[House Report 105-388]
[From the U.S. Government Publishing Office]
Union Calendar No. 228
105th Congress, 1st Session - - - - - - - - House Report 105-388
GULF WAR VETERANS' ILLNESSES: VA, DOD CONTINUE TO RESIST STRONG
EVIDENCE LINKING TOXIC CAUSES TO CHRONIC HEALTH EFFECTS
__________
SECOND REPORT
by the
COMMITTEE ON GOVERNMENT
REFORM AND OVERSIGHT
together with
ADDITIONAL VIEWS
November 7, 1997.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
COMMITTEE ON GOVERNMENT REFORM AND OVERSIGHT
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York HENRY A. WAXMAN, California
J. DENNIS HASTERT, Illinois TOM LANTOS, California
CONSTANCE A. MORELLA, Maryland ROBERT E. WISE, Jr., West Virginia
CHRISTOPHER SHAYS, Connecticut MAJOR R. OWENS, New York
STEVEN SCHIFF, New Mexico EDOLPHUS TOWNS, New York
CHRISTOPHER COX, California PAUL E. KANJORSKI, Pennsylvania
ILEANA ROS-LEHTINEN, Florida GARY A. CONDIT, California
JOHN M. McHUGH, New York CAROLYN B. MALONEY, New York
STEPHEN HORN, California THOMAS M. BARRETT, Wisconsin
JOHN L. MICA, Florida ELEANOR HOLMES NORTON, Washington,
THOMAS M. DAVIS, Virginia DC
DAVID M. McINTOSH, Indiana CHAKA FATTAH, Pennsylvania
MARK E. SOUDER, Indiana ELIJAH E. CUMMINGS, Maryland
JOE SCARBOROUGH, Florida DENNIS J. KUCINICH, Ohio
JOHN B. SHADEGG, Arizona ROD R. BLAGOJEVICH, Illinois
STEVEN C. LaTOURETTE, Ohio DANNY K. DAVIS, Illinois
MARSHALL ``MARK'' SANFORD, South JOHN F. TIERNEY, Massachusetts
Carolina JIM TURNER, Texas
JOHN E. SUNUNU, New Hampshire THOMAS H. ALLEN, Maine
PETE SESSIONS, Texas HAROLD E. FORD, Jr., Tennessee
MICHAEL PAPPAS, New Jersey ------
VINCE SNOWBARGER, Kansas BERNARD SANDERS, Vermont
BOB BARR, Georgia (Independent)
ROB PORTMAN, Ohio
Kevin Binger, Staff Director
Daniel R. Moll, Deputy Staff Director
Judith McCoy, Chief Clerk
Phil Schiliro, Minority Staff Director
Subcommittee on Human Resources
CHRISTOPHER SHAYS, Connecticut, Chairman
VINCE SNOWBARGER, Kansas EDOLPHUS TOWNS, New York
BENJAMIN A. GILMAN, New York DENNIS J. KUCINICH, Ohio
DAVID M. McINTOSH, Indiana THOMAS H. ALLEN, Maine
MARK E. SOUDER, Indiana TOM LANTOS, California
MICHAEL PAPPAS, New Jersey BERNARD SANDERS, Vermont (Ind.)
STEVEN SCHIFF, New Mexico THOMAS M. BARRETT, Wisconsin
Ex Officio
DAN BURTON, Indiana HENRY A. WAXMAN, California
Lawrence J. Halloran, Staff Director and Counsel
Robert Newman, Professional Staff Member
Samatha Sherman, Professional Staff Member
Ann Marie Finley, Professional Staff Member
R. Jared Carpenter, Clerk
Cherri Branson, Minority Counsel
LETTER OF TRANSMITTAL
----------
House of Representatives,
Washington, DC, November 7, 1997.
Hon. Newt Gingrich,
Speaker of the House of Representatives,
Washington, DC.
Dear Mr. Speaker: By direction of the Committee on
Government Reform and Oversight, I submit herewith the
committee's second report to the 105th Congress. The
committee's report is based on a study conducted by its
Subcommittee on Human Resources.
Dan Burton,
Chairman.
C O N T E N T S
----------
Page
I. Summary..........................................................1
A. Findings in brief..................................... 3
Diagnosis.......................................... 3
Treatment.......................................... 4
Compensation....................................... 4
Research........................................... 4
B. Recommendations in brief.............................. 4
Diagnosis.......................................... 4
Treatment.......................................... 5
Compensation....................................... 5
Research........................................... 5
II. Background.......................................................6
A. Listening to Gulf War veterans........................ 8
B. Chemical detections and exposures..................... 15
C. Toxic exposures in the Gulf War theater............... 22
Chemical weapons................................... 22
Biological weapons................................. 24
Infectious diseases................................ 25
Deleted uranium.................................... 27
Oil well fires and petroleum contamination......... 30
Experimental drugs and vaccines.................... 33
Pesticides and multiple chemical sensitivity....... 35
D. Acute v. chronic effects of low level exposures....... 37
E. Exposures and VA diagnostic protocols................. 42
F. Impact of missing records............................. 61
G. Stress related diagnoses.............................. 62
H. Treatment and research................................ 65
I. Other executive agency actions on Gulf veteran's
illness.............................................. 68
III. Findings........................................................73
Diagnosis.......................................... 73
Treatment.......................................... 100
Compensation....................................... 104
Research........................................... 107
IV. Recommendations...............................................111
Diagnosis.......................................... 111
Treatment.......................................... 119
Compensation....................................... 121
Research........................................... 123
V. Appendix.......................................................127
VIEWS
Additional views of Hon. Henry A. Waxman, Hon. Edolphus Towns,
Hon. Paul E. Kanjorski, Hon. Thomas M. Barrett, Hon. Eleanor
Holmes Norton, Hon. Chaka Fattah, Hon. Elijah E. Cummings, Hon.
Danny K. Davis, Hon. John F. Tierney, and Hon. Harold E. Ford,
Jr............................................................. 130
Additional views of Hon. Bernard Sanders......................... 134
Union Calendar No. 228
105th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 105-388
_______________________________________________________________________
GULF WAR VETERANS' ILLNESSES: VA, DOD CONTINUE TO RESIST STRONG
EVIDENCE LINKING TOXIC CAUSES TO CHRONIC HEALTH EFFECTS
_______
November 7, 1997.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______________________________________________________________________
Mr. Burton of Indiana, from the Committee on Government Reform and
Oversight, submitted the following
SECOND REPORT
On October 31, 1997, the Committee on Government Reform and
Oversight approved and adopted a report entitled ``Gulf War
Veterans' Illnesses: VA, DOD Continue to Resist Strong Evidence
Linking Toxic Causes to Chronic Health Effects.'' The chairman
was directed to transmit a copy to the Speaker of the House.
I. Summary
Responding to requests by veterans, the subcommittee in
March 1996 initiated a far-reaching oversight investigation
into the status of efforts to understand the clusters of
symptoms and debilitating maladies known collectively as ``Gulf
War Syndrome.'' We sought to ensure sick Gulf War veterans were
being diagnosed accurately, treated effectively and compensated
fairly for service-connected disabilities, despite official
denials and scientific uncertainty regarding the exact causes
of their ailments. We also sought to determine whether the Gulf
War research agenda was properly focused on the most likely,
not just the most convenient, hypotheses to explain Gulf War
veterans' illnesses.
After 19 months of investigation and hearings, the
subcommittee finds the status of efforts on Gulf War issues by
the Department of Veterans Affairs [VA], the Department of
Defense [DOD], the Central Intelligence Agency [CIA] and the
Food and Drug Administration [FDA] to be irreparably flawed. We
find those efforts hobbled by institutional inertia that
mistakes motion for progress. We find those efforts plagued by
arrogant incuriosity and a pervasive myopia that sees a lack of
evidence as proof. As a result, we find current approaches to
research, diagnosis and treatment unlikely to yield answers to
veterans' life-or-death questions in the foreseeable, or even
far distant, future.
We do not come to these conclusions lightly. Nor do we
discount all that has been done to care for, cure and
compensate Gulf War veterans. But lives have been lost, and
many more lives are at stake.
Six years and hundreds of millions of dollars have been
spent in the effort to determine the causes of the illnesses
besetting Gulf War veterans. Yet, when asked what progress has
been made healing sick Gulf War veterans, VA and DOD can't say
where they've been and concede they may never get where they're
supposed to be going. The CIA continues to resist broader
declassification of Gulf War records. The FDA meekly chastises
the Defense Department for the failure to observe agreed-upon
rules for the humane use of experimental drugs.
Sadly, when it comes to diagnosis, treatment and research
for Gulf War veterans, we find the Federal Government too often
has a tin ear, a cold heart and a closed mind.
Our hearings convinced us the journey from cause to cure
for Gulf War veterans runs through the pools, clouds and plumes
of toxins in which they lived and fought. It is a journey VA
and DOD might never have taken but for persistent pressure from
this subcommittee, and other House and Senate panels, that
forced the Pentagon to acknowledge a ``watershed event''--the
probable exposure of United States troops to chemical weapons
fallout at Khamisiyah, Iraq.
With that first admission, the three pillars of Government
denial--no credible detections, no exposures, no health
effects--began to crumble. As the number of U.S. troops
presumed exposed grew from 400 to almost 100,000, as the
credibility of other chemical detections was sustained, and as
private research probed the parallels between Gulf War
illnesses and the known symptoms of chemical poisoning, some
significant role for toxins in causing, triggering or
amplifying neurological damage and chronic symptoms could no
longer be denied.
Before Khamisiyah, voluminous and compelling, albeit
circumstantial, evidence regarding neurotoxic exposures had
been ignored, denied or discredited, while far less abundant
evidence and far less plausible psychological theories of
causation were pursued with vigor. As a result, diagnostic
protocols were insensitive to exposure effects, treatments were
limited and vital research was delayed.
Only recently were VA and DOD health registry
questionnaires modified to consistently capture the best and
only remaining evidence of toxic exposures: veterans'
recollections. Only recently was research funded to measure the
health effects of sustained, low-dose exposure to the
combinations of chemicals, pharmaceuticals and environmental
toxins to which Gulf War veterans were exposed.
Those denials and delays are symptomatic of a system
content to presume the Gulf War produced no delayed casualties,
and determined to shift the burden of proof onto sick veterans
to overcome that presumption. That task has been made
difficult, if not impossible, because most of the medical
records needed to prove toxic causation are missing or
destroyed. Nevertheless, VA and DOD insist upon reaping the
benefit of any doubts created by the absence of those records.
The subcommittee believes the current presumptions about
neurotoxic causes and effects should be reversed and the
benefit of any doubt should inure to the sick veteran.
Finally, we reluctantly conclude that responsibility for
Gulf War illnesses, especially the research agenda, must be
placed in a more responsive agency, independent of the DOD and
the VA.
Fortunately for Gulf War veterans, excellent research into
Gulf War illnesses has taken place outside Government
sponsorship. This research has advanced a case definition for
some illnesses, an important step toward improved diagnosis and
treatment. Some experimental treatments have brought relief to
afflicted veterans and their families. The subcommittee
believes this work must be included within the scope of that
agency made responsible for Federal efforts to solve the puzzle
of Gulf War illnesses.
We note with approval efforts at the National Institute of
Environmental Health Sciences [NIEHS] and other public health
agencies to study exposure effects and genetic susceptibility
to environmental toxins. Funding for this research would be an
important first step in the effort to have an independent
agency, with significant expertise in environmental hazards,
involved in the solution to Gulf War veterans' health problems.
There is no ``silver bullet'' to explain or cure so-called
Gulf War Syndrome, which is not a discrete syndrome at all, but
a variable cluster of symptoms and disease states with
different triggers and susceptibilities. The battle to cure
Gulf War illnesses must be fought at the cellular, molecular
and genetic levels if we hope to heal the delayed wounds of
that war and protect future warriors. Absent precise exposure
data which can never be recaptured, the best evidence linking
toxic causes to chronic effects lies within the bodies and
minds of Gulf War veterans. That evidence has been too long
ignored.
A. Findings in Brief
Diagnosis
1. VA and DOD did not listen to sick Gulf War veterans as
to possible causes of their illnesses.
2. The presence of a variety of toxic agents in the Gulf
War theater strongly suggests exposures have a role in causing,
triggering or amplifying subsequent service-connected
illnesses.
3. Gulf War troops were not trained to protect themselves
from the effects of exposure to depleted uranium dust and
particles.
4. Pyridostigmine bromide [PB] can have serious side
effects and interactions when taken in combination with other
drugs, vaccines, chemical exposures, heat and/or physical
exercise.
5. VA and DOD health registry diagnostic protocols relied
on the unfounded conclusion there were no chemical, biological
or other toxic exposures to U.S. troops in the Gulf War
theater.
6. VA and DOD health registry diagnosis protocols continue
to be based on the unwarranted conclusion that, unless there is
an immediate and acute reaction, exposures to chemical weapons
and other toxins do not cause delayed or chronic symptoms.
7. Prematurely ruling out toxic exposures as causative, VA
and DOD doctors relied on diagnoses of somatoform disorder and
Post Traumatic Stress Disorder [PTSD] to explain Gulf War
veterans' illnesses.
8. There is no credible evidence that stress or PTSD causes
the illnesses reported by many Gulf War veterans.
9. Accurate diagnosis of veterans' illnesses remains
difficult due to inadequate or missing personal medical
records, missing toxic detection logs, and unreleased
classified documents.
10. Accurate diagnosis of veterans illnesses was also
hampered by the VA's lack of medical expertise in toxicology
and environmental medicine.
11. Exposures to low levels of chemical warfare agents and
other toxins can cause delayed, chronic health effects.
Treatment
12. Neither the VA nor the DOD has systematically attempted
to determine whether sick Gulf War veterans are any better or
worse today than when they first reported symptoms.
13. Treatment of sick Gulf War veterans by VA and DOD to
date has largely focused on stress and PTSD.
Compensation
14. Compensation ratings for sick veterans are minimized
due to inadequate personal medical records, missing toxic
detection logs, and unreleased classified documents which could
help veterans establish service-connection of post-war
disabilities.
15. Compensation ratings are also minimized by over-
reliance on somatoform disorder and PTSD as the basis of
disability claims.
Research
16. Federal research strategy has been blind to promising
hy-potheses due to reliance on unfounded DOD conclusions
regarding chemical exposures.
17. Institutional and methodological constraints make it
unlikely the current research structure will find the causes
and effective treatments for Gulf War veterans' illnesses in
the short term.
18. The FDA was passive in granting and failing to enforce
the conditions of a waiver to permit use of PB by DOD.
B. Recommendations in Brief
Diagnosis
1. Congress should enact a Gulf War toxic exposure act
establishing the presumption, as a matter of law, that veterans
were exposed to hazardous materials known to have been present
in the war theater.
2. The VA should contract with an independent scientific
body composed of non-Government scientific experts
representing, at a minimum, the disciplines of toxicology,
immunology, microbiology, molecular biology, genetics,
biochemistry, chemistry, epidemiology, medicine and public
health for the purpose of identifying those diseases and
illnesses associated in peer-reviewed literature with singular,
sustained, or combined exposures to the hazardous materials to
which Gulf War veterans are presumed to have been exposed.
3. The VA Gulf War Registry and the DOD Comprehensive
Clinical Evaluation Program should be re-evaluated by an
independent scientific body which shall make specific
recommendations to change both programs from crude research
tools into effective clinical diagnosis and outcomes monitoring
efforts.
4. The VA should refer all Phase II Registry examinations
to Gulf War Referral Centers.
5. The VA should add toxicological and environmental
medicine expertise to the staff resources dedicated to Gulf War
illnesses.
6. DOD and VA should make every effort to find, and where
necessary re-create through veterans' testimony, individual
Gulf War medical records to reflect vaccines administered, PB
use, and exposure to DU, pesticides and other hazardous
materials.
7. The President should order an intensified effort to
declassify Gulf War documents in any way related to Gulf War
veterans' illnesses and should personally certify to the
appropriate committees of Congress when he deems
declassification of such documents to be against the national
interest.
8. DOD failure to adhere to recordkeeping requirements or
clinical protocols under an informed consent waiver should
result in the presumption of service-connection for any
subsequent illness(es) suffered by service personnel to whom
the drug or protocol was administered.
Treatment
9. VA and DOD should systematically and effectively monitor
the clinical progress of Gulf War veterans to determine the
most effective treatments.
10. VA and DOD clinicians should be encouraged to pursue,
and be trained in, new treatment approaches to suspected
neurotoxic exposure effects.
11. The diagnoses for somatoform disorders and Post
Traumatic Stress Disorder [PTSD] should be refined to insure
that physiological causes are not overlooked.
Compensation
12. Denials of Gulf War veterans' compensation claims
attributable in any way to missing medical records should be
reviewed and veterans given the benefit of any doubt regarding
the presumptive role of toxic exposures in causing post-war
illnesses and disability.
13. For purposes of compensation determinations,
disabilities associated with presumed exposures should be
deemed service-connected without any limitation as to time.
Research
14. Congress should create or designate an agency
independent from the Departments of Defense and Veterans
Affairs as the lead Federal agency responsible for coordination
of all research into Gulf War veterans' illnesses and
allocation of all research funds.
15. The lead Federal agency on Gulf War veterans' illnesses
should focus research on the evaluation and treatment of the
common spectrum of neuroimmunological disorders known as Gulf
War Syndrome, multiple chemical sensitivity, chronic fatigue
syndrome and fibromyalgia.
16. DOD and VA medical systems should augment research and
clinical capabilities with regard to women's health issues and
the health effects of combat service on women's health.
17. VA, in collaboration with NIH, CDC, FDA and other
public health agencies should establish an interdisciplinary
research and clinical program on the identification, prevention
and treatment of environmentally induced neuropathies.
18. FDA should grant a waiver of informed consent
requirements for the use of experimental or investigational
drugs by DOD only upon receipt of a Presidential finding of
efficacy and need.
II. Background
Since the Gulf War ended in 1991, there has been a growing
number of reports of chronic illnesses among the nearly 700,000
United States troops who served in Saudi Arabia, Kuwait, and
Iraq. Although the illnesses are most common among reservists
and National Guardsmen who served in the Gulf, full-time
active-duty soldiers have also complained about various
maladies.\1\
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\1\ Status of Efforts to Identify Persian Gulf War Syndrome, 104th
Cong., 2d sess., p. 48 (1996) (``Human Resources and Intergovernmental
Relations Subcommittee hearings, Nos. 1-4'') (statement of Major Thomas
Cross, Gulf War veteran and member of the Presidential Advisory
Committee on Gulf War Veterans' Illnesses).
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Health complaints by Gulf veterans from Canada, Great
Britain, Kuwait, Australia, Czech Republic, Hungary, New
Zealand and Norway have also begun to surface. There has also
been an increased incidence of similar illnesses in the
civilian populations of Kuwait, Iraq, and Saudi Arabia,
according to a report to the Human Resources Subcommittee by
chemical/biological weapons expert Dr. Jonathan Tucker,
director of the chemical and biological nonproliferation
project, Monterey (CA) Institute for International Studies.\2\
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\2\ A report submitted to the subcommittee by Jonathan Tucker,
``Chemical/Biological Weapons Exposure and Gulf War Illness,'' January
29, 1996, p. 1. [Hereinafter ``Tucker Report''] (in subcommittee
files).
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Listed in the Persian Gulf health registries of the
Departments of Defense [DOD] and Veterans Affairs [VA] are
about 113,000 Gulf War veterans [DOD's Comprehensive Clinical
Evaluation Program with 44,900 names as of August 1997, and
VA's Gulf Health Registry with 67,989 names as of May 1997].\3\
Most participants in the registries have been diagnosed,
approximately 20 percent remained undiagnosed, and roughly 10
percent of those listed had no detectable symptoms.\4\ Many
veterans have reported flu-like symptoms, chronic fatigue,
rashes, joint and muscular pain, headaches, memory loss,
reproductive problems, depression, loss of concentration,
gastroin-testinal problems, and other maladies.\5\
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\3\ Memorandum to the subcommittee from the Department of Defense
dated September 10, 1997 (in subcommittee files).
\4\ Congressional Research Service Report, ``Gulf War Veterans'
Illnesses,'' 95-450 SPR, April 11, 1997, p. 2.
\5\ Statement of Lennox E. Gilmer, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 95.
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According to American Legion: ``One of the key questions
that arises from evaluating [VA Health] Registry data is: What
is happening to those veterans that complain of the most common
symptoms? What is the outcome of their visit to the VA? Are
they getting better, or are they slipping through the cracks?
Our hypothesis is that these veterans who complain of the
symptoms are not receiving the proper follow-up and treatment
they deserve.'' \6\
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\6\ Statement of Matt Puglisi, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 81.
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Many Gulf War veterans are concerned that their medical
problems are chronic and disabling, and are the result of
exposures to one or more chemical, biological or nuclear agents
present in the theater of operations. Health problems of Gulf
veterans may stem not only from chemical and biological warfare
agents but from other sources such as: pesticides and insect
repellants; leaded diesel fuel; depleted uranium; oil well
fires; infectious agents; and the anti-nerve agent drug,
pyridostigmine bromide.\7\
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\7\ Status of Efforts to Identify Persian Gulf War Syndrome: Recent
GAO Findings, 105th Cong., 1st sess., pp. 42-43 (1997) (``Human
Resources Subcommittee hearings, No. 3'') (statement of Donna Heivilin,
GAO).
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In 11 hearings \8\ since March 1996, the Human Resources
Subcommittee has examined issues dealing with veterans'
symptoms and complaints about the handling of their health
problems by the VA, especially about inappropriate medical
treatment or denial of treatment, missing or inadequate
personal medical records, compensation issues, and lack of
valid and timely Government research conclusions about the
causes of their illnesses. The subcommittee also sought to
ensure that any research programs conducted by the Departments
of Defense [DOD], Health and Human Services [HHS], and the
Environmental Protection Agency [EPA] were well-focused and
coordinated.
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\8\ Human Resources Subcommittee hearings on Gulf War illnesses in
the 104th & 105th Congresses: March 11 and 28, June 25, September 19,
December 10 and 11, 1996; January 21, April 24, June 24 and 26, 1997. A
hearing on informed consent issues, including DOD's use of PB tabs
under an informed consent waiver, was held on May 8, 1997.
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The subcommittee has examined studies of effects of low
level chemical exposures on humans and animals, and probable
exposures of large numbers of troops to chemical warfare agents
and other toxins during and after the war. Typical complaints
of Gulf veterans are similar to known effects on humans who
have been exposed to organophosphates, such as pesticides and
other chemical agents.\9\ Organophosphates are chemically
related to Sarin and other warfare agents present in the Gulf
War theater.
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\9\ Persian Gulf Veterans' Illnesses, 104th Cong., 2d sess., p. 280
(1996) (``Human Resources and Intergovernmental Relations Subcommittee
hearings, Nos. 5-6'') (statement of Charles Jackson).
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Not listening to veterans' health complaints, many military
and VA doctors--often unable or unwilling to diagnose veterans'
illnesses as the after-effects of possible neurotoxic
exposures--have insisted veterans suffered instead from stress,
or post-traumatic-stress-disorder [PTSD].\10\ Many private
physicians and researchers believe DOD and VA doctors have
relied too heavily on psychological theories of causation while
discounting the possibility of neurotoxic exposures.\11\
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\10\ Statement of Kimo Hollingsworth, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 29;
statement of Brian Martin, Human Resources and Intergovernmental
Relations Subcommittee hearings, Nos. 1-4, p. 324; statement of Julia
Dyckman, Human Resources and Intergovernmental Relations Subcommittee
hearings, Nos. 5-6, p. 195; statement of Michael Donnelly, Human
Resources Subcommittee hearing, No. 2, p. 40. Also correspondence from
Gulf veterans (in subcommittee files).
\11\ Statement of William Baumzweiger, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 500;
statements attributed to Eula Bingham and Claudia Miller, NY Times,
November, 21, 1996, p. B11. See also, Streich, et al., ``Symptomatology
of Gulf War Era Service,'' Military Medicine, Walter Reed Army
Institute of Research, Bethesda, MD, March 1995.
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The Human Resources Subcommittee has listened carefully to
hundreds of Gulf War veterans who have written and called the
subcommittee since hearings began in March 1996. The
subcommittee has also listened to the testimony of 23 Gulf
veterans who testified in the 11 hearings held.
A. Listening to Gulf War Veterans
Among Gulf veterans testifying before the subcommittee were
Steven Wood, Barry Kapplan, Chris Kornkven, Julia Dyckman, and
Brian Martin, all of whom reported health complaints typical of
the range of maladies often called the ``Gulf War Syndrome.''
Army S/Sgt. Steven Wood testified that during the first
week of March 1991, he drove through ammunition storage sites
destroyed by U.S. forces. Near a bombed out bunker, he
inspected artillery rounds on the ground which he identified in
an Army manual as chemical weapons. ``Later that day,'' Sgt.
Wood stated, ``I started to get very sick with symptoms I
suffer still today. I sought medical assistance that day . . .
[and] . . . never once received any comprehensive, much less
compassionate, treatment from the Army. I was told it was `all
in my head.' ''
Transferred back to Germany following the war, his symptoms
continued. In 1994, Sgt. Wood, unable to get treatment from
Army doctors and unable to perform his duties, contacted a
German physician. ``This German doctor did more tests in 2
hours than the Army did in 5 years. When my wife and I left the
[German] doctor's office, we were told that I `had been
poisoned.' These findings were immediately dismissed [by Army
doctors] as being worthless since they did not come from a
military doctor. Then it was stated to me by this military
doctor that they did not like Gulf War veterans [complaining]
with health problems.'' \12\
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\12\ Statement of Steven Wood, Human Resources Subcommittee
hearings, No. 2, pp. 49-50, 52.
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Major Barry Kapplan, a career Army pilot who had passed 15
flight physicals in the 11 years prior to deployment to the
Gulf War, ``began to feel increasingly ill'' in April 1991 but
dismissed the symptoms as related to the harsh desert
environment. On May 8, he reported ``violent nausea, vomiting,
diarrhea attack.'' On May 28, now back in Germany, he was
admitted to a military hospital with ``cardiac arrhythmias . .
. severely bleeding gums, cough with sputum production,
shortness of breath, severe fatigue, diarrhea, hair loss, skin
rashes/lesions, and abdominal discomfort.'' Military doctors
diagnosed Major Kapplan with ``just post traumatic stress.''
With severe brain, nerve, heart and gastrointestinal problems
but still being diagnosed with ``somatoform disorder,'' he was
given a discharge by the Army ``due to unemployability'' in
October 1995.\13\
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\13\ Statement of Barry Kapplan, Human Resources Subcommittee
hearings, Nos. 1-4, pp. 328-330, 332.
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Major Kapplan's wife Nancy, a registered nurse, testified
about ``the medical issues facing our family'' since her
husband's return from the Gulf. Her four children have suffered
from continual chronic infections and one child has ``. . .
esophagitis, gastritis and gastroesophageal reflux disease . .
. with little relief of her symptoms.'' Mrs. Kapplan reported
that she has similar chronic symptoms since her husband came
home from the war.\14\
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\14\ Statement of Nancy Kapplan, Human Resources Subcommittee
hearings, Nos. 1-4, pp. 337, 339.
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S/Sgt. Chris Kornkven, an Army Reservist, reported, ``While
still in the Gulf I began experiencing symptoms that continue
to this day. I had difficulty remembering significant events
that happened days earlier . . . my knees and shoulders [were]
especially painful . . . and fatigue stayed with me
constantly.'' After the war, his symptoms worsened and included
intestinal problems and headaches. He sought treatment in 1992
from VA doctors who--without any physical exam, testing or
treatment--referred him to the mental health clinic where he
was diagnosed ``PTSD.'' \15\
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\15\ Gulf War Syndrome: To Examine New Studies Suggesting Links
Between Gulf Service and Higher Rates of Illnesses, 105th Cong., 1st
sess., pp. 268-269 (1997) (``Human Resources Subcommittee hearings, No.
