3 HEALTH CARE PROBLEMS AND CONCERNS OF PERSIAN
GULF WAR VETERANS: THE RESPONSE OF THE DEPART-
MENT OF VETERANS AFFAIRS AND THE DEPARTMENT
OF DEFENSE AND RELATED ISSUES
^Y 4. V 64/3: 103-33
Health Care Problens and Concerns o. . .
HEARING
BEFORE THE
SUBCOMMITTEE ON
0\^RSIGHT AND IM^STIGATIONS
OF THE
COMMITTEE ON VETERANS' AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRD CONGRESS
FIRST SESSION
NOVEMBER 16, 1993
Printed for the use of the Committee on Veterans' Affairs
Serial No. 103-33
U.S. GOVERNMENT PRINTING OFFICE
3-904 CC WASHINGTON : 1995
For sale by the U.S. Government Printing Office
Superintendent of Documents. Congressional Sales Office, Washington. DC 20402
ISBN 0-16-046657-1
] HEALTH CARE PROBLEMS AND CONCERNS OF PERSIAN
GULF WAR VETERANS: THE RESPONSE OF THE DEPART-
MENT OF VETERANS AFFAIRS AND THE DEPARTMENT
OF DEFENSE AND RELATED ISSUES
Y 4, V 64/3: 103-33
Health Care Problens and Concerns o...
HEARING
BEFORE THE
SUBCOMMITTEE OX
OVERSIGHT AND IM^STIGATIONS
OF THE
COMMITTEE ON VETERANS' AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRD CONGRESS
FIRST SESSION
NOVEMBER 16, 1993
Printed for the use of the Committee on Veterans' Affairs
Serial No. 103-33
-? s
U.S. GOVERNMENT PRINTING OFFICE
0-904 CC WASHINGTON : 1995
For sale by the U.S. Government Printing Office
Superintendent of Documents. Congressional Sales Office. Washington, DC 20402
ISBN 0-16-046657-1
COMMITTEE ON VETERANS' AFFAIRS
G.V. (SONNY) MONTGOMERY, Mississippi, Chairman
DON EDWARDS, California
DOUGLAS APPLEGATE, Ohio
LANE EVANS, Illinois
TIMOTHY J. PENNY, Minnesota
J. ROY ROWLAND, Georgia
JIM SLATTERY, Kansas
JOSEPH P. KENNEDY, II, Massachusetts
GEORGE E. SANGMEISTER, Illinois
JILL L. LONG, Indiana
CHET EDWARDS, Texas
MAXINE WATERS, Cahfomia
BOB CLEMENT, Tennessee
BOB FILNER, California
FRANK TEJEDA, Texas
LUIS V. GUTIERREZ, Illinois
SCOTTY BAESLER, Kentucky
SANFORD BISHOP, Georgia
JAMES E. CLYBURN, South Carolina
MIKE KREIDLER, Washington
CORRINE BROWN, Florida
BOB STUMP, Arizona
CHRISTOPHER H. SMITH, New Jersey
DAN BURTON, Indiana
MICHAEL BILIRAKIS, Florida
THOMAS J. RIDGE, Pennsylvania
FLOYD SPENCE, South Carolina
TIM HUTCHINSON, Arkansas
TERRY EVERETT, Alabama
STEVE BUYER, Indiana
JACK QUINN, New York
SPENCER BACHUS, Alabama
JOHN LINDER, Georgia
CLIFF STEARNS, Florida
PETER T. KING, New York
Mack Fleming, Staff Director and Chief Counsel
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
LANE EVANS, Illinois, Chairman
MAXINE WATERS, CaUfomia
BOB FILNER, California
LUIS V. GUTIERREZ, Illinois
JAMES E. CLYBURN, South Carohna
MIKE KREIDLER, Washington
JILL LONG, Indiana
THOMAS J. RIDGE, Pennsylvania
SPENCER BACHUS, Alabama
TERRY EVERETT, Alabama
JACK QUINN, New York
(II)
CONTENTS
Page
OPENING STATEMENTS
Chairman Evans 1
Hon. Jack Quinn 2
Prepared statement of Congressman Quinn 103
Hon. Thomas J. Ridge 5
Hon. Mac CoUins 6
Prepared statement of Congressman CoUins 106
Hon. Joseph P. Kennedy II 6
Hon. Spencer Bachus 11
Prepared statement of Congressman Kreidler 104
Prepared statement of Congresswoman Brown 105
WITNESSES
Albuck, Troy, accompanied by KelU Albuck, Barrington, IL 19
Prepared statement of Troy and Kelli Albuck 168
Blanck, Maj. Gen. Ronald R., Commanding General, Walter Reed Army Medi-
cal Center 72
Brown, Hon. Jesse, Secretary, Department of Veterans Affairs; accompanied
by Dr. John T. Farrar, Acting Under Secretary for Health; Dr. Susan
H. Mather, Assistant Chief Medical Director, Environmental Medicine and
Public Health; Dr. Susan Ritter, Ph.D., MPH, Persian Gulf Family Support
Program Coordinator, Persian Gulf Health Advisory Clinic Co-Director, VA
Medical Center, Birmingham, AL, R.J. Vogel, Deputy Under Secretary for
Benefits; J. Gary Hickman, Director, Compensation and Pension Service,
Veterans Benefits Administration; and Mary Lou Keener, General Counsel . 82
CuUinan, Dennis, Deputy Director, National Legislative Service, Veterans
of Foreign Wars of the U.S., accompanied by Brian Martin, Niles, MI 31
Prepared statement of Mr. Cullinan 176
Egan, Paul S., Executive Director, Vietnam Veterans of America 33
Prepared statement of Mr. Egan appears 184
Gelband, Hellen, Senior Associate, Health Program, Office of Technology As-
sessment, accompanied by Maria Hewitt, Senior Analyst, Health Program,
and Clyde J. Behney, Assistant Director, Health, Life Sciences and the
Environment 3
Prepared statement of Ms. Gelband 157
Hollingsworth, Kimo S., Assistant Director, National Legislative Commission,
The American Legion 31
Prepared statement of Mr. Hollingsworth 179
Jackson, Dr. Charles, Environmental Physician, Staff Physician, Staff Physi-
cian, VA Medical Center, Tuskegee, AL 58
Prepared statement of Dr. Jackson 218
Martin, Brian, Niles, MI 25
Shayevitz, Dr. Myra B., Director, Cardio-Pulmonary Laboratory, Pulmonary
Rehabilitation Program, VA Medical Center, Northampton, MA 56
Striley, Timothy James, Fulton, IL 22
Prepared statement of Mr. Striley 171
(III)
IV
MATERIAL SUBMITTED FOR THE RECORD
Documents:
Analysis and amendment to H.J. Res. 15 44
Written committee questions and their responses:
Chairman Evans to Department of Veterans Affairs 221, 223
Congresswoman Long to Department of Veterans Affairs 237
Chairman Evans to Dr. Myra Shayevitz 238
Chairman Evans to Department of Defense 243
Chairman Evans to Veterans of Foreign Wars 263
Chairman Evans to Dr. Charles Jackson 265
HEALTH CARE PROBLEMS AND CONCERNS
OF PERSIAN GULF WAR VETERANS: THE
RESPONSE OF THE DEPARTMENT OF VET-
ERANS AFFAIRS AND THE DEPARTMENT OF
DEFENSE AND RELATED ISSUES
TUESDAY, NOVEMBER 16, 1993
House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Veterans' Affairs,
Washington, DC.
The subcommittee met, pursuant to call, at 9 a.m., in room 334,
Cannon House Office Building, Hon. Lane Evans (chairman of the
subcommittee) presiding.
Present: Representatives Evans, Montgomery, Gutierrez, Ken-
nedy, Long, Kreidler, Ridge, Bachus, and Quinn.
Also Present: Representatives Browder and Collins.
OPENING STATEMENT OF CHAIRMAN EVANS
Mr. Evans. The hearing will come to order.
On June 9, the Subcommittee on Oversight and Investigations
conducted a nine-hour marathon hearing on the health care prob-
lems and concerns of Persian Gulf War veterans. From veterans
and their loved ones, we learned that many who served are now
chronically ill.
These heroes of the Persian Gulf War are shackled by a wide
array of health problems and symptoms. They had been healthy
and physically fit before their Gulf services. Now, they cannot re-
sume the active and productive lives they led before serving in the
Gulf.
These ongoing health problems were reemphasized last week
when the full committee, at the request of Congressman Joe Ken-
nedy, conducted a special hearing and received added testimony
from more than a dozen individuals.
In June, we also learned veterans and active duty servicemen
and women were not always receiving priority medical attention for
their health problems. In some cases, veterans were reportedly told
they would not receive care until they made a copayment. In other
cases, repeated efforts to get help from their government produced
only repeated failure. Some Gulf War veterans turned elsewhere
for help. Others simply gave up.
Witnesses representing VA and DOD told the subcommittee
some Gulf War veterans did have health problems, but a diagnosis
had been elusive. More research was needed. Gulf veterans' health
(1)
problems were not a mystery to several private physicians who ap-
peared before the subcommittee. But while they identified cause,
diagnosis and treatment, their answers were not the same.
In the 5 months since the June hearing, what has been done and
what has been learned about these health care problems? How
have the VA and DOD responded and how have they worked to-
gether?
What research has been conducted and what new information
has been gained? What treatment is being provided and is it suc-
cessful?
What has been learned from the Gulf War Registry programs?
Do we know what happened in the Gulf and the causes of these
health care problems?
Has all the information which might be essential for effective
treatment been provided?
These and many other related subjects are the issues before the
subcommittee today.
I am very pleased at this point to recognize the distinguished
chairman of the full committee, Sonny Montgomery.
Mr. Montgomery. Thank you very much, Mr. Chairman. As you
said in your statement, we need to get all of the information and
all of the facts we can about chemical weapons that could have
been used or not used in the Persian Gulf.
I commend you for having this hearing, and I commend you for
starting on time.
Mr. Evans. Following your leadership, Mr. Chairman.
The gentleman from New York.
OPENING STATEMENT OF HON. JACK QUINN
Mr. QuiNN. Thank you, Mr. Chairman, and thank the chairman
of the full committee, Mr. Montgomery, for reminding the three of
us that we are on time.
Mr. Chairman, I appreciate more than any the work you have
done on this issue, and look forward to hearing testimony this
morning.
It seems that each and every week more information comes to
light on this matter, and the important thing for all of us to recog-
nize and to keep in the forefront of our minds is that we don't fool
around and wait with this thing. Time is of the essence, and the
sooner we get to it the better. I think all of us agree with that.
I will have an opening statement for the record, but I appreciate
the time
[The prepared statement of Congressman Quinn appears at p.
103.]
Mr. Evans. It will be included in its entirety, and we salute you
for being here at the beginning, as you are regularly.
Mr. Quinn. Thank you.
Mr. Evans. The subcommittee's first witness today is Hellen
Gelband, Senior Associate, Health Program, Office of Technology
Assessment. She is accompanied by Maria Hewitt and Clyde
Behney.
Hellen, your entire statement will be made part of the hearing
record, without objection, and you may proceed when you are
ready. If you care to summarize, you may do so.
STATEMENT OF HELLEN GELBAND, SENIOR ASSOCIATE,
HEALTH PROGRAM, OFFICE OF TECHNOLOGY ASSESSMENT,
ACCOMPANIED BY MARIA HEWITT, SENIOR ANALYST,
HEALTH PROGRAM, AND CLYDE J. BEHNEY, ASSISTANT DI-
RECTOR, HEALTH, LIFE SCIENCES AND THE ENVIRONMENT
Ms. Gelband. Thank you, Mr. Chairman, for the opportunity to
participate in this hearing.
PubUc Law 102-585 charged the Director of OTA with assessing
the potential utihty of the DOD and VA Registries for "scientific
study and assessment of the intermediate and long-term health
consequences of military service in the Persian Gulf."
Our first report, issued 2 months ago, focused on the Department
of Veterans Affairs Persian Gulf Veterans Health Registry, which
is the examination program initiated by the VA for Persian Gulf
veterans.
We also started to look at how the Defense Department is carry-
ing out its mandate, developing a geographic information system
linking troop locations with exposure to oil well fires.
When Congress directed the VA to create a Registry for health
examinations of Gulf veterans, the greatest potential hazard ap-
peared to be the smoke pouring from hundreds of oil wells that had
been set on fire by the Iraqis. The Defense Department mandate
also centered on assessing the risk to health posed by the fires.
Once completed, the DOD system may be used in various ways
to consider possible health damage from oil fire smoke. DOD will
be able to tell individual veterans about his or her level of exposure
by using daily company locations and modeled estimates of air pol-
lutant concentrations, although it will be difficult to explain just
what those exposures mean in terms of the veteran's health. The
DOD system also could be used to identify cohorts of individuals
with relatively high and relatively low exposures to the oil fire pol-
lutants should it be decided that it is necessary to do in depth stud-
ies.
The emphasis on oil fires as the exposure around which both
DOD and VA conducted their activities, however, means that it will
be much less useful for exploring other potential hazards. The limi-
tations of DOD's and VA's mandated activities are worth noting.
The VA Registry can provide only descriptive information about
the individuals who requested an examination either because they
are sick or because they fear potential ill effects of their Gulf serv-
ice. The hope is that the individuals who do come will serve as sen-
tinels for health problems that might be emerging among Persian
Gulf veterans more widely, but no valid conclusions about cause
and effect can be made on the basis of the Registry population
alone.
The task of deciding whether to pursue a possible health problem
in a separate study will be the big challenge and one for which
there is no set of rules to follow. The judgments of experts in medi-
cine and epidemiology will have to be relied on and strong dif-
ferences of opinion about what to do are guaranteed.
The DOD system will be used mainly for studying the effects of
oil fires and possibly also for other geographic variables, but al-
ready there are concerns about inoculations, depleted uranium, ve-
hicle paint, diesel fumes, and chemical warfare agents to name a
few, and these will benefit relatively little from DOD's Registry ac-
tivity.
Whether or not these represent real threats, they must at least
be acknowledged and considered for further evaluation and that
work will have to proceed on an ad hoc basis in addition to the
mandated Registry.
Decisions about whether epidemiologic studies should be under-
taken will be made ultimately on the basis of expert opinion offered
by the Institute of Medicine's Medical Follow-up Agency, and, of
course, also by VA and DOD. But there is no neat formula for them
to make those decisions.
The lOM's job could be made easier however, by making sure
that they have an accurate historical record of troop activities in
the Persian Gulf and that there is a clear idea of what information
about possibly hazardous exposures exist in personnel and other
military records. This information is not now easily available, as
we found out when we were asking to get records of that sort.
OTA's report includes the following suggestions: (1) that specific
changes be made in the Department of Veterans Affairs' examina-
tion protocol; (2) that coordination between DOD and VA be
strengthened, perhaps by appointing a single advisory board to
oversee both activities, which would be independent of VA and
DOD and would include technical experts and veterans representa-
tives; (3) that the Department of Defense assemble information
about the Persian Gulf Conflict, including the specific activities of
military units and the distribution of other potential exposures and
experiences.
Next, that DOD and VA each catalog and describe other medical
information available for Persian Gulf veterans from before, during
and after their tours of duty, such as their intake examinations,
blood samples that may have been stored and other medical exami-
nations.
And finally, that VA and DOD standardize the terminology that
they are using in their activities. We believe that that is relatively
simple and should be happening now.
We are working on our second mandated report which will focus
on DOD's Oil Fire Modeling Project. This includes the development
of a geographic information system which comprises satellite map-
ping, atmospheric monitoring, modeling of contaminant concentra-
tions, and health risk assessment, all being carried out currently
in a pilot phase by the Army Environmental Hygiene Agency.
The Army expects to report on the pilot project at the end of the
calendar year, and OTA's report is due in February. Those efforts
will eventually incorporate troop location data being assembled by
the U.S. Army and Joint Services Environmental Support Group.
OTA will report on the technical merit of each major component
and on how the system will work together.
A particular concern and one that requires coordinated effort be-
tween VA and DOD now is how information about individual risks
will be communicated to veterans.
Thank you again for the opportunity to appear here, and we will
be happy to answer any questions.
[The prepared statement of Ms. Gelband appears at p. 157.]
Mr. Evans. Thank you very much.
Before asking members of this panel questions, I want to intro-
duce some of the Members that have joined us, including the rank-
ing minority member, Tom Ridge from Pennsylvania.
OPENING STATEMENT OF HON. THOMAS J. RIDGE
Mr. Ridge. Thank you, Mr. Chairman. Let me thank you for your
continuing interest and your leadership in this measure. I believe
you initiated the first set of hearings on the Persian Gulf syndrome
and the problems affecting our veterans in that area many, many
months ago, and I applaud your leadership.
Last week, we heard some very compelling and collaborative tes-
timony fi-om Persian Gulf veterans, and I know that the Depart-
ment of Defense and the Department of Veterans Affairs are con-
cerned about medical causation. There is a great deal of work we
need to do in order to determine whether or not some or all of
these men and women are presently suffering as a result of their
service.
But I have been a long-standing proponent of giving these men
and women veterans anywhere the benefit of the doubt. And, as
the doctors and the scientists scramble to determine medical causa-
tion and therefore service connection, it seems to me that there are
enough of these men and women who experience this wide range
of physical problems and they all have one thing in common. They
didn't have these problems before they got to the Persian Gulf.
Physical manifestations were evident either at the time of service
or shortly thereafter.
Caring for our veterans is a continuing cost of our defense, and
I certainly hope that the Department of Veterans Affairs will give
these men and women the benefit of the doubt while the scientists
determine medical causation down the road. I think it is absolutely
imperative.
We heard testimony last week that some of these men and
women are waiting in excess of a year for that initial examination.
So I applaud your continuing effort and pledge to work with you
in whatever way possible to get them into these facilities for that
initial examination, and give them the benefit of the doubt. They
deserve to be treated. It is a continuing cost of defense, and not to
do anything, in my judgment, would be literally turning our backs
on them, and I don't think anybody in this committee wants to do
that.
I thank you, Mr. Chairman.
Mr. Evans. Thank you. I associate myself with your remarks and
will be working with you to address these issues.
Let me introduce the number one point man in Congress, I be-
lieve, in terms of dealing with this entire issue. Glen Browder from
Alabama.
Mr. Browder. Thank you, Mr. Chairman. We have got a lot of
witnesses that we all want to hear from today. I have no remarks,
other than to thank you for your leadership on this.
Mr. Evans. Does the gentleman from Georgia have any opening
statement?
OPENING STATEMENT OF HON. MAC COLLINS
Mr. Collins. Thank you, Mr. Chairman. I appreciate the oppor-
tunity of being allowed to participate this morning. I do have a
statement I would like to submit for the record, and also permis-
sion to submit statements and letters on behalf of the 24th Naval
Reserve Construction Battalion from Columbus, GA, they have sent
up that they would like to have submitted for the record also.
[The prepared statement of Congressman Collins, with attach-
ments, appears at p. 106.]
Mr. Evans. Without objection, so ordered.
The gentleman from Illinois.
Mr. Gutierrez. Mr. Chairman, I am going to refrain from mak-
ing any comment right now. I am going to wait for the witnesses
from the State of Illinois and the City of Chicago at our hearing
that you were so generous to conduct with me a couple of weekends
ago to expound on this issue.
Thank you very much for calling this hearing.
Mr. Evans. The gentleman from Massachusetts.
OPENING STATEMENT OF HON. JOSEPH P. KENNEDY II
Mr. Kennedy. I am sorry I had to be a couple minutes late, Mr.
Chairman, but I do appreciate the opportunity to give an opening
statement this morning.
I want to thank you for holding this very, very important hearing
and the impressive array of witnesses that you have been able to
assemble. Chairman Evans, who is the chairman of this sub-
committee, has done yeoman's work in trying to continue to pursue
exactly what happened in the Persian Gulf and what potential ex-
posures created the illnesses that we have heard so many individ-
ual soldiers indicate that they are facing.
Today marks the fifth hearing that this committee has held to
investigate the health concerns of Persian Gulf veterans. Yet today
the VA and DOD are not any closer to understanding the ailments
of Persian Gulf veterans. Measurable progress has not been made.
Today, even more questions remain to be answered by the Defense
Department and the VA about possible causes and diagnoses and
treatment of the serious illnesses experienced by thousands of sol-
diers.
Last week, the Pentagon acknowledged the Czechoslovakian De-
fense Ministry findings that chemical warfare and mustard gas
agents were detected during the early phases of the Persian Gulf
War. Yet despite repeated calls by the Congress, DOD's investiga-
tion has been cursory at best.
DOD maintains that there were no U.S. reports of detections and
that there were no reported health effects in the field. This runs
contrary to the accounts of many of our Persian Gulf troops.
At a special committee hearing last week we heard compelling
testimony from veterans who believe that they were hit by chemi-
cal and biological warfare agents. We were assured by DOD that
those cases would be investigated by today, but so far we have had
no response back from the Pentagon. In fact, from the DOD brief-
ings, it sounds like the Pentagon and our soldiers fought two dif-
ferent wars. There must be full and public disclosure of all infor-
mation about chemical and biological agents and all other possible
exposures behind these ailments that might explain the sicknesses.
In light of recent concerns about biological and chemical warfare
agents, I will commend VA Secretary Brown for taking swift steps
to announce a pilot program for testing veterans who feel that they
may have been exposed to these agents.
Last week's testimony from Persian Gulf veterans about their in-
ability to get recognition and treatment for their health concerns
demonstrated in human terms the many common threads of their
experiences, not only a similarity of symptoms of their illnesses,
but the pattern of inadequate response from the VA and DOD med-
ical systems designed to provide for their care. They feel that the
VA and DOD have turned a deaf ear to their concerns.
Government efforts have not been comprehensive or aggressive
enough. While the VA and DOD ponder the next steps, our des-
perately ill Persian Gulf veterans struggle for answers amid dete-
riorating health and bankrupt savings.
The men and women who served our country in the Persian Gulf
deserve resolution of their health concerns. VA and DOD must now
convince them that their service to our country has not been forgot-
ten by responding now.
Mr. Chairman, I thank you again for holding these hearings, and
I very much look forward to the testimony of our witnesses today.
Appreciate the time.
Mr. Evans. Thank you very much.
Does the gentlewoman from Indiana have any opening remarks?
Ms. Long. I have no opening statement.
Mr. Evans. Ms. Gelband, we are going to be focusing today on
the coordination between the Department of Defense and VA. We
have had concerns about the Department of Defense not giving VA
timely information, particularly about chemical attacks.
One of the issues that you suggest might be improved upon is
supplementing existing coordination and cooperation with regards
to the Registries. Could you elaborate a little bit more on that?
Ms. Gelband. I think the most important recommendation that
we made in that regard is to have a joint oversight committee that
is not part of DOD or VA to help look at the big picture — what are
the potential uses of all these various information collection sys-
tems and how can they be used best to help the veterans.
At the moment what we see is that VA and DOD are both very
much concerned with carrying out their mandates and individually
developing their systems, and in that they are making considerable
progress, but there isn't focus on the bigger picture.
For instance, the potential chemical agent situation could be — an
oversight committee, which would be better at deciding or helping
decide where studies could be done and what exactly needs to be
done at a given moment.
Mr. Evans. The gentleman from Pennsylvania.
Mr. Ridge. Are you satisfied with the protocol that the Depart-
ment of Defense has established in collaboration with the VA to
identify troop locations, to deal with troop movements, to take the
history we have of the different SCUD missile attacks, location of
the oil fires, bringing all of these things into consideration so that
they are in a position to either affirm or deny some of the testi-
8
mony, or reject some of the testimony made by individual veterans
with regard to their relationship to these different attacks and the
impact on them and their personal health.
Ms. Gelband. We haven't fiilly evaluated DOD's activities. That
is our second report. But we have started to, and I think in terms
of troop locations we are comfortable that that is proceeding apace
and that the information that the environmental support group will
need is available both in some computerized records and in paper
records, and that that will be taken care of.
We also are confident that the position of the oil fires is fairly
well known fi-om satellite photographs and ground monitoring of
the air. DOD also is carrying out modeling for periods when they
had no on-the-ground monitoring, and that also is probably rel-
atively secure.
I don't know that they have any plans to include the positions
of SCUD missiles. That wasn't part of their mandate and I don't
know whether they have that information.
Mr. Ridge. Okay. Well, I appreciate that.
There was a gentleman who testified last week that based on his
training and based on the device that they had in their area that
would detect chemical or biological or bacteriological warfare, that
shortly after what he thought was a SCUD missile attack, he felt
a burning sensation of his skin, his eyes were watering, he had a
bad taste in his mouth, and 20-some-plus men in his unit out of
30 plus people, had very serious physical problems manifested
shortly thereafter.
And one of the things we might want to do, Mr. Chairman, is to
see to it that future studies include the proximity of some of these
attacks. They still haven't been really forth-coming as to whether
or not chemical agents were used, but it seems to me that the man
had been trained as a soldier to detect chemicals, the use of chemi-
cals or biological weapons. He made that personal detection based
on his training. The equipment that they had set up sounded
alarm, suggesting there was an agent in the air, which was consist-
ent with his physical reaction at that time. I think it is very impor-
tant that we see to it that future studies include, perhaps, some
tests of that as well.
And I thank you very much for your testimony.
Mr. Evans. Mr. Chairman.
Mr. Montgomery. Thank you, Mr. Evans.
Over the years I have found that departments of government
sometimes have a problem cooperating with each other, and it
would seem to me in a situation like this, Ms. Hewitt, that the De-
partment of Defense and the Veterans Department has got to to-
tally cooperate with each other to get to the bottom of this situa-
tion. We have to get the information from the Defense Department
for this committee to move ahead and to see that veterans are
treated fairly.
What is your assessment of how these two Departments are
working so far to come up with some answers that we can use?
Ms. Gelband. Well, I think they have both been carrying out
their mandates. But, as I mentioned, when the mandates were first
given, the main concern was the oil fires because that is what was
so visible and looked like such a potential hazard. The mandate
hasn't changed, and yet now we are seeing that there may be a lot
of other things that aren't being picked up in that mandated infor-
mation system and that aren't really being addressed.
Mr. Montgomery. In the Department of Defense is it
Ms. Gelband. Yes. Because they have been spending all of their
effort to develop a system to look at the effects of oil fires, which
is what they were originally tasked to do by the Congress. While
there are certainly people in DOD looking at these other questions,
most of their effort is going into the oil fire problem. And it may
just be that there needs to be a slight redirection.
Mr. Montgomery. That is a good point.
Mr. Chairman, are there any defense people here this morning,
do you know?
Mr. Evans. General Blanck will be testifying today.
Mr. Montgomery. Good.
Mr. Evans. Will the gentleman yield for a minute?
Mr. Montgomery. Yes.
Mr. Evans. Ms. Gelband, would you be recommending then that
Congress broaden the mandate by legislation? We won't be able to
broaden the mandate without legislation, is that correct?
Ms. Gelband. I don't know if you can. I am not sure.
Mr. Evans. Thank you. I yield back to the gentleman.
Mr. Montgomery. Thank you. I would hate to have to mandate
it. It is their responsibility. I would hope that the Defense Depart-
ment would get on this as quickly as possible.
You mentioned something about an oversight committee? We
have an oversight committee here. Why would we need any more
oversight committees?
Ms. Gelband. Well, as wonderful as this body is at oversight, I
was thinking of the more boring kind of scientific group — epi-
demiologists and physicians, people who would be thinking about
the technical uses of this information. What was suggested by our
group of advisors was a technical body which also would include
veterans representatives, so they could deal with both the technical
issues and the issues that were of greatest interest to the veterans
on a technical level.
Mr. Montgomery. Thank you, Mr. Chairman.
Mr. Evans. The gentleman from New York.
Mr. QuiNN. Thank you, Mr. Chairman. And thank you, Ms.
Gelband for your testimony.
I want to associate myself with the remarks of Mr. Kennedy a
little bit earlier this morning. We have heard testimony last week
and at four other hearings from veterans and others. We heard
from a mother last week who lost a son 11 months after he re-
turned fi-om the Persian Gulf. We heard fi*om a veteran who left
the hospital to come here and testify and then returned to the hos-
pital.
I don't know why these folks would not be telling the truth. I
don't know why we can't get the attention of the VA and DOD.
You make an excellent point, and so does the chairman of the
full committee, that we need to get these two government offices
working together. You are very polite when you say that they need
a slight redirection. I couldn't agree with you more, and appreciate
your candor.
10
Mr. Kennedy said that the VA and the DOD needs to convince
the veterans that they are helping them, and I couldn't agree more.
I think that the VA and the DOD needs to convince me that they
are working for the veterans. I think they need to convince this
committee and the rest of the Congress that they are.
You mentioned on the first page of your testimony that the law
mandating and creating the Registry also mandated that the OTA
assessment in the long term set up an arrangement for review. I
am interested to know, if you can tell us, what the long term
means. How long?
Ms. Gelband. Well, I think the long term at the moment is 10
years. I believe the agreement with the Institute of Medicine,
which is what you are referring to
Mr. QuiNN. Yes.
Ms. Gelband (continuing). Is for 10 years.
Mr. QuiNN. Okay.
Ms. Gelband. But I also think that we all know that there is
more than 10 years to go.
Mr. QuiNN. And in terms of an oversight committee, I made a
note of that when you mentioned it earlier today and the other
members have probed that a little bit. Could I explore that with
you, just for a few minutes?
I think you are suggesting that if we are going to get the VA and
the DOD cooperating together, redirected a little bit differently so
that they are sharing information, they are sitting down with each
other, that maybe an oversight committee of these people with
some veterans group be formed.
Ms. Gelband. Yes.
Mr. QuiNN. And how would that help you? What would be the
best thing that could do?
Ms. Gelband. In our view, they would be responsible for looking
at the bigger picture and they wouldn't be involved in carrjdng out
specific mandates, which VA and DOD are extremely busy doing.
VA and DOD have been given difficult tasks and they are working
on them. But I feel that they haven't had time to take a look at
a broader view.
Plus from what we know, we are not happy that there is enough
scientific oversight in epidemiology to think about what the ulti-
mate uses of these information systems might be. I think the Insti-
tute of Medicine, when they get started and when they start re-
porting, will be using the kind of people necessary for this task. So
maybe at that point they will fall into that oversight role. But right
now in these developmental stages that are so important, we don't
feel there is a group like that.
Mr. QuiNN. Okay. Thank you.
And, Mr. Chairman, if your suggestion to broaden that mandate
helps facilitate what we are hearing this morning, it sounded to me
like you were headed in that direction, I would be willing to help
you with that. I think it is a great idea.
Ms. Gelband, thank you for your answers to the questions. I ap-
preciate it.
Mr. Evans. Thank you. I look forward to working with you.
The gentleman from Alabama.
11
OPENING STATEMENT OF HON. SPENCER BACHUS
Mr. Bachus. Thank you, Mr. Chairman. I would just Hke to em-
phasize agreement with your statement for a joint oversight com-
mittee. It is needed very much. Because I think the VA is moving
ahead after a long slow start, because they are dependent upon the
DOD to demonstrate to them that there was some exposure, and
the VA, I think, has made a very good start on this.
And, frankly, I am not impressed with the Department of De-
fense's response to this problem. That is why I think the joint over-
sight committee is very, very important.
Thank you.
Mr. Evans. The gentleman from Georgia.
Mr. Collins. Thank you, Mr. Chairman. In reference to the co-
operation between DOD and VA several — well, approximately 2
months ago we contacted both and suggested and requested that a
joint task force be formed to go down to Columbus, GA, and talk
to those reservists down there.
We were notified by DOD that they were going and are going on
December 4 and 5. Last week in the hearings we had here, it was
mentioned to the DOD as well as Major General Blanck about the
fact that the Department of Defense was going down but VA had
not been included.
Since that day we have received confirmation from the Depart-
ment of Defense that a VA person will be accompanying them to
Columbus, GA. However, we have not received confirmation that
the VA will be accompanying DOD to Al Jubail, Saudi Arabia, for
the same purpose.
But there seems to be some small step toward some cooperation
between the two agencies in trying to get to the bottom of what
happened over in the Persian Gulf as well as what we can do to
see that these people get the proper help. The proper help that
they so deserve.
It is a small step. However, in terms of what we have been going
through for the last 2 V2 to 3 months and what some of these veter-
ans have been going through for the last 12 months, I consider it
to really be a giant step.
I too picked up on the comment you made about the oversight
committee. I think that could be very helpful, as well as these com-
mittee hearings, in trying to get to the bottom. I know when I met
with the Department of Defense a couple of months ago we had a
roomful of people. V7e had a commander from the Persian Gulf who
was actually over the reserve units from Columbus, GA.
A lot of mention was made to the fact that the logs, the daily logs
of events that happened would reflect whether or not there was a
chemical attack on the troops in Al Jubail. However, when I asked
the question. Have you actually reviewed those logs? The comment
was, "No, we have not."
So maybe if we — I know when I would get to the bottom or some-
body actually reviewing logs or bringing the logs and then letting
this Congress know exactly what happened over there. We are try-
ing at least to get to the bottom of what happened.
Again, thanks for allowing me to participate. And thank you for
your testimony.
Mr. Evans. My colleague from Illinois.
12
Mr. Gutierrez. Thank you very much, Mr. Chairman.
Ms. Gelband, in your summary you Hst other concerns that have
surfaced in addition to the oil fires. For example, you include inocu-
lations and depleted uranium, vehicle paint, diesel fiimes and
chemical warfare agents. You say that these should be acknowl-
edged and evaluated whether or not they represent, in your words,
"real threats."
I am just wondering what you meant by real threats. What level
of evidence do you need for it to be real? Are there other threats
out there that you might think are fake threats to the veterans?
Ms. Gelband. I was listing things that have arisen in the popu-
lar press and in records that may well be threats to health. We
don't know if people were actually exposed to all of them. Some
things might certainly be threatening to health if you are exposed.
If no one was exposed, well that would be a good thing, and they
wouldn't be real threats.
So, no, I don't have a level of evidence. My point there was just
that the data systems that have been set up weren't designed to
look at those things, and that we need to be able to look at them
and to assess whether they are important and whether we really
should be looking at them.
There are all kinds of things that are going to come up over the
years, some of which will be more important than others, and we
should have some way of sorting them out. The mandate given to
DOD and VA was really only about oil fires. So, just to acknowl-
edge that there are these other things that we should be concerned
about.
Mr. Gutierrez. I was particularly interested in one suggestion
that you had, and others alluded to it here this morning, in terms
of the task force. To ensure the credibility of the Pentagon's report,
you say that a representative group of veterans should offer input
before the report is released. I support that idea very much because
I believe that nobody knows this issue better than the men and
women who lived through it.
Can you talk to me about what assurance you think there could
be that veterans would indeed have an opportunity for real input
in a final report?
Ms. Gelband. I am not sure what you are referring to. Where
are you reading from?
Mr. Gutierrez. It says — on page 9. It says "It is important to en-
sure credibility that a mechanism be developed to allow input and
review from representative groups of veterans before the report is
issued. In addition the report should be written so that it is readily
understandable by individuals not schooled in military operations."
Ms. Gelband. Right. These are two reports that we rec-
ommended that DOD and VA put together about what actually
happened in the Gulf. And this one in particular may be a unit-
by-unit description of what people's major activities were, that
should be put together based on military records. Veterans who
served in those units should be able to review that information and
make sure that it is accurate, because we all know that sometimes
what gets written down isn't exactly what happened, and we just
want to make sure that we have a history of the war which will
be helpful in doing health studies later on. That it not only be accu-
13
rate according to what was recorded but what people remember ac-
tually going on.
Mr. Gutierrez. Well, let me just suggest that I highhghted that
part because I think it is very important to much of what we have
been trying to do and much of the obstacles that have presented
themselves as we look at the Gulf War and the effects to the veter-
ans, and whether or not they are being taken seriously, and wheth-
er any report is going to be taken seriously, whether their indica-
tion and their testimony, their beliefs about what happened to
them are being taken seriously by anyone.
So when I saw that in the report, it seemed to me that we need
to have real assurances that they are going to have a real impact
on the final report, and that we need to make a real commitment
to full and fair consideration to those comments that the veter-
ans— because, see, I really don't believe we would be here today
having this hearing if there had been given fair consideration to
what veterans have to say.
And I think that it is going to be a major obstacle, because in
everything that we have heard from the very beginning, they basi-
cally have been telling veterans, "Well, we are not quite sure which
one of you are lazy or malingerers and want a government pension
to live off of. It is fine to send you off to the Gulf War. We are not
quite sure."
They have questioned. They have questioned. The Veterans De-
partment and many have questioned the integrity and credibility
of the veterans that have served in the Gulf War. They didn't ques-
tion that integrity or that courage sending them there or when
they came back. We all agreed and applauded and there were
many parades for them. But now when they are a little sick, they
wonder.
And so the tests have not been about chemical warfare or the re-
actions or the agents that have been there, but whether or not the
veterans are telling the truth. They said, "Well, you know, you
might have a psychological problem." And so they have been given
medication for psychological problems.
And I really think that the real psychological problem that we
have had up to now- there is one. It is called denial on behalf of
the Department of Defense and the Veterans' Affairs Department.
And in order to break through that it is going to be very essential
that you and others, as you compile your information, give credence
to what veterans are saying in a real meaningful way, and that be-
fore they come — before those veterans are asked to come before
that they understand that they are going to be believed and that
they are not going to be questioned, and that their integrity and
credibility is not going to be at stake as it has been thus far.
Thank you very much for your testimony here this morning.
Mr. Evans. The gentleman from Massachusetts.
Mr. Kennedy. Thank you, Mr. Chairman. Thank you all for com-
ing and testifying this morning.
I think that you can play a very important role in trying to de-
fine much more clearly the exact role that now needs to be played
by both VA and DOD. I appreciate your notion that somehow a
joint task force ought to be assembled, but I think that given the
lack of enthusiasm that we have seen by both agencies to get to
14
the bottom of this issue requires us to be somewhat more definitive
in terms of what we expect.
Now, I have read your basic conclusions here. One, VA should
focus immediately on revising the examination protocol. Two, ter-
minology used by the VA and DOD should be brought into conform-
ity where appropriate. Three, a joint oversight body for the VA and
DOD Registries and their related activities should be appointed,
and would enhance existing coordination and cooperation for infor-
mation on exposures and other experiences of Desert Shield-Desert
Storm should be assembled by DOD into a qualitative history of
the Persian Gulf theater of operations. And, five, DOD and VA
should assemble annotated inventories of all sources of relevant
health and demographic data other than Registries for Persian
Gulf veterans.
It sounds good. But what it doesn't do is recognize that right now
you can have the Registry, but if you got a guy down in Houston
who is sajdng, "These are nothing but a bunch of malingerers," who
is running the Houston VA, it doesn't work. I mean, so the fact
that you coordinate a joint response between VA and DOD isn't
really going to get to the root cause of the problem.
We heard testimony at a hearing over a year ago by a professor
at M.I.T. This professor's name I can't — I can't quite remember
what his name was, but he — Thall, I think was the guy's name.
But anyway, he said that his life's work at that university was to
take the kind of chemical exposures that many people have in in-
dustry today — oil workers, people that work in fires, and a whole
range of other industrial personnel — and determine the level of ex-
posures that they face on a day-to-day basis and the kind of sick-
nesses that can be predicted would occur as a result of those expo-
sures.
Now, it seems to me that it ought to be possible for an organiza-
tion such as OTA to define very clearly in very specific steps what
is necessary to draw certain conclusions about cause and effect.
What we have got is a basic problem where on the one hand, as
Mr. Gutierrez just indicated, there is a sense that this is a bunch
of malingerers or people that have head cases or are complaining
about something other than an issue that was directly related to
an exposure of chemical or biological or other kinds of environ-
mental exposures that they encountered in the Persian Gulf versus
the notion that these fellows are really sick.
What I would like to ask is whether or not either of the three
of you — any of the three of you, have the capability of defining in
a very systematic, specific manner exactly what would be required
for us to be able to get a handle on whether or not the depleted
uranium, oil fires, perhaps a nerve gas or a biological agent that
went off and was hit by a SCUD being hit by a Patriot thousands
of feet above the air, and the best guess at what kinds of illnesses
might be caused by an exposure to those chemicals that would have
been vastly dispersed versus if the bomb goes off right next to you.
How do we begin to get a handle on whether or not the VA and
DOD are really going to the depth that they need to in order to
make these determinations?
And I will just finish by suggesting that even on the most fun-
damental issues of just following up on specific cases that have
15
come in, that we have gotten on this committee, we still can't get
the DOD to follow up. So my sense of the lack of the ability of us
to go in and get the job done, just in terms of following up on spe-
cific cases is indicative of the lack of enthusiasm that they have for
actually getting to the root cause of this problem.
So, what I would like is OTA to tell us what steps should be gone
through in order for us to feel confident that we are going to get
at the root cause of this problem. And I guess my sense is these
five steps aren't even close to going to be to get there.
Ms. Gelband.
Ms. Gelband. Well, a couple of things. First, the Institute of
Medicine's role over the next 10 years is to do at least some of what
you suggested: to look at exposures that have been suggested might
be harmful and to also review the results of the VA examinations.
I understand that there are about 10,000 Persian Gulf veterans
who have been examined and their records are now available to be
looked at systematically. That was the purpose of the committee's
mandating that the Medical Follow-up Agency review all of that in-
formation on an ongoing basis, and to do that they have a contract
jointly with VA and DOD. It wasn't OTA's role to do that.
Mr. Kennedy. No. But I actually did, I think, sponsor that
amendment, and that was, again, our committee's response to the
lack of diligence on behalf of DOD and VA to get to the root cause
of it. So what I am saying is that, you know, what you have got
is sort of this ad hoc group of Congressmen, you got Glen Browder
and Matt Collins who come from the DOD committee who are in-
terested in this issue. You have got a bunch of folks up here that
are kind of scattershot trying to get at — get a handle on this issue,
Ms. Gelband, and it seems to me to be a very reasonable request
to suggest that we don't feel, first of all, that it is right to wait 10
years. My God! We ought to be able to do better than that.
What we are trying to do is say aren't there a series of questions
that could be asked — I don't mean to make you laugh. I am just
trying to say there has got to be a series of 5 or 10 or 15 or 25
or 35 steps that we can ask DOD and VA to take up that are per-
haps going to be a little more detailed than we are going to do on
the seat of our pants up here that ought to define how they should
approach this problem. And that is something that I would think
that OTA would be in a very good position to help us define so that
we can ask those agencies to comply.
Ms. Gelband. Well, first, the Institute of Medicine has a 10-year
commitment, and they should be reporting regularly during that
period. That is how it was envisioned. That they would be review-
ing this information regularly and feeding back regularly. I don't
know what their plan is at the moment, but they were to carry out
that ongoing oversight of the data.
In terms of the bigger picture of all of the things that need to
be done to investigate and get to the bottom of things, as you say,
our mandate was specifically to evaluate the activities that were
mandated by the Congress
Mr. Kennedy. But isn't it your job to provide information to the
National Academy of Sciences to make considerations for further
epidemiological studies and the like? Isn't that part of your man-
date?
16
Mr. Behney. Well, what we can do is, in response to your ques-
tion, we could report back to the committee with a long memo to
you which would lay out how to respond to your question. It would
include examing the literature to see what's known about cause
and effect for certain exposures, how the National Academy of
Sciences and Institute of Medicine are responding to their respon-
sibilities, and how that fits into what you are asking for.
It would be difficult for us to respond today on the strength of
evidence between exposures and the specific diseases we are look-
ing at.
Mr. Kennedy. I wasn't really asking that. I wasn't expecting you
to provide me with that plan this morning. What I wanted to do
was determine — my understanding of what OTA does is provide
these kinds of specific recommendations when there is kind of a di-
lemma or a problem or a lack of enthusiasm by an agency to fulfill
the job that the Congress is asking.
So, we need some help in defining the series of questions that
will allow us to get to whether or not there was a cause and effect
relationship between the work that was done by our troops in the
Persian Gulf and the illnesses that they are currently feeling. And
what I want to do is just make a very simple determination wheth-
er or not your agency is the proper agency to help define for us
what those series of questions might be.
Mr. Behney. It is subject to our congressional board of directors
as to whether we actually undertake it, but it is an appropriate
role for OTA. It is the type of thing we do for Congress.
We don't initiate anything on our own, as you know. So if the
committee asks us to help them with that process, think it through,
see what would be needed and make suggestions about how to get
where you want to go, that is an appropriate role for OTA and
something that we do for Congress.
Mr. Evans. Will the gentleman yield?
Mr. Kennedy. Certainly.
Mr. Evans. We hereby request that information.
Mr. Behney. If you could put it in writing it would fulfill our
statute actually.
Mr. Evans. Thank you.
Mr. Behney. But we would be happy to get a letter like that.
Mr. ICennedy. I would be happy to put it in writing, but given
how difficult it was to get you to get this far, I am not sure we are
going to get to the root cause of the problem. But anyway, I would
be happy to and we look forward to any help or consideration you
might be able to give us in tr5dng to define what these issues are,
all three of you.
It really does, I think, warrant some scientific and medical analy-
sis that I don't believe was ever anticipated that Members of Con-
gress in and of themselves ought to bring to the table. This is what
OTA is supposed to do. So I think that it is entirely appropriate
for you to come forward and give us the list of questions.
I want to know what happened out there. That is what these
troops want to know. They are not looking for money. They are not
looking for some way to hurt the government. They are looking to
be told that the service that they provided is causing them these
illnesses, and it seems to me to be very reasonable to expect that
17
OTA could help define for us the series of steps that we should ex-
pect both DOD and VA to go through in order to make those deter-
minations.
Maybe you are never going to get to it and be able to definitively
say this occurred because that took place. But we might be able to
make a very well-educated guess. My sense is that that is what you
are probably going to be able to do.
But, if we don't ask the right questions and we don't do it in the
proper way, then somebody is always going to say the study was
flawed. So I want to make sure that we go through asking the
questions in the proper manner in order to make the proper conclu-
sions.
Sorry, Mr. Chairman. Thank you very much.
Mr. Evans. The time of the gentleman has expired.
The gentlewoman from Indiana.
Ms. Long. Thank you, Mr. Chairman. I don't have any questions
for this panel, but as a result of the panel's testimony I do have
some questions for panel five. And I am going to have to leave to
go to another meeting and I am just wondering if I can submit my
questions for the record.
Mr. Evans. Those will be submitted for the record, and the an-
swers thereto will also be submitted for the record, and we appre-
ciate your attendance today.
(See p. 237.)
Mr. Evans. We are very pleased to be joined by another gen-
tleman from Alabama, a very active member of our subcommittee
who joined us in his hometown last Friday at the Birmingham VA
facility, Spencer Bachus.
Mr. Bachus. Thank you, Lane.
Ms. Gelband, we have been doing some reading on Iraq and their
use of biological warfare during the Iran-Iraq War, and I think
there are several documented instances of Iraq and Saddam Hus-
sein using biological warfare.
I noticed in your assessment you didn't list the possibility of bio-
logical warfare, and I notice the so-called binary theory where you
mix chemical warfare agents and biological warfare agents, and I
think that it has been documented that Iraq on occasions used
that, and that Russia used it in Afghanistan, and it may have been
used in Laos. Was that considered?
Ms. Gelband. I don't think that was part of our task, really, to
consider what other things may have been happening. I would hope
that the Institute of Medicine would consider that kind of informa-
tion and perhaps review any medical information fi*om those other
instances. We were asked to review what had been done in re-
sponse to the mandates of the VA and DOD and it just didn't fall
within our purview.
Mr. Bachus. So, the use of biological agents really wasn't consid-
ered?
Ms. Gelband. We didn't consider any agents specifically because
we were concerned about the ability to investigate that sort of com-
bination of things and any other agents or exposures that arise. It
would't be done by us.
Mr. Bachus. Can our detectors detect biological agents, espe-
cially, say, mycotoxins?
18
Ms. Gelband. You are way out of my field. I don't know.
Mr. Bachus. I know you mentioned the fact that the nerve gas
and the Sarin and the mustard gas were very low concentrations.
But I wondered if our detectors can detect these mycotoxins.
Mr. Behney. I hate to keep saying we didn't look into that, but
our response was to the congressional mandate to DOD and VA,
which is primarily concentrated on oil well fires, and the reason
that we listed some other possible agents, exposures of various
kinds, is because the current efforts are not going to be able to
allow us to look at things as you are suggesting.
So, we are agreeing with you that a capability needs to be devel-
oped in order to find out if those exposures took place. But we
didn't look at that and so can't answer your specific question. But
we agree that someone has to be able to.
Mr. Bachus. I think with Sarin and with this HD, the mustard
gas, there is a lot of research on the exposure levels and what the
results are, but I think when we get into whether biological agents
were used, we really lack the expertise, at least I have seen noth-
ing in these studies to indicate that we have. Is there a possibility
that biological warfare was practiced by Saddam Hussein during
the Persian Gulf War?
Mr. Behney. I just don't know how to answer that. Nothing we
have done would give us any base fi*om which to answer that.
Mr. Bachus. Either way?
Mr. Behney. Yes.
Mr. Bachus. To either exclude it or otherwise? What I am con-
cerned about is that we have spouses and children of our Gulf War
veterans who are exhibiting symptoms of some disease or infection
and I don't know how we account for that. Have you got any
thoughts on that, as to why?
You all have seen evidence of that too, I am sure, or complaints
by veterans that their children and their spouse are coming down
with symptoms.
Mr. Behney. I don't know anything about that. We are not inter-
acting directly with veterans or their spouses.
Mr. Bachus. Have you received information from the VA that
that is being reported?
Ms. Gelband. No we haven't. In the VA examination they do ask
about reproductive effects in spouses — about births — but not about
other illnesses.
Mr. Bachus. Yes. Are you aware of that? Were you aware that,
as we are hearing from veterans back in our district, that their
wives and their children are exhibiting some of the same symptoms
that they have?
Ms. Gelband. We don't have that information.
Mr. Bachus. I don't know how widespread this is.
Ms. Gelband. I haven't seen anything.
Mr. Bachus. No further questions.
Mr. Evans. We want to thank this panel for testifying. We ap-
preciate your work.
Because of the technical problems we have been having, we are
going to recess for 5 minutes so they can be corrected.
[Recess.]
19
Mr. Evans. We will now reconvene. If everyone could be seated,
please.
The members of our second witness panel are Troy Albuck, Tim
Striley, Paul Egan, Kimo Rollings worth, Dennis Cullinan, and
Brian Martin.
Troy is a Persian Gulf War veteran from Barrington, IL. Tim is
a Persian Gulf veteran from Fulton, IL. Paul is Executive Director
of Vietnam Veterans of America. Kimo is a Persian Gulf War vet-
eran who testified before the subcommittee in June. Today he is
testifying on behalf of The American Legion. He is Assistant Direc-
tor for the Legion's National Legislative Commission. Dennis is
Deputy Director, National Legislative Service, Veterans of Foreign
Wars of the U.S. He is accompanied by Brian Martin, a Persian
Gulf War veteran from Niles, MI.
Without objection, your entire statements will be entered into the
record. Troy, once you are situated we will start with you. Troy is
from the Chicago area. We welcome him today as we did on No-
vember 6 last year when the subcommittee was in Congressman
Gutierrez's district.
If you could help us, Tim. Please pull the microphone over to Mr.
Albuck. Troy you may proceed.
STATEMENTS OF TROY ALBUCK, ACCOMPANIED BY KELLI
ALBUCK, BARRINGTON, IL; TIMOTHY JAMES STRILEY, FUL-
TON, IL; PAUL S. EGAN, EXECUTIVE DIRECTOR, VIETNAM
VETERANS OF AMERICA; KIMO S. HOLLINGSWORTH, ASSIST-
ANT DIRECTOR, NATIONAL LEGISLATIVE COMMISSION, THE
AMERICAN LEGION; DENNIS CULLINAN, DEPUTY DIRECTOR,
NATIONAL LEGISLATIVE SERVICE, VETERANS OF FOREIGN
WARS OF THE U.S., ACCOMPANIED BY BRIAN MARTIN, NILES,
MI
STATEMENT OF TROY ALBUCK
Mr. Troy Albuck. Thank you. The first thing I would like to do
is, I wrote something but I am going to depart from that for just
a second.
We are spending a lot of time talking about what kind of agent,
biological, chemical, where it came from, who used it, did it really
happen, did we detect it — that would be much the same as if I
walked in with a sucking chest wound from a gunshot wound and
you trying to figure out what kind of rifle shot the bullet before you
give me any medical attention. Okay?
This is a wound that we sustained in combat that just had a lit-
tle lag time on it. Okay?
Unlike, you know, the lucky guys who just get gunshot wounds
and get it treated, we are the unlucky ones that got something that
took some time to show up. Okay.
Honorable ladies and gentlemen of the House of Representatives,
I want to thank you for this opportunity to speak.
Growing up I knew I could do anjrthing I wanted, but the key
was to find something worth doing. I thought I had found it, a most
noble endeavor, defend the Constitution.
I enlisted in the Army in 1984 when I was 17. I made sergeant
at 18, and was commissioned a lieutenant at 19. I was an airborne
20
ranger, infantry officer from the 82nd Airborne Division with a
combat infantrjnnan's badge from Panama and Iraq by the age of
24. I had expected to be a captain within months and a colonel by
35. The country's money problems changed that course.
I would have stayed with absolutely no pay, but no one seemed
to listen to that. I had 30 days to, take my new family back to
where I came from. Unknown to me, I also carried a chemical
wound sustained in Iraq. Gradually that wound began to take its
toll. And I will pause here to say this.
I volunteered, so I just have to take what I get. However, my
wound has caused identical wounds in my wife Kelli and my son
Alex. They did not volunteer. They did not take my oath. They
have been drafted against their will to fight the enemy. They fight
untrained. They fight unarmed. And they will never receive the
purple heart they have earned and deserve.
Now, before I get carried away with all this complaining, let me
outline the problem and your solution.
So, we fought a war, and a lot more people got wounded than we
initially thought. The majority of the wounded, though, feel they
must conceal their wounds or they will be eliminated from the
service. That is a monumental problem. Additionally, many of the
Gulf War vets have already been separated from the service and
the only recourse for these families is to seek medical attention
from the VA Medical Centers.
In 1865, Abraham Lincoln charged the VA "to bind up the Na-
tion's wounds, to care for him who shall have borne the battle and
for his widow and his orphan." Unfortunately, the VA fails to ac-
complish this clearly defined mission. The VA is choked into inac-
tion by regulation and restriction.
So, what can we do for our wounded who are afraid to seek care,
who have VA care for themselves and not their family. The answer
must provide for entire families and should ajso make it easier for
those who must create a medical solution.
One of the major obstacles to the medical solution is the length
of time it will take to study. I think the number we are talking
about is 10 years. We will probably just be the most researched
bunch of corpses by then.
The true numbers of wounded and dying are unknown. So the so-
lution must draw the wounded out of concealment and provide for
those too wounded to provide for families while research continues.
My families' experience should provide you with a good example.
My wife Kelli is 23. My daughter Shelby is 3V2, and Alexander
is almost 10 months old. After the Gulf War we had two mis-
carriages during 1992, one in January and the other in May. This
nearly tore us apart, and for this we sought counseling.
In October, Alex nearly miscarried, but the doctors managed to
halt the delivery. My wife and I had both developed red spots and
began to collect a series of other symptoms. My symptoms also in-
cluded itchy, painful, bull's-eye red spots that began to spread. I
began to swell. My lips split open and bled. My eyes swelled shut
and my throat swelled closed.
An ER visit and steroids reduced the swelling, but the spots lin-
gered and the fatigue continued to increase over the year. It only
21
took my family doctor a week to give up and tell me to go to the
VA where they "know about these things."
I spent more than a year trying to coax answers out of the North
Chicago VA Medical Center. Even more symptoms have developed:
breathing problems, digestive problems, diarrhea, bleeding gums,
hair loss, difficulty sleeping, and hearing problems.
Alexander had a March 7 due date, but he arrived on January
20th, 7 weeks early. His fight was tough from the start. In addition
to our red spots, he had spinal meningitis, strep reinfection, cranial
hemorrhage, and an immediate need for respiratory ventilators to
survive.
Initially, the neonatologist said he had less than a 20 percent
chance to live. During his first 3 months he encountered many re-
verses and on three separate occasions we were called to spend our
last hours with him. They cut out the top half of his left lung and
inserted a dozen chest tubes, one or two every time a lung would
collapse. He was fed by a tube through his nose and was on and
off ventilators five times.
He generated 1,200 pages of medical records. He had a half a
million dollars lifetime medical insurance. It was entirely gone in
less than 90 days.
Alex's prognosis includes vision and hearing problems, growth re-
tardation, baby emphysema, and cerebral palsy. He requires phys-
ical therapy, oxygen, suctioning, breathing problems and two mon-
itors. He has been approved for SSI disability but I had to person-
ally beg his doctors to continue to treat him after the regular insur-
Eince was gone. I know that he never would have survived in a mili-
tary or VA medical facility.
Alexander stabilized, due in large part to my hero wife who has
trained herself to be his doctor, nurse, respiratory therapist, phys-
ical therapist, et cetera, et cetera, when we began to care for him
in our home. But Kelli and I started to get worse and worse, so we
made the decision that I would go to the VA alone and I would not
leave until we had an answer.
I came from Houston. I am still a patient there. I am not sure
I am going back.
I cannot get medical care for my wife and son, but I tried to get
the VA to give me the key to a medical resolution of our chemical
wounds. I also wanted to help all the Gulf War vets that have been
calling me to say that their family is wounded but they are waiting
on me to get the solution in place. Currently, I am in the Houston
VA, but it has taken a week to get the real truth: At this time
there is absolutely nothing that can be done for any of us other
than to comfort us because there has not been enough research.
In order to make the wounded available and care for all members
of the wounded families, I recommend that all those suffering Per-
sian Gulf syndrome be put on active duty and made comfortable
and available for research. It will also ensure that their jobs are
protected by your law.
We are only asking for medical attention for the wounded. We
are only asking that we are available for research. We are only
asking for the same level of care that the United States is giving
Iraqi ex-POWs and their families, 200 of which are given asylum
in the county next to mine. This would get us off public aid and
22
prevent many VA home loans from going into default. Because, ul-
timately, if we cannot see our way clear to help our wounded vet-
eran families, many reduced to public aid, how can we offer this
level of health care to the entire United States under health care
reform.
Airborne rangers lead the way.
[The prepared statement of Troy and Kelli Albuck appears at p.
168.]
Mr. Evans. Thank you, Mr. Albuck. We appreciate your testi-
mony.
Tim, please pull the microphone directly before you.
STATEMENT OF TIMOTHY JAMES STRILEY
Mr. Striley. Good morning, Mr. Chairman, other members of
the committee. I appreciate the chance to speak.
My name is Tim Striley and I am a veteran of Operation Desert
Shield, not of Operation Desert Storm. I deployed to Saudi Arabia
on the 14th day of September of 1990 with the 101st Airborne Divi-
sion, Air Assault, of Fort Campbell, KY.
Upon my arrival, my fellow soldiers and I were detailed to set
up tents, a tough job on the hard earth of King Fahad Inter-
national Airport. After 2 days of doing this I suffered a second de-
gree sunburn on my face, neck and arms. This healed up over the
course of the following days and everything seemed to be all right.
Weeks passed before, during the guard duty one day, my neck
began to bum. When I reached around to the back of my neck, my
hand returned with pus and blood all over it.
After finishing my guard shift, I immediately went to our pre-
scribed medical unit seeking relief. The doctor there prescribed top-
ical creams to combat the unknown rash. Over the course of the
next days, the rash had spread to my face and to my scalp. The
clinic doctors at this time prescribed a different regime of topical
creams. Again, there was no relief.
I returned later with the same lesions that were described as
weeping and crusted, at this time also experiencing gastrointestinal
discomforts including fever, vomiting and diarrhea. This time there
were new medications for the intestinal problems and more creams
for the rash. By this time the sores were also on my arms and
hands.
The internal problems seemed to go away and I was then sent
to other medical units for evaluation. This continued until I was
given a shaving profile. I was told to grow a quarter inch of beard
hair. Again, with no relief. They put me on oral steroids, one of
which was Prednisone.
On November 21st of 1990 a strange incident happened at King
Fahad airfield. At this time I was already sick. I had some sort of
lesions, probably a secondary infection. We got hit with something
that day. Our ammunition depot blew up. We had a missile that
hit. We were told it was a Hellfire missile fired from an Apache
helicopter. Whether that was true or not I have no idea. I am not
at liberty to say.
The sores after this time worsened. I started having more prob-
lems. And on that particular day I was already unable to wear a
mask. I could not seal a mask at that time.
23
My battalion commander, Lieutenant Colonel Garden, stepped in
to help and had me evaluated by the Division Surgeon General,
Golonel Kimes. I was evacuated to the Navy's 5th Fleet Hospital
in Al Jubail. It was there that I first showed signs of some im-
provement during Desert Shield. I stayed there under sterile condi-
tions and was on a strong course of medications, and it did some-
what clear up. Shortly after returning to my base, I again got sick.
During this time, December and January of 1990, my unit's gas
alarms went off frequently. Each time we immediately donned our
protective mask and occasionally our entire protective suit.
One particular occasion, we were ordered to seek cover in under-
ground tunnels. During each of these occurrences we were told that
SCUD launchs had been detected. Each time we were told "all
clear" and the missiles were said to have either been exploded prior
to, prior to now, coming over the Saudi border.
On one of these particular occasions a civilian airliner even land-
ed with a bunch of troops that ran out of there in their MOPP gear,
fully decked out, ready to go. The crew of the civilian aircraft came
off of the plane running for cover, running into the bunkers. It got
pretty serious.
At this time it was evident that my protective mask would not
seal. Senator Tom Harkin of Iowa stepped in and inquired about
my health. Senator Harkin was told that I could still seal a protec-
tive mask, which contradicted all the training we had been given
pertaining to sealing a mask. With his continuing inquiry, my com-
mander told him that we were not expecting to be gassed. Accord-
ing to my commander, even if I could not seal a gas mask it was
irrelevant.
He (Senator Harkin) finally had to step in and have this com-
mander send me back to the United States because of these sores.
I could not even eat in the chow hall because of these unsightly
sores. These sores were so bad that they were bleeding and oozing.
That, and the fact that I could not seal a mask, is why I was sent
back to the United States.
But right before I left, my company commander said, "Well, Tim,
we are going to send your medical records back via the U.S. mail."
"All right, sir. That is fine. Get me out of here."
It was the day before "K-Day". Fine with me. That was the last
time I seen those medical records. And that seems to be occurring
quite a bit throughout this — what we are finding here. Many of our
records are now "Missing."
When I asked him, after they came back from the Gulf War,
what had happened, he said those were destroyed in the war.
My dermatologist at Fort Campbell, KY, did some tests on me,
allergy tests and what not, and said that I had contact dermatitis.
She also said I had eczema and it was a family hereditary condi-
tion. That my siblings had it. That was a lie. I don't know where
she got that from. She tried to have me discharged for false enlist-
ment. I don't know where she got that information fi-om, nobody in
my family has eczema or dermatitis .
Over the course of events, in May of 1991 my fiancee, now my
wife, suffered a miscarriage at 4V2 months into her pregnancy.
They have found — after the miscarriage, she started hemorrhaging
and they took her in the emergency room. They made her have a
24
livebirth and let the baby die on the table. All right? The medica-
tions that could have helped her was not cost effective. That was
the general idea of what was going on there.
They let the baby die. After the delivery they gave Karen a DNC
where they found a strange infection in her uterus. They could not
figure out what it was. They said it was like a venereal disease,
but tested negative for ever)i;hing. They did a PAP smear later
(after antibiotics) and said everything was fine.
Well, after this time my unit started having problems with me.
They started calling me a malingerer, a h3q30chondriac. I was given
an Article 15 for strange reasons. It was just a really bad time at
that point.
I was honorably discharged on August 30th of 1991. At this time
I immediately filed a VA claim for service-connected disability in
which my records pretty much stood alone. I was rated at 10 per-
cent for eczema.
In September of 1991, my wife again had a miscarriage. It hap-
pened the same exact way. She was still on active duty. The same
exact way. And once again the doctors came back and said, "We
found an infection. We don't know what it is. We can't figure out
what to do about it." She went through a long course of antibiotics
again. In November she saw her GYN doctor again, a pap smear
was done, and she was "okayed" to get pregnant again.
On January 16 I came here to Washington, DC, and was in a
press conference to discuss this issue. This is how early this has
been going on in my instance. During this visit I visited Walter
Reed Army Hospital and was tested for the parasite leishmaniasis.
This test came up positive. The actual quote was, I tested positive
on the low end of the positive side, and I was referred to my VA
hospital.
At the VA hospital I had a bone marrow test done that came up
negative.
Months passed and I started seeing civilian doctors. At this time
I had given up on the VA. They had lost my medical records, a big
mess had occurred. On August 25 my wife actually delivered a
baby. Six weeks after this birth she hemorrhaged and ended up in
the emergency room. This time with civilian doctors. She was out
of the Army. They found a strange infection and the doctor, and I
quote, "found a strange infection that acted like a venereal disease
but tested negative for everything they could test." .
This has been ongoing. Now, my doctor has found a cyst covering
over 50 percent of my right kidney. They have done biopsies on this
cyst. They don't know what is causing it. They say they are going
to take out my kidney sometime after January 1994.
My doctors are up in the air. They are holding off as long as they
can hoping that this evidence, the illness we have, will come out
before they have to start taking internal organs and start taking
me apart piece by piece.
I have got bursitis now in my knees. Now, I have got to suddenly
walk with a cane when my knee swells up. My employers are act-
ing like — well, they are worried about it. Am I contagious? And I
don't blame them.
This continues and just goes on and on and on. It seems like we
are not getting any help here. It seems like nobody cares. Now,
25
some VA doctors are talking about post-traumatic stress disorder.
Yes, some of us do have that I am sure. But some of the mental
problems that are coming out of this are caused by what they are
putting us through.
You have to understand people like us, here. We fought for our
country, and we came back. Now all of sudden we are losing our
health, our jobs, and our families. We have very little left. That is
where we stand right now.
And before I close here I just want to mention also, when we first
came back from the war they worried about leishmaniasis. They
said that because of leishmaniasis we should stop giving blood.
They put a ban on our blood. Fourteen months later they lift the
ban.
Now, during these 14 months more soldiers come forward. We
have got thousands of them now. The evidence is overwhelming.
We have wives that are having miscarriages. We have wives and
children that are starting to have symptoms. Well, why is it that
we can now give blood?
Mr. Congressmen, I don't understand. But, if my neighbor's child
is in a car accident and goes out and has an operation, I would lose
sleep at night thinking that some Gulf War vet that might not real-
ize that he is sick is potentially killing that child (by giving blood).
This is serious. This could be an epidemic. We can't wait 10
years. We can't wait 20 years. We have got to do this now, and
that's what we are here for.
Thank you.
[The prepared statement of Mr. Striley appears at p. 171.]
Mr. Evans. Tim, thank you very much. We appreciate your testi-
mony.
Dennis, you are our next witness.
I have been advised that Mr. Martin is being requested on the
Senate side for similar hearings. If he has a statement to make, we
would let him make that statement at this time and then excuse
him from any questions.
Mr. CULLINAN. That is fine, Mr. Chairman. I am just accompany-
ing him. I am here to present Mr. Martin.
Mr. Evans. Then we would be glad to hear from you.
Mr. Martin, do you have a statement?
STATEMENT OF BRIAN MARTIN
Mr. Martin. Yes, I do, Mr. Chairman.
Thank you for having me here today to testify. As you know, my
name is Brian Martin. I served with the 37th Engineer Battalion,
which was an airborne unit stationed on Fort Bragg also, during
Operation Desert Storm and Desert Shield.
I deployed to Saudi Arabia in October of 1990 until March of
1991. On January 1, 1991, I was chosen out of 13 other people to
be my battalion commander's driver. By the end of February, I was
awarded an Army Achievement Medal and an Army Commenda-
tion Medal for having logged over 18,295 accident and incident-free
miles.
In all those miles, I had traveled from Dhahran to Rhaffa, Saudi
Arabia, along the Tapline Road many different times. On one of
those trips through Hafar al Batin, in January, I had seen a SCUD
26
being blown up by what looked like to be a Patriot. The reason I
say what looked like to be a Patriot is all I actually saw was a tail
of something and a large explosion.
The next day, while driving back through Hafar al Batin, Saudi
Arabia, I made a mental note of how many dead animals I had ac-
tually seen that was not there prior to that day. I even had taken
some pictures of some camels that were on the side of the road that
were laying dead.
My battalion had set up a forward operating base near Rhaffa,
Saudi Arabia, just before the air war began. This base camp had
been equipped with the M8 chemical alarms in four different areas
of our perimeter berms. Thirty minutes before the air war began,
I was called to the colonel's tent and instructed to start taking
antinerve agent treatment pills.
Approximately 40 hours after the air war began, our alarms had
started going off one to three times daily on a regular basis for the
whole duration of the air war. All the way up, actually, until the
day, the minute we were getting ready to join the convoy in Iraq
for the ground war.
The colonel and I had drove up to the MSR Eagle near the es-
carpment of the border of Iraq to check on the convoy progress, and
when we came back to the battalion holding area everyone was al-
ready in MOPP Level 4. We immediately went to MOPP Level 4
to find out what was going on, and we stayed in it until the order
was given "all clear," which every other time these alarms would
go off, we would do that. We would go to MOPP Level 4 until the
"all clear" was given, which is around 45 minutes to 2 hours.
We were briefed at first that vapors from the sand was the rea-
son for the alarms going off, but we argued that the sand was the
same sand during Operation Desert Shield and the alarms never
went off then as they were during the air war in Desert Storm. We
were then briefed that the alarms were going off because minute
traces of chemicals were detected and it was to be believed that it
was fi-om the chemical and biological manufacturing plants being
blown up north of us from the air campaign. But it would not be
enough to damage us, they told us.
As a matter of fact, I had even made a video letter to my wife
on January 29, 1991, just after a so-called false alarm, telling her
of the briefing that the colonel had given me and the rest of the
battalion, and commenting on how it was only 12 days into the air
war and all this stuff was going on.
