House Committee on Government Reform
Subcommittee on National Security, Veterans Affairs,
and International Relations

Statement by Dr. William Winkenwerder, Jr.

Assistant Secretary of Defense for Health Affairs /
Special Assistant for Gulf War Illnesses, Medical Readiness,
and Military Deployments

Mr. Chairman, I appreciate the opportunity to appear before the Subcommittee on National Security, Veterans Affairs, and International Relations to report on the Department of Defense's continuing efforts related to the illnesses and undiagnosed physical symptoms of veterans of the Gulf War, to review the ongoing medical research into the health of veterans of all deployments, and to provide information on the status of some deployment health surveillance programs.

First, let me emphasize that the Department of Defense is committed to providing a world-class health care system for its servicemembers and their families. This commitment is especially strong today when our soldiers, sailors, airmen, Marines and Coast Guardsmen are deployed throughout the world in support of Operation Enduring Freedom and other contingencies. As America's sons and daughters serve and protect our nation, I recognize they may encounter unique challenges from operational or environmental conditions as well as from combat. The Gulf War and subsequent deployments to Somalia, Bosnia, and Kosovo provided the Department of Defense important insights into the importance of deployment health protection. In response, we have changed processes, revised procedures, and invested heavily in research to develop more effective force health protection measures and equipment for our people, but we are not finished. We are assessing and monitoring current deployments and are committed to provide for all who have health concerns related to deployments.

Issues and concerns from the Gulf War remain and I intend to continue our vigorous efforts to address and resolve these issues. I am equally committed to broaden those efforts to include issues and concerns arising from current and future deployments.

I take seriously my role as the Special Assistant for Gulf War Illnesses, Medical Readiness, and Military Deployments and have begun to focus on deployment health issues as they affect the entire military health system.

I have aligned the staff of the office of the former Special Assistant into my Deployment Health Support Directorate, which will continue to provide support and outreach to all those with issues associated with any deployment. Through my Deputy Assistant Secretary of Defense for Force Health Protection and Readiness, the Deployment Health Support Directorate, in cooperation with the Joint Staff and the military services, will provide me critical assessments of deployment health related processes and issues. As a result, I can more closely monitor force deployment health protection issues. Improving the adequacy of environmental surveillance, completeness of individual medical records, and implementation of other lessons learned will allow the military health system to be responsive to the health concerns of our servicemembers, veterans, and their families.

One area in which we continue to advocate the health concerns of servicemembers and veterans is through our support of medical research. As you may know, Health Affairs, and the Deputy Under Secretary of Defense for Science and Technology participate on behalf of the Department on the interagency Research Working Group of the Military Veterans Health Coordinating Board. This Research Working Group facilitates coordination and collaboration of research among the Departments of Defense, Veterans Affairs, and Health and Human Services. I believe the veterans are best served by following accepted scientific processes for selection and funding of medical research. I am committed to investigating the possible causes of illnesses and treatments for medically unexplained physical symptoms that are affecting veterans.

Numerous studies have documented that Gulf War veterans report physical symptoms and medical problems at a greater frequency than do their contemporaries who did not deploy to the Gulf. Although the precise reasons for these differences are unclear, we must evaluate these observations to better understand the potential health effects of military deployments.

The Department's research priorities for this fiscal year include:

In addition, we have begun research on the health of military personnel over their entire careers and beyond. A prospective study of U.S. military forces, called the Millennium Cohort Study, responds to the need for a longitudinal study to assess the health impact of major elements of military service, especially deployments and their associated risks. This study also responds to recommendations from Congress and the Institute of Medicine to systematically collect population-based demographic and health data to evaluate the health of servicemembers throughout their military careers and after leaving military service. This study will eventually use a cross- sectional sample of over 140,000 military personnel who will be followed prospectively every three years over a 21-year period through 2022.

Further, in response to veteran concerns and congressional direction, we have established three centers focused on deployment health issues. These centers provide research, medical surveillance, and clinical care services. For example, the Center for Deployment Health Research in San Diego has established a DoD birth defects registry and monitors reproductive outcomes among all military families, including those of personnel who have deployed. All three centers work closely with their VA counterparts-two centers for the study of war-related illnesses.

The Department also has taken steps to ensure that military personnel are fit and healthy when they deploy, that we monitor their health while they are deployed, and that we assess their health when they return. The Center for Deployment Health Surveillance at Walter Reed Army Medical Center in Washington D.C. is our key to tracking and analyzing these deployment health data. Our policy and practice is to assess potential health threats in areas of deployment, and minimize such threats where feasible. All of these principles are incorporated in DoD policy letters and directives and into a policy memorandum of the Joint Staff. The combatant commanders and their component commands through the extensive professional efforts of the military services' medical departments execute these policies and directives in the field.

As documented for Gulf War veterans, the majority of ailments found in deployment participants have been medical conditions seen commonly in other military, veteran, and civilian outpatient populations. The Deployment Health Clinical Center, also at Walter Reed Army Medical Center, in cooperation with the Department of Veterans Affairs, has developed and tested a patient-oriented, evidence-based clinical practice guideline to aid primary caregivers in the assessment of illnesses that occur after deployments. Implementation of this guideline will begin next month. My expectation is that all beneficiaries who have been involved with deployments - including families of deployed servicemembers - will receive health care that is fully responsive to any special health issues which arise after deployments. I believe this clinical practice guideline will foster an important partnership between the individual with the health concern and the caregiver who directs individualized treatment for better continuity of care. This guideline is the most recent in the DOD's and the VA's history of collaboration on clinical practice guidelines for medical problems in our beneficiaries.

In addition, the Department continues to work towards fielding medical information systems to provide complete patient health records electronically, including all immunizations. Such systems will greatly facilitate the preservation of individual health records, epidemiological studies of military health, and transfer of health records to the Department of Veterans Affairs.

We will continue our close collaboration with the VA to improve medical service to our veterans. In addition to the clinical practice guideline, we have instituted common separation medical examinations, which efficiently serve the needs of veterans, the DoD, and the VA. Another result of DoD-VA partnership is "FEDS HEAL". This program establishes a network that links the provider resources of the VA and the Department of Health and Human Services Division of Federal Occupational Health to furnish physical examination, immunization, dental screening, designated dental treatment, and other specified diagnostic services to units and individuals in the National Guard and Reserve components. I fully expect additional successes from our continuing collaboration with the VA.

In conclusion, the Department of Defense is committed to ensuring the health of our military forces, and I am committed to doing everything in my power to provide a world-class health care system for our servicemembers and their families.

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