1'') (statement of Chris Kornkven).
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``I reported blinding headaches with only offers of
aspirin. I reported memory loss . . . dismissed as stress. I
reported skin problems . . . and was told `it's not cancer yet
. . . come back as needed.' I reported breathing problems . . .
no diagnosis. I reported intestinal problems . . . and rectal
bleeding . . . dismissed [and] no follow-up. I reported joint
pain . . . diagnosed as fibromyalgia . . . no treatment other
than Motrin. I reported chest pains . . . and racing heart
beats . . . [and] was told it was due to an abnormal heart
valve . . . [which] was hereditary,'' a point which S/Sgt.
Kornkven says ``nicely avoids VA's rating guidelines.'' \16\
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\16\ Ibid., p. 271.
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During the war, thousands of troops, including S/Sgt.
Kornkven, climbed on Iraqi vehicles destroyed by depleted
uranium [DU] rounds which leave a residue of dangerous
radioactive dust particles when inhaled or ingested. He was
tested by the VA and told he ``had a higher DU count than those
[troops] carrying around [DU] fragments in their bodies . . .
[but] it was nothing for me to worry about.'' \17\
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\17\ Ibid., p. 270.
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``My wife had a miscarriage in which the fetus had to be
surgically removed. She has as much trouble with fatigue as I
do. She was diagnosed by a private physician as having
fibromyalgia. My son, who is 2 years old, has not slept a
complete night since being born. He appears to have intestinal
problems, his stools are very acidic, he is VERY light
sensitive, and has the exact same rashes on his legs as I do.''
\18\
---------------------------------------------------------------------------
\18\ Ibid.
---------------------------------------------------------------------------
As far as the VA's emphasis on stress as a cause of Gulf
veterans' illnesses is concerned, S/Sgt. Kornkven stated that
while stress may play some part in his malady, he believes that
``. . . veterans are subjected to much more stress by trying to
navigate the bureaucracy of the VA, and with worrying how to
cope with medical conditions that are ignored. All the while
being unable to work, and wondering how to feed or house a
family.'' \19\
---------------------------------------------------------------------------
\19\ Ibid., p. 272.
---------------------------------------------------------------------------
Gulf War and Vietnam War veteran Reserve Navy Captain Julia
Dyckman is a registered nurse who was in charge of the
emergency room and the out-patient clinic of Combat Zone Fleet
Hospital 15 near Al Jubayl, Saudi Arabia, an area often under
SCUD missile attacks. Her unit took care of 8,211 out-patients,
697 in-patients, and 90 combat admissions. In her hearing
statement, she identified the following medical conditions
reported by troops in-theater and treated by her hospital
personnel: respiratory problems; unexplained fevers; vomiting;
diarrhea; various rashes; numerous reactions to immunizations;
unexplained stomach and abdominal pains; and cardiac
problems.\20\
---------------------------------------------------------------------------
\20\ Statement of Julia Dyckman, Human Resources Subcommittee
hearings, Nos. 5-6, p. 192.
---------------------------------------------------------------------------
On returning to the United States, Captain Dyckman was
assigned to interview returning Gulf veterans. She stated:
``Many personnel voiced concerns over long term health effects,
current health conditions, and numerous pay and family
situations. The Readiness Commander did not like the results of
my interviews . . . interfered with my medical care . . . [and]
. . . records of interviews I conducted were discarded. For
most Gulf reservists, the only avenue available for medical
care was civilian or possibly the VA. Some veterans were too
ill to hold down a job and therefore had no medical insurance
to cover civilian care.'' \21\
---------------------------------------------------------------------------
\21\ Ibid., p. 194.
---------------------------------------------------------------------------
``During this time my health continued to deteriorate. I
was released from active duty even though my medical problems
were not resolved. I sought care at the VA [for the following]:
hearing loss; bronchitis; chronic cough; hypertension; rashes;
foot and joint pain; stomach ulcer; diarrhea; headaches;
abdominal pain. I was diagnosed with gout (although the gout
test was negative); offered Tylenol; and told, `Nothing is
wrong with you, get it through your head!' '' \22\
---------------------------------------------------------------------------
\22\ Ibid., p. 195.
---------------------------------------------------------------------------
``For over 2\1/2\ years I was shuffled from one VA clinic
to another, each investigating a different body system. No
coordinated treatment or diagnostic effort was ever
experienced. It has been a problem with records [needed] for
disability claims . . . [which were] . . . lost in the VA
system. Disability and claims procedures are complicated and
time consuming. In order to obtain VA treatment for Gulf
illness, you have to first have a service connected illness or
injury which is difficult to prove even when you were treated
in-theater. Also, the VA only considers military and VA medical
records for service connection, excluding expert civilian
records. Additionally, they only use selected parts of records
that agree with the VA and disregard any positive findings.''
\23\
---------------------------------------------------------------------------
\23\ Ibid., pp. 196-197.
---------------------------------------------------------------------------
``You might ask what it is like to be a Persian Gulf war
veteran after 6 years. Each day starts with uncertainty. When
you eat you are constantly sick and have intermittent diarrhea.
Mobility is difficult due to swollen joints and muscle aches.
Severe headaches are intermittent. Sometimes you forget what
you are doing and what you were going to do. Pain and fatigue
are constant companions. You are forced to deal with constant
denials from the Pentagon that `nothing happened' during the
war. These statements confuse medical providers who then doubt
your credibility. What is needed is recognition, though not
coded by the CDC, that Gulf war illness is a combination of
unique symptoms and outcomes. This is why specific protocols
need to be run before the VA says that this illness `doesn't
exist' or is `all in your head.' '' \24\
---------------------------------------------------------------------------
\24\ Ibid., p. 198.
---------------------------------------------------------------------------
Sgt. Brian Martin was a former member of the 37th Airborne
Engineer Battalion, a unit which detonated and destroyed the
Iraqi ammunition depot at Khamisiyah containing 100 bunkers and
43 warehouses. He videotaped the event and made it available to
the subcommittee and television networks in the summer of 1996.
Sgt. Martin testified: ``On March 4th, 1991, we entered the
depot area, placing explosives in and around 33 bunkers. We set
time charges for detonation, then moved south 3 miles to what
we considered a `safe zone.' At no time whatsoever did we fear
. . . chemical exposure. We were told . . . there were no
chemicals in the area. Our commanders knew nothing about
chemicals in the bunkers. Seven minutes later the destruction
of Khamisiyah began.''
``Witnessing these awesome explosions was a remarkable
sight. The explosions blew straight into the air, then would
spread at the top . . . [it was] . . . the closest thing to a
nuclear mushroom we would ever see. Our excitement quickly
turned to fear when `cook offs' or fallout from the explosions
began showering down on us. Several missiles landed underneath
our trucks, spinning and taking off until blowing up. Men were
running everywhere for cover. Giant clouds . . . were covering
us. The 82d Airborne [12 miles away] asked us to stop the
detonation because of `cook-offs' penetrating their area. Our
battalion moved into convoy formation and proceeded to vacate
the area. Twenty miles later we found an area with no signs of
`cook-offs.' ''
``For the next 3 days it rained harder than any of us had
seen in the 6 months we were there. Our commanders joked about
us `putting something into the air to change the weather.' For
the next 5 days it was unsafe for us to return to Khamisiyah to
finish destroying the remaining 67 bunkers. The skies were
dark, gray and cloudy for those 5 days.''
``Since Khamisiyah, I suffer from . . . blood in vomit and
stools, blurred vision, shaking and trembling . . . muscles
weakening . . . chest pounding like my heart was going to
explode. My symptoms were simply written off [by Army doctors]
as a `stomach viral infection of an unknown origin.' My medical
conditions were ignored. In December 1991, I put in for an
`early out' from the military. I did not receive an exit exam
nor did I know I was supposed to.''
``I suffer from excruciatingly painful headaches, memory
loss, and severe diarrhea . . . mood swings . . . I violently
vomit if I smell perfumes, vapors or chemicals. I get lost and
forget where I am sometimes. I am an ex-paratrooper who needs a
cane and wheelchair to get around. My joints . . . swell, burn
and hurt.''
``Today . . . I have some clearly defined diagnoses from
the VA of multiple chemical sensitivity, inflammatory bowel
disease with scarring of the colon and stomach due to chemical
exposure, temporal lobe brain damage also with scarring due to
chemical exposure, Reiter's Syndrome, chronic fatigue syndrome,
and tinnitus. I have abnormally high platelets around my blood
cells, and recently I began testing for Lupus and Alzheimer's
Disease. I am worn out all the time, yet I am an insomniac. For
all of this, except [for] the chemical injuries . . . the VA
rated me in 1994 at 100 percent compensation . . . then in 1996
added Permanent and Total [disability, following DOD's
announcement about Khamisiyah].'' \25\
---------------------------------------------------------------------------
\25\ Statement of Brian Martin, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 320-
322.
---------------------------------------------------------------------------
Other Gulf veterans testified before the subcommittee about
life-threatening illnesses such as cancers, heart and lung
problems, and Amyotrophic Lateral Sclerosis [ALS].
Colonel Gilbert Roman, U.S. Army Reserve, volunteered for
active duty in the Gulf War and was named Deputy Commander of
the 311th Evacuation Hospital, Army Medical Service Corps. He
stated [in spite of profuse nasal bleeding from pre-cancerous
polyps during testimony]: ``I arrived in Theater on January 6,
1991 . . . [and] . . . during official visits to strategic
military cities there were frequent SCUD attacks during which I
heard chemical alarms sound. When I asked if these alarms meant
chemicals had been detected, I was told that the chemical
alarms had malfunctioned. I [soon] became ill and was treated
for nausea, headaches, vomiting, diarrhea and high temperature.
Rashes I had over my body I thought were normal and expected
since I spent most days in the sand, wind and sun with all the
attendant fleas, flies and desert parasites. Headaches I
attributed to fatigue and lack of sleep.'' \26\
---------------------------------------------------------------------------
\26\ Status of Efforts to Identify Gulf War Syndrome: Multiple
Toxic Exposures, Human Resources Subcommittee hearing of June 26, 1997.
(Statement of Gilbert Roman, p. 2) (in subcommittee files).
---------------------------------------------------------------------------
``The symptoms . . . continued after I returned home and
got progressively worse. In 1993, I registered at [a] veterans'
hospital after receiving an invitation from the VA to come in
for an examination if I was a Gulf veteran. They recorded all
of the ailments I indicated . . . [but] . . . no treatment was
offered. The VA hospital billed me for my supposed `free
examination' and they ended up attaching my next year's meager
tax return.'' \27\
---------------------------------------------------------------------------
\27\ Ibid., pp. 3-4.
---------------------------------------------------------------------------
``To date, although I have now had three official
examinations since 1993, I still continue to receive requests
for more and more information from the VA claims office.
Materials sent are never acknowledged as received, phone
numbers given are not to any VA recognized exchange, and the
name given for contact is not a true VA employee. Frustration .
. . [I've been] in the VA `system' 4 years with no real contact
from a person; just requests for more information.'' \28\
---------------------------------------------------------------------------
\28\ Ibid., pp. 4-5.
---------------------------------------------------------------------------
``In 1996, I was hospitalized three times and treated by my
private physician for a respiratory ailment. I could not walk
more than 25 steps without having to stop, out of breath and
fatigued. This ailment, which was life threatening, would not
allow me to lie on my back to sleep as I would begin to drown .
. . as my lungs filled with fluid. I was forced to sit up for
sleep and was constantly fatigued due to lack of sleep and no
energy.'' \29\
---------------------------------------------------------------------------
\29\ Ibid., p. 5.
---------------------------------------------------------------------------
``My [private] cardiologist, Dr. Peter Steele, diagnosed me
as having `cardiomyopathy with congestive heart failure.' Dr.
Steele stated [in a letter]: `What is clear is that he served
in the Middle East and that he has a cardiomyopathy. I would
submit that this may well be part of the Gulf War Syndrome.' ''
\30\
---------------------------------------------------------------------------
\30\ Ibid.
---------------------------------------------------------------------------
Major Michael Donnelly, USAF retired, who flew 44 combat
missions during the Gulf War, often flying through plumes from
bombed Iraqi munitions manufacturing and storage facilities,
stated: ``Upon return from the Gulf, I was reassigned to
Florida . . . [where] . . . I first started to experience
strange health problems. I didn't feel as strong as I once had
or as coordinated . . . [and] . . . always fighting a cold or
the flu. By the summer of 1995 . . . [and] . . . stationed in
Texas . . . I was exposed to malathion fogging, an
organophosphate pesticide used for mosquito control, while
jogging in the evenings. I started to have serious health
problems.''
``Schetoma, or blind spots, in front of my eyes and my
heart would beat irratically. Palpitations, night sweats,
sleeplessness, trouble concentrating and remembering, and
trouble taking a deep breath. Extremely tired much of the time.
By December, I had trouble walking and experienced weakness in
my right leg. In January 1996, I explained my symptoms, and
mentioned I had been in the Gulf War, to a flight surgeon who
immediately talked about the effects of stress. I was referred
to a neurologist.''
``During the first visit with the neurologist, I heard the
line that I would hear throughout the whole Air Force medical
system: `There's no conclusive evidence that there's any link
between service in the Gulf and any illness.' '' \31\
---------------------------------------------------------------------------
\31\ Statement of Michael Donnelly, Human Resources Subcommittee
hearings, No. 2, pp. 39-40.
---------------------------------------------------------------------------
Major Donnelly, in his 20's during the war, was diagnosed
in January 1996 with ALS or ``Lou Gehrig's Disease.'' ALS, a
rare fatal disease which generally affects people between the
ages of 40 to 70, is ``a progressive wasting of muscles that
have lost their nerve supply.'' \32\
---------------------------------------------------------------------------
\32\ Report by the National Organization for Rare Disorders, ALS
Report #57, April 1997 (in subcommittee files).
---------------------------------------------------------------------------
DOD's Special Assistant for Gulf War Illnesses Dr. Bernard
Rostker, an economist, has admitted that nine cases of ALS
among Gulf veterans have been confirmed, and stated under oath
that ``for the population that served in the Gulf, we would
expect to see roughly between 7 and 11 cases of ALS. And we're
looking at nine cases of ALS.'' \33\
---------------------------------------------------------------------------
\33\ Statement of Dr. Bernard Rostker, Human Resources Subcommittee
hearing, No. 2, p. 100.
---------------------------------------------------------------------------
However, [in response to Dr. Rostker's claim] the director
of the Cecil B. Day Laboratory for Neuromuscular Research at
Massachusetts General Hospital and an ALS expert, Robert H.
Brown, Jr., M.D. and Ph.D., stated in a letter to the Human
Resources Subcommittee:
``The incidence of new cases of ALS is about 1/100,000
individuals in our [overall] population. Thus, it is true to
say that a group of 700,000 individuals might, in the
aggregate, be expected to show 7 or so new cases of ALS over a
year's time. However, these statements about aggregate
populations must be interpreted carefully. In particular, they
assume an age-spread that reflects an entire population
[emphasis added]. If one looks at the age of onset of ALS, the
mean onset age is 55 years. The number of cases showing onset
below the age of 40 [emphasis added] is probably no more than
20-25 percent or so of the total. Thus, one might expect 0.20-
0.25 cases/100,000 individuals [or an estimated 1.4-1.7 cases
of ALS in the 18-40 age range]. As I understand it, there are
now 9 or 11 cases of ALS in the Gulf War veterans population.
This seems excessive to me [emphasis added].'' \34\
---------------------------------------------------------------------------
\34\ Letter from Robert Brown, director, Cecil B. Day Laboratory
for Neuromuscular Research, Massachusetts General Hospital, to Mr.
Robert Newman, subcommittee staff, September 15, 1997 (in subcommittee
files).
---------------------------------------------------------------------------
According to a study by Dr. Will Longstreth, professor of
neurology at the University of Washington School of Medicine,
people exposed to organophosphate compounds, such as pesticides
and other chemicals, may be at twice the risk of developing
ALS.\35\
---------------------------------------------------------------------------
\35\ Reuters News Service, ``Gehrig's Disease Tied to Chemicals,''
June 24, 1997.
---------------------------------------------------------------------------
Another Gulf veteran with ALS is Marine Major Randy Hebert,
also a subcommittee witness, who testified that he may have
been contaminated from a reported exploding chemical mine near
his vehicle when the Kuwait invasion began February 24, 1991.
Major Hebert stated: ``I recall my right hand feeling cool and
tingling'' \36\ as he struggled into his protective clothing
and gear. After removing his mask when told it was a false
alarm, he received another radio message: ``Your lane is dirty,
chemical mine has gone off, go to MOPP 4 [full protective
equipment].'' Major Hebert testified, ``I now feel that
[removing his mask] was a mistake.'' Shortly after, Major
Hebert said, ``he felt funny'' and had trouble breathing.\37\
---------------------------------------------------------------------------
\36\ Statement of Randy Hebert, Human Resources and
Intergovernmental Relations Subcommittee hearings, No. 5-6, p. 109.
\37\ Ibid., pp. 110-111.
---------------------------------------------------------------------------
Returning home in May 1991, Major Hebert reported symptoms
of memory loss, mood swings, vomiting, diarrhea, depression,
and severe daily headaches. By the fall of 1994, he experienced
uncontrollable coughing, throat muscle constriction, and
atrophy in the right arm and hand. In October 1995, after more
than 4 years of undiagnosed symptoms, he was finally diagnosed
with ALS. ``I believe the medical problems I have discussed are
due to low level chemical exposure over an extended period,''
\38\ Major Hebert concluded.
---------------------------------------------------------------------------
\38\ Ibid., pp. 112-113.
---------------------------------------------------------------------------
Nick Roberts, a subcommittee witness, was a Seabee with
Naval Mobile Construction Battalion 24 stationed near the Port
of Al Jubayl, Saudi Arabia--an area reportedly hit by SCUDs. He
stated: ``On January 20, 1991, I was awakened by a loud
explosion. Running to the bunker, I heard a second explosion
and noticed a large fireball. I put my gas mask on. We sat
there for approximately 20 minutes and then the all-clear was
given. We went outside. I estimate that half of the unit
returned to their tents and the other half remained outside
talking.''
``I was one of the men outside talking. Within just a few
minutes, my arms, neck and face were stinging, my lips felt
numb and I had a strange taste in my mouth, like a copper penny
. . . a metallic taste. Some say a mist came over the camp . .
. [it seemed] more of a fog. Chemical alarms began sounding.
Alarms going off everywhere. Marines camped nearby began to
yell, `Go back to your bunkers. We have been gassed.' We were
ordered to MOPP level 4. Radio transmissions were coming in,
`Confirmed gas attack. Repeat, confirmed gas attack.' ''
``We were given the all-clear once again. Afterwards, many
of us went to the water tank and washed ourselves down to stop
the stinging. My first symptoms were redness of the skin and
welts on my chest that afternoon.''
Petty Officer Roberts reported that ``in the days and weeks
that followed my symptoms began to grow in number: rashes and
small blisters, fever, night sweats, and flu-like symptoms,
just to mention a few. After a month, my lymph glands were
swollen and my joints hurt. Once home . . . we were turned over
to the VA . . . the Navy said they were not set up to take care
of our medical needs. I never got any medication from the VA,
nor was I ever diagnosed by the VA.''
Petty Officer Roberts reported that after 1\1/2\ years of
no help from the Navy or VA, ``I sought private medical help.
Within 6 weeks of testing and a biopsy of my lymph gland, I was
diagnosed with non-Hodgkin's lymphoma, a cancer, in stage
three. I started on chemotherapy 2 days later.''
``The cause of my symptoms is very obvious. I stand by my
charge--as I have from the very beginning--of chemical
[warfare] exposure, not to mention the overall exposure from
fallout due to intensive [United States] bombing of [Iraqi]
chemical and biological plants, radiation fallout from
thousands of depleted uranium rounds used by the United States,
exposure to vaccines and nerve gas pills, and months of
breathing smoke from more than 300 oil well fires. I don't see
how you can call it anything else. Gulf veterans are suffering
[from] chemical poisoning.'' \39\
---------------------------------------------------------------------------
\39\ Statement of Nick Roberts, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 345.
---------------------------------------------------------------------------
Petty Officer Roberts concluded: ``By the end of 1993,
[there were] 399 men out of 758 [in Battalion 24] who had been
put out of the service because they were medically unfit.''
\40\
---------------------------------------------------------------------------
\40\ Ibid., p. 346.
---------------------------------------------------------------------------
B. Chemical Detections and Exposures
According to Gulf veterans who testified before the Human
Resources Subcommittee, thousands of chemical alarms sounded
and numerous chemical detections by trained U.S. chemical
specialists with state-of-the-art equipment were made only to
be ignored by American commanders. Czech chemical warfare
experts recorded numerous detections, including detections
along the Saudi border where hundreds of thousands of United
States troops were massed for the invasion.
DOD has admitted that ``the Czech detections were valid.''
\41\
---------------------------------------------------------------------------
\41\ U.S. Department of Defense, Assistant Secretary of Defense
(Public Affairs), News Briefing, Czechoslovakian Chemical Report,
November 10, 1993, p. 2.
---------------------------------------------------------------------------
In May 1994, DOD Secretary William Perry and Joint Chiefs
Chairman John Shalikashvili signed a memorandum to Gulf
veterans declaring: ``There have been reports in the press of
the possibility that some of you were exposed to chemical or
biological weapons agents. There is no information, classified
or unclassified, that indicates that chemical or biological
weapons were used in the Persian Gulf.'' \42\
---------------------------------------------------------------------------
\42\ U.S. Department of Defense, Assistant Secretary of Defense
(Public Affairs), News Release No. 323-94, Department of Defense Letter
of Gulf War Veterans, May 26, 1997.
---------------------------------------------------------------------------
In October 1994, however, the Senate Banking Committee
released a staff report which compiled official documents and
eyewitness testimony suggesting that U.S. troops had been
exposed to chemical warfare agents during the Gulf War.\43\
---------------------------------------------------------------------------
\43\ Staff Report No. 3, Senate Committee on Banking, ``Chemical
Warfare Agent Identification, Chemical Injuries, and Other Findings,''
October 7, 1994, pp. 1-24 and appendix materials (in subcommittee
files).
---------------------------------------------------------------------------
In March 1995, another event cast some doubt on DOD's
insistence that there were no chemical or biological warfare
agent exposures. In a television interview, John Deutch, then
Deputy Secretary of DOD repeatedly qualified his statements
regarding chemical weapons exposures in the Gulf War:
Mr. Deutch. Our most thorough and careful efforts to
determine whether chemical agents were used in the Gulf
lead us to conclude that there was no widespread use of
chemicals against U.S. troops.
Bradley. Was there any use? Forget widespread.
Mr. Deutch. I--I do not believe . . .
Bradley. . . . was there any use?
Mr. Deutch. I do not believe there was any offensive
use of chemical agents by Iraqi military troops. There
was not . . .
Bradley. Was there any--any accidental use. Were our
troops exposed in any way?
Mr. Deutch. I do not believe that our troops were
exposed in any widespread way to chemical . . .
Bradley. In any narrow way? In any way?
Mr. Deutch. The Defense Science Board did an
independent study of this matter and found, in their
judgment, that there was not confirmation of chemical
weapon widespread use in the Gulf.\44\ (emphasis added)
---------------------------------------------------------------------------
\44\ Statement made to CBS News, 60 Minutes, March 12, 1995; also
see supra note 2, Tucker Report, p. 5.
The Pentagon, after 5 years of denial that United States
troops were exposed to chemical weapons, finally admitted in
June 1996 that 300 to 400 soldiers were ``presumed exposed'' to
chemical warfare agents from fallout following detonation of
Iraqi munitions bunkers at Khamisiyah. The number of ``presumed
exposed'' continued to rise rapidly and by July 1997 the
Pentagon had raised the number of exposed to 98,900.\45\
---------------------------------------------------------------------------
\45\ Shenon, Philip, ``Study Sharply Raises Estimate of Troops
Exposed,'' New York Times, July 24, 1997, p. A18. See also, statement
to the Presidential Advisory Committee on Gulf War Veterans' Illnesses
by Bernard Rostker, Special Assistant for Gulf War Veterans's
Illnesses, U.S. Department of Defense, July 29 and July 30, 1997.
---------------------------------------------------------------------------
In a January 1996 report to the Human Resources
Subcommittee, Dr. Jonathan Tucker stated, ``Considerable data
[exists] suggestive of such exposures during the Gulf War.
During 1993-94, the staff of the U.S. Senate Banking Committee
issued three reports compiling extensive circumstantial
evidence for both direct and indirect exposures to U.S. troops
to CBW [Chemical/Biological Warfare] agents during the war. In
addition, a workshop sponsored by the National Institutes of
Health [NIH] in April 1994 found that despite the lack of hard
evidence, the possibility of CBW exposures should not be ruled
out prematurely. The NIH report concluded, `Until it can be
unequivocally established that chemical and/or biological
weapons were not used and that troops were not exposed to
plumes of destroyed stockpiles, the possibility remains that
some symptoms are chronic manifestations of such exposure.' ''
\46\
---------------------------------------------------------------------------
\46\ See supra note 2, pp. 4-5, citing National Institutes of
Health, Office of the Director, Persian Gulf Experience and Health:
Technology Assessment Workshop Statement, April 27-29, 1994 (Bethesda,
MD, National Institutes of Health), p. 12.
---------------------------------------------------------------------------
Dr. Tucker pointed out that in the last few years
considerable information in the public domain--including press
accounts, interviews, declassified Government documents under
the Freedom of Information Act or posted on GulfLink \47\ --
presents a variety of evidence indicating Coalition troops were
exposed to low levels of chemical warfare agents. He stated
that while these exposures had no influence on the war's
outcome, ``they appear to have resulted in delayed health
problems in many of the exposed troops.'' In addition to
``affected United States troops, Gulf War illness has been
reported among Australian, British, Canadian, Czech, Hungarian,
Kuwaiti, New Zealander, and Norwegian veterans.''
---------------------------------------------------------------------------
\47\ GulfLINK is the Internet website maintained by the Department
of Defense containing information on Gulf War issues. It can be found
at URL http://www.dtic.dla.mil.gulflink/.
---------------------------------------------------------------------------
Chemical detections during the war were also reported by
French and Czech forces, Dr. Tucker stated. Among detections by
the French were nerve and mustard vapors near King Khalid
Military City during the air bombing campaign. Among the Czech
detections were some along the Saudi border where hundreds of
thousands of United States ground troops were massed for the
invasion of Iraq.
According to a General Accounting Office [GAO] report, ``It
is important to note that detections of the nerve agent Sarin
occurred on January 19, 1991, and of mustard gas on January 24,
1991, by Coalition partners from Czechoslovakia in areas near
Hafir al Batin. DOD has verified the reliability of the Czech
equipment but has never identified the source [emphasis added]
of these detections, although both DOD and CIA have deemed the
detections credible. One cannot rule out the possibility that
these detections were the result of fallout from Coalition
bombing.'' \48\
---------------------------------------------------------------------------
\48\ U.S. General Accounting Office, ``Gulf War Illnesses,'' GAO/
NSIAD-97-163, June 1997, p. 63.
---------------------------------------------------------------------------
A recent NY Times report, following an interview in Prague
with Defense officials and Gulf War veterans, stated: ``Czech
detection teams patrolling the northern Saudi Arabian desert in
January 1991 were convinced that nerve gas detected in the
early days of the war had been released from Iraqi chemical
plants bombed by the United States.''