I had also told the colonel that after the pills I had been taking
I was feeling very strange. My eyes were affected in a moving back
and forth, jiggling-type manner, my scalp felt like it was being
stretched over my skull very tightly. My heartbeat became rapid
and I felt like I had the jitters, like if you are on a high-speed caf-
feine buzz from drinking too much coffee.
My best friend, who was 24 years old, and he was my former
squad leader, died of a heart attack on March 8th, 1991, during the
ceasefire, in Saudi Arabia. He had moved back when we were still
north. And I have always felt it was due to these pills because of
the effect they had on me.
In addition to any other chemicals we are exposed to in an engi-
neer unit, we are always building roads or ammo supply points and
27
in doing that we were always putting diesel fuel in different areas
to keep the dust level down. We also burned diesel fuel in our ker-
osene heaters due to having no supplies of kerosene. We used it in
our immersion heaters for our showers and our shaving water also.
And, of course, all of our engineer equipment burned diesel fuel.
To this day, for the last 15 months I have experienced swollen
and burning feet, swollen knuckles and loss of strength in my right
hand, problems with my heartbeat, shortness of breath, fatigue, I
am tired all the time but yet I have insomnia. I can hardly sleep
at all. I have profusive nights weats, to where my wife has had to
change the bedding on our bed daily. I have gone to the emergency
room several times for severe headaches. I have had watery, burn-
ing eyes on more than one occasion, lumps inside of my mouth. I
have a bad rash on my waist, buttocks and legs, loss of hair on my
legs, on the inner part of my thighs. I have digestive problems, vio-
lent choking until I vomit. I have lumps that appear on my chest
like molds. I have a swollen pelvic area, thick phlegm, and my
mood swings have been compared to Dr. Jekyll and Mr. Hyde.
All of these problems have rendered me unable to work and I am
having a very hard time right now making ends meet with a 1-
year-old son and a 3-year-old daughter and a wife who now is also
infected. She is in the middle of her third severe cervix infection.
She has a rash exactly like mine, and she has now become — she
has gotten swelling and lumps on her left hand.
My 1-year-old son almost died at birth. They induced labor on my
wife 10 days early, and his umbilical cord was just abnormally too
long. It was tied in a true knot around his throat three times, his
body twice, and his leg once. He now has a respiratory problem. I
mean he is not — we are fortunate compared to this child right here.
And I myself am not getting better. My mental capacity is dete-
riorating at a rapid speed to where if I do not write something
down I will forget it immediately. I have taken Indocin, a steroid
called Prednisone. I must take 800 milligrams of Motrin three
times a day, and I also take a steroid nasal spray for the headaches
that I have. These all lighten the pain but they do not take it
away.
If it was not for my family living in my parents' second home,
we would be out in the street and homeless. We have absolutely
no income, because my wife takes care of three cliildren: a 1-year-
old, a 3-year-old, and a 31-year-old.
Once again, Mr. Chairman, I would like to thank you for allow-
ing me this time to tell my story on behalf of myself and the other
ill veterans that could not be here today. And I would like to thank
the VFW for sponsoring my way to Washington to testify, to be
heard for this.
Mr. Evans. Thank you, Mr. Martin.
Before you go I do have a series of questions I would like to ask
all four veterans of the Persian Gulf War.
I think all of you have reported that alarms were set off during
some attacks, is that correct?
Mr. Martin. Yes, sir.
Mr. Evans. DOD has reported that an effort was made to con-
firm all M8A1 chemical agent alarms. Based on your personal
28
knowledge, was an effort made to confirm each and every M8A1
chemical agent alarm?
Mr. Troy Albuck. After an MS chemical alarm sounded, you im-
mediately go to MOPP 4 and attempt to use another piece of equip-
ment called an M256 chemical — what it does is detects, it tells you
what kind of agent you are facing.
Now, with both the M8 chemical alarm and this piece of equip-
ment you need a certain parts per million in the air for it to react.
And the kit that you use after the M8 alarm, it is sort of like a
pregnancy test. You know, you have got kind of a peach color, light
blue color, whatever the case may be, depending on the agent. If
there is not enough agent in the air, it is going to show that there
is nothing there and we are going to go out of MOPP 4. Because
being in MOPP 4 is less than a comfortable experience.
So my feelings are that every time this happened we were just —
the MS alarm had just gotten enough to get over the parts per mil-
lion necessary to sound but it wasn't a high enough dosage in order
for it to show up on the M256 kit.
Mr. Evans. Same experience, Tim?
Mr. Striley. Mr. Congressman, once again, my experiences with
that were November-December of 1990. I don't recall any M256. I
wasn't involved with that personally. I was an electronics techni-
cian.
However, we were told, once again, that the SCUDs never came
across the border. They had been exploded in the air.
Sounds pretty curious to me. But then again when you are talk-
ing about the possibility of a biological agent, and there is no way
to test for that. It would be just like Hussein. I mean, he has used
these weapons against his own people, why wouldn't he use it
against us?
Mr. Martin. Mr. Chairman, these alarms would go off, like I
said, one to three times a day for 40 days. It was about 3 to 4 days
into the air war when they started going off. We would almost set
our watches by them. We would make jokes. You know. Well, we
haven't had a chemical alarm yet, I wonder what is wrong.
And, like Mr. Albuck said, the low levels that could not be de-
tected by the 256 kits, even — I mean that much exposure at low
levels for 40 some days still will add up.
And these alarms, you know, they were not a figment of our
imagination. It caused total chaos in our base camps when they
would go off, and there is a reason why we were in our chemical
suits for 45 minutes to 2 hours before the "all clear" signal was
given. They know there was chemicals in the air.
I became good friends with the colonel that I drove for. We spent
a lot of time together and this man shared very important informa-
tion with me, and that is why I have decided that I need to say
something, because I wasn't a colonel in the Army but I was with
a colonel in the Army, and the man was, he was fantastic to me
and the rest of our battalion. And I know that these things hap-
pened and nobody can change my mind of this.
Mr. Evans. Kimo Hollings worth.
Mr. Hollingsworth. Yes, sir. Our alarms were constantly going
off, also. The problem we face is that our alarms were kept at the
battalion level, so what type of checks they did after that I cannot
29
tell you. I can tell you, though, that generally speaking your paper
is only going to detect one or two types of chemicals that may be
in the air, and if there is a cocktail mix, which Soviet doctrine spe-
cifically talks about, you won't be able to detect that.
Mr. Evans. Which suggests another question about the alarms
and that is just how reliable these alarms were. If I understand it,
Troy, you are saying that there is a lower threshold for the Al, and
that may be there is a higher threshold for the 256 kits?
Mr. Troy Albuck. That is my suspicion. You know, we use the
M8 chemical alarm just as a matter of course during our training,
and I have had that chemical alarm go off in Fort Bragg, NC. So
the reliability of it is backed up by redundant systems.
The redundant systems include the wearing of M9 paper on your
uniform to detect liquid agents, the using of the 256 kit after a
chemical alarm to detect what agents are present, and then how
to react from that by the 256 kit.
Mr. Evans. If the M8A1 chemical agent alarms were so routine
and were commonly false positives, does that mean that these
alarms are unreliable?
Mr. Troy Albuck. No, sir. I believe they are reliable, but with
everything that, you know, the Army considers reliable we use a
redundant system, whether it is communications — we had a triple
redundant system with communications. Okay? Because we didn't
have the nice array Racal-Motorola radios that the Iraqis had. We
had our regular whatever we get radios.
So, with everjrthing you do in the military it is intelligent to use
redundant systems. The redundant systems that were used in the
chemical situation were the M9 paper, the M8 chemical alarm, the
M256 kit, and a heavy dose of common sense, and what we had
been trained with, you know, to detect those sjonptoms personal,
you know like excessive flow of saliva, headache, difficulty breath-
ing, constriction of the chest, twitching of exposed muscular or ex-
posed skin areas, whatever the case may be.
I didn't experience those. The 256 kit didn't show anything.
Nothing on the M9 paper, while the MS chemical alarm got some-
thing that was so low it was not going to affect us, so let's get out
of MOPP gear before we die of sweating to death.
Mr. Evans. The agents disperse rather quickly, so you would use
the 256 kit test almost immediately?
Mr. Troy Albuck. Yes, sir. As a lieutenant, I had one of my
ammo pouches without ammo. Essentially, it was 256 kits. My con-
cern for the chemical war was pretty high, and looking through my
notes that I kept at that time, which I just got out like a week ago
going through my rucksack and whatever, I had written down ex-
actly what was told to us about chemicals.
We were told that there was a better than 50 percent chance
that chemicals would be used. We were told that the delay in going
across the border was to wait for the stuff to lose effectiveness. We
were told not to go near any FROG or artillery positions that had
been destroyed. The reasoning for that was that if there were
chemical munitions prepositioned at those locations that they
would have spilled onto the desert from the air attack during their
destruction. So, to avoid those altogether, and less contamination.
30
I think that there was not an understanding at that time of the
cumulative effect of low levels of nonlethal exposure to chemical
weapons. I believe that chemical weapons nonlethal exposure over
a period of time gave us a cumulative dose. Enough that damage
was done to ourselves that is now being evidenced.
Mr. Evans. Mr. Martin needs to be excused to go to the Senate
side, unless my colleagues quickly had a question.
Mr. Bachus. I have got one.
Mr. Evans. We have questions for Mr. Martin.
Mr. Bachus. I have one. Did you see any dead animals or plant
life?
Mr. Martin. There wasn't very much plant life over there. But
I have seen — I have got a lot of pictures of dead animals, and I
have seen a lot of dead animals.
Mr. Bachus. What was your — I mean describe that to me in
some detail? I mean were these whole herds of animals dead?
Mr. Martin. Mainly the sheep. I saw herds of sheep that were
dead. Camels were an individual basis, maybe. Maybe two, maybe
three together at once. Because I didn't see herds of camels. I only
seen, maybe, a half a dozen running together at a time at any one
time. But most of the sheep that I seen dead were large herds of
sheep, anywhere from 10 to 25, 30 sheep, I would see scattered.
Mr. Bachus. When you first got there were these herds there
and healthy, and then at some point they started all dying? Would
you see a herd when you were moving around?
Mr. Martin. Well, like I said, sir
Mr. Bachus. I am trying to get a picture in my mind.
Mr. Martin. In the miles that I traveled along Tapline Road,
which was a main access road along the border, or up northern
Saudi Arabia, came up the side and up north, I got to notice a lot
of area. I seen it a lot.
And it's like if you would notice a landmark in your city, and you
notice the next day you drive by something is different with it.
Maybe they took a banner down or added a banner. Yes, I made
a lot of mental notes about different things that I seen.
And we would even — I would have to stop my Humvee on many
occasions to let herds go across the street, and it seemed like a per-
fectly normal area. A day or two later I would come by and there
would be dead animals on the side of the road. And the most that
I can remember was the incident in Hafar al Batin.
And like I said, I think that is why I took pictures, because it
was so different from what I had seen before. There was no dead
animals there prior to that and when I came back through they
were everjrwhere. And I do, I got out and I have a picture of me
standing by these dead animals. Because I just — it was fascinating
that they just lay there like that. Nobody ever tries to pick them
up or clean them up or police them up. They just leave them there.
Mr. Bachus. Kimo Hollings worth.
Mr. Rollings worth. Yes, sir. I would like to add that there
were many dead animals. One of the things my unit took notice to,
a lot of the marines there, is that generally when you have dead
carcasses lying around there is a lot of flies and insects. We ob-
served that there were no flies and insects around these dead ani-
mals. We grew a little bit suspicious of that.
31
Mr. Evans. Mr. Martin, you are excused. We appreciate your tes-
timony and your coming forward before us today, and I wish you
Godspeed over on the Senate side.
Mr. Martin. Thank you, sir.
Mr. Evans. Dennis, we will now ask you to proceed with your
statement.
STATEMENT OF DENNIS CULLINAN
Mr. CULLINAN. Thank you very much, Mr. Chairman. And thank
you for your consideration in allowing our witness to head on over
to the Senate.
As I mentioned earlier, I was really here just to introduce Mr.
Martin. I will be very brief in my remarks.
On behalf of the 2.2 million men and women of the Veterans of
Foreign Wars, I wish to express our deep appreciation for your on-
going leadership and for conducting todays most important over-
sight hearing.
As you know, the VFW is absolutely adamant that those who
served in the Persian Gulf War not suffer the same neglect and de-
nial with respect to the government's properly caring for their spe-
cial service-connected disabilities as did their brother veterans of
the Vietnam War.
Mr. Chairman, the VFW is very disturbed in the face of the fact
that literally multiple thousands of Persian Gulf veterans are suf-
fering from a multitude of ill health symptoms, a government agen-
cy, the Department of Defense, namely, is stonewalling. They seem
to be doing everything in their power to suggest that there is no
problem. Business as usual. This, in our view, is an absolute out-
rage.
While there are, in fact, a multitude of theories about why these
veterans are suffering or what they are suffering from, everything
from burning oil wells to parasites in the sand to depleted uranium
to Iraqi poison gas attacks, the bottom line issue in our view has
to remain the fact that these veterans are suffering from disabil-
ities. They have been sickened in the service of their Nation and
they need and deserve help today.
With that I will conclude my statement, Mr. Chairman.
[The prepared statement of Mr. Cullinan appears at p. 176.]
Mr. Evans. Thank you, Dennis.
Kimo Hollingsworth.
STATEMENT OF KIMO S. HOLLINGSWORTH
Mr. Hollingsworth. Mr. Chairman, The American Legion
wants to thank you and the committee for taking the time to con-
duct yet another hearing on this emotional and sensitive issue. We
would also like to express sincere appreciation to Congressman
Kennedy and his staff for putting together a hearing on November
9 that covered some of these same issues.
In June, The American Legion testified before this committee
concerning health issues of Persian Gulf veterans. As a result of
that hearing the House put together legislation, that ultimately
passed the House, to provide priority health care to Persian Gulf
veterans. The American Legion and American veterans thank the
32
committee for their swift action. There is a similar bill in the Sen-
ate, and we can only hope that they will take swift action.
Mr. Chairman, since that hearing the number of names on the
VA's Persian Gulf Registry has more than tripled. And finally, as
a result of last week's DOD briefing, DOD has finally come forth
and admitted that not only hundreds, but possibly thousands, of ac-
tive duty personnel are ill. The American Legion is pleased in that
acknowledgement because the problems are not only limited to Na-
tional Guard and Reserve units.
The Legion is also pleased with the proactive position that the
VA has taken with their measures down in Tuskegee, AL, and we
hope that they can continue to march forward in that regard.
Legion representatives attended a DOD press conference on 10
November and we were terribly disappointed with the explanation
of the chemical detection reports by the Czech chemical teams.
Until recently, DOD adamantly denied exposure or any reports of
exposure to both chemical or biological agents.
The Legion felt that the press conference produced half truths
and understatements as to the degree of exposure of coalition
forces to chemical agents. The issue of possible exposure to biologi-
cal agents was never addressed.
The practice of mixing chemical and biological agents is a known
delivery technique of Soviet doctrine. With the presence of chemi-
cals now being acknowledged by DOD, the possible presence of bio-
logical agents must now also be addressed.
Mr. Chairman, based on research and practical experience I can
tell you that when you check for radiation you can find it in the
combat environment with a RAD meter or a Geiger counter. For
chemical agents, you can readily test with M8 paper or M251 de-
tection kits. However, the inability of a person to detect biological
agents on a combat battlefield is nonexistent. Detection must be
done or performed in a laboratory.
Mr. Chairman, the Marine Corps Institute's Command and Staff
College for the Nonresident Program Section 5 addresses Nuclear
and Chemical Operations specifically discusses aspects of biological
warfare. I would like to read a couple quotes from that DOD
manual.
"Biological agents can't be detected by the human senses. A per-
son could become a casualty before he is aware that he has been
exposed to a biological agent. An aerosol or a mist of biological
agent is borne in the air. It moves with the air currents and can
enter buildings and fortifications. These agents can silently and ef-
fectively attack man, animals, plants, and in some cases, material."
It also states that "It is likely that agents will be used in com-
binations so that the disease symptoms will confuse diagnosis and
interfere with proper treatment." Gentlemen, the sjrmptoms re-
ported by Persian Gulf veterans today have clearly confused most
doctors and have defied almost all treatments.
Additionally, the text states that "The microorganisms of possible
use in warfare are found in four naturally occurring groups — the
fungi, bacteria, rickettsiae, and viruses. The fungi range from sin-
gle cell, such as yeast, to multicellular forms, such as mushrooms
and puffballs. The bacteria may occur in varying shapes, such as
rods, spheres and spirals, but are all one-celled plants."
33
I want to remind this subcommittee of the testimony presented
by Dr. Edward Hyman last June. To date, Dr. Hyman has success-
fully treated nine Persian Gulf veterans and three of their spouses.
His research has found that all 12 patients have had in their
urines bacterias the shape of spheres and also the presence of
yeast, which would indicate a fungus.
Referring back to the Marine text: "In field trials using harmless
biological aerosols area coverage of thousands of square miles have
been accomplished. The aerosol particles were carried long dis-
tances by air currents."
Prior to the ground war, American and Allied aircraft consist-
ently bombed chemical and biological ammunition stockpiles. As a
Marine who participated in the Persian Gulf War from January
through May, I give you firsthand testimony that the wind direc-
tion was predominantly in a southerly direction.
In reviewing military health records from returning Gulf veter-
ans, The American Legion has noticed a form used by health care
providers that question personnel about the possible exposure to
environmental hazards, specifically chemical or biological expo-
sures. Many questions on that form perfectly match the symptoms
being reported by Persian Gulf War veterans. This form clearly in-
dicates that DOD had anticipated these sjonptoms.
Sir, I have a copy of that form here with me today, and during
the question-and-answer period, I would be more than happy to
run down a list of questions that have been asked of Persian Gulf
veterans.
The American Legion believes that the United States intelligence
agencies are withholding valuable information that could play a
critical role in finding the cause and cure for medical problems by
Persian Gulf veterans. The American Legion continues to urge
Congress, the VA and DOD to conduct a full epidemiological study
on the health care issue of Persian Gulf service.
Mr. Chairman, that concludes my testimony.
[The prepared statement of Mr. Hollingsworth appears at p. 179.]
Mr. Evans. Kimo, thank you. The questionnaire that you have
offered will be entered into record of the hearing.
Mr. Hollingsworth. Yes, sir.
Mr. Evans. We have one more witness before we go to questions.
Mr. Kreidler, do you have a statement you would like to make?
Mr. Kreidler. I would just like to ask unanimous consent to
submit an opening statement.
[The prepared statement of Congressman Kreidler appears at p.
104.]
Mr. Evans. Without objection, so ordered.
Mr. Kreidler. Thank you, Mr. Chairman.
Mr. Evans. Mr. Egan.
STATEMENT OF PAUL S. EGAN
Mr. Egan. Thank you, Mr. Chairman.
The testimony here this morning is incredible. Unfortunately, it
sounds all too familiar.
We have a rather long and inglorious history in this country of
treating those having served in military situations and who have
been exposed to a variety of different kinds of agents as if they
34
were never exposed; that they have never run into problems; that
everything is fine; and now we are even hearing that they are
being told that all their problems are somehow psychiatric or relat-
ed to post-traumatic stress.
By the time veterans exposed to ionizing radiation during experi-
ments were finally compensated for any of their disabilities, many
of them, if not most of them, had already died. We are only now
within a couple of months of resolving the experiments using mus-
tard gas a long, long time ago. Agent Orange took 13 years before
we finally got the first compensation bill, and that was in February
of 1991, thanks to your efforts. And now here we have Persian Gulf
syndrome.
Much of the problems with the Agent Orange exposure and fi-
nally getting to a point where there was a reasonably decent ac-
ceptance of the fact that Agent Orange causes damage results fi'om
the fact that we have relied on government agencies to carry out
science, and agencies carr3ring out the science with a policy agenda
other than getting at the facts, getting at the truth.
These are lessons from the Agent Orange issue, an issue that is
not over by any stretch of the imagination. We have now a Gulf
Registry. We had an Agent Orange Registry, which still is in exist-
ence, but is there anyone to ensure the integrity of that Registry.
Medical exams were given to individuals exposed to Agent Or-
ange, but no one really assured the integrity of those exams to be
sure that testing that was done for Agent Orange exposed individ-
uals was in any way relevant to the symptoms or problems that
might ultimately result.
Can we say that the medical exams given to Persian Gulf veter-
ans are any better? I am not sure what the answer to that is, but
I don't think there is anybody that has really made it their busi-
ness to ensure the integrity of that work.
In order to avoid the extraordinary delays that were experienced
and continue to be experienced by those individuals exposed to
Agent Orange, it has to be assumed that chemical and biological
agents were used and that individuals in the Persian Gulf were ex-
posed to them. It has to be assumed that individuals in the Persian
Gulf were exposed to multiple chemicals resulting from oil fires,
medications issued, and a host of other indigenous exposures.
We have to avoid wasting time and to determine that in fact we
can go ahead and compensate diseases if there is a reasonable as-
sociation between exposure and disease. And we, perhaps most im-
portantly, have to come to the conclusion that the Federal Govern-
ment is inherently untrustworthy in reaching conclusions and in
reaching the facts about the damages done as a result of these ex-
posures.
I have a few suggestions for you as a way of, perhaps, providing
a road map for getting at some of the answers. I might add, Mr.
Kennedy, you asked some questions of OTA and, incredibly, it
sounded like deja vu. I mean, as far as we are concerned, Vietnam
veterans and those exposed to Agent Orange, OTA has not particu-
larly played a helpful role here. Just today you asked the question,
or somebody asked the question, and the response is essentially
that looking at chemical and biological exposure wasn't in their job
description.
35
We believe that a model can be fashioned on the basis of the ex-
perience that we have seen with the success of the National Acad-
emy of Science and its report. Not its science, but its report of a
review of the science that has been done on Agent Orange. It is a
nongovernmental entity, and lo and behold, in July when it re-
leased its report it was trustworthy and it, in fact, drew some con-
clusions about diseases that are reasonably associated with expo-
sure. The same thing needs to be done again.
There is an entity that needs to be contracted for to do that
work. Another entity needs to be established to determine what
kinds of epidemiological studies need to be done, and those studies
need to be done by nongovernmental entities.
We need to find a way to take out of the hands of the govern-
ment and put into the hands of a nongovernmental entity respon-
sibility for assuring the integrity of the Registry, ensuring the in-
tegrity of the exams that are done, and ensuring the integrity of
the assembly of the data that arises from the scientific inquiry.
Some kind of entity needs on that basis to make recommenda-
tions, just as the NAS did for Agent Orange exposed veterans, on
what diseases bear a reasonable association to exposure. Health
care needs to be available, needs to continue to be available
through the VA and unhesitatingly so.
And finally, as part of this we need to find a way to create, per-
haps, a quasi-governmental entity, something akin to a scientific
inspector general operation with broad-ranging subpoena and pros-
ecutorial authority to assure that Federal agencies are coming for-
ward with the information that, in our experience, the Vietnam
veterans' experience, government agencies were not willing to come
forward with.
And finally, there should be someone to head up this entire oper-
ation, Eind that person should be someone, perhaps, most appro-
priately appointed by the President with Senate confirmation, so as
to assure there is a proper oversight process to offer the best likeli-
hood the individual isn't working for some chemical company or
some other proprietary interest with a stake in the outcome of the
findings of this operation.
I think it is critically important, Mr. Chairman, as I am well
aware that you know, that we find a way to borrow from the les-
sons of the Agent Orange and previous exposure-tjrpe experience so
that a resolution can be facilitated and so that we can avoid the
extraordinary, and I submit unnecessary, delays that might yet be-
fall the victims of the Persian Gulf War.
[The prepared statement of Mr. Egan appears at p. 184.]
Mr. Evans. All right, Paul, thank you very much.
Troy, you reported to Houston a week ago yesterday, is that cor-
rect?
Mr. Troy Albuck. Yes, sir.
Mr. Evans. I take it by your remarks that you are thinking
about not going back?
Mr. Troy Albuck. From the person that was introduced to me
as the renowned expert the response, ultimately after filling out a
questionnaire and going through a question-and-answer period,
was that there is really nothing that can be done for us in any
case. The testing that is being done, the next thing on the line is
36
a sleep study and that should basically take care of all the things
they were going to do with me.
I am pretty well convinced that a sleep study is not going to get
an5^hing more than the multiple psychological evaluations that I
have had to endure. So, the need to fly all the way back down there
and probably spend another week to get that done seems to be just
too much at this point.
Though, I would like to say that everyone I have come in contact
with in the VA has been willing to try. They just don't have any
direction. And I only just became aware that the VA was, you
know, started in 1865 by Abraham Lincoln and that it is supposed
to be for everyone. And I am really disappointed that they have
never taken on that aspect of their mission.
The way I see it, they were supposed to bind the Nation's
wounds. Well, that's easy to say. I mean, we are here for life, lib-
erty and the pursuit of happiness. What if we only got life and lib-
erty? That is the way I see it.
Mr. Evans. Tim, or Kimo, have you thought about going through
the VA program? Have you participated in the Registry itself?
Mr. Striley. Yes, sir. And I would like to note that I didn't know
about the Registry until I joined a private support group. There
was no letter in the mail, no nothing. I had even been to the VA
and no one said anything about the Gulf War Registry.
Mr. HOLLINGSWORTH. Mr. Chairman, I did participate in the Gulf
War Registry. And I will tell you that the VA in Washington, DC,
was very professional and they were very expedient in dealing with
me.
However, in the beginning of August, I filed a claim with the VA
and it is lost and it is nowhere to be found.
Mr. Evans. You filed a claim?
Mr. HOLLINGSWORTH. I filed a claim with the VA in early August
and there is no record of it any where, sir.
Mr. Evans. Have any other records been lost by the military?
Mrs. Kelli Albuck. I have the records right here.
Mr. Evans. You have the records
Mrs. Kelli Albuck. For when Troy was first put into Persian
Gulf Registry.
Mr. Evans. Go ahead, Mrs. Albuck.
Mrs. Kelli Albuck. I would like to read something off of it, if
you don't mind. This is for the past just one year.
Mr. Evans. Would you identify yourself as Kelli Albuck?
Mrs. Kelli Albuck. Yes. My name is Kelh Albuck.
Mr. Evans. Okay.
Mrs. Kelli Albuck. It has his diagnosis, his clinical diagnosis
noted but not treated after all of this. You know, he has had every
kind of test — Persian Gulf syndrome, chronic fatigue syndrome,
ruled out multiple stress related to, you know, social stresses.
Mr. Evans. So, Troy, you are saying that they are trying to help
but they didn't have a handle on it? They just don't know what the
problems are, I take it.
Mr. Troy Albuck. T3TDically, you can't manage a horse to water,
and unfortunately, it seems like everyone is standing around wait-
ing for the word to come down, and that is why the Army has
"green tab" leaders. If you had just staff functionaries all waiting
37
for the word to come down, we wouldn't have an Army. You have
to lead. And unfortunately, no one has been given the nod or no
one has the motivation or just whatever — the initiative, to go ahead
and lead and find answers.
A year ago when I started all I got were blank stares. Now, I am
starting to get, you know, "Oh, yes," out of people when we start
talking about the symptoms and that sort of thing.
But really the bottom line has been, from Dr. Miller, which I
think she was in an earlier hearing, that there is really nothing we
can do. The immunologist says, well, it can't be chemicals, if we are
giving it to somebody else. It has to be a virus. But how do we go
about finding out what that virus is? I am sure it is, you know, a
lengthy process for them.
And really, like I said in my initial statement, in order to burden
families with this sort of burden as far as medical, which is over-
whelming to any family to have to try and take that on — this is
just Alex's records for 3 months, and this cost us $245 to get a copy
of. I mean that doesn't go into the millions of dollars of medical ex-
penses for real medical care, for symptoms.
We are unable to combat that alone. The only thing we can do
is make a sort of a general plea for assistance, and with the num-
bers of families that I think are going to begin showing up, once
we get this out in the open, because the dozens of families that I
have spoken to will not admit to being sick, either because they are
on active duty and they know that they will then get a hiccup in
their career and it will be over because of a need for zero defects
in a military career now to be successful because of the money
problems.
What we will end up with is people concealing until the last
minute that they are sick. By that time they are physically beat.
They are financially drained. They are unable to — the help agen-
cies that are out there are unable to deal with the monumental
problems that these families are showing up with. That is why I
recommended that active duty may be the only way, so we could
make these people comfortable either until they die or until we re-
search an answer and get them a solution.
Mr. Evans. Did you experience some of the previous miscarriages
while Troy was still on active duty?
Mr. Troy Albuck. No.
Mrs. Kelli Albuck. Yes, the first one.
Mr. Troy Albuck. Yes, the first one was just prior to leaving ac-
tive duty, and the second one was right after leaving active duty.
Mr. Evans. What about the level of care you received through
the military hospital system?
Mr. Troy Albuck. We don't go to military hospitals.
Mr. Evans. You did not go to the military hospital?
Mr. Troy Albuck. Not if you are smart.
Mr. Evans. We are getting static fi-om a cabbie or something.
Please continue.
Mr. Troy Albuck. The best bet is to avoid those generally be-
cause of the long wait, not because of the level of care. The people
are just as caring, have just as much motivation and desire to help
you, but you would run into a wait period that makes, you know —
unless it is a real emergency situation where you can get, you
38
know, emergency treatment. Other than that you don't want to
deal with a mihtary or VA facihty for cUnical care.
Mr. Evans. One last question. I wanted to ask Mrs. Albuck, did
you want to say something else?
Mrs. Kelli Albuck. I just wanted to say a lot of the wives and
women are having a lot of infections and female problems, and the
one problem that I found going to a military hospital, when he was
active duty, I was pregnant, and it seemed like there was a lot of
children, a lot of women pregnant right after the war.
So, the problem that I had was I had a lot of female problems
so I had to seek, go through CHAMPUS, and I still had a lot of
problems getting my bills paid through CHAMPUS because there
was such a long wait.
I was having this unknown bacterial problem that no one seems
to know what it is. I have — my medical records are about this thick
as well. Still no one seems to know what is going on. So that is
why we sought medical help outside of the military.
Mr. Evans. Kimo, regarding the form. The Southwest Asia De-
mobilization-Redeployment Medical Evaluation form, was this
something that DOD used to
Mr. HOLLINGSWORTH. Sir, it is my understanding that not all
units but some units were using this form. And with your permis-
sion I would like to read some of these questions on here.
Mr. Evans. Well, my time has expired. Let me quickly just ask
the two other vets here, have you seen this form before?
Mr. Troy Albuck. I am looking through the form. I know I have
never seen that one.
Mr. Evans. You were never asked.
Tim, have you seen something similar?
Mr. Striley. Me either, Mr. Congressman. And other soldiers
that were with the 101st Airborne that I have talked to have never
seen that thing before. I have talked to other soldiers out of Fort
Hood that have had it, though.
Mr. Evans. Kimo, I will come back to you.
Let me yield to the Congressman from Pennsylvania.
Mr. Ridge. I remember during the course of my own training
that time of the day that, as recruits and even as a training NCO,
I knew the young soldiers didn't particularly care for was the bio-
logical and chemical training, when they took you in that enclosed
room and everyone left one of the masks open just a little bit, and
threw in a tear cannister. There is just something about operating
in a chemical and biological environment that is intimidating even
in terms of training, let alone actually being involved in the theater
that you were in.
But during the course of that training you do learn to personally
identify. You don't need alarms. You don't need scientists. You
learn to personally identify certain physical responses to an un-
known agent, which is the alarm that you are trained to respond
to.
And I would ask all the veterans if in your experience over there
you personally identified in the theater any of these physical symp-
toms that manifested themselves that were consistent with your
training?
Mr. Troy Albuck. To go in order, I will start.
39
Mr. Ridge. Sure.
Mr. Troy Albuck. Sir, that has been one of the most confound-
ing things for me, as I cannot point to a certain incident or event
and say that must have been it. So when I finally, you know, start-
ed to get really up on what everybody's information is about this,
and I read Senator Riegle's report and he talked about the
nonlethal dose delivered by air from the bombing of the production
facilities, that is the only thing I can point to.
I did not have a response to the pyridostigmine bromide or an-
thrax inoculations. I did not — and I waited 3 days for the soldiers
to take them first. I cheated. But I didn't have a response to that.
I didn't have a specific thing that I could point to that said that
must have been the chemical attack.
I was in Riyadh guarding King Fahad with the 3rd Brigade of
the 82nd in the initial SCUD attacks, and we watched, you know,
the SCUDs come into Riyadh. And I have looked in my notes on
the SCUD attacks. I had written down the dates, on January 18
and 21 about the attacks on January 17 and 20, and then I had
made some notes on the side of that, that I wasn't going to tell the
soldiers fi-om the poop meeting about what was going on — to my-
self-—that I had watched two of the SCUDs hit Riyadh just on the
other side of the airfield where we were located.
So, I may have been, you know, in the location of the SCUDs at
that time, but I do not point to that as a chemical attack in my
memory.
Mr. Ridge. I might add, just as an aside, I noticed in your testi-
mony you enlisted at 17, you were an officer by the time you were
19, and from the basis of your presence and your testimony now
I can understand why.
Mr. Troy Albuck. I do not have any specific time and date that
I can realize. Of course, there are questions about what caused a
sudden intestinal illness, diarrhea, vomiting, fevers, the whole 9
yards, and no specific time.
Mr. Rollings WORTH. Sir, our unit, when we started the ground
war we engaged in the prep fires for units going into Kuwait. At
that time, I was an artilleryman, and we were engaging an Iraqi
artillery position. At that time we received what appeared to be an
illumination round. We thought at that time that maybe we were
being marked for further artillery attacks, because sometimes you
can use an illumination round to mark a target. Beyond that — and
it was surprising to us that no direct volleys from thereof occurred.
Beyond that I don't think there is any one particular incident that
I can say.
I will note again that there were numerous dead animals in the
area, and I will also note that at some time very shortly after the
ground war my entire unit came down with diarrhea, fevers, vomit-
ing. They were dehydrated — things of that nature.
Mr. Ridge. I merely raised that question to highlight a point.
That doesn't necessarily mean that you weren't exposed. It just
means that the training that you had or the agent that seems to
have adversely affected you and your families was not detectable
from the traditional means that we previously employed.
There have been some instances, chronicled by individual veter-
ans, where the alarms went off, and there was the burning sensa-
40
tion of the eyes, the mouth, the rash, et cetera, almost immediately
thereafter, and they evidenced many of the same kinds of physical
problems that you have.
So I just use your testimony to highlight the point that the fail-
ure for you to personally detect in a combat situation the presence
of those agents does not mean that they were not there, because
similar symptoms have been detected by others where alarms went
off that corroborated that there was something in the air.
And we all know that the bacteriological agent you wouldn't be
detecting. You can't detect that through any tests. You have to ac-
tually use the science and bring it to the laboratory in order to de-
tect it.
Let me ask the three veterans, if I could — then I want to get
back to you, Paul — were you given a discharge physical?
Mr. Troy Albuck. Sir, when we returned from the sort of victory
block leave we went right into an intensive training cycle. By the
time we returned from that intensive training cycle, really the situ-
ation for me was that myself and most all of the lieutenants who
were about to make captain had pink slips, and by the time we re-
turned from that intensive training cycle those had been sitting in
our in-box for several weeks and we had less than 30 days to get
out of the military. Just the out-processing, the things that you had
to do to out-process take more than 30 days.
Mr. Ridge. I understand.
Mr. Troy Albuck. So, one of the things that I decided not to do
was, you know, get my out-processing physical because at the time
I was still in fairly good shape.
Mr. Ridge. Mr. Striley.
Mr. Striley. With me, sir, I did have a physical and the prob-
lems with the joint problems, the intestinal problems and the ec-
zema, or so-called eczema was noted, (the sores/lesions). And I did
at the day of discharge, with that physical, file a claim with the
VA and was given 10 percent service connection for that.
Mr. Ridge. Mr. HolUngsworth.
Mr. Hollingsworth. I was given an out-processing physical.
During that physical I indicated that I was coughing up sputum
every morning in chunks. I also indicated that I had a pain in my
center chest.
They did a full array of tests on me and they all came up nega-
tive, so the doctor concluded at that time that he felt I was per-
fectly normal.
Mr. Ridge. All right. Paul, my time has elapsed, so what I am
going to do is just get in touch with you. I think your suggestion
with regard to the National Academy of Sciences is an excellent
one. You know as well as the chairman of this committee every-
thing we went through with Agent Orange, and there one of the
complicating factors was that the physical manifestations of expo-
sure did not reveal themselves until much later on — in most in-
stances until much later on, after the soldier was out of the field
and out of the Army. Here we have physical manifestations of men
and women, and regrettably, tragically, families, either while they
are within the field or shortly thereafter. So I think that is a good
idea and I will follow up with you.
41
I just would like to say, Mr. Chairman, you are going to have to
forgive me. I do have to leave. These men and their families give
very, very compelling testimony again. And, as we go about trjdng
to determine medical causation, because ultimately we can only
treat S3anptoms until we get to the cause, the etiology, but for the
time being there is no reason in God's green earth why these men
and women and their families shouldn't be given the benefit of the
doubt in VA facilities, or elsewhere if they are not acceptable, at
the government's expense.
It is pretty clear that we have got a problem here. And if we
horse around for the next 13 years, et cetera, dealing with the
issue, as we did with Agent Orange, sadly many of these problems
are going to take care of themselves and in a manner which should
not be, and is not acceptable to you or me or any other American.
I thank you.
Mr. Evans. I thank the gentleman from Pennsylvania. It is al-
ways good to have your expertise as a combat veteran of Vietnam
on this committee, and we appreciate your active participation and
attendance with the subcommittee.
The gentleman from Illinois.
Mr. Gutierrez. Thank you very much, Mr. Chairman.
First of all, it is really a pleasure to have all of you here today
with this testimony. And I would like to specifically say hello to
Mr. and Mrs. Albuck. I am happy to see them here again.
And I want to thank them for coming out and taking the time
out at the field hearing that we had that the chairman was good
enough to hold in Chicago the weekend before last, and it is good
to see you again.
I want to commend you, Troy, of course for taking the brave
stance that you have and by telling us your story, and I hope that
the government demonstrates as much courage and honesty as you
have here today.
Troy, I know you spent the last week or so in the Houston Refer-
ral Center, and I would just like to ask if it has just been any dif-
ferent than the experiences you have had in the VA hospitals, first
of all?
Mr. Troy Albuck. It has been different in that they are actually
focusing on Persian Gulf syndrome and not, you know, the experi-
ence I had in North Chicago, which was primarily out patient for
the first year, which was to just go clinic to clinic and look at one
symptom at a time and try to come up with an overall answer,
which, you know, obviously, there is no way to do that.
A doctor looks at one symptom and tries to say, you know, it is
one thing. Another doctor looks at another sjrmptom that is his
area of expertise and say it is another. So it is good that they have
a referral center, and they have some doctors there that can look
at environmental health problems, and they are trying to get the
doctors from all the different areas of the human body together to
discuss what the thing is.
But one of the themes that I am hearing recurrently is that at
this time there is nothing we can do until there is more research.
And the reason for that is no one submitted to accepting low levels
or nontoxic or nonlethal exposure to chemicals for research pur-
poses, understandably. So they just don't have studies yet com-
42
pleted about people getting nonlethal exposures to chemicals or bio-
logical, or you know, whatever the case may be.
And again, I would like to say that, you know, who cares where
it came from or what it was. Let's take care of the families first.
Then we will sleuth down what the answer to the whole thing is.
Mr. Gutierrez. Troy, what exactly is the diagnosis that they
have given you? What do they say your problem is right now?
Mr. Troy Albuck. Well, at Houston, they have switched from
what they said at North Chicago. At North Chicago they said it is
not mental health related, which was the only good news I got. But
they ruled out Persian Gulf syndrome and they had ruled out post-
traumatic stress. They had ruled out chronic fatigue syndrome, and
they just had no answer.
At Houston, they said. Well, this is Persian Gulf syndrome, and
so I asked what Persian Gulf syndrome means and what I got is
that the word "syndrome" means "the same road," so it is people
that have traveled the same road come under a syndrome.
So, in other words, Persian Gulf vets that are sick have Persian
Gulf syndrome, and that is all the further they can go. The immu-
nologist says it has to be a virus because families are getting it.
The environmental health person says it has to be chemicals be-
cause there were so many chemicals there. Or someone else says
it has to be the oil fires. Or the radioactive, yes.
In most of the cases we are not showing the evidence of that be-
cause our bodies detoxify a lot of those things.
Mr. Evans. Will the gentleman yield?
Mr. Gutierrez. Absolutely, Mr. Chairman.
Mr. Evans. I thank the gentleman for yielding.
Are they saying it is symptoms or what you were exposed to or
both?
Mr. Troy Albuck. Well, all they can do right now is focus on the
symptoms, and if we want Motrin or if we want Pepto-Bismol or
whatever the case may be, now there is a list of symptoms, and if
you have a few of them, then you are part of the Persian Gulf syn-
drome.
And there is a list of 50 syrnptoms. I don't have all of them. My
wife has a symptom entirely different from me. She has pain in the
ears that is not related to an ear infection, just sort of a mysterious
severe aching and pain in the ears that the doctors can't figure out.
I have never had that symptom, though I have some severe sleep
pattern changes that she doesn't have.
But we do have some symptoms in common: the red spots,
breathing problems and things like that that make us both part of
the Persian Gulf syndrome.
Mr. Gutierrez. Mr. Chairman, it seems to me it would probably
be good — and Mr. Kennedy probably remembers that day because
we both questioned the doctors that were here at the hearing about
a test. And we had a couple of doctors here who said to us — we
asked the simple question, can you give a test? Is there a medical
test that beyond any reasonable doubt that we will know, and they
said yes.
And we asked them whether they could give us particular infor-
mation to the committee at that point. So I think it would be good
to take a chance and go back to those two doctors and see just
43
what tests they know of, because they gave us very clear, compel-
hng information that they had a test and they would know whether
they had chemical, or whether it was chemical. At least that is the
way I remember it.
Mr. Evans. It might be. We will review the record and we can,
perhaps, submit written questions to them in this instance.
Mr. Gutierrez. It occurred to me that maybe we could go back
just for a second and talk to those. The question was can you figure
out whether you are a malingerer or really sick? Is there like a test
that you can give? And they said, yes, we can do it. We can give
a test.
And there were two doctors, and they were from Massachusetts,
if I remember.
Mr. Kennedy. Yes. I think that was on multiple chemical sen-
sitivity.
Mr. Gutierrez. Well, see what we can get and see how many of
them we can begin to identify.
Well, thank you, Mr. Kennedy, for clearing that up.
I just want to ask, Troy, just a second, about the economic kinds
of problems that you have confronted after leaving the service and
that the illness has brought on.
Have you got any compensation from the VA at all? Do you re-
ceive any money from the Veterans' Administration.
Mr. Troy Albuck. No, sir. I did file a claim. My understanding
is that at this time those claims are being summarily denied across
the board for environmental health, other than a limited number
with leishmaniasis or immediate exposure to the oil fires.
Economically, the things I have encountered are that progres-
sively over the year I physically became less and less reliable as
an employee. I took a job with — well, it was the first job that was
offered, because I was out of the military very rapidly and didn't
want to be on, you know, like unemployment or something like
that. So what I did was I took a job with Radio Shack in the man-
ager training program. I stacked up 9 consecutive months as the
Manager Trainee of the Month in the Chicago region and then as
a manager 4 consecutive months of the top sales gain in one of the
smallest Radio Shacks, behind a building behind a garbage dump
in Chicago. So I worked very hard.
But during that year it became progressively more difficult to do
my level of performance, to the point where I only had two modes:
I was at work, I was sick.
And we spent the one day off a week that I would take from bell
to bell at the VA hospital doing whatever clinic visit we could get
done that week. And we would pack a lunch, the entire family, and
go spend our day at the VA trying to get one or the other clinic
visit done.
Finally, I just realized my own limitation and quit the job. Tried
to get a job that was less hours and less effort, but I was even un-
reliable in that because I had difficulty getting coherence, you
know, before noon. I was having a lot of problems breathing and
just trying to do a regular job, so I quit that one too and decided
to go into the VA until I got an answer, and that is where I am
at now, still searching for an answer.
44
Mr. Gutierrez. Well, let me just — I know my time is up. I just
want to say to Tim, I believe you. We have heard a lot of testi-
mony, and I tell you, the members of this committee believe you.
We have heard it. We have all discussed it amongst ourselves, and
so you should know that. It is not much compensation, but your
word is getting out.
And last, Mr. Chairman, back in our State of Illinois, we have
got two witnesses from our home State here today who have given
very compelling. I would like to enter into the record, given that
there are some colleagues of ours back in the State legislature
which are going to be conducting hearings tomorrow in the State
of Illinois and they have a State task force that is being put to-
gether. I would like to enter into the record these documents put-
ting together the resolution and putting together the committee, so
people can know that there are some people back home doing the
same kind of work.
Mr. Evans. Without objection, so ordered.
Mr. Gutierrez. Thank you, Mr. Chairman.
[The documents follow:]
RESOLUTION ANALYSIS
BESOLUTIOM HJR 1$ AHALTST Ralph Eoan (81?2) Kw
SPONSOR Part DATE OF IKTROOUCTIOH 3/25/93
COMMITTEE Vet«rani' Affairs DATE OF ANALYSIS 3/29/93
Provides for tht creation of a Joint Task Korce on Gulf Mar Diseases to study
the health problems facing returning Gulf Mar veterans.
AiJALISlS
Tht resolution establishes a Joint Task Force on Gulf Har Diseases to study
the health problems facing returning Gulf Mar veterans.
Provides that the task force will be made up of the Director of the Illinois
Department of V»t>ran«' Affair* ^^^ «a.k... ..« 1.1.. />..^ 1 • ..1.. ... x. .
r.v..«, tn.t ine tasn Torce will De made up of the Director of the Illinois
Department of Veterans' Affairs. Uo members of the General Assembly and two
members of the public appointed by the Leaders of the General Assembly.
1*11 ^^!"* J*?!^ '"®''" "^^ complete a study of the health problems fadny
G!n«r^"L!«r, "*!•*,'!'■?''*«•"'* '"*•' '■'P'"'^ '*» findings to the Governor, th
Con2»Lf«^!fi^' *''!."-^- 0«P4'-t»«"t Of veterans' Affairs and the Illinois
congressional Delegation by January 1. 1994.
III iVrlWVr!'.lVrWJ"^"J '•* "" *'' **"<*y "^y «^" 19-000 •"" *"d women
Who served in the Gulf War have manifested medical problems.
45
(.Ritiosaiocscb
X HOUSE JOINT RESOLUTION .Jftfjf^ /^T^
} WWtftEAS. Ov«{ H.OOO m«n •ni won>«n Ifi out aiiiUary -ho
3 S«rvtd In th* Guit W*r r\«v« Mnlf«»i»<J medl<.-4l. probl»(«s frc«
4 ch«i{ Suir W4r sarviei: «nd
1«
17
S HVEXEA4. Th«»e httltn ptobltm* lnclud«, but at* "Ot 20
< limited to, h*ir las«, txtrim* fatl^u*. blood in »tool. 2i
7 •«er«ni« rt<n«s, n«utl«. f«v«r, scid oth«c tymptoma: 4r.d 32
fl WBUEAS. Th««« m«dlc»l proDl«m« c»n l«Bd t« "or« ««tiou9 25
9 illn«**«« «nd c»ua« s«v*r« phy«ieai, »nd mvneal sctalns; and 2(
X9 viXXEAS, In Additian, chti« probXama causa job 4nd family 2?
II eonetrns du« to dlsabilieiaa or inabilitiaa to i>«c{9rmi and 20
13 WHEII£y*St Rtcant reports in tna nawa madia Indicate eh« 3J
13 extent o< tha pceblam across tna nation Cer tnosa whw xvivvu 3*
14 in tha CuXf< and documantad dxsaasaa lixa br Is-nnianiasis anvl 33
15 prcblams relating to patrolaum sanvitivity at* widespread, 3<
16 varifiabla, and appear to b« *erviw«-conn«ct*di and
17 WHtKCAS. Tht U.S. Dapartmant of veterans ;kf;a'.:s i3 in 39
;• tha procsss oC evaluating tJia issuai and 'ill
19 WH£R£AJ. Out larvicaraan and iarvieawoman served t.'iis ^1
20 nation adinirably and heroicai./ in our na^nif leant Suit m^i *'
21. victory with our aiiies> and triey deserve apprepri«t» :i«alkn 43
22 care and disability benefits; anU
23 WH£NUkS. .W« ou« t.iam a cofflni tniciit Lo be exhaustive in our <!
24 researcn and resolve t.iese iasuea as soon as poasible: snd 49
25 WBEXUkS, It is important that va axpadita \'n* soi'ition of S:
2< this issue in order to prevent 4 repeat of e:^« Jif Cicul t iea S3
27 wnicn arose from Aqant orinqe; criercfuca b« is S4
2« aCSOUVtO. B» THE HOUSt \it «EPR£SEKT*TIV£$ OF TME J7
29 EICaTT-EICHTH CCHERAI. ASSEKBt,/ «r TME STATE OT ILLIMOIS. THE J«
46
•2-
l.ll»8l3S810CScb
SrNATC CONCURflINC KCSCIN. tn«e th«ft is Ct»»ted « Joint T4JK.
rorct on Culf H»r 3l$»*»e«, to contuc of tn« 3it»ctor o< t^•
Illinoi* C«p«rti«enc oJ V»t«f«n« Affair*, •« officio, plu» two
m«mb«rs of tn« C«n«r<l ASftmCly «nd tvo T.cnbers of the public
•ppoinctd by t«cn cf th« follouin9 ofCiei«Xs: tn« Spcaiec of
tha Heua* of !(epr«««ncaciv*9, tn* Pr«sl^«nc of ch« 3«n*te,
ch« Minority Leader of the Roust of Bapctiencat Ivts , *nd th«
^/nknotit<f C.«ad«r of t^• Sanactt and b« it further
R£SOLVtO, That tht Joint Taak Forea on CuIC Wae Olxaso
anall atudy (M« health pcobXam* facing our rsturninq Culf ^*t
v«tarana, and snai; report it* findings and cecomr<«nda t ions
CO th« Covvrnor, the Cenaral Aat««bly, trim 'Jnlttd Stales
Dapartaenc of Veteran* Affair*. and t.^ia Illinoi*
Con^rtaaicnal Otlaqation oy January 1. ;J9<.
S9
<;
62
£}
S4
P^pf ^F f.V4 /A^^.
lf%)!U^A")h L{^KJUUA4
47
LRB880Sa30CBcbam01
1 AM£NOM£NT TO HOUSK JOINT RESOLUTION 15 14
2 AMENDMENT NO. . Amend House Joint Resolution 15 on 18
3 pa9« If in line 14, by cnanging ■brisnmaniasis" to
4 "Isishmaniastis" ; and
5 on pa<38 2, by deleting lines 3 and 4, and Inserting Instead 21
6 th« followiiiij:
7 "Illinois Department oC Veterans Affairs, ex officio, plus 23
8 four menbecs of the House of Representatives, four members of 24
9 the Sen«te> and two members of the public". 2S
48
wiHcmorr analysis
AMENOMENT 2 TO
OFFERED lY Dart
COMMITTEE noor
HJR 15
Oirt
ANALYST Rajon Zmn (81??) mm
DATE OF ANALYSIS 4/16/93
BILL SYNOPSIS
Provides for the creation of a Joint TasK. Force on Gulf W*r Diseases to study
the health problems facing returning Gulf War veterans.
AMEWOMENT ANALYSIS
The amendntnt Increases the meinbershlp of the Task Force on Gulf Har Diseases
to 20 members.
The task force will Include th» following membtrs:
• Th« Director of the CJepartment of Veterans' Affairs.
• The Director of Public Health.
• Four members of the General Assembly appointed by the Speaker of the House
of (fepresentatlves,
• Four members of the General Assembly appointed by the President yf the
Senate.
• Two members of the General Assembly appointed by the House Minority Leader.
• Two members of the General Assembly appointed by the Senate Minority
Leader.
• Two members of the public appointed by the Speaker of the House.
• Two members of the public appointed by the Prasldent of the Senate.
• One member of the public appointed by the House Minority Leader.
• One member of th# public appointed by the Senate Minority Leader.
49
Mr. Striley. Mr. Chairman, I was wondering about that subject
myself. I have got other veterans in the lowa-Wisconsin-Ilhnois
area, let me know when and where and I will have those veterans
there. I think we can do something in our area.
Mr. Evans. We hope you will communicate with our respective
staffs about having some of our representatives at these meetings
and hearings in the future.
Mr. Striley. Yes, sir.
Mr. Evans. Let me recognize the gentleman from Georgia.
Mr. Collins. Thank you, Mr. Chairman.
Just briefly, I find of interest the remarks of Officer Albuck refer-
ring to those who are still on active duty and their fear of coming
forward with their problems, and I call the chairman's attention to
information that I submitted on behalf of Nick Roberts from Co-
lumbus, GA, a list of individuals that he has gathered that also
have severe health problems.
And in his comments he refers to the fact too that he had a num-
ber of other names that he could submit but by request of those
people, they were still on active duty and were afraid to come for-
ward. I too would like to submit a list of questions that on August
31 was submitted to the Department of Defense, Secretary of De-
fense and Department of Navy, questions revolving around chemi-
cal warfare that Officer Albuck has answered some of those ques-
tions here today.
But I would like to submit this for the record, if there is no objec-
tion.
And thank you, Mr. Chairman.
(See p. 109.)
Mr. Evans. The gentleman from Massachusetts.
Mr. Kennedy. Thank you, Mr. Chairman.
I wondered, Mr. Hollingsworth, you referred to the Marine Corps
Institute Command and Staff College Non- Resident Program on
Nuclear and Chemical Operations dealing with some biological
agents which states limitations in detecting biological agents.
These U.S. military limitations, I assume, are reasonably well
known. But we heard testimony some time ago by Dr. Hyman, who
I think you are familiar with. Is that correct?
Mr. Hollingsworth. That is correct. I was treated by Dr.
Hyman.
Mr. Kennedy. Yes. Dr. Hyman in his testimony, as I recall it,
not only indicated that there was some kind of germ that he had
been able to detect, but he was the first person, although he didn't
directly say it, he certainly implied through his answers and
through his inflections that he felt that at some point some kind
of biological or nerve agent will be uncovered.
I wonder if you could, perhaps, clarify or just talk a little bit
about what your sense of Hyman's work is and how it pertains to
the recent acknowledgments that there were in fact some small
doses of nerve or biological agents present as a result of the Czech
study.
Mr. Hollingsworth. The first thing I want to remind the com-
mittee is that, number one, when we talk of chemicals and what
the DOD has now acknowledged, that the Czechs did indeed find
some chemicals, I just want to point out that with the presence of
50
chemicals now into play, I can't reiterate enough that now biologi-
cal agents have to be looked at.
In terms of Dr. Hjrman, his research has indicated both a strep
and a staph infection, okay? I want to say, and you can contact him
because I am not a medical expert. But I want to say that a lot
of it hinges on an account developed back in the late fifties by a
Dr. Case out of Harvard, and what he basically stated is, there was
a caveat in there on the term significant.
In other words, if you have a bacterial count that is less than
100,000, it is not termed significant. Okay?
I have checked this with my doctor here in Rockville and he con-
firmed to me right out that you should have nothing in your urine,
whether it is one strand of bacteria. There should be nothing there.
Mr. Kennedy. And is there a strand in yours?
Mr. HOLLINGSWORTH. That is correct. I had the opportunity to
both look under Dr. Hyman's microscope and to see a growth that
he produced out of my urine which was a strep and a staph infec-
tion.
Mr. Kennedy. And was there anything that led you to believe
that that was anything other than a strep germ that might be car-
ried by a number of people in this room?
Mr. HOLLINGSWORTH. No. Well, actually there are two parts to.
that question. Not initially. I will say that now yes, and the reason
being is that Hyman has treated nine veterans and three depend-
ents. Okay? And I can't reiterate enough that all nine veterans and
all three dependents have shown the same types of things.
His last veteran that he treated was Sterling Simms. He has
been to the VA for 2 years for skin conditions of which they kept
giving ointments and pills and he did not get better. He had a 4-
hour visit with Dr. Hyman, was given some drugs and he is 90 per-
cent better now.
Mr. Kennedy. I appreciate that, and I am not trjdng to make
you answer questions that would be much more appropriate to be
answered by Dr. Hyman. I am just trying to get to whether or not
this new admission that there were in fact some kind of chemical
agent present in the Persian Gulf pertains in anyway to the kind
of presumptions that Dr. Hyman has as to what the cause of these
strep and other bacteria that are found in the veterans that he has
treated might be.
Mr. HOLLINGSWORTH. First, let me state that I can't reiterate
enough that Soviet doctrine calls for a cocktail mix. If there has
been admission to low level chemicals in the Persian Gulf, they
need to do a full epidemiological study to look at the biological as-
pects also. Okay?
Mr. Kennedy. Okay. In terms— yes?
Mr. HOLLINGSWORTH. The next thing I want to say is that, num-
ber one, I am not sitting here and insinuating that biological
agents were used in the Persian Gulf. There very well could have
been a bacteria that is present in Saudi Arabia, Kuwait, or Iraq
that we Americans are not used to.
These things could have come from allied bombing. The winds
were blowing in a southerly direction. For all we know, there could
have been a chemical such as a nerve agent or mustard based
agent that weakened the immune systems to make us susceptible
51
to these things. I don't know. But we need to do a study in this
area.
Mr. Kennedy. Thank you very much, Mr. Chairman.
We have asked, and Chairman Evans and others on this commit-
tee have asked that we look into Dr. Hyman's work. I think at our,
in a hearing, I don't know how long ago that hearing was
Mr. HOLLINGSWORTH. June 9th.
Mr. Kennedy. June 9th — thank you very much — we asked Gen-
eral Blanck, who is going to be testifying in a little while, to look
into the potential of linkages between Dr. Hyman's work and these
potential exposures. My understanding is that that was supposed
to get back to us in October. I am just told that that has now been
delayed at least until December. So I think it is important to try
to continue to have the DOD and VA look into this possible linkage
and try to get to the bottom of it.
Mr. HOLLINGSWORTH. I think DOD is fully aware of it. And let
me state this. That last week Les Aspin stated that he was going
to assign Joshua Lederberg to head a committee to investigate Per-
sian Gulf syndrome. Dr. Lederberg is a bacteriologist. He won the
Nobel Prize in 1958 for genetics with bacteria. I find that a very
strange coincidence.
Mr. Kennedy. Are you happy with that?
Mr. HOLLINGSWORTH. I am very happy with that. The problem I
have is that once again we feel that the DOD is not producing all
the truth. We think there needs
Mr. Kennedy. Why is that? I am having a hard time following
you. If Deutsch has appointed this fellow who you are happy with,
what indicates that you feel that they aren't doing a good job.
Mr. HOLLINGSWORTH. Mr. Kennedy, I can't reiterate enough that
until recently the DOD adamantly denied any presence of chemi-
cals in the Gulf.
Mr. Kennedy. Fair enough. Fair enough. Thank you very much,
Mr. Chairman.
Thanks, Mr. Chairman.
Mr. Evans. Thank you.
The gentleman from Alabama, Mr. Bachus.
Mr. Bachus. Thank you.
Mr. Hollingsworth, are you aware that the Department of De-
fense appropriation that was just passed appropriated a million
point two to Dr. Hyman?
Mr. HOLLINGSWORTH. Yes, sir, I am.
Mr. Bachus. I don't know whether this committee was aware of
this fact.
Mr. HOLLINGSWORTH. That came about in a conference report.
Mr. Bachus. You are aware of that, that that was done?
Mr. HOLLINGSWORTH. It would be interesting to note also that
depleted uranium studies and the multiple chemical sensitivity
studies got reduced.
Mr. Bachus. I don't know whether you are aware of it, but I am
from Alabama and Sterling Simms and several others. We have
been communicating with them and with Dr. Hyman for some 2 or
3 months, and I am on the same side of this issue as you are.
Mr. HOLLINGSWORTH. Yes, sir.
52
Mr. BacHUS. I am not in any way an adversary, but I think it
will enable him more with the promising work he is doing simply
from the fact that I have several veterans from my district who he
has treated successfully. So I think it is going to be interesting to
see where that work leads. But he now has an appropriation of a
considerable amount of money.
Mr. HOLLINGSWORTH. Once again I can't reiterate the fact that
with the acknowledgment of chemicals in the Gulf a full epidemio-
logical study needs to be addressed. Until recently, the word chemi-
cal and biological issues was not addressed in terms of agents. It
just wasn't addressed.
And, you know, the June 9 hearing, that was 6 months ago. Why
the delay? We need to address these issues with also multiple
chemical sensitivities and antibiotics or whatever we were given,
the shots that we were given. The whole slew needs to be looked
at, and that hasn't happened to date. It has been very narrowly fo-
cused.
Mr. Bachus. I agree. I am just saying that I think this Oversight
Committee has been the very committee here in the House that
has demanded that we do this, and Mr. Browder has pursued the
question of whether our troops were exposed to chemicals.
You have got to understand that not only you but this committee,
was told the Pentagon, and the Pentagon position has always been
that there was no evidence of exposure to chemical agents, that the
chemical sensory alarms didn't go off, that in the whole Persian
Gulf theater not one allied unit ever reported a possible exposure
to chemical warfare.
Now, we find out, in the last month or so, that these alarms, ac-
cording to testimony we heard today, these chemical sensory
alarms went off on maybe a daily basis.
So, that is one possible explanation for why we have not made
any headway. You have been told the same thing we have been
told, and I think, for one thing, that delays us in considering bio-
logical warfare, because we know Saddam Hussein has practiced
chemical warfare and biological warfare in the past, but we knew
that if in fact it had happened in the Gulf War that there would
have been a detection at some point, and we were told that there
weren't any.
Mr. HOLLINGSWORTH. Mr. Bachus, I would like to say that I dis-
agree with you on one point. First, we have not had a lot of delays
in dealing with this issue. I once again can't thank Lane Evans and
the full committee here for the actions they have taken. Okay? We
have been moving along. It has gone slowly, but we have been mov-
ing along.
I bring back to the attention of H.R. 2535. I can't comphment
this committee enough for taking such swift action on that. We
need to get legislation out of the Senate now that is going to do
the same and we need to continue on with the process. The key
point is that we don't have 10 years to conduct an investigation.
Veterans are dying now, and their families are being affected.
Mr. Bachus. I say, Kimo, that we agree with you. I guess what
I am saying is I am somewhat frustrated over the fact that the
Pentagon has told us there was no evidence of any exposure by our
troops to chemical warfare, and if we had been told that early on
53
I think we would have pursued that inquiry from day one and we
would have considered whether there was biological warfare, and
that issue would be as far along as some of these other issues
which we have investigated.
Mr. Troy Albuck. Excuse me. Could I say something, just real
briefly? I think that the way we asked the question of the Pentagon
as far as were there chemical exposures, in my experience when
the M8 chemical alarm went off and we did the 256 test and we
got a negative response from that, well, that's not a chemical expo-
sure.
And I imagine that in most instances where the M8 chemical
alarms went off, even on a daily basis, if those tests came up nega-
tive at that time there was not a chemical exposure.
I think that is why we might have gotten a response from, you
know, whoever the big- wigs are at the Pentagon or the Army or
wherever that say, "No, no chemicals." But down at our level we
were getting, you know, sort of a mixed — you know, we were get-
ting chemical alarms but we weren't reading any agents.
Mr. Bachus. But you know, I wonder. If these alarms were going
off as often as we have heard testimony that they were, then either
they are false alarms, and there is something wrong with the de-
tectors, or — is that not at least evidence that something is in the
air?
Mr. Troy Albuck. This may sound like a really funny analogy,
but I think it fits. It is like missing a period and then you do the
little dip test and you get a negative, you are not pregnant. When
you are on the ground at that time it seemed like it was an all or
nothing thing. You are not half pregnant.
But now it turns out that there is sort of a case in the — you
know, that is where the analogy breaks down — that you can be,
and that is that we got a nonlethal dose with a cumulative effect
over weeks or months, whatever the case may be depending on the
unit's deployment time where we are now, you know, experiencing
symptoms from damage that was done by either chemicals or by a
virus or bacteria that we are carrying.
Mr. HOLLINGSWORTH. I think the important thing here, sir, is
that there has been no formal studies done on low level exposures
to both chemical or biological agents.
Mr. Bachus. There have been in pesticides.
Mr. HOLLINGSWORTH. That is correct.
Mr. Bachus. Which is — and this is some of the same agent.
Mr. Striley. Sir, I find it interesting to note also, if I could, that
I have been in dealings with Dr. Hyman myself and he has sent
me a urinalysis kit. I sent my samples to him and he found the
same thing that he found in Mr. Hollingsworth here.
Dr. Hyman talked to me over the phone, making no promises or
diagnosis, and then sent a urinalysis kit. It took weeks for the re-
sults. But yet, a VA doctor talks to me over the phone, asks me
questions — are you having this, this, this and this — well, she diag-
noses me over the phone as having multiple chemical sensitivity.
My doctors, my civilian doctors have told me that is a quack. Any
physician that diagnoses a person over the phone is unproffessional
and could be considered a quack. This doctor works for the VA,
54
Dr. Hyman is someone who is here to help us, and the VA it
seems Hke, with this particular person anyway, doesn't want to
help.
Mr. Egan. Mr. Bachus, I would like to just, you know, make a
point of clarification here. I think history sometimes is useful on
these things. When you pursued the line of questioning about the
fact that the Pentagon hasn't told the Congress that chemical
agents were used, or perhaps biological agents, or perhaps in some
sort of a cocktail combination, I have personally sat through hear-
ings both in front of this committee as well as the Senate Commit-
tee on Veterans Affairs where the topic was the individuals ex-
posed to ionizing radiation during a nuclear test in the fifties, and
the Department of Defense consistently said, well, everything was
fine. We have the soldiers that were exposed, we had them wearing
badges. And lo and behold, there wasn't any indication on the
badges that anybody had received any dosages of low level or high
level radiation.
Well, later it turns out that many of these badges were defective,
perhaps deliberately so. And then you come to find that some of the
individuals were wearing badgers that had lit up like a stoplight.
So, for policy purposes here, if you assume Soviet military doc-
trine requires or suggests using chemical and biological agents, and
if you further assume Saddam Hussein was following pretty closely
the Soviet military doctrine, you have to conclude that our military
personnel deployed in the Middle East were exposed.
Then you have to determine what it is those exposures cause,
and then you have to begin the business of providing disability
compensation for those things. It is not surprising that the Depart-
ment of Defense has dragged its feet in bringing the truth forward.
Mr. HOLLINGSWORTH. Sir, I just want to add to that, that once
again I want to reiterate I think we are heading in the right direc-
tion, and don't misinterpret me. I am not implying that DOD is
lying. I think there is a lot of information out there that they are
not releasing. Okay? And I think that we need to get that informa-
tion because it is going to be critical in determining both the cause
and a cure.
Mr. Evans. I believe it is frustrating to Members of Congress,
and it must be agonizing to the veterans themselves. We have been
very much aided by the other gentleman from Alabama in doing
that, and I would like to recognize him at this time. Glen Browder.
Mr. Browder. Thank you, Mr. Chairman. I appreciate the oppor-
tunity to participate on this subcommittee, although I am not on
the Veterans' Affairs Committee.
I would like to just, I guess, put in a motion here that we orient
ourselves toward the target that we are chasing. I hear the hounds
barking and they are on the right track and they are barking up
the right tree.
Let me suggest, though, that we not look over here and send the
hounds off in the direction of another tree — and that is DOD. We
are on their trail. If we have to, we will take that building apart
brick by brick and put it back together to get their attention to
chemical and biological agents in defense.
I have been in Congress since 1989. We have had legislation in-
troduced trying to get them to do so, or recommending it. Last
55
night, we passed a conference report on the defense authorization
bill which gives specific direction.
Some people can call it micromanagement, which we don't like
to do. But when somebody is not doing something right, Congress
will manage it. If we have to pass that kind of legislation, we will
do it, and we are doing it this year. We are going to get them on
track with this legislation on chemical and biological warfare and
defending our military personnel against it.
I believe that in these hearings and Armed Services Committee
hearings and Senate hearings, we are going to nail down that
chemical and biological defense has not been that high a priority
with the Defense Department. We think that they did not give us
adequate information in response to our questions about whether
there was exposure. But that is, frankly, a question that we are
going to get at in other hearings and some here today.
But I think you are right. We have got people out there, Gulf
War veterans, who are sick and dying, and we intend to get to the
bottom of it and get them help at the same time that we are going
after the Department of Defense to acknowledge the chemical and
biological threat, and the fact that they need to be more responsive
to us and to our veterans and active military personnel on this
issue.
Thank you, Mr. Chairman.
Mr. Evans. Thank you very much.
Kimo, I said I would ask you to comment on the questionnaire.
Mr. HOLLINGSWORTH. Sir, I would just like to run down a Hst of
questions. I want to let the committee know it is my understanding
that Senator Riegle's office has the official copy of this, the true
form. This is a copy. Okay?
This is called a Southwest Asia Demobilization/Redeployment
Medical Evaluation.
Question number one reads: What diseases or injuries did you
have while in the Southwest Asia region?
Question number two: Are you receiving any medicine or other
treatment at the present time?
Question number three: Do you have fever, fatigue, weight loss
or yellow jaundice?
Question number four: Do you have any swelling of Ijonph nodes,
stomach or other body parts?
Question number five: Do you have any rash, skin infection or
sores?
Question number six: Do you have a cough or a sinus infection?
Question number seven: Do you have a stomach or belly pain,
nausea, diarrhea or bloody bowel movements?
Question number 8: Do you have any urinary problems such as
blood or stones in the urine or pain and burning with urination?
Question number nine: Have you had any nightmares or trouble
sleeping?
Question number ten: Have you had recurring thoughts about
your experiences during Desert Shield/Storm?
And question number eleven: Do you have reason to believe that
you or any members of your unit were exposed to chemical warfare
or germ warfare?
56
Mr. Chairman, clearly these, and I am not implying that DOD
is covering up again, but it seems to me that they may have been
anticipating some things. And I can only say that this needs to be
fully investigated also.
Mr. Evans. And we intend to ask them about it when they testify
today.
