitoring the health of 33 - Level I - soldiers that who were exposed to DU. Here is a sample of what these reviews have told us:

• From the VA in their 1997 Annual Report to Congress, published last March, "Preliminary results from clinical follow-up study at the Baltimore VA Medical Center of 33 Gulf War veterans with embedded DU fragments show neither evidence of renal damage nor any other long term consequences to date. This clinical study complements two important animal toxicology studies conducted by the Armed Forces Radiobiology Research Institute that examine cancer and non-cancer endpoints in laboratory animals with embedded DU." And again, in their Evaluation Protocol for Gulf War Veterans with Potential Exposure to DU (July 1998), "The medical effects of DU exposure are continuing to be evaluated ... While no clinically significant adverse effects of DU have been evident to date in this group, some abnormalities have been detected on specialized testing."

• From the National Institutes of Health, published in 1994 in the Journal of the American Medical Association,, "Uranium, a heavy metal, causes kidney damage and when inhaled can accumulate in the lungs, but no pulmonary toxicity has been reported. The symptoms reported among the Persian Gulf veterans do not appear to be related to the heavy metal uranium."

• From the Presidential Advisory Committee in their 1996 report, "It is unlikely that health effects reported by Gulf War veterans today are the result of exposure to DU during the Gulf War."

• From the "Independent Consultant Report" prepared by the VA�s Dr. Melissa McDiarmid for the Senate�s Veteran Affairs Committee, released September 1998, concluded, "Because the radioactivity of DU is very low, the chemical toxicity of DU may be the more significant contributor of human health risk. ... Other heavy metals - such as lead, chromium, tungsten, and uranium--are (also) chemically toxic. The toxic properties of DU and uranium have been broadly studied. ... In summary, while DU is a radiological hazard, its relatively low radiological activity, the low likelihood of prolonged duration of exposure (except for the group with retained metal fragments), ... suggests that a significant cancer risk from DU exposure is small."

To assess the health of Gulf War veterans exposed to DU, we also have information from medical evaluations of those that we know have been most heavily exposed to DU. This is a unique source of informationbecause we would never purposefully imbed our soldiers with DU fragments, but because of unfortunate battlefield injuries, from friendly fire incidents, enabling us we are able to evaluate to evaluate these exposures directly. "Since 1993, the Department of Veterans Affairs has been monitoring 33 vets who were seriously injured in friendly fire incidents involving depleted uranium. These veterans are being monitored at the Baltimore VA Medical Center. Many of these veterans continue to have medical problems, especially problems relating to the physical injuries they received during friendly fire incidents. About half of this group still have depleted uranium metal fragments in their bodies. Those with higher than normal levels of uranium in their urine since monitoring began in 1993 have embedded DU fragments. These veterans are being followed very carefully and a number of different medical tests are being done to determine if the depleted uranium fragments are causing any health problems.

"The veterans being followed who were in friendly fire incidents but who do not have retained depleted uranium fragments, generally speaking, have not shown higher than normal levels of uranium in their urine.

"For the 33 veterans in the program, tests for kidney function have all been normal. In addition, the reproductive health of this group appears to be normal in that all babies fathered by these veterans between 1991 and 1997 had no observable birth defects."

This last July (1998) the DoD and VA instituted a medical follow-up program to evaluate the remaining veterans who received the largest DU exposures during the Gulf War --Level 1 and Level 2. The follow-up program is aimed at ensuring that Gulf War veterans with higher-than-normal levels of uranium in their bodies are identified and given appropriate monitoring and treatment. The follow-up will be executed in phases. It is likely that most soldiers will have normal levels of uranium in their bodies. The program requires a 24-hour urine collection for urine uranium level and a detailed DU exposure questionnaire in addition to the examination Gulf War veterans receive through the CCEP or the VA�s Gulf War Registry. Should any health problems be detected, there will be an opportunity for a medical follow-up with a local primary care physician and/or specialists. The staff at the Baltimore VA is available to consult with primary care physicians about how to assess DU exposures clinically, how to interpret the results of tests for urinary uranium, how to educate veterans who have concerns about DU, and other relevant clinical questions.

Let me make this perfectly clear. While we are focusing on soldiers in Level 1 and 2, the implementing directive from the VA states, "if the veteran was not identified by DOoD as a possible DU exposure, but ... has a high level of concern after counseling by a DoD or VA registry provider, a DU protocol examination should be completed."

Of course, this program is built on the existing Baltimore VA program. Unfortunately, the results of the Baltimore program have sometimes been misrepresented, but here is the description that Dr. McDiarmid has approved for the DU "Fact Sheet" that accompanies the new follow-up program:

"Since 1993, the Department of Veterans Affairs has been monitoring 33 vets who were seriously injured in friendly fire incidents involving depleted uranium. These veterans are being monitored at the Baltimore VA Medical Center. Many of these veterans continue to have medical problems, especially problems relating to the physical injuries they received during friendly fire incidents. About half of this group still have depleted uranium metal fragments in their bodies. Those with higher than normal levels of uranium in their urine since monitoring began in 1993 have embedded DU fragments. These veterans are being followed very carefully and a number of different medical tests are being done to determine if the depleted uranium fragments are causing any health problems.

"The veterans being followed who were in friendly fire incidents but who do not have retained depleted uranium fragments, generally speaking, have not shown higher than normal levels of uranium in their urine.

"For the 33 veterans in the program, tests for kidney function have all been normal. In addition, the reproductive health of this group appears to be normal in that all babies fathered by these veterans between 1991 and 1997 had no observable birth defects."

DoD and VA plan to evaluate the DU testing results for the Level I and II soldiers and will then determine if further testing is warranted. Our office plans to release an updated Environmental Exposure Report on DU in the Gulf War in about one year.

Let me raise one final point The American Legion has been a leader in pressuring the DoD in DU training. As you know, The Deputy Secretary of Defense ordered a review of the current training and asked my office to monitor this training. After the first of the year, I will be sending field site evaluation teams to monitor DU training and report back to The Deputy Secretary of Defense on program execution. This is an area where we intend to be very proactive.

Again, in closing, let me say that I concur with the position taken by our organization. Specifically, "The American Legion is awaiting the completion of the ongoing research agenda before it will concur with definitive statements regarding the causes of Gulf War Illnesses. We (the American Legion) acknowledge, however, that the available scientific evidence weighs against DU as a likely risk factor for GWI."

Thank you very much.