``Yet despite the reputation of Czech soldiers and their
chemical equipment for reliability, combat logs compiled by
officers working for Gen. Norman Schwarzkopf show that American
commanders ignored Czech warnings that low levels of nerve and
mustard gas had been detected in the vicinity of American
troops,'' The Times reported. ``Czech soldiers recalled that
even as they hurriedly pulled on their gas masks and rubberized
chemical warfare suits after detecting chemical agents in the
northern Saudi desert, the Americans who were stationed only
several hundred feet away remained unprotected.'' \49\
---------------------------------------------------------------------------
\49\ Shenon, Philip, ``Czechs Say They Warned U.S. of Chemical
Weapons in Gulf,'' New York Times, October 19, 1996, p. A1.
---------------------------------------------------------------------------
According to the Tucker Report, ``Although DOD officials
insist that all chemical agent detections by United States
forces in the Gulf were false, they have reluctantly admitted
that detections by Czech chemical defense detachments operating
under contract to the Saudi government appear to have been
authentic.'' \50\
---------------------------------------------------------------------------
\50\ See supra note 2, Tucker Report, p. 18.
---------------------------------------------------------------------------
``In addition to chemical alarms not associated with any
obvious military activity, which were presumably triggered by
chemical fallout from the bombing campaign,'' Dr. Tucker
stated, ``many sick Gulf War veterans describe incidents in
which they believe they were directly exposed to a chemical
attack. Although most of these accounts are based exclusively
on eyewitness testimony, in some cases the veterans' accounts
have been corroborated by the available documentary record. A
number of direct chemical exposures reported by veterans were
associated with attacks by Iraqi SCUD or Frog ballistic
missiles.'' \51\
---------------------------------------------------------------------------
\51\ Ibid., p. 23.
---------------------------------------------------------------------------
One such exposure cited by Dr. Tucker included the
statement: ``Testifying in March 1994 before a subcommittee of
the House Armed Services Committee, Sgt. George Vaughn . . .
described a SCUD attack . . . in which he claimed he was
exposed to some toxic chemical. During an alert, Vaughn
experienced a problem with sealing his gas mask and the lens
fogged up . . . but in the heat of the moment . . . [he] took
the mask off his head. He immediately experienced a bitter
almond taste and began choking. Within a day or two, Vaughn and
three other members of his unit began to experience nausea,
diarrhea, and severe fatigue. The gastrointestinal symptoms
persisted after the four men returned from the Gulf. All four
also developed fatty skin tumors called angiolipomas, which
were surgically removed but have grown back repeatedly. Vaughn
testified that the tumors have caused numbness in his arms and
limited his motor skills.'' \52\
---------------------------------------------------------------------------
\52\ Ibid., p. 23-24.
---------------------------------------------------------------------------
Among numerous detection devices and equipment used in the
war by U.S. forces were M8A1 detector/alarms and the FOX
detection vehicles. The Tucker report states that each of the
nearly 14,000 M8A1 alarms deployed in the war went off an
average of two or three times a day.\53\
---------------------------------------------------------------------------
\53\ Ibid., p. 16.
---------------------------------------------------------------------------
``The alarms went off so frequently, day and night, that
some commanders ordered their troops to disregard or even
disable them because no obvious symptoms of nerve-agent
poisoning had been observed. DOD officials contend that every
one of the tens of thousands of chemical agent alerts during
the Gulf War was a false alarm,'' \54\ Dr. Tucker reported.
---------------------------------------------------------------------------
\54\ Ibid.
---------------------------------------------------------------------------
The most sophisticated CW agent detection system deployed
in the Gulf was the German-made FOX Nuclear/Biological/Chemical
[NBC] Reconnaissance Vehicle, an air-tight detector vehicle
designed to detect chemical contamination on the ground so that
advancing troops can avoid those areas. It carries a crew of
four.
Two detection experts in the Gulf War, Army Major Michael
Johnson and Marine Gy/Sgt. George Grass, appeared before the
Human Resources and Intergovernmental Relations Subcommittee on
December 10, 1996. Though still on active duty, they agreed to
testify despite concerns about their military careers.
Major Johnson was commander of a FOX troop of detection
vehicles. In testimony before the Human Resources Subcommittee,
he stated: ``On 7 August 1991, the 54th Chemical Troop received
the task of confirming the presence of a suspect liquid
chemical agent at the Sabahiyah High School for Girls [Kuwait].
I led the mission . . . [with] two FOX vehicles. The mass
spectrometer showed the presence of H-Agent (Mustard, a highly
volatile blister agent) in the soil. Simultaneously, a
dismounted collection team, in full chemical over garments,
moved to the container (estimated to be 800-1,000 liter
capacity) with chemical agent monitors [CAM] and chemical
detection equipment. The dismounted collection team employed
detection paper and the CAM . . . the detection paper
[registered] H-Agent detection; the CAM registered H-Agent.''
\55\
---------------------------------------------------------------------------
\55\ Statement of Michael Johnson, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, pp. 79-81.
---------------------------------------------------------------------------
Major Johnson indicated that additional tests by both FOX
vehicles registered the same results--H-Mustard agent. He also
reported that while withdrawing liquid from the container, a
British soldier and member of team, had liquid drops make
contact with his wrist. He was in extreme pain immediately and
going into shock. He was decontaminated and taken to the
hospital. The tapes and samples were turned over to personnel
wearing camouflage with no rank or patches. It is unknown what
happened to the tapes and samples [or the British soldier],
according to Major Johnson.\56\
---------------------------------------------------------------------------
\56\ Ibid., pp. 82-83.
---------------------------------------------------------------------------
``I would like to emphasize that these are the facts and
not speculation of what actions we took,'' stated Major
Johnson. ``I know that my unit . . . did in fact detect and
confirm the presence of toxic chemical warfare agents in
Kuwait.'' \57\
---------------------------------------------------------------------------
\57\ Ibid., p. 84.
---------------------------------------------------------------------------
Gy/Sgt. Grass, a FOX vehicle commander, also reported
confirmed detections to the Human Resources Subcommittee. One
detection reported was near an ammunition storage area outside
Kuwait City. He testified: ``The alarm sounded on the mass
spectrometer with a full and distinct spectrum across the
monitor and a lethal vapor concentration of S-Mustard. We drove
the FOX closer to the dug-in ammo bunkers and fully visible
were the skull and crossbones on yellow tape with red
lettering, and scull and crossbones on boxes [of ammo] and on
signs. As we continued driving through the same ammo storage
area the alarm sounded again . . . HT-Mustard in lethal dose
came across the monitor . . . again with skull and cross bones.
Another alarm sounded showing positive readings of Benzine
Bromide.'' \58\
---------------------------------------------------------------------------
\58\ Statement of George Grass, Human Resources and
Intergovernmental Relations Subcommittee hearing, Nos. 5-6, p. 103.
---------------------------------------------------------------------------
Gy/Sgt. Grass stated: ``I gave my superior officers all the
mass spectrometer tickets from the Al Jaber Airfield
[detections in the oil fields] and the ammo storage area . . .
I never saw the tickets I had given them again. When the EOD
[ordnance disposal team] arrived, I escorted them to where the
chemical weapons were detected [in the ammo storage area] . . .
they donned full protective equipment . . . [and later] . . .
verbally acknowledged the presence of chemicals weapons in the
storage area.'' \59\
---------------------------------------------------------------------------
\59\ Ibid., p. 104.
---------------------------------------------------------------------------
``Since returning from the Gulf War, I have spoken to
almost every FOX vehicle commander from both the 1st and 2d
Marine Divisions,'' Gy/Sgt. Grass concluded, ``and every one of
them has verbally acknowledged the positive identification of
chemical agents in their area of operations.'' \60\
---------------------------------------------------------------------------
\60\ Ibid.
---------------------------------------------------------------------------
A DOD report on the Gy/Sgt. Grass' detection stated:
``Based on the information available thus far in this
investigation, the presence of a chemical warfare agent in this
area . . . is judged to be `Unlikely.' Although two members of
the FOX crew believe that their mass spectrometer detected
something, the MM-1 did not sound an alarm. Senior NBC officers
said that there was no report of chemical warfare agents at
this time. Finally, there is no physical evidence--no spectrum,
no sample, et cetera.'' \61\
---------------------------------------------------------------------------
\61\ Report by the U.S. Department of Defense, Office of the
Special Assistant for Gulf War Illnesses, ``Case Narrative: U.S. Marine
Corps Minefield Breaching,'' CMAT Control #7/29/97, 1997191-0003-330,
July 29, 1997, p. 13 (in subcommittee files).
---------------------------------------------------------------------------
When a subcommittee Member asked Major Johnson and Gy/Sgt.
Grass if they were suffering any physical effects from their
Gulf War service, both men answered yes. Major Johnson said he
began to have problems after he returned home . . . ``changes
in my blood pressure, headaches, burning eyes, joint pain, a
mysterious growth in my left knee, chest pains, and
gastrointestinal bleeding.'' \62\
---------------------------------------------------------------------------
\62\ Testimony of Michael Johnson, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 90.
---------------------------------------------------------------------------
Gy/Sgt. Grass said, ``I have rashes on my ankle and other
parts of my body. My wife has been diagnosed with multiple
sclerosis, and there are just numerous cases of illnesses that
people have from something that went on over there, whether
that was the exposure of chemical weapons or the biological
weapons or both.'' \63\
---------------------------------------------------------------------------
\63\ Testimony of George Grass, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 97.
---------------------------------------------------------------------------
Dr. Tucker, in testimony before the Human Resources
Subcommittee, stated: ``Low level exposures to chemical weapons
appear to have resulted from three sources: Chemical fallout
from the aerial bombardment of Iraqi field munitions depots
containing chemical weapons; explosive demolition of munitions
bunkers by United States combat engineers; and sporadic and
uncoordinated Iraqi use of chemical weapons in the ground
campaign. The Pentagon would have us believe that the
Khamisiyah incident is the whole story, I will argue that it is
just the tip of the iceberg.'' \64\
---------------------------------------------------------------------------
\64\ Statement of Jonathan Tucker, Human Resources Subcommittee
hearings, No. 2, p. 269.
---------------------------------------------------------------------------
Dr. Tucker, in his statement, identified over 55 specific
chemical weapons detection or exposure incidents, and their
locations, from January 13 to March 26, 1991.\65\ In addition,
he cites a U.S. Marine Corps survey of 1,600 chemical-defense
specialists from Marine units who served in the Gulf War. A
declassified Marine report stated that 221 respondents (about
13 percent) reported some contact with or detection of Iraqi
chemical weapons during the ground war.\66\
---------------------------------------------------------------------------
\65\ Ibid., pp. 280, 286.
\66\ Ibid., p. 270 citing Captain T.F. Manley, ``Marine Corps NBC
Defense in Southwest Asia,'' Research Paper No. 92-0009, Marine Corps
Research Center, Quantico, VA, July 1991, p. 11.
---------------------------------------------------------------------------
In addition, the possibility is raised by Dr. Tucker that
the Iraqi saboteurs who ignited the Kuwaiti oil well fires may
have deliberately contaminated some of them with chemical
warfare agents. He cites a captured top-secret Iraqi military
record which gives detailed instructions for sabotaging 31 oil
wells with explosives. The record includes an attached letter
from the commander of the 29th Infantry Battalion which states
in part: ``Please send an assigned person from your personnel
to the Chemical Rank Command of Battalion 14 to receive the
chemical preparations (Tucker emphasis) distributed to your
units according to the directions of the command above.'' Part
of the document also makes reference to the use of individual
chemical protective gear and decontamination stations for
equipment and vehicles.\67\
---------------------------------------------------------------------------
\67\ Ibid., pp. 271-272 citing ``Captured Iraqi Military Record,''
December 2, 1990, at GulfLink file #20tr2__6.j17.
---------------------------------------------------------------------------
``This document raises the possibility that Iraqi troops
deliberately contaminated the oil well fires with chemical
warfare agents, generating clouds of poison-laced smoke with
the intent of debilitating Coalition forces downwind,'' \68\
Dr. Tucker stated.
---------------------------------------------------------------------------
\68\ Ibid., p. 272.
---------------------------------------------------------------------------
In that connection, FOX vehicle operator Gy/Sgt. Grass also
testified about detections at Kuwait's Al Jaber Airfield during
the oil well fires: ``As the mass spectrometer was monitoring
for chemical agent vapor contamination with the usual readings
from the oil fires, the alarm went off and the monitor showed a
lethal vapor concentration of the chemical agent S-Mustard.''
Gy/Sgt. Grass noted that when he reported the detection to the
Division NBC officer, he was told the reading was false and had
been produced by oil well vapors. ``We explained to him [NBC
officer] that we already know what the oil fire vapors looked
like on the monitor and the readings were clearly distinct with
the words S-Mustard printed across the screen and on the tape
printed out as evidence of the contamination the Marines were
exposed to. Division still insisted we had false readings and
abruptly signed off the radio.'' \69\
---------------------------------------------------------------------------
\69\ Statement of George Grass, Human Resources and
Intergovernmental Relations Subcommittee hearing, Nos. 5-6, p. 102.
---------------------------------------------------------------------------
Dr. Tucker's hypothesis about Iraqi disbursement of toxic
agents in the updraft and high downwinds of the oil well fires
is supported by the experience of ex-CIA agent Dr. David
Morehouse. While in the Gulf theater, Dr. Morehouse and other
CIA agents found multiple empty canisters or metal cylinders
about 20 inches long and 4 inches in diameter placed upright in
the sand [and] ``leaned like the Tower of Pisa,'' downwind of
numerous well-head fires. In his book ``Psychic Warrior,'' he
writes: ``It's obvious that the Iraqis placed the canisters
next to the fires to mask the plume from the canisters. So I
think they released a slow-acting toxin to poison the Coalition
forces, and they covered it up with oil well fires. Every
soldier downwind of those fires must've inhaled the bug of
whatever it was. The heroes had been poisoned.'' \70\
---------------------------------------------------------------------------
\70\ David Morehouse, Psychic Warrior (St. Martin's Press, 1996),
pp. 168-171.
---------------------------------------------------------------------------
Dr. Tucker's subcommittee statement concluded: ``Evidence
in the public domain from a variety of sources indicates a far
larger number of credible chemical weapons detection and
exposure incidents than DOD or CIA have thus acknowledged.
Eyewitness accounts, declassified intelligence records, and
operational logs all suggest that Iraq deployed chemical
weapons into the Kuwait Theater of Operations [KTO] prior to
the Gulf War and may have employed them in a sporadic and
uncoordinated manner against the Coalition forces during the
ground war. U.S. troops also appear to have been exposed to low
level chemical warfare agents from the air bombardment and
ground detonations of chemical facilities.'' \71\
---------------------------------------------------------------------------
\71\ Statement of Jonathan Tucker, Human Resources Subcommittee
hearings, No. 2, pp. 275-276.
---------------------------------------------------------------------------
Dr. Tucker, a former senior policy analyst to the
Presidential Advisory Committee on Gulf War Veterans' Illnesses
[hereinafter ``PAC''], was dismissed summarily from the PAC in
December 1995, allegedly for his research on chemical exposures
to U.S. troops and gathering the views of people inside and
outside the Government who also believed that Gulf veterans
were suffering from toxic exposures. His dismissal with only 1
hour's notice was in spite of high performance review
ratings.\72\
---------------------------------------------------------------------------
\72\ Ibid., p. 275.
---------------------------------------------------------------------------
C. Toxic Exposures in Gulf War Theater
U.S. troops who served in the Gulf War were exposed to
multiple toxins, any one of which--alone or a combination of
toxins producing a synergistic interaction--may well be
responsible for the illnesses reported by thousands of
veterans.
According to a GAO report, ``U.S. troops might have been
exposed to a variety of potentially hazardous substances. These
substances include compounds used to decontaminate equipment
and protect it against chemical agents, fuel used as a sand
suppressant in and around encampments, fuel oil used to burn
human waste, fuel in shower water, leaded vehicle exhaust used
to dry sleeping bags, depleted uranium, parasites, pesticides,
drugs to protect against chemical warfare agents (such as
pyridostigmine bromide), and smoke from oil-well fires. DOD
acknowledged in June 1996 that some veterans may have been
exposed to the nerve agent Sarin following post-war demolition
of Iraqi ammunition facilities.'' \73\
---------------------------------------------------------------------------
\73\ See supra note 48, pp. 1-2.
---------------------------------------------------------------------------
Chemical Weapons
After 5 years of denial that United States troops were
exposed to any chemical weapons, DOD disclosed on June 21, 1996
that some 400 soldiers were ``presumed exposed'' to Iraqi nerve
agents. This event occurred when the 37th Army Combat Engineers
detonated enemy munitions bunkers at Khamisiyah, Iraq in March
1991, sending plumes of nerve gas wafting into the atmosphere
and dispersing over unprotected soldiers.\74\
---------------------------------------------------------------------------
\74\ U.S. Department of Defense, Assistant Secretary of Defense
(Public Affairs), News Briefing, June 21, 1996, p. 4.
---------------------------------------------------------------------------
The number of exposed troops began to rise in following
months as the DOD and CIA reconsidered modeling results
pertaining to wind direction and other factors. In September
1996, DOD raised the number to 5,000 exposed; in October, to
nearly 21,000 exposed.\75\
---------------------------------------------------------------------------
\75\ U.S. Department of Defense, Assistant Secretary of Defense
(Public Affairs), News DOD News Briefing, September 19, 1996, p. 1, and
October 22, 1996, p. 2.
---------------------------------------------------------------------------
On July 24, 1997, results of a new computer modeling study
were revealed by the DOD and CIA suggesting that 98,900 United
States troops must be ``presumed exposed'' to chemical weapons
from the Khamisiyah bunker detonations. Original CIA computer
modeling estimates released in June 1996 stated the plumes
carried northerly for perhaps 25 miles. New modeling estimates
stated the plumes carried southerly for perhaps 300 miles from
the blast site, producing fallout over some 100,000 troops
positioned in southern Iraq, Kuwait, and northern Saudi
Arabia.\76\
---------------------------------------------------------------------------
\76\ See supra note 45.
---------------------------------------------------------------------------
In April 1997, the CIA released 41 declassified documents,
1 of which stated the CIA had warnings starting in 1984 that
thousands of chemical weapons were stored in Khamisiyah
bunkers.\77\ According to news accounts, the CIA claims they
notified the Pentagon before the war of the presence of these
weapons at Khamisiyah. The DOD had denied it until February 25,
1997, when the Pentagon disclosed that the CIA had in fact
warned the Army but it never reached commanders of the 37th
Army Engineers Battalion that detonated the Khamisiyah
depot.\78\
---------------------------------------------------------------------------
\77\ Document released by the U.S. Central Intelligence Agency to
accompany the report, ``Khamisiyah: A Historical Perspective on Related
Intelligence,'' April 9, 1997, p. 3.
\78\ Dana Priest, ``CIA Warned of Chemical Arms in '91,''
Washington Post, February 26, 1997, p. A1.
---------------------------------------------------------------------------
The United Nations Special Commission on Iraq [UNSCOM]
testified on July 29, 1997 at the Presidential Advisory
Committee [PAC] meeting in Buffalo, NY that the aerial
bombardment during the war of the Ukhaydir, Iraq chemical
weapons storage depot, and possibly the Mymona depot, sent
toxins into the air that may have produced fallout over United
States troops stationed in Saudi Arabia.\79\ The CIA, also in
testimony at the PAC meeting, stated: ``CIA and DOD now assess
that there may have been a release of chemical agent from the
Ukhaydir Ammunition Depot as a result of aerial bombing . . .''
The CIA is continuing exposure modeling of this event.\80\
---------------------------------------------------------------------------
\79\ Report of the United Nations Special Commission [hereinafter
``UNSCOM''], ``Investigation of Deployment of Chemical Weapons,'' July
1997.
\80\ Statement of Robert Walpole, Special Assistant for Gulf
Illnesses, U.S. Central Intelligence Agency, to the Presidential
Advisory Committee on Gulf War Veterans' Illnesses, ``Probable Release
of Mustard Agent From the Ukhaydir Ammunition Storage Depot,'' July 29,
1997.
---------------------------------------------------------------------------
In August 1997, it was reported that a 1990 study by the
Lawrence Livermore National Laboratory informed the U.S. Air
Force--3 months before the Gulf War began--that bombing of
Iraqi chemical weapons manufacturing facilities would release
deadly nerve agents over U.S. troops who were massing several
hundred miles to the south. This report predicted a dispersion
of chemical warfare agents over an area 10 times greater than
subsequent DOD and CIA studies would show.\81\
---------------------------------------------------------------------------
\81\ ``Chemical Risk to Gulf Troops was Forecast,'' USA Today,
August 14, 1997, p. 1.
---------------------------------------------------------------------------
According to testimony before the Human Resources
Subcommittee by Gulf War expert James Tuite, director of the
Gulf War Research Foundation, the Livermore Laboratory study
proved to be prophetic. He stated: ``Up to now, the missing
element . . . has been the mystery of how the [chemical] agents
were transported from the research, production and storage
sites in Iraq to [Coalition] troops.'' This has been an
especially difficult issue given that it has been the long-held
assertion of DOD, DIA, and the CIA that the winds were blowing
in the wrong direction [northerly] during the detection events.
``The report I submit today [I believe] solves the mystery
of the [chemical] detections that occurred after the initial
wave of Coalition bombings of these chemical warfare agent
storage facilities during the first 2 days of the air war.
Using available visible and infrared meteorological satellite
imagery from NOAA [National Oceanic and Atmospheric
Administration], which was available to military planners [but
not used] during the war--a war before which they expressed
deep concern over the fallout effects from these bombings--I
have been able to determine that a thermal plume rose into the
atmosphere over the largest Iraqi chemical warfare agent
research, production, and storage facility at Muthanna after
Coalition aircraft and missile bombardment.''
``Seventeen metric tons of Sarin were reportedly destroyed
during these attacks, which began on January 17, 1991. These
thermal and visual plumes extended [southerly] directly toward
the areas where those same chemical warfare agents were
detected and confirmed by Czechoslovak chemical specialists.
Hundreds of thousands of U.S. servicemen and women were in the
area where these detections occurred, assembling for the
upcoming ground invasion of Iraq and the liberation of
Kuwait.'' \82\
---------------------------------------------------------------------------
\82\ Statement of James Tuite, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 439.
---------------------------------------------------------------------------
Biological Weapons
According to Dr. Jonathan Tucker's 1996 report to the
subcommittee, Iraq had initially denied possession of
biological weapons following the war. Over the next 5 years,
however, persistent detective work by UNSCOM personnel
gradually forced Iraqi authorities to admit the existence of an
offensive biological warfare program, an extensive and
sophisticated effort led by Ph.D. scientists trained in the
West.
Dr. Tucker stated: ``As the centerpiece of this effort,
Iraq mass-produced and weaponized three [biological] agents on
a large scale: the bacterial agent that causes the disease
anthrax, which is nearly always fatal within 4 days; botulinum
toxin, an exceedingly potent bacterial toxin; and aflatoxin, a
fungal toxin that is a liver carcinogen but can also serve as
an incapacitating agent. In addition . . . Iraq experimented
with a range of other lethal and incapacitating agents.'' \83\
---------------------------------------------------------------------------
\83\ See supra note 2, Tucker Report, p. 1.
---------------------------------------------------------------------------
Dr. Tucker reported that Iraq conducted field trials of
biological agents in bombs, rockets and aerosol generators from
1988 until Iraq invaded Kuwait in August 1990. At this point,
their research and development [R&D] program shifted to a
``crash'' effort on large-scale production and weaponization.
``Even if Iraq was deterred from a large-scale or overt use
of chemical and biological weapons [as a result of United
States warnings of massive retaliation], it may still have
engaged in covert or insidious (i.e., low-level) operations.
Certainly, Iraq would have nothing to gain by admitting that it
had employed chemical or biological weapons during the Gulf
War, and much to lose politically and economically, since such
as admission would make it even less likely that the UN
sanctions would be lifted. Thus, Iraq's denials [of chemical
and biological weapons use] should not be taken at face-value,
especially in view of the evidence for Iraqi chemical weapons
use.''
Dr. Tucker cites Iraqi military manuals on the use of
chemical and biological weapons. An Iraqi Air Force Academy
manual on nerve agents notes that these poisons ``have a
cumulative effect; if small doses are used repeatedly on a
target, the damage can be very severe.'' \84\ An Iraqi Chemical
Corps manual states: ``It is possible to select anti-personnel
biological agents in order to cause lethal or incapacitating
casualties in the battle area or in the enemy's rear areas . .
. [and] incapacitating agents are used to inflict casualties
which require a large amount of medical supplies and treating
facilities, and many people to treat them. Thus it is possible
to hinder the opposing military operations.'' \85\
---------------------------------------------------------------------------
\84\ U.S. Department of Defense, Defense Intelligence Agency,
(translation of) Iraqi field manual, ``A Course in Nuclear, Biological
and Chemical Protection,'' August 23, 1991, p. 5.
\85\ U.S. Department of Defense, Armed Forces Medical Intelligence
Center, (translation of) Iraqi manual, ``Chemical, Biological and
Nuclear Operations,'' January 12, 1992, p. 6.
---------------------------------------------------------------------------
A report by the U.S. Navy's Biological Defense Research
Program, which performed BW detection and analysis for U.S.
forces during the Gulf War, concluded: ``No agents (including
anthrax and botulinum toxin) detected during Desert Shield/
Storm despite fielding of state-of- the-art detection
methods.'' \86\
---------------------------------------------------------------------------
\86\ Report of the Naval Medical Research Institute, U.S. Navy,
``BW Detection Capabilities'' Biological Defense Research Program,
Naval Medical Research Institute, Bethesda, MD, September 3, 1997,
Summary page (in subcommittee files).
---------------------------------------------------------------------------
A recent GAO report stated: ``DOD has consistently denied
that Gulf War veterans were intentionally or unintentionally
exposed to biological warfare agents, and prior to June 1996,
it denied any exposure to chemical warfare agents. If
servicemembers were exposed, exposure would have occurred in
one of three ways: 1) through intentional Iraqi use of chemical
or biological warfare agents; 2) through theaterwide
contamination resulting from air war bombings of Iraq, or 3)
through site-specific events. DOD has taken the position that
chemical and biological agent exposures can be confirmed only
through evidence of mass [and immediate] incidents of morbidity
and mortality. Since there were no such instances, DOD asserted
that Gulf War veterans were not exposed.'' \87\
---------------------------------------------------------------------------
\87\ See supra note 48, p. 62.
---------------------------------------------------------------------------
The GAO report observed: ``According to the CIA . . . the
Iraqis had weaponized several biological agents at the time of
the Gulf War, including anthrax, botulism, and aflatoxin (a
potent liver carcinogen). . . . [Aflatoxin's] effects may not
be observed until decades after low-level exposure . . .'' \88\
---------------------------------------------------------------------------
\88\ Ibid.
---------------------------------------------------------------------------
Infectious Diseases
According to the PAC December 1996 report, ``Infectious
diseases endemic to the Gulf region include shigellosis,
malaria, sandfly fever, and cutaneous leishmaniasis. Along with
these infectious diseases, DOD medical personnel also monitored
troops for dengue, Sindbis, West Nile fever, Rift Valley fever,
and Congo-Crimean hemorrhagic fever. The documented low rates
of infection among U.S. troops suggest exposures were minimal
and/or preventive measures were ineffective.'' \89\
---------------------------------------------------------------------------
\89\ Final Report of the Presidential Advisory Committee on Gulf
War Related Illnesses, (U.S. Government Printing Office, Washington,
DC, 1996) [hereinafter ``PAC Report''], pp. 98-99.
---------------------------------------------------------------------------
Microbiologist and immunologist Dr. Howard Urnovitz,
chairman of the Calptye Biomedical Corp., testified before the
Human Resources Subcommittee on the Gulf War Syndrome. He
stated: ``One of my research efforts is focused on how chemical
and infectious agents interact to initiate and maintain a
chronic disorder. The symptoms [of Gulf War Syndrome] are
similar to those of over a dozen unexplained epidemics over the
last 60 years . . . including headache, muscle pain, slight
paralysis, damage to the brain, spinal cord or peripheral
nerves, mental disorders . . .''