We have no other questions. Thank you for your long and
lengthy testimony here today and your service to our country. We
really appreciate you stepping forward. We know it is not easy.
And we know we can count on you in the future to help us with
more questions that need to be answered.
We thank the veterans service organizations as well. This panel
is now dismissed.
Mr. Evans. Members of our next witness panel are two VA phy-
sicians who examine Persian Gulf veterans. Dr. Myra Shayevitz is
Director, Cardiopulmonary Laboratory, Pulmonary Rehabilitation
Program at the VA Medical Center in Northampton, Massachu-
setts. Dr. Charles Jackson is an Environmental Physician and Staff
Physician at the VA Medical Center at Tuskegee, AL.
Dr. Shayevitz, we will proceed with you once you are situated.
STATEMENTS OF DR. MYRA B. SHAYEVITZ, DIRECTOR,
CARDIOPULMONARY LABORATORY, PULMONARY REHABILI-
TATION PROGRAM, VA MEDICAL CENTER, NORTHAMPTON,
MA; AND DR. CHARLES JACKSON, ENVIRONMENTAL PHYSI-
CLAN, STAFF PHYSICIAN, VA MEDICAL CENTER, TUSKEGEE,
AL
STATEMENT OF DR. MYRA B. SHAYEVITZ
Dr. Shayevitz. I first became acquainted with the multiple
chemical sensitivity syndrome when I myself became incapacitated
from MCS in 1989. About a year ago, I was casually reading about
the mysterious Gulf War syndrome and there before me were
symptoms I recognized all too well.
The majority of cases of MCS begin with a combination of stress,
a petrochemical and/or pesticide exposure, and therefore the unique
circumstances and exposures of the Desert Storm conflict may well
have resulted in MCS in susceptible individuals.
Another important feature of the illness is that subsequent dis-
abling symptoms are triggered by very low levels of unrelated
chemicals in common usage. MCS is not limited to veterans of
Desert Storm. The diagnosis and treatment of MCS is listed by the
Occupational Health Clinic at Massachusetts General Hospital,
Emory University School of Public Health, Robert Wood Johnson
Medical School, Yale and Johns Hopkins, among other prestigious
university clinics.
Now, here are the textbook symptoms of multiple chemical sen-
sitivities syndrome: fatigue, gastrointestinal sjonptoms, headache,
muscle and joint pains, difficulty concentrating, confusion, aching
in the chest, eczema, among other symptoms, and here are the
symptoms of our veterans supplied to me by Dr. Han Kang, epi-
demiologist of Veterans' Affairs Central Office: Fatigue, skin rash,
headache, loss of memory, muscle and joint pain, shortness of
breath, cough, diarrhea, and chest pains. The Desert Storm veter-
57
ans may not have MCS, but they do have identical symptoms to
those with that disorder.
Many of the veterans I have seen are unable to work and have
little to no funds. At our Medical Center there is no budget for spe-
cial testing, organic rotation diets, air purifiers, protective masks,
and nutritional supplements. There was insufficient staff available
for patient education, psychological support and testing, exercise
training, nutritional counseling, an investigation of family and oc-
cupational problems, and there is ilo chemically clean area for pa-
tient examination or treatment.
There are many theories being proposed as causative of the ill-
ness of the Gulf War veterans. However, it seems to me that the
common denominator is the symptoms of this illness itself which
clearly approximates those of the multiple chemical sensitivity syn-
drome about which much is already known and for which a ration-
al and safe therapy exists. This treatment is most effective when
accomplished early in the course of the disease.
I maintain that it is absolutely urgent for us to attempt a treat-
ment plan now. We at Northampton VAMC have submitted such
a proposal to VA Central Office, based on a 30-day hospital stay
in a chemically clean ward with an interdisciplinary team of spe-
cialists. We would follow these patients intensely for a minimum
of one year with comprehensive biological and psychological testing.
We feel that our treatment proposal would be of great benefit and
could serve as a pilot program for other such units, and as an edu-
cational and training resource.
I would like to read an excerpt from a statement by one of my
patients.
After returning from a combat tour in Iraq in April 1991, I began
to suffer from several ailments previously uncommon to me. The
worst ailment was recurrent severe frontal headache. My weight
began to drop from a steady 165 to 140 pounds. Chronic fatigue
was the most persistent. I found myself fatigued regardless of the
amount of sleep. Also, problems with my short-term memory.
In May of 1993, I underwent a Persian Gulf environmental ex-
amination by Dr. Myra Shayevitz. Dr. Shayevitz prescribed vita-
mins, instructed me to avoid all chemicals and petroleum products.
I no longer suffer from chronic fatigue. My current weight is nearly
160 pounds and I haven't experienced a severe headache. On my
November 9 visit I reported no problems whatsoever, and I feel
that the treatment was wonderfully successful. Glen R. Bono.
In summary, my message is that the Gulf War syndrome is most
likely multiple chemical sensitivity and that to prevent permanent
injury we need to provide our veterans with treatment now.
I know how very difficult, from personal experience, it is to con-
tend with this syndrome, how very difficult it is to change lifestyle,
how terrifying it is not to be able to concentrate, to walk around
fatigued with headaches all the time. I was very lucky. I had the
finances, I had the social support of a wonderful husband physi-
cian, and, in fact, I even have a kindly employer at VA North-
ampton that makes accommodations for me, and I feel that within
the VA I had a unique experience and with that came the singular
responsibility to try to step forward and be of help.
And I thank you very much more inviting me here today.
58
[The prepared statement of Dr. Shayevitz appears at p. 190.]
Mr. Evans. Thank you, Doctor, very much.
We have a vote pending, and I think it might be wise if we recess
until the vote is concluded. It should be about 15 minutes.
[Recess.]
Mr. Evans. If everyone would please be seated. We would like to
reconvene this hearing.
Dr. Jackson, as soon as everyone is seated, we will call on you.
We appreciate you coming up from Tuskegee and look forward to
your testimony.
You may proceed now.
STATEMENT OF DR. CHARLES JACKSON
Dr. Jackson. We at Tuskegee VA hospital in Atlanta wish to
thank this committee for allowing us to come and speak before it.
Basically, I will summarize the written statement that we have
here. I think everyone has a copy of the statement, which is a 2-
page, typed statement.
We, in August of 1992, at the VA Medical Center in Tuskegee,
AL, began enrolling veterans in the Registry.
In view of their complaints about the vaccine, particularly an-
thrax, that they received in the Gulf, complaints about recurrent
diarrhea, joint pains, excessive fatigue, shortness of breath, mem-
ory problems and other multiple problems, the VA in Tuskegee de-
viated from the suggested protocol of a physical examination, CBC,
chest X ray. Profile 8, and urinalysis.
In view of the endemic diseases of the Middle East, complaints
of diarrhea, joint pain, and exposure to dead animals, which we
had gotten comments about from the veterans, the VA in Tuskegee
systematically performed an expanded number of tests on the first
100 veterans seen in the Registry. Febrile agglutinins, hepatitis
profile, ANA, rheumatoid factor, sedimentation rate, fungal titers
and Immunoelectrophoresis serum were performed on the first 100
veterans of the Registry.
Where appropriate stool cultures, stools for ovarian parasite and
blood culture were performed. All of these tests were basically nor-
mal except for what are discussed below.
Finally, by 1993, in September, the VA in Tuskegee had com-
pleted data on over 180 individuals. A summary of the results of
the 180 individuals in the Tuskegee Registry are these: Number
one, of 180 individuals, 28, or 15 percent, had complaints referable
to diarrhea or recurrent diarrhea or gastroenteritis problems.
Twenty-three, or 13 percent, had complaints of excessive fatigue.
Twenty-two or 11 percent of the 180 had complaints of joint pains,
particularly fingers and knees, not associated with injury or any
prior trauma. Twenty, or 11 percent, had complaints of rash on ex-
tremities off and on since the Gulf Ten, or 6 percent, had com-
plaints of excessive shortness of breath which did not exist prior to
the Gulf. Three, or 1 percent, had muscle aches and twitching
which did not exist prior to the Gulf.
Most of the people had more than one sjmiptom, and thus there
is overlap. A total, however, of the group of 180 people, 63 percent
of the group were symptomatic.
59
Number two: Physical and abnormal findings were found in 26
percent of this group. No individual is in more than one category
in this group, thus truly 25 to 26 percent, or in other words, one-
fourth of this group of 180 individuals actually have abnormal lab
and physical findings which are not usually expected.
Elevated serum protein levels of greater than 8.3 grams occurred
in 14 of the 180, or 11 percent. Seropositivity for hepatitis B virus
occurred in 11 people, or 6 percent. Interestingly, none of these
people were icteric or had a history of hepatitis that they knew of.
Hypogammaglobulinemia was found in 8, or 4 percent, of the
group: Lymphadenopathy generalized was found in 4, or 2 percent
of the group. And an elevated sedimentation rate of 30 or above
was found in 5 patients, or 2 percent.
Other abnormalities which were found in the 180 individuals in-
cluded one with gastrointestinal candidiasis, two with th3a-oid dis-
ease, one with non-Hodgkin's lymphoma, abnormal liver on echo in
several individuals. Thus 25 percent, or one-fourth of the people
who were seen in the Persian Gulf Registry had definite docu-
mented medical physical abnormalities.
In summary, we at Tuskegee have the opinion that in view of
other considerations and the information that has been obtained
within the last several weeks by the Czech report we feel that we
at Tuskegee should, with cooperation and working with Dr. Roswell
out of Birmingham, pursue the consideration that there was chemi-
cal and/or biological agents contamination in the theater. We do
not speculate on the etiology or the cause of this.
Thank you.
[The prepared statement of Dr. Jackson appears at p. 218.]
Mr. Evans. Thank you. Doctor.
What led you to deviate from the normal, suggested protocol for
a physical examination?
Dr. Jackson. We had continued the suggested protocol from Au-
gust until January. In that time, a number of individuals, particu-
larly those in CB 24th in Columbus had stated there were a num-
ber of people who were going to private doctors who were ill, and
even though we had gotten normal test results from them they
were sick.
So, we felt that it was prudent medical, good medical practice
simply to expand our testing base to see if we could come up with
an organic basis for the illnesses which these veterans were com-
plaining of
Mr. Evans. You are reported to have stated that at least 5,000
veterans have possibly been subjected to some type of genetically
altered biological toxin. Is that correct?
Dr. Jackson. I don't think that is exactly correct. I think the
statement was that there are approximately 5,000 people who are
on the Registry who are ill and having medical problems.
Mr. Evans. How would you define Persian Gulf S3nidrome? How
is it defined? Is it acute or chronic? And is it disabling?
Dr. Jackson. Well, I don't think you are going to find it in the
medical textbooks. Loosely, individuals (1) who had been in the
Persian Gulf; (2) had problems, the symptoms of which have been
described before, who could not — rather did not have an expla-
nation which could come under definite diagnosis.
60
I think the two things are put together and we just simply de-
scribe it as the Persian Gulf syndrome. We didn't really know why
they were having problems, but we knew a lot of the things that
they did not have.
Mr. Evans. How is chemical or biological warfare agents expo-
sure determined, and is this disabling?
Dr. Jackson. I think there are several parts to the answer to
that question. One is it is basically going to be determined by, as
mentioned before, if the levels are high enough there will be a
body's reaction to that, or using the chemical detectors that the
military have provided for the veterans.
Number two, there is some question as to whether or not low lev-
els of chemical exposure have long-term disabilities. This is one of
the things that Dr. Roswell is going to be investigating in Bir-
mingham. And, in terms of the biological aspects of low exposure,
we don't have a lot of answers on that, and that is one of the things
that we are going to be pursuing at Tuskegee, if we can test for
biological agents.
We know that tests can be done and we know that tests are
available. The question is whether or not we could be able to detect
biological agents. And number two, we will have to do some testing
and working with individuals on whether or not there are long-
term consequences of exposure.
Mr. Evans. The illnesses that you have found to be in 26 percent
of the group are abnormal illnesses, should they enable veterans to
be compensated as service-connected? Can you show that?
Dr. Jackson. One of the problems that we have is you cannot ab-
solutely prove that these individuals were normal under these tests
prior to being deployed to the Gulf. In other words, these tests are
not normal tests which would be obtained in a routine physical ex-
amination.
We must, I think, assume though that individuals who are in the
reserve, who meet the physical test requirements periodically, who
are deployed to a combat area, I think we must assume that they
are basically in good health.
And finally, the association of s3anptoms with the abnormal test
results that we find suggests that these individuals did not have
these problems prior to deployment to the Gulf.
Mr. Evans. When you say we in terms of Tuskegee, you mean
other colleagues of yours that are interested in pursuing biological
warfare
Dr. Jackson. Yes. We have a team of people that we get together
periodically to discuss what tests need to be done next, exchange
thoughts, et cetera, and one of these teams is the Research Com-
mittee which has helped other physicians there. So it is not per se
a really organized body, but it is a group of people that have been
kept abreast of what the thinking is and the results that we have
given you.
Mr. Evans. Who heads that specific task force?
Dr. Jackson. Well, I guess technically the Chief of Staff is over
the group of individuals, and we keep him abreast of the general
overall trends in test results, et cetera. The day-to-day activity I
guess is the responsibility of the environmental physician at the
hospital.
61
Mr. Evans. Let me yield to the gentleman from Alabama.
Mr. Browder. Thank you, Mr. Chairman.
It is ironic — if you will allow me just a minute. Some people have
asked me why I became interested in this issue and why I went
to the Czech Republic to examine the Czech reports when there
were rumors about it. Besides having veterans of the Gulf War who
had these mystery ailments, I also have in the Third Congressional
District of Alabama the Nuclear, Biological and Chemical Center,
the U.S. Army Chemical School, which is the home of chemical and
biological defense training and the only live agent training facility
in the free world. I also have in the Third Congressional District
of Alabama one of the eight continental U.S. stockpile sites where
chemical weapons have been stored for the last half century and
that we have to dispose of for the Chemical Weapons Convention.
And you guessed it. Dr. Jackson and Tuskegee VA Center are in
the Third Congressional District of Alabama. So we have, I have
an intense interest in this, and I would like to ask Dr. Jackson a
few questions, leading questions, because I think that they are per-
tinent to what he has testified to before your committee before and
today.
And, Dr. Jackson, I will ask you to answer these as briefly as
possible, if you will, so that we can — I think it will lead us in a
productive direction, but I would like to leave room for other people
to ask questions.
You have talked — I have pursued and followed your statements
all along, and I noticed one thing about your statements. Despite
what the headlines said, you have always talked about chemical or
biological exposure, possible symptoms, and that interested me, be-
cause in the beginning we were just talking about possible chemi-
cal exposure.
Can you differentiate, and just briefly tell us, how do you dif-
ferentiate between whether you think somebody, perhaps — nobody
is asking you to say that something caused something, but you can
identify symptoms that are not incompatible with chemical expo-
sure or biological exposure. How do you differentiate between
whether something is suspected, somebody is suspected of having
chemical exposure versus somebody who has had biological expo-
sure? Is that possible?
Dr. Jackson. Symptomwise the answer is probably no. It would
depend on the levels of the chemicals and the levels of the biologi-
cal exposure.
Mr. Browder. But if you — you can devise a grid or a chart, say,
for high exposure or low exposure with pertinent sjonptoms? If
somebody were exposed to chemicals, that would be different from
somebody who were exposed to biological?
Dr. Jackson. That is possible. It is stretching the point.
Mr. Browder. Okay. Then how do you say that you expect— that
you would like to examine biological as opposed or in addition to
chemical?
Dr. Jackson. There are a number of considerations. One is the
recurrence of the sjrmptoms in the veterans. Ordinarily, if you have
a one point or zero point in time exposure to a low chemical agent,
as an example, low level of chemical agent, one would expect
62
maybe no symptoms or one would expect symptoms over a short
period of time and then a resolution.
If one has moderate or high level exposures of a chemical agent,
one could expect recurrent symptoms, but one would expect for the
individual at the scene to have had a physiological reaction, which
was described by the members of the prior panel.
So, basically, you can feel confidence in saying that there were
not moderate or high levels of chemicals in the theater or the sol-
diers would have gotten sick right then.
The interesting thing about a biological agent is that you can
have low levels of biological agents, either one point exposure or ex-
posure over a period of time, still having levels which are not de-
tectable through the detection methods which from my understand-
ing are used by the DOD but that the accumulation of the effects
of these agents are cumulative and they could cause long-standing
and permanent problems.
Mr. Browder. Thank you. Can you differentiate between biologi-
cal weapons, the symptoms that you are talking about, biological
weapons and endemic diseases or environmental factors such as
the oil fires?
Dr. Jackson. Endemic diseases, I think the answer is yes. In
general medical practice we have a lot of tests which can isolate
various kinds of bacteria, tjrphoid, et cetera, cholera, which do give
similar problems, but you would expect to have positive test results
showing these things. We have done basically all these different
tests and we have found no evidence that in this group of 180 indi-
viduals that they are suffering from endemic diseases.
In reference to effects of oil well fires and/or multiple chemical
sensitivities from other elements, there are some tests which can
be performed, but we cannot say that we have been concentrating
in that area.
Mr. Browder. And, Mr. Chairman, just very quickly, do you
think that this could have happened because of the vaccinations
that our soldiers received?
Dr. Jackson. No, I do not.
Mr. Browder. And finally, do you think that the symptoms that
you have observed, that you have talked about, that those are
markedly significantly different from what you would expect to find
in the general population?
Dr. Jackson. Yes.
Mr. Browder. Thank you.
Thank you, Mr. Chairman.
Mr. Evans. Thank you.
Mr. ColHns.
Mr. Collins. Thank you, Mr. Chairman.
Dr. Jackson, I want to personally thank you for all the work that
you have done for the 24th Naval Construction Battalion, Attach-
ment 1624, the Seabees out of Columbus, GA. They have felt like
all along it has been coming to Tuskegee that you were and are an
ally for them, and that oftentimes you were the only one that was
really giving them the attention that they so deserve.
You conducted testing on members of the 24th CB unit from Co-
lumbus and I believe you also sent a letter on July 17, 1993, to the
commander discussing the severity of problems on that unit, and
63
I also understand that one of the Seabees was diagnosed with
lymphoma cancer, four more have been tentatively diagnosed with
early stages of lymphoma cancer, and 11 believe that they have
tested positive for HTLV-1 and 2 which can cause lymphoma can-
cer but have not been shown their diagnosis.
How many members of that unit did you test for the HTLV-1
and 2 virus and how many of the unit tested positive?
Dr. Jackson. You must understand that we did not have imme-
diate financial resources to go into a whole unit and test the whole
unit. So, what we decided to do was in view of the fact that we
knew that certain members of the CB24 were very ill, and one of
which had non-Hodgkin's lymphoma, we felt that testing the sick-
est members of that group would be appropriate to tell us if we
were going in the right direction or not.
We tested — well, approximately 50 to 60 individuals were in that
detachment which went to the Gulf, and we tested what we felt
were the sickest ones, including the gentleman with non-Hodgkin's
lymphoma. So, we tested approximately 12 or 15 individuals out of
that unit and none of them tested positive for the HTLV-1 or 2
virus.
Mr. Collins. Did you not tell Michael Moore, Roy Morrow or Roy
Butler that they tested positive?
Dr. Jackson. No. What I think is indicated at this point is to
just briefly discuss the virus, the fact that the virus is a natural
virus, the fact that it is found in approximately 1 out of 5,000, 1
out of 6,000 naturally and is not associated — every time you find
the virus there is no association of illness. So, the virus can be
found naturally.
The question that we had was does a high number of that group
have the virus or parts of the virus? Now, in order to make the di-
agnosis that these individuals have the virus what we must do is —
the test is broken down into a sequence of different tests because
the virus is broken down, in terms of testing, into different por-
tions. In order for the diagnosis to be made that a person has the
virus, one should test positive in four of these different test areas
for the virus, and we found that no individual in that group that
we tested had the entire virus.
Now, the particular individuals that you are discussing they did
test positive for part of the virus, and the fact that those individ-
uals tested positive for part of the virus was not statistically sig-
nificant in terms of being able to say. Well, if the whole group test-
ed positive for the same part of the virus, we would have been sus-
picious, but the whole group did not test positive for the same part
of the virus, which is acceptable statistical normality.
Mr. Collins. Okay. I understand that we are going to retest
these same individuals.
Dr. Jackson. That is a possibility, but at this point we are not
really seriously considering HTLV-1 and 2 as being the etiology of
their problem.
Mr. Collins. The Seabees tell me that you told them that they
had a live virus, as they so called it, and told them that they could
not donate blood for life and that they must practice safe sex and
take other precautions because the disease is communicable. Is
their illness commimicable?
64
Dr. Jackson. I think there is a Httle misunderstanding here. I
think that what we were trying to communicate with them was
that (1) we don't know what their problem is, we don't know if they
have an illness which can be communicated to their spouses, and
we did have individuals of that unit whose wives had come down
with medical problems which were not diagnosable by their physi-
cians, and so we were suspicious there might be some commu-
nicable problem in this.
It was just simply good medical practice to caution them about
their options, the possibilities. But I don't think that we ever said
you definitely have the virus and you definitely are contagious be-
cause of the virus. We have never known anybody had the virus.
Mr. Collins. Can you elaborate on the letter you gave to Larry
Kaye about his diagnosis as being chemical-biological warfare expo-
sure?
Dr. Jackson. Yes. That was a clinical diagnosis based upon a
number of considerations. One, Mr. Kay and other members of his
unit had gone through a good, extensive battery of tests, all of
which had shown nothing. Number two, I was in personal contact
with doctors at Bethesda, and since he is a member of one of the
12 detachments of the CB24, I had been given the names of 70
other individuals in CB24 scattered throughout the Southeast who
were ill, some of which had gone to Bethesda, some of which had
the same "we don't know what is wrong with them" diagnosis.
So, in view of all of that, it was a safe clinical opinion that, be-
cause we had cut down all the other trees, they were exposed to
chemical and biological agents.
Mr. Collins. Very good. Thank you, Dr. Jackson. And again, I
want to thank you for the service you render to those veterans.
They have a lot of confidence in you and hopefully that you will be
able to continue servicing them in conjunction with the Bir-
mingham pilot program.
Thank you, Mr. Chairman.
Mr. Evans. The gentleman from Massachusetts.
Mr. Kennedy. Thank you, Mr. Chairman.
Dr. Jackson, I just want to follow up a little bit on the answers
you just provided to Mr. Collins. I am still a little bit confused. I
think there was a situation where, as I understood the facts that
you provided us, there are 50 or 60 guys that had some sense that
they were sick, is that correct? Out of this entire battalion? Or is
that 50 or 60 people in general?
Dr. Jackson. Let me help you with that. There are 12 different
cities that have branches of this 24th CB battalion. Columbus is
only one of those cities. Approximately 800 members comprise the
whole battalion.
Now, 15 percent of that whole battalion is sick. The 50 individ-
uals of the Columbus area are only members of one detachment,
and maybe 25 or 50 percent in that group is ill also.
Mr. Kennedy. Okay. So you got — out of 800 guys, you got a —
soldiers — 120 of them are sick about, is that correct?
Dr. Jackson. Yes.
Mr. Kennedy. All right.
Dr. Jackson. Now, this is information I have gotten through
communication with the regimental headquarters in Atlanta on the
65
other members of the CB24 and also talking to individuals of the
CB24 in other places — Greenville, Asheville, Atlanta, et cetera.
Mr. Kennedy. We appreciate that, Doctor.
Now, out of the 120 fellows that got, or folks that got sick, do
most of them have similar symptoms that you are familiar with?
Dr. Jackson. Most of them have symptoms under one of those
7 or 8 categories that we talked about — diarrhea, fatigue, shortness
of breath, lymph node swelling. Yes.
Mr. Kennedy. Are those illnesses that they are suffering from,
in your professional opinion, caused by some — in all probability by
some similar event?
Dr. Jackson. Yes.
Mr. Kennedy. Do you think that event occurred at one time?
Dr. Jackson. Let me
Mr. Kennedy. Or perhaps, did the same event occur over a num-
ber of exposures?
Dr. Jackson. That is what I was going to elaborate on. The vet-
erans of that particular unit specifically talk about — excuse me —
January 20th, 1991. In that particular incident they specifically
noted physiological body symptoms, the itching in the mouth, the
skin, et cetera, et cetera, but it is very possible that this is an accu-
mulation of a number of
Mr. Kennedy. I understand. I understand. Doctor. I only have a
couple of minutes left, so please let me just ask you some quicker
questions. Okay?
Now, do you have any information, did you look into in any way
or ask the Department of Defense about the possibility of any kind
of event, a violent event that took place on January 20th, 1991.
Dr. Jackson. No, I didn't.
Mr. Kennedy. Don't you think that would be a logical question
to ask? Did you ask any of the men?
Dr. Jackson. Yes.
Mr. Kennedy. And what was their response?
Dr. Jackson. They said yes, and they have testified before com-
mittees stating that this
Mr. Kennedy. I understand. Yes, I understand.
Dr. Jackson. See, I didn't have a reason to directly approach the
DOD because they were saying that nothing happened and it had
in terms of chemical and biological agent exposure.
Mr. Kennedy. Okay. Now, if 120 of these fellows have one of
these or several of these eight symptoms, they all indicate a par-
ticular day when they feel that these symptoms came on, they all
happened to be in a strange country that was under military at-
tack, would it be your professional opinion that given the answer
you just gave us a few minutes ago that this was not an issue that
necessarily was pertaining to a chemical agent — you did indicate
that this would be a possibility or a probability of some kind of bio-
logical agent?
Dr. Jackson. The problems they are having are also consistent
with a biological agent which we know has been used in that thea-
ter before.
Mr. Kennedy. When you say "which we know has been used in
that theater before," can you explain that a little bit, please?
66
Dr. Jackson. Yes. Particularly, in 1984 in the Iran-Iraq war
there was an attack on Marginoon Island where the Iraqis attacked
the Iranians and they used, and this was documented by the Unit-
ed Nations, they used a combination of chemical and biological
agents in the same attack.
Mr. Kennedy. Doctor, has there been any attempt by anyone to
attempt in anyway to pressure you to come up with anything other
than your own personal best analysis and decisions as to what
might have taken place?
Dr. Jackson. I just want to make a slight correction. This is not
just my opinion. We have a group of people at Tuskegee and over
the last 8 months we have progressed from thinking that this was
an endemic disease problem or hepatitis problem or HTLV problem
to a chemical and biological agents problem.
Mr. Kennedy. That is your professional opinion and the group
that you work with's professional opinion?
Dr. Jackson. Yes.
Mr. Kennedy. Did anybody in any way try to denigrate that de-
cision, try to in any way create any pressure on you to change your
opinion from your professional opinion?
Dr. Jackson. No. Basically, no one outside of the VA, this group
that I am talking about, knew that we were progressing towards
that opinion, so no one could really influence it.
Mr. ICennedy. Mr. Chairman, if I might just ask one additional
question, or I could ask you the question.
I had read in the newspaper of Dr. Jackson's work, and there
was a great to-do about that work maybe a week and a half or 10
days ago — 2 weeks ago.
Then I read in the newspaper that you had retracted your posi-
tion and that you no longer were maintaining that this was — that
these fellows got sick as a result of potential
Mr. Evans. Will the gentleman yield? I think that was in one
specific diagnosis, not a general across-the-board diagnosis.
Mr. Kennedy. Okay. That is exactly what happened?
Dr. Jackson. I think what is confusing the issue is that the let-
ter was written and it mentioned the chemical and biological
agents. I think it should be considered a fact that this was not the
official opinion of the VA and that I think accounts for the dif-
ferences.
Mr. Kennedy. When you say it is not the official opinion of the
VA, it happens to be the official position of the group of doctors
that was responsible for looking into this battalion's sicknesses. Is
that correct? And how many doctors?
Dr. Jackson. Two physicians, one nurse, and then we have two
other people we talk to and discuss things, Chief of Lab, et cetera.
Mr. Kennedy. Okay. Thank you very much, Mr. Chairman.
Thank you. Dr. Jackson.
Dr. Shayevitz, if I could just say there are a lot of veterans up
in new England that very much appreciate the efforts that you
have made on their behalf. I know that you have come under per-
sonal attack for many of the kindnesses and the professionalism
that you have shown, and we just want to let you know that we
appreciate your willingness to stand up for veterans that were ex-
67
posed to multiple chemicals in their service to the Gulf. You have
done a great job and we thank you very much for your efforts.
Thank you, Mr. Chairman.
Mr. Evans. Let me echo that. I have a few questions on the next
round that I want to ask you, so please bear with us.
The gentleman from Alabama.
Mr. Bachus. Thank you.
Dr. Jackson, the unit you are talking about that is the sickest
is a Seabee unit?
Dr. Jackson. Yes.
Mr. Bachus. How many are sick?
Dr. Jackson. I want to state that of that 180 there are only 15-
20 individuals.
Mr. Bachus. Are you saying 15 or 20 of the unit?
Dr. Jackson. Yes. But there are 80 other individuals from other
units that are just as sick or even sicker than they are.
Mr. Bachus. Okay. Let's just discuss the Seabee unit. You have
seen 20 people from the Seabee unit?
Dr. Jackson. Between 15 and 20, yes.
Mr. Bachus. Fifteen and twenty? Do any of them have cancer?
Dr. Jackson. Only one.
Mr. Bachus. One?
Dr. Jackson. That we know of, yes.
Mr. Bachus. How about their lymph glands?
Dr. Jackson. Yes, four or five of those individuals besides the
one with the cancer have lymphs swollen.
Mr. Bachus. What does that indicate?
Dr. Jackson. It suggests that their immune system is attempting
to fight something or other. They have a reaction which is affecting
their immune system.
Mr. Bachus. So, there are approximately as many as a third of
them who have some unidentified infection?
Dr. Jackson. Are you just talking about the lymphatic swelling?
Mr. Bachus. Yes.
Dr. Jackson. Well, 5 out of 50. We use the number 50, so that
is 10 percent.
Mr. Bachus. All right. Is that within the Seabee unit?
Dr. Jackson. Within that detachment. Of those 50 individuals
that went to the Gulf, let's say 5 of them have lymphatic swelling
and one of which has cancer.
Mr. Bachus. If you have an exposure to a biological agent, would
it cause an elevation in your lymph? Would your lymph system re-
spond in that way?
Dr. Jackson. It depends on the agent, and the agent that we are
looking at primarily, yes, it targets the lymphatic system.
Mr. Bachus. What is that agent?
Dr. Jackson. They are called mycotoxins.
Mr. Bachus. Mycotoxins?
Dr. Jackson. Which are the same agents used in the attack in
1984.
Mr. Bachus. By Saddam Hussein?
Dr. Jackson. Yes.
Mr. Bachus. Was that in a binary — was that used in conjunction
with chemical warfare too?
68
Dr. Jackson. Yes. This particular attack was the first docu-
mented attack by the United Nations of the combined use of a
chemical and a biological agent in the same episode.
Mr. Bachus. And that technology has been around for years and
years, hasn't it?
Dr. Jackson. At least a decade.
Mr. Bachus. All right. Have you heard reports from the veterans
that their wives and children are also suffering?
Dr. Jackson. Yes, I have. We have gotten calls from all across
the country of spouses who are having problems.
Mr. Bachus. Is that consistent with a biological agent?
Dr. Jackson. Yes, it is. It could depend upon what tjrpe of bio-
logical agent, but yes.
Mr. Bachus. So, a soldier could be exposed to a biological agent
in the Gulf. He could come home and infect his family members?
Dr. Jackson. Yes.
Mr. Bachus. Would we call that contagious? Would that be con-
tagious? Is that the right word for it?
Dr. Jackson. That is an acceptable word.
Mr. Bachus. So the condition could be contagious?
Dr. Jackson. Yes, which explains why Mr. Collins was making
his comments and why we say, well, we don't know what we are
dealing with, so you might want to take precautions.
Mr. Bachus. Have you been in communication with the CDC?
Dr. Jackson. Yes, we have.
Mr. Bachus. What has been their response?
Dr. Jackson. Well, we have been in communication with several
elements of CDC, one of which was we were considering a problem
with the vaccination process and we communicated with the vac-
cine area of CDC, and the other is in relation to a communicable
disease, which we are discussing now, and so we are going to go
working with them on an epidemiological study.
Mr. Bachus. Are you satisfied with their response to date?
Dr. Jackson. Yes.
Mr. Bachus. I have no further questions.
Mr. Evans. Does the gentleman from Alabama have more ques-
tions?
Mr. Browder. Dr. Jackson, just to draw to a close on my ques-
tions about your work, I don't want to put words in your mouth,
but you and I have had some discussions. For the next month or
couple of months, you are going to be studying these veterans. You
and Tuskegee and Birmingham are going to be conducting a pilot
study.
Dr. Jackson. Yes.
Mr. Browder. Would you recommend that as part of that study
that these veterans be also included in the protocol, that they
would be checked for cancer?
Dr. Jackson. I don't have any objections to it, but Dr. Roswell
is over the pilot study, so that would need to be discussed with him
as to how he wants to approach the situation.
Mr. Browder. Would you recommend that part of the protocol be
that they, their spouses be checked or that they be asked about
their spouses or family members as they are examined?
Dr. Jackson. We do that automatically.
69
Mr. Browder. You do.
Dr. Jackson. That is already part of our questioning.
Mr. Browder. Okay. And would you recommend that the CDC
become more involved in this effort?
Dr. Jackson. Well, we are going to be approaching them even
more, so we expect them to be involved, because the spouses aren't
eligible under the VA, so looking into their health problems will
have to be under some organization, and I can't think of any other
except the CDC.
Mr. Browder. You are participating in the pilot study. Are you
personally professionally satisfied with the work that the pilot
study, the way that it is designed now and the way that it is going
to be working?
Dr. Jackson. Yes, but it's just starting. But I think Dr. Roswell
is an incredible and a fantastic individual and I think he is going
to go in the right direction.
Mr. Browder. Do you think that we will be able to get an an-
swer when this pilot study is completed, get an answer about
whether these people have symptoms that are compatible with
chemical exposure and/or biological exposure?
Dr. Jackson. We definitely hope to have some statistical infor-
mation in about 90 days.
Mr. Browder. Ninety days.
Dr. Jackson. We, depending upon the problems we run into, we
may or may not have answers about chemical or biological expo-
sure. But we are hoping to, with verification and getting control
groups and comparing blood samples and things like that, we are
hoping to have some answers in about 6 months.
Mr. Browder. Thank you very much.
Thank you, Mr. Chairman.
Mr. Evans. All right, doctor, I think we will have some addi-
tional written questions to submit to you and your answers to those
questions will be made part of this record.
Dr. Shayevitz, I understand the VA agrees with AMA's Council
on Scientific Affairs which concluded, number one, that there are
no well-controlled studies establishing a clear mechanism or cause
for MCS; and two, that there are no well-controlled studies provid-
ing confirmation of the efficacy of the diagnostic and therapeutic
modalities relied on by those who practice clinical ecology.
Do you agree or disagree with the VA's agreement with the
AMA?
Dr. Shayevitz. If the VA in fact did say that I disagree with
them.
Mr. Evans. Are there then any well-controlled studies which es-
tablish a clear mechanism or cause for MCS?
Dr. Shayevitz. There has been a lot of research done. There was
an entire symposium by the National Research Council on MCS.
Controlled studies have been difficult to do, it is true, but what I
meant was if the VA in fact said there is no such entity as MCS,
and I have not known them to say that, it is to that which I dis-
agree.
I want to point out what I pointed out before. That brilliant re-
searcher at M.I.T., Dr. Nicholas Ashford, who somebody was trying
to remember his name here, and that places such as Mass General,
70
Yale and other prestigious universities, all recognize this sjmdrome
diagnosis and treat it.
Mr. Evans. All right.
Dr. Shayevitz. You know there are many diseases which we
treat that we don't know the cause of. In fact, perhaps most of the
diseases we treat we don't know exactly the cause of them.
Mr. Evans. Let me take it one step forward from that. In your
personal opinion, if you make a diagnosis that a veteran has MCS,
should the Veterans Benefit Administration accept this diagnosis
when adjudicating the veteran's claim for service-connected disabil-
ity compensation?
Dr. Shayevitz. Yes. And, you know, multiple chemical sensitivity
is recognized by the Social Security administration at this time.
That is the reason they get Social Security disability.
Mr. Evans. Family members of some Gulf veterans have also re-
ported developing some of the symptoms experienced by these vet-
erans. Is MCS communicable?
Dr. Shayevitz. No, it isn't. But I would like to remind you that
up to 15 percent of the population of the United States according
to the National Research Council may have multiple chemical sen-
sitivity syndrome, so it is possible that families of veterans may
have this disorder also.
And one useful theoretical model is that we are all individuals
and we kind of had to be tolerable, biological, psychological and
chemical, and when that is exceeded MCS can result. And I can tell
you that the spouses of these veterans are on overload from the
stress of their husbands being so ill.
Mr. Evans. Doctor, thank you.
The gentleman from Alabama.
Mr. Bachus. Doctor, are you familiar with Dr. H5rman in New
Orleans?
Dr. Shayevitz. I only know what I read in the paper. I did try
to call. I called his office but I wasn't able to speak to him.
Mr. Bachus. Have you read about his regimen, what he is doing
by putting these people in the hospital, isolating them fi-om offend-
ing chemicals and treating them with antibiotics?
Dr. Shayevitz. Well, only in the newspapers.
Mr. Bachus. All right. So, you are not familiar with what his
treatment routine has been?
Dr. Shayevitz. No, not intimately.
Mr. Bachus. From a layman's standpoint, I look at what you are
doing and you are basically isolating these people away fi-om aller-
gens, is that right?
Dr. Shayevitz. I am recommending that we do that.
Mr. Bachus. You are recommending, yes.
Dr. Shayevitz. I have no way to do that at this time. From not
only allergens, but all chemical incitants as well as allergens.
Mr. Bachus. Have they been desensitized? That is what you rec-
ommend doing, is that right?
Dr. Shayevitz. I am recommending something which would
cause what we call deadaptation. I will use an easier word to un-
derstand— detoxification, being away in a chemically clean world,
with very clean atmosphere, clean water, organic foods that are ro-
tated in another complete program.
71
Mr. Bachus. Did you recommend any antibiotics or medication
with this treatment?
Dr. Shayevitz. I recommend antibiotics if there is an infection.
Mr. Bachus. All right. Dr. Hyman has done basically what you
are recommending. He has isolated these individuals in a sterile
environment for some, I think, 2 weeks or 3 weeks and treated
them.
Dr. Shayevitz. And that will cause deadaptation. If you do that
people will get better.
Mr. Bachus. Yes. And I will tell you that he has been very suc-
cessful, and you may have heard. And it sort of strikes me as very
similar to your proposal, although there are things that you pro-
pose that he doesn't. But it is the same approach.
Let me ask you about this. When we have had veterans come be-
fore us they have also — I saw a list of your symptoms — talked
about bronchitis and loss of pulmonary function. That is not listed
as one of yours, but have you found that it could be symptomatic?
Dr. Shayevitz. Well, that is very common, though. Respiratory
sjrmptoms are very common.
There are so many symptoms, when I took the list out of the
book I took a simplified, you know, list.
Mr. Bachus. Right.
Dr. Shayevitz. Nasal S3rmptoms. Respiratory s3anptoms are ex-
tremely common.
Mr. Bachus. With this condition?
Dr. Shayevitz. Oh, yes.
Mr. Bachus. Because they are having an allergenic reaction or
allergic reaction?
Dr. Shayevitz. Right. And because there is a lot of nasal irrita-
tion fi*om sensitized — the nasal lining cells are very sensitized and
irritated in a lot of cases.
Mr. Bachus. All right.
Dr. Shayevitz. You know, I would like to just mention one rath-
er elegant theory which ties this all together, and that is that the
nerves in the nose, the nerves of smell, go directly to the brain
without any blood brain barrier. And to what part of the brain?
The limbic system. And what does the limbic system govern? The
immune system, the reproductive system, eating disorders, emo-
tional disorders, and that once the brain becomes sensitized or
what we also call kindled, that means that we have started with
this agent out here. Now, it spreads, so that tiny exposures of very
common chemicals send all these amplified neuronal responses to
the hypothalamus and limbic system, and to me this ties the whole
theory together.
And these patients and some of the tests that I recommend, they
have depletion of natural killer cells and these are the patients
who come down with the cancers. They have problems with their
immune system. They have problems with reproductive systems
and we are hearing today about a variety of problems in the repro-
ductive field.
So, I think this is a very important neurobiological theory which
has been tested, well tested in animals, by the way, and I feel that
it ties this whole syndrome together.
Mr. Bachus. All right. Thank you very much.
72
Mr. Evans. Doctor, thank you. What is the current status of your
proposal at Northampton?
Dr. Shayevitz. The current status is that it is now funded.
Mr. Evans. All right, Doctor, thank you, and Dr. Jackson. We
will now stand in recess for about 10 minutes.
[Recess.]
Mr. Evans. If everyone would be seated we would appreciate it.
Our next witness is Maj. Gen. Ronald Blanck, Commanding Gen-
eral, Walter Reed Army Medical Center.
General Blanck, the committee understands you rewrote your
statement last night?
General Blanck. Yes, sir.
Mr. Evans. We look forward to receiving your comments this
morning and invite you to proceed whenever you are ready.
STATEMENT OF MAJ. GEN. RONALD R. BLANCK, COMMANDING
GENERAL, WALTER REED ARMY MEDICAL CENTER
General Blanck. Thank you. As always, I appreciate the oppor-
tunity to give you some update on the medical issues regarding the
illness now characterized as the Persian Gulf syndrome.
DOD has worked closely with the Veterans' Administration since
we became aware of the s3Tidrome shortly after the end of the war,
and, in fact, in mid-1992 sent out messages to all of the commands
asking that this illness be reported and worked with the VA on de-
veloping a standardized evaluation physical examination mecha-
nism.
Our main concern at the time was to identify those with this ill-
ness without all of the problems with having profiles being sepa-
rated involuntarily from the military and so forth, and to provide
medical care either in the military facilities or in the Veterans' Ad-
ministration hospital. Though there were many, many problems
that were faced in that regard, I think we are able to say that by
and large we are doing that today as well as we can, because we
still have significant problems in understanding exactly what the
illness is and, in fact, even in defining it.
DOD at this point has a group of civilian physicians working to
come up with a case definition, I described that to you at my last
testimony, so that we can do the epidemiology studies that some
groups have recommended and that I fully support, and once we
have that completed, hopefully that will be this year, we will be
able to proceed with setting up the models in those studies.
We also continue to look for causes, and with my cover memo is
an information paper that tells you the status of our studies into
the oil fire smoke, depleted uranium, leishmaniasis, and so forth.
In general, our tack has been, after seeing that folks got the best
care we could give them given that — it is very frustrating since we
can't give good answers because we don't know them — is to look at
specific causes, and in the absence of those specific causes to look
at areas such as chronic fatigue syndrome and multiple chemical
sensitivity. You have heard testimony about that and I think you
know where we are in addressing that.
There is a subgroup within those complaining of the Persian Gulf
syndrome that seem to have a very specific single exposure to
something that then has caused this illness, or at least the illness
73
has followed that exposure, and the sentinel group of that is the
24th Construction Battalion — the Seabees — in Columbus, GA.
The Navy along with the Veterans' Administration is doing a
full-scale epidemiologic evaluation of that. They will visit the Sea-
bee unit, I believe, the 11th and 12th of December, interview all
of them, and the Navy is also sending a team to Al Jubail to look
at what kind of chemicals this unit might have been exposed to
that will help us in, I think, trying to evaluate everyone else.
I would particularly thank the committee for their help in provid-
ing funding for ongoing research, particularly in the multiple chem-
ical sensitivity area, and although I believe the VA as of August
of 1993 has been designated the lead agent for research and has
moved out with lots of initiatives, we will continue to work on fol-
lowing those that have been exposed to depleted uranium, oil fire
smoke and all of that kind of thing that we have already done.
With that, I would ask if there are any questions?
[The prepared statement of General Blanck, with attachment,
appears at p. 200.]
Mr. Evans. Thank you, general.
The gentleman from Alabama.
Mr. Browder. Thank you, Mr. Chairman.
General Blanck, I have a couple of questions pursuing a line of
inquiry that I have been following about the possible exposure of
our military forces to low level agents.
I said this morning that I am not impressed with the Depart-
ment of Defense's responsiveness on this issue. I guess the main
thing that frustrates me is that the Department of Defense is issu-
ing very circumspect statements in dismissing the possibility that
these veterans' problems are related, might be related, to expo-
sures.
As a matter of fact, I have got the Department of Defense report
that says, "Given the limited locale of the incidents, the very low
level of agent reported and the absence of other valid detections
there is no plausible connection between the Czech report and the
symptoms being experienced by some Gulf War veterans."
Throughout the Defense Department's statements wiggle words
are placed in at certain places but the message is alv/ays the same:
We see no reason to think that there is any connection between
possible, between these problems and any possible exposure that
may have occurred.
That concerns me because we have got sick and dying veterans
who do have problems. I am not saying as a truism that these vet-
erans are sick and dying because of this or that. What I am saying
is that the Department of Defense has been rather cruel in making
these, and irresponsible in making these statements, and I think
that we have got to pursue them and identify the circumspection
of the Defense Department's statements.
For example, in the Department of Defense release about dis-
missing the exposure, and even in your statement, "Based on the
levels reported and our knowledge of effects of chemical warfare
agents, long-term health consequences would not be expected."
I looked at the assessment, the health assessment and the tech-
nical assessment, and I keep seeing examples where the assess-
74
ment says "known health effects of GB and HD." That word known
is very important and very deceptive there.
Now, I know you are trjdng to be very careful in your state-
ments, but it leads to the wrong — it sends the wrong message on
nerve agents. Low dose, you say "No symptoms at all." But on long-
term effects you say, "Low dose, no known long-term health effects
in exposed individuals." On mustard agent, long-term effects, low
dosage, "there are no known long-term effects for short term, low
dose."
Those are true statements but they communicate, I think, a mes-
sage that we cannot accept. The Defense Department is emphasiz-
ing "no known," and that is being used to dismiss something that
we may not know about.
As a matter of fact, we say no known long-term of low dosage,
it is hiding the fact that we really don't know much. That is not
saying that we've got extensive scientific research about low dose
and all of it is that there is no known effect.
The fact is — and if you disagree with me, disagree with me
now — we do not have extensive research, scientific research on low
dose long-term effect of these agents.
General Blanck. If I may, sir, you are correct. We do not have
research on low-level exposure that causes no symptoms. We have
a considerable body of research from studies done from the mid-fif-
ties through the mid-seventies on low level exposure that was
enough to cause symptoms and that was reported by the National
Academy of Sciences. However, even they qualify their conclusions.
And so, in summary, I would agree with you that we must keep
an open mind, number one. Number two, the intent was by no
means to dismiss either the illnesses or the potential causes, but
simply to put it in perspective, because we need to be very careful
that we focus on getting at the truth, whatever the truth is, and
that is the real causes, and I think you and I share exactly that
perspective.
Mr. Browder. General — and Mr. Chairman, if I could pursue
this because I think this is very, very important?
Mr. Evans. I would 3deld my time to the gentleman,
Mr. Browder. We have to be very careful because I think this
is being misconstrued. Let me read from the — you cited, and Dr.
Deutsch cited, some studies, some literature that he had that dem-
onstrated this no known effect. I have some of that research here
that was cited in that press conference, and I would like to read
two paragraphs.
"The panel therefore is unable to rule out the possibility that
some anti-CHE agents produce long-term adverse health effects in
some individuals. Exposures to low doses of OP compounds" — and
those are the things we are talking about — "have been reported but
not confirmed to produce subtle changes in EEG, sleep pattern and
behavior that persist for at least a year."
And then "No firm evidence has been seen that any of the
anticholinergic — you will have to correct my pronunciation of
these — "test compounds surveyed produce long range adverse
human health effects in the doses used at Edgewood Arsenal. More
intensive study is required to confirm this conclusion."
General Blanck. Yes, sir.
75
Mr. Browder. I would like to read an opening paragraph from
a paper that was given to us at the pilot study in Birmingham this
past week, "Possible Long-Term Health Consequences of Exposure
to Nerve Agents."
"Relatively little is known about the long-term health con-
sequences of exposure to nerve agents because of their limited use
in war time and the difficulties in identifying and following individ-
uals who may have been exposed."
I would like to read to you from — if I can find it — a 1992 text-
book, Chemical Warfare Agents, which opens Chapter 5, "Behav-
ioral Effects of Low Dose Nerve Agents": "Most biological research
on chemical warfare agents has been concerned with prophylactic
and treatment strategies for high dose, potentially lethal expo-
sures. Consequently, there is a sparsity of data on behavioral ef-
fects of low level exposures."
As a matter of fact, that textbook notes, "Not only does high ex-
posure to nerve gas lead to unconsciousness, convulsions, breathing
problems, and death," but the same book also notes that "lower ex-
posures lead to vision problems, tightness in the chest, forgetful-
ness, irritability, poor judgment, lack of comprehension, tenseness,
depression, insomnia, and nightmares."
As a matter of fact, if you go back there is an Army field manual,
back during the Cold War, and I don't know the date on it — an
Army field manual dating back to the Cold War entitled Chemical,
Biological and Radiological Operations that states that nerve gas,
how it kills, and then the manual states this about GB or Sarin,
the nerve gas detected twice by Czech troops:
"Any exposure to GB lowers the body cholinesterase level. Re-
peated exposures to even low dosages over a period of days or
weeks gradually lower the cholinesterase level until the individual
becomes a casualty."
General Blanck, I really think that these statements by the De-
partment of Defense with the few wiggle words like "known" or "as
of now" are being used to footnote the possibility with the bulk of
the material coming out of the Defense Department, besides saying
we are going to study this and try to find out, is sa3dng there is
no reason to believe that any of these problems are caused by the
possibility of exposure to these agents.
And I would — we are going to pursue this on the Armed Services
Committee about why the Defense Department continues to do
this. But I would really encourage you to be more evenhanded from
now on in talking about the possibilities, that we don't really know
a lot about what we are trying to figure out here now.
Thank you very much.
General Blanck. Thank you, sir, and I assure you that medically
I have, we all have an open mind and will continue to pursue this.
Thank you.
Mr. Browder. Thank you, Mr. Chairman.
Mr. Evans. Thank you. The gentleman from Massachusetts.
Mr. Kennedy. Thank you very much, Mr. Chairman.
I want to sort of follow up on the points that Mr. Browder was
making. You know, they ought to review the history of your in-
volvement in this issue. General.
76
But, in your testimony and DOD's health assessment conducted
in response to the Czech report you state that "Long-term health
consequences would not be expected," and the Pentagon has discon-
nected any link between chemical and biological agents exposures
and the serious illnesses experienced by the Persian Gulf vets.
Now, DOD's immediate denial of these health concerns comes
even though DOD Under Secretary Deutsch has admitted extreme
limitations in biological agent detection technologies. And in Janu-
ary of this year, GAO reported to the Congress that chemical and
biological defense, that the U.S. forces are not adequately equipped
to detect all threats. That study indicated that U.S. military — that
the U.S. military had extremely limited capabilities to detect bio-
logical agents, and at the beginning of the war U.S. troops did not
have the capability to detect any Iraqi biological agents.
Now, you are familiar with the fact that some of us have been
told that the Czech report might have been — there was at least
some possibility that people had ginned the thing up. That maybe
people were interested in selling technologies and other kinds of is-
sues that were associated with that.
The impression, again, that somehow these issues are imme-
diately debunked by the Department continues. We had asked for
an assessment of FOX vehicles, which in fairness. Secretary
Deutsch came back just now indicating that there were no link-
ages. The letter actually raises a few more questions. But I guess
in my own sense — first, there seems to be about three questions
that we ought to come to grips with.
First of all, how can DOD write off this exposure? It just doesn't
seem to me to make sense.
Second, how does DOD plan to investigate possible biological war
time exposures given Dr. Jackson's testimony?
And how do you respond to Dr. Jackson's concerns that biological
agents may be the cause of illnesses that vets face with their fami-
hes?
I don't think our questions or concerns ought to be construed
that we are saying that we believe that is the case. But there has
been a constant, seeming endless attempt by the Department of
Defense to immediately sever any notion of linkage.
Now, I think that there are a few theories as to why that would
be happening, but it definitely is happening. And the fact that we
have to continue to come back — it takes Glen Browder going over
to Czechoslovakia getting the Czech study, demanding that it be
made public, the fact that you have Dr. Jackson coming forward as
an independent VA physician that is bringing these issues to light.
The fact that we have so many individual witnesses that continue
to come forward with their cases, I suppose creates a very strong
impression that despite the fact that you have been on this case
for a considerable period of time that we simply are not getting to
the bottom of it. And that is despite your assurances that have
gone on now for a year or so, I don't know, maybe 8 months or
something, you know, that you realize that your initial reaction to
this might have been wrong and that, you know, that you are hell-
bent on trying to get to the bottom of it.
I guess we continue to be left with the impression that in fact
the Department is doing much more to debunk any possible link-
77
ages and not to really just have an honest, forthright, complete ap-
praisal of what in fact took place.
So, can you respond to those three specific questions and then
maybe the general question as well?
General Blanck. Yes, sir.
First of all, let me assure you that we do take it seriously and,
in fact, are going hell bent in trying to find this out. It isn't easy
to do it in the fashion that would both allow us to accurately diag-
nose and ultimately to treat very rare illnesses. And we do not re-
ject chemical or biologic out of hand. I am sorry if you have that
impression.
We simply try to — I believe the Department put it in a perspec-
tive that would say it is more or less likely than some of the other
kinds of things.
Mr. Kennedy. Wait a second. I have been to several briefings.
I have heard your testimony before. You say there isn't any link.
I mean, you know, I don't think that there has been an honest as-
sessment here of whether or not there were linkages. Why do you
have to wait for the Czech report?
The fact is that we have been saying, and other Members of the
United States House and Senate have been saying this for many,
many months. I don't think it is right to suggest that the Depart-
ment has just been sort of checking this out and you have been try-
ing to be scientifically accurate. That is not what has been going
on.
There has been an effort to not investigate it, and any time
someone has come forward to basically try to undercut them, that
is what has happened.
General Blanck. I appreciate your comments and respectfully
disagree. There has been a serious long-standing effort to get at
this. I would submit that we use the terms "chemical" and "bio-
logic" to mean lots of different things. I fully think that this is
chemical. I fully think that there may be an aspect of biologic. I
don't know if it is warfare agents.
The data that I have been given would suggest that it is not, but
I don't reject that out of hand.
Biologic, in fact there were detectors that the British had and
gave us some of them. They detect, by particle size, the organisms
and, of course, infections, that are results of biologic agents leave
markers. They leave markers of elevation of antibodies,
nonspecifically, and so forth and so on, altered white counts and all
of that kind of thing. That was not seen, and we have looked for
them.
As far as chemical agents, I would absolutely agree that the vet-
erans in Desert Shield/Storm were exposed to a multitude of chemi-
cal agents. And we have talked about them on a number of occa-
sions from the industrial pollutants stored at Al-Jabayaal to the
pesticides that were all over the place. And add to that the possibil-
ity, which I would absolutely agree with you, of chemical warfare
agent makes it more significant to try to get to the bottom of this;
and we are.
Mr. Kennedy. General, all I am pointing out is that I have seen
the Department try to undercut Dr. Hyman. I mean, evidently Dr.
Hyman has gotten some money which I was unaware of prior to
78
a couple of hours ago to investigate his contention that this is a bi-
ological agent which was completely laughed off when he testified
before this committee.
You know, there was specific attempts to undercut the Czech
study which you are very familiar with. There has been a lack of
a willingness to check out — any kind of desire to check out the indi-
vidual cases that have been brought forward. I am not sa)dng that
that continues at this time, but that is a recent development.
So, you know, I am not trying to cry over spilled milk. I am try-
ing to point out that it really hasn't been a legitimate effort to date.
I hope that is changing. So, let me just — along those lines, let me
just ask you one additional question. We have heard a lot of talk
this morning about this form that, evidently, servicemen and
women were asked to complete with question No. 11.
Are you familiar with the form?
General Blanck. I am.
Mr. Kennedy. "Do you have any reason to believe that any mem-
bers of your unit were exposed to chemical or germ warfare?" Why
was that question asked?
General Blanck. This was a form developed before the conflict
where we felt there might be use of chemical or biologic agents,
and so that question was included.
Mr. Kennedy. What were the results of the question?
General Blanck. To the best of my knowledge, no one acknowl-
edged being exposed to such agents because they were told that
they weren't there.
Mr. Kennedy. Have you asked?
General Blanck. Have I asked about
Mr. Kennedy. Asked what the answers to the form were?
General Blanck. We have tabulated the forms, as many as we
have.
Mr. Evans. Would the gentleman yield?
Mr. Kennedy. Yes.
Mr. Evans. Is this an individual medical record that goes in the
individual's file? Or is this document or data for the Department
of Defense?
General Blanck. No. This was for an individual's record. A lot
of units collected them and forwarded them.
Mr. Kennedy. Did you get the results of the question then?
General Blanck. Yes, sir.
Mr. Kennedy. Did you?
General Blanck. Yes.
Mr. Kennedy. Have you compiled them?
General Blanck. I can only speak to that one question.
Mr. Kennedy. And you are saying, out of all of the people that
were asked the question, not one single soldier said yes?
General Blanck. Not in the data that we have. Not that has
been reported to me, no.
Mr. Kennedy. Excuse me if I sound a little skeptical. How many
forms have you looked at?
General Blanck. I have not looked at any. The medical folks
have looked at a number of forms.
Mr. Kennedy. How many?
General Blanck. Thousands.
79
Mr. Kennedy. Are any of them here with you today?
General Blanck. No. This is
Mr. Kennedy. I guess — you know, it just would appear to me
that if you have a form out there that asks a specific question and
you know you are coming up here, I would think that we would
have a little bit better sense.
How about all of these other questions? Like, 2: "Are you receiv-
ing treatment at the present time?"
"Do you have fever, fatigue, weight loss, or yellow jaundice?"
"Do you have swelling from lymph nodes, stomach, or other body
parts?"
"Do you have any rash or skin infection or sores?"
"Cough or stomach or belly pain?"
"Nausea or diarrhea?"
"Bloody bowel movement?"
"Do you have any urinary problems?"
"Any night problems or trouble sleeping?"
Do you have any breakdown of what the results of those ques-
tions were?
General Blanck. Those were individual physical exam questions.
And to those specific things, do I have a breakdown? No. Most of
them went into the individual records.
Mr. I^NNEDY. Is it hard to pull those records, General?
General Blanck. Yes, sir.
Mr. Evans. Will the gentleman yield?
Mr. Kennedy. Yes.
Mr. Evans. I must admit that if something was going to hold me
up in theatre that I might say "no" to a bunch of questions in order
to get home. If someone has said "yes" to any of these questions,
would they have been put on hold?
General Blanck. No.
Mr. Evans. They are not the population as a whole
General Blanck. They are representative. And, in fact, the whole
purpose of it was to, one, give a clue for further investigation that
might be warranted before they separated and for documentation
of problems that might come up later.
Mr. Evans. Well, individuals who might have said yes, what
would have happened to them at that point in time?
General Blanck. To that question, it would have simply gone in
their medical record, because the feeling was that there were no
biologic or chemical agents. They might have been questioned on
it and probably not much more.
To the specifics, let's say somebody said, I still have bloody diar-
rhea, that should have triggered a medical response of evaluation.
Mr. Kennedy. That is going to get, at some point in time, a self-
fulfilling prophecy if we say there are no biologic or chemical weap-
ons, which is the point I was driving at a few minutes ago. If you
say there were no biologic or chemical weapons, then you have a
question on the form — you have no testing equipment to determine
whether or not there were, in fact, biological or chemical weapons
utilized in the theatre.
General Blanck. There was a lot of equipment for that.
Mr. Kennedy. I am going by what the GAO report told the Con-
gress, General. The GAG report told the Congress that U.S. forces
80
are not adequately equipped — I am quoting from the General Ac-
counting Office — are not adequately equipped to detect all threats
and indicated that the U.S. military had extremely limited capabil-
ity to detect biological agents. And at the beginning of the war U.S.
troops did not have the capability to detect any Iraqi biological
agents.
Now, you know, again, what we are trying to suggest is if you
would come up with a conclusion that there was no chemical or bio-
logical agents and then any time there are pieces of evidence that
are provided that maybe this conclusion wasn't right, and so what
happens is you immediately get into a defensive mode where you
are trying to undercut any of that evidence that comes forward.
You end up, perhaps, with not a very accurate picture of what took
place.
And, hence, the hundreds — you know, when we started down this
road, I was told that there was about 24 — I remember the num-
ber— 24 guys that had these sicknesses. Twenty-four. And then the
number went up to 240. And then it went up to — you know my of-
fice kept getting hundreds of these phone calls.
And so what surprises me is that I would be hearing, as a Mem-
ber of Congress, about these issues long before the Army itself
would have heard about them.
General Blanck. No, sir. I suspect I heard about them first. All
of them. And I don't say even now that I know all of them, because
I don't believe I do. I am sure that there are those out there that
haven't reported it despite the efforts that we made. So you are
right.
And if your issue is, did we and do we take it seriously? Abso-
lutely. Does everybody and did everybody? I don't know. But I do
and Health Affairs does and DOD does and the VA does.
Mr. Kennedy. I know my time has expired, Mr. Chairman. Are
you going to ask for more questions? Can I ask one quick follow-
up?
Mr. Evans. I will yield to the gentleman.
Mr. Kennedy. In a joint letter signed by the Secretary — and I
think this question just referred to you as "Secretary Blanck" — but
in any event, by yourself and Secretary Aspen, government officials
underestimate the scope of the unexplained Persian Gulf illness
stating that there are only 250 personnel in the category of, quote,
mystery illness.
Obviously that doesn't mesh with the hundreds of reports that
we have heard. Do you remember that notion of 250 personnel?
General Blanck. Yes. That we were aware of. That is correct, at
that time.
Mr. Kennedy. You just said to me that you had heard from them
first, right?
General Blanck. Uh-huh.
Mr. Kennedy. You are saying that you only heard from 250?
General Blanck. No. I heard from, oh, gosh, thousands, most of
which I could explain on other bases: like hepatitis, like leishmani-
asis, like diabetes, like heart disease.
Mr. Kennedy. And you stand by that right now?
General Blanck. Yes, sir.
81
Mr. Kennedy. That all of those thousands of reports that have
responded to, the proposals that Mr. Evans provided to establish
this Persian Gulf registry, all but 250
General Blanck. No, sir. I am sorry. No. Of course not.
Mr. Kennedy (continuing). Are explained by these other ration-
ales?
General Blanck. No. At the time I told you the 250 number, that
is all I knew then. I know of far more now that I can't explain.
And even then I emphasized that' I know I don't know a lot of
them. In fact, I have several from your State who I have personally
called and talked to and tried to help out and find out information.
Mr. Kennedy. I appreciate that, General.
My point is that you, in a joint letter that you signed with Sec-
retary Aspen, government officials estimated that the scope of the
unexplained Persian Gulf illness stated that there were only 250
personnel in the category of mystery illness.
And you said that you have known of all of these people. And all
I am saying to you is, good God, General, we were hearing from
literally hundreds and thousands of these soldiers.
And so, again, it creates an impression that you were not up to
speed on what was going on within the armed forces on the kinds
of complaints that we continue to hear about.
And, you know, again, it is sort of spilled milk; but the point is
that there doesn't seem to have been the kind of energetic response
to this illness that we saw in response to Saddam Hussein by any
stretch of the imagination.
Thank you, Mr. Chairman.
Thank you. General.
Mr. Evans. The gentleman from Alabama, do you have any ques-
tions?
Mr. Browder. No.
Mr. Evans. General Blanck, let me proceed on some other issues
that I think are important at this time.
We have had a number of families of Gulf veterans experiencing,
we believe, a disproportionately high number of miscarriages, some
of whom I would assume went through military hospitals for pre-
natal care and so forth.
Have you collected any data on this? Have you investigated this
issue?
General Blanck. Yes, sir. In early 1992 through mid-92, we col-
lected the data on incidents of miscarriages, the percent of mis-
carriages in those individuals who had deployed to the Persian
Gulf area compared to the same population — not necessarily the
same people but the same population before deployment, and were
unable to find any difference in the incidents of miscarriage. It is
about 8 percent in both cases.
Now, I cannot tell you that there might not have been an individ-
ual exposure to something that would have led in an individual
case to a miscarriage. But overall, the rate did not appear to in-
crease. I have not done that since that time, and we will pursue
that as well.
Mr. Evans. In response to a request submitted following the
June, 1993 hearing, you stated, quote, "Much of what is known
82
about MCS today is largely anecdotal and unsubstantiated by well-
controlled research.
I doubt that the mainstream medical community in the U.S. or
DOD will accept MCS as a legitimate diagnosis until more research
has been published in medical literature."
I understand that there is now research supportive of this diag-
nosis. Is that correct?
General Blanck. Yes, it is. And that continues to be a struggle
in the DOD disability agencies as to how to deal with this. We are
working very closely with the VA in trying to come up with some
standardized way of addressing it, and I suspect that the diagnosis
of multi-chemical sensitivity, as a basis for disability, will be put
on hold until we come up with more standardized ways of testing,
using the SPEC scans or other diagnostic modalities.
Some of the other studies referred to may well be ways of getting
out this also.
Mr. Evans. General, I have numerous other questions that I
would like to explore with you now, but because of time con-
straints, we are going to have to move on. We appreciate your testi-
mony.
The gentleman from Alabama doesn't have anything else?
Thank you very much General Blanck.
Your responses to the submitted questions will also be entered
into the record.
(See p. 243.)
General Blanck. Thank you.
Mr. Evans. To accommodate VA witnesses, we will recess until
3 o'clock.
[Recess.]
Mr. Evans. We will now reconvene.
We are especially pleased to welcome VA Secretary Jesse Brown.
We know it's been a long day for the Secretary. We appreciate his
going beyond the call of duty to be with us this afternoon.
He is accompanied by Dr. John Farrar, Dr. Susan Mather, Dr.
Susan Ritter, John Vogel, and Mary Lou Keener.
The prepared statement submitted by the Department will be
made part of the hearing record, without objection.
Secretary Brown, you may proceed when you are ready.
STATEMENT OF HON. JESSE BROWN, SECRETARY, DEPART-
MENT OF VETERANS AFFAIRS; ACCOMPANIED BY DR. JOHN
T. FARRAR, ACTING UNDER SECRETARY FOR HEALTH; DR.
SUSAN H. MATHER, ASSISTANT CHIEF MEDICAL DIRECTOR,
ENVIRONMENTAL MEDICINE AND PUBLIC HEALTH; DR.
SUSAN RITTER, PH.D., MPH, PERSIAN GULF FAMILY SUP-
PORT PROGRAM COORDINATOR, PERSIAN GULF HEALTH
ADVISORY CLINIC CO-DIRECTOR, VA MEDICAL CENTER, BIR-
MINGHAM, AL, R.J. VOGEL, DEPUTY UNDER SECRETARY FOR
BENEFITS; J. GARY HICKMAN, DIRECTOR, COMPENSATION
AND PENSION SERVICE, VETERANS BENEFITS ADMINISTRA-
TION; AND MARY LOU KEENER, GENERAL COUNSEL
Secretary Brown. Thank you very much, Mr. Chairman.
83
Mr. Chairman, I want to thank you for giving me this oppor-
tunity to discuss the health problems of Persian Gulf veterans. I
want to start by emphasizing one key point.
While there may be many questions about the causes of health
problems of some veterans, there is no question that many of our
veterans are sick and need help. We have seen the statistics and
we have heard the personal stories of Persian Gulf veterans who
are suffering, and I suggest, sir, that we must be responsive.
Mr. Chairman, I have been deeply moved by what I have heard
and what I have seen. Veterans are suffering from cancer, chronic
fatigue, memory loss, painful joints, and other physical and psycho-
logical problems. That is why I made this issue a top priority from
the beginning of my administration. That is why we are doing ev-
erything possible to help those who are suffering right now while
we continue to look for more complete scientific answers. And that
is why we will give veterans the benefit of the doubt on all ques-
tions about problems that may be related to service in the Persian
Gulf.
Before describing the steps VA has taken, let me comment on the
recent news concerning the presence of chemical agents in the Gulf.
The level of public concern was raised following recent reports that
an allied chemical detection unit found traces of nerve agent and
mustard gas during the war.
The VA and Congress must rely on the Department of Defense
for information about what occurred during that war. But at the
same time the VA has a responsibility to remain sensitive to the
concerns of our veterans. So we have had an open mind from the
beginning. Our search for answers has never, never ruled out
chemical agents.
On October 7th, 1993, 3 weeks before learning of DOD's inves-
tigation of the Czech's report and announcing an expansion of our
research efforts, I noted that one of the growing concerns over the
health consequences of Gulf service was chemical warfare agents.
I said at that time that we must do everything that we can to get
answers.
On November 1, 1993, the Birmingham VA Medical Center was
selected to review the scientific literature on the effects of such
chemical agents. They are developing a specialized neurological
examination protocol involving Persian Gulf veterans from Ala-
bama and Georgia and will serve as a focal point for chemical
agent studies.
People have asked whether our veterans are suffering because
Iraq used chemical agents or the U.S. bombing of weapon sites
might have released such agents. Some are dismissing this possi-
bility because only low levels of chemical agents were detected, the
winds were blowing away from our troops, and there were no
human or animal effects notable around the chemical facilities we
bombed.
Mr. Chairman, let me state the VA's position on this debate. We
have never dismissed this possibility and we will not prejudge this
issue. We will pursue all scientific avenues until we have conclu-
sive answers.
Mr. Chairman, my prepared testimony presents a description of
the VA's many initiatives already underway or soon to begin. We
84
are actually proceeding on three tracks at the same time, but our
priority must be in the area of providing help now.
Immediate medical care is the first track. I have instructed all
VA medical facilities that Persian Gulf veterans are to receive pri-
ority care. I have directed that VA staff be sensitized to the seri-
ousness of these veterans complaints and that they be treated with
sensitivity, compassion and dignity. I will accept nothing less.
As you are aware, VA has proposed legislation to provide special
eligibility for care of Persian Gulf veterans. This important legisla-
tion was favorably acted upon by this body, and I hope, Mr. Chair-
man, that it will be enacted before the end of this session.
