Mr. Chairman, I appreciate the opportunity to appear before the Subcommittee on Health and the Subcommittee on Oversight and Investigations to report on the progress of the Department of Defense investigation of Gulf War illnesses. In previous testimony presented before the full Committee on February 11, 1997, I outlined the mission of my office and described the full extent of the commitment of the Department of Defense. We are truly committed to finding out everything we can to determine the possible causes of these illnesses while providing the best possible care for those who are ill. We also have an eye toward the future as we learn from our Gulf experience and make the necessary changes in policies, doctrine, and technologies to protect our forces in the future.
With an increased level of resources and redirected efforts, we have focused on the goal of conducting as thorough an investigation as possible into why many of our veterans who served in the Gulf War are ill and have entered into a broader dialogue with them as we proceed in our investigation. We remain committed to our veterans who served our nation so willingly; and committed to the mutual trust upon which the military contract with our service members depends. We know full well that if that commitment doesn't express itself in action - it doesn't exist.
That commitment was demonstrated in the recent presidential decision to extend the presumptive period for compensation for Persian Gulf veterans with undiagnosed illnesses. As you know, the government compensates for disability, not exposure. In the case of symptoms that may be attributed to Persian Gulf veterans' illnesses, the benefit of the doubt regarding service connection would be in favor of the veteran. We welcome this because it completely eliminates any argument that our actions are driven by concerns over government liability. Our inquiry never has been, and never will be, driven by such concerns. Our only interest is to support our veterans by vigorously searching for the causes of illnesses among our Gulf War veterans.
Throughout this process our first and foremost concern has been, and will always be, the health of our veterans. We are continuously encouraging anyone who is ill to contact the DoD Comprehensive Clinical Evaluation Program (CCEP) or the VA Registry Examination Program to schedule an appointment for medical evaluation.
The CCEP provides medical evaluations and care for DoD beneficiaries who are Persian Gulf War veterans including active, Reserve, National Guard, and retirees, and eligible family members of such personnel. Individuals calling the toll-free hotline will receive a call from their local medical treatment facility within seven days to schedule an appointment. The medical treatment facilities must do the initial evaluation within 30 days. These evaluations help us diagnose symptoms and begin a program of medical care. As of today, over 41, 000 have been enrolled in the CCEP and 27,160 have completed exams. To date, approximately 3,024 exams are in process. The CCEP receives an average of 200 calls a week which lead to enrollment in the program. In addition to the CCEP program, the Veterans Affairs Registry Examination Program has a current enrollment of approximately 70,000 veterans.
The DoD continues to approach the problem of the Persian Gulf veterans illnesses in a far-reaching, inclusive and comprehensive manner. When we realized that the Khamisiyah demolition operation had the potential of chemical exposure for our troops, we directed our investigative team to expand the search to all possible operational, intelligence, and medical sources which may shed light on the causes of illnesses suffered by many of our veterans. Our investigation shifted to better understand two fundamental questions. First, what was the potential for exposure to chemical agents at Khamisiyah and second, who might have been exposed. Our approach also required that we examine all events in the theater of operations for their possible linkage to the causes of illnesses. In this investigative process, we have unearthed facts that were not previously known. Our aim is to provide as complete an account of these events as possible.
During the course of our investigation, we have worked to communicate with our veterans to explain our efforts and to gain an understanding of their personal concerns. Since December, our activities in the area of risk communication have intensified. We have eliminated the backlog of calls from veterans who call our 1-800 Incident Reporting Line. This one-on-one contact with veterans has helped our investigators obtain valuable information that is incorporated into our investigation. Approximately 90% of the people who have called have been fully debriefed by a trained investigator. Their insights have increased our understanding of various events and incidents before, during, and after the war.
We launched an outreach effort in January mailing surveys to approximately 20,000 Gulf War veterans who may have been within 50 kilometers of the Khamisiyah site when bunker demolition took place. Veterans were asked if they witnessed chemical detection from indicators such as M8 alarms, M256 kits, or Fox vehicle detections; if symptoms were experienced or observed; and, if they saw or heard anything that may be helpful to the investigation. To date, more than 6,000 veterans have responded; of that number, approximately 300 commented that they experienced health problems since leaving the Gulf; approximately 300 provided information on recollections they had regarding the site. This latter group is receiving follow-up calls from our investigators for a full debriefing of their experiences. This response has provided our investigation and analysis team with many new leads which are being followed up with telephone interviews.