``Recent studies have found that prolonged and aggressive
antibiotic therapy appears to abate many of the symptoms
associated with Gulf War Syndrome. Usually the therapy takes
longer than ordinary treatments (i.e., 6 to 9 weeks instead of
less than 3 weeks) and in many cases the symptoms return when
the therapy is discontinued. It is not clear whether this
response is directly due to the control of some antibiotic-
sensitive microorganisms or a direct action on an inflammatory
or neurologic process or some placebo effect.''
``It is known that the Gulf War was one of the most toxic
battlefields in the history of modern warfare. Syndromes
associated with organophosphate-induced delayed neuropathy
[OPIDN] could explain many of the observed and unexplained
illnesses. However, it may not be mutually exclusive to have
tissue damage resulting from toxic exposures, which leads to
inflammatory responses in critical tissues with ensuing
opportunistic bacteriological, viral, and fungal infections.
The continued presence of these pathogens may greatly impair a
possible healing process. All of these risk factors need to be
considered in trying to understand the underlying pathology of
Gulf War Syndrome.'' \90\
---------------------------------------------------------------------------
\90\ Statement of Howard Urnovitz, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 194-
196.
---------------------------------------------------------------------------
Dr. Garth Nicolson, chief scientific officer and research
professor at the Institute for Molecular Medicine, states that
some illnesses can be explained by exposure of veterans to
various biological agents, called chronic pathogenic
infections, in combination with chemicals and then transported
home to family members. Dr. Nicolson, who has studied 650 Gulf
veterans and their immediate family members, discounts stress
as a major factor in causing Gulf veterans' illnesses.
In testimony before the Human Resources Subcommittee, Dr.
Nicolson stated: ``Gulf War illness [GWI] is not caused by
stress, it is caused by multiple exposures to chemical,
environmental, radiological and/or biological agents that cause
chronic multisystem signs and symptoms that for the most part
can be diagnosed as existing diseases. We have been
particularly interested in veterans with GWI whose family
members are now also sick with similar signs and symptoms,
suggesting that many GWI patients suffer from biological, not
chemical or radiological, origins for their illnesses.
Illnesses caused by chemical or radiological exposures should
not be transmitted to family members. GWI in immediate family
members is officially denied by DOD and VA.'' \91\
---------------------------------------------------------------------------
\91\ Prepared statement of Garth Nicolson, Human Resources
Subcommittee hearing of June 26, 1997, p. 1 (in subcommittee files).
---------------------------------------------------------------------------
``After examining GWI patients'' blood for the presence of
chronic biological agents, the most common infection found was
an unusual microorganism, Mycoplasma fermentans (incognitus
strain), a slow-growing mycoplasma located deep inside blood
leukocytes (white blood cells) of slightly under one-half of
GWI patients studied. When they are in the blood, similar to
other bacteria, they can cause a dangerous system-wide or
systemic infection. In addition, cell-penetrating mycoplasmas,
such as Mycoplasma fermentans, may produce unusual autoimmune-
like signs and symptoms . . .'' \92\
---------------------------------------------------------------------------
\92\ Ibid., p. 3.
---------------------------------------------------------------------------
``In GWI patients that tested positive for mycoplasmal
infections in their blood, we have found that this type of
infection can be successfully treated with multiple courses of
specific antibiotics, such as doxycycline. Multiple treatment
cycles are required, and patients relapse often after the first
few cycles, but subsequent relapses are milder and patients
eventually recover.'' \93\
---------------------------------------------------------------------------
\93\ Ibid., pp. 4-5.
---------------------------------------------------------------------------
``Chemical exposures can cause toxicological effects and
produce many but not all of the signs and symptoms of GWI. In
addition, chemical exposures can result in immunosuppression
and leave an individual susceptible to infections.'' \94\
---------------------------------------------------------------------------
\94\ Ibid., p. 7.
---------------------------------------------------------------------------
Leishmaniasis is also an infectious disease and is caused
by a microscopic parasite that invades certain types of white
blood cells. The disease is transmitted by sandflies, and a
number of different leishmania species are known to infect
humans. Disease that involve low levels of parasite infection
can be particularly difficult to diagnose. It is rarely seen in
the United States; however, more than 30 cases have been
diagnosed among Gulf veterans. Accurate diagnosis of
leishmaniasis, which can have a long latency period, is
important because effective treatment involves the use of
potentially toxic drugs in clinical trials but not yet approved
by the Food and Drug Administration [FDA].\95\
---------------------------------------------------------------------------
\95\ See supra note 48, p. 60.
---------------------------------------------------------------------------
Depleted Uranium
Depleted uranium [DU] is a highly, toxic, radioactive by-
product of the uranium enrichment process.\96\ DU is used in
munitions as armor-piercing rounds fired at enemy tanks, and as
protective armor on U.S. tanks. When a DU penetrator impacts a
hard target, most of the round burns up, scattering uranium
dust and shrapnel in and around the target. In the Gulf War, DU
is credited with destroying over 1,400 Iraqi tanks, as well as
other equipment and weapons storage facilities.\97\
---------------------------------------------------------------------------
\96\ U.S. General Accounting Office, Operation Desert Storm: Army
Not Adequately Prepared to Deal With Depleted Uranium Contamination,
GAO/NSIAD-93-90, p. 1.
\97\ Report by the National Gulf War Resource Center, Inc.,
Washington, DC. ``Gulf War Syndrome,'' Fall 1996, p. 5 (in subcommittee
files).
---------------------------------------------------------------------------
``Exposure to DU armor and/or penetrators is dangerous, but
DU poses the greatest risk to those who: breathe smoke or dust
from a burning vehicle hit by DU rounds; climb on or enter a
vehicle hit by DU rounds; or were in a friendly fire incident
involving DU rounds.'' \98\
---------------------------------------------------------------------------
\98\ Ibid.
---------------------------------------------------------------------------
One of the more severe DU exposure events occurred in July
1991 in Doha, Kuwait when a major U.S. Army ammunition depot
and motor pool exploded and burned for 2 days. DU armor on
vehicles and 9,000 pounds of DU rounds were oxidized to powder
exposing 3,500 soldiers in the vicinity to radiation and DU
aerosol particles that were widely distributed by high winds.
Soldiers involved in the cleanup several days after the fire
were not warned of DU contamination and, therefore, wore no
protective gear.\99\
---------------------------------------------------------------------------
\99\ International Action Center, Metal of Dishonor (Depleted
Uranium Action Project, International Action Center, New York, NY,
1997), pp. 33-35. [Abstract 5, ``How U.S. Troops Were Exposed to DU'']
---------------------------------------------------------------------------
According to the booklet ``DU: The Stone Unturned,''
published by Swords to Plowshares: ``Even after the [Doha]
fire, soldiers were never told about the presence of DU
contamination. Soldiers swept the compound with brooms, picked
up debris with their bare hands, and were never issued
respiratory masks or other protective clothing.'' \100\
---------------------------------------------------------------------------
\100\ Report by Dan Fahey, ``DU: The Stone Unturned,'' Swords to
Plowshares, March 28, 1997, p. 10 (in subcommittee files).
---------------------------------------------------------------------------
``Like most soldiers,'' the DU publication continues, ``S/
Sgt. Chris Kornkven was unaware of the use of DU munitions
during the war. Due to his exposure to DU dust on destroyed
Iraqi vehicles, he has since tested positive for internalized
depleted uranium.'' [S/Sgt. Kornkven testified before the Human
Resources Subcommittee on January 21, 1997.] \101\
---------------------------------------------------------------------------
\101\ Ibid., p. 11.
---------------------------------------------------------------------------
Radiation exposure expert Dr. Asaf Durakovic, a medical
unit commander in the Gulf War and most recently the chief of
nuclear medicine at the VA Medical Center in Wilmington, DE was
a witness at the Human Resources Subcommittee hearing on June
26, 1997. Dr. Durakovic reported that his expertise was never
used because he and his staff were never informed of the
intended use of DU before the war or during the war.\102\
---------------------------------------------------------------------------
\102\ Prepared statement of Asaf Durakovic, Human Resources
Subcommittee hearing of June 26, 1997, p. 2 (in subcommittee files).
---------------------------------------------------------------------------
In late 1991, following the war, 24 ill soldiers from the
144th Transportation & Supply Company in New Jersey were
referred to Dr. Durakovic at the VA Medical Center in
Wilmington for diagnosis and treatment. These soldiers had
worked on battle damaged tanks and vehicles in the Gulf from
January to March 1991 without protective equipment or clothing.
In March, a Battle Damage Assessment Team arrived in full
radioprotective clothing, inspected the vehicles, declared them
``hot'' and off-limits.\103\
---------------------------------------------------------------------------
\103\ Ibid.
---------------------------------------------------------------------------
Preliminary testing showed 14 of 24 veterans ``contained
decay products of radioactive uranium.'' According the Dr.
Durakovic, urine samples sent to the Army Radiochemistry Lab in
Aberdeen, MD, disappeared. Dr. Durakovic recommended
additional, more comprehensive testing--including tests to
determine if the 24 veterans had also inhaled DU particles--but
further tests and treatments were denied by the VA. Of the 14
veterans, 2 have since died, and the remaining members of the
144th Company have scattered around the country making medical
follow-up unlikely.\104\
---------------------------------------------------------------------------
\104\ Ibid., pp. 2-3.
---------------------------------------------------------------------------
``None of my recommendations was ever followed. Every
conceivable road block was put in my line of management of
those patients. I was ridiculed. There were obstacles
throughout my attempt to properly analyze the problems of those
patients. My plan failed because of total lack of interest on
the part of the VA to do anything for those unfortunate
patients. I [even] received phone calls from DOD suggesting
that this work is not going to yield meaningful information and
should be discontinued.'' \105\
---------------------------------------------------------------------------
\105\ Testimony of Asaf Durakovic, Human Resources Subcommittee
hearing of June 26, 1997, original transcript, pp. 135-136 (in
subcommittee files).
---------------------------------------------------------------------------
Dr. Durakovic was later terminated by the Wilmington VA
hospital, he alleges for his outspoken views of the VA
concerning the diagnosis and treatment of sick Gulf War
veterans.
Physicist and DU expert Leonard Dietz, who testified before
the Human Resources Subcommittee, writes and speaks frequently
on the dangers of depleted uranium. In a recent abstract he
stated, ``A large number of unprotected Gulf War veterans could
easily have acquired dangerous quantities of DU in their
bodies. We refer to scientific measurements that have been made
of the atmospheric wind-borne transport of uranium aerosols up
to 25 miles from their sources. Micrometer particles of DU can
spread over a large region and poison many people both
radiologically and chemically.'' \106\
---------------------------------------------------------------------------
\106\ See supra note 98, p. 135. [Abstract 20, ``DU Spread &
Contamination of GW Veterans.'']
---------------------------------------------------------------------------
``A comprehensive epidemiological study should be made of
all Gulf War veterans and their families,'' Dietz said,
``searching for evidence of residual DU in their bodies and for
causes of genetic defects in their children. The health issues
associated with DU munitions should be investigated and
evaluated by independent medical and scientific experts
separated completely from the DOD, VA, National Laboratories,
U.S. military services and their contractors.'' \107\
---------------------------------------------------------------------------
\107\ Ibid., p. 149.
---------------------------------------------------------------------------
Dr. Michio Kaku, nuclear physics professor at City
University of New York, stated, ``Ultimately, the Gulf War
Syndrome will be traced to a variety of factors, simply because
the Pentagon released so much firepower on the Iraqis during
that war that large quantities of materials were sent into the
atmosphere, including DU and chemicals stored in warehouses.
Ultimately, when the final chapter is written, DU will have a
large portion of the blame.'' \108\
---------------------------------------------------------------------------
\108\ Ibid., p. 114. [Abstract 17, ``DU: Huge Quantities of
Dangerous Waste.'']
---------------------------------------------------------------------------
``The Pentagon should release all its classified
information concerning the Gulf War Syndrome and depleted
uranium,'' Dr. Kaku said. ``It is a national embarrassment that
the Pentagon, even at this late date, is still withholding
vital information about precisely what happened during the Gulf
War.'' \109\
---------------------------------------------------------------------------
\109\ Ibid., p. 115.
---------------------------------------------------------------------------
A 1993 report by the GAO concluded, ``Although the Army's
stated policy is to minimize personnel's exposure to radiation,
it has not effectively educated its personnel in the hazards of
DU contamination and in proper safety measures appropriate to
the degrees of hazard. What little information is available is
not widely disseminated and training on DU is basically limited
. . .'' \110\
---------------------------------------------------------------------------
\110\ U.S. General Accounting Office, ``Operation Desert Storm:
Army Not Adequately Prepared to Deal With Depleted Uranium
Contamination,'' GAO/NSIAD-93-90, January 1993, p. 2.
---------------------------------------------------------------------------
The DOD did not properly train Gulf troops to the dangers
of DU before and during the war, according to Dr. Bernard
Rostker, DOD's Special Assistant for Gulf War Illness. He made
this statement in a July 1997 meeting on depleted uranium with
Human Resources Subcommittee staff. Dr. Rostker advised the
Human Resources staff that steps were being taken to educate
troops, who may fight future wars, on the toxic effects of DU
exposure.
Oil Well Fires and Petroleum Contamination
Iraqi troops, in a deliberate act of sabotage and revenge,
ignited hundreds of Kuwaiti oil wells during the Gulf War.
According to a Defense Science Board Report, ``On February 23,
1991, Iraqi forces began to destroy and set fire more than 700
oil wells throughout Kuwait.'' \111\ The date is challenged by
the University of Arizona's Environmental Research Laboratory,
concluding that, ``Solar radiation data indicate that the first
oil well fires were most likely set on or around January 17,
1991'' \112\ [an important date because it suggests an
additional month of troop contamination]. The last of the 749
oil well fires, including storage tanks and refineries, were
extinguished 10 months later, in November 1991.\113\
---------------------------------------------------------------------------
\111\ Final Report of the Defense Science Board, U.S. Government
Printing Office, 1994, p. 50.
\112\ Riley, et al., ``Effect of Kuwait Oil Field Fires on Human
Comfort and Environment in Saudi Arabia,'' International Journal of
BioMeteorology, 1992, pp. 36-38.
\113\ Report prepared by Craig Stead, ``Oil Fires, Petroleum and
Gulf War Illnesses,'' June 1997, at tab J, citing testimony of Gary
Friedman, Texas Lung Institute to the PAC (in subcommittee files).
---------------------------------------------------------------------------
Oil well fires and petroleum related exposures are another
possible cause of the Gulf War Syndrome. In testimony submitted
to the Presidential Advisory Committee [PAC], chemical engineer
and expert on health effects of petroleum exposure, Craig Stead
stated: ``Petroleum was a major Gulf War environmental
exposure. American troops were exposed to petroleum from oil
well fires, oil contaminated drinking and shower water, oil
soaked clothing, and use of petroleum for dust suppression,
pesticide application, and fuel. Petroleum inhalation,
ingestion and skin absorption causes illness. The symptoms of
petroleum illness are consistent with symptoms reported by Gulf
War veterans.''
``Clinical techniques exist to diagnose petroleum
illness,'' Mr. Stead said. ``These techniques include broncho
alveolar lavage [BAL], computed tomography, and magnetic
resonance imaging. Known treatments for petroleum include the
use of anti-inflammatory steroids, expectoration of oil in the
lungs, and diet. Left untreated, petroleum illness is a
progressive disease which can lead to emphysema and cancer as
endpoints.'' \114\
---------------------------------------------------------------------------
\114\ Statement of Craig Stead to the PAC, March 26, 1996, p. 2
(excerpt in subcommittee files).
---------------------------------------------------------------------------
Sick Gulf War veterans testified about their experiences
before the Presidential Advisory Committee and a National
Institutes of Health Gulf War workshop. Testimony included:
``When they blew the oil well fires, it was unlike anything
I ever seen in my life. It was like being in a locked closet in
the dark. We are in the middle of 500 oil well fires. And the
only thing that they [U.S. military] gave us was a white T-
shirt and [said] `Put it over your face.' When they brought in
the civilian contractors to put out these oil well fires, they
had self-contained breathing apparatus. They had chemical
suits. They had everything. Members of my team did [get ill].''
\115\
---------------------------------------------------------------------------
\115\ Statement of Scott Russell to the PAC, August 6, 1996
(excerpt in subcommittee files).
---------------------------------------------------------------------------
``[I] was in the center of the oil fires in Kuwait City
with no capability of distinguishing the sun from the moon for
the first 6 weeks after the liberation of Kuwait. [My] body was
so oil and soot covered that a black watch band was camouflaged
on [my] wrist. The scarf [I] wore around [my] face did not
filter out the air borne debris. [My] spit looked like oil and
when [I] sneezed [my] mucus looked like axle grease.'' \116\
---------------------------------------------------------------------------
\116\ Statement of Herb Smith to the National Institutes of Health
Gulf War Workshop, April 27-29, 1994, (excerpt in subcommittee files).
---------------------------------------------------------------------------
``We were by the oil well fires for 2 weeks and we camped
right next to them.'' \117\
---------------------------------------------------------------------------
\117\ Statement of Kevin Jenson to the PAC, August 6, 1997 (excerpt
in subcommittee files).
---------------------------------------------------------------------------
``I developed severe nasal problems from the oil smoke. I
got breathing problems.'' \118\
---------------------------------------------------------------------------
\118\ Statement of Michael Lanning to the PAC, August 6, 1997
(excerpt in subcommittee files).
---------------------------------------------------------------------------
``I lived six city blocks from the fires for almost 2
weeks. I flew in the stuff every day.'' \119\
---------------------------------------------------------------------------
\119\ Statement of Ronald Matthews to the PAC, February 27, 1996
(excerpt in subcommittee files).
---------------------------------------------------------------------------
``For 7 months, my husband's ship chartered through burning
oil derricks in the water. They were on the oil spill. They
ingested oil-infested water. They cooked with it. They showered
in it. He has chemical sensitivity. He has asthma. He got it in
the service.'' \120\
---------------------------------------------------------------------------
\120\ Statement of Betty Zuspan to the PAC, February 7, 1996
(excerpt in subcommittee files).
---------------------------------------------------------------------------
``We suffered chemical ingestion when our drinking,
cooking, washing, and bathing water became heavily contaminated
with some sort of chemical that burned our mouth, throat,
esophagus, and stomach. When we took our showers, we smelled of
petrochemicals as well as the freshly washed clothes we put on.
The food tasted of kerosene. We were in a 100 percent
contaminated environment. I became very sick with digestive
problems that same day that the contamination came aboard ship
in our drinking water. The Navy ships' distilling plants . . .
cannot filter out chemicals.'' \121\
---------------------------------------------------------------------------
\121\ Statement of Antonio Melchor to the PAC, February 7, 1996
(excerpt in subcommittee files).
---------------------------------------------------------------------------
Gulf War veteran Debbie Judd, an Air Force nurse, testified
before the PAC on a survey completed in 1995 by the Operation
Desert Storm Association on 10,051 sick Gulf veterans. She
reported the following results: ``Specific to the oil in the
environment there, those breathing or enveloped in oil fire
smoke was 96 percent; within clear visual area of the oil fires
was 90 percent; worked in, lived in, or made travel through the
burning oil fields was 72 percent; washed in water with an oily
sheen was 68 percent. Those having oily taste to their food was
66 percent, and those with oily taste to the drinking water was
65 percent.'' \122\
---------------------------------------------------------------------------
\122\ Statement of Debbie Judd to the PAC hearing, November 7,
1995, (excerpt in subcommittee files).
---------------------------------------------------------------------------
A study, ``Kuwait Oil Fire Health Risk Assessment,'' by the
U.S. Army's Environmental Health Agency concluded: ``Results of
this [report] indicate the potential for significant long-term
adverse health effects for the exposed troop or civilian
employee populations is minimal . . .'' \123\
---------------------------------------------------------------------------
\123\ Final Report, Kuwait Oil Fire Health Assessment, Department
of the Army, U.S. Environmental Hygiene Agency, Report No. 39-26-L192-
91, February 1994, p. 1. [Executive Summary].
---------------------------------------------------------------------------
Craig Stead provided a statement to the Human Resources
Subcommittee in which he said the Army study was flawed: ``In
1994, the Army issued the final Kuwait Oil Fire Health Risk
Assessment. The Assessment used Gulf air pollution data
gathered in May through November 1991. Air pollution from the
oil field fires during this time was much less than during the
Gulf War for the following reasons: The months of May through
November [when the study was done] have the Shamal winds
blowing from the northwest causing the smoke plume from the oil
field fires to disperse widely and ascend to great heights.
During the Gulf War (February and March) low wind speeds and
air inversions were common. Under these conditions the smoke
plume was on the ground, creating high localized levels of air
pollution to which the troops were exposed.'' \124\
---------------------------------------------------------------------------
\124\ Prepared statement of Craig Stead, Human Resources
Subcommittee hearing of June 26, 1997, p. 3 (in subcommittee files).
---------------------------------------------------------------------------
An Institute of Medicine [IOM] document confirms Mr.
Stead's statement: ``The Army Health Risk Assessment could not
launch a successful air-sampling effort until the beginning of
May, after the more stagnant air conditions of the winter
months had passed. Those who undertook the sampling efforts did
so with this knowledge.'' \125\ Principal author of the Army
report, Dr. Jack Heller, also confirmed the Stead statement:
``What we measured at the time we were there starting in May
when the Shamal winds were strongly blowing and there was a lot
of thermal lofting of the pollution. We didn't have those
ground level impacts [present during the war]. In fact the
whole time I was there I had [only] one ground level impact.''
\126\
---------------------------------------------------------------------------
\125\ National Academy of Sciences, Institute of Medicine, Health
Consequences of Service During the Gulf War, [``IOM Report''] (National
Academy Press, 1996) p. 45.
\126\ See supra note 113, statement of Jack Heller to the NIH
Workshop: ``Persian Gulf Experience and Health, April 27-29, 1994, tab
I (in subcommittee files).
---------------------------------------------------------------------------
Mr. Stead stated: ``Dr. Heller did not factor into the
Assessment study the high levels of wartime air pollution to
which the troops were actually exposed. The Assessment is
seriously flawed . . . [and] . . . is a primary document relied
upon by DOD, PAC, VA and IOM in concluding the oil field fires
presented no health hazard to the troops.'' \127\ Mr. Stead
also said the study was additionally flawed because it
neglected to include troop exposures to contaminated rain
during the fires, oil contamination in water for drinking,
cooking and showering.\128\
---------------------------------------------------------------------------
\127\ See supra note 124, p. 4.
\128\ Ibid.
---------------------------------------------------------------------------
Also, a January 1991 study by the U.S. Army Intelligence
Agency, issued on the eve of the invasion, forewarns of the
threat of the oil well fires and tends to refute the U.S. Army
Environmental Health Agency's Risk Assessment. The Army
Intelligence report stated: ``Owing to Iraq's defensive
`scorched earth' plan for Kuwait, the overall Kuwaiti oil
infrastructure presents a serious hazard to advancing ally
ground forces. There is overwhelming evidence that once
ordered, the Iraqi forces will initiate demolition of oil
wells, oil-gathering centers, oil-storage depots, pumping
stations, large tank farms, refineries, and oil/product loading
terminals. Demolition of these facilities and complexes will
result in massive fires--`Burning Kuwait.' ''
``The danger of oil fires, toxic gas, and smoke in the
Kuwaiti Theater of Operations [KTO] is very serious [emphasis
added]. These dangers . . . are as follows: 1) Associated toxic
and highly flammable gas from spilled raw sour crude oil from
nonburning oil wells; 2) Intense heat of oil-well fires,
possible natural-gas wells, and fire trenches; 3) Dense smoke
and superheated gases from these fires. By far the greatest
danger is from dissociated hydrogen sulfide gas and highly
volatile light ends [gases] released from wellhead blowouts. In
the KTO, the prevailing winds generally blow from the north-
northwest southward toward Saudi Arabia [emphasis added]. Smoke
and gases from Kuwaiti fires and blowouts most likely will be
blown in the face of northerly advancing [United States] forces
along the southern front of the KTO.'' \129\
---------------------------------------------------------------------------
\129\ Report of the U.S. Army Intelligence Agency, U.S. Army
Foreign Science Center, ``Kuwait: Serious Oilfire, Gas and Smoke
Dangers,'' AST-2660Z-148-90, January 9, 1991, pp. iii, 1 (in
subcommittee files).
---------------------------------------------------------------------------
Experimental Drugs and Vaccines
In December 1990, a month before the war, the Food and Drug
Administration [FDA] agreed to issue a waiver to the DOD
allowing the military to issue experimental drugs and vaccines
to U.S. personnel in the Gulf without first obtaining informed
consent. A factor possibly contributing to the illnesses of
Gulf veterans was the ingestion of anti-nerve gas pills,
pyridostigmine bromide tablets [PB tabs]. Troops were required
to take the experimental drug to counter the effects of
potential exposure to chemical warfare agents.
PB expert Dr. Thomas Tiedt, a neuroscientist and former
pharmaceutical industry researcher, testified before the Human
Resources Subcommittee that ``evidence shows that Gulf War
Syndrome was easily predicted. The symptoms largely match those
of cholinergic syndrome, which results from inhibition of the
life-critical and development-critical enzyme
acetylcholinesterase [AchE]. Pyridostigmine bromide, Sarin, and
organophosphate pesticides are examples of AchE inhibitors . .
. [which] cause stunning nerve and muscle degeneration moments
after a single dose, which worsens with multiple doses.'' \130\
---------------------------------------------------------------------------
\130\ Statement of Thomas Tiedt, Human Resources Subcommittee
hearing, No. 2, p. 301.
---------------------------------------------------------------------------
``My team's research at the University of Maryland during
the mid-1970's about physiological and microscopic AchE
toxicity was comprehensive,'' Dr. Tiedt stated. ``Our work was
followed by an explosion of research by DOD during the 1980's,
the most relevant of which was produced by my co-authors and
colleagues at Maryland and the [Army's] chemical-warfare R&D
center in Aberdeen [MD]. DOD [research] established by the
early 1980's that: 1) PB would be harmful in healthy
individuals; 2) PB was worthless, even counterproductive, as a
protectant against chemical warfare; and 3) PB was more toxic
than sub-lethal doses of chemical warfare agents. I understand
PB was taken by about 500,000 soldiers . . . [and] it has been
reported that 50-60 percent of soldiers taking PB have acute
side effects.'' \131\
---------------------------------------------------------------------------
\131\ Ibid., p. 303.
---------------------------------------------------------------------------
Dr. Tiedt concluded: ``More attention is needed on the long
record by the military to conduct involuntary, meritless, and
hazardous experiments on soldiers. The Nuremberg Code [signed
following World War II] states, `No experiments should be
conducted where there is an a priori reason to believe that
death or disabling injury will occur.' The use of PB was an
experiment. It was the first time we used PB for such a
purpose. There were no data supporting its use or the way it
was used. Sadly, no records remain or were kept.'' \132\
---------------------------------------------------------------------------
\132\ Ibid., p. 306.
---------------------------------------------------------------------------
Researcher and pharmacologist Mohamed Abou-Donia of Duke
University has conducted research on animals using
pyridostigmine bromide and other chemicals. Dr. Abou-Donia fed
groups of hens with the anti-nerve agent PB, the insecticide
permethrin, and the insect repellant DEET--all routinely used
by the military in the Gulf War theater. Each chemical was
administered alone and in various combinations.