The VA also provides special treatment for Persian Gulf veterans
with unusual symptoms which cannot be diagnosed. These veterans
are referred to one of three special centers in Washington, LA, and
Houston.
We have now modified our benefits program for Persian Gulf vet-
erans. Priorities given to veterans with claims for disability due to
exposure due to environmental hazards, and I am pleased to report
that for the first time criteria have been established to grant serv-
ice connection for chronic fatigue syndrome. We are also providing
pension benefits to veterans who are unable to work due to illness.
Our second track involves using our resources to find answers to
these very complex questions. In 1991, the VA established the Per-
sian Gulf Registry. The 10,800 veterans now in the Registry have
been provided a comprehensive physical examination, baseline lab-
oratory tests, and other tests when indicated. We are closely mon-
itoring the Registry to identify any pattern of illness or complaints,
and we are now implementing several improvements in the Reg-
istry as recommended by OTA.
Early this year, we established a Persian Gulf Scientific Panel
composed of experts in environmental and occupational medicine.
We have chartered this panel as a permanent advisory committee,
and these experts from both inside and outside government will
continue to advise us on diagnosis, treatment and research of Per-
sian Gulf related health conditions.
Finally, I want to comment on our research program. President
Clinton has designated VA as lead agency for all Federally funded
research into the health effects of the Persian Gulf War. I have
asked the heads of Defense, HHS, EPA to assist VA in this effort,
and recently VA awarded a contract to the National Academy of
Sciences for an independent review of the possible health effects of
the Persian Gulf service.
At the recommendation of a VA working group that included our
national veteran service organizations we will be establishing our
own research centers. Each center will include scientists specializ-
ing in the study of toxic and environmental hazards.
Mr. Chairman, we are doing everything that we think is possible
and reasonable, and we are open to suggestions from all concerned.
If you, Mr. Chairman, or any other member of this committee, or
anyone else, believes that we should be doing something that we
are not doing, we want to hear from you. Please, please let us
know.
Mr. Chairman, in closing, I want to make it very, very clear that
this Secretary for Veterans' Affairs does not intend to repeat the
85
mistakes made in the past with respect to Agent Orange, ionizing
radiation, LSD, and mustard gas. I am reminded of Maya
Angelou's poem in which she said, "History despite its wrenching
pain cannot be unhved, but if faced with courage need not be Hved
again." We must not allow history to repeat itself.
The veterans who served in the Persian Gulf did not hesitate to
put their lives on the line for this Nation. Now, this Nation must
not hesitate to carry out its moral obligation to them, a moral obli-
gation to put veterans first.
Mr. Chairman, this concludes my statement. I would be pleased
to respond to any questions that you may have.
[The prepared statement of Secretary Brown appears at p. 211.]
Mr. Evans. Thank you, Mr. Secretary.
First of all, let me say several of the veteran service organiza-
tions in their testimony and several of the members of this commit-
tee and the Armed Services Committee have already publicly stat-
ed that we appreciate the quick action and appropriate action that
you have taken since this information from the Department of De-
fense came to you.
Your action is clear contrast to where the VA was many years
ago when we were fighting to obtain help for veterans suffering
from Agent Orange. Today, the attitude is different, but so is the
action, and that has been noted by many of us on the committee
and in the veterans community. So thank you very much for that
attitude and that approach.
Secretary Brown. Thank you, sir.
Mr. Evans. We do have some problems, however, that some vet-
erans have raised in terms of the VA's response. I think it has been
an overwhelming problem in certain facilities. Last week several
veterans reported waiting many months to have VA's Registry ex-
amination. In fact, some indicated that appointments in their local
facilities were being scheduled for late 1994 and early 1995.
Can you tell us what the VA is going to do to conduct these Reg-
istry exams in a more timely fashion and which medical centers
are making veterans wait 30 days or more for this exam?
Secretary Brown. We do have that information, Mr. Chairman.
I think before I ask Dr. Farrar to respond it is important to state
that when this issue was brought to my attention one of the things
that we wanted to do was to take immediate proactive action and
to sensitize, as I stated in my prepared remarks, our staff that
these veterans deserve immediate attention.
And, as you know, we are experiencing some problems because
of our timeliness, not just on Persian Gulf veterans. I think it is
only fair for the record to state that a large percentage of people
who are requesting assistance fi-om the VA have to wait 30 days —
anywhere from 30 days to 200 and some days to gain access into
our system, primarily as a result of lack of resources.
If you look at the VA's budget historically, there is no question
in my mind that we have been underfunded and now we are seeing
the results of that. That result is the same — the same pattern ex-
ists on the veterans benefits side. Our timeliness standards are de-
teriorating, or have deteriorated. Our backlog continues to deterio-
rate, although we are beginning finally to make some headway in
that with our modernization program.
86
But I am going to ask Dr. Farrar to respond to that particular
question.
Dr. Farrar. Mr. Chairman, I think we have had a problem in
the VA of long waiting times. Let me address the two parts: one,
the long waiting times in general, and more specifically waiting
times for the Registry.
On November the 1st, I sent out a memo to all directors of all
hospitals urging them to address these veterans with sensitivity,
dignity, caring and compassion and arrange appropriate diagnostic
work-ups with qualified specialists in a timely fashion. That word
has gotten reinforced on our conference call as well as this hearing,
£ind we will follow up, and if you would like we'll get back to you
with how fast the centers are responding.
On the more general problem of waiting times, that is one of our
problems and we are addressing that. The IG has called this to our
attention with considerable force, and I believe that relatively soon
we will see more timeliness in our waiting times for all our pa-
tients.
Mr. Evans. I take it you must be somewhat frustrated with the
Department of Defense in regards to the Czechoslovakian report. I
know we are on the committee, and I think the families are agoniz-
ing over that late information that they received.
But hopefully, looking to the future, do you think that DOD will
be forthcoming with all the intelligence data that it has on a vari-
ety of potential different environmental exposures? Do you feel
there is good cooperation and information sharing concerning pos-
sible biological or chemical exposure to our veterans at this point
and in the future?
Secretary Brown. We have — I might add for the record that Sec-
retary Aspin is a man of integrity. I think that he is moving for-
ward in a manner that he feels is consistent with his mission and
based upon the facts as presented to him.
At the same time, I think that we have to make our own deci-
sions based upon the facts as we see them, and sometimes those
courses may run parallel or may, in fact, run in opposite directions.
I say that simply to say, Mr. Chairman, that we are going to
move forward based upon what we think is best for veterans. Even
before the revelation that the Czech unit detected low concentra-
tions of chemical agents in the Gulf, the VA had taken action that
we were going to look for chemical agents primarily based upon all
of the complaints that we have received from our veterans across
the country.
Likewise, we are going to move forward even though the Depart-
ment of Defense has basically stated that they see no relationship
between those so-called low levels, low concentration of chemical
agents and the complaints that our Persian Gulf veterans are suf-
fering from.
We are moving in a different direction. We are going to let the
science determine whether or not there are any relationships and
that is why we are setting up a screening process, a protocol proc-
ess at our VA Medical Center in Birmingham, AL, to help us to de-
sign the right approach, and that is why we are moving forward,
quite frankly, with our three research centers where we will be em-
87
ploying the best minds in the country both inside and outside of
government, sir.
Mr. Evans. I was able to visit Birmingham VA Medical Center
over the weekend at the request of my democratic colleague from
Alabama and Republican colleague from Alabama, Mr. Bachus, and
we are really pleased with the action you have taken there. It is
a good facility, and I think it shows bipartisan support for what
you are doing, and we are very encouraged.
Also, we are encouraged now that the Seabee unit that has been
having so many problems apparently is going to be visited by a
Navy team as well. I think that is something the Department of
Defense should have done months ago, but it seems to be a signifi-
cant step forward.
I have more questions, but I will yield to my colleague from Ala-
bama, Mr. Bachus, at this time.
Mr. Bachus. Mr. Secretary, how would you characterize the co-
operation between you and the Department of Defense over the
Gulf War illnesses? Has it gotten any better?
Secretary Brown. Well, I think, as I mention in my statement,
we have to rely on the Department of Defense for information. We
do not have independent access to that information, just like the
Congress. And I think everyone is waiting for all of that informa-
tion to be made available, and we are too. And I think that we on
a number of areas, however, we are operating at a level that is
very cooperative in nature.
Mr. Bachus. Okay. Does the VA recognize multiple chemical sen-
sitivity as a diagnosis?
Secretary Brown. No, sir. We do not recognize multiple chemical
sensitivity syndrome as a diagnosis. However, what we have done,
we have made a bold step forward in the sense that we have just
established a criteria which is ratable under — number one, is rat-
able as service connectible and is also ratable under our rating
schedule for fatigue syndrome, and that is new.
But at this point in time we do have — and I am going to ask Dr.
Mather to respond to that. We do have people looking at this so-
called Persian Gulf syndrome to see whether or not it has the na-
ture and the character that will allow us to define it as a diagnostic
entity.
Dr. Mather.
Dr. Mather. Well, I think one of our plans is to get a consensus
conference together of scientists around the country to talk about
more than just multiple chemical sensitivity, because that is really
a broader problem than just the Persian Gulf veterans. That is a
somewhat controversial label in the scientific community at large.
We will ask the consensus committee to look at the Persian Gulf
illness or Persian Gulf syndrome, as it has been labeled, and to
come up with some consensus about that. But I think in order to
be accepted as a diagnosis there have to be criteria for the diag-
nosis that are agreed on by the larger scientific community.
I think the Secretary referred to having chronic fatigue syndrome
now as a diagnosis for which disability can be determined, and
that's been controversial for the last 20 years at least, what the
cause of it is. At least now there is an agreed upon list of criteria
that CDC agrees on, NIH agrees on, and the infectious disease
88
community has sort of agreed on for the diagnosis of chronic fa-
tigue syndrome.
We are not quite there yet for multiple chemical sensitivity, how-
ever, but I think there is going to be a lot of work in this next year
on that to see if we can come up with something that everyone can
agree on, or at least a majority of the scientific community can
agree on.
Mr. Bachus. I guess part of my question is has the Department
of Defense actually discharged some active duty personnel with
that diagnosis?
Secretary Brown. Yes. In fact, I think there were six so-called,
six such cases and I asked Mr. Vogel to do a complete review of
those cases, and I think that we can respond to that.
John Vogel.
Mr. Vogel. Thank you, Mr. Secretary.
We had heard there were six discharges for multiple chemical
sensitivity. We reviewed all of them and there was only one dis-
charged that way. The President of the Army Medical Evaluation
Board said that was an error and a departure from the policy they
had established.
Mr. Bachus. You mean on the other five or on all of them?
Mr. Vogel. No. On the one that they did say had multiple chem-
ical sensitivity as a disability for which one could be, in fact, dis-
charged from the service. We reviewed all of those.
Most of them had a direct service connection, as we call it, for
a known disability incurred while on active duty, which rendered
a few of them unfit to continue on active duty. One was a sensitiv-
ity to rubber, as an example, where the individual couldn't wear
the protective gear. Another was a respiratory disorder. A few oth-
ers had a fatigue syndrome of some kind that resolved and they
continued on active duty, in fact.
So, the long answer to a short question, Mr. Bachus, one case of
discharge for multiple chemical sensitivity that the Department of
the Army says was a mistake.
Mr. Bachus. I maybe should wait until everyone has offered the
testimony they are going to give — are we at that point now?
Secretary Brown. Yes, sir.
Mr. Bachus. Let me ask you this. Are you aware, Mr. Secretary,
that Dr. Hyman has received an appropriation?
Secretary Brown. Yes, of 1.2 million.
Mr. Bachus. And we have had some testimony earlier today that
causes me to think some of what he is doing is similar to some of
what you are doing, studying whatever this condition is, or these
conditions. Is he cooperating with you, or how do you plan to sort
of plug in with that program?
Secretary Brown. We have a long history with Dr. Hyman. As
you know, he was initially brought to the attention of the Depart-
ment because he was treating some veterans, I think, with massive
doses of antibiotic which he said resulted in a cure.
We had a special team, and Dr. Mather herself talked with him
on a number of occasions, asked him to share that information with
us so that we could take a look at it. Obviously, we did not want
to adopt something that could ultimately end up being harmful to
our veterans, so we wanted to look at it very, very carefully before
89
we decided that we wanted to do anj^hing and he would not co-
operate with us at that point.
But I want to say this here, sir, that that is very important to
me. Is that this issue here is so complex that we are willing to look
at everything that is available. And now, hopefully, since he has
this appropriation he will then have to document his findings, and,
of course, we will have access to that information.
And I might add I want you to know that we are willing to co-
operate with him in anyway that we possibly can. I am going to
ask Dr. Mather if she has an5rthing else to add to that.
Dr. Mather. Only that the staff at the New Orleans VA Medical
Center has been working to try to develop a protocol with Dr.
Hyman that could be submitted to the Human Subject Subcommit-
tee because we have to protect human subjects. And, as far as I
know. Dr. Hyman is working on that protocol and has not yet got-
ten back to the staff in the New Orleans Research Service.
Mr. BacHUS. Our office has worked with him since a lot of the
veterans are from my area, and Representative Livingston's office,
and he has assured us that he wants to cooperate with the VA in
this program and share all the information, and I would like to
know whether that is being done. It could be a significant expendi-
ture and we could miss a lot of benefit if we don't know how that
program is doing and the benefit.
Dr. Mather. We will certainly be very interested in the result.
Secretary Brown. I am willing to commit further than that at
this point, sir. We will make it a point, as a matter of record, to
contact him to see if we can arrange a medium by which we can
exchange information.
Mr. Bachus. And you know I am as concerned about his coopera-
tion as I am about yours. I am aware of your long history, and I
would think it would be a shame if this program didn't go forward
in a cooperative manner.
I just want to commend you on the pilot program in Bir-
mingham. It is receiving high marks from the veterans there, and
I just want to congratulate you on something that you have done
that I think is a real accomplishment.
Dr. Farrar. Dr. Ritter, at the table, is the co-chairman of that
group.
Mr. Bachus. I knew that. We met together Friday, and she has
done a great job.
Thank you.
Mr. Evans. The gentleman from Alabama.
Mr. Browder. Thank you, Mr. Chairman.
Secretary Brown, I would like to ask you a couple of questions,
and anybody else. Dr. Farrar or anybody else jump in if you see
fit to.
Secretary Brown, first let me congratulate you on the VA's — the
Veteran Affairs Department's — willingness to be responsive on this.
I know this is a very difficult position for the Department to be in,
but your willingness to be responsive £ind moving ahead with the
pilot program down in Alabama. The three of us visited there last
week, and we are impressed with the good faith effort that you are
making there. I would like to ask you just a couple of questions.
90
You have said that — you have noted that you have to rely on the
Department of Defense about information about what occurred dur-
ing the war, but at the same time you have a responsibihty to re-
main sensitive to the concerns of veterans. You have an open mind.
You also say that you will — we have never dismissed this possibil-
ity of exposure, chemical or biological exposure, and we will not
prejudge this issue. We will pursue all scientific avenues until we
have conclusive answers.
What conclusive answer do you need about possible exposure?
What conclusive answers are you pointing to there?
Secretary Brown. I think the statement there has two signifi-
cants here: One is that it was meant to say that while the Depart-
ment of Defense has said, or admitted that low levels, low con-
centrations of chemical agents were detected, however because of
wind direction, because of the low levels, because there was a lack
of dead animals in the path, there is no relationship between that
concentration and the complaints that Persian Gulf veterans are
having.
I basically reject that. That doesn't mean anything to me, and so
that is — I was trying to say that in a very diplomatic way, because
I believe that that is a question that will be ultimately, in my judg-
ment, resolved by the scientists. I mean, to me it is just a state-
ment, and I think that we need to look at this here very, very care-
fully.
We saw evidence of this kind of problem in our efforts to deal
with Agent Orange. We saw it in our efforts to deal with the adju-
dication of ionizing radiation. We saw it with LSD, and we saw it
with mustard gas. So all of that is nothing new to us.
So what we want to do is, we want to look at this thing fi'om a
rational standpoint and to try to find some answers. That is one
of the reasons why we are investing very, very heavily in research.
We are not only setting up the center down in Alabama to try to
help us develop a protocol, right now we are in the process of set-
ting up at least three research centers that are going to be staffed
by very
Mr. Browder. Excuse me, Mr. Secretary. If you don't mind. My
chairman is going to be turning my light off in just a minute.
Let me ask you, you say you are not going to be satisfied until
you have conclusive answers. Is the conclusive answer an analysis
of the problems that these people, veterans have and how to deal
with them, or is the conclusive answer answering the question of
whether or not they were exposed to chemical or biological agents?
Secretary Brown. I think they are probably interrelated. We are
on basically two tracks. The fist track, of course, is to deal with the
problems that we are having right now, so we want to provide
quality health care to deal with the manifestations and the com-
plaints that veterans are bringing to us. A veteran comes in com-
plaining of a skin disorder, we want to be able to treat that and
resolve that if we can.
The second is that we need to look at the etiology of those com-
plaints. What is the origin of the complaint? And that is one of the
reasons why we are putting a lot of money in the Birmingham
Medical Center, to see if we can identify what is the origin of the
complaints.
91
Now, if it so happens to be deficits as a result of exposure to
chemical or biological agents, then so be it.
Mr. Browder. Is that conclusive answer, is that a responsibility
of the Veterans Affairs Department or of the Defense Department
or both?
Secretary Brown. Well, we believe that — and we take it per-
sonal, that we want to make sure that if a veteran is hurt as a re-
sult of carrying out the policies of the United States Government
that we believe that it is our responsibility to do everything that
we can to make sure that he receives his entitlement.
Mr. Browder. Okay. Well, let me move on. One final question.
What problems does — the present Department of Defense position
on that question, what problems does that create for you, if any?
Secretary Brown. I guess it doesn't create any problem. It would
have been nice to — I guess it doesn't create any problem with us
right now because we are going to move ahead. What we would like
to do is we would like to move ahead together, if they will cooper-
ate with us and put some money into the research projects and so
forth, and I think they will.
Mr. Browder. Can we get the help that these veterans need and
deserve if the Department of Defense maintains its current posi-
tion? Can we get that help and will it be slowed up if the Depart-
ment of Defense maintains its current position?
Secretary Brown. That is one of the areas that we are very con-
cerned about. It took us 20 years to adjudicate Agent Orange. It
took us probably 30 or 40 years to get to the bottom of the question
dealing with mustard gas. It took us in some cases 20 and 30 years
to find out what happened to these veterans that were suffering
from the effects of LSD.
We don't want to wait that long. We want to profit from the his-
tory here.
Mr. Browder. I think I understand the gentleman's answer.
Mr. Chairman, if possible, I would like to return at some later
time to probe that because I think that is very important for our
other committee that we are working on.
Mr. Evans. We will come back to you after Mr. Collins, who is
now recognized.
Mr. Collins. Thank you, Mr. Chairman.
Secretary Brown, I do want to say how much I appreciate Dr.
Mather and Dr. Roswell and Jimmy Clay, Tuskegee and Bir-
mingham, coming by the office 2 weeks ago today and addressing
a lot of the questions and concerns of the group of veterans from
the Columbus area, and we are pleased to know, as we were in-
formed that day, that in the pilot program there will be testing for
the HTLV — 1 and 2, lymphoma cancer, and will be doing some con-
sulting with those families, which we think are all very important.
If I can follow up on Mr. Browder's question about the working
together, the team work of the Department of Defense and your of-
fice, are you having a lot of conversation about this, or is it a one-
sided, "want to do" deal? Is the Department of Defense actually
communicating with you on establishing the team work, working
together as you would like to see?
Secretary Brown. We have. I think we have set the framework
in which to move forward. In fact, we wrote to them on a number
92
of occasions asking them — we wanted, in fact, we asked them for
some money, because I think it is — the way I view this, some might
say that once a veteran becomes a veteran, then it is the VA's re-
sponsibiHty.
But I think it is in everyone's best interest that we try to get to
the bottom of exactly what occurred there. It is in the best interest
of the national defense. I don't think that it serves our Nation very,
very well when people come out feeling as if they have not been
treated fairly.
So if that is the case and you buy into that particular standard,
then it seems like to me that the Department of Defense and every-
one else would want to try to resolve this matter as quickly as we
can. We have offered, and I know that we are working very, very
closely with the Department of the Army and the Department of
the Navy to try to help us move forward, and I am encouraged
about what is beginning to take place.
Mr. Collins. Have you had any positive responses to your letter,
especially the money portion of it?
Secretary Brown. No. That went over on October 8th. You know,
it is a big organization and I am sure that we will hear from them.
Mr. Collins. I expect you will have some help with that one.
Okay. I was notified just, I believe it was Friday or yesterday
that the team going down to Columbus has invited a VA person to
attend that with them. But yet I don't believe you have had the in-
vitation to go to Al Jubail with them, is that not true? Or do you
know?
Ms. RiTTER. I am not aware of it.
Mr. Collins. Mr. Chairman, that is all I have.
Thank you very much.
Mr. Evans. Thank you. I will now yield my time to the gen-
tleman from Alabama.
Mr. Browder. Thank you, Mr. Chairman.
Mr. Brown, I would like to go back and pursue that. Could you
answer me again, is there — can these veterans get the help that
they need and deserve as long as the Department of Defense, if its
current position were to be its absolute forever position and — well,
let's just start with that one.
Secretary Brown. I would say yes, and that is because we are
going to do whatever it takes to resolve it. Regardless of whatever
happens in the other area, we are going to do what we think is
right. So, I think it is going to be resolved, and if it has to be re-
solved by the VA and VA alone, then so be it.
Mr. Browder. Would it help in getting this help for our veterans
if the Department of Defense had a change of position? I am not
asking them to say something that is not true, but they are saying,
they are emphasizing as of now, based on what we know, we can-
not document or confirm any exposure or the presence in any sig-
nificant amoimts of agent, and we cannot say that any of the prob-
lems that the veterans are having were caused by exposure to
these agents.
If they were to just move forward and say we have documented
or we have reports by the Czechs that there were agents present —
we cannot independently confirm that but we have checked them
out and we believe that they did detect what they think they de-
93
tected; if they acknowledge that there are reports from a lot of vet-
erans that they were subjected to chemical agents; if they were to
say that we have a lot of veterans with problems that that fit the
profile for — that are not incompatible with chemical or biological
exposure, we cannot confirm the presence of chemical or biological
agents nor can we deny those agents, period — would that assist,
would that much of an acknowledgment by the Department of De-
fense help in getting these veterans the care that they need?
Secretary BROWN. It was my understanding that is exactly their
position. They are saying that the Czechs detected low levels of
concentration, they sent a team over there to look at the equip-
ment, to look at the personnel that were trained to use that equip-
ment, and they have said that we move forward on the assumption
that there were indeed chemical agents detected. We cannot verify
this through independent sources.
However, they went one step farther, which I think is very good.
They are going to set up some kind of panel to continue to research
that.
Mr. Browder. Mr. Brown, you are being very kind to the Depart-
ment of Defense. They did say what you are talking about, but that
kernel of fact is mixed in a big bowl of a lot of virtual denials. They
make that one statement and then they go on and say, virtually,
that we don't think there is any connection between what these
veterans are saying now and any possible presence of chemical or
biological agents. They go that step forward and then they come
back and say but we are continuing to investigate that.
I guess it is an attitude that I am concerned about, and I would
like to ask is that mixture of attitudes a problem to you in getting
help for veterans?
Secretary Brown. Well, I think that — to me it has more to do
with what we are trying to ultimately achieve. There are many,
many veterans out there that don't know what is wrong with them.
But I think most people, you know, if you go to the doctor and you
have a pain or something, you want to know what is wrong with
you. And. If he tells you, "Oh, it's just an upset stomach," then you
are much relieved because you know it is not cancer. So there is
value in bringing forth all of the circumstances surrounding your
complaints, because probably by and large most of the folks would
be very happy with the results.
But I am going to ask my General Counsel to help me out in re-
sponding to that.
Ms. Keener. I was going to suggest maybe Mr. Vogel would help
us out with that. [Pause.]
Mr. Browder. Is anybody going to help us out with that?
Mr. VOGEL. I think that, you know, we talk about the cooperation
of DOD. My staff and subordinate staff have been dealing with the
Army Evaluation Board folks and what not. Our concern from the
benefits point of view is that we have the medical tools available,
diagnoses, what the condition is, and whether we can in fact pro-
vide disability compensation. I don't see any impediment, especially
with the pending legislation. It allows VA to treat Persian Gulf vet-
erans on a priority basis. No impediment to the VA's care for them
medically.
94
I am not a doctor, but I think the VA's response has been very
vigorous. Nobody needs to pat the Secretary on the back, but his
number one and only concern is veterans, and I think perhaps the
Department of Defense seems to be distracted. When they are no
longer on active duty they are maybe not quite as important to
them as they are to us. They are the number one for Jesse Brown.
And I think we are doing what can be done. We need the answers.
The best way to treat people medically is to know what the under-
lying condition is so that you can provide a regular treatment pro-
tocol.
Dr. Farrar.
Dr. Farrar. As a physician, I want to respond to Mr. Browder.
I think that I want to support Secretary Brown. I don't really think
it makes any difference, Mr. Browder, what the DOD is now say-
ing.
Secretary Brown has had the feeling all along, as have we as
physicians that anything is possible, any combination of biological
and chemical and anything else. So we are looking at all possibili-
ties and not ruling out anything. So, it really doesn't make any dif-
ference what the specific words are that are used by the DOD. We
are looking at everything. And I think that is the way to go.
Mr. Browder. Mr. Chairman, I guess the reason why this is im-
portant is for those of us who are going to be looking at it on the
defense end of it, side of it, we have to be concerned about why in
our mind the Defense Department is not being forthright in ad-
dressing this issue, and I just wanted to illuminate the possibility
that they would be doing so because they don't want the financial
liability of providing this service, this help to veterans.
Apparently, if this help to the veterans can be gained with their
current position, then there must be another reason that we will
have to explore with the Defense Department.
Thank you.
Mr. Evans. We appreciate the gentleman's line of inquiry and we
recognize the other gentleman from Alabama, Mr. Bachus.
Mr. Bachus. Dr. Farrar, I read your prepared remarks.
Dr. Farrar. Yes, sir.
Mr. Bachus. In there you mention Sarin, the nerve agent.
Dr. Farrar. Yes.
Mr. Bachus. That there were some long-term effects from expo-
sure. I know that the exposure that we know about was very low
amounts, but what are the long-term effects of exposure to high
concentrations of nerve agent or is it low concentrations?
Dr. Farrar. Usually — I am going to make one very brief state-
ment and then I am going to turn it over to the real expert. Dr.
Mather. And that is that usually with Sarin there are acute effects,
and it is unusual — but I am not an absolute expert on this — it is
unusual to have long-term chronic effects without having had some
acute effects. But we do have a list of symptoms, but let me leave
that to Dr. Mather.
Dr. Mather. I think one point that needs to be made is the De-
partment of Defense has expressed an opinion based on what is
available in research, that it doesn't have any long-term health ef-
fects. We, I guess, in VA have become somewhat sensitive to long-
95
term health effects of low levels of a lot of different environmental
agents.
A lot of times we are not aware of what those long-term effects
are because they haven't been studied. It is just that simple.
We do know, though, that Sarin is a cholinesterase inhibiting
agent, and there are other similar agents where we have been able
to study long-term health effects, particularly in pesticides. Pes-
ticides are also cholinesterase inhibiting agents.
And so what we have said is that if we don't have a necessary
literature at our disposal now let's look at what we do have and
say, "If this were the case what will we expect to see in these veter-
ans?" If they had been exposed to a cholinesterase inhibiting agent
and it had been significant, and we don't know what significant is,
but if it had been a significant exposure what would we expect to
find 3 years later? And there is evidence that peripheral neurop-
athy can be detected in people who had exposure to cholinesterase
inhibiting agents; that these kinds of subtle cognitive defects — the
difficulty with memory, the trouble concentrating — these things can
be documented with objective neurobehavioral tests and that is
what we are looking at in the veterans.
I think if we do pick up these s3rmptoms, or these signs, in a
large number of people who were in the same place at the same
time, then we will have to look at shared experiences. What kinds
of exposures did they have?
But since we can't determine what happened in the Persian Gulf
3 years ago, there is no way we can do that in VA, all we can do
is take the veterans and look at them. Then if we find objective
findings, go back and look for shared experiences in a control group
to study that.
But I think where you don't have scientific literature, (and I
think what the military is saying to us is we don't — ) it's our opin-
ion, based on what we have got, that this is not a problem. Our
response is maybe what you have got isn't enough and we need to
be looking at this further, and that is the approach we are taking.
Mr. Bachus. Let me ask one or two other questions, if I could.
The study that Dr. Miller is going to do at the University of Texas,
when do you think that study might be completed? I know the ap-
propriation hasn't been made. But do you have any idea when we
can get a report back? What kind of timetable are we under there?
Secretary Brown. Yes. He said the total report is going to take,
the final report is going to take about 3 years, but he said we
should have an interim report
Dr. Mather. There are two Dr. Millers we are talking about.
There is a Dr. Miller with the Medical Follow-up Agency.
Mr. Bachus. Claudia Miller.
Dr. Mather. But Dr. Claudia Miller is at the University of Texas
and she has a proposal for an environmental unit.
Mr. Bachus. And that is funded in the defense appropriation?
Dr. Mather. And as I understand, there is an appropriation
pending in the Defense Appropriations.
Mr. Bachus. That is right.
Dr. Mather. As I recall from her proposal, it would take about
6 to 9 months to get the unit up and going because it will require
some building modification, and then the studies would begin at
96
that point, and it probably would be a year at least. So, we could
possibly be seeing some results in 18 months following the funding.
Secretary Brown. Why don't you go ahead and tell them about
the other Dr. Miller now.
Dr. Mather. The NAS is doing an epidemiologic review about
which they testified on the Senate side. That is a 3-year study and
we will probably have an interim report in 18 months. That is the
other Dr. Miller.
Mr. Bachus. Other than those programs, are we studying Dr.
Shayevitz's proposal which she testified about?
Dr. Mather. That is a proposal for a clinical unit, but it has no
research base, and the decision has been made to look at this in
a research mode rather than in a strictly clinical mode.
Mr. Bachus. The thing that I think attracts me about her pro-
gram is we would start treating people immediately. Are we doing
that now in a specialized setting?
Secretary Brown. We are treating people immediately within —
not timely across the board, but we are treating people for the
manifestations or the complaints. By that I mean if a person comes
in and he or she is suffering from a skin rash or they are suffering
from some type of stomach problem, we treat that right then and
there.
But that is separate and apart from the research. What we want
to be able to do is to find out why is that person suffering from the
skin rash, why is that person suffering from short term memory
loss, and that is where the focus is going to be on research.
So, we are running two parallel courses here, both of which are
very important.
Mr. Bachus. But I guess what I visualize is a lot of veterans out
there with the same symptoms, and we respond with some sort of
treatment, but we don't actually have a program going where we
are bringing in a number of them and treating them and following
them and seeing whether it works.
And yet it is going to be 18 months before we get any report back
from Dr. Miller's study and this other study you have mentioned.
Are there other proposals like Dr. Shayevitz's proposal to go ahead
and start a clinical program and bring our veterans in, a number
of them, and start treating them?
They are telling us, they are coming to us, writing us, they are
sick, they are losing their homes, and now we hear it may be even
18 months before we get the research back as to what is wrong
with them.
What is your attitude about Dr. Shayevitz's proposal?
Dr. Mather. I think there are problems in funding a proposal
that involves an expenditure of approximately $2 million in the
first year which will not provide any answers to the questions other
than that it has helped those individual veterans. It seems that
with that expenditure of money, we should be answering some
questions too and not just sort of treating empirically.
There is a great desire and a need to treat empirically, but I
think from a system standpoint in order to benefit more than 120
veterans or the number that would go through in a year it needs
to have a research focus, and it is entirely possible that we can
97
work with Dr. Shayevitz to establish a research focus to her cHnical
program, her chnical proposal.
Mr. Bachus. I just wrote down what I think it was Troy Albuck
said when he said, "I don't really care about finding out what kind
of agents were used. Why I am suffering." It's kind of like figuring
out what kind of gun created the wound. He said I am not con-
cerned about that, I just want to get better.
And we have veterans that have been sick for 18 months and
some of us are sort of wondering why they are sick, but I think
they are. What they are telling us is they want treatment.
And we do have to know to a certain extent what caused some
of this, but I don't see the treatment waiting another 18 months.
Dr. Farrar. May I respond to that? I think, Mr. Bachus, you are
manifesting the same frustration that we feel. We desperately want
to help the people we can and we don't want to wait for 18 months
to get the final answer.
But, on the other hand, we can't use every possible treatment
that everybody suggests, and Dr. Shayevitz, I think, has a good
one, and Dr. Mather and I are going to review this and see what
we can do to involve her, because it does seem very effective. But
we can't use every treatment that people suggest.
Mr. Bachus. What strikes me about Dr. Claudia Miller's pro-
posal and what she thinks will work, what Dr. Shayevitz is talking
about — I may be mispronouncing her last name, but they mis-
pronounce mine all the time — and even Dr. Hyman to a certain ex-
tent, where he isolates these people in a fairly sterile environment.
All are very similar in what they are proposing.
Dr. Farrar. Let me assure you we will review — Dr. Mather and
I will review, and the rest of the people in Central Office will re-
view Dr. Shayevitz's proposal and work with her to do the best we
can to take care of the veteran.
Mr. Bachus. I would just hope that we could, 6 months from now
or 3 months from now, have some testimony that we took a group
of 20 veterans suffering from this condition and we put them in a
clinical unit and we treated them and they are better or they are
not.
I have my suspicions that the antibiotics have as much benefit
as the fact that Dr. Hjonan hospitalizes them and isolates them
from toxins over a 2 or 3-week period. But they are getting better.
Maybe the antibiotics are doing nothing.
If we could even put 20 veterans in and treat 10 of them with
this and 10 of them a little different and have some report back
in 3 months.
Dr. Mather. Well, unfortunately, even with the environmental
unit it would take us some time to get a clean unit in place. So
3 months
Mr. Bachus. I guess I just don't understand that. And I am not
trying to be critical. I just don't understand why you couldn't have
environmental units up and running now.
Dr. Mather. I don't always understand the slowness of the con-
struction process, but there would be some construction involved.
Mr. Bachus. Well, I would just urge you to start treating some
of these veterans in some of these programs as opposed to waiting
98
another 18 months before getting a preUminary report back on
what we need to do. I am just concerned.
Mr. Evans. One of the problems similar to Agent Orange is the
matter of compensation. There are veterans who are coming to Bir-
mingham, for example, at their own cost for travel. They aren't
working. They don't have an ability to work because many of them
are suffering and ill.
And paraphrasing the statement of the VA, since chemical and
biological weapons exposures cannot be directly detected, VA would
never be positively able to confirm such exposure. Given that, could
the VBA compensate those veterans believed to have been exposed?
Is there a reasonable association we might make to service in the
Gulf with some of these problems?
If not, we are left in a situation, it seems to me, very much like
Agent Orange where for years foes of any Agent Orange legislation
were saying you can't scientifically prove it, that the exposure
caused the condition and therefore we can't compensate it.
What would be your recommendations at this point as far as
compensating extremely ill individuals that are showing the same
kind of common symptoms that many other veterans have faced,
who were healthy before they went into the armed forces?
Mr. VOGEL. Most who present themselves, or who come to us for
disability compensation benefits — about 265,000-267,000 men and
women served in the Persian Gulf, and we have had almost 27,000
claims for disability compensation.
Mr. Evans. And how many have you awarded at this point?
Mr. VOGEL. We have awarded 7,260 of them. Most of them are
receiving compensation based on a direct incurrence of something
that happened to them while on active duty. A shell fi-agment
wound, an injury to one's leg, a fire, or a jeep accident — you know,
the things that happen to people.
Mr. Evans. And I would assume, Mr. Vogel, that most of the
awards have been made on that basis?
Mr. VOGEL. Most of the awards, yes. Now, we have received
about 2,500 claims from veterans for environmental illnesses, usu-
ally describing respiratory disorders, skin conditions, and what not.
Mr. Evans. 2,500 claims.
Mr. Vogel. Beg pardon?
Mr. Evans. There have been 2,500 claims.
Mr. Vogel. About 2,500.
Mr. Evans. And how many have been
Mr. Vogel. And about half of them have been adjudicated. Most
have been denied. We don't find a disability when we do the exam-
ination. In some cases, like you have indicated, Mr. Chairman, we
don't find a cause for something for us. We have symptoms but no
clinical findings. We have only had, on purely environmentally in-
duced illnesses, about 79 cases where we have granted a service
connection for them.
It would seem that the agents used, if they were, have a fairly
well-known cause. We just need to get the answer from the medical
people how, and that is what Dr. Mather so well described a few
moments ago. We have an answer about what the long-term causes
are of the exposure at whatever level.
99
We have no more problem from the disabiHty compensation point
of view. We simply provide the compensation at the appropriate
amount based on how disabled the individual is, and we have done
the right thing there.
Mr. Evans. Can you supply to us the breakdown of the particular
ratings of those 79, 10 percent, 20 percent, and maybe you can pro-
vide us information today about the claims for disabilities due to
exposure to environmental hazards which have been approved?
Mr. VOGEL. I can provide that for the record. Most of them are
respiratory and gastrointestinal and skin conditions.
Mr. Evans. If you could provide the information to us I think it
would be very helpful.
[The information follows:]
SERVICE-CONNECTED DISABILITIES BASED ON EXPOSURE
TO ENVIRONMENTAL HAZARDS
As of January 12, 1994, 163 veterans who filed claims for
disabilities they believe resulted from exposure to
environmental hazards have been notified of favorable
decisions. Service connection has been granted for one or more
disabilities because evidence in these veterans' records
indicate their conditions were related to their military service.
The attached is a summary of the findings.
BODY SYSTEM mZMBEE
Lower Respiratory
(LUNGS) 77
Skin 35
Upper Respiratory
(SINUS) 18
Digestive 13
Headaches 10
Eye 4
Hemic/Lymphatic 4
Systemic 3
Cardiovascular 3
Genitourinary 3
Neurological 3
Psychiatric 3
Musculoskeletal 2
Ear 2
Endocrine 1
Mr. Evans. I think we are in a very difficult situation trying to
help so many of the veterans who have come to testify and the peo-
ple that we have met in Birmingham continue in the programs that
we have set aside. If they can't get some kind of economic com-
pensation soon, I think many of them will have to drop out of that
kind of treatment program.
I understand the situation that you are in, but we are going to
have to be making some decisions sooner or later on this committee
as to where we go next. I don't have any answers myself, but we
will need your help in making that decision.
100
Do you have any recommendations for us at this point in trying
to look forward to compensation legislation?
Mr. VOGEL. I don't have anything at this time, Mr. Evans. The
Secretary and I were discussing it the other day. We will be, of
course, pleased to work with you. We know where you are coming
from on it. We want to work with you.
Secretary Brown. I have just one brief observation to make, Mr.
Chairman. I think you asked the right question there. There is no
doubt in my mind that the greatest tragedy here is that when you
have a veteran who for whatever reason is unable to obtain and
maintain substantial gainful employment for something that he
feels or she feels that happened to them while they are in the serv-
ice, and there is no way that they can prove it, or let us just take
for illustration purposes, let us say, for instance, a veteran served
in the Persian Gulf and he has short-term memory loss, but he
didn't complain of anything in the military and he probably didn't
even have his first manifestation until maybe a year after he got
out.
Well, that makes it very difficult. Number one, it makes it dif-
ficult how do you rate that? How do you verify it? How do you rate
it? But at the same time it could be of such intensity and mag-
nitude that it interferes with his ability to get on with his life.
So, clearly the question that you ask is one that needs to be
looked at very, very carefully, sir.
Mr. Evans. Do either of my two colleagues have any other ques-
tions?
Mr. Bachus. I am going to restate something that I said before.
When there was an appropriation given to Dr. H3mian, I think one
of the reasons was it was the only testimony we had of a program
that was working. I think we would have preferred a VA program
where the VA came to us and said we have a program and we are
treating people for this condition. I mean in a unit.
But all we had was Dr. Hyman, or veterans saying they had gone
down there and were much better. And that is why today the only
testimony we have had of a unit of this nature is of Dr. Shayevitz's
unit. Her proposal is the only proposal for a unit where we start
treating these veterans in a group situation.
This problem is not going to go away, and I think if we are back
here early next year. Congress is probably going to try to attempt
to deal with the problem. They are probably going to continue to
go out of house and appropriate money for programs and treatment
if the VA does not establish some sort of an in-house program deal-
ing with this specific situation.
I am not saying that is going to happen. This is not a threat. It
is not even appropriate for me to say that. It is just that I think
that will happen. I think the public will demand that we move in
that direction, and I think they probably should.
Secretary Brown. I agree with you. We have no problem with
that.
Quite frankly, I think that the Nation is better served when we
have people from all walks of life with different resources, different
perspectives on a given situation to get involved. So we agree and
encourage that process. Because, obviously, if something productive
101
comes out of it, then we can just grab a hold of it and run with
it.
But I made one statement, and that is, that if we — if you recog-
nize or you come up with something that we are not doing that you
think we should be doing to let us know. I have heard your mes-
sage, and why don't you give us a chance to take a look at this par-
ticular project and let us see what we can do with it.
Mr. Bachus. Thank you. Very much appreciate that. And that
was very responsive.
Mr. Evans. The gentleman from Alabama.
Mr. Browder. Thank you, again, Mr. Chairman.
Mr. Brown, one suggestion or request. I notice when we asked
down at the pilot program whether they had any extra people as-
signed to them for this program I think the answer was zero. Isn't
that right? I think it is — that just raises questions.
Dr. Mather. I talked to Dr. Roswell last week and asked him to
get us a request in for whatever enhancement, program enhance-
ment he needed, and he said he would get on that. So we are ex-
pecting a request.
Mr. Browder. Okay, good. And one other thing. Probably every
member of this committee who is concerned about this issue has
talked to medical specialists throughout the country who have been
treating veterans who couldn't, frankly, weren't getting help
through the Veterans' Administration.
I would request and suggest to you that you either talk to us or
the veterans and find some of these people, I could name several
of them off now, who have the veterans' trust because they have
been responsive to the veterans from the beginning.
And frankly, and I am not promoting the doctor in New Orleans
or anybody else like that, but there are some doctors that these
veterans feel like they have gotten some help from. I would rec-
ommend in the pilot study that you incorporate, build these people
in. Not just say they are welcome to come visit with us, but build
them into the consultations so that this will pass the smell test, I
guess, for the veterans.
Secretary Brown. We will have someone to contact somebody on
your staff.
Mr. Browder. Thank you.
Mr. Evans. Secretary Brown, one last question. You announced
that the records of the Persian Gulf Registry would be reviewed to
determine if any veterans should be called back for further testing.
Can you tell us how reviews will be conducted and what criteria
will be used for reexamination? If my understanding is correct, the
reexaminations are supposed to be done in Birmingham. Will the
VA pay travel expenses of veterans across the country who may be
called back for reexaminations?
Dr. Mather. We will be looking at the results of Birmingham
and also looking at the Registry exams with the kinds of symptoms
that we would expect to see. Our hope is that we would not have
to bring the veterans into Birmingham, but would be able to repro-
duce what Birmingham is doing all around the country.
Mr. Evans. Mr. Secretary.
Secretary Brown. What about travel pay?
102
Dr. Mather. Well, then travel pay wouldn't be an issue, if they
were going to their local VA.
Mr. Evans. If they were going to Birmingham, though, would you
look at that issue?
Dr. Mather. Our hope is — there is no way that probably Bir-
mingham could handle all of these.
Mr. Evans. But if there are some of them that have to go to
Birmingham?
Ms. RiTTER. It is our plan at this point to develop a protocol that
could be exported to other VA Medical Centers throughout the
country, so no one would have to make the long trip here. I mean
not here, but to Birmingham.
Secretary Brown. Yes. But answer this question. Let's just say,
for instance, a veteran lives 60 miles from his local VA. Would he
have to pay travel expenses?
Ms. RiTTER. Unless something happens to change the authority,
only people who are service-connected are eligible for travel pay.
Secretary Brown. Give us a chance to look at that, sir.
Mr. Evans. We appreciate that.
Thank you very much for your testimony, Mr. Secretary. We ap-
preciate your work as well as the panel's work.
I just want to emphasize to everybody here we appreciate all the
veterans of the Persian Gulf War that have been with us all after-
noon.
This is a bipartisan issue, as far as I am concerned. We have had
good support on the Republican side. We very clearly want to get
answers just as quickly as possible, and we appreciate the VA try-
ing to help us in that way.
We will now conclude the hearing.
[Whereupon, at 4:17 p.m., the subcommittee was recessed, to re-
convene subject to the call of the chair.]
APPENDIX
Statement Of The Honorable Jack Quinn
Subcommittee On Oversight And Investigations
November 16, 1993
Mr. Chairman, this is my fifth hearing in which we have examined the large number of
Gulf War veterans who complain of a "mystery illness" - Gulf War Syndrome.
Some explain it as Multiple Chemical Sensitivity Syndrome (MCSS). Others offer some
kind of virus as an explanation. Still others feel it may be the result of a bite of a sand
flea.
Regardless, Mr. Chairman, close to three years after the end of the war in the Persian Gulf
and after the initial reports of these ailments we still don't know what exactly is causing our
veterans to become ill.
Too many of our service men and women are suffering from the same kinds of symptoms -
fatigue and muscle and joint pain among them. We must get to the bottom of this.
I am deeply alarmed and outraged by allegations of chemical warfare conducted by Saddam
Hussein and the Iraqi forces. Iraq could be responsible for exposing our vets to hazardous
chemical agents.
As you are aware, Mr. Chairman, the Department of Defense (DOD) released a statement
last Thursday stating that Czechoslovakian chemical defense units detected chemical agents -
the nerve agent sarin and the mustard agent yperite - during the first days of the Gulf air
campaign.
Although low and explained as "probably the result of allied air strikes against chemical
munitions depots in Iraq," these reports raise the possibilities that our forces were exposed
to hazardous chemicals.
While DOD maintains that there is little likelihood of a connection between the Czech
reports and the unexplained Gulf War illness, it still raises many questions.
Just what happened? Was the presence of these chemical agents a result of Iraqi chemical
munitions depots being destroyed by allied air strikes or was it a result of a chemical attack
by Iraq? What were the levels of concentration of these chemicals in the atmosphere?
What will be the effect on our veterans in both the short and long run? How can we best
monitor these effects and what effective treatments are available?
I commend Secretary Brown for his recent announcement that VA will begin testing Persian
Gulf vets for health problems that may be related to their exposure to chemical agents - it is
certainly a step in the right direction. We must consider all possibilities.
By collecting medical history and exposure information, I hope we can start putting the
pieces of this puzzle together.
I understand that DOD has sent officials to Prague to investigate these reports and I will be
sending a letter to Secretary Aspin emphasizing my concerns and the importance of a
thorough inquiry.
I believe it is the least we can do for the veterans I have heard testify before this
Subcommittee and the Full Committee; for the veterans I have heard from across the United
States; and particularly those back in my home district of Buffalo in Western New York.
(103)
104
Congressman Mike Kreidler
Opening Statement
Oversight and Investigations Hearing
November 16, 1993
Mr. Chairman, during Desert Storm I was called to active
duty and assigned to an army hospital in Washington State to
process troops going to and coming from the Middle East. So I
have a deep, personal commitment to the men and women who served.
I would like to express to you my gratitude for holding this
hearing and for leading the fight on behalf of Persian Gulf
veterans.
After our hearing on June 9th and the subsequent passage of
H.R. 2535, I felt the VA and DoD were beginning to give the
medical problems of Persian Gulf veterans the proper priority and
recognition. However, today I no longer feel this way.
During the past month, we learned the Czech military
detected possible chemical weapons use during Operation Desert
Storm. I cannot express my disappointment with the DoD's
response to this information. DoD's continuous denial and
recalcitrance on this issue is hauntingly similar to its history
with Agent Orange.
The connection between chemical exposure and subsequent
illness is not an easy one to prove and is even more difficult
when the kinds of chemical levels of exposure aren't readily
available. But that doesn't mean we can't or shouldn't try to
find it. There are too many cases of veterans with mysterious
symptoms to dismiss them. DoD has an obligation to the service
men and women to be forthcoming with all its information and it
cannot continue to ignore the men and women who defended their
country.
While I am dismayed by DoD's actions, I am very pleased by
Secretary Brown's initiative to have the Department of Veterans
Affairs begin testing Persian Gulf veterans for health problems
that may be related to exposure to chemical agents.
I strongly urge the Administration to start a coordinated
agency effort to put to rest the questions surrounding chemical
weapons use in the Persian Gulf. In the mean time, I hope this
committee and the House Armed Services Committee will continue
its search for information.
105
GOVERNMENT OPERATIONS
Congress of tlje ®nitcb States
J^oust of JRfprefitntatibes
SHasbington, 23C 20315
CORRINE BROWN
3D DISTRICT. FLORIDA
WASHINGTON OFFICE:
1037 Lonaworth Building
Washingion. DC 20616
(2021 225-0123
FAX (2021 225-2266
REP. CORRINE BROWN
)r1ando. FL 32809
(407)872-0656
< (407) 872-6763
VA Subcommittee on Oversight and Investigations
Hearing on Persian Gulf Veterans
November 16, 1993
Statement
(904)264-4622
( (904) 264-4669
Thank you. Chairman Evans for holding this hearing. I want
to thank you, ^4r. Kennedy and other members of the Committee who
have been leading the way on this issue. We need full disclosure
and accountability by the Department of Defense on the possible
chemical and biological warfare agent detection and exposure in
the Persian Gulf and their link to the illnesses exhibited by our
Persian Gulf veterans. In addition, I hope that the Department of
Veterans Affairs is prepared to answer questions from this
Subcommittee about the problems that our Persian Gulf veterans are
having in getting medical treatment from the VA system.
Last Friday, I was on a local television show which focused
on the problems of Persian Gulf veterans. Two veterans, a man and
a woman, told me of their serious health problems which have eluded
diagnosis, and the financial hardship that they are under. To
them, the worst part of all was that they did their duty and
faithfully served their country in the Persian Gulf; and now they
are engaged in a new battle with the DoD and VA to get the
recognition and medical treatment that they deserve.
To Persian Gulf veterans around the country, I want to assure
you that your voices are being heard and that Congress will
continue to fight to get to the bottom of this tragic situation.
The Veterans Affairs Committee has undertaken an aggressive agenda
to address the concerns of the brave men and women who served in
the Persian Gulf, and we will continue to do so. Thank you, Mr.
Chairman.
106
Statement by Rep. Mac Collins (GA-3)
Mr. Chairman,
I appreciate the opportunity to participate in this
hearing today. A number of veterans from my district
have been suffering from illnesses they believe to be
connected to their service in the Persian Gulf, and quite
frankly their battle for health care at home has been
more difficult than winning Desert Storm.
Back on August 12, I first met with members
of the 24th Naval Reserve Construction Battallion based
in Columbus, Georgia. My goal from the first time I
spoke with them was to see that they received the
quality health care that they need and deserve. Dr.
Charles Jackson from the Tuskegee Veterans Medical
Center has tested these men, and I look forward to
discussing this with him this morning. The reports on
the illnesses of these CBs are confusing to them and
us, and I hope today to get to the bottom of some of
those questions. Dr. Jackson has tested a number of
them for HTLV l&ll a virus which causes cancer, and
could be caused by biological weapons. Three were
told that they tested positive, four have been tentatively
diagnosed with lymphademopathy or early stages of
lymphoma, and one has full blown lymphoma cancer.
Also the CBs heard that eleven of them who were
tested for HTLV l&ll tested positive and could develop
lymphoma cancer. They were never given the results
of their tests. We must get to the bottom of the
diagnosis of these troops. They are suffering and their
families are suffering. Enough is enough.
Since that first meeting, I have had corresponded to
and had meetings with representatives from the Office
of the Secretary of Defense, Joint Chiefs, Navy, Army,
Defense Intelligence and Reserve Commands. I later
met with Major General Blanck, and want to publicly
thank him for his candor and willingness to work on
behalf of the members of the detachment. I have also
met with Dr. Susan Mather, Dr. Roswell of the
Birmingham Veterans Medical Center and Mr. Jimmie
Clay of the Tuskegee Veterans Medical Center. I have
corresponded with Secretary Brown and various DOD
Undersecretaries as well. I believe the new program at
107
Birmingham VA Medical Center is a step in the right
direction.
On January 20, 1991 the members of the 24th
Naval Reserve Construction Battallion, Detachment
1624 were based in Al-Jubayl, Saudi Arabia. On that
evening their unit came under what they believed to be
a missile attack. They heard explosions which I
understand that the military is now calling sonic booms.
They immediately went to MOPP level 4, indicating the
strong possibility of a chemical attack. Within two
hours after being notified that all was clear the military
collected all their gear. Shortly after this incident a
number of the CBs began to feel numbness around the
lips and burning sensations. They believe they were hit
with a chemical attack. I pursued this question in
meetings with DOD and am told that there was no
chemical attack.
My first concern is getting health care to these men
immediately. If there was a chemical or biological
attack we should know that and do what is necessary
to provide these men with health care. If there was not
such an attack we should seek to discover what is
causing their illnesses, whether it be multiple chemical
sensitivities or other. But the bottom line is that they
need answers, and they need health care now.
The health of these men is deteriorating. This is
not a philosophical debate about the role of the
Department of Defense or the Veterans Administration.
It is a life and death struggle for these men and their
families. Someone must take responsibility for these
Gulf War Veterans.
At my request. Major General Blanck has worked
with the Navy to have a team to go down to Columbus
December 4 and 5. Last week, I received a letter from
Undersecretary of Defense Edward Martin that said they
would include someone from VA on that team. I also
understand this team plans to go to Al-Jubayl, Saudi
Arabia to conduct testing there.
I have a number of statements from members of
this unit that I would like to have inserted into the
record. I thank the members of this committee for their
108
diligence and dedication to getting to the bottom of this
crisis. Let me close with a note from Kristin
Westbrook, the granddaughter of Chief Petty Officer
Roy Butler from detachment 1624. "Hi my name is
Kristin, I am 1 1 years old. Why won't our government
help my grandpa? My mama says you are trying to help
him, so are alot of other people. Thank you very
much... She goes on to ask that we tell President
Clinton about the sick veterans. She closes with: "Tell
him to hurry, because I don't think my Poppa has much
time left. I love him very much and I don't want to
lose him."
Thank you Mr. Chairman.
109
Congre«man Mac Coilins
1116 Longworth HOB
Washington, O.C.
Dear CongnMsaman Collins,
Wa am tha grand«hilci«m of Chief Petty Officer Roy W. Butler Naval Mobile Conttruction
Battalion 24 Detachment 1624 from Columt>us, Georgia. We are very concern aoout our Poppa.
He la vary sick ainoe his service in the Persian Gulf War. He gets worM every day. We are
aaWng you to please help hinriWe love our Poppa very much, we donl want him to ale The
doctors at the V.A. will not help him ,t^ey will not even give him anything for pain. Our Poppa
hurts everyday. It is very hard for him to go to */ork everyday. Please hurryl We dont know hew
much longer ha will be able to work. Please, rleaaa help get our Poppa his disability started.
Hi, my name ia Courtney. I am 6 yeaii« old. Please, help my Poppa get better! love him very
much,
HI my name is Michael Ryaa i am 4 years old. Please help my Poppa. I dont want nim to dia
caus« I love him and he loves me.
Hi my name is Stephsnie. I am 16 years old. H our country cant traat our Veterans any better
than the Gulf War Vets are being treated then maybe everyone should be Ilka ProaidBnt Ciinton
and stay out of the senAce. I think it is really avA^i that m« can spend more money trylr^ to teed
the Somaliana than we can to help our Gulf War Vets. Please help my Poppa. I love him very
much.
HI my name is Kristin. I am 1 1 years old. Why won't our govemmerrt help my grandpa? My
mama says you are trying to help him, so are alot of other people. TTiank you very much. It
means so much to all of us. Please ask President Clinton why he never saya anything on T.V.
about our Seabees, doasnt he care? Please tell him to help all of the sick Vets. Tell him to hurry
because I dont think my Poppa has much time left I tova him very much artd I dont want to loaa
him.
Hi my name la Scott. I am 8 years. My Poppa and I go dear hunting and four-wheeling
together.but he is sick now and vm dont get to do as much anymore. Please help my Poppa he
Is a good man. He loves all of ua very much, He doesnt laugh and smile as much as he used to.
I miss my old Poppa please help me get him back. I pray for him every night I ask Jesus to
make him well again. Please help my Poppa if you can
Hi, my name is Bryan . I am 17 years old. Thank you for all the help you are giving all of ua. Tell
everyone else who is helping that we appraciata their help as well. I often thought of joining the
service to sen« my country like my Poppa has, but if I am going to be treated like he has I think
I will find another way to serve my country! am prouc to bean American.butrlght nowlam
ashamed of my govemmem.l wish the Pentagon would admit the truth about what happened In
the Gulf. My Poppa tells me what happened.he doesnt He, but the Pentagon continues to say he
is.l am asking you to keep worKing for us until they tell the truth, so many Uvea are at stake.
Without people like you we would have no hope. Make me proud of my go/emment again.
Hi my name is Dave. I am 1S years old Why does everyone act like Saddam would not use
chemical or biological V)/arfare on our people when he used it on his own people? I think
Saddam is just like Hitler. Why does our world let him get awey with ell the things he does7But I
guess he is right this is The Mother of all Wars'". If the Pentagon contnues to deny chemical
no
weapons were used what about biological warfare? TTiats what Poppa said Or. Jackson said
was wrong with him . He diagnoised him w<tn H.T.LV.iand2. Hesaid rtworKsliKe A.I.O.S. but
itsnotA.I.D.S. It is caused by germ warfare. Why want anyone talk about thls^tf this 1$ true my
Mimi could die tool So could slot of other people, what if it is in our blood supply? Saddam could
kill urn alllPleace work to bring out the tnjth.Help Or.Jackson to continue to help all of our Vets
sometimes I think he is the only doctor in the v. A. that cares. ThanK you tor all your help.we will
never forget you and all you have done for our family.
^^■Uj,tUt»k
\\-\\-r^
Ill
RayW. Butler
5807 Webb Ave.
Columbus. Georgia 31909
Nov«mbor 14,1999
Congressman Mac Collins
1118 Longworth HBO
Washington, DC. 2051 S
Dear Congressman Collins,
My name is Roy W.Butler patty officer first class. I sen/ed with Naval Mobile Construction
Battailon24 at King Abdual Aziz Stadium, with the first and second M.Y T H which Is located
south of Al Jubayl , Saudia Arabia. I served my country proudly for 24 years. I am also a Vietnam
veteran.
On January 20,1991 about 03:00 our compound wa$ awaken by two large explosions. Everyone
put on their gas mask and went to the bunkers. We stayed in tnt bunkers until the all clear was
given. Alter the all clear, several of us were standing around the latrine waiting our turn. When
the sky above us lit up,
Sliortly after the hand crank siren on the watchtower beiiind us sounded. A marine on the
handorank started yslling "chemical attack, chemical 3ttaok"mark level 4. By the time I don my
mask all of my axpoced skin was burning lika I was on flr».l had to remove my mask to clear my
natal passages as I could not breath. My lips turned numb. As I learned in training this was a
symptom of nerve gas so I immediately put on my chemical suit There was a message from the
port that the Britsh chemical detectors had detected mustard gas. A short time later the front
gate called for decontaminatton teams to come to the gate and decontaminate six passsengers
and a vehicle. Both messages come across our radio frequency. It was shortly after the events
of this night I began to, have problems.
I suffer from hair loss, memory loss, stiffness and joint puins vvhich continues to worsen daily. I
also have deformed toenails, headaches and have lost an Inch and a half in height. My health Is
rapidly deteriorating .1 can't continue to work much longer. I have a very dltricult time getting out
of bed as I am so stiff and In much pain.
On July26,1993 Dr. Jackson of the V.A. hospital in Tuskegee Alabama diagnosed me with
H.T.LV. land 2 Category.He aa diagnosed Roy Morrow with the same thir>g. Dr. Jackson talked
to us for several hours explaining his diagnosis. He told both of us it was a man-made virus that
destroys the immune system allowing cancer to set in. He told us that It was very contagbus,not
to have unprotected sex, give blood, or albw anyone to eat or drink after us I told him "weVa
been home for two and half years dont you think its a littte too late to be tailing us this
now."Everything Dr. Jackson said would happen to u£ is happening, it is falling in place just as
he said it would. Someone in Washington has got to listen to this man, .The consequences of
v/hat he is saying are far reaching and devastating. Gulf War Veterans are sick and dying.Moat
are dying from cancer just as Jackson said we would. He says there is no cure.This virus is
probably in our country's blood supply. It might be too late for me, but I can try to save son:\eone
else. The truth has to come out. I know our government they will never allow it to happen though.
I am asking you to please help me get my disability started as soon as possible, i have a family
to support and bills to pay. I am trying as hard as I can. but I cant last much longer
I dont want to leave my wife vi/ithout anything to take care of her. If what Dr. Jackson says is true
my wife will end up being sick as well. Please we need help NOWl
I want to thank you and so many others for all your help. We have no one else to turn to. Our
government has turned their back on us. We were good enough to go to war for our country.but
they dont think we are good enough to save or helpWe are yesterday's garbage to them they
have thrown us in the gutter to die.Please get ue out of the gutter. We are important and worth
the trouble. We gave all we had.
i^ €mZ^
112
Phyllis S. Butler
5607 Webb Ave.
Columbus, Georgia 3ld09
November 12, 1993
Congressman Mac Collins
1118 Longvwrth HOB
Wgshington DC, 20515
Dear Congressman Collins,
I am writing on behalf of my husband Roy W. Butier. Roy was diagnosed by Dr.Jackson at
the V.A. Hospital in Tuskfiflee, Ala as having the viruses of the H T l. V 1 and 2 category
It vras the 26 of July 1 993 that Dr. Jackson talked to my husband and Roy Morrow who also
served in the Cult War. He talked to them for several hours explaining his diagnosis, his
research on this and what Diey could expect to happen to their health. Attached ie a copy of
what was writlten down that night while he was talking to them.
I can't explain or begin to explain what this diagnosis hat> dune lo both man. 'Uvbu whole
world has been turn upside down. Or.JacKson aald he believed tnev were exposed to Biological
and Chemical Warfare.
August 13,1603, my husband had an appointrnsnt at the V.A. not related to Dr. Jackson, but
by chance wb got to talk to him. He said the Navy and Washington had been calling and ttiey
were very angry with him and he refused to discuss Ro/s diagnosis with me. He was rude to
me and in return I was rude to him. I gathered he had been told to shut-up, the familiar tvw)
words told to the Gulf Veterans about the chemical aihiokthey experienced January20,1993.
Finally Dr. Jackson explained Roy's diagnosis to me and what to expect after I demanded I had a
right to ask questions.
After Dr. Jackson dropped the bomb on my husband and Roy Morrow telling them it's
contagious, could give this to Uielr familise, thoy would end up with cancer, would have to be
monitored the rest of their lives and so forth he never said i want to see you in Nvo weeks or one
month or nothing- he Just dropped them with no follow-up.
My husband served hie country In Viet Nam and in the Gulf War Is this what he deserves for
that?Roy needs medical care , everyday is precious-time is not on their side.He has swollen
lymph nodes In groin area, joint aches, constant p3in, memory lo<u just to name part of what he
is going through.
I know now or I believe Dr. Jackson gave Roy Butler and Roy Mon-ow his test results on them
hoping to bring this out in the opan.l do know this man is the cnly V.A. doctor trying to help our
Veterans but some one tried to silence him.
Defense Secretary Les Aspin ruined his Image v/ith the American people over hi« handling «f
Somalia, I hope he realiies his denial and possibi* e^ver-up cou4 finish him off He's in no
postion to make another mistake.
Congressman Collins, I want totake time now to express mv graditude for all your help and
support and believing in our Gulf Veterans. Your have devotijH a lot of time to them and this will
not be forgotten. You have proven you are a very caring man.
Sincerely.
113
Dana Westbrook
B Layfjeld Dr.
Phenix City, Alabama 36869
205-2d1-0010
November 14,1903
Congressman Mac Collins
IIIBLongworth HOB
Wa8hington,D.C.20515
Dear Congressman Collins,
I am the daughter of Roy W Butler.Chief Petty Officer 1 class My dad was a member of
Naval Mobile Construction Battalion 24 detachment 1624 of Columbus, Georgia. I am virTiting
today on his behalf and all of his fellow veterans.l have many concerns regarding this situatJon.
My dad liks many other vats, is suffering from many different aymtoms such as swollen
lymph nodes, memory loss wtiteh continues to vrareen rapidly, joint aches, hair loss,
headaches, and constant pain. My dad like many other vets is finding it increasing harder
everyday to vi«3rk. He has starting keeping a notebook to help him remember things, but loses
his notebook he cant remember vi^here he puts it. The lymph nodes in hie groin area are so
swollen it Is painful for him to walk.
Like you I wonder wtiy our goverment will not come clean on this issue. What do they have to
hide? Who are they protecting? Are they guilty of Illegal activltes? Did someone in our
govemment sell Saddam the technology or products he need to create his chemical and
biological stock pile? Did he then turn around and use this on our people or pemaps we blew it
down on our seifs from the bombing?At any rate I want answers to the puzzle. The problem has
recked havoc not only on my family but thousands of others as well. We ail live with these and
many other questions everyday. We dont know what the future holds for us. I am sure this will
be the last Christmas for many of our veterans. It is hard to face Vm Christmas season with such
thoughts.My dad is too young to die but vets younger than him have already dIed.Where will all
of this end?
If what Dr Jackson told my dad is true I will probably bury my mother as well. Do I desen/e to
lose both of my parents because my dad served his country?Dr. Jackson told my dad and mom
both that the virus that he diagnostsed him with is contagious. How many Am«ricane have to
become sick or die b«for« our govemment wakes up?Doe6n't anyone realizes It what Dr.
Jackson is saying is true this virus is nr»re than likly already in our country's blood supply? It will
continue to spread unchecked. We will be facing a new A 1. 0 8 epidemic, are we ready for
that? I don't think so. So many are trying to shoot down Dr. Jackeun's diagnosis but my gut
feeling tells me he Is right on the money. I believe thats why they tried so hard to shut him up. I
hope more than anything in the world he is wrong I stand to tose too much if he is right I pray tor
answers and a miracle everyday. This is a heavy burden to carry.
I am asking you to help my dad get his disability pushed through faster If possible. My parents
are facing possible death they should not have to worry about losing everything they worked for
all their lives. My dad needs immediata medictjl attention. He doesn't need to hear its all in his
head anymore. Its difficult to work while you are In constant pain. A sick man can only go for so
long.
As Saddam said this is The Mother of all Wars, we have to fight our own govemment. A
government that Is suppose to be there to ser/e us. Les Aspin, the Joint Chiefs, V.A. and
President Clinton just to name a few would do well to remember that in a democracy the
supreme power is retain by the people. If they want a fight they have one. The American people
will only put up with their garbage for so long and when they had enough all hell will break loose.
If they value the jobs they had better get busy and do what ^e taxpayers of this country are
paying them to do I've already had all I intend to tska. I will fight with all I am and all I have to
see justice for our veterans and their families.
114
Congressman Collins just knowing you and so many othere are on our side makes this situation
more bearable. We appreciate all your help, concern, compassion and honesty. You have
proven your integrity to all of u$. Let me also say Mrs. Gillispie is one in a million, she is never
too busy to talk to us v^en we call . She answers our questions and has comforted me many
times when I cried, May God bless all of you and guide us to the answers we seek.
Siifcerely,
115
'ZM^^^^(->-<^ y(^<^^ .yAcA/^Ly^ tl<»to^^j,C€v,^ •
"flou.ii^ x66^Ya-u<u;fe<t:7?W^-''<ii^ 0^
116
,],J^3iZ.
<5<^<Se-^^.^ii^
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;
:\thpj>2c_^jfi.L^^3^.<oA^.. 3KL03.
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117
AyyiDAViT. gowBR qy M-rosKyy amp Rgrj>aB
TOR MBDICAL RECORDS
•-' My nama is Klcholas Eugane Robertis. I Uave bstn axaalned and
treated at th© Vetsran'B Afitoinistration Hospital, Tu2}ceg«a,
Alabama, for injuries and disaasAs resulting from oombat duty in
Saudi Arabia during ths yaars 1990-1991 as a meober ot N.M.c.B. 24 «
I desire and request of the Veteran's Administration Hospital that
a copy of all medical records of all tests perforaed, clinical
©xaalnations and evaluations, laboratory testing and data, history
and physical notes, examinations, tr«atfflents, evaluations, doctors'
i&preasions and diagnoses; all correspondence between the
snvironsentalist physician, c. Jackson, M.D., and any and all
Veteran's Administration, Navy Departaent, Army Department, and
Walter Reed Hospital personnel; all records or schedules
demonstrating scheduled examinations (including blood gathering) to
be performed on August 21, 1993, and/or august 28, 1993, at the
Naval Training Canter, Columbus, Georgia; all correspondence
between any physician or administrative personnel of the Veteran's
Administration Hospital in Tus]cegee, Alabama, said any other party
including the Veteran's Administration, Washington, D.C., united
States Kavy Department, Washington, D.C., Comnanding Seneral Ronald
Blanck, Walter Reed Army Medical Center, Washington, D.C., United
States Public Health Service or any of its subsidiaries concerning
me or any other member of my Naval Reserve Unit N.M.C.B. 24; all
records at Veteran's Administration Hospital, Tuskegee, Alabama, of
my being afflicted with Lymphadenopathy , Lymphoma, Hepatitis A and
Hepatitis B, immunity problems manifested with serum
C^)
118
iBumuioelaetroplioresia. and viruses of the HTLV-I/II categories j all
cerr«spond«nae canceling blood gathering from m* scheduled for
August 21, 1993, and/or August 28, 1993, at the Naval Training
Center, Colusibus, seorgia; all rftcords of Dr. Rollins, all records
of Dr. Sebea, and all records from Bureau of Medicine (BuMed) of
the United States Navy having reference to any treatment or
examination or disease for which I was e^camined or diagnosed while
at the Veteran's Administration Hospital in Tuskegee, Alabama, be
provided to my attorney, TranX 0. Surge, Jr., 2300 SouthTrust
Tower, Birmingham, Alabama 35203, and, by these presents, I do
hereby authorize and appoint him my duly attorney in fact to
rec«ive these records from the Veteran's Administration Sospital,
Tuskegee, Alabama.