Communication with veterans, Congress, and the American people is a high priority for our investigation. To this end, we have improved our GulfLINK INTERNET website to include a news article format to explain what we are doing on a week-to-week basis. A hyper-text capability on the site will provide supporting information to the more technical case narratives as they are released. Our GulfLINK website is now interactive. Veterans who have questions about our investigation can now e-mail the Defense Department with their concerns and get answers. We hope this will allow us to hear from the public and be even more responsive to Gulf War veterans.
To strengthen our relationship with VSOs, I have held two monthly roundtable meetings with veterans service organizations -- one in February and one in March. I consider feedback and participation from veterans' organizations in this investigation to be a critical element in answering questions pertaining to the relevant health care issues that concern them. Nationwide public forums have been scheduled. At the invitation of the Veterans of Foreign Wars and the American Legion, I will participate in nine town hall meetings throughout the country beginning on April 20, 1997. I look forward to this opportunity to have a one-on-one conversation with our veterans. Meetings will be conducted in Cleveland, Kansas City, Dallas, Atlanta, and Boston. In May we will travel to Denver, San Diego, Seattle and Chicago.
Our investigation is organized around a formal case management system.
Cases may include examination of incidents like Khamisiyah or other environmental hazards and issues such as the use of pyridostigmine bromide (PB) tablets and pesticides. Case managers direct the efforts of many teams that review events and issues that occurred before, during or after the war to assess how events relate to potential causes of illnesses or to the need for future changes in policy.
The Investigation and Analysis Directorate (IAD) comprises the largest element of the Office of the Special Assistant and directly supports the analytical effort. The Chemical and Biological Warfare Agents Team is presently the largest team within the IAD investigating 25 cases of suspected or reported chemical detection.
The Environmental and Occupation Exposures team is investigating all cases relating to environmental and occupational exposures including depleted uranium, pesticides, and similar potential causes of illnesses.
The Medical Planning Issue Team is investigating the medical planning, policy and relevant exposure issues relating to immunizations, pyridostigmine bromide, stress, infectious diseases, and any other potentially medically-related causes of illnesses among Gulf War veterans.
The results of each investigation will be released to the public. The Khamisiyah narrative published in February was the first in a series of reports intended to open up a dialogue with Gulf War veterans. We intend to publish narratives related to incidents or issues involving Camp Monterey, Fox Vehicle capabilities, Marine Breaching Operation, Czech/French detection, Mustard Exposure, and Al Jubayl in the next 60 days.
Also central to our investigation is the Veterans Data Management team who work practically around the clock calling veterans for their input and observations. We are asking veterans that we interview to share with us any logs, journals, videotapes, or photographs they might have in addition to eyewitness accounts to further the investigative efforts.
The Khamisiyah narrative is an interim report which portrays our best understanding of what occurred as we know it at this point in time. The narrative does not represent a final product. It was released with an appeal to individuals who were in the Khamisiyah vicinity to contact us with any information that would help us better understand the activities at this facility after the war. As we receive additional personal descriptions from veterans as well as survey results, the IAD will continue to refine the case narrative.
Ultimately, we endeavor to determine if the demolition activities at Khamisiyah during March and April 1991 relate to why some of our Gulf War veterans are sick. As we learn more about the demolition itself, and unit locations in the area, we'll have a better sense of who may have been exposed.
Given the contradictory information that has been uncovered about the demolition at Khamisiyah, it is prudent to rely on only the confirmed demolition that occurred on March 10. During that demolition operation, there were no reports of chemical munitions nor were there reports of anyone experiencing symptoms consistent with exposure to chemical agent. Subsequent inspection by the U.N. in late 1991, early 1992, and then again in May 1996 suggested that there were chemical munitions stored at Khamisiyah during the time in which U.S. forces destroyed the depot. It was not until 1995 that the evidence led CIA, and later DoD, to begin investigating the possibility that U.S. forces could have destroyed these munitions and possibly been exposed to chemical agents. This was confirmed in a U.N. visit in May 1996 and announced by the Department in June 1996.
Efforts to determine potential exposure have been ongoing. Because of the difficulties inherent in modeling the pit, Deputy Secretary of Defense White requested that the Institute for Defense Analyses (IDA) convene a panel of experts in meteorology, physics, chemistry, and related disciplines to review all of the modeling efforts. IDA also reported continued concern about the inability to describe the many variables of the agent-munition release mechanism. The IDA agreed with the CIA that huge uncertainties remained in attempting to estimate key variables such as the number of rockets present for destruction and the number of those destroyed, total quantity of agent released, mechanism of release, and purity of agent. Both the CIA and IDA presented testimony on this issue before the March 4, 1997 public meeting of the Presidential Advisory Committee on Gulf War Veterans. At this time, DoD is working with the CIA to conduct a series of small scale tests at Dugway Proving Ground in Utah to provide insights into numbers of rockets destroyed, mechanism and quantities of agent released, and initial agent behavior.