According to Dr. Abou-Donia: ``This study shows that
relatively high doses of PB, DEET, and permethrin appear to
cause minimal health risk when used individually. It
demonstrates, however, the increased neurotoxicity associated
with coexposure to the same doses of test compounds. Although
this study was not intended to simulate actual exposure
conditions that may have existed during the Persian Gulf War,
nor was it designed as a dose-response study, from it one can
hypothesize why co-exposure to test compounds may have
contributed to Gulf War veterans' illnesses. The variety of
symptoms reported by veterans make it unlikely that a single
etiologic cause is responsible for producing the Gulf War
illnesses.'' \133\
---------------------------------------------------------------------------
\133\ Mohamed Abou-Donia, et al., ``Neurotoxicity Resulting from
Co-Exposure to Pyridostigmine Bromide, DEET, and Premethrin:
Implications of Gulf War Chemical Exposures,'' Journal of Toxicology
and Environmental Health, 1996, 48:pp. 35-56.
---------------------------------------------------------------------------
Dr. Satu Somani, PB expert and professor of pharmacology
and toxicology at Southern Illinois University's School of
Medicine, also testified before the Human Resources
Subcommittee on the health effects of pyridostigmine bromide.
Dr. Somani stated:
``Years after Desert Storm, many veterans continue to
suffer from medical problems such as fatigue, headache, joint
pain, gastrointestinal disorders, and other ailments. This
testimony is based on the premise that Gulf veterans were
taking pyridostigmine as a precautionary measure against
potential exposure to nerve agents (e.g., Sarin) and they were
exposed to insecticides and other harmful chemicals. They were
also under physical stress that modified the effects of such
exposure. The toxic, harmful or poisonous nature of nerve
agents is exacerbated by the fact, even if an individual were
provided pre- or post-treatment, there is still a strong
potential for such effects to continue because of delayed
neurotoxicity [Somani emphasis]. Further, while acute toxicity
can be treated with atropine, oxime and diazepam, no treatment
is available for delayed neurotoxicity.'' \134\
---------------------------------------------------------------------------
\134\ Statement of Satu Somani, Human Resources Subcommittee
hearing, No. 2, p. 321.
---------------------------------------------------------------------------
``Delayed neurotoxicity, first reported in the 1950's, can
occur 5 or 10 years after exposure to nerve agents. Studies
have shown that organophosphate-induced delayed neurotoxicity
[OPIDN] is due to inhibition of neurotoxic esterase enzyme in
the nervous system, and histopathological axonal degeneration.
This also produces muscular weakness and ataxia (difficulty in
movement).'' \135\
---------------------------------------------------------------------------
\135\ Ibid.
---------------------------------------------------------------------------
Dr. Somani concluded: ``Based on recent experimental
evidence and the similarities of symptoms of delayed
neurotoxicity reported by workers in the organophosphate
industry and also by Desert Storm veterans, the author
concludes that GWS may be due to low-level exposure to Sarin [a
chemical warfare agent] exposure, intake of pyridostigmine
[bromide], and exposure to pesticides and other chemicals. The
adverse effects of such exposures were amplified by physical
stress conditions.'' \136\
---------------------------------------------------------------------------
\136\ Ibid.
---------------------------------------------------------------------------
Vaccines were also given to Gulf War troops. Anthrax was
tested and approved by the FDA for limited use, and was
administered to about 150,000 troops in the Gulf region.
Botulinum toxoid vaccine was approved by the FDA for use with a
waiver of informed consent, and about 8,000 troops were given
this vaccine. It is also not known if side effects could occur
with these vaccines when combined with PB or other
chemicals.\137\
---------------------------------------------------------------------------
\137\ See supra note 97, p. 5.
---------------------------------------------------------------------------
The PAC report was critical of the FDA and DOD handling of
experimental drugs and vaccines. It stated: ``The Committee
also found that DOD and FDA deliberated carefully before
enabling, through rulemaking, DOD to require troops to take
pyridostigmine bromide [PB] and botulinum toxoid [BT] vaccine
as pretreatments for possible CBW agents without FDA approval
of the products for that purpose. We were concerned that FDA
had failed, in the 5 years since the Gulf War, to devise better
long-term methods governing military use of drugs and vaccines
for CBW defense. We also found DOD's inability to produce
records of who received PB or BT indicative of much need for
wholesale improvement in the government's performance on
medical recordkeeping during military engagements.'' \138\
---------------------------------------------------------------------------
\138\ PAC Report, p. 18.
---------------------------------------------------------------------------
Pesticides and Multiple Chemical Sensitivity [MCS]
Multiple chemical sensitivity is a disease that is being
debated throughout the medical field. While a number of leading
medical organizations have published papers that question the
existence of multiple chemical sensitivity its diagnosis and
its possible treatments,\139\ a growing number of physicians
and scientists have accepted the basic premise that exposure to
a wide range of chemicals existing in the modern world can
produce synergistic effects and cause a variety of health
problems.
---------------------------------------------------------------------------
\139\ These organizations include the American Academy of Allergy
and Immunology, the American College of Physicians, the American
College of Occupations Medicine and the Council of Scientific Affairs
of the American Medical Association. See also supra note 97, p. 7.
---------------------------------------------------------------------------
MCS expert Dr. Claudia Miller of the University of Texas
Southwest Medical Center at San Antonio has focused her
research, and co-authored several books over the past 9 years
on patients who report developing chronic illnesses and
chemical intolerances. These illnesses follow low level
exposure to various chemicals, including pesticides, solvents,
and combustion products. In subcommittee testimony, she stated:
``In 1995, we published a study of 37 patients who had been
exposed to pesticides . . . who subsequently reported
developing multi-system symptoms and new-onset chemical, food
and drug intolerances. Eighty percent of these individuals . .
. were no longer able to work or could only work part-time
because of their health problems.'' \140\
---------------------------------------------------------------------------
\140\ Statement of Claudia Miller, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 511.
---------------------------------------------------------------------------
Dr. Miller testified that common symptoms reported by these
patients at the time they were exposed were often flu-like
illnesses, fatigue, concentration difficulties, headaches,
shortness of breath, musculoskeletal pain, and gastrointestinal
symptoms. The patients also reported, according to Dr. Miller,
``new and unusual intolerances for common chemicals such as
fragrances, traffic exhaust, gasoline, and household cleaning
products. In addition, many found they could no longer tolerate
alcoholic beverages, various foods, caffeine, and
medications.'' \141\
---------------------------------------------------------------------------
\141\ Ibid.
---------------------------------------------------------------------------
Beginning in 1992, Dr. Miller was asked by the Houston VA
Medical Center to consult on the first group of sick Gulf War
veterans. Dr. Miller evaluated 75 veterans and testified that
``These veterans' symptoms and their frequent reports of new-
onset intolerances to chemicals, foods, and medications
reminded me of the civilians we studied with histories of
exposure to organophosphate or carbamate pesticides or to
mixtures of solvents at low levels. Comparison of eight symptom
scales derived by factor analysis revealed similar ordering of
symptoms in the Gulf veterans and the pesticide-exposed
civilians.'' \142\
---------------------------------------------------------------------------
\142\ Ibid., p. 512.
---------------------------------------------------------------------------
Pesticides and insect repellants were heavily used before,
during and after the Gulf War, according to Albert Donnay,
executive director of the MCS Referral & Resources in
Baltimore. Information he received from the DOD indicates that
21 different pesticides were used but no records were kept of
amounts used, what they were used for, or who applied them.
In a memorandum to the Human Resources Subcommittee, Mr.
Donnay stated: ``Officials in DOD responsible for pesticide use
have told me that they kept no records of pesticide use during
the Persian Gulf deployment. We urge DOD to focus on the
chronic effects of pesticide exposures, not just the two
pesticides currently being studied (DEET and Permethrin), but
all 21 pesticides that the DOD admits sending to and using in
the Persian Gulf during Operation Desert Shield and Desert
Storm.'' Mr. Donnay wrote that ``. . . data from the EPA,
DowElanco and others linking MCS to organophosphate pesticides
[showed that] . . . of the top 10 pesticides associated with
MCS reports from 1984-1990 by the EPA-funded National Pesticide
Telecommunications Network, 7 are on the DOD list of those used
in the Persian Gulf. Even if the veterans' exposures to nerve
agent fallout were not enough to induce illness, the DOD failed
to consider how these may have interacted synergistically
[emphasis added] with the veterans' extensive exposure to
chemically similar pesticides. None of the CCEP [DOD's Gulf
health registry] reports published to date discuss MCS data. We
are concerned that MCS [data] was abandoned without any
analysis . . . and data are now being withheld from qualified
researchers.'' \143\
---------------------------------------------------------------------------
\143\ Memo from Albert Donnay, executive director, MCS Referral &
Resources Center to Robert Newman, subcommittee staff, September 18,
1996 (in subcommittee files).
---------------------------------------------------------------------------
The PAC report states, ``The Committee concludes it is
unlikely that health effects and symptoms reported today by
Gulf War veterans are the result of exposure to pesticides
during the Gulf War. Lindane is an animal liver carcinogen, but
it is too early to see an elevated liver cancer rate in Gulf
War veterans.'' The PAC report draws no conclusion about MCS,
but comments that ``There is no consensus case definition for
MCS, although two recent government-sponsored conferences have
attempted to develop one.'' \144\
---------------------------------------------------------------------------
\144\ PAC Report, p. 81.
---------------------------------------------------------------------------
D. Acute v. Chronic Effects of Low Level Chemical Exposures
In testimony before the subcommittee, Dr. Stephen Joseph,
formerly DOD's Assistant Secretary for Health Affairs, stated,
``Current accepted medical knowledge is that chronic symptoms
or physical manifestations do not later develop among persons
exposed to low levels of chemical nerve agents who did not
first exhibit acute symptoms of toxicity.'' \145\ This
unequivocal statement became the basic medical policy of DOD
and VA in terms of diagnosis, treatment, compensation and
research of the illnesses affecting thousands of Gulf War
veterans.
---------------------------------------------------------------------------
\145\ Statement of Stephen Joseph, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 221.
---------------------------------------------------------------------------
Dr. Claudia Miller, an expert on low level chemical
exposures, stated before the subcommittee that Dr. Joseph's
statement was not necessarily true. ``I think it is premature
for anyone to say that low levels of organophosphates cannot
cause chronic health problems,'' Dr. Miller said. ``There is a
lot of literature now suggesting that is quite a possibility
and there are ways to approach that question scientifically.''
\146\
---------------------------------------------------------------------------
\146\ Testimony of Claudia Miller, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 271.
---------------------------------------------------------------------------
``Sarin was not the only organophosphate-type exposure
soldiers may have encountered in the Gulf: pesticides in this
chemical class and pyridostigmine bromide, a related carbamate
drug, were also widely used,'' Dr. Miller stated. ``There are
now several studies, in addition to our own, linking chronic,
multi-system symptoms to [low level] organophosphate/carbamate
exposure.'' \147\
---------------------------------------------------------------------------
\147\ Statement of Claudia Miller, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 511-
512.
---------------------------------------------------------------------------
Dr. Stephanie Padilla, Environmental Protection Agency
[EPA] neurotoxicology expert, agrees. In subcommittee
testimony, Dr. Padilla said, ``Exposure to organophosphates may
produce residual adverse effects . . .'' and cause ``. . .
organophosphate-induced-delayed-neuropathy [OPIDN]. Recent
studies . . . indicate there may be long-term health effects
associated with exposure . . .'' and ``. . . one [study]
concluded that `results clearly indicate that there are chronic
neurological sequelae to acute organophosphate poisoning. . .
.' '' \148\
---------------------------------------------------------------------------
\148\ Testimony of Stephanie Padilla, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 252-
254.
---------------------------------------------------------------------------
In response to Dr. Joseph's statement that chronic symptoms
from low level chemical exposure do not later develop unless
acute symptoms first appeared, Dr. Padilla testified that
pyridostigmine bromide, the anti-nerve gas tablets which the
troops were required to take, would dampen or ``mask the acute
effects'' of chemical exposure.\149\
---------------------------------------------------------------------------
\149\ Ibid., p. 268.
---------------------------------------------------------------------------
The subcommittee also learned that a 1974 study of low
level chemical exposures, conducted by Dr. Karlheinz Lohs, then
director of the Institute of Chemical Toxicology of the East
German Academy of Sciences, concluded that ``mustard CW agents
are capable of producing a wide range of mutagenic,
carcinogenic, hepatotoxic [causing liver damage] and neurotoxic
effects. It is important to note that even in the case of
exposure to very slight amounts which do not necessarily bring
on acute symptoms, toxic reactions may set in. How far this may
lead to nerve-cell, hematopoietic or parenchymatous lesions
depends largely on the state of health of the individual (for
example, previous injury to any particular organ), duration of
exposure or intervals between exposures and, last but not
least, on individual `detoxification capacity' (enzymatic
polymorphism, genetic disposition, and so on.)'' \150\
---------------------------------------------------------------------------
\150\ Lohs, Karlheinz, Delayed Toxic Effects of Chemical Warfare
Agents (New York: Almqvist & Wiksel International for the Stockholm
International Peace Research Institute, 1995), pp. 14-15.
---------------------------------------------------------------------------
Dr. Joseph was not familiar with the Lohs study.\151\
---------------------------------------------------------------------------
\151\ Human Resources and Intergovernmental Relations Subcommittee
hearings, Nos. 1-4, p. 248.
---------------------------------------------------------------------------
Also in the 1970's, Dr. Frank Duffy, associate professor of
neurology at Harvard University Medical School, and his
research associates conducted a study for the U.S. Army's Rocky
Mountain Arsenal [RMA], a facility where nerve gas containing
munitions were stored and decommissioned. The Army post
surgeon, Dr. Maurice Gaon, noted an unusual number of civilian
employees with a symptom complex including fatigue, sleep
difficulties, memory loss, trouble concentrating, irritability,
loss of libido, among others. These symptoms were primarily
noticed in employees much later following reported exposures to
the nerve agent Sarin, an organo-phosphate. The Army called on
Dr. Duffy and his associates to plan and implement a study of
these exposures.\152\
---------------------------------------------------------------------------
\152\ Statement of Frank Duffy, Human Resources Subcommittee
hearings, No. 1, p. 228.
---------------------------------------------------------------------------
This situation provided Dr. Duffy with an opportunity to
study the effects of accidental low level Sarin exposures on
humans after 1 year, comparing their symptoms with symptoms of
rhesus monkeys after 1 year by injecting the primates with low
doses of Sarin.
The results, according to Dr. Duffy, indicated that ``low
levels of exposure to the nerve agent Sarin can produce long-
lasting effects. It was perfectly clear that not only were
people, after [low level Sarin] exposure showing long-term
effects, but it was widely accepted in the pesticide industry
that exposure to related compounds like malathion and
parrathion or the chlorinated hydrocarbon insecticides led to
long-term consequence.'' \153\
---------------------------------------------------------------------------
\153\ Testimony of Frank Duffy, Human Resources Subcommittee
hearing, No. 1, p. 226.
---------------------------------------------------------------------------
Dr. Duffy stated: ``It has been suggested that since Army
personnel did not appear to suffer acute symptoms which could
be clearly recognized as resulting from acute Sarin exposure,
that this explanation for Gulf War Syndrome must be irrelevant.
This is not necessarily a valid assumption. First, the low
level exposure to the monkey group demonstrated no symptoms . .
. and second, most of the exposed Army personnel at RMA
suffered relatively minor symptomatology.'' \154\
---------------------------------------------------------------------------
\154\ Statement of Frank Duffy, Human Resources Subcommittee
hearings, No. 1, p. 230.
---------------------------------------------------------------------------
According to the NY Times, Dr. Frank Duffy and his research
colleagues Dr. James Burchfiel of the University of Rochester
and Dr. Peter Bartels of the University of Arizona, ``said in
interviews that the Pentagon seemed intent on ignoring or
dismissing their evidence. Their research, which studied the
effects of low doses of Sarin on humans and primates, showed
the exposure resulted in long-term or chronic, perhaps
permanent, changes in brain waves, which could be connected
with . . . symptoms common among Gulf veterans.'' \155\
---------------------------------------------------------------------------
\155\ Shenon, Phillip, ``New Look Urged on Gulf Syndrome: Important
Evidence Withheld by Pentagon, Scientist Says,'' New York Times,
December 10, 1996, p. A1.
---------------------------------------------------------------------------
In a 1987 letter to Robert Hall of the Hawaii Institute for
Biosocial Research, Dr. Duffy also noted the possible confusion
between organophosphate-delayed-neuropathy and stress: ``I
applaud your effort in raising the level of consciousness about
the serious potential for long-term effects due to exposures to
these [organophosphate] compounds. It has been our experience
that the side effects of minimal but continual exposures to the
compounds mimic the symptoms associated with a stressful life
[emphasis added]. Accordingly, most individuals are unable to
determine whether their irritability is related to a stressful
life or to a recent organophosphate exposure. This is a serious
issue.'' \156\
---------------------------------------------------------------------------
\156\ Letter from Frank Duffy letter to Robert Hall, March 26, 1987
(in subcommittee files).
---------------------------------------------------------------------------
Results of U.S. Air Force [USAF] studies on the health
effects of sublethal, low dose exposure to nerve agents,
published in 1992, bear on the question of acute v. chronic
symptoms. The study was ordered because some AF personnel
(e.g., bomb loaders and medical personnel) worked in
potentially contaminated environments. USAF's Armstrong
Laboratory conducted the studies of nerve agent behavioral
toxicity in laboratory rhesus monkeys, and concluded that:
``Behavioral deficits [in primates] can be reliably detected in
the absence of any overt [acute] signs of toxicity. This is
especially important when assessing the effects of low-level
exposures to extremely toxic compounds such as OP
[organophosphate] nerve agents.'' The Air Force studies suggest
that ``. . . repeated low-dose exposure to soman [a nerve
agent] caused progressive and lasting inhibition of ChE
[cholinesterase enzyme] . . .'' \157\
---------------------------------------------------------------------------
\157\ Somani, Satu, Chemical Warfare Agents, (Academic Press,
1992), containing the study by Hargraves and Murphy, ``Behavioral
Effects of Low-Dose Nerve Agents,'' pp. 125-154.
---------------------------------------------------------------------------
Also disputing Dr. Joseph's statement was Dr. Seymour
Antelman, University of Pittsburgh professor of psychiatry, who
in a letter to the editor of the New York Times, stated: ``[Dr.
Joseph's] view . . . is almost certainly wrong. My research,
published in leading scientific journals and the subject of a
June 21, 1988, Science Times article, has shown that the
effects of chemicals can develop and grow over time, and need
not be present at the time of exposure. Such `time dependent
sensitization' is more likely after exposure to a low level
stimulus.'' \158\
---------------------------------------------------------------------------
\158\ Letter to the editor, Seymour Antelman, New York Times,
November 15, 1996 (in subcommittee files).
---------------------------------------------------------------------------
In May 1996, 7 weeks prior to DOD's first admission of
chemical exposures, Major General Ronald Blanck, commander of
the Walter Reed Army Medical Center and the Army's chief
physician, said, ``Clearly there is some evidence of low level
exposure.'' \159\
---------------------------------------------------------------------------
\159\ Statement of Ronald Blanck to the PAC, May 2, 1996.
---------------------------------------------------------------------------
Two VA physicians--Dr. Victor Gordan of the Manchester (NH)
VA Medical Center and Dr. Charles Jackson of the Tuskegee (AL)
VA Medical Center--began to suggest soon after the war that the
sick Gulf veterans they had examined were exposed to chemicals.
However, their views did not receive much attention from VA
headquarters, DOD, or the news media.
In Human Resources Subcommittee testimony, Dr. Gordan, who
has treated 544 Gulf veterans since 1991, stated, ``What is
strikingly consistent in these veterans' stories are: 1) a
drastic change in their health status from very good to
perfect, as it was before deployment to the Gulf War, to poor
to fair after their return from the war; 2) the large variety
and number of symptoms suggesting dysfunction of more than one
organ system in their bodies; and 3) the very consistent
history of being exposed to chemicals in the Gulf, including
the strong belief [by veterans] of being exposed to chemical
warfare. These consistent stories point very strongly toward
the environmental hazards as the cause or causes of these
unexplained illnesses. Unless the science addresses these
environmental hazards, we will never be able to adequately
explain and hopefully solve these medical problems.'' \160\
---------------------------------------------------------------------------
\160\ Testimony of Victor Gordan, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 282.
---------------------------------------------------------------------------
Dr. Gordan concluded, ``Chemicals . . . are the greatest
masquerader in the modern medicine . . . because they penetrate
into all sorts of systems and organs, and those organs get
dysfunctional, and those dysfunctions bypass symptoms, and
symptoms can mimic so-called quantifiable disease, including
arthritis, even PTSD.'' [emphasis added] \161\
---------------------------------------------------------------------------
\161\ Ibid., p. 291.
---------------------------------------------------------------------------
In the same hearing, Dr. Jackson, an environmental
physician covering Agent Orange and Gulf War illnesses, said,
in reference to the chairman's earlier question to the VA,
``Well, one of the questions that you asked to Dr. Mather was
whether or not one person in the VA had made the clinical
opinion that there was a veteran exposed to chemical and/or
biological agents, and, yes, there was. We did this back 3
years ago.'' \162\
---------------------------------------------------------------------------
\162\ Testimony of Charles Jackson, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 275.
---------------------------------------------------------------------------
Attributing the illnesses he was seeing to the product of
multiple chemical exposures, Dr. Jackson said, ``Symptoms of
the veterans are not inconsistent with those of the farm and
veterinary workers with chronic low dose exposure to
organophosphorus insecticides.'' \163\
---------------------------------------------------------------------------
\163\ Statement of Charles Jackson, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 280.
---------------------------------------------------------------------------
Dr. Jackson added, ``Recent DOD and CIA revelations
concerning the destruction of tons of mustard and Sarin in Iraq
have supported the probability of exposure to the . . .
agents.'' \164\ ``We have gone on record as saying that we
believe this is a significant factor. . . . It was not a
popular opinion, nor was it the official opinion of the VA.''
\165\
---------------------------------------------------------------------------
\164\ Ibid.
\165\ Ibid., p. 295.
---------------------------------------------------------------------------
Dr. Frances Murphy, the VA's Director of Environmental
Agents Service, offered the Department's official opinion,
which supports Dr. Joseph, in testimony before the Human
Resources Subcommittee: ``Studies of low level chemical warfare
agent exposure were not given high priority . . . because
military and intelligence sources had stated that U.S. troops
had not been exposed to chemical agents. Current body of
research proves that low level exposures cannot cause health
effects [emphasis added].'' \166\
---------------------------------------------------------------------------
\166\ Testimony of Frances Murphy, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 141,
109.
---------------------------------------------------------------------------
The results of a study conducted by Dr. David Schwartz and
his University of Iowa Medical School research colleagues were
recently published in the Journal of the American Medical
Association [JAMA].\167\ The Schwartz study, supported by the
Centers for Disease Control and Prevention, found that Persian
Gulf veterans are reporting more medical and psychiatric
conditions than their military peers who were not deployed to
the Gulf War. Gulf veterans reported an 11 percent higher
prevalence of symptoms of cognitive dysfunction or problem
thinking, but only a 1 percent increase in PTSD.\168\
---------------------------------------------------------------------------
\167\ Schwartz, et al., ``Self-reported Illness and Health Status
Among Gulf War Veterans.'' Journal of the American Medical Association,
January 15, 1977, Vol. 277, No. 3, p. 238.
\168\ Statement of David Schwartz at National Press Club, January
15, 1997 pp. 1, 3 (in subcommittee files).
---------------------------------------------------------------------------
Dr. Robert Haley and his research colleagues at the
University of Texas Southwestern Medical Center also completed
a study in early 1997 of Gulf veterans, the results of which
were published in three articles in JAMA. According to the
study, ``Some Gulf War veterans may have delayed, chronic
neurotoxic syndromes from wartime exposure to combinations of
chemicals'' and that ``clusters of symptoms of many Gulf War
veterans reflect a spectrum of neurologic injury involving the
central, peripheral, and autonomic nervous systems.'' \169\
---------------------------------------------------------------------------
\169\ Haley, et al., ``Is There a Gulf War Syndrome?'' Journal of
the American Medical Association, January 15, 1997, Vol. 277, No. 3, p.
215; ``Evaluation of Neurologic Function in Gulf War Veterans,''
Journal of the American Medical Association, January 15, 1997, Vol.
277, No. 3, p. 223; and ``Self-reported Exposure to Neurotoxic Chemical
Combinations in the Gulf War,'' Journal of the American Medical
Association, January 15, 1997, Vol. 277, No. 3, p. 231.
---------------------------------------------------------------------------
People have asked why most Gulf War veterans have not
reported illnesses while only some veterans were affected. Dr.
Kenneth Olden, director of the National Institute of
Environmental Health Sciences, was recently quoted in the
press: ``We've known for a long time that when several hundred
people are exposed to the same environmental toxicants, some
people get sick and others don't. There are a number of enzyme
systems that detoxify chemicals. If you have too little--that's
a problem.'' \170\
---------------------------------------------------------------------------
\170\ Sternberg, Steve, ``Study Seeks Genes That Make People
Vulnerable to Toxins'' USA Today, September 18, 1997, p. A3.
---------------------------------------------------------------------------
The results of a second study by Dr. Haley on Gulf veterans
was published in August 1997 by the National Academy of
Neuropsychology.\171\ The new study compared the brain-related
and psychological functions of ill and well Gulf veterans, and
found no evidence of psychological problems, including PTSD or
other stress-related illnesses. Some Gulf veterans, the study
says, suffer from a form of brain damage found in toxic
poisoning victims.
---------------------------------------------------------------------------
\171\ Horn, Haley, et al., ``Neuropsychological Correlates of Gulf
War Syndrome.'' Archives of Clinical Neuropsychology, August 1997, Vol.
12, No. 6, pp. 531-544.
---------------------------------------------------------------------------
A New York Times article reported, ``Stephen C. Joseph, the
Pentagon doctor overseeing the investigation of the Gulf War
Syndrome, is under attack on the political battlefield. Senator
John D. Rockefeller 4th (D-WV) has called him arrogant and
demanded his resignation. ``Dr. Joseph is at the heart of a
culture that has never looked at this problem seriously
enough,'' said one senior White House official involved in this
issue. The uproar involves . . . questions over how the
Pentagon responded to veterans' health complaints and its
refusal to acknowledge that the veterans might have reason to
worry about exposure to chemical or biological agents, anti-
nerve gas pills, or other environmental factors in the Persian
Gulf.'' \172\
---------------------------------------------------------------------------
\172\ Shenon, Philip, ``Pentagon Health Chief Fights Claims of Gulf
Cover-Up,'' New York Times, November 3, 1996, p. 30.
---------------------------------------------------------------------------
As a result of increased congressional and news media
attention on issues surrounding the Gulf War veterans'
illnesses, then DOD Deputy Secretary John White assumed the
role of DOD spokesman on Gulf issues in October 1996.
Dr. Joseph resigned in March 1997.
One of the most frequently asked questions by the veterans,
public and press is why the DOD for 5 years continued to deny
that troops were exposed to chemical warfare agents or that low
level exposures caused illness. The U.S. News & World Report in
an article ``Gulf War Mysteries'' stated: \173\
---------------------------------------------------------------------------
\173\ ``Gulf War Mysteries: Why Americans May Never Know What's
Making These Veterans Sick,'' U.S. News & World Report, November 25,
1996 [cover story].
---------------------------------------------------------------------------
``If exposure to chemicals is ever tied to widespread
illnesses among veterans, the government may face other
dilemmas. A link could open the door to thousands of disability
claims, plus legislation mandating greatly expanded health
coverage for veterans. The repercussions could reach to future
battlefields as well. An official determination that chemicals
have seriously harmed U.S. soldiers would be an admission of
vulnerability, likely to encourage Iraq and other potential
foes such as North Korea to use chemical weapons if they ever
face off against the United States in the future. The next time
the alarms start going off, the all-clear may not be so quick
to follow.''
E. Exposures and VA Medical Protocols for Gulf Veterans
In view of DOD's admission on June 21, 1996, after 5 years
of denial, that Gulf War troops were presumed exposed to
chemical warfare agents at the Khamisiyah bunker detonations,
and in view of the missing or inadequate medical records of
veterans and chemical detection logs, Human Resources
Subcommittee Chairman Shays wrote to then VA Secretary Jesse
Brown calling for an immediate re-evaluation of the diagnostic
and treatment protocols, and compensation practices, for Gulf
War veterans.