Done at Birmingham, Alabama, this the '^ day of September,
X993.
STATE OP ALABAMA)
JEFFERSON COUNTV)
Before me the undersigned authority in and for said county and
state, personally appeared NICHOLAS EUGENE KOBESTS, who is known to
ne and who after being by me first duly svom, states that the
facte set forth in the foregoing Affidavit are true and oorxeot.
This Ij* ,,.dav of September, 1993.
nicJholas eocene Roberts
Svom to and Subscribed
before me this the (i,
day^-of September!^ 199 J
(3^
119
8nsi or osoisxA
OOIMXX OP NnUWETHIR
AFTzmviz
Pacaoolly &pp«ar6d before tho <iAcl«rai9D*d otti.c»s, duly authorlsad to
adMinittcr oAHha, xBoaois i.. oAitpn, coNMSBXcjuxoiis CBisr roa mmcb 24's air
PB., who aaya undar o«th the following:
"At approxlakBtaly 3 1 30 All January or Fabruary, 1990, tvo ground
sbakin? blase occurred la our area.
I had left the r/wwanri i^oat aunkeir earlier to gat a few heura sleep.
BUZ Liader was a&nniitg the radloa at the tioe of the blast.
It wasn't but just a few minutes after I got back to the c» that the
'All Clear* was Bounded.
tinder and I oalled the bunkers and the 'holes • relaying the 'All
Clear* oessage we had reoeived.
Shortly after thlS/ a meeaoge eaae down to the st&tiona on our covered
net, 'hL9Sh 6 BttAVO, ALPBA 6 BBAVO, We have a confirmed ohemlcel agent."
Our ean^ net, broadcast a message to all etationo, 'Mop Level 4, Mop
Level 4, All stations. This is not a drill*
AC that tine Z relayed the massages to our people.
Sente store of our people fell into the CP at this point saying a fine
mist had fallen over the csmp and others ware complaining of nuobness in
their lips and fingers. One man even pulled off his mask ooaplaining about
not being able to breath. Everything was really hectic at this point.
One of the radios sent down a neesaga asking for the Deoon Teams.
Another individual radioed asking "Mhat to do.'
120
SAOC KM ••adiAff 'Doim Wind )i«ii49U'
z wae trying to put on my mop g»ve, ttMa ammnagm* «ad try to kaep from
pAsicking.
Hy OMMaecy la aot r«&l el«A£ oc •v«sythlna< but I do rapacibnr later
tAAt nomlag a aarljv aad our csa mjuv CMi* to tha buakar and said to im,
•Hot a fualdng tblng happsnad last night 1« that daar, no Mlg boabAd ub
mad lt« not laylag bally up In the Gulf - Ro O«coa xaams, sot a tucking
thing happsaad.*
I bav« b4Mn talXlag doeters for two y*aza thla la what happened to us
oT«r th*r*. 9h«y dp not want to hoar It. On* aald I bKtm ?ott Trauaatlo
9te*ti Byndroo*. Xha doeter at tha V& aald "I don't knew what's wrong with
you guys . *
All I know Is what h^p*n*d to us."
TcaZHBR ai£last say«th not.
/^^<fi<v^ ^ V^
TBQMU L. B&apSR - M7
SMORK TO AKD SUBSCaUBBD BBFOBS MS
THIS 7^K fiiy OP JOKB, 1993.
( .uv^dL^, Wo. L^WtvvJ^'UjVin|
KOTARX VtALXe (SBAL)
121
Movember 14, 1993
Dear Sir«
In my affidavit* June 7, 1993 I neglected to name our CBS
man. His nanc is 3C2 Harold BdirBrde.
Than)c you.
/Vfc^iA^ (^ ljff<^>^yti,v\^'^
Thomas L. Harpsr
256-U-8184
P. 0. BOX 233
Shiloh, Seorgia 31826
706-845-3224
122
NQTenber* 14, 1993
DQ&r Sir)
My name is Thoaaa Levis Harp«jr. I V9.s a member oS NMCB-24'3
Air D«t. statioaad at King Abdul Aziz Naval Base, AL Jubal, S»udia
Arabia during Operation Desert Sbiaid/Daaert Storm. Since returning
hone I have been sicic and beliov^ it vas from b«ing exposed to
cbSinical and biological weapons used by Iraq during tbe >far. My
«ymptofflS ar« aching joints, heartburn, memory lose, shortnats of
breath, fatigue, rashes, dizzy epeils, diarrhea, avollan lymph
nodes -and headaches.
Before t vas dapioyed to Saudia Arabia : vas in good health.
After our return, I told our Medical Department repeatedly that I was
sick and believed it vas from being exposed to Cheinieal Keapons used
by Iraq during the xar. I vae told by the Medical Department they
weire going to send everyone that vas having problema to Bethesda Naval
Hospital to get help. T vas told to put my name on the list to go-
The Navy put me on the Physical Readiness training Program
(Fat Boy's Club} on July 16, 1992. My body fat percentage was getting
too high for Mavy standards.
on Septenber 12, 1992 T went for a physical at Fort Sennlng and
I told the doctor of my eyraptoms. Ke as)ced if I could do the Physical
Readiness Teft and I toid him no. He didn't even asK why, he just taid
"Okay, no P.T."
In November 1992 a team of doctors from Bethesda Naval Hospital
came to the Reserve Center. I told the doctors of my symptoms and
they said I night have arthritis, and that it was all in my head.
They also told me 1 have Post Traumatic War Stress Syndrome.
Also in November 1992 I got on the Desert Storm Register. They
made me an appointment for February, 1993.
In December 1992 I vent to my fjimily doctor because my health
was getting vorse. Ha prescribed nodicatione to help me get by until
my appointment at the VA Hospital in February.
February 1993 I took the Desert storm physical and they drew
blood for lab vorl? at the v.a. Hospital in Tuskegee and saw the doctor.
The doctor asked if I vas having any problems. I told him of my
tymptoms and he sent na to the lab for more blood work- I received no
treatment for any of ay problems.
123
PA(3E 2
In March 1993 Z v«b put out of the Raserres for failing to meet
the Navy'a Physical rtaaineas Stanflards. i was told it vouid be an
aeninlstratlv* aiseharg«. I i»X9i th« corman why it wasn't a ir>edical
dlscharfla and he shovad me my mddicai racord*. There w«» a statement
inclosed by sona doctor i have never s««n saying aomething about
failure to show progress and that I bsd been counciled. There was
nothing in ny records about my many complainte of being eiclc or vhat
the doctore for Betheida told me. I tfao advised by the Cormaa to take
the discharge and not stic up any trouble. Ae of today I still have
not received ay DD-214.
on April 16; 1993 I vae called back for more blood tests. X
didn't even s&e a doctor at this time.
July 29, 1993 Dr. Jackson had me come to the YA Hospital for
another blood te«t> the HTLV 1 s, 2. I aav Dr. Jaekeon on this visit
and told him ay joints, memory loss and fatigue were getting real
bad. He found my lyaph codes vere evollen and set me up for an
appointment to have a biopsy done. He also gave me medications for
ray joints/ heartburn^ and something to help me sleep. Thie is the
first time I actually got any kind of treatment.
AugTigt 2, 1993 vhen I vent for the biopsy the surgeon told me
he didn't see any eenee in giving me a "free cut" so Br. Jackson
could do his little test. He said they vere not swollen bad and the
last tvo people he did didn't shov anything, t went hone, a wasted
day, no biopsy, no treatment, no nothing.
On August 4, 1993 the rash vae on my neck, shoulders and arms
real bad. I w«nt to my family doctor August 3th, he said he had
never seen a rash like this before but he prescribed some medication
hoping it would help. The rash just got worse. I had to leave work
on August 9th to go to the VA Hospital hoping they would help me.
or. Jackson admitted me that night, said he had not seen the rash
that bad on say of the Sulf veta and told me vhile I was there he
would get the biopsy done. I vaa put under Dr. Sellins care on
August 10 but didn't see him until 3:30 P.M. He gave me a physical
and asked alot of questions about my problems. On August 11th, Dr.
Rollins examined my lymph nodes and said they vere not significantly
evollen to have a biopsy. On the same day Dr. Jackson told ae if Br.
Rollins wouldn't schedule a biopsy to go to the Chief of Staff.
August 13th, Dr. Rollins said he and Dr. Jackson agreed there was no
need at this time to have a biopsy done. I was in the hospital for
a week for "contact dermatitis:?, and received no treatnent except
being given Prednisone vistaril for itching.
with Dr. Jackson stressing I needed to have a biopsy and Dr.
Solline stressing not to worry about it 1 decided to go to a private
doctor.
On August 18, 1993 I went to Dr. Chipman in Columbus, Georgia.
He examined ma and said ny lymph nodes were swollen and scheduled me
for a CT Scan. I went back for the results on August 27, the diagnosis
was lymphadenopathy . He told me to come back in November for another
CT Scan so he could see If there was any change.
124
PAGE 3
Octob«r 5, 1993 I went to the VA Hospital for a follow up visit
with Dr. Rollins. He asked if I vas having any probleais. I told him
about seeing Dr. Chipman end tll* diagnoais. He then examined me and
said my lymph nodes vera swollen and wanted to do his own CT Scan. I
don't undarstand vhy or. Soiiina vaited until nov to admit my lymph
nodti vere svollen enough to do a CT Scan vhen he wouldn't do it vhile
I vas in th« hospital and Dr. JacKson vas saying they definitely needed
to be checked out. It vas only two weeks between the time Or. Rollins
eaid "Don't worry about your lymph nodes" and I was diagnosed by Or.
Chipman vith lymphadenopathy. Dr. RollinB also set me up for upper
GI Series and for an HIV test.
On October 20, 1993 I went to the VA Hospital for a CT Scan.
1 ran into Dr. Jackson and he told me he was going to call everyone
bacK for more testa. He nov believed it vas a biological agent ve
vere exposed to, possibly the sane as Russia used on Afganistan. He
also looked at the results of my H17 test, it vas negative. One less
thing they can blame it on!
November 4,1993 I vent to the VA for the Upper 81 Series. I
aslced the x-ray technician why Dr. Rollins would want the GI done.
He loolced in my records and said the doctor had put in them that I
have a history of uloers. 2 don't have a history of ulcers! That
vas the first GI I have ever had, I didn't have stomach problems
before the var. I also saw Dr. Jaocson and ha got By CT scan results
and told me it vas suggestive pancreatitis. He aslced if I drink
alcohol and I told him I am a non-drinker. He said they usually see
this in excessive drinkers.
On November 10, 1993 I went back to see Dr. Chlpmaa as told to.
He examined my lymph nodes and said there vas no change, they vere
still swollen ^but before doing another CT Scan he wanted to do some
blood tests. 'Dr. Chipman requested all results from all tests the
VA Hoepital had done and all he received vas some of the results of
the earliest tests done. They sent nothing to help him treat ma.
Dr. Chipman decided to do his own blood test consisting of the
executive profile, hepatitis eomprehansivB profile and the HTLV 1 i, i.
He also prescribed an antibiotic (Diflucan 200 mg) after I told him
that Dr. Jackson beieives it vas a biological agent I vas exposed to
during the war. He hoped the antibiotic would tei^liamy .furt$tf§'«^aii3fed by
the agent. So far Dr. Chipman has diagnosed me vith anxiety, fatigue
and lymphadenopathy.
Every time 1 go to the VA Hospital the first thing I am asked is
"Ace you service-connected?" When I tsil them no they tell me to have
a seat and I wait for hours to be called. If you are service-connected
you have precedence over everyone eiae. Hov do Z get eervice related
vhen the doctors at the va Hospital keep giving me the run around?
They keep suggesting or questioning if my problems could be caused
from my civilian Job, if I an gay, a drug abuser, if I have arthritlis
or if I am involved in "hanky-panky". With all the blood tests done
by this time they should be able to rule all these possibilities out
and make come type of diagnosis.
All 1 vant to know is what I was exposed to in the Gulf 'so I
can get the proper medical treatment i need without all the run
around. I miss work having to sit all day at the va Hospital even
125
PAGE 4
though I have aorning appointmente. When I don't vgrk I don't get
paid. Having to go to private doctors becauge of the run a round
from the Vk Hospital doctors and being in the hoepitui for a veek ia
causing me asd my (aslly financial problema. It has al60 put a lot
of stress on me snd my family.
I filed a Claim irith the DAv in November 1992 but they can't
help me without a diagnosie.
I fought for my country and nov that I may be fighting for my
life lb aeema my oountry hae turned its back on me. It took the
Viet Nam VDte almost 20 years to get help for Agent Orange/ is it
going to take ub that long? The Gulf War vets are dying nov.
Please ve need your help nov, not tvecty years from nov.
Thank you,
Thomas L- Harper
256-11-8184
P. 0. Box 233
Shiloh, Osorgia 31826
70e-846-3224
126
19 septotoer 1993
ELVIS R. RICH 444-40-8158
USR Reeeive (Retired lSep92)
Problems since returning £ian Ferslan Gulf/ Operatlcn Desert StoznwOesert
Shield!
(1 ) Had sinus and ear bLodcaga starting while in Saudi Arabia. Seen at
Colunibus Elnergency Medical Center, Whltesvilla Rd, Columbus, <3k, Sep 92.
Treated for acute akin infection with ractiva lymphadenopathy.
(CaLunbus Etnergency Medical Ctr 322-2223)
(2)Frostate enlargement found on vm discharge physical fron active duty bade
to reserve status, work-vp started at Martin Axny Hospital until benefits
ran out. I went to civilian physician v*>ere prostate biopsy was dene. Pathology
report revealed "focal atypia". Gcmtinulng follow-up.
(3) Chronic ^^igastric distress (swelling, bloating, exacerbated by eating).
Medlcidly diagtesed with gastritis and duodenitis. Gastric biopsy revealed:
Acute fungal Inflainnatlon consistent with candidiasis of esophagus. Focal
acute and chronic iirflaranatlcn of stonach. PtdblstBs persist to date with
little relief frcm medications. Presently taking ZAirnAC y2 daily; OOXStD/CUND
daily x4.
PHJfSICIAKS: Dr. Jeff S. Zabel FH: 322-1066
Or. vgilllam R. LaHouse Ph: -322-7884
nr. W. M. Harper PH: 322-0631
ELVIS R. RICH 444-40-8158
127
29 October 1993
TO WHOM IT MAY OCRCESN:
I, Elvis R. Rich, OSNR {rstirod lSep92), submit that since retuming
from ths Persian Gulf, Operation Desert Storm^-Dosert Shield have had
the following medical problems:
1) had sinus and ear blockage starting while in Saiidi Arabia. Seen
at coluinbus sanergency Medical Centar, Whitesvllle M, Columbus, Gk
Sep 92. Treated for acute skin infection with reactive lymphadenopathy.
2) have had prostate enlar^oieiit found on USN discharge physical fron
active duty bade to reserve status. Wcork-up started at Martin Army
Hbspital until benefits ran out. I went to civilian physician vAiere
prostate biopsy was done. Pathology report revealed "focal atypia".
Continuing follov up.
3] Oironic epigzistrlc distress (stalling, bloating, exacerbated by
eating). Medically diagnosed vith gastritis and duodenitis. Gastric
biopsy revealed: Acute fungal inflaimiation consistent with candidiasis
of esophagus. My physician is baffled by this, since he says this is
something seen in persons with In^ired imnune systans. Itiis pot^aLefn
continues to data with little or no relief fron medicaticns.
4) had crampy lower abdominal pain with passage of blood and mucus
in stools. Biopsy of oolon revealed two sigmoid polyps one diagnosed
as benign vlllotubular ad8no(Ba;the othsc was "hyperplastic" polyp.
4) presently undergoing work-up (CT chest and abdotnen) for axillary
lynphadenopathy.
5) further, I suffer periodic skin eruptions, chronic fatigue, hair loss,
as well as nenory loss - all of which I attribute to exposure to
chenical or biological warfare exposure v^le statlcsied in the Gulf,
None of the above medical problems existed prior to my duty in the Gulf,
Respectfully,
Elvis R. Rich
4715 Langdon Street
Columbus, Georgia 31907
128
14 Novonber 1993
TO WHOM rr ^ffiy ooncesn:
If, as DCD has recently concluded, there was no ev±6sK» of chemical oc
biological warfare agents used by the Iraqis during the Gulf war I viould
lite an explanation for the dead sheep I perscrally observed while travel-
ing fron camp to camp between the Saudi Arabian touns of Se's al Mish'ah
and Al Jubayl. I would like a reasonable explanation for the causes of the
aany illnesaes plaguing myself and other manbere of my unit as wall as other
service nenbsrs returning frcm the Gulf viar area.
I personally have gone fron a healtbly fit individual vtto rarely needed a
physician to ana plagued vdth constant abdominal pain, manory loss, hair loss,
pcostate problems, skin rashes and enlarged lymph nodes. My health has .
continued to deteriorate since returning frcm Saudi Arabia, "niere has to be
seme explanation for these maladies suffered by so many of us veterans of the
Gulf, other than "post traumatic stress". So far, none has been forthocBiing.
I sincerely hope that scmeone in the goverrsnent will care enou^ to seek the
cause and at least try to help those of us veterans v;ho are out here sick and
pexhaps ^Ing without a reasonable explanation for why this is happening.
Respectfully,
ELVIS R. RICH
AU-40-B15&
129
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WORK copy - DO NOT FKE MDRROU JR.RQV M 424-62-3394 07/26/93
FORn 10-1338 WORK COPY
TU9KEGEE V« MEDICAC CENTER CLINICAL LABORATORY REPORT
nORROM JR,ROy W 07/26/93 19139
SSNi 424-62-B394 SEXt M AGE i 46 LOCi P6V
Qraared Byi JACK60N, CHARLES E
Specimen I SERUM. SEND 93 1546
05/27/93 10:39
Test nama Result unite Ref . range
HIV NON-REACTIVE
Comment I HTLV I/II AB WESTERN BLOT ^^ ^ ' J y, I . ^51 -^ i.{t-9 M^l
FINAL INTERPRETATION 0tlfyi4ff^ [ ^ i Z \Jirr*t^-*^ V\ f"^'*!"*-'
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Septentier 15, 1993
To Whan It May Concamj
My name is Renee Baughman and I e»r v«-iting this letter on tiatvilf of my husband, Jlnmie
Baughnan, SCqfe 573 - i7-<^ODto.
Jinitiy was in the U. S. Army for four years. IXrring his anlistmant, he served in
Saudia Arabia fron Septerter 3, 1990 to March 29, 1991 (six months, twenty-sevon de^B).
His ETS date was May 7, 1993.
V)hlle in the Army, Jinmie became ill. He had syirptcrs of decreased appetite, weakness,
back and leg craitps and easy bruising. He did make several trips to the sick hall but
was instructed to go hare and rest, ITese symptons continued after his discharge frcm
the Aziny. Cnoe home, Jiirniie sought iredical attention at Colurtjus Medical Center,
Colunhus, Georgia and vras newly diagnosed with acute niyelaicmocytic leukemia. Ha was
then transferred to the Medical College of Georgia, Augusta, Gecargia for further
evaluatiion and treatment. Jimnis has sinoe reoaived his first treatmant of chemo-
tterapy and has had bed reactions to his iredicaticn.
Sinoe I have been at my husband's bedside, we hove lost our hcnne due to having no
inccme. Vie hove two anall children, three years and six nonths old who have been
staying with family. VS N^P HELP 1! Please help us.
Sincerely,
Renee Bau^man
138
Nov. 12, 1993
y.T . Chairman and Conrtressrasn.
As I Nick Roberts stated before you on Nov. 9, 93 about having
173- cases of cancer, brain cancer, braine damage, and also
of deaths from cancer . I submit this list of persain gulf
veterans as to back my statement up. As I stated there are
Names I cannot reveal because many are on active duty and
have been threaten. They are scared and sick.
I also state I have no document to back up these names nor
proof of there medical condition. These axe only vets that
have called stateing there problems. Some names were given to me
threw a network of other gulf war veterans. Also the media.
I think you will see that this list will show that there is a
real problem, I am sure you are getting many such other list
of gulf war veterans.
Some of the names may show up 2- times. as calls come in , please
excuse this matter. We can.t do everything someone will have
to sort out and make a master list.
Thank You for your time.
Nick Roberts
Nov. 12, 1993
139
dhanlon Fri Nov 12 17:34 page 3
Todd Richmond (319) 351-8339 Surgery now.
Pat TayloxL (919) 432-9802 slok b«d. Xnowa of aany others.
Lavranoa Hensey (617) 963-8165 Has canear. Couldn't talk much.
Sgt. Raooa (ralative would not leave /) Olad of cancer.
Rocky Coneales (919) 432ol539 Has kidney cancer.
Richard White (405) 352-2062 Died of cancer.
Randy Springs (SOS) 477-6610 Has cancer.
Mi)(e Moore (209) 29B-S085 Navy CB. Thyroid shut dovm.
Terry Avery (205) 297-8415. Navy CB. Sick wife and kids.
Elvis Rich (706) 568-3546 Has rocal atypia/ duodenitis. Navy cb.
Roy Morrow, Jr. (205) 291-5303 Navy CB w/ ehenical/blological exposure.
Col. LaDuc (706) 561-5666 Hbs lung cancer.
Fred Hllloughby (706) 327-4303 Navy CB, has colon polyps.
Hike Tldd (706) 322-6072 Navy CB, has night sweats/dizzy spalls /headaches.
William Travis (205) 855-4187 Navy CB, has rectal bleeding, wife has problems,
Tom Harper (706) 846-3224 Navy CB w/ early signs of lymphoma.
Roy Butler (706)563-3095 Navy CB. tested posltlva for HTLV I & II, has early
signs of lymphoma.
Larry Kay (706) 561-5019 Navy CB, chemlcal/bioloQical exposure.
Gene Trucks (205) 629-5732 Navy CB w/ brain damage.
Sgt. HcCaln (no nuober) Has lynpttoma/ is in DC hospital.
Mr. Haines (Father) (803) 358-8790 Navy CB, has brain damage.
Mr. Haines (Son) " n n ^^^ ^g^ Yia.a brain damage.
Chief Perry (704) 279-7999 Navy CB, has brain damage.
Stes-ling Slmms (205) 833-1449 Navy CB, has brain damage.
Chief Lane, treated by Dr. Kymann (no number)
Clark Edwards (704) 858-6232 Bad medical problems.
Lt. Bottoms (no number) In 644th. Has cancer.
Ed Boscavieh (no number) In 644th. Has cancer.
Bill Greig (714) 593-9389 Has cancer.
Mr. Todd (313) 351-8339 Has cancer.
333 PBS 20s-agn-329e uiac bdbert? pt m
140
dhanlon Fri Nov 12 17:34 page 2
rsally 8ie)c, bad cough, daprasslon, memory loss,
ringing, eara 24 hra a day.
Brad Jaalson (502) 899->1508 with 1st sarine divlelon, saw bllstars on 2
Marines during breach of land nines.
Claudia Walter (203) 429-7322 Brother-in-law Drew Dickinson died from lymph
node cancer at 48 after being in Gulf.
Maggie Hipp (618) 644-9318 (H) , (618) 398-7790 Navy medio with Construction
' Battalion Hospital Unit 22/ Fleet Hoepital 6 based on
Bahrain. Knows of half a dozen slok guys from that unit but
won't give me numbers yet. she's sicK too.
Kelly Decker (914) 856-6999 Was in lOSth Military Airlift Croup. His job was
to Bhoot the video. He was in and out of Saudi
Arabia in Al-Jabar and King Pahd airport, Ohahran
and Bahrain. He now has major Intestinal
problems. Possible leishmaniasis.
Sheila Guy (318) 436-0818 With 194th Replacement Detachment, Navy Rserve from
Z<ake Charles, lA, assigned to 7th Corp Personnel
from Germany. Has central nervous system problems.
Marty Alexander (515) 465-5949 with National Guard I034th Quartermaster Unit
based near Mafa Al-A)}atm north of Kuwait. Has
had sinus surgery/memory loss/respiratory
infections.
Tim Strlley (815) 589-4382
Bill Rider (814) 237-0947 Has lymphoma.
Jerry Phillips (405) 226-2812 Has chemical sensitivity.
Steve Chung (313) 461-2234 Testing for lymphoma.
James Weathers (205) 687-9423 Testing for colon cancer.
Russell Thompson (803) 379-3099 Has rare muscle disease.
Bellna Nelson (405) 355-2751 Has brain damage, (yeah, no kiddingl)
Shirley Jackson (617) 233-9500 Being tested.
James Peterson (405) 436-1920
Kirk Burns (409) 760-4373 Has brain cumor.
Mike Lande (714) 968-4330 Has lymphoma. Also knows of 2 others w/ brain
tumors .
capt. Joe Ellis (904) 376-8668 Has bad problems.
Mr. Hay (cannot give number) Died of brain cancer.
Doug Farmer (BOO) 241-2663 (Dad) Died of lymphoma cancer.
William McClouster (206) 692-7121 Has lymphoma.
Frank combs (904) 259-5760 Has lymphoma.
PCB-?gq-32BE N1C< FDBEOTS PC H.
141,
dhanlon Fri Nov 12 17:34 page 1
8LUa SEO* VSITER KODIFXED tv«il TIKZNO LC
GULF VICTIMS tvail W«d Nov 10 i6:37 1993 LOCKED 5:55 224
J««ae Vasquez (512) 882-5415 Sick vet
Ed creadan (717) 364-6121 (PA) 1st Marine Division Bronchitis/Antidots
side affscts
Lauria Gallegoa (303) 259-4839 Her husband Rocky vaa in Gulf, now both are
Bick with fatigue/ sinua problems/ blackoutc/
nigrainee/ ahortnass of breath.
Bannell White (919) 353-6205 Sick vet
Cayle Tappley (501) 679-5037 Migraines/ loss of breathing capacity.
Charles Hioka (813) 537-2373 Sick vet
Peter Winoahster (602) 890-1612 Sick vat in AZ... knows 150 other sick vets.
Dawn EBusert (317) 547-5650 sick vet and knows others sick/had support group.
Peter wincehster (602) 890-iei2 sick vet in AZ... knows iso other sick vats.
Dawn Emmert (317) 547-S650 Sick vet and knows others sick/had support group.
Adrienne Lockstar (410) 377-2910 Has theories on Gulf War Syndrome causes. Dan
Valley (914) S97-9554 CBS enalneer who was in Gulf with Dan Rather,
called Heaghan in NY to say ha was sick.
4ary Lee Ryder (914) 238-5082 (K) , (9i4) 739-1166 (w) Her son William is dying
of Gulf War illnesses.
Jinny Hazen (509) 525-4935 Reserve nurse who had antidote shot and then had
heart attack and never went to the Gulf.
lath White (412) 881^4748
!r. Rhodes (717) 765-0263
ranny Butler (619) 253-4577
ranes Saith (313) 896-5790 Nephew has cancer
ihana Avery (614) 99S-2593 Same battalion as Brad Jamison, has tape of
eheaical attack during breach of land nines.
andy salzar (703) 347-0989 Just wants transcript
ames Eaten (713) 392-4592 (H) , (713) 647-3236 (W) Has in the Gulf right after
the war, civilian works for engineering cunpatiy,
now suffers from rash, etonach problems, had
thyroid removed.
red whittaker (919) 484-8380/ (919) 391-0134 Army pilot with illness.
turls Plushert (410) 224-6564 Her husband was there with the 2nd Harinec and
is sick.
lohard Mejaslo (215) 346-0288 Has Hodgkin's lymphoma.
imie ovens (916) 782-8106 Her husband was in Navy CHB unit.. now
rfl*^ rion^' -i'juL^
142
David DsnialS 303 973-6036
Unit J ?S8G MARINES
Symtoms: Joint pBin, chest pain< cols freguently/ sinus.
Burnlna eyes* hard g«ttlng ue in the irorning, Diagnosed
NOV. 1990 With personality disorder .ETC.
John Occonal 719 380-8893
Unit! 4th Battalion 70th Armory 1st Armor Division (-ray ad)
Symptoms; Sinus, breathing problsms* musais and joint pains.
Fatigue, etc
Miles Harvey No Phone
1st 82nd Airborne Battalion
SymptomBi Sleep disorders, Hairioss, lover back pain,
short term memory, short of breath, suicidal thoughts,
assalut charges 2 times sines the return from the cuif
veight loss of 40 pounds, etc.
Tim Dilard 303 452-1278
Unit I Unknown at this time (national Gaurd)
Symptoms 1 Tingling in elbov and arms and spine, sleeping problems.
Richards Oak 303 477-2233
Alpha Company 57th Signal Battalion Army
Symptoms: Loss of Finger nails on left hand. Rashes, Joint pain,
Diarrhea, very emotional, sinus problems/ suicidal thoughts,
uranary irgancy. Etc.
Stephen Shaffer 303 588-2265
Please call for unit and syptoms.
Dennis Wilson 303 247-0384
Unit? Alpha company 7th Battalion/ ISdth Aviation reg.
4th Battalion 229 Aviation reg 11th bregaid
symptoms! Short of breath, veight gain, etc.
143
Tony Calioni 216 671-8991
Unit: 2ND LAAM Battalion Marinas
Symptoms: Heart Palpitations, saver ra8]:ies, Matalic taste
_8hake8/ frequent colds, blurred vision, stuttering, vsight
increase, bleeding gums, more sensitive to light, mind on
fast forvard, ehort term memory, etc.
303 259-4839
sever t
thoughts, •
ount ,
Ward Whiteman 719 596-2495
Units A Company 7. ISSth Farp team 4 229 Army
Symptoms: Personality disorder. Narcolepsy symptoms, diagnosed
chemical eonsitive, unable to handle authority figures,
suicidal thoughts, sever rages, testical pain, night sweats,
memory loss. Head aches. Btc.
Terry Morrow 303 356-2427
UNiti 3rd Assult Amph. Battalion Ist Marine Division Navy
SyraptoniB: Fatigue, foot fungus; lost toe left foot because
of tumor, sores and rashes all over bo^y, dental problems, bottom
gum deteriating, psychological problems > ect.
Charles Edwards Patterson ix 303-986-5380
Unit :46th Engineers, Supported 24th infantry Army
Symptoms: Severe headaches, fatigue, rashes, exhaust and
cigarett smoke bother him, blisters on tongue, hair loss,
diarrhea and abdominal pain, short term memery, eot.
MiJce Lannlng 307-638-0876
Unit! 40l8t tec fighter wing div. . Air Force (ACTIVE DUTYj
Symptoms: fatigue, body aches, liver problems, CMV disease,
testical pain, thyroid and possible diabetes, ring worm type
rash, s^'fr.
MarK Perslcy 303-343-6426
Unit :3rd Battalion 9th Marines
Symptoms: headaches severe, memory loss, heartburn, shortness
of breath, colds, sinus problems, insomnia, short tempered. a4&«
Jill Roathlisdergsr 303-659-6956
Unit: 31 Fox Switchboard MSU Alpha Company
1st Signal Battalion
Symptoms: Mood swings, fatigue, head aches, diahrea,
Has T.B., urinary night urgancy, blurred Vission,
increased gas blotting Etc.
144
Frank Combs ~ Testing for lynphoma cancer- glands.- 1-904-259-5760
Willlain Mc Clouster - Lymphoma CAMCJil? 1-206- 692-7121
DouEh farmer- died lymphoma CANCER- Dads # 1-800-241-2663
Capt. Joe Ellis- sick, prombleras — 1-904-376-8668
Mike Land — lymphoma CANCER- knows of others- 1-714-968-4330
Two of "nr. Lands fret'^t^'? has br^-^" t'T-ors,- see above #
Kirk Burns- Brain tumors- Cancer not known yet- 1-409-760-4374
James peterson- says he has important info — 1-405-436-1920
Shirley Jackson would not give number
Pete Winchester- sick - testing now- 1-617-232-9500
1-602-890-1612
Sealina Nelson- ~ Brain Damage- 1-405-355-2751
Russell Thomason - Hare muslce disease- 1-803-379-3099
James weathers- testing , for colon cancer- 1-205-587-9428
Steve Chung - Testing for glands - 1-313-461-2234
Jerry Phillips - Chemical sencatvity 1 -405-226-281 2
Bill Rider- - Lymphoma Cancer 1-814-237-0947
Tim Striley- sick - testing now 1-815-589-4382
Hoy Morrow- Dign, Chemical- Biologacal exposure-1 -205-291 -5203
hi vis Rich- Hare fungus , stomach, rashes — 1-706-568-3564
Terry Avery- sick - Navy C.B. Columbus Ua. 1-205-297-8415
Terry Avery, s wife- spouse, sick , same #
mr. Averys two children sick- concerned of health same #
Mike Moore- Thyroid shut down in country. Radiation- 1-205-298-8035
Mr. Moores wife- Fatique, weak at times, concerned- same ^t^
Kr, Moores daugter- Thyroid proy.blems- on medicine- very concerned!
Col, La Due — Lung cancer — yt. Benning (ia, cannot give #
Fred Willoughby- sick , fatique, testnow, on colon- 1-706-327-4305
i'Ted ,s wife showing some of same problems- same # as above.
Kike Tidd- sick - tired, night sweats, dizzy, 1-706-322-6072
William Travis- Heart promblems, rectal bleeding- 1-205-855-4 187
Mr, Travis ,8 wife - having problems- would not go into detail.,.
Tommy Harper- Enlarged spleen, glands swollen, lmphonathpy1-706-846-3224
Wife having some of the same symptoms, see above, spleen o,k,
Hoy Butler - tested pes. htlv, 1-2 , eick vet. 1-706-563-3095
Larry Kay- Chemical- biological exposure- 1-706-561-5019
Wife showing some of same problems - not all, # above
145
— PERSAIN GULF VSTS —
Gulf Vets - Cancer, Brain danage, sickness, and syrotoms.
Chariot Qilbreath- mom, son died lymphoma cancer-contact- 1-705-666-2736
Delbert Pushert- very sick — 1-410- 799-7493
Sgt. Major Cancer, on active duty- would not give number.
Hogue Gonzalez- warrant officer- sick — 1-919-356-6466
Pedro Juarey — died cancer — contact — 1-219-736-5929
Suaan Darget- Knows of many sick vets - Camp penniton Calf.
Jeff Taylor- Very sick, Lungs , infections. 1-207-989-4646
Elmor illliott- 24 th. battalion, very sick, Athens Ga.
Dale Clinton - Permanant lung damage — would not leave phone number.
Phillip Mc Gill - nmcb- sick
Dale Clover- very sick - Bad sick, cannot give number- active duty,
if'red Johnson- sick- 1-414-675-6496
Don Drake- Hashes, hair coming out, pain, bleeding. 1-205-535-0960
Ward '.Vhiteland- Chemical senaativty -sick,- 1-719-595-2495
Vaughn Kidwell- high white blood count, rashes, 1-619-365-3492
James Eaton- sick 1-713-392-4592
Dan Valley- C.B.S. news was there, very sick, bad- 1-212-975-2301
Chris Kelly- says test kit showed mustard gas. 1-805-984-6712
Sgt. Vaughn- Ft. Mead - Tumors, very sick. — i .41 0-437-8779
Sgt. Jim bowden- K.K.M.C. says he came in contact-gas. 1-205-775-8644
Fred Jones — Glands swollen, sick, 1-414-675-6496
SOMEONE CALLED AND SAID TO CHECK OUT 844 th. engineers many sick.
Mr. Ferbert - very sick- 181 st. Nat,l Guard- 1-508-697-6230
Lawrance Henesey- lukoplakia CANCER- 1-616-963-8165
Randy Springs CANCER-- Bone, 181 st. Nat,l Guard- 1-506-477-66 10
Bobby Bell - Lymphoma Cancer— would not give number.
Nick Roberts - Lymphoma Cancer — Navy, Ja-Bail. S.A. 1-205-297-3286
Mr, May- died - CANCER — cannot give number —
Richard '^ite- died - Cancer — 1-405-353-2062
Rocky Gonzalue- CANCER- kidneys 1-919-432-1539 —
Sgt, Rajnouse- died of CANCER- Relative would not give number,
Pat Taylor — very sick- knows of others- 1-919-432-9802
Todd Richmound- testing now, glands swollen bad- 1-319-351-8339
146
Gene Trucks - Brain Damage- TOO % C.B. «/t Batt. 1-205-529-5732
Sgt. Mc Cain - cancer in hospital wash. D.C.
Mr. Haines - Dad- Brain damage- C,B. 24 th. Batt. 1-803-358-6790
Mr. Haines- son — Brain damage- C.B. 2k th, Batt. Same #
Cheif Perry- testing,- posibly brain damage- 2i| th. 1-70^-279-7999
Sterllg Sijnms- Rashes , sores, fatique, memory loss- 1-205-833-1H5
Cheif Lane — being tested by Ilr, Hyman in New Orleans , no #
Willie Hicks- very sick- 644- Maint,
Cl«rk Edwards- very sick - 1-704-858-6232
Lt. Bottoms-- Cancer- very sick - 644 th, Maint. would not give*
Sd Boscavich- Cancer- sick 644 th, Maint, would not give #
Bill Greig- Cancer- cancer 1-714-553-9389
Mr. todd — Cancer- sick - 1-313-351-8339
Mike Addcock- died of Imphoma CANCEP mom — 1-904-368-6984
Mr, garcia- Cancer- not good- could not talk much-1 -91 5-757-3302
Nick Roberts - wife, Fatique, memory loss, 1-205-297-3286
Nick Roberts - Daughter- lung infection, S-yrs. can,t shake it, !
John Canaway- very sick - 1-501-356-3062
Mr. Hurasle- cancer- sick- 1-617-963-8165
Steve Pvans - cancer- sick- 1-313-747-6194
Mike Shaffer- Cancer- sick- 1-813-783-1435
Chris Dower- Cancer- many tumors- 1-508-534-0847
Scott Ferenze- sick - testing now- 1-904-593-5567
Bennel White- Bad sick 1-919-353-6205
Mr, dillard - Cancer, 1 st. calv. Gainsville Fla. would not give #
Sara Hawkins- died of Cancer- contact- 1-904-684-2228
Larrea Rosalius- 209 th. supp. Sick- 1-815-683-2557
Mr. Larifey - lymphoma Cancer- sick- 1-215-343-0826
Jim bowman - leukiraia- cancer- not doing well — 1-205*297-2756
Brett 'Valker- died cancer- .-noms # 1-313-724-8381
Jim Cancer- no- info - CK. # 1-704- 456-6263 ?
Lenord Lynn- Lung problems, night sweats, pain- 1-205-687-4956
Rocky Gallegoes- sick - wife also sick - 1-303-259-4839
Larry Pearson - C.B. concerned, sraptoms- 1-706-687-8078
Mike Shepard- sick , Joint Pain , C.3. 24 th. Batt. 1-706-882-5813
Russell Owens - Fatique, swollen glands, sick. 1-706-568-4988
Robert Nesselrotte- fatique, sweats, dizzy, pain- 1-706-323-4443
147
dhanlon Fri Nov X2 17:34 pag« 4
Lice Adcock (904) 368-6994 (Koa) Died of lynphona.
r. Garcia (915) TSV^SSOZ Not good at the nonent.
lihn Canaway (501) 35C-3062 Very sick.
r. Marasie (617} 963-8165 Has cancer.
tave Evans (313) 747-6194 Has lynphona.
ike Shaffer (ei3) 783-1435 Has cancer.
hrls Dover (508) 534-0847 Has cancer and nany tunora.
eott Fereny (904) 593-5567 Bad problene/ ewollen lymph nodes.
:r. Dillard (no nunber) With ist calvalry, Gaineevllle, FL. Has cancer.
Arrla Roaaliuls (815) 683-2537 With 209th Supply Co./ very sick.
[r. Larrifey (215) 343-0826 Has lynphona.
rin Bownan (205) 297-2756 With 197th at Ft. Banning/ hae leukemia.
Jratt wal){er (313) 724-8381 (Hon) Died of cancer.
rim ? (704) 456-6263 No info.
sgt. George Vaughn (410) 437-8779 Amy Sgt. fighting a nedlcal retirement. He
is sick.
Brian Baker Gilbreath (706) 866-2736 (Hon Charlotte) Died of lymphoma at age
28 in mid-1993. Was with 844th Army Engineers of
Chattanooga, TN.
Dr. Don O'Brien (no number) Retired. Zt. Col. who is sick. From Storm Lake,
Iowa. Buena Vista College.
iTflfin rillMll (iifl f1?'7f "^^ ^^^ 233rd Wb attached to the 1st Infantry
iiiHiJimi H'-'-" -•..— -.— - — — — I 1 —
nnrt I null
333 P0E gOS-23T-3SBB NICK ROSSTTS PC flL
148
Kirk Burns- 101 st. brain tumors- more test — l-/4.09-7bO-i+373
Howard Johnson - r,UTip under arm pit-tired- l-706-dit6-933^
Gary Johnson- sick, fatique, C.S. 2k th. Batt. 1-205-291-9570
Bill Mc Daniel — Fatique- concerned— 1-706-24^3
Michael 1. Caughey- Night sweats, sinus problems- 1-706-989-3275
"■onrie T.and- - raei-, fatique, headaches, — 1-205-699-i(.213
Dale Glover- N.C.O. Chemical field, tumor, - 1-205-295-8127
Tom Muse- Sashes, Fatique, C.B. 2h th. Batt, 1-205- 323-1if6i+
Anthony picou- - sick- 1-210-658-7870
Elizabeth Jones Died Kidney failure- 121 th. trans, unit.
( CANCER )
Bob Wages — Sick, several symptoms, Fox commander, 1 -205-^+80-2081
(Told posible early luikemla cancer )
Steven A. Schaefer- died V.A.-day cancer- wifes # - 1-303-588-2266
Cheryl M. Guy — sick, dizzy spells, nervous system- 1-31 8-A-36-0818
Charles Body - Joiny Pain-Rashes, Swollen glands, cannott give #
Betty Turner — Rashes, Joint pain. Fevers, cannot give #
Richard Haines- sick - 1-812-948-9366
Phillip Owens — Chest pain. Infections , 1-916-782-8106
John Ferbert- Non- hodgins lymphoma- sick — 1-508-697-6230
Harold Rhodes — Rashes, Fatiquw, sick — 1-717-765-0263
149
Nov. 10, 93
Mr . Chairman
'"^1= ptp.teirer.t '"-."r ■— '^'^ =--' ^p?'- --he -t^t^r.^nt I made on
Nov. 9, 1993 . I Nick Roberts Made claim that I had to
obtain em attorney to get my medical test results from the
V. A. hospital in Tuskgegee Al. after failing to on my
own. It took only 1- year and aprox, 2 months to finally
get my records. My records also showed in Nov, 2, 92
I had swollen lympth glands, low fevers , rashes, dizzy
spells.
Affidavit is attached.
Copy of certain medical records are also attached.
Thank you
Nick Sober
150
AFFIDAVIT. POWBR OP ATTORMBY AMD RELgXSB
FOR MBDICAL RECORDS
- My nsund is Nicholas Eugene Roberts. I have been examined and
treated at the Veteran's Adainistration Hospital, Tuskegee,
Alabama, for injuries and diseases resulting from coabat duty in
Saudi Arabia during the years 1990-1991 as a member of n.M.C.b. 24.
I desire and request of the Veteran's Administration Hospital that
a copy of all medical records of all tests performed, clinical
examinations and evaluations, laboratory testing and data, history
and physical notes, examinations, treatments, evaluations, doctors'
impressions and diagnoses; all correspondence between the
environmentalist physician, c. JacJcson, H.D., and any and all
Veteran's Administration, Navy Department, Army Department, and
Walter Reed Hospital personnel; all records or schedules
demonstrating scheduled examinations (including blood gathering) to
be performed on August 21, 1993, and/or August 28, 1993, at the
Maval Training center, Columbus, Georgia; all correspondence
between any physician or administrative personnel of the Veteran's
Administration Hospital in Tuskegee, Alstbama, and any other party
including the Veteran's Administration, Washington, D.C., United
States Navy Department, Washington, D.C., commanding General Ronald
Blanck, Walter Reed Army Medical Center, Washington, D.c, United
States Public Health Service or any of its subsidieuries concerning
me or any other member of my Naval Reserve Unit N.M.C.B. 24; all
records at Veteran's Administration Hospital, Tuskegee, Alabama, of
my being afflicted with Lymphadenopathy, Lymphoma, Hepatitis A and
Hepatitis B, immunity problems manifested with serum
151
iummnoelectrophoresis, and viruses of the HTLV-I/Il categories; all
correspondence canceling blood gathering from ne scheduled for
August 21, 1993, and/or August 28, 1993, at the Naval Training
Center, Columbus, Georgia; all records of Dr. Rollins, all records
of Dr. Rebea, and all records from Bureau of Medicine (BuMed) of
the United States Navy having reference to 2my treatment or
examination or disease for which I was examined or diagnosed while
at the Veteran's Administration Hospital in Tuskegee, Alabama, be
provided to my attorney, Frank o. Burge, Jr. , 2300 southTrust
TQwer, Birmingham, Alabama 35203, and, by these presents, I do
hereby authorize and appoint him my duly attorney in fact to
receive these records from the Veteran's Administration Hospital,
Tuskegee, Alabama.
Done at Birmingham, Alabama, this the '** day of September,
1993.
STATE OF ALABAMA)
JEFFERSON COUNTY)
Before me the undersigned authority in and for said County and
State, personally appeared NICHOLAS EUGENE ROBERTS, who is known to
me and who after being by me first duly sworn, states that the
facts set forth in the foregoing Affidavit are true and correct.
This lU day of September, 1993.
NICHOLAS EUGENE R(^£RTS
Sworn to and Subscribed
before me this the JL,
dav.-af September j^ 199:
152
ri NOV 16,1992 Conpensatlon and Pension Exan Report Paget 1
TUSKEGEB
** FINAL *•
For GENERAL MEDICAL Exam
Nanei ROBERTS, NICHOLAS E SSN: 257906104
C-Numbar: 257906104
OOBi JXIN 26,1954
Address: 3 FINE RIDGE ESTATES
City, State, Zip I Res Phonet 205-297-3286
PHENIX CITY ALABAMA 36869 Bus Phonei 205-297-4644
Entered active service: DEC 3,1990 Last rating exam date:
Released active services MAT 4,1991
priority of exam: original SC
Examining physician: M. V. SALAMANCA, M.o.
Examined on: NOV 2,1992
Examination results:
A. OCCUPATIONS:
B. MEDICAL HISTORY:
1. THIS 38 YEAR OLD WHITE HALE WAS IN DESERT STORM FROM DECEMBER 1990
TO MAY 1991. ON HIS RETURN HE NOTED A RASH ON HIS LEFT LEG IN JANUARY
1991. IT IS A DRY PATCH WHICH IP IRRITATED WILL BLEED. HE WAS GIVEN
SOME OINTMENT WHICH CLEARED THE LESION.
2. WHILE IN SAUDI, HE WAS GIVEN MANY SHOTS AND PILLS TO TAKE. THE SHOTS
AND PILLS MADE HIM HAVE DIZZY SPELLS ON AND OFF WHICH PERSISTED EVEN UP
TO NOW. ALSO HE STATES GETTING TIRED EASILY, HAS ACHING IN HIS JOINTS,
FEVERISH AT TIMES AND ALSO SOME LOSS OF MEMORY.
C. PRESENT COMPLAINTS: RASH - ITCHES, BURNS, BLEEDS .«..^^
0. HEIGHT: 74" WEIGHT: 165 BUILD/NUTRITION: WELL DEV. WELL NOURISHED
TEMP: 96.6 TIME: 9:05 CARRIAGE: NORMAL POSTURE: ERECT
GAIT: NORMAL RIGHT HANDED, ASKED
E. SKIN: TATTOO BOTH ARMS AND UPPER CHEST, fiti LOCALIZED PATCH WITH
MACULAR ERUPTION LEFT LEG
F. LYLMPHATIC AND HEMIC: PALPABLE LYMPH NODES BOTH INGUINAL AREAS,
WITH MILD TENDERNESS, ALSO ON CERVICAL AND ANCILLARY AREAS
G. HEAD, FACE AND NECK: NORMAL
H. NOSE, SINUSES, MOUTH AND THROAT: NORMAL
1. EARS: NORMAL
(^^
TOO SNIITTOO OVW O Isl O O « I^ V Q O : O T ES ST
153
Madicol Canter Twkeoee, AL 36083
^
Veterans
Administration
0««r Commander I
this letter Is a follow up o£ the telephone conversation of last
week. As was dlscussedi the membera of your unit have medical problems
which appear to ba different from those that are being observed by
other Persian Culf War veterans, namely lytophadenopathy and lymphoma.
It now appears that there are a number of members of the 24 th Sattallon
who were stationed near Al Jubayl on the coast of Saudi Arabia who
are experiencing these same physical abnormalities. Vlth your perolsslon
we plan on testing the members of your unit who went to the Sulf.
Specifically, we will be testing for evidence of Hepatitis A and
B, Inmune problems as Danlfest with an iaDunoelectrophoresls(serun)
and for viruses of the HTLV-I/II category.
Vou suggested that august 28 would be a good date for drawing the
blood. It has been suggested by one of the members of your unit that
we also come on August 21 as many members will be present on that
date and not on August 28. If this Is acceptable with you, we will
come on both dates^lnce the number of individuals will be smaller
on each date, the entire length of time that we will have to interfer
with your unit activities should not exceed one hour on each date.
Please notify by pnone which opcion Is acceptable with you; one vlsit-
please designate date-or two vislcs.
Thank you
C. Jackson uTC.
Environmental Physician
Out Patient 11 A
V.A. Hospital
Tuskegee, Ala. 36083
Tele # 205-727-0550 ext. 3380,3370
154
Nov. 1^, 93
Mr. Chairman and Congressman.
It has been said by Generals and even a President that we were
Americas best. We were told we were the best trained , best
equipped, and also the best physically trained troops in the
world. It is appearant something is very wrong. Seems we were
not trained as well as we thought. We did not know how to
detect or read chemical test kits corectly, Nov/ for some reason
all of the chemical detection devices and test kits we had
did not work properly. Now we are finding many gulf veterans
have post dramatic stress and many have been told we needed
psychiatric help. You mean to tell me that the United States
sent to war ill, untrained , stressed out mentally and in
need of psychiatric help. Thats a crime in it self.
I can asure you that if the need came again for me to go to
war , I would most certainly want the same expertise of all
gulf war veterans on my side. Congressman , you have heard
from veterans on earlier dates as you are about to hear others.
You are indeed hearing from americas best, remember our statis
in the milatary was high, and we have great respect for
patiotism. Its hard to stand by and watch your comrades fall
and be treated with no respect. Our testamony and the facts
of what happened durring the gulf war will surly come together
and show that maybe the troops were,nt the ones needing
psychiatric help .
I certainly would not under estimate us. Listen and you will
get the fill of what did happen, so as as the v/eeks pass
and more come forward you will see we have set the stage
as care full as the pentagon. It seems as if we play some
sort of game, we come forward , then they do , and so on,
we are at a good pace now. Butt , you will see that pace
begin to move even faster. All v/e want is the truth, and
know if we can get medical help.
Thanks. y/Kf^^Jt^Mi^Gi^
155
BRIEFING FOR CONGRESSMAN MAC COLLINS
Septemoer 13. 1993
1416 Lonsworth H.O.B.
BRIEFERS;
Captain S. William Berg. USN
Captain Steven Cuniuon, USN
Coionei Rick Erdtmann. MD. USA
Colonel Reginald G. Moore. MD
CDR James L. Bullock, USN
Mr. Denny Ross
LTC Glenn Baker, USA
LTC Parry Hamiil USA
LEGISLATIVE .\FFAIRS:
Capt. Bob Shields
TamaraCrail
Betty McGraw
LTC David Schock
LCDR Pam White
NEPMU2
BUMED
US Army Surgeon General's Office
J4- Medical Readiness Division
NAVFACENGCOM
DIA Chemical Expen-requested by J2
JCS
OSD-Reserve Aifairs
JCS-LA 703-614-1777
OSD-LA 703-697-8784
BUMED-I^ 202-653-0157
USA-LA 703-697-9690
USN-L-\ 703-697-6196
156
REPRESENTATIVE MAC COLLINS (GA-3)
Following is a list of questions that I provided to the Office of
the Secretary of Defense* On September 13, 1993, I met with various
officials from the Department of Defense to discuss these
questions:
1. Does the OSD have any indication that chemical or biological
weapons were used against U.S. troops in Al-Jubal, Saudi
Arabia on January 20, 1991 or at any other time?
2. If there was any possibility that these troops had been in
contact with chemical or biological weapons, were they briefed
as to this possibility?
3. Why did alarm signals go immediately to MOP level 4 at the
time of the attack?
4. Why was all chemical gear taken by the military following the
attack? Does this indicate that the gear had been
contaminated? It is my understanding that chemical protective
suits, can be safely re-used for up to six months if they have
not been contaminated, is this accurate?
5. Were CBs or any other troops ordered to de-contaminate
military vehicles, etc..., following this attack? If so, why?
6. It appears that the Department of the Navy is removing the
doctor who diagnosed these CBs from their case. Is that true?
Why is he being removed from their case?
7. Why are the CBs blood tests, and other medical procedures
being postponed?
8. The CBs believe that an attempted cover-up is taking place.
They are suffering from lymphodemopathy , lymphoma and they
will likely end up with Human T-Cell deficiency and Lymphoma-
Leukemia. Their symptoms differ from diagnosis of other, non
Al-Jubal, Gulf War Veterans. Does this give OSD reason to
believe that they possibly were subject to chemical or
biological attack?
9. Would it be possible for me to review the reports which these
CBs filled out for their medical records when they returned
from the Gulf? If Saudi Arabia related materials have been
removed from their files, why was this done?
10. The virus that these CBs have contracted has been diagnosed
as highly contagious. The wife of at least one of these
CBs has also tested positive with this virus, and others are
experiencing similar symptoms. What is being done to provide
medical assistance to dependents of these CBs?
11. If these individuals were subjected to chemical or biological
weapons, what sort of medical treatment and follow up is
recommended by the Office of the Secretary?
I am making no assumptions in this case and at this time
consider it to be confidential. However, I do want to ensure that
these individuals are given the medical attention that they
deserve.
MAC COLLINS
157
Iota
TESTIMONY
1
Statement of
Hellen Gelband, Senior Associate
and
Maria Hewitt, Senior Analyst
OTA Health Program
accompanied by
Clyde J. Behney
Assistant Director
Health, Life Sciences, and the Environment
Before the
House of Representatives Committee on Veterans'
Affairs
November 16, 1993
The Persian Gulf Health Registries
l3l
Congress of the United States
I Office of Tectinology Assessment
Washington, DC 20510-8025
158
Summary
Thank you for giving OTA tiie opportunity to present testinnony at this
hearing. I am Hellen Gelband, Senior Associate in the OTA Health
Program, and with me is Maria Hewitt, a Senior Analyst, also in the Health
Program.
When Congress directed the U.S. Department of Veterans Affairs (VA)
to create a registry for health examinations of Persian Gulf veterans, the
greatest potential hazard appeared to be smoke pouring from hundreds of
oil wells that had been set on fire by the Iraqis. The U.S. Department of
Defense (DoD) list of Desert Storm/Desert Shield participants and the
locations of their units in relation to oil fire smoke--the other piece to this
registry complex (see figure)-also was driven singularly by concern about
the effect of the fires on veterans' health, not only in the short run, but for
years afterward. In addition to its role in providing comprehensive medical
examinations to concerned Persian Gulf veterans, the VA registry was
conceived as a means to identify "sentinel" conditions possibly
consequent to Persian Gulf service. Because the registry comprises veter-
ans who either have health problems or are particularly concerned about
their health--not a representative sample of veterans-analyses of the
registry data cannot, themselves, provide clear evidence of a link between
Persian Gulf exposures and any specific medical condition. But
conditions seen in registry participants could provoke suspicion of a link,
which could then be investigated in a formal epidemiologic study.
The law mandating creation of the VA registry also mandated this
Office of Technology Assessment (OTA) assessment and, in the long
term, set up an arrangement for review of the registry data by the Institute
of Medicine's Medical Follow-Up Agency (MFUA). It is MFUA that will have
the difficult task of recommending when in-depth studies should be
considered.
Once completed, the registry complex may be used in various ways to
consider possible health damage from the oil fire smoke. DoD will be able
to answer questions from individual veterans about their level of exposure
using daily company locations and modeled data on air pollutants. The
DoD registry also could be used to identify cohorts of individuals with
relatively high and relatively low exposure to oil fire pollutants, should it
be desirable to do so for the purposes of an in-depth study. The
159
FIGURE: The Persian Gulf Registry "Complex"
VA
Persian Gulf
^
Veterans'
Standardized, coded records
Health
o( each Persian GuK
Registry
registry examination conducted
at a VA Medical Center
OoD
Persian Gulf
Registry
Personnel List:
Defense Manpower Data Center
file of all who served in the
Persian Gulf
Dally Troop Locations:
U.S. Army and Joint Services
Environmental Support Group file of
daily grid coonjinates for each military
unit during the Persian Gulf era
Air Pollution Model:
U.S. Army Environmental Hygiene
Agency model of oil fire pollutants over
the Persian Gulf theater of operations
taased on concun-ent pollutant monitoring
and atmospheric data
160
OTA's Mandate to Assess the Persian Gulf Registries | 3
emphasis on oil fires as the exposure around which the registries are
constructed, however, means that they will be much less useful for
exploring other potential hazards, except those with known geographic
distributions or those that may be unique to certain units or military
occupations.
The limitation of the registries, which have been conceived in accor-
dance with congressional mandates, are worth noting. In the VA registry,
only relatively rare or unusual conditions, or more common conditions oc-
curring at extremely high rates, will stand out against background rates.
In-depth studies of factors other than oil fire smoke, other strictly
geographic variables, or possibly those associated with military
occupations, will not be facilitated by the DoD registry. Information on
exposures other than oil fires would have to be collected on an ad hoc
basis, and may not be possible to document. Already, concerns about
inoculations, depleted uranium, vehicle paint, diesel fumes, and chemical
warfare agents, to name a few, have surfaced. Whether or not these
represent real threats, they must, at the very least, be acknowledged and
considered for further evaluation. It should be stressed that data from the
VA registry can provide only descriptive information about that self-se-
lected population. While the registry population can and should be com-
pared with a similar group not enrolled in the registry, that comparison
cannot tell us about a relationship between serving in the Persian Gulf and
the occurrence of health conditions.
Some near-term activities that could improve the quality and overall
utility of the VA registry are discussed in the body of this background
paper and include:
• VA making changes in the collection of medical history and exposure
information for the Persian Gulf War Veterans Health Registry;
• VA and DoD standardizing terminology used In their respective
registries;
• supplementing the existing coordination and cooperation between
DoD and VA to enhance compatibility of the registries by appointing
a single Advisory Board to oversee both activities;
• DoD assembling qualitative information about the Persian Gulf
conflict, including the distribution of other "exposures" and the
specific activities of military units; and
• DoD and VA each cataloging and describing other health-related in-
formation available for Persian Gulf veterans from before, during, and
after their tours of duty.
161
4 I The Department of Veterans Affairs Persian Gulf Veteran's Health Registry
OTA'S MANDATE TO ASSESS THE
PERSIAN GULF REGISTRIES
OTA'S mandate for this report comes
from Public Law 102-585, which charged the
Director of OTA with assessing Ihe potential
utility" of the DoD and VA registries for "scientific
study and assessment of the intermediate and
long-term health consequences of military
service in the Persian Gulf;" the extent to which
the registries meet the requirements of the law;
the extent to which the data are being collected
and stored appropriately; how useful they would
be for scientific studies: and related operational
questions. The law calls for separate OTA
reports on the VA and DoD registries.
This first report focuses on the VA
"Persian Gulf War Veterans Health Registry,"
which is referred to here as the "examination
registry." The second report, due in February
1994, will report on DoD's "Persian Gulf Registry,"
which is actually the combination of three unique
pieces: 1 ) a list of all individuals who served in
the Persian Gulf, 2) daily locations for each unit
(probably at the company level) during the
Persian Gulf era, and 3) daily oil fire smoke
pollutant levels modeled for the Persian Gulf
theater of operations during the period when the
wells were burning. The registries have distinct
and separate functions, but they also must be
compatible so that information from the
personnel registry can be retrieved easily for in-
dividuals in the VA registry. For this reason, we
refer to the VA and DoD activities together as a
"registry complex." The interrelated nature of
VA's and DoD's work necessitated OTA be-
ginning to examine DoD's efforts in order to
evaluate VA's registry properly. The result is that
some of the conclusions in this report apply both
to DoD and VA, and some to DoD alone. The
second report may also refer back to VA
activities.
A small group of experts in
epidemiology, statistics, medicine, and
toxicology assisted OTA with this evaluation at a
July 29, 1993 workshop. The Institute of
Medicine (lOM) also was represented by the
Director and staff members of Medical Follow-up
Agency (MFUA) and a consultant statistician.
The morning consisted 6f presentations from the
DoD and VA offices engaged in registry activities.
DoD also briefed the group on several studies
bearing on Persian Gulf veterans' health that they
have been carrying out, which have already
produced useful information and which should
continue to do so.
CURRENT STATUS OF THE VA
EXAMINATION REGISTRY
VA began offering a Persian Gulf medical
examination in early 1993, consisting of a brief
medical history, some questions about exposure
to oil fire smoke in the Persian Gulf, a complete
physical and general laboratory tests and
optional special tests (e.g., for lung function) and
referrals. The examination is available at all VA
medical centers. Two physicians at each center,
the designated "environmental physician" and
specified alternate, are charged with conducting
the examinations. Three referral centers have
been established, in Washington, DC, Houston,
and West Los Angeles, for cases not diagnosable
at the local centers. The Houston site has a
special focus on multiple chemical sensitivity,
and leishmaniasis cases are being seen in
Washington, DC.
Examination results are recorded in the
veteran's medical record and selected
information is entered on a 2-page registry form
that is sent by the VA medical center at which the
examination takes place directly to a central
processing center in Texas where the data are
keyed into the registry file. The VA reports that
this basic arrangement is similar to the agent
orange and ionizing radiation registries.
Early on, the VA developed an
addendum to the examination to elicit a more
detailed medical history, mental status, history of
exposures and experiences in the Persian Gulf,
162
The Department of Veterans Affairs Persian Gulf Veteran's Health Registry! 5
and various other pieces of information. The ad-
dendum is being administered to only a sample
of veterans in a pilot trial. The VA intends to
assess the usefulness of the addendum with the
help of an existing "blue ribbon panel" or a
successor to it, a permanent advisory committee
that has not yet been appointed.
As of June 30, 1993, about 8,000 Persian
Gulf examinations had been conducted and
about 6,000 had been recorded in the electronic
database.
VA has encouraged Persian Gulf
veterans to take advantage of the examination in
a number of ways. Posters have been placed in
all VA medical centers, mobile displays have
been sent to various places, the veterans' service
organizations have been notified, and a Persian
Gulf newsletter has been produced. Letters have
been sent to all veterans or their survivors who
have been compensated for Persian Gulf-related
problems, notifying them of their eligibility for the
registry (presumably, the existing medical re-
cords for these individuals would be used in
place of a new examination). VA worl<ers have
been instructed to offer the special examination
to Persian Gulf veterans who come to medical
centers for treatment or other services.
Information on Persian Gulf veterans can be
included in the registry only with their consent,
however (except for deceased veterans, who
may be included without consent of their next-of-
kin, according to VA).
COMMENTS ON THE VA REGISTRY
EXAMINATION PROTOCOL
An important function of the VA
examination is to provide veterans wflth a
comprehensive medical checkup and to investigate
particular complaints. The protocol in use seems
to fulfill this need. However, striking the right
balance for collecting information that will be
useful as a surveillance tool over the long
term is more difficult. A useful guidepost for
deciding about what to include or exclude is the
desire to keep the registry simple and avoid
collecting data that are not justifiable given the
limitations of the sample. Information related to
health status should be collected as precisely as
possible, but effort collecting information on
exposures, for which no control group is
available, would be wasted.
Some specific problems related to the
examination protocol and the coding sheets,
particularly for their surveillance value, are
identified in Appendix A of the OTA report. This
section discusses general concerns with these
items.
Medical and Personal History
The current protocol is somewhat weak
on medical and personal history, which is
covered in great detail in the addendum. The
addition of some history questions is justified
(e.g., smoking history and civilian occupational
history), but there may be too many in the
addendum. Resolution of this issue requires a
vision of what the information will be used for, be-
yond any immediate use in dealing with the
veteran's medical problems. Even if it may be of
immediate use, it may not be of long-term value,
so may not need to be a permanent part of the
registry (presumably, much more information Is
generated during the examination and recorded
on the medical record than is actually coded).
Health Status Information
The value of the registry to detect
sentinel health conditions depends entirely on
the medical information captured in the system,
but the coding form places strict limits on how
much of this information will enter the registry.
There is room to write in and code only three
complaints and three diagnoses. Even a simple
recording of the number of complaints a veteran
has is limited to five (an entry of "5" denotes five
or more complaints). People reporting with what
163
6 I The Department of Veterans Affairs Persian Gulf Veteran's Health Registry
has been termed the "mystery illness"^ may have
more than five complaints, and this information
would be lost. Nor are there instructions in the
Coding Manual to guide a physician about hovi/
to choose which three complaints to write out.
VA should consider making sure that all relevant
medical status Information is captured In the
registry and that the amount of this Important
information Is not limited arbitrarily (i.e., all com-
plaints and diagnoses should be written out and
coded). The basic form need not be made
unduly long if a form can be added for people
with many complaints. Losing this information is
not acceptable.
Exposure Information
An attempt is made in the current
examination protocol to collect Information about
exposure to oil fires using six questions (e.g., "I
was enveloped In smoke," and "I ate food or drink
that could have been contaminated by oil or
smoke"). Answers are graded from "definitely
yes" to "definitely no." A number of questions
about other experiences and exposures during
Desert Shield/Desert Storm sen/ice are in the
addendum. Other than asking veterans what
they think might be the cause of their conditions,
and possibly what other exposures or
experiences in the Gulf are worrisome, there is
reason to question whether any of this self-
reported exposure Information will prove to be of
value. Unless It can be justified in terms of
potential surveillance use, VA should consider
dropping It and limiting any other exposure
questions from the addendum. If these
questions are kept, the wording should be
The "mystery illness" denotes a variable group of
symptoms reported by members of the 123rd Army
Reserve Command after their return from the
Persian Gulf. The "outbreak" was investigated
thoroughly by the Walter Reed Army Institute of
Research and reported on in a June 15, 1992
report.
reviewed for clarity (e.g., a veteran might answer
"yes" if he or she was heavily exposed to passive
cigarette smoke).
Standardization
Given that this examination is being
offered at all 1 71 VA medical centers around the
country, a general concern Is the problem of
standardization. VA does provide training for en-
vironmental physicians using the protocol, but
the written Instructions may not be sufficient to
ensure an understanding of what Is expected.
The examples described atjove related to
medical status (no instruction on how to select
which complaints and diagnoses to code) and
exposure (no Instruction on how to elicit why the
veteran thinks he or she might be ill) illustrate the
potential problems that might arise if physicians
at different centers are inclined to make different
choices.
Protocol Revision Process
VA has indicated that it will seek the
advice of an advisory group to evaluate the
addendum and agree on a final protocol. This
would be a very useful approach. The advisory
group must be chosen carefully for this particular
task, however, including sufficient medical and
epidemiologic expertise to evaluate each item
critically, both In terms of the validity of the
question and of the potential value of the
information collected. Information on exposures
and the various psychological questions on the
addendum are of particular concern. The issue
of standardization among centers also should be
considered. As discussed in the section below
concerning coordination between VA and DoD, it
is important that each item, particularly those
relating to military experience and
demographics, be reviewed with DoD input for
consistency with the data in their personnel
registry. A decision also must be made about
whether to go back to those veterans (either in
person or by mail or telephone) who already
have been examined to seek additional
information.
164
The Department of Veterans Affairs Persian Gulf Veteran's Health Registry! 7
STRENGTHS AND LIMITATIONS OF
THE REGISTRY COMPLEX
Strengths
One factor that distinguishes this registry
from others that rely on self-referrals is that the
reference population-all Persian Gulf veterans-is
known. A Defense Manpower Data Center
(DMDC) electronic file lists all those who sen/ed
in the Gulf, including reservists and those still on
active duty, and contains a set of demographic
and military information about each. It should be
possible to compare the registry population with
a sample (or possibly the entire) population from
the DMDC file to find out how different or similar
they are. This could be useful to MFUA in its
judgments about the medical conditions
reported.
Limitations
While the registry complex can serve a
useful purpose, the limits of what can be
achieved are substantial. First and foremost, it
cannot be used to determine cause-and-effect
relationships. It never will be possible using the
registry to say that any particular condition is
caused by a particular exposure or event that
happened in the Persian Gulf. At best, it will play
the role of case reports in medicine, alerting VA
and MFUA that veterans believe they may be
suffering effects of Persian Gulf service. It is
probably safe to say that for many conditions, no
suggestive link will be found. For others, a
decision will have to be made whether to pursue
a potential link through focused epidemiologic
studies, considering both the strength of the
suspicion and the feasibility of acquiring the
necessary exposure information.
People reporting to the registry will not
be representative of the population of Gulf
veterans, a point of which Congress was aware
when it mandated creation of the registry.
Veterans presenting for the examination are
either suffering from a condition or concerned for
other reasons about their health. This much is
obvious. But it should also be pointed out.
based on experience with other registries, that
the makeup of the registry population may well
be influenced by external factors, including
stories in the news about particular problems
being experienced by veterans. So even what
appears to be an unusual number of cases (in
proportion to the total registry population) with a
particular diagnosis or symptom may not
represent an excess in the veteran population as
a whole. A question on the registry form asking
what prompted the veteran to seek an ex-
amination might be helpful in understanding the
distribution of conditions reported. The difficult
task is sorting out the conditions that may
actually be linked to Persian Gulf service from the
unlikely ones.