Many questions remain to be answered. Why during the demolition operation were there no reports of anyone, soldier or civilian, experiencing symptoms consistent with exposure to a chemical agent? If there was a release of agents into the atmosphere, did it go up and who did it pass over? If there was an exposure, what are the possible health effects?
The Department of Defense believes that our search for answers to the question of who may have been exposed to chemical agents requires action now. Therefore, having discussed these concerns with the Presidential Advisory Committee at their last meeting, I am going forward with an analysis of participation rates for personnel registered the CCEP and VA medical registry programs and that were examined prior to July 1996 with regard to time and unit locations relative to Khamisiyah events. We believe that our measure of outcome, while not having scientific rigor, will help further our investigation.
In time, when modeling yields its best estimate of where chemical agents may have affected troops, we can observe whether the rates of participation are in some way associated with the dispersal of chemical agent.
Research will help us understand the long-term effects of exposures to a number of factors present in the Gulf War. As I reported to the Committee in February, the DoD has strengthened its research program to study a wide range of medical issues related to Persian Gulf veterans' illnesses. For fiscal year 1997, we will spend up to $27 million in Gulf War-related research. The Department's research program is conducted with extensive collaboration with the Departments of Veteran Affairs and Health and Human Services through the Research Working Group of the Persian Gulf Veterans Coordinating Board. We are actively pursuing solid research proposals examining the consequences of possible exposure to low levels of chemical agent. In late 1996 and in early 1997, requests for proposals were published in the Commerce Business Daily to solicit proposals investigating the causal relationships between illnesses and symptoms among Gulf War veterans and possible exposures to hazardous material; chemical warfare agents; stress; combinations of inoculations and investigational new drugs during military service in the Gulf War. Proposals have been received and they are undergoing internal and external scientific review.
To insure that we fully understand the existing state of science on a variety of issues related to the health of Gulf War veterans and to help focus our future efforts, we have asked the RAND Corporation to prepare extensive medical literature reviews in nine areas including: pesticides, immunizations, chemical warfare agents, pyridostigmine bromide, stress, biological warfare agents, depleted uranium, infectious diseases, and environmental exposure to oil fires. The literature reviews will examine published articles, books and government reports.
We continue to seek the advice of oversight organizations for recommendations throughout this investigative process. The Department of Defense has taken guidance in many matters from the Presidential Advisory Committee on Gulf War Veterans' Illnesses. In March, the Departments of Defense, Veterans Affairs and Health and Human Services submitted to the President an action plan in response to the recommendations contained in the Committee's Final Report.
Additionally, the DoD IG is investigating the disposition of CENTCOM's nuclear, biological, and chemical logs. The Army Inspector General is conducting an investigation of events at Khamisiyah. The Assistant to the Secretary of Defense for Intelligence Oversight is conducting a further investigational effort that deals with the intelligence aspects of Khamisiyah. We expect both of these reports to be completed later in the spring.
Our investigation is one that deals concurrently with the past, the present and the future. We are attending to the health needs of our veterans, seeking them out
and responding to their concerns. We are examining the past through a very thorough, painstaking investigation to find out what occurred that could be affecting the health of many veterans. We are also looking to the future and applying what we learn to ensure that the Department implements necessary changes to military doctrine, procedures, and equipment to ensure that we protect our troops in the future. As we discover new leads, we will use every resource at our disposal to move our investigation forward. We will "widen the net" with outreach, communication, town-hall meetings and any other vehicle that maximizes the dissemination of vital information and provides further insights into our investigation.
We are conducting an open investigation. We are actively declassifying documents and making them available to the public. The Army as the executive agent for declassification has pursued every lead and recently visited numerous installations, facilities, and commands to ensure the most complete compilation of documents pertaining to the Gulf. This very pro-active approach has recently produced another 66,000 additional new pages of information. We will fully disclose everything we learn, when we learn it.
You have my commitment that we will aggressively pursue all of these issues. No effort will be spared to determine the causes of these illnesses and to provide the medical care our Gulf War veterans need and deserve.
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