The chairman's letter follows:
If the VA claims it has ``always accepted the possibility
of exposures,'' it should be noted that: 1) the VA did not add
specific questions on chemical warfare exposures to its VA Gulf
Health Registry until late 1995, 4 years after veterans began
reporting illnesses; and 2) there is no VA or DOD research on
the health effects of low level exposure to neurotoxic agents
yet available.
In a subcommittee hearing on December 11, 1996, Chairman
Christopher Shays questioned Dr. Susan Mather, VA's Chief
Public Health and Environmental Hazards Officer, and Dr.
Frances Murphy, VA's Director of Environmental Agents Service,
about when the VA first ``accepted the possibility of chemical
exposures.'' Their testimony follows:
Mr. Shays. Do they [VA doctors] listen to that [sick]
veteran or do they listen to DOD who says we have had
no credible verification of chemicals being used? Who
do they listen to?
Dr. Mather. The veterans.
Mr. Shays. If you were listening to veterans, why are
we still now only beginning to think that maybe
exposure to chemicals might in fact be credible?
Dr. Mather. Our perspective and our emphasis has been
on the illness that the veterans had, and we were
looking at the illnesses that the veterans had and
working back from that.
Mr. Shays. To help you in this analysis . . . to
truly understand the illnesses that are affecting your
patients, you would want to know what kind of an
environment they were in and what physical
confrontation they had with that environment.
Dr. Mather. Exactly. That's the reason we revised the
questions we asked the veteran.
Mr. Shays. When did you make that revision?
Dr. Mather. Unfortunately, the revision did not get
finished until this past year. It took a long time to
get it approved and I apologize for that.
Dr. Murphy. We began educating our physicians early
on about all the exposures that were known. We
addressed the whole range of exposures and asked them
to question veterans about those exposures.
Mr. Shays. But the fact is, we have under oath
documentation that soldiers weren't asked vital
questions dealing with chemical exposures until after
Khamisiyah [events were announced]. When did you really
start to change your approach? When, if fact, did the
form get changed?
Dr. Murphy. The form was published in September
1995.\174\
---------------------------------------------------------------------------
\174\ Testimony of Susan Mather and Frances Murphy, Human Resources
and Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p.
247.
In the following Gulf War hearing on January 21, 1997, the
same subject was raised again by Chairman Shays with the
---------------------------------------------------------------------------
witness Dr. Kenneth Kizer, VA's Under Secretary for Health:
Mr. Shays. Dr. Kizer, what mistakes has the VA made
in the last 6 years with regard to the Gulf War issue?
Dr. Kizer. I don't know I would characterize them as
mistakes . . . the research agenda . . . was delayed
because of information that was provided.
Mr. Shays. Provided where?
Dr. Kizer. By the Department of Defense.
Mr. Shays. So in essence, the only thing you would
describe as a mistake, and you wouldn't even describe
it as a mistake, is that you relied on information from
the DOD that our troops weren't exposed to chemicals .
. . ?
Dr. Kizer. The issue of chemical warfare agents . . .
and the investigation into that arena, was delayed, and
that investigative focus was given a lower priority
because of the information that had been provided by
DOD.
Mr. Shays. So the bottom line is, because the DOD
denied . . . any exposure . . . VA made a determination
that therefore our troops were not exposed to . . .
chemicals?
Dr. Kizer. No, I don't think that characterizes what
I said, Mr. Chairman.
Mr. Shays. OK. Say it over again in a different way.
Dr. Kizer. The VA has been consistently . . . open to
and have been concerned about the exposure of troops to
chemical warfare agents. As far as specific research
protocols that were funded, the potential exposure was
given lower priority than others.
Mr. Shays. Because?
Dr. Kizer. Because of the information that was
provided by DOD . . .
Mr. Shays. So you didn't ever begin to ask our troops
until 1995 if they felt they were exposed to chemicals?
Dr. Kizer. I don't believe that is correct, sir,
because our physicians were asking the question before
that.
Mr. Shays. So I will ask the question again. Is it a
fact that the Registry did not require these questions
[to be asked by VA physicians] until 1995?
Dr. Kizer. Again, physicians performing the Registry
examinations before that time [1995] asked those
questions. Did everybody ask it? I can't say they did,
no . . .\175\
---------------------------------------------------------------------------
\175\ Testimony of Kenneth Kizer, Human Resources Subcommittee
hearing, No. 1, pp. 50-60.
In the December 11, 1997 hearing, Chairman Shays questioned
VA's Dr. Mather and Dr. Murphy about research on low level
---------------------------------------------------------------------------
chemical exposures. Their testimony follows:
Mr. Shays. The VA has expressed to us that there has
not been a focus on low level exposure because the DOD,
whose information you rely on, has said there has been
no use of chemicals in the Gulf and no exposure.
Dr. Mather. That is very true in the research arena.
I think research into low level exposure has a low
priority.
Dr. Murphy. It was not viewed as high priority to
take asymptomatic exposures to chemical warfare nerve
agents and look for health effects, because there was
no evidence either from what we were being told from
DOD . . . [or] that [exposure] was a likely
possibility. What we did not address was low level
exposures and the potential long-term health effects.
Current body of research proves that low level
exposures cannot cause health effects [emphasis
added].\176\
---------------------------------------------------------------------------
\176\ See supra note 174, p. 52 (Mather testimony), pp. 80, 99, 109
(Murphy testimony).
Veterans and medical witnesses at Human Resources
Subcommittee hearings maintain that the VA medical protocol
does not sufficiently address exposure history. In fact, the VA
Health Registry questionnaire relies on the ability of the
veteran to recognize toxic exposures by asking such questions
as: ``Did you witness Chemical Alarms?'' \177\
---------------------------------------------------------------------------
\177\ U.S. Department of Veterans Affairs, Persian Gulf Registry
Questionnaire (in subcommittee files).
---------------------------------------------------------------------------
In addition, VA physicians who examine Gulf veterans for
the first time are not trained to take toxic exposure
histories.\178\ This is critical in that many veterans may have
been exposed in theater but would not have realized it. VA
physicians trained to ask the right questions can identify
potential exposures of which the veteran may not have been
aware.
---------------------------------------------------------------------------
\178\ Human Resources and Intergovernmental Relations Subcommittee
staff conference call with Claudia Miller, September 20, 1996.
---------------------------------------------------------------------------
The issue of trained VA physicians to detect the health
effects of chemical exposures was also raised in Human
Resources Subcommittee hearings:
Mr. Shays. I get the sense that you don't really have
the background in chemical exposures. Is that correct?
Dr. Mather. I'm not a toxicologist. I'm a chest
physician.
Dr. Murphy. I'm a neurologist, sir.
Mr. Shays. How many doctors work for the VA?
Dr. Murphy. Over 1,800.
Mr. Shays. How many toxicologists?
Dr. Mather. I don't know.
Dr. Murphy. Physicians are rarely toxicologists.
That's a Ph.D. level kind of specialty. Dr. Kizer, for
instance, is a medical toxicologist physician. I would
have to go back and look specifically.
Mr. Shays. It would be an estimate. One percent? Ten
percent? A half percent?
Dr. Murphy. I cannot estimate.
Dr. Mather. I honestly don't know.
Mr. Shays. Can you name me 10 toxicologists that you
know are working for the VA?
Dr. Mather. No.
Dr. Murphy. I can't come up with 10 off the top of my
head.
Mr. Shays. Can you name me five?
Dr. Murphy. Dr. Peter Spencer is a neurotoxicoligist.
Mr. Shays. That's one. Can you name another?
Dr. Murphy. No, sir.
Mr. Shays. You can only name one expert in a field
that deals with chemical exposure? What other
specialities would there be besides the toxicologists?
Dr. Murphy. Most of the subspecialities we have in
investigating toxic exposures, include neurologists,
pulmon-ologists, and occupational health physicians.
Mr. Shays. So it might not be their primary focus,
but they might have some knowledge of chemical exposure
and its effect?
Dr. Murphy. Yes.
Mr. Shays. It is telling though that you cannot name
more than one person in the entire [VA] department [who
is a toxicologist.].
Dr. Murphy. We can provide that for the record.
Mr. Shays. I would definitely like it for the
record.\179\
---------------------------------------------------------------------------
\179\ See supra note 174, pp. 259-260. See also infra text to
accompany note 391.
On February 11, 1997, the VA provided the following
information:
Department of Veterans Affairs (VA)
Veterans Health Administration (VHA)
responses to information request from chairman christopher shays
1. The results of a survey of each VA medical center to gather specific
information on specialized professional and research
credentials of VIA medical personnel.
We were aware of your earlier requests for information related to
the number of toxicologists and other specialists on VA medical staff
and were in the process of assembling it. Based on our employment
records, we have found four toxicologists on the research rolls.
However, the toxicologists do not treat patients. Persian Gulf veterans
are treated by licensed medical doctors who are internists or primary
care providers supplemented by specialists. As of Dec. 31, 1996, the
following number of specialists were on our rolls (note that
occupational medicine is not a physician specialty category):
------------------------------------------------------------------------
Full- Part-
time time
------------------------------------------------------------------------
Neurologists............................................ 181 299
Pulmonologists.......................................... 175 134
Oncologists............................................. 46 54
Infectious Disease...................................... 94 109
Rheumatologists......................................... 33 92
Gastroenterologists..................................... 122 178
Dermatologists.......................................... 31 160
Toxicologists (non-physician)........................... 4 0
------------------------------------------------------------------------
The lack of a specific case diagnostic criteria for Gulf
illnesses also reflects a flawed approach to these illnesses on
the part of the VA. Illnesses in Gulf veterans have been
reported since 1991. A critical factor in identifying
uncharacterized illnesses is the development of a case
definition of the illness. Gulf War illnesses include a range
of symptoms previously mentioned--rashes, headaches, muscle and
joint pains, neurological and cognitive abnormalities, and
more.
Dr. William C. Reeves of the Centers for Disease Control
and Prevention [CDC], presented results of his epidemiological
investigation into the Gulf War Syndrome to the PAC in both
January and September 1996. CDC was able to develop a working
case definition of Gulf illnesses. CDC defines a case as ``at
least one chronic (present for 6 months or longer) symptom from
two or more of the following categories: fatigue; mood and
cognition related symptoms (feeling depressed, difficulty
remembering or concentrating, feeling moody, feeling anxious,
trouble finding words or lack of interest in sex); and
musculoskeletal related symptoms (joint pain, joint stiffness
or muscle pain).'' \180\
---------------------------------------------------------------------------
\180\ Statement of William Reeves to the PAC, January and September
1996, slides 31-36 (in subcommittee files).
---------------------------------------------------------------------------
Using this definition, Dr. Reeves showed that Gulf-related
illnesses are more frequent in Gulf War veterans than non-
deployed troops. If CDC could conduct an epidemiological
investigation, it would seem logical that the VA could also
have conducted a similar epidemiological study and achieved the
same results. Furthermore, CDC did not start its investigation
until late 1994, whereas VA began receiving complaints from
Gulf veterans as early as 1991 and could have initiated a
study.
VA medical policy may have been biased against findings of
chemical exposure by relying on DOD assertions and unproven
theories of toxic causation. VA continues today to maintain
that chronic symptoms in Gulf veterans cannot be attributed to
toxic exposures unless acute symptoms first appear at the time
of exposure.
There is no credible, scientific evidence to substantiate
the VA and DOD position that chronic symptoms cannot later
develop from low level chemical exposures unless acute symptoms
are observed when the exposure occurred.
The question of whether delayed or chronic effects result
from exposure to low level chemical agents without first having
acute or immediate symptoms is critical to Gulf veterans. The
answer determines whether or not Gulf veterans will be
diagnosed and treated properly, as well as compensated
appropriately for injuries suffered in the war zone. Many sick
veterans did not report acute symptoms during the war but later
developed chronic symptoms, thereby being denied appropriate
compensation for their illnesses.
On the other hand, many veterans report that they may have
had flu-like symptoms, rashes, or other reactions during the
war which they ignored as part of serving in a harsh, desert
environment or as a reaction to vaccines or drugs. The ``low
level'' symptoms could be considered acute, but mild, reactions
to low level chemical agents. The taking of anti-nerve gas
pills [PB] may also have masked acute symptoms, as Dr. Padilla
testified.
F. Impact on Veterans of Missing Records
Personal medical records of veterans, including sick call
records, are inadequate or missing. Documents which could help
verify possible exposures and military unit locations remain in
DOD files.\181\ Most of the military nuclear-biological-
chemical [NBC] logs, which are records of toxic warfare agent
detections, are missing or destroyed. Readouts from chemical
detection equipment have vanished. Many CIA intelligence logs
concerning Iraqi chemical/biological weapons [CBW] storage
depots and manufacturing facilities, and documents concerning
enemy capabilities and intentions to use CBW against U.S.
troops, have remained unreleased since the war.
---------------------------------------------------------------------------
\181\ PAC Report, p. 52. See also, supra note 125 [IOM Report], pp.
6, 7, 10.
---------------------------------------------------------------------------
All this critical information comprises the complete
medical history of each Gulf War veteran. In the absence of
full documentation needed to prove a service-connection, sick
veterans have a difficult--if not impossible--task of receiving
proper medical treatment and fair compensation.
Since no Government low level exposure research is
available, proof of toxic exposure as a cause of medical
disability is nearly impossible to obtain. Furthermore, the
burden of proof that the disability or illness is service-
connected falls on the veteran exclusively under current VA
regulations. Since the scientific research on the medical
effects of exposure to low level chemical and biological has
not been conducted, a veteran cannot prove a service-connected
disability related to chemical or biological toxic exposure.
``Current VBA policies allow compensation for conditions
which began during or were exacerbated by military service,
including exposure to chemical warfare agents resulting in
medically recognized sequelae.'' \182\
---------------------------------------------------------------------------
\182\ See supra, entire text of Secretary Brown's letter in text
section entitled, ``Exposures and VA Medical Protocols for Gulf
Veterans,'' (original in subcommittee files).
---------------------------------------------------------------------------
If basic scientific research has not been conducted to
identify medically recognized sequelae produced by toxic
exposures, compensation for service connected disability cannot
be proven by the veteran and the VA will not compensate the
veteran without this proof.
Congress enacted legislation in 1994 allowing the VA to pay
compensation benefits to veterans for disabilities related to
the Gulf War caused by ``undiagnosed'' illnesses.\183\ In the
past, the VA had always required that compensation be based on
clearly diagnosed diseases.
---------------------------------------------------------------------------
\183\ Public Law 103-446.
---------------------------------------------------------------------------
According to Congressional Research Service [CRS], ``Under
regulations issued in February 1995 (38 CFR 3.317), a veteran
can be compensated only for undiagnosed illnesses that manifest
themselves during Gulf War service or arise within 2 years of
departing from the Gulf. Veterans must provide objective
evidence of chronic illness and be at least 10 percent
disabled. However, as of January 1997, the VA had denied 9,688
(93.5 percent) of the 10,357 undiagnosed illness claims that
had been reviewed. Approximately 55 percent of the denied
claims were rejected because the illness did not manifest
itself until after the 2-year presumptive period. President
Clinton [last March] extended the presumptive period by 8
years, until December 31, 2001. The VA plans to re-evaluate the
claims that were denied on the basis of a 2-year presumptive
period to determine if they now qualify for compensation under
the extended period.'' \184\
---------------------------------------------------------------------------
\184\ See supra note 4, p. 6.
---------------------------------------------------------------------------
G. Stress-Related Diagnoses of Veterans' Illnesses
VA has consistently diagnosed veterans presenting these
symptoms as stress-related, or PTSD, or other psychological
conditions, as opposed to conducting the appropriate
epidemiological investigations to differentiate psychological
conditions from psycho-neuro-immunological conditions such as
fibromyalgia, chronic fatigue syndrome and central nervous
system disorders which may have resulted from toxic exposures.
Of the 21 sick Gulf veterans--all with symptoms of
undiagnosed origin--who appeared before the Human Resources
Subcommittee as witnesses, 13 were diagnosed by VA and/or DOD
doctors as ``Stress'' or ``PTSD,'' 3 cases as ``Nothing wrong;
all in the head,'' 3 cases as ``Undiagnosed,'' and only 2 cases
of ``Chemical exposure.''
One sick veteran who testified, Air Policeman James Green
of the Air Force, with orders to ship out to the Gulf War from
Germany, had taken the vaccines and PB tabs and become sick.
His orders were canceled at the last moment. ``I signed up for
the VA Health Registry in 1994. They sent me to the VA hospital
for an exam. The [VA] doctor asked me what was wrong and to
describe the symptoms. I was . . . referred to the mental
health clinic for stress-related problems. Seems awful funny to
me that my illness is stress and I was not even in the
theater.'' \185\
---------------------------------------------------------------------------
\185\ Testimony of James Green, Human Resources Subcommittee
hearing, No. 1, p. 220.
---------------------------------------------------------------------------
Dr. Matthew Friedman, a professor of psychiatry at
Dartmouth Medical School and executive director of the National
Center of Post Traumatic Stress Disorder, disputes emphasis on
stress as the principal cause of the illnesses. The NY Times
quoted Dr. Friedman: ``They [the PAC, DOD and VA] have very
nicely laid out why this is such an attractive hypothesis
[stress], but the data are not there to support it.'' The Times
article stated that Dr. Friedman's research on sick Gulf
veterans ``showed that only about 10 percent . . . were
suffering from PTSD . . . an extreme form of stress caused by
exposure to battle or other forms of trauma.'' \186\
---------------------------------------------------------------------------
\186\ Shenon, Philip, ``Studies Seem to Back Veterans Who Trace
Illnesses to Gulf War,'' New York Times, November 26, 1996, p. 1.
---------------------------------------------------------------------------
Dr. Katherine Murray Leisure, an infectious disease
specialist formerly at the VA Medical Center in Lebanon, PA,
who treated more than 700 sick Gulf veterans, said in the same
Times article it was clear to her that battlefield stress had
little to do with the veterans' ailments. She said, ``Out of
the hundreds of people I've seen, there's been fewer than a
half dozen who had PTSD. It's negligible.'' \187\
---------------------------------------------------------------------------
\187\ Ibid.
---------------------------------------------------------------------------
Neurologist and psychiatrist Dr. William Baumzweiger, a
former fellow at the VA Outpatient Clinic in Los Angeles who
has examined more than 100 sick Gulf veterans, stated in
prepared testimony before the subcommittee, ``I do not believe
that the majority of symptomatic Gulf War participants
experienced any stress which would be sufficient to precipitate
PTSD. I concluded they had suffered from environmental
intoxication . . . and that the disorders are neurological
illnesses that involve the central nervous system and the
immune system.'' \188\
---------------------------------------------------------------------------
\188\ Statement of William Baumzweiger, Human Resources
Subcommittee hearings, Nos. 1-4, p. 500.
---------------------------------------------------------------------------
According to Dr. Leisure and Dr. Baumzweiger, both doctors
were recently released by the VA, allegedly for their outspoken
views on the cause and treatment of Gulf veterans'
illnesses.\189\
---------------------------------------------------------------------------
\189\ Correspondence from William Baumzweiger and Katherine Murray
Leisure (in subcommittee files). See also, Shenon, Philip, ``VA
Punishes Doctors for Speaking Out on Gulf Illnesses'' New York Times,
December 12, 1996, p. A12.
---------------------------------------------------------------------------
Dr. Eula Bingham, a toxicologist and environmental health
professor who is chairman of the VA's Gulf War Expert
Scientific Committee, in an earlier interview with the New York
Times said, ``It's pretty clear that the veterans who were in
the gulf have a whole series of symptoms that other veterans
don't.'' She added, ``Certainly we know that there was
widespread exposure to chemicals during the war. We really
don't have good data on what health effects are caused by long-
term, low-level exposure to those agents.'' Dr. Bingham was
further quoted saying, ``I'm very troubled when any committee
says, `Well, it's stress.' Have they analyzed it? Why are they
saying it? I think it's a very poor word to use at this time.''
\190\ Dr. Bingham is also the former Administrator of OSHA.
---------------------------------------------------------------------------
\190\ Shenon, Philip, ``Panel Disputes Studies on Gulf War
Illness,'' New York Times, November 21, 1996, p. B11.
---------------------------------------------------------------------------
In the same Times article, Dr. Claudia Miller, a physician
and environmental research professor who is also a member of
the VA's Gulf War Expert Scientific Committee, said that
``stress may be a contributor to these health problems but we
should be looking at potential chemical causes, particularly
given the kind of chemical environment that our soldiers faced
in the Gulf.'' \191\
---------------------------------------------------------------------------
\191\ Ibid.
---------------------------------------------------------------------------
A 1993-1994 study of veterans from Pennsylvania and Hawaii,
sponsored by the Walter Reed Army Institute of Research,
stated: ``The major conclusion concerning physical health of
these veterans is that for those who deployed to the Gulf War
and recently reported physical symptoms, neither stress nor
exposure to combat or its aftermath bear much relationship to
their distress; only the fact of deployment differentiates them
from their less-burdensome counterparts.'' \192\
---------------------------------------------------------------------------
\192\ Streich, et al., ``Symptomatology of Gulf War Era Service,''
Military Medicine, Walter Reed Army Institute of Research, Bethesda,
MD, March 1995.
---------------------------------------------------------------------------
Dr. Daniel Clauw, Assistant Professor of Medicine at
Georgetown University Medical Center, in testimony before the
Human Resources Subcommittee, stated: ``The problem with
considering these [Gulf War] illnesses as psychiatric
conditions: In clinical practice, telling an individual with
this type of illness that it is `all in their head,' or that
there is no `organic' basis for their symptoms, will always
lead to frustration and a sense of abandonment by the
individual. It is not difficult to see why many of the veterans
with these illnesses, as well as their families and advocates,
have become so frustrated with this vicious cycle of no
diagnoses, no effective treatment, and psychiatric attribution
of symptoms.'' \193\
---------------------------------------------------------------------------
\193\ Statement of Daniel Clauw, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 186.
---------------------------------------------------------------------------
``Take these veterans seriously. The physical and emotional
toll of this type of illness is great, and these individuals
developed these problems while serving our country. View with
skepticism anyone who might assert that because there are no
abnormalities on these individuals' blood tests, x rays, or
other diagnostic studies, that there is nothing wrong, or that
the individual is suffering from a psychiatric condition. It is
arrogant of us as scientists to feel that because we cannot
precisely define a problem, it doesn't exist.'' \194\
---------------------------------------------------------------------------
\194\ Ibid., p. 189.
---------------------------------------------------------------------------
H. Treatment and Research
The GAO Report on ``Gulf War Illnesses'' responded to the
mandate of the Fiscal Year 1997 Defense Authorization Act. GAO
examined three issues and made findings and recommendations
based on results of the study. The GAO conducted a 6-month
study on the Government's clinical care and medical research
programs relating to illnesses that members of the armed forces
might have contracted as a result of their service in the
Persian Gulf War.\195\
---------------------------------------------------------------------------
\195\ See supra note 48, p. 1.
---------------------------------------------------------------------------
Issue 1: The efforts of DOD and VA to assess the quality of
treatment and diagnostic services provided to Gulf War veterans
and their provisions for follow-up of initial examinations.
Finding: Neither DOD nor VA has systematically attempted to
determine whether ill Gulf War veterans are any better or worse
today than when they were first examined.
Issue 2: The Government's research strategy to study the
Gulf War veterans' illnesses and the methodological problems
posed in its studies.
Finding: The majority of the research has focused on the
epidemiological study of the prevalence and cause of the
illnesses rather than diagnosis, treatment, and prevention of
them.
Issue 3: The consistency of key official conclusions with
available data on the causes of the veterans' illnesses.
Finding: Support for some official conclusions regarding
stress, leishmaniasis (a parasitic infection), and exposure to
chemical agents was weak or subject to alternative
interpretations.
Dr. Donna Heivilin, Director of Planning and Reporting for
GAO's National Security and International Affairs Division,
appeared before the Human Resources Subcommittee on June 24,
1997, to review results of the GAO study. Concerning the
quality of medical treatment and diagnostic services, Dr.
Heivilin stated: ``Over 100,000 of the approximately 700,000
Gulf War veterans have participated in DOD and VA health
examination programs [DOD's Comprehensive Clinical Evaluation
Program or CCEP, and VA's Persian Gulf Health Registry]. Of
those veterans examined, nearly 90 percent have reported a wide
array of health complaints and disabling conditions. Officials
of both DOD and VA have claimed that regardless of the cause of
veterans' illnesses, veterans are receiving appropriate and
effective symptomatic treatment. Both agencies have tried to
measure or ensure the quality of veterans' initial examinations
through such mechanisms as training and standards for physician
qualification. However, these mechanisms do not ensure a given
level of effectiveness for the care provided or permit
identification of the most effective treatments.''
``We found that neither DOD nor VA has mechanisms for
monitoring the quality, appropriateness, or effectiveness of
these veterans care or clinical progress after their initial
examination and has no plans to establish such mechanisms. VA
officials involved in administering the Health Registry program
told us they regarded monitoring the clinical progress of
registry participants as a separate research project, and DOD's
[CCEP] program made similar comments.''
Dr. Heivilin said that such monitoring is important
because: 1) undiagnosed conditions are not uncommon among ill
veterans; 2) treatment for veterans with undiagnosed conditions
is based on their symptoms; and 3) veterans with undiagnosed
conditions or multiple diagnoses may see multiple providers.
``Without follow-up of their treatment, DOD and VA cannot
say whether these ill veterans are any better or worse today
than when they were first examined.'' \196\
---------------------------------------------------------------------------
\196\ Statement of Donna Heivilin, Human Resources Subcommittee
hearing, No. 3, pp. 47-48.
---------------------------------------------------------------------------
Concerning the Government's research strategy, Dr. Heivilin
stated: ``Federal research on Gulf War veterans' illnesses and
factors that might have caused their problems has not been
pursued proactively. Although these veterans' health problems
began surfacing in the early 1990's, the vast majority of
research was not initiated until 1994 or later. This 3-year
delay has complicated the task facing researchers and has
limited the amount of completed research currently available.
Although at least 91 studies have received Federal funding,
over 70 or four-fifths of the studies are not yet complete, and
the results of some studies will not be available until after
the year 2000.'' \197\
---------------------------------------------------------------------------
\197\ Ibid., pp. 48-49.
---------------------------------------------------------------------------
``We found that some hypotheses [about causes of the
illnesses] received early emphasis, while some hypotheses were
not initially pursued. While research of exposure to stress
received early emphasis, research on low level chemical
exposure was not pursued until legislated in 1996. The failure
to fund such research cannot be traced to an absence of
investigator-initiated submissions. According to DOD officials,
three recently funded proposals on low level chemical exposure
had previously been denied funds. We found that additional
hypotheses were pursued in the private sector. A substantial
body of research suggests that low level exposure to chemical
warfare agents or chemically related compounds, such as certain
pesticides, is associated with delayed or long-term health
effects.'' \198\
---------------------------------------------------------------------------
\198\ Ibid., p. 49.
---------------------------------------------------------------------------
Dr. Heivilin said there is evidence from animal
experiments, studies of accidental human exposures, and
epidemiological studies of humans that low level exposures to
certain organophosphorus compounds, including Sarin nerve
agents to which some of our troops may have been exposed, can
cause delayed, chronic neurotoxic effects. The ill-defined
symptoms may be associated with objective brain and nerve
damage, and due in part to organo-phosphate-induced delayed
neurotoxicity [OPIDN], according to Dr. Heivilin.\199\
---------------------------------------------------------------------------
\199\ Ibid., p. 50.
---------------------------------------------------------------------------
Studies ``further linked the veterans' illnesses to
exposure to combinations of chemicals [emphasis added],'' Dr.