CONCERNS ABOUT COORDINATION
OF VA AND DOD ACTIVITIES
Ooprdination between VA and DoD is
taking pi§ee. but it may not be sufficient to
ensure that, at a practical level, the registry
complex can be most effective. Coordination
activities should take place among the people
responsible for the tasks involved, but a joint
VA/DoD permanent oversight group with
responsibility for both registries may also be
needed.
Three main areas could benefit from
increased coordination: 1) ensuring that both
veterans and those on active duty have the
opportunity to enter the registry; 2) ensuring
consistency in the personal identifying infor-
mation in the two registries so that they can be
linked easily; and 3) ensuring consistency of data
elements between the two systems where appro-
priate and eliminating redundant information
from the VA registry. These three topics are
discussed briefly below.
According to the law, active duty military
personnel who served in the Persian Gulf should
have the option of entry into the registry. Thus
far, very few individuals on active duty have been
included, and this lack appears to be due in part
165
8 I The Department of Veterans Affairs Persian Gulf Veteran's Health Registry
to lack of facilitating administrative arrangements.
The number of people on active duty who vi/ould
avail themselves of this opportunity may be
small, but their option should not be foreclosed.
In addition, it would be useful for information on
inpatients (either active duty or retired) with
Persian Gulf service who are treated at DoD
hospitals to be available for review by VA and
MFUA, if it is possible for DoD to provide this.
Some agreement between DoD and VA may be
required for this to happen.
A number of items on the VA coding
sheet correspond to information on the DoD file.
To the extent possible, the items should be
collected in a consistent fashion. For example,
the codes for race/ethnicity on the VA form are
different from those used by the services, and do
not allow the range of choices that might be
desirable. The personal identifiers (mainly name
and Social Security number) may be recorded
appropriately for cross-matching the VA and DoD
files for individuals, but it is not clear that there
has been consultation on this. In addition,
military unit is recorded differently in the VA and
DoD registries. The VA registry form asks for the
veteran's unit by name (e.g.. Company C, 1st
Battalion, 4th Army), while the DMDC database
classifies the units using an alphanumeric code
that is unrelated to the names. Translating one to
the other is not a complicated task, but it is not
obvious where it will take place or who will do it,
should it be necessary.
This information would serve as a better
cross-check if it were consistent. (The Office of
Management and Budget has issued a directive
with standards for collecting race and ethnicity
information, which might be used for this
purpose.) Other information, such as military
history, is available from the DoD personnel
registry, taken directly from each individual's
personnel file. It may not be necessary for the
veteran to recount this on the VA form. It
probably would be beneficial for each item on the
VA form to be reviewed with DoD to assure con-
sistency and to evaluate whether it needs to be
collected at all. If there is a question about
possible errors in the DoD file, VA could arrange
with DoD for a printout of the DoD file to be sent
to each veteran in the registry for corroboration
after the examination.
OTHER EXPOSURES OF INTEREST
Discussion and concern about
exposures other than oil fire smoke already are
apparent. They have been brought up at
congressional hearings and in print; included are
depleted uranium, inoculations, an anti-nerve gas
compound (pyridostigmine), exposure to
petrochemicals in other ways (e.g., diesel fumes
from tent heaters), pesticides, microwaves,
infectious agents (e.g., leishmaniasis, malaria),
chemical warfare agents (though there was no
known use), a special paint, and others.
Additional concerns are bound to surface in the
coming years. Unlike oil fire exposure, where
exposure estimates will be based on recorded
information, finding out about many other
exposures may depend on personal recollection.
Qualitative History of Persian Gulf for
Exposures
It is not possible, nor would it necessarily
be desirable, to gather individual, detailed data
on a large number of exposures or experiences
that occurred in the Persian Gulf, just in case
they become important later on. The general
environment and the military activities were
complex and data on the occurrence and
distribution of exposures are generally not easy
to get. Some basic information about unit
movements and activities and about the range of
activities of individuals could be gathered now-in
the form of a "qualitative history" -and could
serve as a reference later on. If this is to be
undertaken, it should be done soon. At least
some of the information needed is "labile" and will
become more and more difficult to ferret out and
verify with the passage of time.
166
The Department of Veterans Affairs Persian Gulf Veterans Health Registry! 9
Items that should be covered in such a
report include:
• Unit-by-unit descriptions of locations and
activities. Base locations will be available
from the DoD registry, but the daily activities
will not. It could become important to know
when units engaged in combat and how
heavy the fighting was. Some idea of the
amount of ammunition used might be helpful,
for instance. In addition, it would be useful to
know how much dispersion there was within
a unit on a given day. While it will not be
possible to quantify this or to describe it on a
day-by-day basis, but at least a relative sense
of dispersion by type of unit or location
would be useful. It could be Important to
know this if a geographically described
exposure is being considered, given that
locations for individuals in the DoD database
are represented by their unit (probably
company) locations only.
• Descriptions of the range of activities tjy
military occupational specialty (MOS). While
MOS defines an individual's activities to
some extent, it is not adequate to describe
the range of activities and exposures of any
individual. With specific exposures in mind
(e.g., degreasers, diesel fuel), it would be
helpful to know what people actually did in
the Persian Gulf.
Getting the information for this report
would involve a combination of research in
military records, possibly other government
documents, probably personal interviews with
key individuals, and sample surveys of veterans
to elicit their personal experiences and
exposures. One caution is that individuals,
particularly in military situations, may not know
about many exposures (e.g., if insecticide is
sprayed one day and troops enter the location
the next, they will not necessarily know the
spraying had been carried out). It is important,
to ensure credibility, that a mechanism be
developed to allow input and review from a
representative group of veterans before the
report is issued. In addition, the report should
be written so that it is readily understandable
by individuals not schooled in military
operations.
OTHER SOURCES OF INFORMATION
ON HEALTH PROBLEMS OF PERSIAN
GULF VETERANS
It has become clear that potentially
useful information on current health problems of
Persian Gulf veterans, whether or not they are
attributable to their service, resides in places
other than the VA registry. It will be important for
MFUA to be aware of this information and to
have access to it for their periodic reviews. This
includes new health records, information already
recorded in the veteran's DoD or VA files, and
results of ongoing VA and DoD studies of Persian
Gulf veterans.
Some sources have been brought to
OTA'S attention. For instance, discharge
diagnoses are recorded for inpatients treiated at
VA hospitals and Persian Gulf veterans, are
specifically identified in that patient treatment file.
In an analysis provided to OTA, VA researchers
listed the distribution of all major diagnosti^,cate-
gories for Persian Gulf veterans and a similar-
sized group of Persian Gulf-era veterans .■{who
had not served in the Gulf).
The deaths of most veterans are
reported to VA and logged in a system that
records all compensation claims. Copies of
death certificates usually are submitted, and
these could be available for review. While rela-
tively few deaths would be expected in this
young population, they would represent the most
serious conditions.
There may also be valuable information
in DoD personnel and medical records and
laboratories (e.g., induction physicals and
psychological testing, stored serum samples). It
is important to researchers for the design of
future studies, should they become necessary, to
know just what sources of data exist for these
individuals.
167
10 |The Department of Veterans Affairs Persian Gulf Veteran's Health Registry
A description of these sources including
data from before, during, and after Persian Gulf
service could be made available from DoD and
VA to Congress and to f^^FUA. If carried out,
each data source should be identified and
described, including a list of all available data
elements. In addition, for each source, an
estimate of the completeness of coverage for
Persian Gulf veterans and other Gulf-era veterans
should be made. Issues related to confidentiality
or other issues of access to the records also
should be covered in the reports. In addition,
up>dates of relevant ongoing studies should be
made available to MFUA.
CONCLUSIONS
A good start has been made on all facets
of the registry complex. Changes made at this
stage could improve the usefulness of the
information gathered in the VA examination
registry and lay a better foundation for co
ordination among the pieces of the registry
complex once they are complete. Specific OTA
conclusions include the following:
1 VA should focus immediately on revising the
examination protocol
2 Terminology used by VA and DoD should be
brought into conformity, where appropriate.
3. A joint oversight body for the VA and DoD
registries and their related activities should
be appointed, which would enhance existing
coordination and cooperation.
4. Information on exposures and other
experiences of Desert Shield/Desert Storm
should be assembled by DoD in a qualitative
history for the Persian Gulf theater of
operations.
5. DoD and VA should assemble annotated
inventories of all sources of relevant health
and demographic data, other than the
registries, for Persian Gulf veterans.
I hope this information is useful to the
Committee. We will be happy to answer any
questions you may have about our work In
assessing the Persian Gulf registries.
168
Troy and Kelli Albuck
28536 W. Lindbergh
Barrington, H. 60010-1825
(708) 381-4876
Honorable Ladies and Gentlemen of the House of Representatives. I want
to thank you for the opportunity to speak at these proceedings.
Growing up I knew I could do anything I wanted, but the key was
to find something worth doing. I thought I had found it, "a most noble
endeavor" defending the Constitution. I enlisted in the Army in 1984, 1
was seventeen. I made Sergeant at eighteen and was commissioned a
Lieutenant at nineteen. I was an Airborne Ranger Infantry Officer with a
Combat Infantryman's Badge from Panama and Iraq by the age of twenty
four. I had expected to be a Captain in months and a Colonel by thirty
five, the country's money problems changed that course. I would have
stayed with no pay but no one seemed to hsten. I had thirty days to take
my family back to where I came from. Unknown to me, I also carried a
chemical wound sustained in Iraq. Gradually that wound began to take
its toU. I will pause here and say this, I volunteered so I have to take
what I get, however, my wound has caused identical wounds in my wife,
KeUi, and my son, Alex. They did not volunteer, they did not take my
oath, they have been drafted against their will to fight the enemy. They
fight untrained, they fight unarmed and they will never receive the
purple heart they earned and deserve. Before I get carried away
complaining, let me outline the PROBLEM and your SOLUTION.
We fought a war and a lot more people got wounded than we
initially thought. The majority of the wounded feel they must conceal
their wounds or they will be eliminated from the service - THAT IS A
PROBLEM., Additionally many of the Gulf War vets have all ready been
separated from the service, the only recourse for these families is to seek
recourse from the V.A. medical centers. In 1865, Abraham Lincoln
charged the V.A. "To bind up the nations woimds, to care for him who
shall have bom the battle, and for his widow and his orphan."
Unfortunately, the V.A. fails to accomphsh this clearly defined mission.
The V.A. is choked into an action by regulation and restriction, so what
do we do for our woimded who are afraid to seek care, or have V.A. care
for themselves and not their family? The answer must provide for entire
famihes and should also make it easier for those who must create a
medical solution. One of the major obstacles to the medical solution is
the length of time it will take to study, and that the true niunbers of
169
wounded and dying are unknown. The solution must draw the wounded
out of conceahnent, and provide for those to wounded to provide for
their families while the research continues.
My families experience should provide you with a good example!
My wife KeUi is 23, Shelby is 3, and Alexander is almost 10 months old.
After the Gulf War, we had two miscarriages during 1992. One in
January and the other in May, this nearly tore us apart and for this we
sought coimseling. In October, Alex nearly miscarried but the doctors
managed to halt the dehvery. My wife and I both developed red spots
and began to collect a series of other symptoms. My symptoms also
included itchy, painful, bull's-eye red spots that spread. I began to swelL,
my hps spUt open and bled, my eyes shut and my throat closed. An E.R.
visit and steroids reduced the swelling. The spots hngered and fatigue
continued over the year, it only took my family doctor a week to give up
and refer me to the V.A." where they know about these things." I spent
more than a year trying to get answers out of the North Chicago Medical
Center, and even more symptoms have developed. Breathing problems,
digestive problems, diarrhea, bleeding gums, hair loss, difficulty
sleeping, mood swings and hearing problems.
Alexander had a March 7 due date, but he arrived on January 20th
seven weeks early. His fight was tough from the start, in addition to our
red spots, he had spinal meningitis. Strep B infection, cranial
hemorrhage , and an immediate need for respiratory ventilators to
survive. Initially the doctors said that he had less than 20% chance to
survive. During his first three months, he encountered many reverses
and on three separate occasions we were called to spend our last hours
with him The doctors had to cut out the top part of his left lung and
insert in a dozen chest tubes, one or two every time a lung would
coUapse,. our son was fed by a tube in his nose, and was off and on
ventOators five times. He generated twelve himdred pages of medical
records. Alex had a half million dollars worih of medical insurance, it
was entirely gone within ninety days. Alex's prognosis includes vision
and hearing problems, growth retardation, baby emphysema, and
cerebral palsy. He is requiring physical therapy, oxygen, suctioning,
breathing treatments and two monitors. He has been approved for SSI
disabOity but I had to personally beg his doctors to continue to treat him
after his regular insurance was gone. I know that he never would have
survived in a mihtary or V.A. medical faciUty.
Alexander stabiUzed, due in large part to my hero wife who
trained herself to be his doctor, nurse, respiratory therapist, physical
therapist, ect. ect. and we began to care for him in our home., but KeUi
and I started to get worse and worse. We made the decision that I would
go into the V.A. alone and that we would not leave until we had an
answer. I can not get medical care for my wife and my son but I tried to
get the V.A. to give me the key to a medical resolution of at least our
170
chemical wounds, I also want to help all of the Gulf War vets that have
been calling me to say that their family is wounded but they are
counting on me to get the solution in place.
Currently I am in the Houston V.A. Medical Center, but it has taken
a week to get the truth. At this time, there is absolutely nothing that can
be done for us., other than to comfort us, because there has not been
enough research. In order to make the wounded available and care for
all members of the wounded families, I recommend that all those
suffering Persian Gulf Syndrome be put on active duty, and made
comfortable, and available to research a solution. It will also ensure that
their jobs are protected by law.
We are only asking for medical attention for the wounded. We are
only asking that research be conducted. We are only asking for the same
level of care that the United States is giving Iraq X-POWs' s and their
families, two hundred of which are seeking asylum in the county next to
mine. This would get us off pubhc-aid, and prevent many V.A. home
loans from going into default, because ultimately if we can not see our
self clear to help our wounded veteran famihes, many reduced to pubhc
aid, how could we ever offer this level of care to the entire United States
under the "health care reform."
AIRBORNE RANGERS LEAD THE WAY!!!!
Troy eind Kelli Albuck
171
Timothy James Striley
1 Larry's Lane
Apartmer)t 4
Fulton, Illinois
61252
November 16. 1993
yiy name is T'mcthy Striley and i am a veteran of Operation Desert Shield, not Operation Desert
Storm I deployed to Saudi Arabia on the 14th day of September, 1990 vvitn the IQIst Aircorr.e
Division { Air Assault) of Fort Campbell, Kentucky Upon arrival, my fellow soldiers and I were
detailed to set uo tents, a tough job m the hard earth of King Fahad International Airport. After-
two days of doing this, I suffered a second-degree sun-burn on my face, neck, and arms. This
healed up over the course of the following days and everything seemed to be okay
Weeks passed before, during guard duty one day, my .neck began to burn. When I reacred
around to the back of my neck, my hand returned covered in cuss and blood. After finishing my
guard snift, I immediately went to our prescriced medical unit seeking relief The doctor there
prescribed topical creams to combat the unknown rash. Over the course of the ne.^t days, the
rash spread to my face and scalp. The clinic doctor this time prescribed a different .regime of
toDical creams. Again there was no relief / .'eturned later with the same "lesions" that were
described as "weeping and crusted. " and this time experienced gastro-intestinal discomforts,
'.ncluding a fever, vomiting, and diarrhea. This time there were new medications for the intestinal
problems, and more creams for the rash. By this time, the sores were also on my arms and
hands.
The internal problems seemed to go sway and I was then sent to other .medical units for
evaluation This continued until I was given a shaving profile {1/4" of growth), again having no
relief and I was put on a regime of the oral steroid. Prednisone. On November 21st. 1990 an
explosion rocked our area of operations, which was later determined to have been caused fly
the mis-fire of a Hellfire missile accidently launched into an Air Force ammunition dumc. The
sores worsened, and cut of genuine concern, my commander. lTC. John M Garden, stepped in
to help and had me evaluated oy the division Surgeon General. COL Kimes. COL Kimes
ordered that I oe evacuated to the Navy's 5th. Fleet Hospital in Al Jupan.
it was there tnat i first snowed any sign of improvement during Operation Desert Shield. I
stayed In the hospital there for one week under sterile conditions and a large dose of anticiotics
Within days of my return to King Fanad International Airport, the sores again re-appeared. The
doctors again attempted treatment
172
During this time (December and January of 1990), my units gas alarms went off freauently.
Each time, we immediately donned our protective masl<s, and occasionally our entire protective
suit On one particular occasion, we were ordered to seel< cover <n underground tunneis. Each
of these occurrences we were told that scud launches had been detected Each time, we were
told "All clear" and the missiles were said to have either been exploded prior to arrival over the
Saudi Arabian oorder or to have been false alarms. On one of these occasions, a civilian
airliner landed with new arrivals. All persons aboard ran from the aircraft and Into Air .Force
bunl<ers, including the civiiian employees.
At this time it was evident that my protective masl< would not seal correctly due to the oeard
growth. Senator Tom Harkin (D-lawa) stepped in and Inquired about my health. Senator harkin
was told that I COULD still seal a protective mask and that we were not expecting Iraq to use
thier chemical or biological weapons. It was at this point that his continuing inquiry finally led to
my evacuation from the Persain Gulf theatre of operations. I packed my gear and arde-f'S were
cut My company commander (MAJ. James Budney) told me that he would send my medical
records later On or about the 15th of January, 1991, I was flown back to Fort Camcceil,
Kentucky. My records from Saudi Arabia did not return from the gulf and when asked after the
war my commander said they were either lost or destroyed during the war
I immediately began seeing a dermatologist at Blanchfield Army Hospital at Fort Campbell (LTC
Marlise Collins, MD). She ran allergy tests and determined I had excema (Which sne concluded
was a hereditary condition with my parents and siblings suffering the same disorder ). She later
sent me to Fort Gordon. Georgia for a second opinion and attempted to have me sent bacK tc
Saudi Araoia with a snaving profile, white gloves, and large amounts of sceaal snamcccs and
steroid creams. She also reported that I should be discharged under "Faise enlistment" charges
(for not telling about .my so-called illness at the time of my enlistment ). No other memcers of
my family have excema. My rear detachment commander elected to keep me m Fort Campoeli
as an aole-bodied soldier needed for his mission.
As time progressed the sores came and went and new symptoms arose, i deveioced rectai
bleeding, nausea, vomiting, problems with my knees, dehydration, and a noticeaoie droo in my
energy level. In May of 1991 my wife, then fiance, suffered a miscarriage caused by a "Strange
infection that seemed like a venereal disease, but tested negative for everything. " / continued
seeking medical nelp even after my unit returned from Operation Desert Storm. Memcers of my
cnain-of-command started calling me a hypocondriac and malingerer which quickly led to
problems. Shortly before my normal date of discharge (ETS). I was given an article 15 and
reduced In rank to PFC (E-3). The harassment continued, I was barred from re-enlistment and
on August 30th. 1991. I was honorably discharged. At this time, I immediately filed a VA ciaim
173
for service corjnected disaoihty, which I was later awarded, of 10% for excema The crccieirs
persisted. In Seotemoer of 1991. my wife agair) suffered a miscarriage from the same
ur^diagnosed infection.
1 learned of. and joined, a support network called the Military Family Support Network, out of
Washington. D. C. and learned others were suffering the same symptoms. On January I6th of
1991, I came to V/ashington for the first time to speaK at a press conferance pertaining to t.ne
"Gulf War Syndrome. " During this visit I was seen at Waiter Reed Army Medicai Center
[Infectious Disease) for Leishmaniasis Plood tests and evaluation, which later came cack
reading "On the low end of the positive side. " I was referred to my closest VA hospital for a
confirmation bone marrow test. (This test was performed later, after getting "Into the system. "
at Iowa City VA medical center. Iowa City. Iowa. Resuit=Negative) Shortly after this test my
medical records became missing and I became frustrated with "The system!"
Months passed and i cegan seeing civman doctors. The symptoms continued and new ones
arose, including cnest pain, dizziness, neadacnes. short-term memory loss, fevers, nignt
sweats, and choto-sensitivity I was given numerous medications and went througn numerous
tests with one result Pericarditis. On August 25th, 1992 my wife gave cirth to a "Healthy" oacy
girl. Six weeks later she (my wife) hemorrhaged, was rushed to emergency surgery, and again
the doctors (civilian doctors} found a "Strange infection. " they thought "Was a venereal disease,
but which tested negative to all known venereal diseases. "
During the summer of 1993 I learned about the Gulf War Registry (through the support network]
and then went back to the 'J A. During my registry physical. m,y doctor found my prostate was
enlarged and I was "Dropping" white blood cells and cell tissue into my urine, wnicn resulted in a
referral to the Urology clinic. Under the care of Dr. Andre Godet. I was subjected to an iVP and
ultrasound which located a large growth on my right kidney, i was then put on antibiotics and
scheduled for a CT scan, which confirmed a cyst over SC/o of the kidney. I again was put on
Antibiotics and scheduled for a return visit, later resulting in a confirmation that the cyst would
not respond to treatment and actually grew during the course of medication. A oiopsy was
ordered, and in September 1 1993) it was completed. The fluid contained within the cyst was
found to Dy dark Drown and tested negative for. Leishmaniasis. Tuberculosis. Career parisites.
and viral infection. On a return visit, Dr Godet and Dr. Andreoni (Infectious Disease) confided
in me that they did not know wnat was causing my problems, it was not "In my head. " and that in
the near future part or all of my kidney would nave to oe removed. The next consultation was
set for January 10th of 1994. allowing time for the answers to be "Found" Before going to the
extremes.
174
More recently. I have also suffered from "Bursitis, " a conditiort that makes my knees swell.
This condition Is usually found In someone much older and new limits my v^aiklng and standing
{which makes the swelling occur). When this condition is at its worst I must use a cane to
walk With all of this, my employer finally had to take a stand and had to re-negotiate my
employment To date, I have not been allowed to return to work because of the problems these
new conditions cause Not only are my employers v^orried about my health and welfare, cut due
to the lacK of a diagnosis and the seriousness of my condition, they are also worried abc^t this
condition being contagious. This I can understand, as my wife is showing some of the same
symptoms, namely: chronic fatigue and headaches.
The symptoms i am having seem to coincide with those of other Gulf War veterans and ; was
not even in the Persian Gulf theatre during Operation Desert Storm. These conditions are very
serious and the outlook into my future seem very grim. I am now (seemingly) unemployed due
to this condition, my bills are going unpaid, my credit is destroyed, my families health is
deteriorating, and my world seems to be crumbling before my eyes I am 24 years old. my wife
29. my child only 14 months old. I am days away from being homeless, my pride has oeen
destroyed by having to ask for public assistance (welfare, food stamps), and I am scared.
At the same time. I am searching for the answers to save my life and the lives of others. We
need help!
! am also concerned that this condition seems to be contagious. When we returned home from
the gulf a ban was put on donations of gulf veterans' blood due to the possibility of spreading
Leishmaniasis. On January 1st of this year (1993) rhe ban was lifted and gulf veterans are
again donating blood. I believe we should again be banned from giving blood in light of the new
evidence that is coming forward.
I have learned about the research being done by Dr. Edward Hyman and I have had urine
samples screened by him, testing positive for what he has found in other Persian Gulf veterans.
I can only speculate about the cause of this illness, but the theory I find most probable Is the
possibility of biological contamination. I find it hard to believe that Iraa would use it's weapons
of mass destruction on Iran and it's own people (the Kurdish), but not against an enormous
coalition military force Certainly, it would (biological warfare such as this) be the work of a
mad-man with no concern for human life. Saddam Hussein deffinately fits the Dili and with no
way known to even detect biological agents. I cannot see how this theory can be denied, it is
likewise possible that Iraq delivered this agent late in 1990. orior to the beginning of hostilities.
The veterans of the gulf war are not hy pocondriacs and we are not out to emoarrass the united
States 3overnm,ent we are simply pleading for help! I come from a long line of veterans on both
siaes of my family, my father a career Navy man. Over the years of patriotic service, our
175
family has never experienced anything of the nature we are experiencing now. Even though !
was never a perfect soidier, to this day I do not regret my service in America's armed 'crces i
am a proud American and i believe in service to my country! However at this ocint in mv life. I
cannot endorse the military to any other person (namely my three younger brothers).
I challenge you to change my new-found opinion! Help us to find the answers to wnat s
happening to us (the gulf war vets), save our lives and give us the chance at life that we
deserve! If we are contagious, treat those we have exposed and stop us from exposing anvone
else! Dont make the men and women that less than three years ago were America's neroes die
and become America's killers (by spreading this disease)! Learn from this, teach it. and never
let it happen again!
Timothy J. Striley
176
STATEMENT OF
DENNIS CULLINAN, DEPUTY DIRECTOR
NATIONAL LEGISLATIVE SERVICE
VETERANS OF FOREIGN WARS OF THE UNITED STATES
BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
COMMITTEE OF VETERANS' AFFAIRS
UNITED STATES HOUSE OF REPRESENTATIVES
WITH RESPECT TO
VA AND DOD RESPONSIVENESS TO PERSIAN GULF WAR VETERANS
WASHINGTON, D.C. NOVEMBER 16, 1993
MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE:
On behalf of the 2.2 million men and women of the Veterans
of Foreign Wars of the United States, I wish to express our deep
appreciation for conducting today's most important oversight
hearing and for including the Veterans of Foreign Wars in this
forum. The VFW is absolutely adamant that those who served in
the Persian Gulf war not suffer the same neglect and denial with
respect to the government's properly caring for their special
service-connected disabilities as did their brother veterans of
the Vietnam war. It is now manifestly evident that many veterans
who served in the Persian Gulf war are suffering from an array of
problems and disabilities that are the result of their service in
that war. Regardless of how many forms the "Persian Gulf Syn-
drome" may assume, or whether or not the exact cause is ever
precisely determined, the VFW insists that this nation honor its
moral and statutory obligation to her combat service-disabled.
Veterans suffering from the Persian Gulf Syndrome must be afford-
ed all of the care, compensation and compassion a grateful nation
has to offer.
That Persian Gulf veterans are now suffering from a multi-
tude of disabilities attributable to their service in that con-
flict is obvious. What is not so clear, unfortunately, is the
cause. There is now a growing body of evidence suggesting that a
number of United States troops assigned to the Persian Gulf
during the Gulf war were subjected to some sort of
chemical/biological warfare attack or exposure due to an indus-
177
trial accident or allied bombing of Iraqi munition sites. But,
while the cause remains uncertain, it is clear that a large
number of Gulf veterans are suffering from a myriad of ill health
symptoms including but not limited to: muscle and joint pain,
loss of memory, heart and intestinal problems, fatigue and run-
ning noses, urinary urgency, rashes and sores, diarrhea, and
bodily twitching. Such symptoms are often associated with expo-
sure to toxic chemical agents and the VFW is absolutely incensed
that until just this past Wednesday DOD denied the possibility of
such exposure outright. Fortunately, thanks to growing public
awareness and scrutiny, DOD has had to reverse itself and ac-
knowledge what many Persian Gulf veterans and a contingent of
Czechoslovakia's Chemical and Biological Warfare experts have
maintained all along: the Persian Gulf Syndrome or "Mystery
Illness" is the result of exposure to toxic chemical agents. It
is our view that DOD recalcitrance in this matter is an absolute
outrage and an affront to the sacrifice and service of all of
America's veterans.
Other "theories" abound as to what exactly is causing Gulf
War veterans to exhibit the symptoms of the so-called "mystery
illness." They include: smoke inhalation due to burning Kuwaiti
oil wells, radiation from rounds fired from allied armored vehi-
cles (known as "uranium depletion") and exposure to parasitic
diseases endemic to the Persian Gulf, such as leishmaniasis. The
tests done at VA for the Health Registry revolve around a basic
physical examination with emphasis placed on these afflictions.
A somewhat more popular theory as to the cause of the "mystery
illness" is something known as "multiple chemical sensitivity,"
which DOD has acknowledged and pursued. Multiple chemical sen-
sitivity is the development of multiple and diverse symptoms due
to exposure to chemicals, but not necessarily chemical warfare
agents. It involves reactions to levels of chemicals well toler-
ated by most people. This reaction can be due to exposure to
chemicals found in: fuels, propellants, paints and preservatives,
solvents, lubricants, pesticides, herbicides, combustion pro-
178
ducts, repellents, and chemical warfare agents. There are even
some investigators who attribute multiple chemical sensitivity to
underlying psychological problems including depression, Page
psychological conditions, stress and even to an inappropriate
belief that chemicals are causing symptoms. However, these inves-
tigators have not ruled out actual chemical exposure as the
cause.
The real issue here, however, is not so much whether Iraq
used chemical or biological weapons on U.S. troops during the
Gulf War, although that is a serious matter and deserves careful
attention. The main issue that concerns the VFW is that numerous
veterans of the Gulf War are suffering from some type of ailment
or ailments due to their service in the Gulf and, mirroring the
Vietnam agent orange experience, there would seem to be a percep-
tible attempt by some to disregard and even cover up the problem.
Bottom line: Persian Gulf veterans need and deserve help and
they need and deserve it today.
Mr. Chairman, this concludes my statement. Once again, I
thank you for conducting today's most important oversight activi-
ty and would be happy to respond to any questions you may have.
179
statement of
Kimo S. Hollingsworth, Assistant Director
National Legislative Conunission
The American Legion
Before the
Committee on Veterans Affairs
Subcommittee on Oversight and Investigation
United States House of Representatives
November 16, 1993
Mr. Chairroan, The American Legion appreciates this
opportunity to testify concerning health issues related to
service in the Persian Gulf. We appreciate your leadership
for holding a hearing on such an emotional and sensitive
issue. The Legion would also like to express its
appreciation to Congressman Kennedy and his staff for
holding a special hearing for Persian Gulf veterans on
November 9, 1993. It is this type of aggressive and
persistent leadership that will help Persian Gulf veterans
and government health care officials to learn more about
possible sources of health problems they now face.
On June 9, 1993 The American Legion and others
testified before this Subcommittee on this very issue. As
a result of that hearing, legislation (H.R. 2535) was
introduced and passed the House that would allow Persian
Gulf veterans to receive priority health care at VA medical
facilities. The Legion sincerely appreciates the actions
and commitment of the members of this Veterans Affairs
Committee in support of H.R. 2535. However, further action
on this measure is still pending in the Senate.
Mr. Chairman, since that hearing the number of
veterans listed on the VA's Persian Gulf Registry has
nearly tripled. More and more veterans, including many on
active duty, have come forth to admit health problems that
they believe to have developed as a result of their service
180
in the Persian Gulf. The American Legion is pleased to
hear the Department of Defense finally acknowledge that
there are "hundreds, possibly thousands" of sick active
duty personnel. This confirms pre\'ious suspicions that the
medical problems were not only being experienced by
Reservist and National Guard personnel.
The Legion is pleased with the pro-active position
taken by the Secretary for Veterans Affairs concerning
chemical sensitivity and chemical/biological warfare. The
Legion would encourage the Department of Defense to follow
suit.
Legion representatives attended the DoD press
conference on November 10, 1993 and were terribly
disappointed with the explanation of the chemical detection
reports by the Czech chemical teams. Until recently, DoD
adamantly denied any reports of exposure to chemical or
biological agents in the Persian Gulf. The Legion felt
the press conference produced half-truths and
understatements as to the degree of exposure of Coalition
Forces to chemical agents. The issue of possible exposure
to biological agents was never addressed. The practice of
mixing chemical and biological agents is a known delivery
techinque. With the presence of chemicals now being
acknowledged by DoD, the possible presence of biological
agents must now be addressed.
Mr. Chairman, based on research and practical
experience, I know that the presence of radiation and
chemical agents can be readily detected by personnel in a
combat environment; however, biological agents can only be
detected by trained laboratory personnel. This inability
of the individual to detect a biological attack is perhaps
the greatest threat to personal safety and the ability to
fight. Delays experienced before the onset of symptoms and
181
-3-
the time required to identify specific agents further
complicates the problem of detection and protection by
individuals in the theatre of operation.
Mr. Chairman, in the Marine Corps Institute's Command
and Staff College Nonresident Program on Nuclear and
Chemical Operations, Section V specifically discusses
Biological Agents. It says: "Biological agents can't be
detected by the human senses. A person could become a
casualty before he is aware that he has been exposed to a
biological agent. An aerosol or mist of biological agent
is borne in the air. It moves with the air currents and
can enter buildings and fortifications. These agents can
silently and effectively attack man, animals, plants and in
some cases, material."
"It is likely that agents will be used in
combinations so that the disease symptoms will confuse
diagnosis and interfere with proper treatment." The
symptoms reported by Persian Gulf War veterans have clearly
confused most doctors and defied almost all treatments.
Additionally, the text states: "Different
antipersonnel agents require varying periods of time before
they take effect, and the periods of time for which they
will incapacitate a person also vary."
"The micro-organisms of possible use in warfare are
found in four naturally occurring groups - the fungi,
bacteria, rickettsiae and viruses."
Fungi - "They range from a single cell, such as yeast, to
multicellular forms, such as mushrooms and puff balls."
Bacteria - "They may occur in varying shapes, such as rods,
spheres, and spirals, but are all one-celled plants."
182
-4-
I want to remind this Subcommittee of the testimony
presented by Dr. Edward Hyman of New Orleans last June. To
date, Dr. Hyman has successfully treated nine Persian Gulf
War veterans and three of their spouses. His research has
found that all twelve patients have had bacteria in the
shapes of spheres present in their urine. He has also found
elements of yeast, which would suggest a fungus.
Referring back to the Marine text, biological agents
are normally dispensed in aerosol form: "In field trials,
using harmless biological aerosols, area coverages of
thousands of square miles have been accomplished. The
aerosol particles were carried long distances by air
currents . "
Prior to the ground war, American and Allied aircraft
extensively bombed the Iraqi chemical and biological
factories, munitions storage facilities and propositioned
ammunition stockpiles. As a Marine who participated in the
Persian Gulf war from January through May, I give you first
hand testimony that the winds blew predominately in a
southerly direction.
Again, since there is presently no test to accurately
determine if biological agents are present. Personnel are
taught to look for dead animals or plants and to be alert
for physical symptoms that are similar to those reported by
Persian Gulf veterans who are now ill. Numerous reports
acknowledged herds of dead animals in northern Saudi
Arabia, Kuwait and southern Iraq.
In reviewing military health records of returning
Persian Gulf veterans. The American Legion noticed a form
(Southwest Asia Demobilization/Redeployment Medical
Evalulation) used by health care providers that questioned
personnel about possible exposure to enviornmental hazards.
183
-5-
specifically chemical or biological exposures. Many of the
questions on that form perfectly match the symptoms being
reported by the Persian Gulf War veterans. This form
clearly indicates that DoD had anticipated these symptoms.
Mr. Chairman, The American Legion believes that the
United States intelligence agencies are withholding
valuable information that could play a critical role in
finding the cause and cure for the medical problems faced
by Persian Gulf veterans.
The American Legion continues to urge Congress, the
VA and DoD to conduct a thorough epidemiological study of
all Persian Gulf veterans. This study would provide the
data base for further testing and evaluations. Time is
critical .
Mr. Chairman, that concludes my testimony. Thank you.
184
Vietnam Veterans ol America, Inc.
1224 M Street, NW
Washington, DC 20005-5183
(202) 628-2700
(202) 628-5880 tax
STATEMENT OF
VIETNAM VETERANS OF AMERICA
Presented By
Paul S. Egan
Executive Director
To The
House Veterans' Affairs Subcommittee
on Oversight and Investigations
On
Persian Gulf Veterans Health Concerns
November 16, 1993
* A non-profit national veterans' service organization *
185
TABLE OF CONTENTS
Introduction 1
Possible Chemical Exposure -- Administration Lacks Cohesive Policy 1
Claims for Benefits 2
Persian Gulf Health Registry 2
The Problems Are Real, Not Imagined 3
Independent Testing, Diagnosis and Treatment Is Needed 3
Conclusion 4
186
Introduction
Mr, Chairman and members of the subcommittee, Vietnam Veterans of America (VVA)
is pleased to have the opportunity to present testimony regarding the current pHght of Persian
Gulf War veterans. Under the circumstances, we take an opportunity to discuss a full range of
issues concerning Desert Storm veterans that ultimately will bear on the claims for benefits these
veterans will file in the future.
In order to explain the concern Vietnam Veterans of America holds for veterans of Desert
Storm, we note that VVA pledged at our founding convention and continues to reaffirm the
principle that "never again shall one generation of veterans abandon another". It is apparent from
the difficulties Persian Gulf veterans experience in getting straight answers from the government
that sent them to war, that their challenges in getting just compensation and treatment for the less
obvious or latent war injuries are virtually identical to those faced by Vietnam veterans exposed
to Agent Orange. To this end, we offer our support, knowledge and advocacy to the needs of
our brother and sister Persian Gulf War veterans.
Possible Chemical Exposure -- Administration Lacks Cohesive Policy
Immediately following the Gulf War it appeared that the government was denying
responsibility for mysterious illnesses many have experienced, blaming "stress" as the causer.
This is particularly disturbing because of the struggle Vietnam veterans waged to get Post
Traumatic Stress Disorder recognized as a legitimate mental health problem. Using PTSD as a
"catch-all" condition seriously detracts from this hard won credibility, and denies these Persian
Gulf veterans appropriate treatment for their physical maladies.
Some Department of Veterans Affairs (VA) and private sector doctors developed
techniques of treating these veteran patients who seem to be experiencing diseases endemic to
the region, multiple chemical sensitivity, conditions related to exposure to smoke from oil fires
or depleted uranium, or possibly the administration of experimental vaccines and drugs to U.S.
troops. Though neither the VA nor the Department of Defense (DOD) officially recognized any
particular pattern among the veterans presenting themselves for care.
Recently reports from the Czechoslovakian government that low concentrations of
chemical agents were detected during the Gulf War seem to support claims made by many
veterans that American sensors also warned of dangerous conditions. Many who describe these
events indicate that superior officers discounted the alarms, however, explaining them away as
malfunctions. DOD still proclaims it has been unable to confirm the Czechoslovakian reports.
And Secretary of Defense Les Aspin postponed a Congressional briefing on the issue because
information was "inconclusive".
Secretary of Veterans Affairs Jesse Brown has announced that the VA will soon begin
testing Persian Gulf vets for health problems that may be related to their exposure to chemical
agents, as a result of the recent revelations. Symptoms include fatigue, headache, diarrhea,
irritability, forgetfulness and weakness. Brown has also directed that exams provided earlier to
those on the VA's Persian Gulf Registry be reviewed to determine if these individuals should be
called back for neurological and other testing.
VA will also begin research on treatment modalities for these conditions. Earlier this
month, VA announced that the National Academy of Sciences (NAS) has been contracted to do
an independent review of possible environmentally related health effects of Persian Gulf service,
similar to that NAS is doing on Agent Orange. VVA is encouraged by these steps, as it reflects
an openness on the part of VA that was absent following the Vietnam War. It is troubling that
coordination between VA and DOD seems to be faltering, however.
One must ask what information is being held back, when two top cabinet officials cannot
agree on the problem, let alone the solution. VVA is very pleased by the actions taken by VA
to address this new information. Although there have been concerns in the past that physician
research on this issue has been suppressed by VA, as has been noted in news accounts of Dr.
187
Charles Jackson's diagnosis of a patient exposure to "chemical biological warfare" in the
Tuskegee VAMC.
Our concern about the lack of a cohesive policy within the Administration, is that it most
certainly is an indication that someone, somewhere is withholding information which could be
very helpful in treating the health conditions experienced by these Persian Gulf veterans. Second,
but not of lesser importance, is the fact that while Persian Gulf military personnel who have been
discharged are able to access testing for chemical exposure through the VA, those who remain
on active duty are being denied similar testing by DOD. Thousands who served in Operation
Desert Storm are career military personnel who remain in the service. To get needed care, many
would have to risk their career or go to great personal expense to secure private sector treatment
for their Gulf War service-connected conditions.
Claims for Benefits
Military leadership promised VA would take care of veterans problems after discharge.
The stark realization that the VA is not in the business of approving claims, but disproving
claims leaves the veteran frustrated, angry and feeling betrayed by the nation he or she served.
Those are the realities faced by veterans and their families, regardless of the claims of the
Defense Department and the VA that this war produced no serious health problems.
Further, these agencies state that the government is doing all it can to correct those
problems that it has identified. VVA would like for that to be true and, while it may be true in
some very clear cut cases, such as wounds received in battle, it is not true in the case of illness
and mental disorder. It would appear that the old adage of "show me the scar and I'll believe
you are disabled" holds more weight than ever before. The veteran who is missing a limb as a
result of a combat wound is more readily believable than a veteran who is suffering from rectal
bleeding, dramatic weight loss, hair loss (which returns with complete loss of pigment), chronic
diarrhea, debilitating fatigue, muscle and joint aches and on and on ad nauseam.
Desert Storm veterans face a more serious problem filing claims for benefits than most
veterans. The recent DOD practice of not providing exit physicals to discharging veterans fails
to alert discharging veterans of health problems they might not have previously noticed.
Conversations with discharging Desert Storm veterans from Fort Dix, New Jersey indicate that
the only medical exam they were given was an eye exam.
Persian Gulf Health Registry
Congress deserves significant credit for the establishment, in the Veterans Health Care Act
of 1992, of the Persian Gulf Veterans Health Registry. This tool, listing every individual who
served in the Persian Gulf theater of operations, will allow a valid and committed researcher to
identify who was there and to have a data base for statistical analysis. The problem is, however,
that statistical analysis can never substitute for an epidemiological study and, when combined
with the Department of Veterans Affairs ten year contract with the NAS, will only provide
statistical data about what has already occurred. Yet, even with these tools, veterans are already
being denied claims because their medical records cannot be located or their military record fails
to reflect their service in the Gulf
While the VA has published the Persian Gulf Registry requirements, it is significant to
note that Reservists and National Guard personnel are not being tracked through the VA system.
This information was obtained through a Freedom of Information Act (FOIA) request.
Similarly, when Gulf veterans report to a general VA facility or to one of these designated
care centers, there is at least some evidence to suggest a deliberate deemphasis of the seriousness
of the symptoms reported.
188
The Problems Are Real, Not Imagined
VVA does not profess to be an expert in the field of epidemiology, nor do we profess to
be medical experts. We do contend, however, that these veterans are worried about effects of
exposure to environmental hazards to themselves and to their families. Many report that their
wives have been suffering miscarriages, hair loss, kidney infections and rashes complete with
lesions. They are both concerned and angered by the glib answers being given. Many are tired
of being told that their symptoms are caused by chronic fatigue syndrome (CFS) or PTSD. We
refuse to believe that all of these symptoms are in their heads.
These veterans are afraid of their deteriorating health. They are afraid of the economic
disaster that they have already encountered by paying out of pocket for diagnosis and treatment
that should have been provided by the VA. They are afraid that they cannot or will not be able
to work and provide an income for their family. They are afraid that, even if allowed to work,
they will not be able to secure medical coverage or life insurance for themselves and their
families without paying exorbitant premiums or being eliminated from reimbursement for pre-
existing conditions. For those who already possess medical coverage, they are slowly depleting
their lifetime maximum benefits by filing claims against their insurance that should have been
covered by the VA.
These concerns are not diminished in any way by the government's reliance upon specific
scientists who, for years, seemed to think that Agent Orange was a soft drink. General Ronald
R. Blanck, now the commander of Walter Reed Army Hospital and a member of the Persian Gulf
Expert Scientific Panel appointed by VA Secretary Jesse Brown (VVA was not invited to serve
on this panel), has been quoted as reporting that extensive evaluation at Walter Reed Army
Medical Center and certain VA hospitals by the Reserve Component medical system and
thorough epidemiological investigations have failed to show any commonalty of exposure or
unifying diagnosis to explain a wide range of symptoms that have shown up among veterans
since the Gulf War. If that is so, than one would be asked to accept that the diagnoses of CFS,
Chrones Disease, Fibromyalgia and Alopecia given to many active duty personnel and veterans
is simply coincidental and has nothing to do with their service in the Gulf War.
Independent Testing, Diagnosis and Treatment Is Needed
The burden of proving that their ailments are related to exposure to chemicals, depleted
uranium, sand flies (parasitic infection), modified (untested) vaccines/inoculations and possible
enemy chemical and bacteriological agents must not be allowed to rest on the shoulders of the
veterans and their families. Their testing and diagnosis must also not be allowed to remain alone
within the realm of the VA, the CDC, or the DOD. These agencies have historically shown a
vested interest in the outcome of studies and the value of their research will forever be
questioned by the veterans community. Some have an interest in denying responsibility while
others are motivated by purely fiscal considerations and all are subject to political whims and
direction.
What is necessary is a bold step, one that should have been taken long ago. Congress
must act immediately to establish entirely independent testing, diagnostic and treatment facilities
throughout this nation.
These facilities must be connected with universities or hospitals that specialize and are
on the cutting edge of diagnosis and treatment of occupational illness (specifically chemical and
radiation exposure). Multiple Chemical Sensitivity, cancer research and parasitic infection (see
attached article on Multiple Chemical Sensitivity in Gulf veterans). These facilities must be
allowed to operate without restriction and/or interference from the VA, DOD, or CDC. Their
findings must be combined and compared and published openly, without prior review or comment
by the aforementioned agencies. They must be allowed to confidentially examine, diagnose and
treat not only veterans, but active duty military. National Guard and Reserve veterans of Desert
Storm and Shield. They must be allowed to examine, diagnose and treat family members of
veterans including children conceived after Desert Storm and who report adverse health affects.
Finally, their diagnosis must be accepted, without challenge by the VA.
189
As part of this proposal, we strongly recommend the establishment of professional teams
of specialists who can travel to Kuwait and conduct medical status surveys of the indigenous
population, similar to the independent study on Agent Orange that we strongly advocate be
conducted in Vietnam. In this way, a better picture can be ascertained of what symptoms and
medical conditions are common to both our veterans and the local population.
We realize that the cost of such a project could be great. Consider, however, the cost to
each individual veteran and their family if we do not undertake such a project. Consider the cost
to this nation in the knowledge that our youth has been sent to war and will be abandoned upon
their return simply because the cost of legitimate diagnosis and treatment is too great for this
nation to bear.
Conclusion
Active duty military personnel report, in anonymity, that their concerns are not being
legitimately handled. So great is their fear of reprisal, that their wives are taking up their fight
in order to preserve their military career. Active duty military personnel and discharging veterans
report that the documentation that is so desperately needed to support future claims presented in
the VA is not being appropriately assembled.
Congress must take on the responsibility of securing information with regard to the health,
treatment and documentation of the sick active duty military personnel and their families. This
must be done with protection of their confidentiality by Congress so that their voice may be
heard without fear of reprisal. The failure of the military to accurately report, document,
diagnose and treat their ailments will result in more veterans being "dumped" into the VA
system, who will have nothing to look forward to but delayed and denied claims while they bear
the burden of proof that their illness is a result of military service.
These items are not new to those of us who have real concern for veterans and active duty
military personnel. It has been exemplified in the DOD and VA treatment of those who were
involved in nuclear testing, testing of LSD and other drugs. Mustard Gas testing and exposure
during WWII, Agent Orange exposure and now, the "Desert Storm Syndrome."
Mr. Chairman, this concludes our testimony. Given the short preparation time for this
hearing, we reserve the right to submit additional comments at a later date.
190
Statement of Myra B, Shayevitz, M.D.,FACP, Veterans Affairs
Medical Center, Northampton, MA 01060 November 16,1993.
In 1989, I considered myself an experienced specialist in Internal Medicine and Pulmonary Disease who
had heard of every entity in my field, when I became ill with a bewildering and completely disabling array
of symptoms. Unable to help myself, I went from doctor to doctor until seeking help from the State
University of New York Health Science Center at Syracuse, I learned that I suffered from Multiple Chemical
Sensitivity Syndrome. After four months of treatment which included strict environmental controls, special
diet and nutritional supplements, exercise, psychological support and education in self protection
techniques, I was able once again to function productively and return to work. At the beginning of this
illness, I could not read for even 10 minutes without becoming confused. After four months, I was able to
successfully complete an advanced examination in Geriatrics.
About one year ago, I was casually reading about the mysterious "Gulf War Syndrome" and there before
me were symptoms I recognized all loo well. I immediately volunteered to become the Environmental
Physician at our medical center and since that time have examined and treated over 25 veterans of the
Desert Storm Operation. I have received calls for help from veterans and from those on active duty from
California to Alaska.
What is the Multiple Chemical Sensitivity syndrome (MCS)! MCS has been defined as an acquired disorder
characterized by recurrent symptoms referable to multiple organs and body systems occurring as a result
of exposure to many chemically unrelated compounds but most frequently to petrochemical and or
pesticide exposure. A clinically useful theoretical model holds that we are all individuals and that MCS
may occur when the total tolerable biological, psychological and chemical load of the individual sufferer has
been exceeded. The majority of cases begin with a combination of stress and a petrochemical/ pesticide
exposure. One may postulate, therefore, that the stress of the Desert Storm conflict accompanied by the
petrochemical /pesticide and possibly low level toxic chemical gas exposure may well have resulted in MCS
in susceptible individuals. In fact, it is well known that many chemically sensitive patients experience
severe symptoms upon exposure to diesel fumes. Another important feature of MCS is that although
the syndrome may arise from an acute trauma or event, subsequent symptoms are "triggered" by multiple
very low levels of unrelated chemicals in common usage. The triggers become so ubiquitous and the
symptoms so frequently incapacitating and difficult to contend with that self imposed isolation from society
may result.
MCS is not limited to veterans of desert storm. The National Research Council estimates that up to 15% of
the US population may suffer from MCS. MCS patients are frequent visitors to occupational health clinics
and the diagnosis and treatment of MCS is listed by MassachusettsGeneral Hospital, Emory University
School of Public Health, Environmental and Occupational Health Clinical Center at U. M.D.N. I, Robert
Wood Johnson Medical School, Yale and lohns Hopkins ( among other prestigious university clinics) in the
directory of the Association of Occupational and Environmental Clinics, and described by the brilliant
researcher at M.I.T. Dr. Nicholas Ashford.
There are four groups of people among whom chemical sensitivity has been described:
1 Table 1 ^ Chemically Sensitive Groups
Croup
Nature of Exposure
Demographics
Industrial
workers
Tight-building
occupants
Cnniammaied
communities
Acute and chronic exposure to
industrial chemicals
Off-gassing from construction
materials, office equipment
or supplies: tobacco smoke:
inadequate ventilation
Toxic waste sites, aerial
pesticide spraying, ground
water contamination, air
contamination by nearby
industry and other
community exposures
Heterogeneous; indoor air
(domestic), consumer
products, drugs, and
pesticides
Primarily males: blue colbr; 20
to 65 years old
Females more than mates;
white-collar office workers
and professionals: 20 to 65
years old: schoolchildren
All ages, male and female:
children or infants may be
affected first or most;
pregnant women with
possible effects on fetuses;
middle to lower class
70-80% females; 50% 30 to 50
years old (Johnson and Rea
1989). white, middle to
upper middle clau and
professionals
'Ashford, N,. A., and Miller, C.S. 1991 Chemical Exposures: Low Levels and High
Stakes. New York: Van Nostrand Reinhoid.
^Association of Occupational and Environmental Clinics 1010 Vermont Street, NW,
Suite 513 Washington, DC 20005
■^Ashford, N.A., and I^iller, C.S. (Multiple Chemical Sensitivities Addendum to Biologic
markers in Immuntoxicology Naional Research Council National Academy Press
Washigton, D.C. 1992
191
Could we now add a new group,to this list: Veterans of Desert Storm f
Here are the textbook symptoms of MCS syndrome :Table 2.
Symptom Perctntage of Patients (N = 70)
(no control group reported)
Fatigue 5^^
Food sensitivities 91
Gastrointestinal symptoms 53
Headache - rg
Arthralgias ^y
Drowsiness 17
Myalgias 3g
Nervous tension 34
Nasal symptoms 34
Depression jq
Difficulty concentrating 27
Irritabiliry 20
Confusion jy
Hives ,j
Insomnia ' 1 j
Aching in chest jg
Fever ,0
Eczema tg
Tachycardia <• - jq
Here are symptoms of our veterans supplied to me by Dr. Han Kang epidemiologist for Veterans Affairs
Central Office: Table 3.
Ten Host Frequent Complaints Ahonq 1404 Veterans and
145 women veterans on tmc pcr3iart gulf registry
All
Veterans
WoMCN VE
Frequency
terans
Complaints
Frecuency
Percent
Percent
rATiauE
191
13.6
31
21.4
SKIM RASH
188
13.4
21
14.5
HEADACHE
180
12.8
28
19.3
L033 or MCHORY
167
11.9
20
13.8
MUSCLh, JOINT PAIH
162
11.5
10
6.9
SHORTNESS OF BREATH
107
7.6
9
6.2
COUGH . /
70
5.0
11
7.6
DIARRHEA
CHfST PAIH
63
4.5
7
4.8
48
3.4
2
1.3
No coMPLAiMT 779 19.9 20 13.8
The Deseil Storm veterans may not have MCS, but they do have identical symptoms to those with that
disorder.
Did our veterans have chemical/pesticide exposures ? The following exposures are some of those
compiled by individual interviews with hundreds of ill gulf war veterans
■* Adapted from Rowe, AH. et al From Bell, Iris, M.D.Phd, Clinical Ecology 1982
Common Knowledge Press
192
3 Nov16,1993 Statement of Myra B. Shayevitz, M.D., FACP
Veterans Affairs f^edical Center, Norttiampton, Mf< 01060
Table4?
1. Healers in work and sleeping areas fueled with diesel ( or Morgas blend)
2. Fuel spills and sprays on body parts
3. Oily clothing from oil, fire and smoke
4. Contact with ground soaked with fuel oil used for dust control
5. Fuel in shower water
6. Diesel exhaust from trucks or tanks in unventilated ship holds
/.Diesel heaters in tracked vehicles
8, Fumes from burning human waste with gasoline or diesel fuel
9. Pesticide fogging
lO.Workinloxiclandfill
1 1 Fumes while refueling vehicles
12. Petrochemicals in the water supply from desalinization system
13. Exhaust from airplanes and tracked vehicles
14. Fumes from freshly painted vehicles and storage containers
1 5. Chemicals used in the cleaning and maintenance of weapons
16.Fumes and smoke from the oil well fires
Almost 100% of the veterans in the environmental clinic at VAMC Northampton suffer from three disabling
symptoms: Fatigue, problems with memory and concentration and depression. Many are unable to work,
have little to no funds and many have little to no social support system. At our medical center there is no
budget for special testing, organic rotation diet, air purifiers proteaive masks and nutritional supplements.
There is insufficient staff available for patient education, psychological support, exercise training, nutritional
counseling, psychological testing investigation of family and occupational problems and vocational
rehabilitation, nor is there any chemically clean area for patient examination.When I ask a veteran to
exercise vigorously ( one of the treatments for MCS) I frequently find their shoes to be full of holes. A few
weeks ago I spent a great deal of time describing a special diet that I thought would help, only to have the
veteran say to me," Dr. Shayevitz, I'm so poor that you're lucky I have any food to eat". The time which
I can spend with these patients is limited to only a few hours per week because of my other duties, as
Director of the Cardio-Pulmonary Lab, Geriatric Evaluation Unit, Pulmonary Evaluation and Rehabilitation
programs.
Finally, I want to discuss the attempted distinction being made tjetween various forms of chemically
induced illness that are being proposed as causative in the Gulf War Veterans. These include actual
poisoning by known agents of chemical warfare including mustard and nerve gas whether deliberately or
accidentally. Others ascribe symptoms to exposure to industrial chemicals as a result of bombing of
plants. Yet others feel that an admixture of environmental toxic substances from oil wells and
environmental factors unique to the Gulf region are producing this syndrome. I strongly encourage
continued research Into all of these possibilities, however, it seems to me the common denominator is the
symptoms of this illness itself which clearly approximates those of the clinical entity. Multiple Chemical
Sensitivity Syndrome, about which much is already known and for which a rational and safe therapy
exists. This treatment is most effective when accomplished early in the course of the disease. It would
seem fool hardy to delay testing a treatment hypothesis while these patietns may still be helped. I support
the need for further research, but I maintain that it is absolutely urgent for us to attempt a treatment plan.
MCS encompasses the physical as well as the emotional and cognitive, and because this syndrome is so
devastating to the veteran and his/her family, we at Northampton VAMC have submitted a treatment
proposal to VA Central Office using a medically sound biopsychosocial therapeutic approach. based on a
thirty day hospital stay in a chemically clean ward, with an interdisciplinary team of specialists skilled in
Environmental Medicine, Psychology, Psychiatry, Nutrition, Exercise Science .Social Work and vocational
rehabilitation who would follow these patients intensely for a minimum of one year. Comprehensive
biological, and psychological testing will be an integral part of this plan and valuable information will result.
Some of our patients are improving, and I have asked a few such patients to include statements for this
record.
^Haines, Richard, Major, Army Reserve, Indiana
193
4 Nov16,1993 Statement of Myra B Shayevitz, M D , FACP
Veterans Affairs Medical Center, Norttiampton, MA 01060
This treatment plan now follows:
A BIOPSYCHOSOCIAL THERAPEUTIC APPROACH
FOR THE TREATMENT OF MULTIPLE CHEMICAL SENSITIVITY SYNDROME
IN VETERANS OF DESERT STORM
at
Department of Veterans Affairs Medical Center
Northampton, MA
The single most widely successful (and accepted) treatment of MCS is avoidance of stressors In this
setting, deadaptation ( withdrawal I occurs and healing commences. To that end, we at Northampton
VAMC propose a 1 2 bed specially modified "Environmental Health Center" for the inpatient treatment of
this syndrome. Our Environmental Health Center may not fully accomplish the "purity" of the
experimental environmental unit, but we feel that we can minimize volatile organic chemicals in the air, food
and water, and achieve an environmental "oasis" sufficient for deadaptation and subsequent healing to
occur. Our program will provide a multidisciplinary team of specialists and employ a well designed
treatment protocol which will guide patients through the clinical course of this process. We hope that our
approach to the diagnosis and treatment of MCS will prove to be most practical and of value to other
future programs.
lust as the patients must deadapt from the results of chemical exposures, they must adapt to the realities
of coping with MCS. Therefore we will offer a concurrent program of strong psychological support,
therapeutic nutritional support and patient education. Therapeutic exercise will also be a vital part of our
agenda.
Northampton VAMC is located in a small New England college town away from major
traffic but only one hour away from a major airport. There is a campus-like setting. VAMC Northampton
has a thriving well equipped exercise training program and center specially geared to those with physical
disabilities. ( A good percentage of the patients exercise wearing oxygen). The staff of the designated unit
is skilled in the rehabilitation of pulmonary patients, many of whom have similar problems and symptoms.
They have seen first hand what can be accomplished witfi the necessary painstaking and meticulous
approach required in these patients. The ultimate goal of our program will be to put the patient back in
control of his/her life as an active participant in their own health care and to reduce or obviate symptoms
so that the patient may return to productive functioning in society without further progression of the
disease.
A. Criteria for Admission:
1. Case Definition for Purposes of Admission: Multiple chemical sensitivity syndrome may be defined as an
acquired disorder charaaerized by multi system symptomatology referable to multiple chemical exposures
which cannot be classified by existing criteria used in current medical practice for psychiatric or physical
illness. The symptomatology occurs at exposure levels well below those thought to be harmful to the
general population. The symptoms must be sufficiently incapacitating to justify admission to an inpatient
treatment program. Incapacitation would be defined as an inability to work, and or such severe self
imposed restriaions in life style and isolation from society that both patient and family members are
adversely affected.
2. Candidate Population would give exposure based Persian Gulf veterans priority, but any veteran
diagnosed as incapacitated from MCS would be accepted if space were available.
3. Referral Procedure: Referrals would be accepted from all VA facilities. The submitted budget does not
allow for VAMC Northampton to pay for travel and referring VAMC would be responsible for round trip
travel fees and arrangements. Self referrals will also be acceptable.
All candidates for referral will receive a Screening Packet containing a carefully crafted medical
questionnaire as well as the Health Locus Questionnaire. The packet will also contain recommended
laboratory and X Ray examinations aimed at excluding any other causes for the patient's
symptomatology. In cases of self referral, we will look to environmental health physicians at the nearest
VAMC to complete the screening requirements.
The screening packet will also provide the veteran with an overview of our program and will help to
identify not only those veterans who are candidates for admission because of the severity of their
symptoms, but also those individuals whose overriding consideration is to get well. The veterans will be
informed that there will be no passes, no coffee , cigarettes or alcohol and no trips to the candy machine.
Their diet and movement within the medical center will be under strict control so as to minimize their
exposure to chemical stressors. They will be expected to study and to comply with all aspects of our
treatment plan . The screening packet will make it clear that the patient's participation will be active rather
than passive and no magic "quick fix" can be anticipated.
Upon receipt of the completed screening packet, a preadmission structured diagnostic interview will be
conducted with the patient by the Program Director. In case of long distances, phone interviews will be
acceptable. Next will come an interview in person or by ;pcc!cc: phcnc v.ilh the Screening Team
consisting of the Nurse Practitioner, Psychologist,Social Worker and the Program Director. The final
decision for admission to the Environmental Health Center will be by consensus.
B. Patient Evaluation:
1 . Evaluation will be directed towards :
a. Choosing appropriate patients I screening out those who could not be expected to respond to the
program or who would be disruptive to the program because of comorbid conditions)
b. Identifying chemical stressors
c. Delineating objective markers of the syndrome
d. Determining test usefulness in diagnosis and treatment
e. Gauging the degree of disability
f. Measuring success or failure of the treatment plan
Because it is well known that no single objective test can be applied to this dcsorder,whenever possible,
the chemically sensitive patient will be used as his/her own control in longitudinal testing.
2. Core Data Base:
194
5 Nov16,1993 Statement of Myra B. Shayevilz, M.D., FACP
Veterans Affairs Medical Center, Northampton. MA 01060
• medical history and physical examination
• social history including smoking, drug and alcohol use
• occupational history
• environmental and allergy history to include known
sensitivities to foods, drugs and ctiemicals and other
environmental allergens
• neurological evaluation with mental status exam
• Health Locus of Control Questionnaire
• MMPI
• Computerized review of systems
• Quality of Life Survey
• routine CBC and blood chemistries to include sed rate, eos count,
hver function tests, ANA litres, thyroid function
• chest X ray
3. Specialized Evaluations:
• body composition and physical fitness survey including tests of strength and aerobic capacity
• comparative fitness testing based on patient's previous armed service physical fitness test on
admission, at discharge from inpatient status , and at 6 months.
• Examples of specialized psychological testing depending on core survey;
• Crisis Questionnaire
•Appearance Concerns Questionnaire
• Carroll Rating Scale for Depression
•Shipley Scale ( vocabulary)
• Raven Progressive Matricies ( over all cognitive ability)
•Weschler Adult Intelligence Scale
• Minnesota Clerical Test ( attention span)
• EEC and Spect Scan whenever there is suggested impairment of neurological or psychological function
• nerve conduction studies whenever evidence suggests possibility of peripheral neuropathy
• pulmonary function testing for respiratory symptoms or complaints of fatigue especially on
activity, This will include sub maximal and maximal stress testing with peak flows and ear oximetry.
• immunotoxicology profile
• nasal and sinus examination for symptomatic patients
• Rast and Elisa- Act for cases of recalcitrant food sensitivity or failure of deadaptation
C. Treatment Plan:
1 . Coals : The goal of our program will be the return of the patient to the pre-illness funaional level with a
minimum of chronic symptomatology and no need for repeat hospitalization within one year of the
inpatient program. Ttiis will be defined by ability to once again successfully complete their respective
services individualized physical fitness test ( so far 100% of patients treated state that they are unable to
do so) within six months of the program. Reaching goal will also be defined as normalization of any
cognitive and memory deficits within one year.(See also endpoints for response)
2. Length of stay: is estimated at 30 days.
3. Medical Supervision: The Northampton Environmental Health Center treatment program will function as
a matrix system. The program director will be responsible for the overall operation and direction of the
treatment team. She will further be responsible for the necessary thorough environmental history and the
development of any individualized aspects of the treatment program. She will guide the patient through
the gamut of reactions which may occur during treatment ,aid in the recognition of environmental hazards
unique to each patient and prescribe the necessary environmental controls and nutritional support. The
program director will be responsible for the operation of the
outpatient program to ensure continuity of care and patient
follow- up. She will ensure that the data collected will be suitably collated and sent to VA Central Office.
4. Control of the Environment:
• 100 % naturally ventilated filtered air
• Central water filter
• Drinking water will be bottled Spring Water
• Air purifiers in every room and in the hallways containing charcoal and high quality filters to remove
odors as well as dust, pollen etc.
• Furniture will be metal
• Mattresses will be specially modified to obviate off gassing of flame retardant chemicals
• All bedding and bed clothes will be 100% cotton and will
pre- treated to ensure removal of all sizing
• All room doors will have weather stripping to minimize the flow of unexpected odors into the room
• janitorial supplies will all be non toxic fume emitting products
• All patients will be issued "safe" toiletries and these will be used by staff also
• All staff will be non smokers and will refrain from wearing scented
toiletries. Their uniforms will be washed in the same manner as those of the patients. They will change
into special "clean" uniforms at work
• All laundry will be washed on the unit by a laundry worker using products described on separate
insert
• All traffic into the unit will be strictly controlled
• The industrial hygienist will check the air quality on a regular daily schedule
5. Nutritional Support: Approximately 80% of patients with MCS have food sensitivities. Foods, in fact,
are composed of chemicals and foods in the same family are chemically similar to each other. Because of
the spreading phenomenon described earlier, individuals may become progressively sensitive, and new
food allergies frequently develop.
To further complicate matters, the masking effect may make it impossible to identify food incitanis. As is
characteristic of the reactions to other chemicals in MCS, it is often only when foods are consumed after a
period of abstinence that patients are then able to recognize their "triggers." For most patients, four days
is sufficient time to accomplish both of these goals.
Practitioners with the most experience with MCS I e.g. Rea National Research Council, MCS) consider a
195
6 Nov16,1993 Statement of Myra B Shayevitz, M.D., FACP
Veterans Affairs Medical Center, Northampton. MA 01060
properly balanced rotation diet to be an essential tool in the treatment of food sensitive patients and to
minimize the development of new food allergies.
In a four day rotary diversified diet, one food from each food family is eaten once in every four days,
although a wide variety of foods, consisting of high quality prolein,complex carbohydrates and fats are
eaten daily resulting in a nutritious and palatable diet. An alternate plan allows for the eating of different
foods from the same food family on alternate days. Processed foods such as bacon are not included,
nor are canned foods, and any foods known to be allergens to any individual patient are automatically
excluded from the start. Some patients may need to be on more restrictive elimination diets. However, a
four day rotation provides a practical solution for the majority, since patient
admissions will not be cohorled (rolling admissions! and patients may simply enter the diet rotation on
admission day.
Our plan is to adapt the current VAMC Northampton diet, which is highly nutritious and diversified, to this
plan. This will minimize added expense and maximize the ability of other similar future VA programs to
utilize a rotation diet successfully. Samples of a four day Rotation Diet are enclosed. A specially trained
dietician with a knowledge of food families will oversee this aspect of care.
Any vitamin or other nutritional supplements will be specially formulated for those with allergies, will not
contain diluents, preservatives or chemical additives, and will be free of plant and animal allergens.
6. Psychological Support: A psychiatrist will be responsible for the overall assessment and treatment of
any comorbid psychiatric disorders. The psychiatrist will be a member of the inter-disciplinary team
working with the psychologist in the overall design and implementation of the psychological aspects of the
treatment program and the development of the individualized treatment plan for each patient on the unit.
In the instance of comorbid conditions, the psychiatrist will be responsible for individual therapy.
The psychologist team member will be responsible for the administration and interpretation of all
psychologically based tests in the core data base and for specialized psychological evaluations. The
psychologist will provide individual therapy using such techniques as meditation, guided imagery and
biofeedback with a specific emphasis on stress reduction procedures, anger management, social skills
training and development of enhanced self esteem and improved coping strategies. The aim of these
approaches will be to assist the patient to develop a sense of inner strength and the ability to "heal from
within."
The psychologist will provide group therapy as well as family and couples therapy as dictated by patient
needs.
The team social worker will also provide counseling in group therapy, family therapy and couples therapy
in addition to his/her role as a member of the screening team. The social worker will also play an active
role in the post hospitalization phase of treatment.
The psychologist will contribute to continuity of care by providing therapy on an outpatient basis both for
individuals and for groups (see also section on long term planning).
The psychologist will also be responsible for post treatment psychological assessment . The psychologist
will analyze this data to determine which tests are predictive of success and which tests or items have
utility in discriminating MCS. He will be instrumental in designing the program evaluation measures and for
the keeping of statistics.
Working with the program director and other members of the inter-disciplinary team, the psychologist will
utilize data to help in the development of a relapse prevention treatment approach for patients suffering
from MCS.
The team chaplain will hold regular sessions using meditations, reflection and music.
7. Education: ( Avoiding the " porcelain village" possibility.)
Patients with MCS feel assaulted by the most common and mundane of items- a new car Interior, fragrance
emanating from the person sitting next to them in a movie, a new coat of paint, a freshly waxed store floor,
deodorant in the rest room. Frightened and wounded, they retreat into social isolation A vicious cycle
ensues, for the less they do, the less they can do. Ignorant of self protection techniques, forays out of
this isolation result in further damage and indeed some sufferers live their lives in porcelain lined dwellings.
Merely removing the patient to an environmental unit and allowing them a degree of deadaptation may be
insufficient to ensure that patients will not relapse and re-enter the highly restricted lifestyle for which they
were admitted.
From the first day of admission to the Environmental Health Center at Northampton, the emphasis will be
on the relief of symptoms and the return to pre-illness functioning. The patient will enter into an active
partnership with the treatment team in an intense program of education. The nurse practitioner will act as
program educator ( as well as coordinator of the program and as right hand to the programdirector).
Upon entering the unit, the patient will be given an audio tape with accompanying printed material. This
tape will describe MCS and introduce all the key concepts. The patient will be able to listen as frequently
as he/she wishes. All other lectures will be completely self contained and no matter what day of the week
the patient is admitted, he/she will be ready to listen to and understand the next lecture. The course will
include detailed information on the nature of MCS, nutrition (including knowledge of food families, the safe
addition of new foods, how to shop and cook), self protection and avoidance techniques, environmental
controls in the home and at work, athletic training and a knowledge of the American with Disabilities Act
and Federal Regulations for the support of disabled employees. Each leaure will be accompanied by
written material so that by the time of discharge, the patient will have a virtual textbook of information
which has been individualized for him/her.
Our education program will take the patients right into the community on guided trips where they can learn
how to enjoy themselves while avoiding incitants. Damaging exposures however, are inevitable, but our
patients will know exactly what to do to mitigate symptoms. Occupational and recreation therapists will
teach patients conservation of energy techniques and provide patients with creative but non toxic projects
and leisure activities. The psychologist will teach them useful techniques to handle stress, fear and despair.
Each patient will receive an individualized exercise program.
In every aspect of our treatment plan, from avoidance techniques to the zealous pursuit of happiness, the
patient will be given his own individualized self- directed plan. A thirty day treatment plan is just a start for
a patient with MCS, but our aim will be to " propel" the patient into momentum for getting well rather than
ever retreating into a porcelain village . Perhaps a motto for our program could be "Don't forget to live."
8. Exercise Training: There will t>e a varied daily program including strength training, aerobics and circuit
196
7 Nov16,1993 Statement of Myra B. Shayevitz, M.D.. FACP
Veterans Affairs Medical Center, Northampton, MA 01060
training supervised by an exercise scientist.
VAMC Northampton has a Pare Course, as well as well equipped Nautilus Exercise training center and
gymnasium. Environmental controls will he employed in those areas as well as the ward.
9. Vocational Rehabilitation: Referrals will be made as required.
10. Longterm ( post hospital ) Planning:
• The program director, nutritionist, exercise therapist, psychiatrist social worker and psychologist will
all hold outpatient office hours. Each member of the team will be able to refer patients to other team
members.
If the director finds problems e.g. with diet, the patient will be referred to the team dietician
• There will also be a bi-monthly support group run by the Psychologist and a similar group run by the
team social worker.
• There will be regularly scheduled supervised outpatient exercise training sessions, three times a week.
• There will be psychological and physiological outpatient testing .
• Patients will be mailed a quality of life examination questionnaire every three months.
• For those patients living far afield from the medical center, scheduled telephone visits will be arranged.
The social worker will provide a valuable link with other VAMC'S.
D. Workload lustification:
1. Occupancy rale : At an occupancy rate of 90%, 130 patients will be admitted per year. We would
hope to see over 1 50 patients thus lowering the cost per patient from the estimate.
2. Estimated cost per case:
$1 3,468.1 1 for a 30Hday inpatient stay and one year of follow up care including visits, support group,
follow up testing, exercise program, medications, air purifier, and disposable dust-mist protective masks.
Cost is exclusive of non recurring expenses.
E. Overall Program Evaluation:
Endpoints for success of this biopsychosocial program :
Psychological:
1 . Improved functional behavior
2. Return of any cognitive deficits to normal
3. Subjective statement of improved quality of life on questionnaire
4. Improvement from pre-test psychological measures
Social:
1. Cessation of social isolation
2. Productive functioning in society
Physical:
1 . Return to at least pre-illness physical fitness level
2. Decreased hospitalization by number and length of stay
3. Improved physiological measurements (see goals)
4. Normalization of any abnormal findings on neurological examinations
Immunological:
1. Normalization of any abnormal test results
Other:
1. Finding objective tests of this syndrome
2. Formulating a practical successful approach which can be of use at other VA medical centers
Ashford, N., and Miller, C. Chemical Exposures: Low Levels and High Slakes, Van Noslrand Reinhold
ISBN: 0-442-00499-0 1991
Bell, I. Clinical Ecology: A New Approach to Environmental Illness Common Knowledge Press, Bolinas,
California, 1982
Bell, I. et. al , A Time Dependent Sensitization Approach to Nonatopic Multiple Chemical, Drug, And Food
Sensitivities: Opioids as Prototypical Stimuli. Department of Psychiatry University of Arizona Health
Sciences Center, 1501 N. Campbell Avenue,Tucson, AZ 85724 , Proceedings of the American Academy
of Environmental Medicine, 1993
Bell, I. et al. An Olfactory-Limbic Model of Multiple Chemical Sensitivity Syndrome: Possible Relationships to
Kindling and Affective Spectrum Disorders. Biological Psychiatry 1992:32
218-242
Braulbar, N. Multiple Chemical Sensitivities, Toxicology and Industrial Health, Vol. 18, No.6, 1992
Cullen, M. Workers With Multiple Chemical Sensitivities, Stale of the Art Reviews, Vol2/Number4 Octover
1987
Didriksen, Nancy D. Psychological Assessment Testing in Chemical Sensitivities. Proceedings American
Academy of Environmental Medicine, 1993
Haller,E., Successful Management of Patients With Multiple Chemical Sensitivities on an In Patient
Psychiatric Unit., ). of Clinical Psychiatry, 54:5, May 1993
Heuser, G. et al. Diagnostic Markers of Multiple Chemical Sensitivity. National Research Council: Multiple
197
8 NOV16.1993 Statement of Myra B Shayevltz, M D , FACP
Veterans Affairs f^edical Center. Norttiampton, MA 01060
Chemical Sensitivities: Addendum to Biologic Markers in Immunotoxicology 1992
Miller, C. et al. Possible Models for Multiple Chemical Sensitivity : Conceptual Issues and Role of the Limbic
System Toxicology and Industrial Health. Advancing the Understanding of Multiple Chemical Sensitivity
Proceedings of the Association of Occupational and Environmental Clinics Workshop on Multiple Chemical
Sensitivity Sept. 1991
Randolph,!, et al. Allergies. Perennial Library Harper and Row Publishers ISBN 0-06-091693-1
Rea, W. et al. Considerations for the Diagnosis of Chemical Sensitivity .National Research Council: Multiple
Chemical Sensitivities: Addendum to Biologic Markers in Immunotoxicology 1992
Simon, G. Psychiatric Treatments in Multiple Chemical Sensitivity Syndrome. Advancing the Understanding
of Multiple Chemical Sensitivity. Proceedings of the Association of Occupational and Environmental Clinics
Workshop on Multiple Chemical Sensitivity Sept. 1991
Vojdani, et al, Immune Alteration Associated With Exposure to Toxic Chemicals, Advancing the
Understanding of Multiple Chemical Sensitivity , Proceedings of the Association of Occupational and
Environmental Clinics, Workshop on Multiple Chemical Sensitivity Sept. 1991
Ziem. C. Multiple Chemical Sensitivity: Treatment and Followup With Avoidance Control of Chemical
Exposures. Advancing the Understanding of Multiple Chemical Sensitivity Proceedings of the Association
of Occupational and Environmental Clinics Workshop on Multiple Chemical Sensitivity Sept. 1991
CURRICULUM VITAE
MYRA B. SHAYEVITZ, M.D., FCCP.FACP
Veterans Affairs Medical Center
Northampton, MA 01060 TEL: 413-584-4040
College:
Barnard College, Columbia University, B.A., 1956
Postgraduate Education:
New York University College of Medicine, M.D., 1959
Dallas VAMC, Soutliwestern Medical School, Resident Physician Internal Medicine, 1959-1961
Baystate Medical Center, Springfield,MA:
Chief Resident in Medicine
Fellow, Pulmonary Laboratory 1961-1963
Appointments:
Consultant in Pulmonary Medicine to the Northampton VA Medical Center 1967- 1978
Founder and Director, Pulmonary Laboratory Holyoke Hospital, 1963-1978
Organizer and Director of Holyoke Hospital Family Planning Clinic, 1968-1978
Chief Pulmonary Medicine, Holyoke Hospital, 1977-1978
Organizer of Cardio- Pulmonary Laboratory, VAMC Northampton 1974
Full time Physician VAMC Northampton, MA 1978-present:
Director, Cardio- Pulmonary Laboratory, Pulmonary Rehabilitation Program,
1978- present.
Chairman of the Medical Emergency Committee and Organizer of the Hospital's
medical emergency plan, 1978-1980
Member of Medical Education Committee for Physicians and organizer of
Visiting Professor Series. 1978 to 1990
Co-Organizer of Exercise Training Program ,1982
Chairman of Medical Education Committee for physicians, 1990 -present
Chairman of Intermediate Medicine Quality Assurance Program, 1989- present
Member of the Intermediate Medicine Screening Committee, 1993
Program Director for the Hospice Care Unit, 1992-present
Director of Geriatric Evaluation, Management Unit, 1990- present
Environmental Physician, 1992- present
Clinical Pertinence Reviewer, Medical Service ,1990-presenl
On- site supervisor of Exercise Science Interns, University of Massachusetts
Department of Exercise Science, 1984-
Adjunct Professor of Exercise Science, University of Massachusetts, Amherst, 1985
Licensure and Certification:
Commonwealth of Massachusetts: 26725
Diplomate American Board Of Internal Medicine ,1969
Member, Critical Care Council, American College of Chest Physicians, 1983
Elected Member, New York Academy of Science, 1984
Fellow American College of Chest Physicians, 1969
Fellow American College of Physicians, 1985
Diplomate in Geriatric Medicine, 1990
ACLS Recertification, 1992
Member Massachusetts Medical Society and Hampshire County Medical Society
198
Nov16,1993 Statement of Myra B. Shayevitz, M.D., FACP
Veterans Affairs Medical Center, Norttiampton. MA 01060
Living Well with Emphysema and Bronchitis, A handbook tor Everyone with
COPD, Doubleday and Co., 1985, 218 pages
Living Well with Chronic Asthma, Bronchitis and Emphysema, A Complete Guide To Coping With COPD,
Consumer Reports Books, 1992 ,210 pages
Athletic Training in COPD, Clinics In Sports Medicine, Saunders and Co., lulyl 986,5:3,471 -491
'^r
Uo^
atch all diagnoses, STBESS!
a /ear then In August of
duty. I was denied do proc
When I Che
rch ot 1993.
of my brain Iha
to do test. Finally Dr.
Chemical sensitivity Synd
diagnoses, I did not acce
me of the environmental
Today, after 8 months of Dr. Sha
once again. Although I have a w
not get out of bed, I shutter to
be tn if not for her. I started
doctor from Northampt
better,
myself
511 yo
Hopefully Yo
OVERSEAS TOUR Vicinvn. Gcmuny. Inly. Tuftey. Puou RkcLPwudu ■»> l>cnuii
Guir
PERSIAN GULF SERVICE Sepi l<MI lo Dec 1991. dcpanoj frofii Saudi. Arabia on Dec :
LIVING CONDmONS Poor lo very poor
ENVIRONMEhn- SaM tionnv lliev poor unitary coifdiiiorii. ere
EXPOSURE Heavy cnncrniraimn nl dievl. oil and paiolmc
SYMPTOMS Memory lo^i laneiK joint paint raid hoarvnctt. TKadaclict diuincu. ck
TREAIMINT llcjvy do^- m .iij.iin,. jii pufifitiv touiional dirii mhjler, MetoMjv
y (ood thapc bclore my dcpanutc to il
199
■t/./l 'l^^nn.cLyiAp/a< p /d
I bejan to jutfer t?
"». I 50U5ht nn froa
ttftar my Dacembar 19
»«*1 allm.nti pravi
tor any of the, ai
lada me decide to
Th« weirst ail — t ^='-iue to sealc help.
•Imilar to that vhlch ^''elpJrlencBd'I.'?^f^?'^!, "°""^*' ''eadache,
a n.rv, .ga„t prevcntati.. TK . ."^ taking Pyrldoatloolna ,
i-.dUt.ly in'reb^a^y ;j,™r?o„ i„':L"? '"""' "" P'iK ''
h.ad.oh.. ontu Dac-bL " j^j j""'^'"'"' to e.perl.nce thaae
Another probJe« I encountered w«. !,.,„>,. ,
raturn £ro,. ir.o i„ »„,;,.„:"*" '" "eight loss. Upon mv
«q in ipiU
tered
, my _
'ly UOlb
1 steady t6Slb
ntake or phyildl eierclse" '"''
Chronic fativu^ -as the nojt
asting untu May of 199J. I found
•agan to drop from
had
with my short-term memory.
Ii: M«y of I99J, 1 underwnt a
f!'™"!"" "' ^'■- "y^' SOiyviti a
.Or. Shaye
U chemical
Ny
ucted
and X
ion
rays
iger sutfa
chr
1« nearly I601bs. and I ha»en-
•'>.r.f< Dr. Shay«vlt2, I reported no =tob
that the treatment was wonderfully sue
very concerned for thoee veterans who
cult Har Syndrome lymotoma and feel th
»S Into thia lllneas.
"er and I fa
suffer froiil
^t^^-_,
To Whom It May Concern:
Day la a time to honor all thos
nd r think It only fitting that w
AdninlBtration as well.
of our Vet
I was a marine machine gun team leader with B Company, 1st
Battalion, 1 st Marine Regiment, lot Marine Division (Task For
Papa Bear) during Operation: Desert Storm. I am proud to say
that I was decorated for my actions but I'm even more proud
just to have served ray country.
Upon my return home, my health seemed to deteriorate and I
thought it best to seek medical advice. I went to the VA
Hospital in Northhampton, MA where I was astonished by the
respect and courtesy granted me by the entire staff, It was
not at all what I'd expected. Here I was directed to Dr. Myr
Shayevit2 to whom I'd like to offer my personal heartfelt tha
My symptoms Included never ending diarrhea and recurring sore
in my mouth. After sending me through numerous and thorough
conventional tests that found nothing and left me with little
hope. Dr. Shayevitz decided to try a natural approach to my
problem and it seems to have had a positive affect. She plac
me on a natural food diet, advised me to refrain from product
lis, and prescribed
I know I'm not speaking for all who served in the Gulf and I
cannot say I'm completely "cured," but If some one can make
another's life a little more comfortable, well that person
deserves commendation and I feel compelled to offer mine. To
one of the unrecognized veterans and her staff, I salute you.
^^ /^.^3
Respectfully Submitted,
Nathan H. walz ,
. vj,i(L ■r'\:i i^svs ^«^3.»*-t4 Jo'-»-*-
S-a^a-i- <. f^Jo C-V.CJ ^^•-'^ OCC-^ ~«J
5Na.-* -ri^^ "
* 1^ XT "vf^ «
l^,^Ks &-
».Vv :=
y /"■'^t-msl
200
STATEMEKT OF MG RONALD R. BLANCK
COMMANDER WALTER REED ARMY MEDICAL CENTER
BEFORE THE
HOUSE COMMITTEE ON VETERANS* AFFAIRS
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
November 16, 1993
Hr. Chainuui emd Mmmbmra ot th» Subcowmittee:
I as grateful to have an opportunity to once again appear
before you to address issuea relating to post-var health issues
of our Persian Gulf War Veterans. The health of our Persian Galf
Mar Veterans is of paraaaunt importance and eoneem to the
Department of Defense and ve will continue to muster the best
possible medical response on their behalf.
I aa submitting, for the record, a copy of the Health
Assessment ve conducted in response to the Czechoslovakian report
which indicated that they had detected, in ttro isolated
incidents, very 1cm levels of a nerve agent and a blister agent
in Saudi Arabia. Based on the levels reported and our knowledge
of effects to chemical warfare agents, long term health
consequences would not be expected. However, many Gulf War
participants still have persistent illnbsses which have
defied explanation despite carefxil, comprehensive, and intensive
medical evaluation.
The Defense Department remains open and vigilant to possible
causes for these ailments and will continue to work closely with
the Department of Veterans Affairs to unlock all possible answers
for the cause of these illnesses.
201
tf0 bava already aadm grmat atrldom in avaiuating •arlimr
axplojxationa for thmaa illneaaes and Z am avbmltting tor thm
raaord a brimf inforaatlon papor os our DoD af forts.
Although our atteapta to idottzity thm caaaaa for thaaa
illnaaaaa haa boon elusive ao far, ve vill aontinua to carm tor
tbaaa votarana and do our utaoat to root out tha rmason for thaix^
llngarlnq health problama.
202
HEALTB ASSESSMBWT
Baek^rount!
On 19 January 1991, two Czachoslovakian Nuclear Biological
Chemical (NBC) units operating northeast of Bafar al Batla,
in Northern Saudi Arabia, reportedly detected very lov levels
of what they claimed was nerve agent (GB) . On 24 January
1991, a third Czech KBC unit was escorted by a Saudi Arabian
official to a site a few kilometers northwest of King Khalid
Military City (KXMC) where mustard agent (HD) was reportedly
detected in a small patch of wet sand. There were no
indications of any Iraqi actions on those dates in those
areas that could have explained these detections. No other
chemical warfare agents were detected prior to or following
these two instances. Neither U.S. nor other coalition forces
identified any chemical agents in the Persian Oulf Theater of
Operations during The Gulf War.
Aaaumptions Used In Assessing Medical Effects
• The Czech detections of GB and HD were valid.
• A small number of U.S. forces may have been operating in
the region where the QB detection occurred and could have
been unknowingly exposed to the very low levels of OB
detected by the Czechs. That concentration (0.05 og/m^) for
a 40 minute exposure was used to assess the health risk.
• No U.S. forces were operating in the immediate vicinity
where the HO was detected by the Czech unit.
Known Health effects of QR wnd HP
GB (Sarin) Nerve Agent:
• Short Term Effects of GB: Nerve agent inhibits the
enzyme cholinesterase which causes symptoms in humans:
- Low Dose: No symptoms at all; in the worst case, some
constriction of the pupils, runny/stuffy nose and mild to
moderate breathing difficulty.
- High Dose: Loss of consciousness, convulsions,
respiratory arrest, vomiting, diarrhea, muscle twitching,
and death.
A-1
203
• Loag Tarn Sfftcts of GB
- Low Dose: Mo known long term haalth effects in
exposed individuals.
- Bigb Dos*: Mild to moderate psychological
difficulties (forgetfulness, irritability, depression, and
sleep problems) for several weeks after exposure;
however, these symptoms would be short lived and would
eventually resolve within 4 weeks.
HD (Sulfur Mustard Agent — Blister Agent)
' Short Term Effects: The short term effects occur 2 to 24
hours after exposure.
- Low Oose: Symptoms include redness of the skin,
blisters, eye irritation, inflammation and breathing
difficulty. In conjunction with these symptoms, HD can
cause gastrointestinal effects (nausea, vomiting,
diarrhea, and/or constipation), anemia, and psychological
effects which resolve in days or weeks.
- High dose: Large amounts of HD over a short period of
time can cause death (see Table 2 below) .
• Long Term Effects:
- Low dose: There are no known long term effects for
short term low dbse. However, daily exposure to HD over a
period of years may be linked to: respiratory conditions
(bronchitis, emphysema, asthma, laryngitis, cancer), skin
conditions (cancer and ulceration), eye disorders, bone
marrow depression, sexual dysfvnction and psychological
disorders .
- High dose: Large amounts of HD can, over long periods
of time, cause death (see Table 2 below).
Werve Agent Exposure Symptomg
Exposure is expressed in unit of concentration (C),
multiplied by exposure time (t) . Typical units are
milligrams of agent in a cubic meter of air for one minute.
This is abbreviated mg*min/m^. in general, an exposure to 50
mg/m3 for 1 minute, or 50 Ct, is equal to an exposure to 10
mg/m3 for 5 minutes.
A-2
204
Tabla 1 ; Kerve Agent Expoaur* Symptoms in Honans
Description
Pinpointed pupils
Extreme runny ncse
Ct
(mq*iain/m3)
O.OOS-Q.g^
0.5-lS.Q
Shortness of breath, tightness of chest
approx. 15. Q
Uncontrolled movement of arms and leos
approx. 30.0
Death
approx. 3S.0
As shown in Table 1, given a concentration of O.OS mg/m^ and
an exposure of 40 minutes — the maximum possible concentration
and exposure time in the Czech reports — one would expect
exposed individuals to exhibit only pinpointed pupils and a
runny nose.
Blister Aoent gxaoBure Symptama
Exposure is expressed in unit concentrat''^n (C), multiplied
by exposure time (t) . Typical units are milligrams of agent
in a cubic meter of air for one minute. This is abbreviated
mg«min/m3 . m general, an exposure to 50 mg/m^ for 1 minutr,
or 50 Ct, is equal to an exposure to 10 mg/ra^ for 5 minutes.
Table 2: Blister Agent Exposure Symptoms in Humans
Description
(mg'min/m'*)
Eye iniurv
100-200
Respiratory Ineapacitation
ISO
Incapacitating blisters
2000
Death fresniratorv>
1500
Death fskin absorption)
10000
Medical Experience Purina The Persian Sulf War
There were no reports of service members exhibiting those
signs or symptoms listed in Tables 1 or 2 which would be
expected after exposure to GB or HO. Soldiers manifesting
such symptoms would be expected to report to sick call and
would be identified by health care providers and the disease
and injury surveillance system; this did not occur.
there is no medical nor epidemiological documentation to link
the unusual and ill-defined symptoms reported by some Persian
Gulf War Veterans to exposure to OB or BO. Ho causal or
temporal relationship can be identified between a potential
chemical exposure in January 1991 and the symptoms reported
in 89 individuals from various units participating in the
A-3
205
Persian Gulf Theater of Operations who have been evaluated at
Army medical treatoent facilities since the Oulf war.
Summary
There is no credible evidence that the 6B or HD reportedly
detected by the Czech NBC teams, when viewed in the context
of all other known facts and information, would have
presented a health threat to U.S. forces operating in the
Persian Gulf Theater of Operations. Although US and
coalition forces were also aggressively monitoring for NBC
agents, no chemical agents were Identified.
There were no reports of a single U.S. service member being
treated at any of our medical facilities for chemical agent
exposure. Furthermore, it is important to note that the
Czech report did not indicate that any of the personnel
operating in the area of alleged chemical incidents
experienced any symptoms of exposure to chemical agents .
Even under the worst case analysis, given the Czech reports,
one would expect no symptoms or, at the worst, mild effects;
and no long term health effects. In conclusion, there is no
reasonable linkage between these incidents and those Oulf Kar
veterans reporting persistent health problems.
A-4
206
TECHNICAL ASSESSMEKT
OYBRYISW
This technical assessment consists of three parts: a
description of two different chemical agent detections by
Czechoslovakian reconnaissance teams; a description of the
U.S. protocol for verifying threat use of chemical weapons;
and, a description of U.S. Axmy chemical detection
organization and capabilities.
Czechoslovakian forces reported the detection of chemical
agents in two separate incidents. Other coalition force
units were within 25 kms of this location. Approximately
five days later, the Czech forces reported a mustard agent
detection. No other unit reported a chemical detection
during this period, or at any other time during the Gulf
War. A detailed summary of these incidents is in Part 1 of
this assessment.
The internationally-accepted requirements for verifying use
of chemical weapons are extensive. Verification requires
corroboration by a variety of means. A discussion of this
is in Part 2 of this assessment.
Part 3 of this assessment outlines U.S. Army detection
capabilities. Army units were equipped, staffed, and
trained for chemical detection. Personnel were alert for
the signs of chemical attack and were actively monitoring.
The medical personnel were trained to recognize the symptoms
of chemical agent exposure. Ho chemical detections or
incidents of exposure were reported by Army units.
B-1
207
16 November 1993
INFORMATION PAPER
SUBJECT: Po3t-Perslftn Gulf War Health Issues
1. Purpose: To provide current information to Congress about
Department of Defense efforts to address health Issues among
Persian Gulf War veterans.
2. Facts:
a. Many preventive measures were taken to protect US
servicemembers from diseases and environmental threats Icnown to
exist in the Persian Gulf area. However, "unexplained" or
"mystery" illnesses have occurred and have been widely
pu>^licized. Some illnesses are due to conunon medical problems
expected in any civilian population; some are difficult to
diagnose even after extensive evaluation at civilian. Department
of Veterans Affairs and military medical centers. Several
possible causes for these illneasea have been investigated and
are summarized here.
(1) KUWAIT OIL FIRES. While the fires were atlll
burning, ^he US Army Environmental Hygiene Agency began two
comprehensive studies of exposure to oil well smoke. The Risk
Assessment Study is to project the long-term health effects from
vhis exposure. A report is due by the end of this year. A
companion study measures biological markers of exposure to oil
well smoke. The preliminary evidence from both studies suggest
no long-term adverse health effects from this exposure.
(2) LEISHMANIASIS. The last case of ' "sceral
leishmaniasis was diagnosed in May 1993 and the last case of
cutaneous leishmaniasis in April 1993 for a total of 31 cases.
About 100 individuals have been extensively evaluated for the
possibility of leishmaniasis, but confirmatory teats have been
negative. Research is ongoing to find reliable screening and
diagnostic teats for leishmaniasis.
(3) PETROCHEMICALS. In August 1992 the Army Surgeon
General's office convened a panel on petroleum exposure composed
of experts in toxicology, occupational medicine, internal
medicine, and epidemiology from governmental, academic and
private institutions. They concluded that petrochemical toxicity
was not the a reasonable cause for unexplained illnesaes.
(4) DEPLETED URANIUM. Soldiers with the highest
potential exposure to depleted uranium have been evaluated and
have not shown harmful uranium levels in their systems. No
significant long-term health effects are expected. This study ia
still ongoing with further medical evaluation planned.
208
(S) CHEMICAL Wa:<FARE AGENTS. A h«alch asseesment of the
chemical agents detected by the Czachoslovakiana demonatrated
that, even under the worst case analysis, the very low levels of
agent detected would have produced no significant long-term
health effects In exposed persons.
b. DISABILITY ISSUES. The US Army Physical Disability Agency
policy is to adjudicate cases on an individual basis to determine
if a soldier is fit for duty. If the soldier is found unfit for
duty, then disability is determined by rating the soldier's
functional irapairmer.ts. As of 21 October 1993, a total 4 7 cases
have entered the disability system for problema due to the
Persian Gulf War. Thirty-on© soldiers have been found unfit for
duty, 9 soldiers fit for duty and 7 soldiers pending adjudication
or further evaluation.
c. Three Department of Defense initiatives:
(1) WORKING GROUP. A working group of internationally
recognized physicians has begun the analysis of the medical
records of Persian Gulf War veterans showing unexplained health
problems. This group is collaborating with the three services
and the Department of Veterans Affairs to establish viable
definitions for the unexplained illnesses. In addition,
consultation is ongoing with physicians who report success in
diagnosis or treatment of veterans with unexplained illness.
(2) MULTIPLE CHEMICAL SENSITIVITIES. The Army Medical
Department is evaluating the role of multiple chemical
sensitivities in causing some of the unexplained syn^toma
reported by Persian Gulf War veterans. F'inding has been
requested for a research facility to study multiple chemical
sensitivities .
(3) OEPARTMENT OF DEFENSE REGISTRi. The United States
Army and Joint Services Environmental Support Group is
constructing a Department of Defense Registry which contains a
file on every military person who participated in the Persian
Gulf War. This part of the Registry is nearly complete. The
registry will ultimately contain information on the daily
position of military units. When used in combination with
exposure data, the registry will be able to determine the
relative health risks for different units who participated in the
Persian Gulf War.
d. In conclusion, the military health care system has sought
extensive consultation from within and with outside agencies and
individual experts in addressing the issue of Persian Gulf War
veterans' medical symptom?. The health and well-being of our
service personnel is of paramount concern to the military
leadership. The Department of Defense and the Department of
Veterans Affairs will continue their investigations and treatment
ot symptomatic veterans who served in Southwest Asia in support
of the Persian Gulf War.
209
16 November 1993
INFORMATION PAPER
SUBJECT: Post-Psrslan Gulf War Health Issues
1. Purpose: To provide current information to Congress about
Department of Defense efforts to address health issues among
Persiajj Gulf War veterans.
2. Facta:
a. Many preventive measures were taken to protect US
servicemembera from diseases and environmental threats known to
exist in the Persian Gulf area. However, "unexplained" or
"mystery" illnesses have occurred and have been widely
publicized. Some illnesses are due to common medical problems
expected in any civilian population; some are difficult to
diagnose even after extensive evaluation at civilian, Department
of Veterans Affairs and military medical centers. Several
possible causes for these illnesses have been investigated and
are summarized here.
(1) KUWAIT OIL FIRES. While the fires were still
burning, the US Army Environmental Hygiene Agency began two
comprehensive studies of exposure to oil well smoke. The Risk
Assessment Study is to project the long-term health effects from
this exposure. A report is due by the end of this year. A
companion study measures biological markers of exposure to oil
well smoke. The preliminary evidence from both studies suggest
no long-term adverse health effects from this exposure.
(2) LEISHMANIASIS, The last case of visceral
leishmaniasis was diagnosed in May 1993 and the last case of
cutaneous leishmaniasis in April 1993 for a total of 31 cases.
About 100 individuals have been extensively evaluated for the
possibility of leishmaniasis, but confirmatory testa have been
negative. Research is ongoing to find reliable screening and
diagnostic tests for leishmaniasis.
(3) PETROCHEMICALS. In August 1992 the Army Surgeon
General's office convened a panel on petroleum exposure composed
of experts in toxicology, occupational medicine, internal
medicine, and epidemiology from governmental, academic and
private institutions. They concluded that petrochemical toxicity
was not the a reasonable cause for unexplained illnesses.
(4) DEPLETED URANIUM. Soldiers with the highest
potential exposure to depleted uranium have been evaluated and
have not shown harmful uranium levels in their systems. No
significant long-term health effects are expected. This study is
still ongoing with further medical evaluation planned.
210
(5) CHEMICAL WARFARE AGENTS. A healch assaasmant of the
chemical agents detected by the Czechoslovaklans demonetrated
that, even under the worst case analysis, the very low levels of
agent detected would not be txpected to produce significant long-
term health effects in exposed persons.
b. DISABILITY ISSUES. The US Army Physical Disability Agency
policy is to adjudicate cases on an individual basis to determine
if a soldier is fit for duty. If the soldier is found unfit for
duty, then disability is determined by rating the soldier's
functional impairments. As of 21 October 1993, a total 47 cases
have entered the disability system for problems due to the
Persian Gulf War. Thirty-one soldiers have been found unfit for
duty, 9 soldiers fit for duty and 7 soldiers pending adjudication
or further evaluation.
c. Three Department of Defense initiatives:
(1> WORKING GROUP. A worlcln? group of internationally
recognized physicians has begun the ar.nlysis of the medical
records of Persian Gulf War veterans *.cwing unexplained health
problems. This group is collaborati- with the three services
and the Department of Veterans Aff---- :o establish viable
definitions for the unexplained il*.-. ;. 3es. In addition,
consultation is ongoing with physiclar.a who report success in
diagnosis or treatment of veterans witr. unexplained illness.
(2) MITLTIPLE CHEMICAL SENSITIVITIES. The Array Medical
Department is evaluating the role of multiple chemical
sensitivities in causing some of the unexplained symptoms
reported by Persian Gulf War veterans. Funding has been
requested for a research facility to study multiple chemical
sensitivities .
(3) DEPARTMENT OF DEFENSE REGISTRY. The United States
Army and Joint Services Environmental Support Group is
constructing a Department of Defense Registry which contains a
file on every military person who participated in the Persian
Gulf War, This part of the Registry is nearly complete. The
registry will ultimately contain information on the daily
position of military units. When used in combination with
exposure data, the registry will be able to determine the
relative health risks for different units who participated in the
Persian Gulf War. j
d. In conclusion, the military health care | system has sought
extensive consultation from within and with outside agencies and
individual experts in addressing the issue of Persian Gulf War
veterans' medical symptoms. The health and well-being of our
service personnel is of paramount concern to the military
leadership. The Department of Defense and the Department of
Veterans Affairs will continue their investigations and treatment
of symptomatic veterans who served in Southwest Asia in support
of the Persian Gulf War.
211
STATEMENT OF
THE HONORABLE JESSE BROWN
SECRETARY OF VETERANS AFFAIRS
BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
HOUSE COMMITTEE ON VETERANS' AFFAIRS
November 16, 1993
Mr. Chairman and Members of the Subcommittee:
I appreciate the opportunity to appear before this Subcommittee provide the status
of Department of Veterans Affairs (VA) Persian Gulf-related activities.
We are and have been proactive ever since I took office on matters pertaining to
Persian Gulf veterans. VA has undertaken a significant number of actions to address the
health concerns of Persian Gulf veterans. We have learned from VA's experience with
Agent Orange. We have looked at all possibilities and have asked for recommendations
from all possible sources and are doing everything we can to get answers to these and
other questions. I want to assure you that as VA analyzes information gathered through
our registry, exams, and statements from veterans, we will honor our obligation to give
veterans the benefit of reasonable doubt as we confront this sensitive issue. We certainly
welcome any suggestion from this Committee. Tell us what actions you think we should
be taking and we will give them every consideration. I will now tell you what VA has
already done to address the medical problems of Persian Gulf veterans.
You may recall, initial Persian Gulf-related concerns focused on the possible
health effects of exposure to pollutants from the oil well fires. VA and DoD worked
closely to learn who could have been exposed to these pollutants and what was known
about the effects of the pollutants on humans. As time went on, it became apparent that
there may be a number of explanations for the many complaints being voiced by Persian
Gulf veterans and their family members. Consequently, the focus of the investigation
has been broadened to include additional potential environmental hazards.
In 1991, VA established a registry modeled on VA's Agent Orange and Ionizing
Radiation registries. We offer a comprehensive physical examination, baseline
laboratory tests, and other tests when indicated. The information derived from these
examinations is entered into a computerized data base with the results closely monitored
to discern patterns of illnesses or complaints among Gulf War veterans. While we are
seeing a wide variety of symptoms, we are unable to identify any u-end or pattern. As of
212
September 30, 1993, approximately 10,000 veterans had reported for an initial ("first-
time") registry examination.
Office of Technology Report
The Office of Technology Assessment (OTA) report, mandated by Public Law
102-585 and released September 1993, assesses the utility of the VA Persian Gulf
Registry examination program. The report concluded that a "good start has been made
on all facets of the registry complex." OTA made a number of recommendations and
VA has taken action to implement their suggestions. The report suggested that VA
should immediately revise the examination protocol. In two days, on November 18,
Persian Gulf Referral Center staff will meet with the Associate Chief Medical Director
for Environmental Medicine and Public Health to finalize plans for utilization of the
newly proposed addendum to the examination protocol. The OTA report also cited some
areas in which VA and DoD may be better able to work together and share information.
We are currently working with DoD to implement the recommendations of using
uniform terminology and establishing a joint oversight body for the V A and DoD
registries to enhance coordination and cooperation.
Legislation
During the past year, VA and the House and Senate Veterans' Affairs Committees
have been working on legislation to address special eligibility for care of Persian Gulf
veterans based on possible exposure. The House version, H.R. 2535, was favorably
acted upon by the House of Representatives on August 2. The Senate version, which is
included in S. 1030, was reported out of this Committee on September 8, and is awaiting
action by the full Senate. This is important legislation and I urge that both Houses of
Congress act upon this measure before the end of the Session.
Treatment
When a veteran's medical condition may be a result of environmental exposure,
VA provides that treatment at VA facilities. If a Persian Gulf veteran presents unusual
symptoms which cannot be diagnosed, a referral may be made to one of three special
referral centers located at VA medical centers in West Los Angeles, Houston, and
Washington, D.C. These centers were selected on the basis of availability of clinical and
academic expertise in such areas as pulmonary and infectious diseases, immunology,
neuropsychology, and access to toxicology expertise. As of October 31, 1993, there have
been 52 admissions of such referrals and 49 discharges. Twenty-five more veterans are
currently being scheduled for care at these referral centers.
213
Research
While considerable effort is made to learn the cause of a veteran's medical
problems, in some cases a definitive diagnosis has proven to be elusive. This is a
frustrating fact of medicine. To address this problem, we have sought expert medical
advice and are beginning a special research initiative. Earlier this year, we established a
"Persian Gulf Expert Scientific Panel," a sixteen member panel composed of experts in
environmental and occupational medicine and related fields from both government and
the private sector and representatives from veterans service organizations. The panel met
in May 1993 and considered issues related to the diagnosis, treatment, and research of
Persian Gulf-related health conditions. Panel members provided their thoughts on the
complex scientific and medical variables associated with these conditions. This panel,
which was chartered on October 16, 1993, will become a permanent advisory committee
to the Department, with their first meeting planned for January 1994.
Out of my very deep concern over the possible health effects of military service
in the Persian Gulf War, on June 28, 1993, 1 established a specialized Persian Gulf
veterans working group to address the need for research into multiple chemical
sensitivity. A panel was convened immediately and as a result of several meetings,
including one at which six veterans service organizations were represented, a report was
prepared recommending VA sponsorship of research into toxic environmental hazards.
On September 21, 1993, 1 approved the recommendations resulting from that
panel, and we plan to release a special solicitation to establish VA research centers early
next year. These centers will provide a nucleus of research activity in toxic
environmental hazards much the same as was done in other areas of special concern for
veterans, e.g., ADDS, substance abuse, and schizophrenia. The centers will serve as a
focal point for coordination of research extending beyond VA in order to take full
advantage of governmental and university resources. Activation of the centers is planned
for the fourth quarter of FY 1994 following appropriate peer review.
Another activity planned by VA to address the issue of multiple chemical
sensitivity is a Consensus Development Conference. We will bring together experts in
the medical community who will endeavor to define this problem. Because differences
of opinion exist as to the definition and scope of this problem, such a conference would
permit public discussion of these differences and perhaps lead to a better understanding
of the issues involved. The planning of this initiative is in the very early stages.
You may be aware that on August 31, 1993, President Clinton designated VA as
lead agency for all federally funded research into health effects of the Gulf War. This
214
was in response to Public Law 102-585. section 707. I wrote to the Secretaries of
Defense and Health and Human Services and the Administrator of the Environmental
Protection Agency on Septemt)er 29. 1993, requesting representatives to serve on the
coordinating council that will be chaired by Dr. Dennis B. Smith, VA's Associate Chief
Medical Director for Research and Development. We have been informed by HHS,
DoD, and EPA that they will be willing participants. The Council will provide a
mechanism for reviewing and coordinating the research activities related to the Gulf
War. Within the next couple of weeks, VA will call a meeting of the agencies concerned
and will consult with these other agencies and Departments before starting any other new
Persian Gulf-related research initiatives.
Complimenting this effort will be the results of a review due in October 1995, of
the existing scientific, medical, and other information on the possible health
consequences of Persian Gulf service to be performed by the medical follow-up agency
of the National Academy of Sciences.
Chemical Agents
Mr. Chairman, there has been a great deal of attention recently concerning the
possible use of chemical weapons by the Iraqi government during the Persian Gulf War.
The level of public concern was raised following reports by a Czechoslovakian Chemical
Unit present in the Persian Gulf during the conflict, that traces of the nerve agent. Sarin,
and blister agent. Mustard Gas, had been detected. A number of veterans have reported
a variety of symptoms that they believe are related directly to their possible exposure to
nerve or other agents. Particular concern has been raised by some members of reserve
units that served in the Persian Gulf theater that they are now suffering the effects of
exposure to chemical agents. Like Congress and the American public, the VA must rely
entirely on the Department of Defense information for reports and findings relating to the
events that occurred in the Persian Gulf. As you know, the U.S. team of experts that
visited Czechoslovakia concluded that the Czechs did detect agents and VA plans to use
whatever information is made available by DoD in our treatment and research efforts.
VA is very active in responding to the concerns of veterans. Even before DoD
reported on the Czech data, the Birmingham VA Medical Center had been selected as the
site for a pilot test to explore the matter further. A review of the literature on the effects
of cholinesterase inhibiting agents, of which Sarin is one, has shown that human beings
do experience long-term neurologic sequelae under certain circumstances. A specialized
neurological examination protocol is being developed at Birmingham to determine if
Persian Gulf veterans are experiencing neurological effects. Initial examinations will
215
focus on members of reserve units in Alabama and Georgia presenting possible
neurological conditions, individuals who have participated in the Persian Gulf Registry at
the Birmingham facility, and local veterans reporting to that facility with symptoms of
concern. I must emphasize that such testing will not confirm whether or not the
individuals were exposed to any particular agent. There is no screening test for
cholinesterase inhibiting agents. The examinations will detect the types of disabilities
which could result from exposure and perhaps provide clues for future diagnosis and
treatment. We have a special obligation in this matter to draw our conclusions based on
medical and other evidence. We need to give these veterans every benefit of the doubt
while we accelerate and expand our efforts to resolve health problems among Persian
Gulf veterans.
It is important to stress that, in the absence of biological or clinical markers, VA
physicians cannot confirm exposure to chemical agents which may have occurred years
ago. We can only confirm the presence of pathological changes which may be a result of
exposure. The continuing uncertainties about exposures to chemical agents reinforce the
need for VA to try to answer veterans' questions about whether their symptoms could be
due to such exposures.
We intend to focus our efforts on reexamining Persian Gulf veterans with
symptoms that could have been produced by exposure to chemical or other toxic agents
while in the military. We will continue to seek reasons why veterans are sick and
provide proper treatment with a goal of restoring these veterans to good health. These
veterans deserve medical explanation for their illnesses. In proceeding with the
development of focused research into other health issues that may have resulted from
Persian Gulf service, it is clearly too early to rule out any conceivable cause of illness.
Disability and Compensation
Officials at VA have also been closely involved in issues regarding compensating
Persian Gulf veterans for the disabilities they are experiencing. The Veterans Benefits
Administration (VBA) has been collecting information on compensation claims in which
disabilities were believed to be due to exposure to environmental hazards. With this
information we hope to identify patterns of claims sharing a common environmental
factor that may point to exposure to environmental hazards.
Our data indicate that the most common ailments claimed by Persian Gulf
veterans as due to exposure to environmental hazards are respiratory complaints and skin
conditions, including hair loss. Some veterans have had complaints involving symptoms
of fatigue, insomnia, other sleep disorders, listlessness, weight loss, and digestive
216
problems. Making decisions on claims for disabilities due to exposure to environmental
hazards is a priority for us. As of October 28, 1993, 1,472 claims from Persian Gulf
veterans, who believe their disabilities are due to environmental hazards, have been
decided. Service connection was granted in 79 of these claims. We have found that
many claims cannot be favorably decided because a large number of claims are based on
exposure only or on residuals without further specification of a disability.
Understanding the cause of symptoms similar to multiple chemical sensitivities
and chronic fatigue syndrome is an integral part of our efforts in granting disability
claims. Some individuals have labeled these conditions as the Persian Gulf mystery
illness. While there may be a mystery surrounding the cause of the health problems
some veterans are experiencing, there is no mystery to the fact that many veterans are ill
and need help. I am pleased to report that criteria have been established to grant service
connection for chronic fatigue syndrome. On November 9, 1993, instructions were sent
to all regional offices detailing the requirements that must be met to establish service
connection for this condition.
As to the multiple chemical sensitivity and Persian Gulf syndrome, VA does not
at this time have a clear mechanism to establish service connection for these illnesses
because they are not widely acknowledged in the medical community as disabilities.
However, as we have already stated, we are providing medical services to veterans
suffering from various health problems believed to have been incurred in the Persian
Gulf War.
Additionally, we have been closely monitoring environmental hazard claims to
determine if a pattern of ailments can be traced to a common origin. To accomplish this,
claims processing has been centralized at the Louisville Regional Office. This action has
provided the added benefit of developing a core of claims examiners with expertise in
rating these issues. With very limited exception, all disability claims based on exposure
to environmental hazards are handled in Louisville, Kentucky. In the event we allow
deviation from this policy, such as with the St. Petersburg Regional Office cases
involving exposure to a paint containing a chemical agent-resisting coating, we ensure
that expertise is shared and communicated in such a way as to maintain integrity in the
decision making process.
Lastly, I would like to confirm our commitment to looking for solutions to these
problems. We intend to take advantage of every opportunity to meet with the
Depariment of Defense and other Federal departments and agencies and we look to
217
Persian Gulf veterans themselves to assist us in resolving Persian Gulf-related health care
issues.
This concludes my formal statement. I will be pleased to respond to any
questions you may have.
218
STATEXBNT OF CHAKEiES E. JACKSON, MD
BEFORE THE
BOOSK VETERANS' AFFAIRS OOHMITTEE
SOBCOMMZTTEB <M OVERSIGHT AND XNVESTIGATTQMS
November 16, 1993
Mr. Chairman and Members of the Subcommittee:
I appreciate the opportunity to appear before this
Subcommittee for the purpose of providing the status of Department
of Veterans Affairs (VA) Persian Gulf -related activities.
In August 1992, the VA Medical Center in Tuskegee, Alabama
began enrolling Persian Gulf veterans in the Registry. In view
of the complaints about the vaccine, particularly Anthrax, that
were received in the Gulf, complaints about recurrent diarrhea,
joint pain, excessive fatigue, shortness of breath, and memory
problems, the VA Tuskegee deviated from the suggested protocol of
physical exam, c.b.c, chest x-ray, profile 8 (SMA 20) and
urinalysis.
In view of endemic diseases of the Middle East, complaints of
diarrhea, joint pain, and exposure to dead animals, the VA in
Tuskegee systematically performed an expanded number of tests on
the first 100 veterans seen on the Registry. Febrile Agglutins,
Hepatitis Profile, ANA and Rheumatoid Factor, sed rate. Fungal
Titre, and Immunoelectrophoresis (Serum) were performed on the
first 100 veterans on the Registry. Where appropriate, stool
cultures and stools for ova and parasite, and blood cultures were
performed. All tests were normal except those discussed below.
Finally by September 1993, the VA Tuskegee had registered 180
individuals.
219
SUMMARY OF RKStTT.TS OF 1 flO TNDIVIDOAT.S QTJ THE TOSKEGEE RgGT5yPBY
1. One hi^ndred eighty (160) Individuals have been seen and have
almost coiDplete statistics compiled from their Persian Gulf
Registry exam. The results are these:
a. Twenty-eight (28) or 15% have complaints of recurrent
diarrhea since the gulf.
b. Twenty-three (23) or 13% have complaints of excessive
fatigue since the Gulf.
c. Twenty-two (22) or 12% have complaints of joint ache
(fingers and )cnees) not associated with injury since the Gulf.
d. Twenty (20) or 11% have complaints of rash on extremities
off and on since the Gulf.
e. Ten (10) or 6% have complaints of excessive shortness of
breath which did not exist prior to the Gulf.
f . Three (3) or 1% had muscle aches and twitching which did
not exist prior to the Gulf.
(Most people had more than one symptom and thus there is
overlap. A total of 63% of the group were symptomatic.
2. Physical and abnormal laboratory findings were found in 26% of
this group. No individual is in more than one category; thus truly
25% of the group of 180 have abnormal lab or physical findings.
These are:
a. Elevated serum protein of 8.3 grams or greater - 1 4 or
11%.
b. Seropositive for HBV, 11 or 6% (none were icteric or gave
history of hepatitis) .
c. Hypergammaglobulinemia was found in 8 or 4% of the group.
d. Lymphadenopathy, generalized, was found in 4 or 2%.
e. Sed rate was elevated over 30 in five (5) patients or 2%.
f. Other abnormalities - candidiasis, thyroid disease, non-
Hodgkin lymphoma, abnormal liver on echo, all 3%, Thus 25% or
one-fourth of the group have abnormal lab or physical
findings.
220
Department of Veterans Affairs
Deputy Assistant Secretary 'Or Congressional Liaison
Washington DC 20420
July 7, 1994
The Honorable Lane Evans
Chairman, Subcommittee on Oversight
and Investigations
Committee on Veterans' Affairs
House of Representatives
Washington, D.C. 20515
Dear Mr. Chairman:
We received correspondence from your office dated June 13, 1994, stating
VA did not respond completely to all of the questions submitted regarding the
November 16, 1993, hearing on Health Care Problems and Concerns of the
Persian Gulf War Veterans.
Enclosed are expanded answers to those questions indicated. We regret
that the initial response was not completely responsive and appreciate the
opportunity to submit this information for the record.
Sincerely yours.
c
Dennis M. Duffy
ciiciosure
DMD/gya
221
WRITTEN COMMITTEE QUESTIONS AND THEIR RESPONSES
QUESTIONS SUBMITTED BY
HONORABLE LANE EVANS, CHAIRMAN
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
COMMITTEE ON VETERANS' AFFAIRS
HEALTH CARE PROBLEMS AND CONCERNS OF PERSIAN GULF WAR
VETERANS: THE RESPONSE OF THE DEPARTMENT OF VETERANS AFFAIRS
AND THE DEPARTMENT OF DEFENSE AND RELATED ISSUES
NOVEMBER 16, 1993
Question 11: Since several federal agencies reportedly recognize Multiple
Chemical Sensitivity (MCS), why is it necessary for VA to conduct a
consensus development conference on MCS? Will Dr. Shayevitz
be invited to participate in this conference?
Answer: Although several federal agencies recognize Multiple Chemical
Sensitivity as an entity, there are differences over the various
symptoms that should be included within the syndrome. A
specially-formed consensus workshop comprised of nationally-
recognized experts in toxicology, environmental medicine, and
other related disciplines, met at the end of April to address the
feasibility of establishing a consensus definition of the "Persian
Gulf Syndrome" which would entail, among other things,
determining if it is a single illness or a combination of separate
afflictions, and how it relates to Multiple Chemical Sensitivities.
The workshop panel concluded that "it is impossible at this time to
establish a single case definition." Dr. Shayevitz was invited to
speak at the workshop and gave a 20 minute presentation on her
professional experiences in treating veterans of the Persian Gulf
War.
Question 14: Identify the medical test(s) administered at each of VA's Persian
Gulf Referral Centers which cannot be administered at other
VAMCs and identify the definite diagnoses made at each of VA's
Persian Gulf Referral Centers which could not be made by
personnel at the referring VAMC.
Answer: There are no medical tests or definite diagnoses made at the
Referral Centers that absolutely could not have been made at
another VA medical center. In some cases, the Referral Centers
provided confirmation of diagnoses made at other VAMCs. In other
cases, diagnoses were made in a more timely fashion by allowing
for concentrated efforts at assessment. The purpose of the
Referral Centers was to establish a cadre of individuals familiar
with the various health issues affecting Persian Gulf Veterans, who
could provide necessary treatment to veterans and provide
consultation for other physicians.
Question 19: VA has reported it was proceeding, through a variety of
approaches, to resolve these complex health issues of Persian
Gulf veterans. Identify each of these approaches and what has
been learned from each approach to date?
Answer: Most of the approaches listed in our original response to this
question are still in progress. However, the results of our
examinations of veterans in the Registry Program and at the
222
Referral Centers have indicated that there is not one condition or
syndrome that affects all veterans of the Persian Gulf conflict, but a
number of conditions which are at present imperfectly understood.
This view was recently confirmed by the NIH Technology
Assessment Workshop, which evolved out of the planned
consensus conference. The one activity for which there is a
preliminary report is the review of birth records of children born to
veterans of selected National Guard units in Mississippi. The
occurrence of birth defects and other health problems in that
population is no greater than would have been anticipated given
the expected rates in the general population.
223
QUESTIONS SUBMITTED BY
HONORABLE LANE EVANS, CHAIRMAN
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
COMMITTEE ON VETERANS' AFFAIRS
HEALTH CARE PROBLEMS AND CONCERNS OF PERSIAN GULF WAR
VETERANS: THE RESPONSE OF THE DEPARTMENT OF VETERANS AFFAIRS
AND THE DEPARTMENT OF DEFENSE AND RELATED ISSUES
NOVEMBER 16, 1993
Question 1:
VA has reported, "it expects to solicit proposals early this fiscal
year from VA researchers to establish from one to three research centers.
By when will VA make final decisions on establishing one or more
of these research centers, what additional resources will be provided to
each of these research centers and when will these resources be provided?
Will each center examine and treat veterans? Will the
examinations and treatment provided by each center not be available at
any other VA medical facility?
Will the expertise available at each center not be available at any
other VA medical facility?
Answer:
A VHA Directive entitled "Solicitation of Proposals for the
Establishment of Research Centers for Basic and Clinical Scientific
Studies of Environmental Hazards ("Environmental Hazards Research
Centers")" was issued to the field on January 10, 1994. Applications for
funding have been received and are currently being evaluated. One to
three centers will be established and funded at a level of up to $500,000 a
year per center per year. Funding will be initiated in fourth quarter FY
1994. As Research Centers, there is no explicit patient care role identified
although it is expected that clinical studies will be initiated.
Responses to an earlier solicitation for pilot studies are currently
undergoing review. These proposals will be funded up to $50,000 a year
and will explore the medical consequences of exposure to environmental
hazards. The Centers will draw on the knowledge and expertise that exist
at the individual VA medical center. They will also draw upon non-VA
sources including, affiliated medical schools, DoD, HHS and EPA. It is
expected that the expertise available at the centers will be made available
to other VA facilities.
Question 2: Identify research currently being conducted at VAMCs related to
the health problems and concerns reported by Persian Gulf War theater
veterans.
Answer:
Intramural research (that is, research utilizing VA's own
investigators and facilities) was recommended as a high priority by the
VA's Persian Gulf Working Group, formed several months ago to
determine the most effective course of action for VA on this issue. VA
immediately began supporting research programs addressing different
aspects of potential Persian Gulf-related afflictions.
Small-Scale Pilot Programs:
VAMC Birmingham, AL
Researchers will investigate medical and
psychological effects of exposure to
petrochemicals and other toxic hazards.
224
VAMC Jackson, MS
VAMC Boston, MA
The Jackson VAMC is acting as an initial
clearinghouse for data on reported birth
defects in children of members of the
Waynesboro (MS) National Guard.
A project examining neuropsychological
profiles of veterans returning from the
Persian Gulf theater.
Question 3:
Answer:
Psychological and Observational Studies
VAMC Clarksburg. WV
VAMC Mountain
Home, TN
VAMC Boston, MA
"An Investigation of the Relation between
the Experience of Operation Desert Storm
and Post-War Adjustment"
"Early Intervention with Appalachian
Marine Reservists in Operation Desert
Storm"
"Desert Storm Reunion Survey"
VAMC New Orleans, LA "Psychological Assessment of Operation
Desert Storm Returnees"
VAMC Salt Lake
City, UT
"Operation Desert Storm Follow-up Survey"
How many times has VA's Environmental Epidemiology Service
(EES) reviewed Registry medical data to generate a hypothesis for in-
depth analytical study, what hypotheses have been generated, which
hypotheses will be tested and when will these hypotheses be tested?
Identify the hypotheses which will not be tested and explain why each
hypothesis will not be tested.
Because the registry is comprised of self-selected veterans who
may not be representative of all Persian Gulf War veterans, a conclusion
of an association between Persian Gulf area service and any specific
health problems cannot be made based on the registry data. However,
unusual clusters of health problems observed in the registry may provide a
suggestion of an association which then can be studied in a formal
epidemiologic study.
To date, VA's Environmental Epidemiology Service has reviewed
the registry data three times. The results of the review were presented to
the VA Persian Gulf Expert Scientific Panel meeting on May 7, 1993, and
the Interagency Persian Gulf Research Coordinating Council meeting on
December 20, 1993. The most recent review was presented to the
NASAOM Committee to Review the Health Consequences of Service
during the Persian Gulf War on January 20, 1994.
Analysis of registry data to date has failed to suggest a hypothesis
for indepth analytical study of any particular health conditions. However,
it was found that disproportionately high numbers of persons having
served in national guard units and reserve units irrespective of branch of
service were reporting to VA for a registry examination. EES plans the
following follow-up analyses.
1. Compare the complaints and medical diagnoses of the national
guard and reserve unit personnel with others who served in the active
units for relative frequency and types of complaints and medical
conditions.
225
2. Ascertain the military experience of these personnel in the
theater (types of unit, time, locations, principal duties, etc.) to establish
any commonalty.
EES will continue to review the registry data periodically.
Question 4: Please explain why VBA does not recognize diagnoses which have
been made by VHA physicians, e.g., Persian Gulf War Syndrome
(PGS) and Multiple Chemical Sensitivity (MCS).
Answer: VA has been unable to grant service connection for illnesses
classified under the catch-all terms PGS or MCS because PGS and
MCS are not at this time widely acknowledged in the medical
community as disabilities. Further, PGS and MCS do not describe
specific disabilities but rather a variety of symptoms or diseases
which seem to be of uncertain etiology.
Question 5: How many PG veteran claims for service-connected disability
compensation has VBA denied in whole or in part because VBA did
not recognize the disability? Identify these disabilities.
Answer: We do not have the number of claims denied because we did not
recognize the disability. However, we believe that the number of
such claims would be very small. Additionally, the type of
condition most likely to fall into this category is a systemic
condition which is now diagnosed as Chronic Fatigue Syndrome
(CFS).
Question 6: How many PG veteran claims for service-connected disability
compensation has VBA denied in whole or in part because the
disability did not result from a disease or injury recognized by
VBA?
Answer: We do not have these statistics.
Question 7: How many Gulf veterans for whom VBA has denied in whole or in
part a claim for service-connected disability compensation are
chronically ill? Disabled by chronic illness?^
Answer: We do not maintain the information requested. The presence of a
chronic disabling illness is not sufficient to establish that the illness
is related to military service. Other factors are considered in making
that determination such as whether the disability was incurred in or
aggravated by service; whether the disability is a chronic condition
occurring within one year following release from service; or
whether the disability is one that is known to be associated with
exposure to a specific environmental agent.
Question 8: What changes would VBA recommend in the adjudication of claims
for service-connected disability compensation to enable the award of
compensation to Gulf veterans who are disabled by chronic illness,
but who do not have a disease or injury which is recognized now by
VA?
Answer: In preparation for the June 9, 1994, House Subcommittee on
Compensation, Pension and Insurance hearing on H.R. 4386,
(Persian Gulf Veterans Compensation for Undiagnosed Illnesses),
we are currently reviewing this matter and will state our views in the
testimony we will be submitting for that hearing.
Question 9: Provide the requirements for service connection for CFS.
Answer: Attached is a copy of our Training Letter 93-5, which provides the
guidelines for rating CFS.
Question 10: Since most claims for compensation based on environmental
hazards are processed by the Louisville regional office, what checks
and balances are being used by VBA to make certain these decisions
are correct?
226
Answer:
Question 11:
VBA's Compensation and Pension Service is collecting copies of
rating decisions for veterans claiming disability which they believe
to be the result of exposure to environmental agents to identify
among other things, patterns of claims sharing a common
environmental factor that may point to potential health hazards, if
any. Additionally, like all regional offices, the C&P Service
conducts a quality assurance review of the compensation work
completed by the Louisville office. A representative sample of each
station's cases is reviewed annually to ensure that all regulations,
manual procedures and directives, including those emanating from
Court rulings, are properly followed. VBA also conducts site
surveys of regionaJ offices to review the local adjudication division's
understanding and compliance of regulations and procedures, in
particular, the newer ones arising from Court of Veterans Appeals'
decisions and new legislation.
Since several federal agencies reportedly recognize Multiple
Chemical Sensitivity (MCS), why is it necessary for VA to conduct a
consensus development conference on MCS? Will Dr. Shayevitz be
invited to participate in this conference?
Answer:
Although several federal agencies recognize Multiple Chemical
Sensitivity as an entity, there are differences over the various symptoms
that should be included within the syndrome. A specially-formed
consensus workshop comprised of nationally-recognized experts in
toxicology, environmental medicine, and other related disciplines, met at
the end of April to address the feasibility of establishing a consensus
definition of the "Persian Gulf Syndrome" which would entail, among
other things, determining if it is a single illness or a combination of
separate afflictions, and how it relates to Multiple Chemical Sensitivities.
The workshop panel concluded that "it is impossible at this time to
establish a single case definition."
Question 12:
What information related to the Persian Gulf War has VA
requested, but not yet received, from DoD? >
Answer:
VA and the DoD have had a very cooperative relationship in their
mutual efforts to resolve health care issues which have surfaced as a result
of the Persian Gulf War. VA is not aware of any instance in which the
DoD did not provide information requested by VA except in the following
instances:
VA awaits responses to correspondence and verbal communique
concerning the following issues:
o the extent of DoD's use of paint containing Chemical Agent
Resistant Compound (CARC); identification of individuals involved
in the use of CARC; unit assignments and locations; and whether
protective equipment was issued.
o exposure to other environmental agents such as cement dust;
CARC at locations other than Ft. Stewart, Georgia and Saudi
Arabia; mustard gas; smoke from oil well fires; depleted uranium;
chemical or bacteriological warfare agents; diesel fuel; and any
other industrial or occupational environmental hazard.
Examples of how VA and DoD cooperate are as follows: In order to
properly address concerns of veterans over exposures to possible
environmental hazards, all individuals who served in the area need to be
identified. To this end, the Defense Manpower Data Center (DMDC)
prepared a computer file of 670,000 troops assigned to the Persian Gulf
area during the war and transferred the file to VA's Environmental
Epidemiology Service, which now has access to all demographic and
military personnel data on troops stationed in the Persian Gulf
Additionally, inpatient medical data of Gulf veterans are being closely
227
TRNG LTR 93-5
November 9, 1993
Director (00/21) 211C
VA Regional Offices
SDBJ: Rating Chronic Fatigue Syndrome (CFS)
1. Chronic fatigue syndrome (CFS) is an illness characterized
by debilitating fatigue and several flu-li)ce symptoms. The VA
recognizes this condition when diagnosed according to the
guidelines published by the O.S. Department of Health eind Human
Services. This disorder has both physical and psychiatric
manifestations and closely resembles neurasthenia,
neurocirculatory asthenia, fibrositis or f ibrooiyalgia.
2. The hallmark of CFS is the sudden onset of the illness,
typically with flu- like symptoms which do not fully resolve.
These symptoms persist chronically, or wax £md wame frequently,
and are accompemied by debilitating fatioue and malaise, and last
any ./here from many months to many years. In order for a valid
diagnosis to be made the symptoms must persist for at least 6
months. The syn^tcois are most severe in the first year of
illness.
3. The diagnosis of CFS currently is one of exclusion. The
following list is a synopsis of the criteria which doctors must
use to make the diagnosis. The list is a guide and is provided
for informational purposes.
A case of chronic fatigue syndrome must fulfill both of the
major criteria. The diagnosis must then meet 6 or more of
the 11 synptom criteria plus 2 or more of the 3 physical
criteria; or 8 or more of the 11 synptom criteria.
a. Manor Criteria
(1) New onset of persistent or relapsing, debilitating
fatigue or easy fatigaJaility in a person irtio has no previous
history of similar symptcms, that does not resolve with bed rest,
and that is severe enough to reduce or impair average daily
activity below 50 percent of the patient's pre- illness activity
level for a period of at least 6 months.
(2) Other clinical conditions that may produce similar
symptoms must be excluded by thorough evaluation, based on
history, physical examination, and appropriate laboratory
findings. (The complete list of malignancies, autoimmune
disorders, infection, chronic psychiatric disease or chronic use
of major psychotropic drugs, chronic inflammatory disease,
endocrine disease, drug dependency, side effects of chronic
medication or toxic agent, or other known dieases is included in
the medical literature available to physicians.)
228
b. Minor criteria - Synptoms
(1) Mild fever (37.5 to 38.6 degrees Centigrade)
reported by the patient; (2) Sore throat; (3) Painful
cervical or aucillary lymph nodes; (4) Unexplained or
generalized muscle weakness; (5) Muscle discomfort or myalgia;
(6) Prolonged generalized fatigue following exercise that would
have been easily tolerated earlier; (7) Generalized headaches
(type, severity or pattern different from headaches experienced
before) ; (8) Migratory arthralgia without joint swelling or
redness; (9) Neuropsychologic conplaints (one or more) of the
following: photophobia, transient visual scotomata,
forgetfulness, excessive irrita±>ility, confusion, difficulty
thinking, inaiaility to concentrate, depression; (10) Sleep
disturbances (insomnia or hypersomnia) ; (11) Description of the
main symptom conplex as initially developing over a few hours to
a few days .
c. Minor criteria - Physical
(1) Low grade fever - oral ten^ierature between 37.6
and 38.8 degrees Centigrade; (2) Non-exudative pharyngitis;
(3) Palpable or tender anterior or posterior cervical or
axillary lynph nodes.
4 . The signs and symptoms of CFS affect the upper
respiratory, lynphatic, neuropsychological and skeletomuscular
systems. When rating a claim in which CFS has been diagnosed,
rate the syn^Jtoms in the major body system eiffected using the
appropriate diagnostic code for that system with an zmalogous
code 6399 to represent CFS. For example, a veteran with a valid
diagnosis of CFS and «dio has significant depression, fatigue,
forgetfulness, irritability, confusion, and inability to
concentrate equal to a generalized anxiety disorder would be
rated under DC 6399-9400. The rating specialist must be aware of
the requirements for a valid diagnosis of CFS and must question
any diagnosis that is not fully supported by statements of major
and minor (symptoms and physical) criteria. Evaluations will be
assigned from zero to 100 percent based upon the syn^tom picture,
level of impairment euid the appropriate diagnostic code .
/S/
J. Gary Hickman, Director
Compensation and Pension Service
229
monitored and analyzed in comparison to Gulf-era veterans not stationed
in the Gulf. Computer matching of the F*TF file with the DoD roster of
Persian Gulf veterans has helped identify 6,092 Gulf veterans and 6,265
Gulf-era veterans treated in VA hospitals on an inpatient basis since the
study began. Lastly, a mortality analysis of all 670,000 Persian Gulf
veterans on the DMDC file will be compared to a sample of Gulf-era
veterans who did not serve in the Gulf area. Cause-specific mortality for
both veteran groups will be compared and also compared to the number of
deaths expected in the U.S. male population.
Question 13a: The Subcommittee understands VA's Persian Gulf Referral
Centers deal with "very unusual and difficult diagnoses". How many
Persian Gulf veterans who have sought treatment from V A have a very
unusual and difficult diagnosis? How many Persian Gulf veterans with
"very unusual and difficult diagnoses" have been referred to one of the
Referral Centers and how many have not?
Answer:
VA has made every effort to diagnose and treat Persian Gulf
veterans presenting unusual and difficult-to-diagnose adverse health
conditions at local VA medical centers. In most instances adverse health
conditions have been diagnosed successfully at the medical center with
appropriate treatment of symptoms. All veterans, with the exception of 4
individuals, have received a diagnosis for conditions for which they were
admitted. VA's policy is that in those instances where it is not possible for
the medical center to arrive at a diagnosis, referrals are made (following
consultation with the Persian Gulf Referral Center stafO to the appropriate
Persian Gulf Referral Center.
Question 13b: How many of the veterans referred to each VA Persian Gulf
Referral Center have been examined by the referral center? How many of
the veterans referred to each VA Persian Gulf Referral Center have not
been examined by each center?
Answer:
As of May 25, 1994, 101 veterans have been admitted and
98 of these were discharged from one of VA's three Persian Gulf Referral
Centers located in Washington, D.C., Houston, Texas, and/or West Los
Angeles. Examinations for an additional 50 veterans, as of that date, were
pending at these facilities.
Question 13c: Who and/or what determines if and when a veteran is referred to
one of the Persian Gulf Referral Centers and what criteria are used to
make this decision?
Answer:
Local medical centers make every attempt to diagnose unusual
adverse health conditions presented by some Persian Gulf veterans.
Referrals are only made following consultation between clinical staff of
the medical center of origin and the referred center of jurisdiction. Such
referrals are made when it is determined that it is not possible at the local
level, to arrive at a definite diagnosis and that such a referral might assist
in making that determination. It should be noted that some veterans, for
various personal reasons, elect not to be referred to referral centers.
Question 13d:
Describe the follow-up VA has provided each veteran following
release from a Referral Center.
Answer: Following discharge of the veteran from the center, Persian Gulf
Referral Center staff, routinely contacts the medical center which
originally made the referral to provide medical findings/diagnoses, if any,
made at the referral center, date of discharge and any recommendations
made for continued medical care. Copies of medical documents
pertaining to the veteran are provided to the referring medical center.
230
Question 14: Identify the medical test(s) administered at each of VA's Persian
Gulf Referral Centers which cannot be administered at other VAMCs and
identify the definite diagnoses made at each of VA's Persian Gulf Referral
Centers which could not be made by personnel at the referring VAMC.
Answer:
Question 15:
Medical tests provided at VA's Persian Gulf Referral Centers are
not unique to those centers. Such medical tests are available at all VA
health care facilities. However, what is unique to the referral centers is
the availability of clinical staff dedicated to the medical evaluation of
Persian Gulf veterans referred for special diagnostic workup. The
Referral Centers also provide the opportunity for extended evaluation of
these individuals with inpatient stays of approximately two weeks.
Identify the expertise available at each Persian Gulf Referral
Center which is not available at any other VA medical facility?
Answer:
VA's Persian Gulf Referral Centers were selected based on the
available medical expertise at each of the three centers. They were
selected for three major reasons: because of their geographic location
(East Coast, Middle U.S., and West Coast); because of their own special
clinical expertise; and finally, because of their geographic proximity to
other centers for military medicine, occupational health and toxicology.
The Washington VA Medical Center was selected because of its expertise
in infectious diseases and neurology, and its geographic proximity to
military facilities such as the Walter Reed Army Medical Center. The
Houston Referral Center was selected, in addition to the above reasons,
because of its proximity to academic facilities having expertise in multiple
chemical sensitivities and industry resources with expertise in
petrochemicals. The expertise available at the Referral Centers (e.g.,
toxicology, neurology, dermatology, gastrointestinal, etc.) is also
available, in most instances, at other VA health care facilities. The
Referral Centers are unique in having a "team" approach in dealing with
individuals referred to those facilities. This provides a more indepth,
intensive diagnostic investigation of Persian Gulf veterans referred for
examination. Veterans referred to the Centers usually have an inpatient
stay of approximately 6 - 10 days and therefore, receive a longer range
health surveillance and avoid the "fatigue factor" that may occur when
multiple demanding medical tests are scheduled in an ambulatory care
facility.
Question 16:
What diagnostic procedures are available at each VA Persian Gulf
Referral Center which are not available at any other VA medical center?
Answer: See response to Question 15.
Question 17: What has each VA Persian Gulf Referral Center accomplished
which could not be accomplished at any other VA medical facility?