Heivilin stated, ``including nerve agents, pesticides, insect
repellants, and pyridostigmine bromide tablets. Exposure to
combinations of organophosphates and related chemicals . . .
has been shown in animal studies to be far more likely to cause
morbidity and mortality than any of the chemicals acting
alone.'' \200\
---------------------------------------------------------------------------
\200\ Ibid., p. 51.
---------------------------------------------------------------------------
The GAO study found the ongoing epidemiological Federal
research suffered from two methodological problems: a lack of
case definition, and absence of accurate exposure data. Without
valid and reliable data on exposures and the multiplicity of
[chemical] agents to which the veterans were exposed,
researchers will likely continue to find it difficult to detect
relatively subtle effects and to eliminate alternative
explanations for Gulf War veterans' illnesses. The study found
that while multiple federally funded studies of the role of
stress in the illnesses have been done, basic toxicological
questions regarding the substance to which they were exposed
remain unanswered.\201\
---------------------------------------------------------------------------
\201\ Ibid., pp. 52-53.
---------------------------------------------------------------------------
Dr. Heivilin stated: ``We found that Federal researchers
have faced several methodological challenges and encountered
significant problems in linking exposures or potential causes
to observed illnesses or symptoms. For example:
Researchers have found it extremely
difficult to gather information about exposures to such
things as oil well fire smoke and insects carrying
infection.
DOD has acknowledged that records of the use
of pyridostigmine bromide and vaccinations to protect
against chemical/biological warfare exposures were
inadequate.
Gulf veterans were typically exposed to a
wide array of agents, making it difficult to isolate
and characterize the effects of individual agents or to
study their combined effects.
Most epidemiological studies on Gulf
illnesses have relied only on self-reports for
measuring most of the agents to which veterans may have
been exposed.
Information gathered from Gulf veterans
gathered years after the war may be inaccurate or
biased. There is often no straightforward way to test
the validity of self-reported exposure information. As
a result, findings from these studies may be spurious
or equivocal.
Classifying the symptoms and identifying
illnesses of Gulf veterans have been difficult. From
the outset, symptoms reported by veterans have been
varied and difficult to classify into one or more
distinct illnesses. It has thus been difficult to
develop a case definition (that is, a reliable way to
identify individuals with a specific disease), which is
a criterion for doing effective epidemiological
research.''
``In summary,'' Dr. Heivilin stated, ``the ongoing
[Federal] epidemiological research will not be able to provide
precise, accurate, and conclusive answers regarding the causes
of veterans' illnesses because of these formidable
methodological problems.'' \202\
---------------------------------------------------------------------------
\202\ Ibid., pp. 53-54.
---------------------------------------------------------------------------
I. Other Executive Agency Actions on Gulf Veterans' Illnesses
DOD and CIA Gulf War Illnesses Investigation Teams
In November 1996, Deputy Secretary John White appointed
Bernard Rostker, Ph.D. economist and Assistant Secretary of
Navy Manpower, to the position of Special Assistant for Gulf
War Illnesses. Under Dr. Rostker, DOD expanded its Gulf illness
investigative team from 10 to more than 100 people. It was up
to an estimated 150 people as of October 1997. To date, the DOD
team has focused its investigation mainly on troop chemical
exposures from fallout resulting from the Iraqi bunker
detonations at Khamisiyah, and on case narratives to disprove
specific chemical detection incidents reported by military
specialists such as Human Resources Subcommittee witnesses
Major Johnson and Gy/Sgt. Grass.
On March 3, 1997, Deputy Secretary John White directed the
DOD Inspector General to take over the investigation of what
happened to the missing nuclear, biological, chemical [NBC]
logs maintained at U.S. Central Command during the Gulf War. As
mentioned, in March 1997 Dr. Stephen Joseph resigned. In April
1997, Secretary Cohen named former Senator Warren Rudman as his
special advisor on Gulf War illnesses. In July 1997, Deputy
Secretary White resigned. DOD's former Deputy Assistant
Secretary for Health Affairs, Dr. Sue Bailey, is expected to be
nominated by the President to replace Dr. Joseph.
In March 1997, CIA Director George Tenet formed a Task
Force on Gulf War Illnesses headed by Robert Walpole. The
team's assignment is to declassify and make public as many CIA
documents as possible concerning the controversy about events
at Khamisiyah. To date, 41 documents have been released,\203\ 1
of which indicates the CIA had received warnings in the 1980's
that chemical weapons were stored in Khamisiyah munitions
bunkers.
---------------------------------------------------------------------------
\203\ See supra note 77.
---------------------------------------------------------------------------
According to the Congressional Research Service [CRS], ``On
April 9 [1997], amid growing tension and charges of a cover-up,
the CIA released a report showing that the agency had solid
intelligence in 1986 that thousands of chemical weapons had
been stored at Khamisiyah. However, the CIA failed to include
the depot on a list of suspected CW sites provided to the
Pentagon before the war. The CIA warned the Army of the
possible presence of chemical weapons at Khamisiyah just days
before the depot was blown up, but the information was not
relayed to the engineers who carried out the detonations.''
\204\
---------------------------------------------------------------------------
\204\ See supra note 4.
---------------------------------------------------------------------------
Presidential Advisory Committee on Gulf War Veterans' Illnesses
President Clinton established the Presidential Advisory
Committee on Gulf War Veterans' Illnesses [PAC] in May 1995 to
examine the health concerns related to Gulf War service. The
Committee, a 12-member panel made up of veterans, scientists,
health care professionals, and policy experts, held 18 meetings
between August 1995 and November 1996 to hear witness testimony
and take public comment. A Final Report of findings and
recommendations was issued December 31, 1996. However, the
President extended the panel's investigation until September
30, 1997. The PAC held additional meetings this year, with
plans to present its updated Special Report to the President by
late October 1997.
While the PAC's December 1996 report found that ``many
veterans have illnesses likely to be connected to their service
in the Gulf,'' it did not support a causal link between the
illnesses and exposures to environmental risk factors.\205\ In
the face of overwhelming evidence that Gulf War veterans were
exposed to multiple toxic agents, the PAC instead placed
emphasis on stress as a cause of these health problems. The PAC
report stated: ``Stress is likely to be an important
contributing factor to the broad range of illnesses currently
being reported by Gulf War veterans.'' \206\
---------------------------------------------------------------------------
\205\ PAC Final Report, Executive Summary, p. 2.
\206\ Ibid., p. 125.
---------------------------------------------------------------------------
The PAC also discounted most environmental risk factors as
causes of veterans illnesses. The December report stated:
``Current scientific evidence does not support a causal link
between the symptoms and illnesses reported by Gulf War
veterans and exposures while in the Gulf region to the
following environmental risk factors assessed by the Committee:
pesticides, chemical warfare agents, biological warfare agents,
vaccines, pyridostigmine bromide, infectious agents, depleted
uranium, oil well fires and smoke, and petroleum products.''
\207\
---------------------------------------------------------------------------
\207\ Ibid.
---------------------------------------------------------------------------
The PAC report did identify DOD and VA ``problems related
to missing medical records, the absence of baseline health
data, inaccurate records of troop locations, and incomplete
data on the health effects of what should have been viewed as
reasonably anticipated risks.'' \208\
---------------------------------------------------------------------------
\208\ Ibid., p. 4.
---------------------------------------------------------------------------
As numbers of troops presumed exposed to chemical weapons
continued to rise following the events at Khamisiyah, DOD's
handling of the investigation into the Gulf veterans' illnesses
came under criticism from PAC members and staff. In September
1996, the PAC's chief investigator, James Turner, stated in a
committee hearing that since the Gulf War, DOD's position has
remained essentially unchanged ``and inflexible . . . in the
face of growing evidence that there were possible low level
exposures.'' Turner said DOD's position ``can be summarized in
three no's . . . there was no use, no exposures, and no
presence of chemical warfare agents in-theater.''
Turner stated, ``The slow, reluctant on-again, off-again
release of information to the public by the . . . [DOD's]
senior level oversight panel, has also served to undermine
credibility and confidence in the DOD's efforts. To fulfill the
government's obligation to tell the truth about chemical
warfare agent exposures to veterans and the American public,
DOD's investigations must be timely, thorough, independent,
credible and public. On each of these counts . . . DOD's
efforts have fallen short of the mark.''
Turner's statement found the evidence of chemical agent
release at Khamisiyah overwhelming, other site-specific
exposures must be presumed, and DOD has conducted a superficial
investigation of possible chemical and biological exposures
``which is unlikely to provide credible answers to veterans'
questions.'' \209\
---------------------------------------------------------------------------
\209\ Statement of James Turner, Chief Investigator, Presidential
Advisory Committee on Gulf War Veterans' Illnesses [PAC], September 4-
5, 1996, p. 5.
---------------------------------------------------------------------------
In the PAC's final public hearing September 5, 1997,
monitored by Human Resources Subcommittee staff and covered by
national news media, the PAC did not amend its conclusions
about the importance of stress as a cause of Gulf War
illnesses, nor its rejection of most environmental risk factors
as possible causes. Some panel members suggested that the
updated Final Report include a statement acknowledging the
possibility of low level chemical warfare exposures, but no
vote on the proposal was taken.
Members did agree in the final meeting, however, to
recommend that the Pentagon's investigation of Gulf War
illnesses be transferred to another agency in view of DOD's
loss of credibility in the handling of chemical weapons
exposures.
``The Pentagon is failing in a multimillion dollar effort
to salvage its credibility among ailing Persian Gulf War
veterans for its investigations into the possible sources of
their illnesses, according to the draft of a final report by a
White House advisory committee,'' the Washington Post reported.
``The report,'' according to the Post, ``scheduled to be
presented to President Clinton next month, concludes, `Public
mistrust about the government's handling of Gulf War illnesses
not only has endured, but has expanded' in the 10 months since
the Defense Department, at the panel's urging, agreed to
intensify its research efforts. It blames the office of the
Pentagon's special assistant for Gulf War illnesses [Dr.
Bernard Rostker] for failing to examine reported incidents
thoroughly and suggests the DOD may be institutionally
incapable of acknowledging that chemical exposures could have
occurred.'' \210\
---------------------------------------------------------------------------
\210\ McAllister, Bill, ``Mistrust of Pentagon on Illness in Gulf
Grows, Report Concludes,'' Washington Post, September 24, 1997, p. 2.
---------------------------------------------------------------------------
In a the New York Times article, Defense Secretary William
Cohen took issue with the PAC's recommendation. ``I think that
the Pentagon is fully capable of conducting an investigation.
So I would disagree with that recommendation.'' \211\
---------------------------------------------------------------------------
\211\ Krauss, Clifford, ``Pentagon Should Retain Role In Illness
Inquiry, Cohen Says,'' New York Times, September 26, 1997, p. A24.
---------------------------------------------------------------------------
Others also disagree with the PAC. In a letter to PAC
Chairman Dr. Joyce Lashof, Congressman Bernard Sanders (I-VT),
a subcommittee member, called for a reassessment of the PAC's
conclusions relating to stress and environmental factors in its
Final Report to the President in view of the growing numbers of
troops that were exposed to chemical weapons and other toxic
agents. The letter, signed by more than 80 Members of Congress
including Subcommittee Chairman Christopher Shays, stated:
``We are writing to ask you to reassess your conclusion
that current scientific evidence does not support a causal link
between the symptoms and illnesses reported by Gulf War
veterans and their exposure to a variety of chemicals during
their service in the Persian Gulf War. In fact, it is our
belief that more and more scientific evidence suggests that a
major cause of Persian Gulf illness is the synergistic effect
of a wide variety of chemicals to which our soldiers were
exposed. Our hope is that by reassessing your conclusion, you
will recommend increasing research into and treatment for the
health effects of chemical exposures experienced in the Persian
Gulf.'' \212\
---------------------------------------------------------------------------
\212\ Letter from Representative Bernard Sanders (I-VT) to Joyce
Lashof, June 20, 1997 (copy in subcommittee files).
---------------------------------------------------------------------------
In response, Dr. Lashof informed Congressman Sanders that
``. . . peer-reviewed literature published since the Final
Report does not, to date, indicate a causal link between the
commonly cited risk factors and the broad range of illnesses
currently being reported by Gulf War veterans.'' \213\
---------------------------------------------------------------------------
\213\ Letter of response from Dr. Joyce Lashof to Representative
Sanders, July 25, 1997 (copy in subcommittee files).
---------------------------------------------------------------------------
Concerning the PAC's official conclusions about the causes
of Gulf veterans' illnesses, GAO's Dr. Heivilin in her June 24,
1997 statement to the Human Resources Subcommittee hearing
said: ``Six years after the war, little is known about the
causes of Gulf War veterans' illnesses. In the absence of
official conclusions from DOD and VA, we examined conclusions
drawn in December 1996 by the Presidential Advisory Committee
on Gulf War Veterans' Illnesses [PAC].''
``First, the Committee [PAC] concluded that `stress is
likely to be an important contributing factor to the broad
range of illnesses currently being reported by Gulf veterans.'
While stress can induce physical illness, the link between
stress and these veterans' physical symptoms has not been
firmly established. For example, a large-scale federally funded
study [by Walter Reed Army Institute of Military Medicine, see
footnote 8] concluded that for those veterans deployed to the
Gulf War `neither stress nor exposure to combat or its
aftermath bear much relationship to their distress.' The
Committee stated that `epidemiological studies to assess the
effects of stress have found higher rates of PTSD than among
individuals in nondeployed units.' Our review indicated that
the prevalence of PTSD among Gulf veterans may be overestimated
due to problems in the methods used to identify it.
Specifically, the studies on PTSD to which the Committee refers
have not excluded other conditions, such as neurological
disorders that produce symptoms similar to PTSD [emphasis
added] and can also elevate scores on key measures of PTSD.''
``Second, the Committee concluded that `it is unlikely that
infectious diseases endemic to the Gulf region are responsible
for long term health effects in Gulf veterans, except in a
small known number of individuals.' Similarly, the Persian Gulf
Veterans Coordinating Board [comprised of representatives of
DOD, VA, and HHS] concluded that because of the small number of
reported cases `the likelihood of leishmania tropica as an
important risk factor for widely reported illness has
diminished.' While this is true for observed symptomatic
infection with the parasite, the prevalence of asymptomatic
infection is unknown, and such infection may reemerge in cases
in which the patient's immune system becomes deficient.''
``As the Committee noted, the infection may remain dormant
up to 20 years. Because of this long latency, the infected
population is hidden, and because even classic forms of
leishmaniasis are difficult to recognize, we believe that
leishmania should be retained as a potential risk factor for
individuals who suffer from immune deficiency.''
``Third, the Committee also concluded that it is unlikely
that the health effects reported by many Gulf veterans were the
result of: 1) biological or chemical warfare agents; 2)
depleted uranium; 3) oil well fire smoke; 4) pesticides; 5)
petroleum products; and 6) pyridostigmine bromide or vaccines.
However, our review of the Committee's conclusions indicated:
While the Government found no evidence that
biological weapons were deployed during the war, the
United States lacked the capability to promptly detect
biological agents, and the effects on one agent,
aflatoxin, would not be observed for many years.
Evidence from various sources indicates that
chemical agents were present at Khamisiyah, Iraq and
elsewhere on the battlefield. The magnitude of the
exposure to chemical agents has not been fully
resolved. As we recently reported, 16 of 21 sites
categorized by Gulf War planners as nuclear, biological
and chemical [NBC] facilities were destroyed. However,
the United Nations Special Commission found after the
war that not all of the possible NBC targets had been
identified by U.S. planners. The Commission has
investigated a large number of the facilities suspected
by U.S. authorities as being NBC related. Regarding
those the Commission has not yet inspected, we
determined that each was attacked by Coalition aircraft
during the Gulf War. One site is located close to the
border, where Coalition ground forces were located.
Exposure to certain pesticides can induce a
delayed neurological condition without causing
immediate symptoms.
Available research indicates that exposure
to pyridostig-mine bromide can alter the metabolism of
organophosphates (the chemical family of some
pesticides used in the war, as well as certain chemical
warfare agents) in ways that enhance chronic effects on
the brain.\214\
---------------------------------------------------------------------------
\214\ See supra note 196, pp. 55-58.
Dr. Heivilin concluded her statement with the following:
``In our report, we recommended that the Secretary of Defense,
---------------------------------------------------------------------------
with the Secretary of Veterans Affairs:
1) set up a plan for monitoring the clinical progress
of Gulf War veterans to help promote effective
treatment and better direct the research agenda;
2) give greater priority to research on effective
treatment for ill veterans and on low level exposures
to chemicals and their interactive effects, and less
priority to further epidemiological studies; and,
3) refine the current approaches for diagnosing post-
traumatic-stress-disorder consistent with suggestions
recently made by the Institute of Medicine. The
Institute noted the need for improved documentation of
screening procedures and patient histories, and the
importance of ruling out alternative causes of
impairment.\215\
---------------------------------------------------------------------------
\215\ Ibid., pp. 58-59.
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III. Findings
Diagnosis
Finding 1: VA and DOD did not listen to sick Gulf War veterans as to
possible causes of their illnesses.
The subcommittee hearing record is replete with examples of
veterans who raised legitimate concerns and backed them with
real information, yet had no effect on VA research, diagnosis,
treatment or compensation policies.
Randy Wheeler is one such veteran. He served in the Gulf
War with the U.S. Marine Corps from August 1990 to March 1991,
and according to his testimony before the subcommittee, he has
experienced a rash of health problems since returning from the
Gulf--including joint and chest pains, shortness of breath,
headaches, severe blepharitis in both eyes, rashes and
diarrhea. A private ophthalmologist has diagnosed the burning
redness and pain in his eyes as chronic blepharitis and a
cataract. VA doctors have refused to acknowledge and search for
a real, physiological cause of his ailments.
The doctor at Eisenhower (Army Medical Center in Ft.
Gordon, GA) told me that my eyes were fine . . . The VA
and the DOD has not helped my family nor I in any way.
I continue to follow up with the VA, and I have
completed the CCEP but still haven't been tested for
anything that might have caused my health problems or I
have not been properly diagnosed.\216\
---------------------------------------------------------------------------
\216\ Testimony of Randy Wheeler, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 18-19.
Kimo Hollingsworth, who served in the Persian Gulf as a
Marine Artillery Platoon Commander, has gone to the VA to seek
a diagnosis and treatment for his chronic headache and fatigue,
severe chest, muscle and joint pain, blurred vision, memory
loss, fever, bladder problems and oral discharge of what he
calls ``hardened chunks of dark green sputum.'' After a
physical examination at the Veterans Affairs Medical Center
[VAMC] in Washington, DC failed to turn up the cause, doctors
refused to acknowledge there may be a physical source of his
stress that requires further inquiry and attention. Again, VA
---------------------------------------------------------------------------
doctors did not listen.
Despite my symptoms, the VA hospital in Washington,
DC . . . concluded that I was in excellent health . . .
I was then directed to a social worker who discussed
the issue of Post Traumatic Stress Disorder. The VA
also provided me a brochure outlining psychological
counseling services available to Persian Gulf
veterans.\217\
---------------------------------------------------------------------------
\217\ Testimony of Kimo Hollingsworth, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 28-29.
Still other veterans, such as Brian Martin, were told by VA
Medical Center [VAMC] personnel that they were not sick, even
after they had already been diagnosed with illnesses.\218\ Mr.
Martin has been rated at 100 percent compensation, yet he told
the subcommittee that upon arriving at the VAMC in Battle
Creek, MI with breathing problems and severe abdominal pain,
his attending physician concluded,
---------------------------------------------------------------------------
\218\ Statement of Brian Martin, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 11.
You're not sick. You don't need to be laying around
stagnant with all the really sick people.\219\
---------------------------------------------------------------------------
\219\ Ibid.
Veterans are not the only ones who believe they were
ignored. Army Staff Sergeant Steven Wood felt his health
complaints were being dismissed while he was still on active
---------------------------------------------------------------------------
duty, under DOD.
I never found anyone in the Army who was serious
about helping me--or anyone else, for that matter. I
was told to suck it up and drive on . . . While still
on active duty, I never received any real health care.
I was told to quit faking, it's all in my head, and my
all-time favorite: ``We do not know what's wrong with
you, but you will be better in 2 weeks.'' \220\
---------------------------------------------------------------------------
\220\ Testimony of Steven Wood, Human Resources Subcommittee
hearings, No. 2, pp. 45-46.
Sgt. Wood grew so unnerved by the military's lack of
concern that he sought treatment outside the military
establishment while he was stationed overseas in April 1996.
According to Sgt. Wood, the German civilian doctor ``did more
testing in 2 hours than the Army did in 5 years,'' but because
the doctor was not a U.S. Army physician, his diagnosis went
unheeded without so much as a cursory glance. Instead, the Army
---------------------------------------------------------------------------
neurologist responded:
`I do not like you Gulf vets that say you're sick. I
was there, and I'm not sick.' This doctor then
proceeded to tell me she felt I had no neurological
problems before even examining me and she flatly
refused to even read the German doctor's findings.\221\
---------------------------------------------------------------------------
\221\ Ibid.
Other veterans, including Major Barry Kapplan, Staff
Sergeant Chris Kornkven, Reserve Navy Captain Julia Dyckman,
Major Michael Donnelly, Marine Major Randy Hebert, and Petty
Officer Nick Roberts, have relayed similar stories of having
their symptoms and concerns either ignored or dismissed as
irrational and therefore insignificant.\222\
---------------------------------------------------------------------------
\222\ See supra notes 12-31, 36-39.
---------------------------------------------------------------------------
The Central Intelligence Agency [CIA], the most highly
trained information-gathering arm of the U.S. Government,
displayed a similar unwillingness to listen to veterans who
suspected a physiological cause of their health problems. When
asked why no one expressed any interest in information
volunteered by Persian Gulf War veterans, Sylvia Copeland of
the CIA's Persian Gulf War Veterans Illnesses Task Force
responded that the pursuit of that information lies outside of
the Task Force's job description.
We are not in the business of interviewing U.S.
soldiers. That is DOD's job. Going over troop logs,
interviewing soldiers is not one of our
responsibilities.\223\
---------------------------------------------------------------------------
\223\ Testimony of Sylvia Copeland, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 416.
Patrick Eddington, a former CIA analyst, paints a darker
picture. He suggests the CIA went out of its way to
deliberately ignore and exclude the opinions of U.S. veterans
---------------------------------------------------------------------------
from its official investigation.
There is absolutely no question that the CIA made a
concerted effort to exclude entire classes of
information from its inquiry . . . The CIA has had,
throughout its entire existence, a specific component
that is designed to do nothing but contact American
citizens about their experiences overseas and their
travels overseas. So for the CIA to refuse to talk to
American veterans about this issue is a complete
departure from standard operating procedure.\224\
---------------------------------------------------------------------------
\224\ Testimony of Patrick Eddington, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 147.
Either way, Ms. Copeland acknowledged the CIA was aware of
---------------------------------------------------------------------------
DOD's research.
DIA [the Defense Intelligence Agency] did the
research, looked at all the intelligence information
and we had meetings together on chemical issues and
they would brief us on their findings . . . Then we
synthesize that with all of our intelligence
information.\225\
---------------------------------------------------------------------------
\225\ Testimony of Sylvia Copeland, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 423-
424.
These combined statements demonstrate a systematic failure
to incorporate evidence of toxic exposures into so-called
``Gulf War Illness'' research, diagnosis, and treatment.
VA Under Secretary for Health Dr. Kenneth Kizer offered
only circumstantial proof the Department listened to sick Gulf
War veterans regarding possible causes of their illnesses. When
asked if VA physicians made a predetermination that there was
no scientific basis for many veterans' health complaints and
consequently refused to pursue their suggestions, Dr. Kizer
avoided the question--saying only that the investigation into
chemical warfare agents was:
delayed and [its] . . . focus given a lower priority
because of information that had been provided by
DOD.\226\
---------------------------------------------------------------------------
\226\ Testimony of Kenneth Kizer, Human Resources Subcommittee
hearings, No. 1, p. 174.
The dismissal of veterans' concerns also occurred at the
diagnosis stage. A followup report by the VA's Office of the
Medical Inspector [OMI] supports this conclusion.
First, data from the OMI's analysis of the Persian Gulf
Registry Health Examination Program show VA physicians had good
reason to pursue contamination hypotheses, given the extremely
high rates of veterans reporting such exposures. According to
the final report:
In 1992 Physician Registry staff documented that 93
percent of the Persian Gulf War veterans reported that
they had been exposed to 1 or more of the 12
contaminants. This percentage declined to a low of 87
percent in 1993, and increased to a high of 98 percent
by 1996.\227\ \228\
---------------------------------------------------------------------------
\227\ Final Report: Persian Gulf Registry Health Examination
Program: Assessment of Exposure History, Office of the Medical
Inspector, Veterans Health Administration, VA (May 5, 1997) p. 5.
\228\ A veteran was counted only once regardless of the number of
contaminants to which he or she had been exposed.
Second, there is reason to believe the percentage of
veterans reporting exposures might have been even higher. The
study states that while Registry physicians had been instructed
by program officials to ask veterans about possible exposure to
these contaminants, the list of contaminants was left off the
Persian Gulf Registry Code Sheet from 1992 to 1995, making it
easy, if not likely, for physicians to omit this task.\229\
---------------------------------------------------------------------------
\229\ See supra note 227, p. 7.
---------------------------------------------------------------------------
Third, the implementation of the Registry protocol was
sloppy and inconsistent.
Registry physicians had been instructed . . . to
record their findings in the Progress Notes of the CHRs
[Consolidated Health Records]. The responses were to
include negative as well as positive responses . . .
The OMI data collectors found large variations in
compliance with the assigned task, that is, recording
positive and negative responses to queries about
possible exposure to specific contaminants in the
Progress Notes. The variations in compliance existed
among physicians at a single VA medical center and
among different VAMCs.\230\
---------------------------------------------------------------------------
\230\ Ibid.
The inability to implement this aspect of the diagnostic
protocol properly and uniformly is especially significant
because it renders the resulting data virtually useless and
indicates an extremely casual attitude toward the pursuit of
this knowledge.
The notion that VA employees sometimes disregard or fail to
implement protocols has been documented elsewhere as well.
Congress commissioned the U.S. General Accounting Office [GAO]
to determine the extent to which VA followed its guidelines for
evaluation and treatment, with damning results. After
conducting a lengthy investigation that included interviews
with officials at VA headquarters, VA's Atlanta Veterans
Integrated Services Network office, medical centers in
Washington, Atlanta and Birmingham, referral centers in
Washington and Birmingham, veterans' service organizations, and
dozens of Persian Gulf veterans, and a review of a sample of
medical records, GAO noted various discrepancies between VA
protocols and action. Among the problems cited were: failure to
give undiagnosed veterans additional baseline laboratory tests
and consultations; failure to evaluate veterans suffering from
undiagnosed illnesses at VA's referral centers; \231\ and
failure to provide personal counseling between veterans and
their physicians to evaluate the registry exam process.\232\
The results led Stephen Backhus, Director of Veterans' Affairs
and Military Health Care Issues, to conclude:
---------------------------------------------------------------------------
\231\ Only 390 out of 15,000 referrals were evaluated.
\232\ Statement of Stephen Backhus before the VA Subcommittee on
Health, 105th Cong., 1st sess., GAO/T-HEHS-97-158, p. 4-5 (1997).
On the basis of our review of medical records and
discussions with program officials, including
physicians, it does not appear that VA's guidance is
being consistently implemented in the field.\233\
---------------------------------------------------------------------------
\233\ Ibid.
Finally, a former VA health official said many physicians
displayed an unwillingness to consider veteran's accounts of
possible toxic exposure when prescribing treatment. Dr. William
Baumz-weiger worked at the VA in west Los Angeles where he
witnessed a pervasive lack of interest in accounts of potential
---------------------------------------------------------------------------
toxicity.