Answer:
As previously noted, the Referral Centers provide VA with the
opportunity to examine and develop a possible diagnosis for the
conditions presented by some Persian Gulf veterans. In this regard, the
Centers have successfully diagnosed the conditions of veterans who have
agreed to transfer to those facilities for the long-term health surveillance
not possible at other VA health care facilities. The team approach
employed at each facility and utilization of multi-disciplinary approaches
have assisted in achieving this record. The special physician coordinator
at each facility also makes a valuable contribution, providing a point of
contact for consultation with referring medical centers, indepth review of
diagnostic work-ups on each patient, development of a comprehensive
evaluation utilizing all relevant specialists and diagnostic tests, and
231
finally, the administrative management of patient scheduling, record
keeping and follow-up.
Question 18: What improvements in the Persian Gulf Registry examination have
been considered and rejected by VA? What improvements in the Persian
Gulf Registry examination have been considered, but neither rejected nor
implemented by VA? What improvements should be made in this
examination?
Answer:
Question 19:
Answer:
Question 20:
Why shouldn't all Registry exams be expanded as have
examinations provided by the Tuskegee VAMC?
VA is currently in the process of redesigning the registry
examination diagnostic code sheet to provide for capturing more than
three symptoms and diagnoses on registry participants. Recommendations
for eliminating what the OTA believes to be non-statistically relevant
information is also being considered. Regarding the examination process,
VA is currently analyzing the types of improvement, if any, which may be
required to meet the health care needs of Persian Gulf veterans. The
examination now provides a comprehensive health picture of the current
health status of registry participants. It is anticipated that the "Pilot"
neurological examination project being implemented at the Birmingham
VA Medical Center will assist in determining what additional tests may be
required.
VA has reported it was proceeding, through a variety of
approaches to resolve these complex health issues of Persian Gulf
veterans. Identify each of these approaches and what has been learned
from each approach to date?
VA has undertaken several major initiatives, including among other
activities: award of a joint VA/DoD contract on September 30, 1993,
with the National Academy of Sciences for a review of the possible
adverse health effects of Persian Gulf service; establishment of special
Persian Gulf Referral Centers in Houston, West Los Angeles and
Washington, D.C.; conduct at the Birmingham VA Medical Center of a
pilot program to provide special neurobehavioral examinations to certain
Persian Gulf veterans; examination of Persian Gulf veterans with
undiagnosable adverse health conditions at the Jackson VA Medical
Center including the review of birth records of children of these veterans
to determine existence and cause of suspected birth defects; undertaking
efforts to establish special VA research centers to deal specifically with
Persian Gulf-related research issues. Health and other data now available
are being analyzed, results of which are still preliminary.
In addition to these efforts, VA is closely cooperating with the DoD
and other concerned Federal and non-Federal entities through special
committees, cooperative research efforts (e.g., joint VA/DoD "Five-Year
Health Surveillance" of Persian Gulf veterans wounded by depleted
uranium munitions being conducted at VA's Baltimore VA Medical
Center) and other activities, to assist in arriving at a research and medical
consensus on the complex Persian Gulf-related health issues in question.
VA has reported the Persian Gulf Registry exam includes a good
general Internal Medicine history and physical examination capable of
leading to the diagnosis of a wide range of conditions. Why is the Persian
Gulf Registry exam failing to diagnose the health care problems of some
veterans? What changes should be made in the Persian Gulf Registry
exam to be able to diagnose health care problems which are not being
diagnosed now?
232
Answer:
VA believes that its registry examination process does provide for
the ultimate diagnosis of most conditions presented by Persian Gulf
veterans. The examination provided is a general physical examination
designed to assess the current health status of the individual. When
necessary, referrals are made to special clinics (e.g., pathology,
rheumatology, dermatology, etc.) to provide additional diagnostic
assistance. Nevertheless, there have been some conditions which have
defied the diagnostic process and which require special attention such as
referral to one of the three Persian Gulf Referral Centers. The inability to
diagnose "all" health conditions is not peculiar to VA's registry. Health
care institutions/facilities throughout the private sector are also confronted
with this phenomenon on a daily basis. In such instances, the medical
emphasis becomes one of treating the symptoms presented by the
veterans/individuals. In most cases such treatments are successful and no
further complaints are presented. VA is currently in the process of
reviewing the registry exanaination process and alternatives to providing
for the diagnosis of individuals presenting seemingly "undiagnosable"
conditions.
Question 21: Describe the new or additional actions VA has taken since June 9, 1993,
to increase veteran (including service members on active duty and
reservists) awareness of VA's Registry program and assess the
effectiveness of each of these actions? What new or additional actions
could VA take now to publicize the registry program?
Answer:
Since June 9, 1993, VA has continued to interface with the Department
of Defense to coordinate our respective Departmental efforts to resolve
the health care issues of concern. V A and the DoD, on September 30,
1993, entered into a joint agreement with the Medical Follow-up Agency
(MFUA) of the National Academy of Science's Institute of Medicine for
the Persian Gulf Health Study mandated by Public Law 102-585. Both
VA and the DoD have transmitted the necessary resources to the MFUA
for this purpose.
Earlier in 1993, VBA modified VA Form 21-526, Veteran's
Application for Compensation or Pension, to include a question
aslang if the veteran wants his or her medical information included
in the registry. If, however, a veteran files an application form
which does not contain this question, a letter is sent to the veteran
explaining the Registry's purpose and providing the veteran an
opportunity to have his or her medical and other records included in
the registry.
VA has also recently received approval to provide for establishment of a
chartered advisory committee to address Persian Gulf health/research
issues. This committee emanated from one of the recommendations of the
special "Blue Ribbon" panel which met in May 1993, to provide VA with
advice on how to proceed on the health care issues generated by the
Persian Gulf War. Since June 9, VA has also established an internal
"Persian Gulf Veteran's Working Group" to address the need and possible
funding for research into multiple chemical sensitivities.
Approval has been given by the Secretary of Veterans Affairs to
establish special research centers at existing VA facilities, a
recommendation which originated from this special internal task force.
Planning for the centers is underway and special solicitations for research
proposals have been sent to researchers throughout VA's health care
system. VA has also initiated a pilot program at the Birmingham VA
Medical Center to investigate possible neurological and other impairments
in some Persian Gulf veterans. Because it was only established very
recently, there are no results which can be reported at this time. In
response to one of the requirements of Public Law 102-585, VA requested
consideration by the President, and was subsequently designated as the
233
lead Federal agency to coordinate Persian Gulf-related research. A
research coordinating committee met twice in late 1993.
Question 22: What has VA's Persian Gulf Expert Scientific Panel learned from
its examination of the concerns of veterans regarding the possible long-
term health consequences of military service in the Persian Gulf theater of
operations? How has VA utilized this information? How will VA utilize
this information?
Answer:
The expert panel met on May 7, 1993, to review a variety of health
issues related to the diagnosis, treatment and research of Persian Gulf-
related health conditions. The meeting was opened to the public and
received considerable attention in the news media. At the conclusion of
the all day session, panel members indicated that additional review and
analysis of research, education and clinical issues are essential in view of
the complex scientific and medical variables associated with these
conditions. VA is considering what would be the most effective way to
follow through on these issues. In October we received approval for a
permanent advisory committee on Persian Gulf-related issues. This
committee will follow-up on the ideas discussed at the panel meeting in
May. The initial meeting of the committee was on February 1994.
Question 23a: According to a study conducted by Dr. Jessica Wolfe, based on
data from over 2,000 Gulf War veterans, 18 months after returning to the
U.S., 9.4 percent of men and 19.8 percent of women had PTSD. Almost
30 percent of men and 41.3 percent of women reported negative change in
their physical health after serving in the Gulf.
Answer:
The percentages in the first sentence should be 9.7 and 20.7,
respectively. Also, the wording in the first sentence should be changed
from "had PTSD," to "reported symptoms suggestive of PTSD."
Question 23b: Are the Persian Gulf War veterans included^in this study
representative of the Persian Gulf War veteran population and can the
results of this study be generalized to the Persian Gulf War veteran
population?
Answer:
The veterans included in this study are not necessarily
representative of the Persian Gulf War veteran population in general in
that the study included only ARMY veterans from the New England area
(i.e., returnees who came back through Ft. Devens, MA), was made up
primarily of Reserve (22.2 percent) and National Guard (56.5 percent)
members, and was based on self-reported information. (See Table 1
below for other demographic information.) Thus, the study results may
not necessarily be generalizable to the Persian Gulf War veteran
population as a whole. (Broader statistical review of Armed Forces
demographics would be needed.)
However, this study does provide important information
generalizable to a subset of the veteran population. Also, it represents a
unique opportunity to examine patterns of readjustment and the factors
that contribute to physical and mental health changes in the years soon
after return from a wartime environment.
TABLE 1. Demographics of Study Population at 18 Months Post
Return (n=2315).
Average age 30.6 years
Average number years of education 13.2 years
Prior Vietnam service 7.5%
234
Gender (% female)
8.4
Marital status (% married)
7.7
Racial status
White
85.6%
Black
6.3
Hispanic
3.7
Rank
Enlisted
37.0%
Non-commissioned officers
55.2
Commissioned officers
7.8
Question 24: What has VA's Persian Gulf Family Support Program (PGFSP)
accomplished and has it completed its mission? When will this program
be terminated?
Answer:
The PGFSP was charged under P.L. 102-405 with the task of
providing marriage and family counseling to Persian Gulf veterans and
their spouses and children. The program through its outreach perspective
has provided marriage and family counseling services to many veterans
and their families. It has also served to coordinate veterans' entry into the
VA system and the Persian Gulf Registry. It has served in many
situations as a referral mechanism to other community programs/resources
needed by Persian Gulf veterans and their families. Through the active
outreach to individual National Guard and Reserve Units the program has
responded to the need to bring the VA to veterans in a way that has not
been done previously. Social work staff attending the National Guard and
Reserve Units have reached veterans that other outreach activities did not,
88.5 percent of the veterans seen state that they learned about the program
via a social work staff briefing at their unit meeting. Social Work Service
has also communicated with the various military services to facilitate
referral of Persian Gulf veterans to the program as they are discharged
from active duty service.
Question 25:
The Persian Gulf Family Support Program (PGFSP), in FY 1993,
provided 12,648 counseling sessions to a total of 17,152 attendees.
Outpatient visits totaled 14,547 at VAMCs which received special funding
and additional staffing and 6,895 at the other VAMCs for a total of 2 1 ,442
at all VAMCs. Outreach activities to National Guard and Reserve Units
were considerable and approximately 63,392 veterans were in attendance
at these sessions. A total of 120,597 public service announcements were
made via newspaper, radio and television informing the public of the
program and serving as another outreach mechanism.
Authority under P.L. 102-405 to provide marriage and family
counseling services expires September 30, 1994. Funding is available to
continue providing the additional social work staffing to VAMCs through
September 30, 1994. After that date, veterans who continue to require
marriage and family counseling services and who are eligible will
continue to be seen via Mental Health Clinic Programs, Social Work
counseling services and other programs available at the VAMCs.
What information is needed to establish a diagnosis of Persian
Gulf War Syndrome with chemical/biological exposure? What tests are
used to establish this diagnosis?
Answer:
Efforts are currently underway at the Birmingham VA Medical Center to
provide for the neurological examination of veterans to determine if their
neurological impairments, if any are detected, are analogous to those
which might be experienced from exposure to chemical/biological agents.
235
Through the research, health surveillance and other efforts previously
discussed, VA and other concerned Federal agencies are attempting to
define the health problems unique to the Persian Gulf. There are no tests
which have been shown to provide an overall diagnosis of the effects of
exposure to such agents.
Question 26: Which agencies or individuals has VA contracted with to provide a
diagnosis for Persian Gulf veterans for whom it has not been able to
establish a VHA recognized diagnosis? How many veterans has VA
referred to these contractors? What diagnoses have these contractors
provided?
Answer: VA's Houston Persian Gulf Referral Center currently utilizes the
services of Dr. Claudia S. Miller, M.D., M.S., Assistant Professor,
Environmental and Occupational Medicine, located at the University of
Texas Environmental Health Center in San Antonio, Texas. Dr. Miller is
employed part-time by VA to provide the necessary expertise in
identifying and diagnosing conditions possibly associated with multiple
chemical exposures. Dr. Miller has identified four veterans as having
possible multiple chemical sensitivity (MCS), but these diagnoses have
not yet been confirmed as valid MCS cases. The special knowledge and
skills available to V A through the services of Dr. Miller are not generally
available at other VA facilities.
Question 27:
Answer:
Question 28:
VA has not entered into a contractual arrangement, at this time,
with other outside agencies or individuals for the purpose of providing a
specific diagnosis for any adverse Persian Gulf-related health conditions.
Nevertheless, through its own internal review of Persian Gulf health
issues, planned Persian Gulf-related research via VA "Environmental
Research Centers," establishment of a chartered Persian Gulf Advisory
Committee, a pilot neurological testing program at the Birmingham VA
Medical Center, its contract with the National Academy of Sciences for a
scientific review of the possible adverse health effects of Persian Gulf
service and its cooperative endeavors with DoD and other concerned
Federal Departments, VA will continue to seek the diagnosis of conditions
presented by some Persian Gulf veterans. As noted in previous responses,
VA believes that in most instances, the adverse health conditions of
Persian Gulf veterans have been diagnosed and the appropriate medical
care has been provided.
Under what conditions or circumstances has or will VA contract
with another agency or individual to provide a diagnosis for Persian Gulf
veterans for whom it has not been able to establish a diagnosis?
VA would only contract with another agency or individual when it is
determined that such referrals would be medically efficacious and that
there is a reasonable expectation that a valid diagnosis could be reached
by such referral.
Which part or parts of VA's Persian Gulf War Veterans Health
Registry medical exam have proven to be particularly useful for
determining: occupation exposures; insect bites; infectious diseases;
exposure to chemical and/or biological agents; consumption of
contaminated food or drink; pesticide exposure; exposure to other
environmental agents during service in the Persian Gulf War theater of
operations?
Answer:
VA's Persian Gulf War Veterans Health Registry provides veterans
with a general physical examination of their current health status.
Standardized tests are made available for this purpose (e.g., enzyme tests,
blood/urine tests, chest x-rays and other tests as medically indicated by the
examining physician. The examination is holistic in that the physician
236
attempts to arrive at a medical diagnosis using the results of such tests in
addition to the usual medical inquiry and "hands-on" examination
processes.
Question 29: Describe the results of VA contacts with Dr. Edward Hyman since
June 9, 1993, concerning his treatment for Persian Gulf veterans.
What information has VA requested Dr. Hyman provide concerning
his treatment for Persian Gulf veterans, when was this information
requested and has Dr. Hyman provided the information VA requested?
Please evaluate Dr. Hyman's treatment methods?
Answer: Prior to June 9, 1993, VA made several requests to Dr. Hyman for
his proposed Persian Gulf-related "chronic fatigue" research protocol.
Despite such requests, the protocol was never provided to VA.
Dr. Hyman indicated that the protocol was not finalized and essentially
indicated that he did not wish to share this information with anyone else.
VA invited Dr. Hyman to lecture clinical staff at the New Orleans VA
Medical Center concerning his treatment methodology. He declined to do
so on the basis that he was involved in other activities and did not have
any interest in working with the medical center. VA has had no further
contacts with Dr. Hyman concerning his proposed research protocol. The
only other contact with Dr. Hyman involved one of his patients who
requested medical care at a VA facility. The medical center requested any
medical information which Dr. Hyman could share concerning the
patient's medical history and treatment. Dr. Hyman refused to share any
medical information with the medical center on that patient and indicated
at that time that if the veteran continued to visit the VA facility he would
no longer provide care to that individual. The patient subsequently
elected to return for care from Dr. Hyman rather than receive medical
treatment from the VA.
Question 30: What progress has been made by VA since June 1993,
determining the cause or causes of the hard to diagnose health problems
reported by some veterans with service in the Persian Gulf theater?
Answer: VA is continuing its intensive efforts to determine the possible
causation of adverse health conditions presented by some Persian Gulf
veterans. A number of suspected environmental exposure/experiences
have been identified and are being investigated by VA, in concert with the
DoD and other concerned Federal Departments, as possible causative
agents for some of the illnesses reported by Persian Gulf veterans (e.g.,
exposure to oil, smoke, smoke byproducts, multiple chemical sensitivities,
microwaves, parasites, inoculations, depleted uranium munitions, mustard
gas/nerve agents, etc.). However, preliminary results of such efforts to
resolve the extremely complex medical and research issues involved are
not definitive. Nevertheless, VA believes that it has made good progress,
as discussed in previous responses, in initiating the process which may
ultimately assist in resolving these issues.
237
QUESTIONS SUBMITTED BY
HONORABLE JILL LONG
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
COMMITTEE ON VETERANS' AFFAIRS
HEALTH CARE PROBLEMS AND CONCERNS OF PERSIAN GULF WAR
VETERANS: THE RESPONSE OF THE DEPARTMENT OF VETERANS AFFAIRS
AND THE DEPARTMENT OF DEFENSE AND RELATED ISSUES
NOVEMBER 16, 1993
Question 1: Two separate registries are used to track the health of members of
the armed services who served in the Persian Gulf— the VA Persian Gulf
Veterans' Health Registry and the DoD Persian Gulf Registry. The Office
of Technology Assessment (OTA) was somewhat critical with the lack of
coordination and standardization between these two registries. What steps
has the OVA taken to ensure veterans on active duty have the opportunity
to enter the VA Registry? Also, do the two registries now use
standardized codes to identify the service member's race/ethnicity and
service member's unit name? Has a joint VA/DoD permanent oversight
group with responsibility for both registries been established?
Answer:
VA is currently cooperating closely with the DoD to ensure
conformity and integration, where possible, of the respective registry
databases of each Department. V A has advised the DoD that it is prepared
to include active duty military personnel in its Persian Gulf War Veterans
Health Registry. Active duty personnel may submit examination
information and completed code sheets prepared by military physicians to
the appropriate VA medical center for inclusion in VA's registry database.
When an appropriate referral is made by a military medical facility, VA
will provide the examination and again, include medical and demographic
data obtained from the examination process in the registry. When active
duty personnel are referred to the VA facility for the examination, a
billing is made to the military for that examination. The administrative
process for the above procedures is already in place between the VA and
the DoD for such referrals.
Question 2:
As regards the establishment of a joint VA/DoD permanent oversight
group with responsibility for both registries, VA and the DoD are
reviewing possible alternatives including utilization of the Persian Gulf
Advisory Committee for which VA recently received charter approval. It
is believed that this Committee, which will include scientific and technical
representatives from both the Federal and the private sectors, would have
the necessary expertise to provide oversight of VA and DoD registries.
The OTA Report indicated that it would probably be beneficial for
each item on the VA form to be reviewed with DoD to assure consistency
and to evaluate the need for collection. Do you plan to implement this
suggestion?
Answer:
Yes. VA has discussed this issue with the DoD and both
Departments are prepared, where possible, to take necessary steps to
ensure consistency in the respective registry databases. Copies of VA's
registry policies and procedures, including diagnostic code forms have
been provided to the DoD for its information and review. Both
Departments will continue to work closely together and with the OTA in
our mutual efforts to integrate registry demographic and clinical data.
238
Response to questions submitted by Honorable Lane Evans,
Chairman Subcommittee on Oversight and Investigations
Committee on Veterans' Affairs
Health Care Problems and Concerns of Persian Gulf War
Veterans:
The Response of the Department of Veterans Affairs and
the Department of Defense and Related Issues.
November 16, 1993
Questions for Dr. Myra Shayevitz
Director
Cardiopulmonary Laboratory, Pulmonary Rehabilitation
Program and Environmental Physician
VA Medical Center Northampton, MA
January 7, 1994
1 . During your appearance before the subcommittee you suggested a grand or
unifying theory to explain the hard to diagnose health problems reported by some
Persian gulf veterans and their family members. If possible, please elaborate on this
possible explanation.
Multiple Chemical Sensitivity syndrome consists of multiple symptoms occurring in
multiple systems and organs of the body as a result of exposure to a wide variety of
chemicals most commonly, petrochemicals or pesticides ; the initiating event is
frequently accompanied by exposure coupled with unusual stress. One theory holds
that each individual has a total tolerable load of chemical, physical, and emotional
stress, and when that load is exceeded, this syndrome may occur. One may postulate
that the stress of the Desert Storm conflict coupled with the petrochemical/pesticide
exposures there ,may well have resulted In this syndrome's occurrence In susceptible
individuals. Furthermore, the National Research Council estimates that up to 15% of
the United States population may be affected and therefore we could expect to see
this problem In the spouses of some veterans.
The most logical explanation lies in the fact that although one end of the nerve of
smell ( the olfactory nerve) lies In the nose, the other end lies in the brain . In 1985,
Shipley showed that many environmental chemicals enter the central nervous system
via this pathway. ( see reference below). The olfactory nerve connects directly with
the hypothalamic/ limbic systems, the focal point In the brain which governs the
interaction between the Immune, autonomic nervous and endocrine systems, the
area of the brain which governs emotions, food cravings. Immune function, digestive
and metabolic activities of the gastro Intestinal tract and reproduction. It Is exactly in
those areas In which we see the symptoms of the Gulf War Veterans.
Once this syndrome occurs, the brain cells in the hypothalamus/limbic area become
"kindled" or sensitized. The sensitivity generalizes from the original agents to low doses
of chemically unrelated substances such as perfume, alcohol, common foods ( foods
are themselves mixtures of organic chemicals) , tobacco smoke, auto exhaust,
newsprint, previously tolerated medications and household cleaning chemicals. The
smallest exposure "triggers" an amplified neuronal response In the brain and the
syndrome is perpetuated.
The incitants are in such common usage that our veterans are literally always at risk of
exposure. It is for this reason that the treatment consists of long-term avoidance of
triggering substances to facilitate gradual improvement. The longer this syndrome is
allowed to go untreated, the more environmental incitants perpetuate It, the harder
it is to control, and the more likely it Is that patients become chronically disabled
leading to high individual and societal costs from lost productivity, social isolation and
239
health care requirements. I therefore recommend establishing a treatment program
as soon as possible .
Also noted is that the sensitizing effects of the chemical overload experienced by our
veterans, does not preclude direct toxic effects of chemicals on brain or other organ
function, nor the presence of concomitant infections or malignancies due to altered
immunity or other abnormalities such as altered function in body detoxification
systems.
2. What problems are Gulf Veterans still having getting treatment from VA?
Although each veterans hospital has a designated environmental physician, no training
in environmental medicine has been instituted. No literature delineating the
treatment of Multiple Chemical Sensitivity Syndrome has been distributed and there
have been no formal training programs. Because of this, the above explained
hypothesis has not been tested and treatment has not been instituted. In fact, at the
present time, there is not only a lack of physician education, there are no
environmentally safe areas in VA facilities for examination and treatment.
3. What else should VA be doing to identify the cause (s)of Gulf veterans health
problems?
1. A pilot clinical treatment program such as outlined by Northampton VAMC
which will test a treatment hypothesis and gather invaluable clinical data.
2. Challenge testing under controlled conditions.
3. Testing of all symptomatic veterans for those abnormalities commonly
found in MCS patients e.g. blood tests for toxic organic chemicals, highest
resolution Spect Scans or PET Scans before and after chemical challenge,
Quantitative EEC before and after chemical challenge, Blood vitamin and
intracellular mineral levels, immunotoxicoigy panels, and tests of cognition.
Furthermore, these should be done by highly experienced laboratories and
personnel.
4. What changes should be made in the VA 's Persian Gulf Registry program and
examination?
1 . There should be a standard questionnaire addressing the following:
• The exact exposure history including types and locations.
symptoms
• Home environment: type heat, presence of mold, dust, new furniture or
carpets, location ( e,g, near a gasoline station?) location of bedroom ( e. g.
above the garage)
• Work history and Environmental history : before during and after
the gulf specifically relating to any chemical or combustion products.
• Hobbies as they relate to above.
• Smoking , Allergy and Alcohol history
•Past history and Family history especially as it relates to asthma and allergies as
well as other medical and surgical illnesses and reproductive problems.
240
•Survey for Environmental triggers: e.g. symptoms exacerbated by pumping
gas, going into malls, carpet stores etc. Temporal and location relationship
of symptoms.
•Dietary survey to detect food sensitivities.
2. There should be chemically clean areas for examination.
3. There must be adequate time budgeted for educated physicians to evaluate
these patients.
4. There should be an inter-disciplinary team which can help the patient with
education in understanding his disease and avoiding incitants, proper diet,
exercise, psychological support, family therapy and education and vocational
counseling.
5. There must be adequate funding for an expanded protocol of lab investigation
as described above.
6. Adequate funds must beallotted for the high quality nutritional
supplements usually required and prosthetic devices such as protective masks
and air purifiers.
References Olfactory Limbic Theory:
!• Shipley, M.T. ( 1985): Transport of Molecules from Nose to Brain.. Brain Res Bull.
15:129-142
2-Bell,l.R., Miller.C.S. et al (1992) An Olfactory Umbic Model of Multiple Chemical
Sensitivity Syndrome: Possible Relationships to Kindling and Affective
Spectrum Disorders . Biological Psychiatry. 32:218-242
3-Burchfiel, James L, Duffy, F.K. et al " Persistent Effects of Sarin and Dieldrin Upon
primate EEG " Toxicology and Applied Pharmacology Vol 35 P 365-379
'*• Bell l.R. ( 1993) Possible Time-Dependent Sensitization to Xenobiotics :
Self-Reported Illness From Chemical Odors Foods, and Opiate Drugs in a
an Older Adult Population Archives of Environmental Health Vol48 No. 5
P.3 15-327
241
Responses to questions from the Honorable Lane Evans from the recent
hearing held by the Subcommittee on Oversight and Investigation on Health
Care Problems and Concerns of Persian Gulf War Veterans conducted on
November 16, 1993. The American Legion submits the following responses.
Question 1: What problems are Gulf War veterans still having getting
health qare from VA?
Answer: As a result of visits to over 30 different Department of
Veterans Affairs Medical Centers, we have found that most Persian Gulf
veterans are having problems just getting scheduled for an initial exam.
There is no continuity within the VA for treating Persian Gulf veterans.
Many VAMCs tell veterans they must first be placed on the Registry
before they can receive treatment. This causes a major problem. Veterans
must first complete the administrative process and then be scheduled for a
medical exam. Since many VAMCs use contract physicians to conduct the
initial exam, only a few exams are scheduled per week. Getting on the
Persian Gulf Registry can take up to 6 months to a year. Once this entire
process has been completed, veterans are "Officially on the Registry."
Then and only then can veterans receive treatment for the medical problems
they are experiencing.
In The American Legion's view, this process is cumbersome, time
consuming and inefficient for placing over 200,000 Persian Gulf War
veterans on the Registry. Further, it is evident that the Department of
Veterans Affairs has not provided the policy guidance to implement their
own programs. There is no standard or continuity from one medical center
to another (one hospital may have several persons assigned to work on the
Persian Gulf Registry and another might have a person assigned in name
only) . The Secretary must place a higher priority on the Registry and
make each medical center director responsible for "its success.
Also, VA staff must recognize that "Persian Gulf Syndrome" exists and
that certain medical problems are associated from service in the Gulf. In
summary, problems related to medical treatment are:
access to care
not being treated until they are "Officially on the Registry"
physicians not being able to make a diagnostic decision
being denied or rated 0-10% for some minor unrelated injury
not being advised by VA that a registry exists
little or no follow up care provided by VA
recognizing that "Persian Gulf Syndrome" exists
The American Legion feels that due to the lack of consistency, the
Registry program is not working and causing many problems among both staff
and veterans.
Question 2 : Are VA staff knowledgeable about the Registry program and
what problems are veterans having with VA's Registry program?
Answer: Very few personnel at VA's medical centers have knowledge of
the program. In most cases, the Registry is assigned to low grade staff
in Medical Administrative Services. This assignment is usually an
additional assignment and not part of the persons JOB DESCRIPTION.
Very little outreach is conducted. No PUBLIC MEDIA/SERVICE
announcements are made and there is very little support from the director
to make this a high profile program. Many veterans have lost faith in the
Department of Veterans Affairs after one or two disappointing visits to a
medical center. Most staff members do not recognize the fact that these
242
veterans are indeed ill. In fact, many veterans are told they are
perfectly healthy. There is little effort to help find a solution in both
medical practice and in staff attitude.
Recommendation : A job description should be assigned to the staff
that is designated as the "Persian Gulf Coordinator." This person
should work full-time maintaining the program.
Question 3: Are most Gulf veterans, including servicemembers still on
active duty and reservists, aware of VA's Registry program?
Answer: Very few veterans are aware that the Department of Veterans
Affairs has a Persian Gulf Registry. Of the thirty or so medical centers
in the Eastern and Central Region that we visited, the average number of
veterans that have completed both portions of the exam (administrative and
medical) totalled about 15-20, with a low of 6 and a high of 70. These
numbers are a clear indicator that the program is not working and that the
word is not getting out. DoD does not inform departing servicemembers
about the Registry. Most veterans learn about the program through
friends, relatives, the media and Veterans Service Organizations.
Recommendation : VA should work closely with VET Centers and
establish an outreach program. DoD provided VA with the names of
657,000 servicemembers who served in the Gulf. Veterans need to
hear from an official government source (DoD and VA) about the
Persian Gulf Registry. Veterans must be encouraged to participate
whether they are ill or not.
Question 4: What special problems are Persian Gulf War veterans having
with VA claims adjudication?
Answer: The main problem in the area of claims adjudication is that
very few veterans are successful in having a claim allowed. The VA does
not recognize disabilities associated with "Persian Gulf Syndrome." Also,
the lack of a comprehensive physical exam is a contributing factor.
Until Congress or the Department of Defense determines what disabilities
are recognized as service-connected, many veterans have no alternative but
to seek medical help and compensation from outside sources.
To get a claim filed a veteran must have a compensation and pension
medical exam to determine , if, in fact, the disabilities are
service-related. Only then can a veteran proceed with the adjudication
process.
243
QUESTIONS SUBMITTED BY
HONORABLE LANE EVANS, CHAIRMAN
SUBCOMMITTEE ON OVERSIGHT & INVESTIGATIONS
COMMITTEE ON VETERANS' AFFAIRS
HEALTH CARE PROBLEMS AND CONCERNS OF
PERSIAN GULF WAR VETERANS:
THE RESPONSE OF THE DEPARTMENT OF VETERANS AFFAIRS
AND THE DEPARTMENT OF DEFENSE AND RELATED ISSUES
NOVEMBER 16, 1993
QUESTIONS FOR MAJOR GENERAL RONALD R. BLANCK
COMMANDING GENERAL
WALTER REED ARMY MEDICAL CENTER
DEPARTMENT OF DEFENSE
[Congressman Evans letter of December 1, 1993]
1 . Compare the health status and health problems of Persian Gulf War theater veterans to
Persian Gulf War era veterans with no service in theater.
An epidemiological study with appropriate samples from the cohorts of Persian
Gulf War-era veterans who deployed and Persian Gulf War-era veterans who did not
deploy has not been performed to date by the Department. The Department is waiting on
the findings of the reviews by the Defense Science Board Task Force on Gulf War Health
Effects and the National Academy of Sciences to determine if such a study is to be
conducted.
The Department of Veterans Affairs has created tabulations on discharge
diagnoses for 6,092 Persian Gulf veterans and 6,265 Persian Gulf era veterans. The
tabulations represent primary diagnoses from inpatient visits, with some veterans having
more than one inpatient stay. A preliminary review of these data show essentially no
differences except in the area of mental disorders with alcohol/drug dependence and
adjustment disorders slightly higher for deploying Persian Gulf veterans.
2. The Army reported contracting for the services of a civilian physician of international
stature to assemble a task force of civilian experts and mihtary specialists to review a
large number of clinical case histories of Gulf War veterans with ill-defined health
problems. Who are the members of this task force and what has been gained from this
review?
The Army contracted with Jay Sanford, M.D., internationally published and
renowned expert in infectious diseases and former President of the Uniformed Services
University of the Health Sciences, Bethesda, MD, to assess clinical case histories of Gulf
244
War veterans. The goal is to attempt to define a standard symptom complex to aid
physicians in diagnosis as well as to suggest possible fruitful areas for research.
Dr. Sanford has completed his review and submitted his preliminary findings to
DoD on January 27. The results of his study have been reviewed by DoD and VA
physicians. With some modifications to the criteria, they hope to implement an interim
case definition in the very near future.
In May, the Interagency Coordinating Board is sponsoring a conference at NIH to
review research results and clinical data. They will attempt to develop a full case
definition at the conference.
3. Which other coalition Persian Gulf veterans have been reported to have ill-defined
health problems?
The Department of Defense does not currently have official information from the
Coalition Forces on this subject. While unofficial inquiries indicate no other coalition
force's veterans are exhibiting symptoms characteristic of our veterans, we intend to make
official inquiries. Dr. Pearson, a representative from the United Kingdom and a member
of our Defense Science Board Task Force on Gulf War Health Effects, has stated that no
members of his country's military who served in the Persian Gulf are experiencing any
problems that can be characterized as undiagnosed illnesses. A private attorney in the
United Kingdom met with Senator Shelby and claimed to represent 50 individuals who
have such symptoms but will not release the names or case descriptions.
MG Blanck accompanied Senator Shelby on two fact-fmding trips to our coalition
forces November 28-December 5, 1993 and January 3-15, 1994. MG Blanck states in his
trip report the following:
- The Czech Republic has medically evaluated 23 (of 200) Persian Gulf
veterans and none had symptoms related to service in the Persian Gulf Seven
are still being evaluated for conditions which are not believed to be due to
Persian Gulf service.
- Of the Persian Gulf veterans in Great Britain who have reported health
complaints, all had normal diagnoses with nothing unusual due to service in
the Persian Gulf.
- The French are unaware of any service personnel with symptoms similar to
that described by US veterans.
- Both Saudi Arabian and Israeli representatives (although not a coalition member,
Israel has significant intelligence resources and medical knowledge of the
Middle East) are not aware of any unusual illnesses in any of the populations
(military and civilian) of Saudi Arabia or in Kuwait. Israel also is not aware of
any unusual illnesses in the population of Iraq.
- Syria reports no unusual illnesses during or after the war for its Persian
Gulf veterans.
- Egypt reports no illnesses in Egyptian forces who served in the Persian Gulf and
are not aware of illnesses in any other Middle East forces who served.
245
4. Was any U.S. service member ordered not to report detection of chemical warfare
agents in the Persian Gulf War theater? Biological Agents?
DoD is committed to full and open discussion of all information that may relate to
the health problems of Persian Gulf War veterans. We are not aware of any case in which
a service member has been ordered not to disclose possibly relevant information.
5. What would be necessary for DoD to confirm Czech reports of the presence of Sarin?
How has DoD attempted to confirm Czech reports of chemical warfare agents in the Gulf
theater of operations and what has DoD learned? What else could DoD do to attempt to
confirm these reports?
The Czechs reported detecting low concentrations of Sarin in vapor form, during a
period of about 40 minutes. Confirmation would have entailed a U.S. unit being present
nearby during that time making the same identification, or a sample being taken for later
confirmation in an independent laboratory capable of making and recording the
identification. By the time U.S. units were able to get to the reported detection site, no
agent could be detected; the Czechs took no sample for independent laboratory analysis.
DoD has met with the Czechs and discussed their oral accounts of their
detections, which are credible; their technical procedures, which are valid; and performed
a visual analysis of their equipment, which is capable of making the identification they
describe.
DoD has arranged to examine the items of detection equipment used by the
Czechs, and submit them to laboratory performance tests. These tests will better define
the capability of the equipment, but will still not enable DoD to confirm the Czechs'
findings in theater. However, we have accepted their reports as valid.
6. How has the U.S. attempted to determine if chemical/biological warfare agents were
detected by any other coalition force(s) in the Gulf War theater of operations and what
was learned from these efforts?
DoD has requested this information from coalition members as part of our overall
investigation; we are still awaiting replies from several of these formal requests. Our
informal discussions indicate that the Czechs and the French are the only forces who
reported valid detections in the theater of operations.
246
7. The Subcommittee understands the M8AI Chemical Agent Alarm detects the presence
of a nerve agent in 25 seconds or less, but the M256A1 Chemical Agent Detector Kit,
used to confirm M8AI Chemical Agent Alarms, requires 25 minutes to confirm or deny
the presence of a nerve agent-
Why does the M256A1 Chemical Agent Detector Kit require 25 minutes to confirm or
deny the presence of a nerve agent detected by an M8AI Chemical Agent Alarm in 25
seconds or less?
The M8A1 Chemical Agent Alarm is an electronic ionization detector designed to
give early warning of the presence of nerve agent vapor, so that troops can put on
protective masks. The M256A1 Chemical Agent Detector Kit uses a variety of wet
chemistry reactions, and is intended for use by troops already in protective gear to
confirm the presence and identity of chemical agent. The M256A1 is much more
sensitive and selective than the M8A1, and can identify other types of agents in addition
to nerve agent. The full suite of tests contained in the M256A1 kit takes about 25
minutes, but the specific tests for nerve agent only require 15 minutes. The time is
required for some of the chemical reactions to occur that indicate by color change the
presence or absence of nerve agent.
Cite the advantages and disadvantages of using the M256A1 Chemical Agent Detector
Kit to confirm of deny the presence of a nerve agent.
The M256A1 supplements automatic alarms by permitting the local commander
to determine if the level of chemical agent in his area is at or below the threshold levels
that can cause degradation in troop performance. It is more sensitive and selective than
the MSA 1 alarm, and also allows for confumation of other chemical agents (blister and
blood agents) as well as nerve agents. Operation of the kit is not instantaneous, but users
are already in protective gear when operating this kit.
Compare the reliability of the M8AI Chemical Agent Alarm and the M256A1 Chemical
Agent Detector Kit.
The mechanical reliability of the M8A1, and the sensitivity and selectivity
performance of both the M8A1 and the M256A1 meet the Army requirement for
chemical warfare detection equipment. Their reliability is not directly comparable, as one
is an electronic device and the other is a small, self-contained chemistry set. However,
the M256A1 is more sensitive and selective than the M8A1.
247
8. Please explain the failure of U.S. personnel to confirm any M8AI chemical agent
alarms.
If no M8A1 chemical agent alarms were confirmed as Under Secretary Deutch has stated,
were M8A1 chemical agent alarms, the procedure used to confirm the M8A1 chemical
agent alarms or both highly unreliable?
The lack of confirmation of chemical agent presence following an alarm does not
indicate unreliability of either the equipment or the procedure; rather, the equipment and
the verification procedures complemented each other as designed. Part of the design
trade-off for having a sensitive and rapid-acting detector to provide early warning is that
it is inherently more sensitive to a wide range of interferents. The field procedure calls
for using a detector of different technology (usually the M256A1) to confirm the
presence of a nerve agent; this is designed to "filter" those alarm events caused by some
substance other than nerve agent.
What other possible explanations can you offer for the failure to confirm any M8AI
chemical agent alarms?
There are only two explanations for an M8A1 alarm event followed by negative
result of an M256A1 check:
(1) nerve agent was not present and the M8A1 alerted to some other substance
(2) nerve agent was initially present in a concentration sufficient to set off the
M8A1, dissipated so quickly as to be undetectable by the more sensitive
M256A1, while never reaching a concentration sufficient to cause human
symptoms.
We believe the first of these two possibilities to be more probable. The M8A1 is known
to false alarm to high concentrations of other substances found in a battlefield
environment, while the M256A1 kit is not typically sensitive to the same interferents.
The second scenario is extremely unlikely, because the M256A1 is 10-100 times
more sensitive to nerve agent than the M8A1 . If an alarm was set off due to a low level
of agent from a distant source, the subsequent use of the more sensitive detector kit
would be able to detect presence of agent at levels far below that necessary to have
initially set off the alarm. If a nearby attack had resulted in vapor concentration sufficient
to set off the alarm, it probably would have also caused concentrations sufficient to cause
acute symptoms in troops; the fact remains that no troops were reported to have died or
shown acute symptoms from nerve agent.
9. Describe the methods used by U.S. forces to detect the presence of biological agents in
the Gulf theater of operations and report what was learned.
U.S. forces operated air sampling devices to collect possible airborne hazards, and
had the capability to detect the presence of anthrax and botulinum toxin in soil samples or
in air sampler residues using monoclonal antibody "dipstick" test kits. Fifteen teams
248
were deployed by the Army to collect and analyze samples, and US Navy assets were
also configured and deployed for biodetection and identification of other possible
biological warfare materials.
Additionally, Army specialists provided consultation and hands-on assistance to
UK, Canadian, and French allies. The UK and Canada developed and deployed
reconnaissance vehicles, each of which included an air sampler, a particle sizer and
various antibody-based tests (immunoassays). The French also deployed with antibody-
based tests for BW agents with assistance from U.S. Army research facilities.
No evidence was collected by any BW detection means, or through normal
medical diagnostic channels that indicated Iraqi use of biological warfare.
10. Are the hard to diagnose health problems reported by some Gulf War veterans
communicable or possibly communicable?
Although we are unsure of the causes of the hard to diagnose health problems
being reported by Persian Gulf War veterans, there is not a pattern of illnesses being
demonstrated that strongly suggests a communicable disease cause for the illnesses. The
Department has not excluded communicable diseases as a mechanism at this time.
1 1 . What evidence will be considered by the independent panel Defense Under Secretary
Deutch reported will examine the issue of chemical warfare agents in the Gulf War
theater? Has DoD previously considered all evidence which will be considered by this
panel? What evidence will this panel consider which has not already been considered by
DoD? How will this additional evidence be obtained?
DoD is providing detailed briefings and data to the Defense Science Board Task
Force on Gulf War Health Effects task force on information compiled to date. We are
also arranging for briefings to be given by other individuals or agencies that can present
information that the task force deems relevant. The agendas of the task force meetings
are structured in line with the requests of the task force members. As independent
researchers, these doctors and scientists have many other sources at their disposal beyond
the DoD, and are considering information gained by all sources.
12. Describe the research currently being conducted and/or supported by DoD to identify
the cause or causes of the hard to diagnose health problems reported by some Persian
Gulf veterans.
A listing of the investigational activities being conducted by the Department is
provided.
249
13. Should an epidemiological study of all Persian Gulf War veterans be conducted?
Does DoD support such a study?
DoD and VA have mutually entered into a contract with the Medical Follow-up
Agency, a division of the Institute of Medicine in the National Academy of Sciences, to
address this issue. In addition, the Defense Science Board Task Force on Gulf War
Health Effects is evaluating available data to assist in developing a decision about the
advisability of specific types of epidemiological studies.
14. How many Persian Gulf veterans have been determined to be permanently or
temporarily unfit for military service? What are the most frequent cause (s) of this
determination?
The Services' Disability Boards are currently reviewing the records of individuals
whose fitness for duty have been evaluated. To date, of the 3,014 cases reviewed, 2,386
have been found to be permanently or temporarily unfit for military service. The most
frequent diagnoses listed for those found unfit for military service include arthritis, back
pain, extremity problems, psychiatric problems, and cardiovascular disorders.
15. Describe DoD's contacts with Dr. Edward Hyman since June 9. 1993. concerning
treatment for Persian Gulf veterans.
What information has DoD requested Dr. Hyman provide concerning his treatment for
Persian Gulf Veterans, when was this information requested and has Dr. Hyman provided
the information VA requested? Please evaluate Dr. Hyman's treatment methods. Does
DoD consider this treatment to be investigational?
Upon public revelation of his findings. Dr. Hyman was contacted by DoD. He
refused to provide any records or data, stating a basic distrust of the military's intent. Dr.
Hyman later agreed to have a reputable physician personally visit him and review his
data. Dr. Sanford traveled from Texas to Dr. Hyman's office and reviewed all pertinent
records. It is Dr. Sanford's opinion that his data and methods are not spurious and are
worthy of further investigation. We are currently working with the V A to see if other
patients under a mutually acceptable protocol, could be evaluated by Dr. Hyman. We
consider Dr. Hyman's work investigational but worthy of further evaluation.
16. What cause or causes has DoD ruled out for the hard to diagnose health problems
reported bv some Gulf War veterans?
The Department has not eliminated any potential cause from consideration in its
investigations into the causes of the illnesses among Persian Gulf War veterans.
250
17. What progress has been made by DoD since June. 1993. determining the cause or
causes of the hard to diagnose health problems reported by some veterans with service in
the Persian Gulf theater?
There has not been any significant new information since June 1993 which would
allow the Department to determine the cause or causes of the hard to diagnose health
problems being experienced by some Persian Gulf War veterans.
Since June 1993, the Army Environmental Policy Institute has drafted the
depleted uranium report; the Army Environmental Hygiene Agency has drafted the
Kuwait Oil Fire Report, the Medical Follow-up Agency, a division of the Institute of
Medicine in the National Academy of Sciences, has convened on Persian Gulf War health
issues; the Defense Science Board Task Force has met several times to review these
issues; Dr. Sanford's group has completed its review of medical records of some Persian
Gulf War veterans with unexplained illnesses; independent investigators in multiple
chemical sensitivities and infectious disease are developing research efforts; and the
special surveillance program for reporting chronic conditions relating to service in the
Gulf has collected more reports.
18. Which health problems are veterans with Persian Gulf War theater service
experiencing more frequently than Persian Gulf era veterans without service in the theater
of operations?
An epidemiological study with appropriate samples from the cohorts of Persian
Gulf War-era veterans who deployed and Persian Gulf War-era veterans who did not
deploy has not been performed to date by the Department. The Department is waiting on
the findings of the reviews by the Defense Science Board Task Force on Gulf War Health
Effects and the National Academy of Sciences to determine if such a study is to be
conducted.
The Department of Veterans Affairs has prepared tabulations on discharge
diagnoses for 6,092 Persian Gulf veterans and 6,265 Persian Gulf era veterans. The
tabulations represent primary diagnoses from inpatient visits, with some veterans having
more than one inpatient stay. A preliminary review of these data show essentially no
differences except in the area of mental disorders with alcohol/drug dependence and
adjustment disorders slightly higher for deploying Persian Gulf veterans.
19. Which biological warfare agent(s) did U.S. service personnel detect the presence of in
the Persian Gulf War theater of operations?
U.S. and coalition forces did not detect the presence of any biological warfare
agent.
251
20. Has DoD interviewed service members who have reported thev believe they were
exposed to and/or detected the presence of CW/BW agents? When will this be done?
DoD is interested in any service member's account of possible chemical/biological
agent detection or exposure. In some cases, service members have been interviewed to
determine if they knew of information that would be useful in helping to resolve the
Persian Gulf health problem. In many cases, however, sufficient information has been
gained from written accounts or public record testimony, and further interviewing has
not, to date, seemed necessary. Congressional members or staffs who know of cases that
they deem credible are encouraged to provide them to DoD for follow-up.
21.1 have been informed by VA staff (Dr. Mather) that they first learned of the Czech
detections through Senator Riegle's staff last summer. When was DoD first told of these
detections?
We were aware of several of the Czech detections (those that were reported
through Central Command) during the war; they were discounted at the time due to the
lack of confirmation, no casualties, and no indications that the detections were in
association with any military activity. Attention was recently re-focused on the incidents
when the Czechs made a press release in July 1993 announcing that their detachments
had made detections during the War. Following the interest of Congress in the incidents,
DoD dispatched a team to investigate.
If DoD is fully cooperating with VA. why wasn't the Department informed that there was
potentially credible evidence indicating that chemical weapons might have been used in
the Persian Gulf?
While we consider the detection events credible, we do not beUeve that they
indicate that chemical weapons were used by Iraq. The Czechs themselves discount the
possibility that the detections were due to Iraqi military activity.
Are there any other detections that VA has not been informed about?
DoD has not yet determined any other reported detection incidents to be credible.
During the war, we were aware that the French had reported detections to the Saudis but
there were no confirmations and no reported physical symptoms of chemical agent
exposure in any of the troops present. CENTCOM logs do record one French detection
on January 21, 1991 but there was no reported confirmation. Senator Shelby was
informed of the French detections during his recent fact finding trip to the Coalition
countries. We are planning to formally request additional information from France on
their detections. VA will be informed if any detections are determined to represent
possible exposure to U.S. troops. A representative from VA is a full participant in the
Defense Science Board Task Force on Gulf War Health Effects that is studying this and
other issues.
252
22. While I understand that there were no independent confirmations of the Czech
detections. I am troubled that DoD failed to fully investigate the credibiHty of the Czech
reports until this Fall. Why did it take DoD so long?
There was no reason to investigate the reporting, in that it had been checked out
by CENTCOM and the official reporting of the incident indicated that the US military
had determined the Sarin reporting as a false positive. There were many such false
positives during the war. There was no hostile military action associated with the timing
of the Czech reports, and there were no other reports of the chemical agents made by
units contiguous to the Czech positions. In short, it appeared at the time that they had
simply had a false positive report.
23. Recently. DoD issued medical discharges for several service personnel based on
medical chemical sensitivities. This appears to reverse DoD's previous pattern.
What was unique about these men and women? How did their symptoms differ from
those of other ill service personnel who served in the Persian Gulf?
The U.S. Army has medically retired only one soldier for a diagnostic impression
of Multiple Chemical Sensitivity (MCS). This case was adjudicated prior to DoD's
guidance regarding the management of cases such as these. This soldier was placed on
the Temporary Disabihty Retired List with a reevaluation scheduled in July 1994. Since
this case, there have been five other cases with findings associated with MCS. In none of
these cases was MCS found to be an unfit for duty condition.
24. Our ability to detect biological warfare is extremely limited at best. Earlier this
week, the Veterans Affairs Subcommittee on Oversight and Investigations heard
testimony from a VA physician claiming that biological weapons were used in the
Persian Gulf.
What evidence do you have to support the claim that such weapons were not used?
While our capability for early warning, real-time detection of biological warfare is
limited, the samplers and field detectors that were in the theater were adequate to detect
and identify the presence of Iraq's biological agents and toxins. Based on the
preponderance of the evidence, there is no basis for suspecting that Iraq employed
biological agents. This includes the absence of any reported occurrences of distinctive
acute symptoms at the time of the conflict; absence of positive laboratory results from the
testing of sample collectors which were in place in various areas of the gulf; and other
inteUigence information. While it is difficult to prove a negative, all the information
available points to the conclusion that there was no use of biological warfare by Iraq
during the Persian Gulf War.
253
25. GAP reported last year that our chemical weapons protection was often faulty and
last week, the Veterans' Affairs Committee heard testimony from veterans who said that
they were never issued MOP gear. Furthermore, they said that they were told that there
was a shortage of MOP gear.
Were any service personnel sent in to the theater of operations without MOP gear and
other protections from chemical/biological weapons?
DoD policy requires that all personnel deploying in theater (e.g., into the Persian
Gulf theater) are issued individual protective gear prior to entering theater; however,
there were some occasions in which units had to be issued some of their protective
clothing after their arrival in theater (in order to expedite their arrival in theater). Stocks
of protective clothing and equipment were sufficient for all US personnel participating in
the operation.
How were our troops protected from such attacks? And how effective were these
protections?
Troops were trained in the use and wear of their standard individual protective
equipment, in the procedures for self and buddy aid, and for individual decontamination.
Since there were no chemical or biological attacks, we have no quantitative
measure for how effective these protective measures would have been in the field.
However, testing data, and daily use by personnel under chemical weapons depot and
live-agent training conditions support our confidence in the effectiveness of fielded
individual protective equipment.
26. Your conclusion that illnesses observed in many Persian Gulf veterans are unrelated
to chemical weapons exposure is based, in large part, on the pesticide studies?
How many studies have you reviewed that dealt specifically with low level exposure to
Sarin?
Our belief that the illnesses in Persian Gulf veterans are unrelated to chemical
weapons are based on chemical agent studies, not pesticide studies. About 48 studies
have been identified in which small amounts of nerve agents were adnunistered to
humans. About 70 percent of these studies involve Sarin. Additionally, there are several
reports of accidental exposure to Sarin by manufacturing or depot workers. However, the
Defense Science Board Task Force on Gulf War Health Effects is evaluating the potential
health effects of low level exposure.
What were the research protocols and findings of these studies?
The research protocols for these studies would take considerable time to explain.
However, the findings indicate that after small amounts of Sarin vapor, the subjects had
miosis, rhinorrhea, and complaints of a tight chest. Some had minor, transient
neuropsychiatric complaints, such as forgetfulness and irritability.
254
Has the research that you have reviewed examined the effects of prolonged exposure
(perhaps over a period of several weeks) to very low levels of chemical/biological
weapons? What were the research protocols and finds of these studies?
Our research studies did not include the prolonged (i.e., over weeks) exposure of
humans to chemical agents.
Have any studies been conducted to examine how low levels of chemical/biological
weapons might interact with the other toxins that were present in the Gulf, such as
petrochemicals, fumes of burning oil wells, experimental pharmaceuticals, and
leishmaniasis? What do you believe that interactive effects of such exposures would be?
No. There is no pharmacological reason to believe that there would be a
biological interaction between chemical agents and petrochemicals, fumes of burning oil
wells, and leishmaniasis. However, smokes or inhalants of any type would aggravate
airway damage from inhalation of mustard or nerve agents if the person were
symptomatic from these agents.
255
THIS IS IN RESPONSE TO QUESTION #12
Persian Gulf Veterans Coordinating Board
Research
DoD Research Activities
Review of the Health Consequences of Service During the Persian Gulf War.
Action: National Academy of Sciences (NAS) - Medical Follow-up Agency
Purpose: As directed by P.L. 102-585, the NAS will review existing scientific, medical
and other information on the health consequences of military service in the Persian Gulf
theater of operations during the Persian Gulf War.
Coordinations: DoD, VA and HHS.
Cooperative DoDA''A Research.
Action: DoD and VA Medical Scientists.
Purpose: Support for partial funding of research on the health consequences of exposure
to environmental hazards during the Persian Gulf War. Some of this research will take
place at VA Medical Centers.
Coordination: DoD, VA and HHS.
Leishmania Research.
Action: US Army Medical Research and Development Command.
Purpose: Develop a blood assay for leishmania.
Coordinations: DoD, VA and HHS.
Epidemiologic Assessment of Suspected Outbreak of an Unknown Disease Among Veterans of
ODS at the Request of the 123d Army Reserve Command, FT. Benjamin Harrison, Indiana.
Action: US Army Medical Research and Development Command.
Purpose: Conducted medical examinations and in-depth surveys of 79 soldiers with
symptoms or concerns potentially linked to service in ODS.
Coordinations: DoD, VA and HHS.
Stress-Related Survey of Soldiers Deployed in ODS.
Action: US Army Medical Research and Development Command.
Purpose: To identify correlations between post ODS symptoms and occupational and
environmental stresses. These questionnaires were completed by active duty and reserve
Army, Navy and Air Force personnel in Hawaii and Pennsylvania. Data analysis is in
progress.
Coordinations: DoD, VA and HHS.
256
Retrospective Studies Involving Military Use of Pyridostigmine as a Pretreatment for Nerve
Agent Poisoning.
Aaion: US Army Medical Research and Development Command.
Purpose: Obtain safety data for pending New Drug Application to FDA.
Coordinations: DoD, FDA and VA.
Retrospective Su'vey of Troops Who Received Clostridium Botulinum Toxoid in the Gulf War.
Action: US Army Medical Research and Development Command.
Purpose: To conduct a retrospective survey of troops who received Clostridium
botulinum toxoid in the Gulf War after troops returned to the US.
Coordinations: DoD, VA and HHS.
Environmental Toxicology Studies.
Action: Armed Forces Institute of Pathology and Army Environmental Hygiene Agency.
Purpose: To conduct a series of studies in environmental and toxicologic pathology
relating to exposures during the Persian Gulf War.
Coordinations: DoD, VA and HHS.
Monitoring Gulf War Veterans With Imbedded Depleted Uranium Fragments.
Action: Armed Forces Radiobiology Research Institute.
Purpose: Conduct clinical follow-up of ODS patients with known or suspected imbedded
depleted uranium fragments and assess health risks from imbedded depleted uranium
fragments.
Coordinations: DoD, VA and HHS.
Working Group to Establish a Working "Case Definition" for Post-ODS/DS Unexplained Illness.
Action: Walter Reed Army Medical Center.
Purpose: Review and analyze medical records of ODS/DS veterans with unexplained
symptoms to establish a working "case definition" for post-ODS/DS unexplained illness.
Coordinations: DoD, VA and HHS.
257
Persian Gulf Veterans Coordinating Board
Research
VA Research Activities
Children of PG Veterans in Mississippi.
Action: VAMC Jaclcson.
Purpose; An examination of children bom to Persian Gulf veterans for evidence of
possible genetically determined health eflfects related to their parents' service.
Coordinations: VA, DoD and HHS.
Review of the Health Consequences of Service During the Persian Gulf War.
Action: National Academy of Sciences (NAS) - Medical Follow-up Agency
Purpose: As directed by P.L. 102-585, the NAS will review existing scientific, medical
and other information on the health consequences of military service in the Persian Gulf
theater of operations during the Persian Gulf War.
Coordinations: VA, DoD and HHS.
Pilot Program to Investigate Medical and Psychological Eflfects of Exposure to Toxic Hazards.
Action: VAMC Birmingham.
Purpose: Conduct pilot program to investigate medical and psychological effects of
exposure to toxic hazards. Results of examinations provided to about 1 1,000 veterans on
VA's PG Registry are also being reviewed to determine if these individuals should be
called back for testing.
Coordinations: VA, DoD and HHS.
Examining Neuropsychological-Psychological Profiles of Veterans Returning fi-om the Persian
Gulf Theater.
Action: VAMC Boston.
Purpose: Conduct a small-scale pilot program examining neuropsychological-
psychological profiles of veterans returning fi-om the Persian Gulf Theater.
Coordinations: VA, DoD and HHS.
Environmental Hazards Research Centers.
Action: Three VAMCs (to be determined).
Purpose: A request for proposals to establish up to three, VA-based, research centers for
the study of the medical consequences of exposure to environmental and toxic hazards,
initially focused on the problems cited by personnel in the PG conflict.
Coordinations: VA, DoD and HHS.
258
Persian Gulf Interagency Research Coordinating Council.
Action: VA, DoD and HHS.
Purpose: VA, DoD and HHS, make up the newly formed Persian Gulf Interagency
Research Coordinating Council. The council, established by the Persian Gulf War
Veterans' Health Status Act, will coordinate all research activities undertaken or funded by
the Executive Branch of the Federal Government on the health consequences of military
service in the Persian Gulf theater of operations during the Persian Gulf War. As an initial
step, the i.^uncil members agreed to organize a conference of experts from within and
outside the federal agencies, with a goal of reaching a consensus definition of "Persian
Gulf Syndrome."
Coordinations: VA, DoD and HHS.
Persian Gulf Advisory Committee.
Action: VA.
Purpose: A 16 member panel composed of experts in environmental and occupational
medicine and related fields from both government and the private sector and
representatives from veterans service organizations chartered to address issues related to
the diagnosis, treatment and research of PG related health conditions.
Coordinations: VA, DoD and HHS.
Investigation of the Relation Between the Experience of ODS and Post- War Adjustment.
Action: VAMC Clarksburg.
Purpose: Assess diflBculties in post-war adjustment among ODS soldiers.
Coordinations: VA, DoD and HHS.
Early Intervention with Appalachian Marine Reservists in ODS.
Action: VAMC Mountain Home, TN.
Purpose: To provide an early intervention debriefing to Marine reservists about the
stresses of deployment and combat. Follow-up contacts and tests indicated a high degree
ofPTSD.
Coordinations: VA, DoD and HHS.
Desert Storm Reunion Survey.
Action: VAMC Boston.
Purpose: Study a broad range of combat and non-combat experiences associated with
deployment during ODS. The study will delineate and quantify those experiences and
determine their impact on subsequent patterns of adjustment.
Coordinations: VA, DoD and HHS.
Psychological Assessment of Operation Desert Storm Returnees.
Action: VAMC New Orleans.
Purpose: Conduct comprehensive psychological assessments and debriefings of troops
mobilized in ODS.
Coordinations: VA, DoD and HHS.
259
Operation Desert Storm FoUow-Up Survey.
Action: VAMC Salt Lake City.
Purpose: A survey designed to elicit VA medical center employees perceptions of ODS
activation, deployment, and reintegration experiences.
Coordinations: VA, DoD and HHS.
Psychological Adjustment in ODS Veterans.
Action: VAMC Gainesville.
Purpose: A study of 542 National Guard and Reserve members was conducted with one
group being actively involved in ODS and a Control group. Psychological tests were
given to determine if differences existed between the service veterans and the control
group in terms of overall mental health.
Coordinations: VA, DOD and HHS
260
Persian Gulf Veterans Coordinating Board
Clinical
DoD Clinical Activities
Persian Gulf Environmental Monitoring Study
Action: U.S. Army Environmental Hygiene Agency
Purpose: To characterize the concentration of envirorunental pollutants that DoD
personnel were exposed to during their stay in the Gulf region.
Coordinations: EPA, VA, CDC, NOAA, NCI, OSHA
Persian Gulf War Industrial Hygiene Evaluation
Action: U.S. Army Environmental Hygiene Agency
Purpose: To monitor and characterize occupational exposures of DoD personnel who had
potential high risk exposure to oil fire emissions.
Coordination: Unknown
Persian Gulf War Biologic Surveillance Study
Action: U.S. Army Environmental Hygiene Agency
Purpose: To refine the results obtained fi-om the health risk assessment study.
Coordination: Unknown
Persian Gulf Health Risk Assessment
Action: U.S. Army Environmental Hygiene Agency
Purpose: To assess the health risk firom environmental exposures in the Persian Gulf using
EPA guidance for Comprehensive Environmental Response, Compensation, and Liability
Act (CERCLA) sites.
Coordination: EPA,
Illness and Injury Among U.S. Marines during ODS
Action: U.S. Navy Surgeon General
Purpose: To provide information on the magnitude and severity of acute health problems
possibly related to the air pollution firom the oil fires.
Coordination: none
DoD Persian Gulf War Personnel Registry
Action: U.S. Army and Joint Environmental Support Group
Purpose: To establish a listing of individuals who were deployed to the Persian Gulf
during Operation Desert Storm.
Coordination: VA, USAEHA
261
Combat Unit Tracking Data Base
Action: U.S. Army and Joint Environmental Support Group
Purpose: To establish a listing of units deployed to the Persian Gulf and their geographic
locations during Operation Desert Storm.
Coordination: VA, USAEHA
Environmental Hazard Exposure Model
Action: -U.S. Army Environmental Hygiene Agency
Purpose: To provide information on estimated pollution levels on numerous dates and
locations throughout the Desert Storm Theater of Operations.
Coordination: VA, NOAA
Leishmaniasis - Clinical Evaluation
Action: Walter Reed AMC
Purpose: To evaluate individuals who were manifesting symptoms compatible with
parasitic infection by Leishmania species.
Coordination: WRAIR, CDC
Illness Cluster Investigation - 123 rd ARCOM
Action: Army Medical Department
Purpose: To investigate an outbreak of illnesses among members of the 123rd Anny
Reserve Command in Indiana
Coordination: unknown
Persian Gulf Environmental Industrial Exposures
Action: U.S. Army Environmental Hygiene Agency and
the U.S. Navy
Purpose: To attempt to characterize the potential industrial sources for environmental
hazards in the Persian Gulf region.
Coordination: unknown
Illness Cluster Investigation - 24th Naval Reserve CB
Action: Navy Environmental Preventive Medicine Unit - 2
Purpose: To investigate an outbreak of illnesses among members of the 24th Naval
Reserve Construction Battalion in Georgia and North Carolina
Coordination: USAEHA, DIA
262
Persian Gulf Veterans Coordinating Board
Clinical
VA Clinical Activities
Persian Gulf Registry.
Action: VACO.
Purpose: Establish a special record (mandated by P.L. 102-585) listing certain individuals
who served in the PGW. Registry listings total over 127,000. About 1 1,000 Registry
health exams have been completed.
Coordination: VA, DoD and HHS.
Persian Gulf Referral Centers.
Action: VAMCs - D.C., West L. A, and Houston.
Purpose: Establish three centers at VA medical centers to handle cases of unusual
symptoms in PG veterans whose evaluation at a local VA medical center has evaded
diagnosis. Fifty-three veterans have been treated and discharged.
Coordinations: V A, DoD and HHS.
Family Support Program.
Action: VA
Purpose: Provide marriage or family counseling for PG veterans their spouses and
children. Over sixty three thousand veterans have been reached through outreach
activities, with 12,608 receiving individual, group, or marriage and family counseling.
Coordinations: VA, DoD and HHS.
Readjustment Counseling Service.
Action: VAMCs.
Purpose: To ease Gulf theater veterans transition to civilian life and gain assistance in
such areas as benefit questions, substance abuse, marriage counseling, employment, and
PTSD. About 40,000 Gulf theater veterans have been seen to date.
Coordinations: VA, DoD and HHS.
263
VETERANS OF FOREIGN WARS OF THE UNITED STATES
OFFICE OF THE DIRECTOR
April 6, 1994
Chairman Lane Evans
Subcommittee on Oversight
and Investigations
House Committee on Veterans Affairs
U.S. House of Representatives
Washington, D.C. 21515
Dear Chairman Evans:
Please find below the VFW s responses to your post-hearing
guestions of the Oversight and Investigations Subcommittee
hearing on November 16, 1993 regarding health care problems and
the concerns of Persian Gulf War veterans. It is my pleasure to
provide you with this information.
1. What problems are Gulf War veterans still having getting
health care from VA?
RESPONSE: A number of veterans report that there are still VA
medical centers who do not seem to be aware that Persian Gulf
veterans are now authorized priority health care under law.
Further, while certain VAMCs seem to be aware of PL 103-210, they
are slow and uncertain as to how to go about answering its
mandates. Some VAMCs are billing insurance companies for care
provided to Persian Gulf veterans. As it now stands, if the
veteran fails to file for service-connection with VA for a
Persian Gulf disability, he is subject to a co-payment based on
income. Insurers are then billed.
2 . Are VA staff knowledgeable about the Registry program and
what problems are veterans having with VA's Registry program?
RESPONSE: The awareness about the Registry Program would still
seem to be uneven throughout the VA system. When a Persian Gulf
veteran goes to a VAMC or a VARO for assistance, he or she should
be informed about the existence of the Registry. This is not
always the case. VA should also conduct much more aggressive
outreach so that Persian Gulf veterans who do not go to VA for a
given service will nonetheless learn about the existence of the
program.
• WASHINGTON OFFICK •
VT-V,- MEMORIAL BllLDINi; • JdO MAnVI„\Nr) A\T;\rK. NK • W ASIIIM .Ji i\
264
Page 2
3. Are most Gulf veterans, including service members still on
active duty and reservists, aware of VA's Registry program?
RESPONSE: As indicated in response #2, VA and POD need to be
much more active in advising Persian Gulf veterans about the
existence of the Registry Program.
4. What special problems are Persian Gulf War veterans having
with VA claims adjudication?
RESPONSE: The main complaint would seem to be the length of time
it takes to process such claims. Also given that there is
currently no definitive "case definition" for Persian Gulf
Syndrome, VA lacks the guidelines to appropriately respond to
veterans claims' for compensation for their Persian Gulf related
disabilities.
Sincerely,
^f^^^^^
Dennis Cullinan, Deputy Director
National Legislative Service
265
Congressman Lane Evans ^ ^" 2-26-94
36 Cannon House **
Wa8t\^ngton, DC. 20515-6335 --^
Dear Congressman Evans, First I wish to apologize for the delay In
reply to your letter dated Dec. 1,1993. We were ho^ln* to be able
Co:.glve you significant Information about toxins boc Dr. Mlrocha
at^he University of Mlnnfsota had to order new equipment in order
to perform the tests for mycotoxins and as yet, the tests have not
been completed. -•
Let me address the second question, first : "What problems are gulf
veterans still having getting treatment from V.A. .
My understanding from talking to many veterans andi^heir spouses
is that there are long waits to get on the registry^many doctors
seem uninterested and many hospital^ are doing little or no testing
outside of the original protocol of,CBC, Profile 8, urinalysis and
chest X ray. Treatment for symptoms' from the gulf ,^arrhea , rash,
shortness of breath, fatigue, memory problems hadtbeen unsuccessful
and therefore people still have their same problems?
Question three:"What else should the V.A. be doing- Co identify the
cause(s) of the Gulf veterans health problems." ''■e
In my opinion, we need the broad based testing that was suggested
in the 9-9-93 recotnoendations of the staff report Co Senator Rlegle
regarding viral, fungal, DNA studies, Bacterial antitoxin studies.
We have been in contact with such a Lab-Dr . Andresen >of the Lawrence
Llvermore Forensic Sciences Lab in Llvermore California. The central
problem is that this broad based testing cost $3500-$5000 per
person and the DVA hospital in Tuskegee cannot afford do the test(s).
We are in contact with many people with various typAs of problems
from various regions of the Gulf. It would be appropriate to take
10 or 20 of these people and test them with the complete battery
of test available. '>
Question oneV^"^ direct evidence supports your conclusion that U.S.
Troops were subjected to toxin." At. present we have->no direct, positive
Laboratory test. You may know however that the diagnosis of exposure
to toxins(cllnicaI dKLgnosis) is based upon "Hisccry", symptoms-memory
problems, trouble sleeping, muscle twitching, perSiaAality changes
and cholinesterase levels. There are many "historltt'C" of alarms going
off, positive test from FOX vehicles, testimony of treterans hit with
blister agents, etc. Tht, symptoms are common. We atf testing for
cholinesterase levels now. We cannot answer as to the altering of
agents. The Rlegle statement proves that they hb.d the agents.
Question four:"What changes should be made in the pe>sian gulf protocol.
Since we have fou d an unexpected pervelance of evelations In Innnune
globulins and hepatitis tests, SEd rate. Hepatitis ^rofle A and B
and Imounoelectrophoresis should be- added to the p^'Otocol.
Finally I wish to reiterate the need for funds for-"' testing. The Lawrence
llvermore Lab is highly regarded by the Pentagon and Congress. Testing
is expensive. Only 20 people need to be used as a t^st group. We
feel that the evidence presented to your committee «ver the last
year has shown that this testing is Indicated. '^
Sincerely
C. y^ckson M.D.
Environmental Physician
DVA Hosp Tuskegee, ALA.
o
ISBN 0-16-046657-1
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60M66571
90000
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