With the constant denial that there was any agent in
the Gulf and with the feeling that you have to have
acute toxic symptoms to have problems, no one really
pursued it as the leading hypothesis . . . I do not
think there was an agency-wide policy against there
being Gulf War syndrome or an agency-wide conviction
that organophosphates did not matter. I think this is
something that just crept into parts of the structure
of the organization.\234\
---------------------------------------------------------------------------
\234\ Testimony of William Baumzweiger, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 530,
536.
As many people have attested, warnings were sounded. The
problem stems from the refusal to listen to them. Taken as a
whole, the body of evidence suggests what veterans have feared
all along--the existence of a systematic and chronic disregard
on the part of physicians and other personnel at the VA, DOD,
and the CIA for their concerns regarding the severity and
possible sources of their maladies. What makes this blatant
disregard even more abhorrent is the fact that it seems to have
permeated the system despite its potential to worsen the
already deteriorating health of U.S. veterans and their
families.
Finding 2: The presence of a variety of toxic agents in the Gulf War
theater strongly suggests exposures have a role in causing,
triggering or amplifying subsequent service-connected
illnesses.
For the past 6 years, many veterans have been saying they
believe their illnesses are the result of direct exposure to
toxic agents in the Gulf War theater. Over those years,
investigators have amassed a mountain of evidence, primarily
inferential or circumstantial, that this is, in fact, the case.
The presence of chemical weapons and other toxins is no longer
in question, thanks in part to a belated admission by the
Pentagon. It is also supported by eyewitness accounts of
veterans who heard, saw, tasted, and felt what they believe to
be various incidents of toxic exposure. Finally, veterans
experienced symptoms consistent with current scientific
conclusions regarding the role various toxins play in causing,
triggering, or accelerating chronic problems.
Veterans, scientists, and researchers have long suspected
the existence of a variety of toxic agents in the Persian Gulf
during the war. The suspected toxins include: chemical and
biological warfare agents, organophosphates found in pesticides
and insect repellents, leaded diesel fuel, depleted uranium,
oil well fire smoke, leaded vehicle exhaust, contaminated
drinking water, shower water, and clothing, parasites, and
pyridostigmine bromide and other drugs to protect against
chemical warfare agents.\235\
---------------------------------------------------------------------------
\235\ See supra note 73.
---------------------------------------------------------------------------
Dr. Theodore M. Prociv, former Deputy Assistant to the
Secretary of Defense for Chemical and Biological Weapons told
the U.S. Senate Committee on Banking, Housing and Urban Affairs
that each of the nearly 14,000 M8A1 detector alarms deployed in
the theater went off an average of two or three times a
day.\236\ Given the noise the alarms must have made, most
veterans had at least some reason to believe they were in a
toxic environment.
---------------------------------------------------------------------------
\236\ See supra note 2, p. 16.
---------------------------------------------------------------------------
For others, the clues were more numerous and specific.
Major Randy Lee Hebert of the Marine Corps believes he was
exposed to chemical agents on February 24, 1991, or Ground
Attack Day, based on what he heard, was told, and felt. Shortly
after directing his vehicle to Lane Red One following a
chemical alarm, Major Hebert, who was not wearing protective
gear, was told a chemical mine had soiled the lane.
I learned after the war that the chemical mine
detonated in Lane Red One was confirmed for the nerve
agent Sarin and also for the agent Lewisite Must Gas by
FOX vehicle in the lane. I also learned that two
Marines in an AMTRAC received chemical burns, and that
the chemical mine confirmation was reported by the
regimental commander of the Sixth Marines.\237\
---------------------------------------------------------------------------
\237\ Testimony of Randy Hebert, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 107.
Major Hebert recalls he ``felt funny'' at the time. His
health problems started less than 3 weeks later, and by the
fall of 1994, he had experienced an array of symptoms,
including throat muscle constriction, lumps, rashes, and
atrophy in his right arm and hand. As noted in the Background
section of report, he has since been diagnosed with amyotrophic
lateral sclerosis [ALS], or Lou Gehrig's disease, which he
attributes to long-term chemical exposure.\238\
---------------------------------------------------------------------------
\238\ Ibid.
---------------------------------------------------------------------------
For veterans such as Sgt. Steven Wood, the awareness of a
toxic presence was triggered by a visual clue.
While part of a convoy leaving Kuwait and heading
back into Iraq, my driver and I stumbled across . . .
an artillery round that was roped off with yellow
engineer tape . . . Upon closer examination I saw it
was a sort of greenish-blue in color, with green and
yellow painted bands . . . Later that same day . . . I
now had time to look in my manuals for the markings I
had seen earlier on the shell. I was shocked to see it
was a perfect match for a Soviet nerve agent.\239\
---------------------------------------------------------------------------
\239\ Testimony of Steven Wood, Human Resources Subcommittee
hearings, No. 2, p. 45.
Still others have noted signs that were more overt. Many
veterans sensed the approximately 700 oil well fires the Iraqis
set throughout Kuwait \240\ had contaminated the air and water,
as well as veterans' bodies. Subcommittee witnesses commented
that the oil seemed to get into their lungs and skin, making
them smell of, discharge, and taste kerosene at every
turn.\241\
---------------------------------------------------------------------------
\240\ See supra note 111.
\241\ See supra notes 115-121.
---------------------------------------------------------------------------
However, the most compelling testimony comes from chemical
detection experts Army Major Michael Johnson and Marine Gy/Sgt.
George Grass. Johnson said his unit confirmed the presence of
H-Agent Mustard using the sophisticated FOX Reconnaissance
Vehicles, and that their results were supported by additional
CAM tests. At the same hearing, Gy/Sgt. Grass reported
registering positive readings for not one but three chemical
agents: S-Mustard, HT-Mustard, and Benzine Bromide. Grass added
any doubt he may have had as to the accuracy of the readings
was eradicated when he noticed the international symbol for
poison--the skull and crossbones--emblazoned on yellow tape,
boxes of ammunition, and posted signs.\242\
---------------------------------------------------------------------------
\242\ Testimony of George Grass, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, pp. 2-4,
6-9.
---------------------------------------------------------------------------
Dr. Jonathan Tucker, director of the chemical and
biological weapons nonproliferation project at the Monterey
Institute of International Studies, concluded based on his
research:
The sheer number and detail of [declassified military
intelligence] reports suggests that Iraqi chemical
weapons were indeed present in Kuwait before the Gulf
War. The CIA, for its part, claims that Iraq . . .
withdrew them before the start of the air war in
January 1991. Yet it is not logical that Iraq would
renounce a potent weapon in the face of a major ground
invasion, and then tie up its logistics moving
thousands of chemical munitions out of Kuwait. No
evidence in the public domain indicates that such a
withdrawal took place. On the contrary, according to
Charles Duelfer, Deputy Chairman of the UN Special
Commission, Iraq transported more than 2,000 rockets
filled with nerve gas from the production plant at Al
Muthanna in central Iraq to the bunker complex at
Khamisiyah during the second week of January 1991.\243\
---------------------------------------------------------------------------
\243\ Testimony of Jonathan Tucker, Human Resources Subcommittee
hearings, No. 2, p. 262.
Dr. Tucker's conclusion that toxic agents--and specifically
chemical warfare agents--were indeed present in the Gulf War
theater echoes those of French and Czech detection experts and
James Tuite, director of the Gulf War Research Foundation and a
former Senate staffer in charge of investigating Gulf War
illnesses. However, the detection teams and Tuite take the
debate even further.
According to the foreign specialists, chemical warfare
agents were not just present in the Gulf, but were released
into the atmosphere where Coalition forces could have been
exposed to them. The New York Times reported that French and
Czech detection specialists, who are considered the best in the
world, have been saying since 1991:
. . . that nerve gas detected in the early days of
the war had been released from Iraqi chemical plants
bombed by United States forces.\244\
---------------------------------------------------------------------------
\244\ See supra note 49.
Meanwhile, Tuite uses satellite images to show chemical
warfare agents were not simply emitted into the air, but were
emitted in the direction of Coalition troops. Tuite presented
the subcommittee with pictures taken by the National Oceanic
and Atmospheric Administration [NOAA] before and after the
January 19, 1991 bombing. The images were recorded on AVHRR
channels 1 and 2, which measure visible activity, and channel
4, which measures thermal and infrared activity, and show both
the direction and nature of a thermal and visible plume.
---------------------------------------------------------------------------
According to his analysis:
The images directly contradict several DOD and CIA
positions about the direction the fallout moved and the
stated position that U.S. forces were not exposed to
chemical warfare agents `in any widespread way.' \245\
---------------------------------------------------------------------------
\245\ Report on the Fallout From the Destruction of Iraqi Chemical
Warfare Agent Research, Production, and Storage Facilities into Areas
Occupied by U.S. Military Personnel During the 1991 Persian Gulf War,
James J. Tuite III, Gulf War Research Foundation (September 19, 1996)
Human Resources and Intergovernmental Relations Subcommittee hearings,
Nos. 5-6, p. 63.
After years of denial, the Pentagon finally acknowledged
there were some exposures in the wake of the war. On July 24,
1997, DOD, in conjunction with the CIA, confirmed 98,900 United
States servicemen and women were ``presumed exposed'' to some
level of chemical warfare agents as a result of the detonation
and destruction of Iraqi ammunition bunkers at Khamisiyah.\246\
---------------------------------------------------------------------------
\246\ Modeling the Chemical Weapons Agent Release, U.S. Central
Intelligence Agency [CIA], Persian Gulf War Illness Taskforce (July 24,
1997).
---------------------------------------------------------------------------
In its Report on Intelligence Related to Gulf War
Illnesses, the CIA's Office of Weapons, Technology and
Proliferation confirmed:
Nerve agent was released as a result of inadvertent
United States postwar demolition of chemical rockets at
a bunker and probably at a pit area at the Khamisiyah
Ammunition Storage Area in Iraq.\247\
---------------------------------------------------------------------------
\247\ Report on Intelligence Related to Gulf War Illnesses, CIA,
Human Resources and Intergovernmental Relations Subcommittee hearings,
Nos. 1-4, p. 390.
The CIA based this conclusion on a comprehensive review of
intelligence documents that suggested Khamisiyah had been used
as a chemical weapons depot, as well as evidence collected by
the United Nations Special Commission [UNSCOM] during a May
1996 inspection. The retrieved items included: remnants of 122-
mm rockets believed to have contained a combination of Sarin
and GF at Bunker 73; several hundred mostly intact 122-mm
rockets containing nerve agent detected with ``Chemical Agent
Monitor [CAM] at a pit area about 1 km south of the main
storage area; and over 6,000 intact 155-mm rounds containing
mustard agent in an open area several kilometers west of
Khamisiyah.\248\
---------------------------------------------------------------------------
\248\ Ibid., p. 391.
---------------------------------------------------------------------------
The Pentagon had initially estimated only 400 soldiers
would be affected, but it revisited that estimate after the
release of computer models showing the nerve gas cloud traveled
southward, covering parts of southern Iraq, Kuwait, and
northern Saudi Arabia where approximately 98,900 United States
troops were stationed.\249\ Officer Kapplan was one of those
troops and remembers the change in the air:
---------------------------------------------------------------------------
\249\ See supra note 45.
We had the smoke coming from the left, smoke coming
from the right from the oil fires and we were downwind
of the chemical munitions being blown up, approximately
30 to 40 kilometers downwind of this operation.\250\
---------------------------------------------------------------------------
\250\ Testimony of Barry Kapplan, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 327.
While the Pentagon has only officially admitted the
existence of presumed exposures during the detonation at
Khamisiyah, Dr. Bernard Rostker, Special Assistant for Persian
Gulf War Illnesses at DOD, concedes additional incidents
---------------------------------------------------------------------------
involving chemical agents and other toxins cannot be ruled out.
There is a whole range of potential chemical
exposures, plus some cross-cutting papers that we're
producing on FOX vehicles and other things that cut
across.\251\
---------------------------------------------------------------------------
\251\ Testimony of Bernard Rostker, Human Resources Subcommittee
hearings, No. 2, p. 252.
For instance, Dr. Tucker believes chemical agents were not
released solely as a result of United States bombing of Iraqi
ammunitions bunkers, but may also have been actively deployed
---------------------------------------------------------------------------
on occasion.
The declassified operations logs corroborate numerous
veteran reports of detecting low levels of chemical
warfare agents during the ground war, including Sarin,
lewisite and Mustard Gas. Many of these detections were
made with analytical methods that are highly reliable
and have a low false alarm rate. Thus, while adverse
weather conditions and the speed of the coalition
advance precluded the large scale use of Iraqi chemical
weapons, there is strong evidence for sporadic,
uncoordinated use.\252\
---------------------------------------------------------------------------
\252\ See supra note 244.
As for positive confirmation for the presence of other
---------------------------------------------------------------------------
toxins, there is no shortage of evidence:
According to GAO, the CIA has determined
Iraq possessed several biological weapons agents at the
time of the war, including anthrax, botulism, and
aflatoxin.\253\
---------------------------------------------------------------------------
\253\ See supra note 88.
---------------------------------------------------------------------------
Dr. Garth Nicolson stated undiagnosed
veterans have tested positive for the presence of the
microorganism Mycoplasma fermentans which can cause
dangerous infection.\254\
---------------------------------------------------------------------------
\254\ Testimony of Garth Nicolson, Human Resources Subcommittee
hearing of June 26, 1997 (original transcript, p. 149, in subcommittee
files).
---------------------------------------------------------------------------
Depleted uranium [DU] was heavily used by
DOD as both a means of destroying enemy tanks and
protecting our own.
The Defense Science Board confirmed Iraqis
set more than 700 oil well fires in Kuwait, which may
cause illness through petroleum inhalation, ingestion,
and skin absorption.\255\
---------------------------------------------------------------------------
\255\ See supra note 111.
---------------------------------------------------------------------------
Fear of poisoning from the chemical agent
soman drove the military to obtain a waiver from FDA
allowing them to order immunizations using experimental
drugs and vaccines \256\ which may become toxic when
used under certain conditions.
---------------------------------------------------------------------------
\256\ See supra note 130 and accompanying Background text.
---------------------------------------------------------------------------
Finally, the insect-ridden environment in
the Gulf caused veterans to become dependent on
pesticides and Government-issued insect repellents of
dangerous concentrations.\257\
---------------------------------------------------------------------------
\257\ Testimony of Robert Haley, Human Resources Subcommittee
hearings, No. 1, pp. 238-239.
By all accounts--official, scientific, and first-hand--the
Gulf War theater was not just a warzone; it was a cesspool of
toxic substances. While the direct scientific proof linking
toxic exposures in the Gulf to the onset and exacerbation of
what has collectively come to be known as ``Gulf War Illness''
has yet to be indisputably established, all of the pieces are
there. What makes the presence of toxins in the Gulf relevant
and a causal link most likely is the timing, nature, and scope
of the undiagnosed illnesses that ensued are consistent with
the known effects of similar exposures in other settings.
Veterans complaining of so-called ``Gulf War Illness''
noticed their symptoms following incidents of presumed
exposure, which is consistent with a causal relationship to
their experiences in the Gulf. The onset of the symptoms was
immediate in some cases, and delayed in others, but they were
always subsequent to their Gulf War service. Had any of the
servicemen and women been ill before the war, it is highly
unlikely that he or she would have been deployed to the region.
In fact, Dr. Gordan, who has treated more than 500 veterans,
says nearly all of them reported ``very good to perfect''
health before deployment, versus ``poor to fair'' health
afterward.\258\
---------------------------------------------------------------------------
\258\ See supra note 160.
---------------------------------------------------------------------------
To the extent to which they are able to ascertain,
scientists have confirmed that the nature of the symptoms
associated with ``Gulf War Illness'' is also consistent with
presumed exposures during the war. Put conversely, neither the
VA nor DOD has found evidence that these undiagnosed symptoms
were not caused by one or several of the toxins that were
present in the theater. The only argument against a causal link
is the fact that while many veterans are sick with undiagnosed
illnesses, most are not. However, as Dr. Kenneth Olden,
director of the National Institute of Environmental Health
Sciences, explained:
We've known for a long time that when several hundred
people are exposed to the same environmental toxicants,
some people get sick and others don't.\259\
---------------------------------------------------------------------------
\259\ See supra note 170.
Olden and other Federal researchers are now pursuing
research that would suggest the answer lies in the genes that
control human susceptibility to toxic chemicals and other
poisons.
Finally, the scope of so-called ``Gulf War Illness'' is
also consistent with a causal relationship. Some veterans have
seen members of their immediate and extended families become
ill, either upon coming into contact with them or articles they
sent back from the Gulf War theater. As previously noted in the
Background section, Major Barry Kapplan's wife Nancy told the
subcommittee she and her four children handled her husband's
wet and stained clothing, army gear and war souvenirs, only to
experience continual chronic infections, with one child
becoming very ill.\260\
---------------------------------------------------------------------------
\260\ Testimony of Nancy Kapplan, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 335-
337, 343.
---------------------------------------------------------------------------
According to Dr. Claudia Miller, Assistant Professor of
Environmental and Occupational Medicine at the University of
Texas Health Science Center, the experience of the Kapplan
family is consistent with those of many agricultural workers
who come into contact with clothing that has been saturated
with organophos-phates--the same kind of compounds which were
present in many pesticides and insect repellents used in the
Gulf. So far, the clothing and equipment have tested negative
for organophosphates, but as Dr. Miller notes:
They may degrade after a period of time and it has
been 5 years since the war, so I think there are so
many uncertainties.\261\
---------------------------------------------------------------------------
\261\ Testimony of Claudia Miller, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 532.
A second example may be seen in the unusually high number
of cases of ALS among Gulf War veterans. While DOD's Dr.
Rostker says the nine confirmed cases of ALS are what
scientists would expect to find given the population of Gulf
War veterans,\262\ Dr. Robert Brown notes that analysis does
not take account the relatively young age of veterans. Given
the fact that the average age for ALS onset is 55, Dr. Brown
says the number of ALS cases among Gulf War veterans, who are
typically between 18 and 40 years old, would appear
``excessive.'' \263\
---------------------------------------------------------------------------
\262\ See supra note 33.
\263\ See supra note 34.
---------------------------------------------------------------------------
A new study by Dr. Will Longstreth at the University of
Washington School of Medicine in Seattle once again suggests a
causal link between ALS and the presence of toxic agents.
According to the study, exposure to agricultural chemicals--
including pesticides--may increase men's chances of developing
the degenerative disease. Researchers say men whose histories
showed high exposures to these chemicals are at 2.8 times more
risk than those who were never exposed.\264\
---------------------------------------------------------------------------
\264\ Reuters, ``Gehrig's Disease Tied to Chemicals'' (June 24,
1997).
---------------------------------------------------------------------------
The existence of a variety of toxic agents in the Gulf is
well-established, and confirmed by a host of witnesses,
documents, and facts. While the research has yet to cement the
link between toxic exposures and delayed, chronic illnesses,
the timing, nature, and frequency of undiagnosed illnesses
among Gulf War veterans strongly suggest such a link does exist
and will, given the appropriate interest, funding and support,
be confirmed.
Finding 3: Gulf War troops were not trained to protect themselves from
the effects of exposure to depleted uranium dust and particles.
Depleted uranium [DU] maintained a pervasive presence in
the Gulf War theater. In the form of armor-piercing penetrator
rounds, DU, upon reaching enemy targets, ignites and becomes a
toxic agent that could poison anyone who came into contact with
it, including U.S. troops. The threat might have been minimized
had Gulf War servicemen and women been trained to protect
themselves against such exposure, but as numerous veterans,
Defense and GAO employees have attested, the military
establishment did not prepare troops for the dangers they would
encounter or the risks they would incur.
DU penetrator rounds are credited with destroying more than
1,400 Iraqi tanks, in addition to other equipment and weapons
storage facilities during the Persian Gulf War.\265\
---------------------------------------------------------------------------
\265\ See supra note 97.
---------------------------------------------------------------------------
Veteran Michael Stacy's eyewitness testimony confirms the
military depended on DU as a preferred weapon of war, and used
it to destroy everything from tanks to light-armored vehicles
to bunkers.
We wanted to shoot the good stuff and as much as
possible. We were at war, with the best equipment out
of all the Coalition Forces--no law, no rules, engage
at will . . . As you can well expect, we were
constantly in contact with this ammo.\266\
---------------------------------------------------------------------------
\266\ Testimony of Michael Stacy, Human Resources Subcommittee
hearing of June 26, 1997, original transcript, p. 53-54 (in
subcommittee files).
When a DU round hits a hard target such as a tank, most of
it burns up, spraying uranium shrapnel and pulverized uranium
dust into the air, where it may be transported up to 25 miles
by high winds.\267\
---------------------------------------------------------------------------
\267\ See supra note 106.
---------------------------------------------------------------------------
According to Leonard Dietz, a retired General Electric
physicist and DU expert, at least 300 tons of DU munitions were
fired over a period of 4 days of ground fighting. He says that
if only 2 percent of the uranium became aerosolized upon
impacting the tanks, it would generate at least 6 tons of
depleted uranium aerosol particles.
This is a huge amount, much of which would have
become airborne over the battlefields. This amount in 4
days is more than 10,000 times greater than the maximum
airborne emissions of depleted uranium allowed in the
air over Albany in 1 month.\268\
---------------------------------------------------------------------------
\268\ Testimony of Leonard Dietz, Human Resources Subcommittee
hearing of June 26, 1997, original transcript, p. 125 (in subcommittee
files).
Another large emission of DU resulted when a United States
Army ammunition depot and motor pool exploded in Doha, Kuwait
in July 1991, oxidizing some 9,000 pounds of DU rounds and
vehicle armor to powder.\269\
---------------------------------------------------------------------------
\269\ See supra note 99.
---------------------------------------------------------------------------
When oxidized particles are ingested or absorbed through
the skin via contact with burned out tankers or the uniforms of
wounded soldiers, DU can present a serious health hazard. To
explain its high toxicity, Dietz referred the subcommittee to
the Handbook of Chemistry and Physics:
Chronic exposure to small concentrations of uranium
is known to cause kidney failure. Depleted uranium is
more than 99 percent Uranium-238, just a single
isotope, which is always accompanied by two decay
daughters that emit penetrating particles and gamma
rays.\270\
---------------------------------------------------------------------------
\270\ See supra note 268, pp. 125-126.
Mounting scientific and circumstantial evidence suggests
veterans were not just surrounded by DU, but were in fact
exposed to it. This has long been the contention of veterans
such as Michael Stacy, who found himself in ``more than one
friendly fire incident'' involving tanks with DU armor.\271\ On
June 26, 1997 Bernard Rostker of DOD confirmed 29 combat
vehicles were contaminated in this manner, with possible
additional exposures resulting from the Doha ammunition dump
explosion.\272\ Out of the 33 veterans who were in Army
vehicles struck by DU rounds and are now being evaluated, 16
have DU shrapnel in their bodies.
---------------------------------------------------------------------------
\271\ See supra 266, p. 46.
\272\ Testimony of Bernard Rostker, Human Resources Subcommittee
hearing of June 26, 1997, original transcript, p. 184-185, (in
subcommittee files).
The Health Surveillance Program has shown that those
who have retained shrapnel identified radioactively are
excreting increased amounts of uranium, indicating that
the metal particles are not entirely inert.\273\
---------------------------------------------------------------------------
\273\ Ibid., p. 85.
Unaware of the toxic dangers they faced from DU exposure,
U.S. troops did not know that they needed to take special
precautions to protect themselves, nor what those precautions
might entail.\274\ As a result, many veterans such as Paul
Canterbury did not bother putting on MOPP gear when they were
in and around burned-out tanks and other contaminated
areas,\275\ while some even slept on the tanks' blowout panels,
exposing themselves to DU toxins over extended periods of
time.\276\
---------------------------------------------------------------------------
\274\ See supra note 266, p. 46.
\275\ Testimony of Paul Canterbury, Human Resources Subcommittee
hearing of June 26, 1997, original transcript, p. 29 (in subcommittee
files).
\276\ See supra note 266, p. 46.
---------------------------------------------------------------------------
After the ammunition fire in Doha where approximately 3,500
troops were based, some servicemen reported cleaning up the
site using nothing but brooms and their bare hands. According
to Dietz:
This is something that would make a qualified,
radiological worker shudder.\277\
---------------------------------------------------------------------------
\277\ See supra note 268, p. 128.
Considering all the information Pentagon had available at
the time, there is no reason U.S. servicemen should have been
allowed to engage in such high-risk behavior. Veteran Michael
Stacy says the Army had documented the hazards more than a year
---------------------------------------------------------------------------
before the war.
In a report from the U.S. Army Ballistics Research
Lab, dated December 1989, test results showed that
soldiers who came into contact with contaminated
vehicles could inhale resuspended, depleted uranium
dust or ingest depleted uranium via food intake,
cigarette smoking, et cetera prior to not washing hands
and face.\278\
---------------------------------------------------------------------------
\278\ See supra note 266, pp. 45-46.
In a July 1997 conversation with subcommittee staff,
Rostker stated DOD had not properly prepared Gulf troops for
the DU dangers they would encounter--the same conclusion GAO
reached in 1993.\279\ Rostker said the Pentagon was working on
producing newer, universal masks as well as taking other steps
to prevent future troops from facing a similar fate.\280\
---------------------------------------------------------------------------
\279\ See supra note 110.
\280\ Bernard Rostker also told the subcommittee that DU has been
the target of an Iranian-run disinformation campaign because of its
high effectiveness. He says United States intelligence agencies have
intercepted diplomatic traffic in and from Iraq. Iraqi embassies were
reportedly told to downplay the health hazards associated with low-
level chemical exposure and play up the notion of DU as the more severe
toxin. See supra note 272, pp. 189, 226.
---------------------------------------------------------------------------
As noted in the ``Background'' section of this report, Dr.
Michio Kaku believes history will show Gulf War illnesses to be
the result of a variety of factors, but DU will bear ``a large
portion of the blame.'' \281\ The post-war experiences of
veterans who were among the most at-risk of DU exposure suggest
the same conclusion. Canterbury has been diagnosed with
hypertropia, large vertical muscle imbalance, and esophoria,
while Stacy suffers from multiple undiagnosed illnesses
including respiratory problems, sinus problems, and severe
memory loss.\282\
---------------------------------------------------------------------------
\281\ See supra note 108.
\282\ See supra note 266, p. 47.
---------------------------------------------------------------------------
Finding 4: Pyridostigmine bromide [PB] can have serious side effects
and interactions when taken in combination with other drugs,
vaccines, chemical exposures, heat and/or physical exercise.
Pyridostigmine bromide [PB] pills were distributed to and
ingested by U.S. personnel under the threat of court-
martial,\283\ as a means of protecting them against the nerve
agent soman.
---------------------------------------------------------------------------
\283\ Testimony of Steven Wood, Human Resources Subcommittee
hearings, No. 2, p. 55.
---------------------------------------------------------------------------
According to Dr. Stephanie Padilla, who works at the
Neurotoxicology Division of the U.S. Environmental Protection
Agency [EPA], PB produces some of the same reactions as the
very nerve agent it is intended to protect against, making it
difficult to determine its effectiveness:
It is my understanding that pyridostigmine, the idea
is to mask the effects of the nerve agent, but also
they would produce some of the same effects that the
nerve agent would produce and so you either have an
extremely high baseline or it would mask the effect of
the nerve agent.\284\
---------------------------------------------------------------------------
\284\ Testimony of Stephanie Padilla, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 528.
Dr. Robert Haley of the University of Texas Southwestern
Medical Center points out another danger. When introduced to
the human body after exposure to a neurotoxin such as soman has
taken place, PB can trigger a side effect from an otherwise
---------------------------------------------------------------------------
safe agent:
Research published since the war has shown that
giving a protective drug after the exposure can
paradoxically promote brain damage from even a low dose
of a neurotoxic chemical that might not have caused a
problem otherwise.\285\
---------------------------------------------------------------------------
\285\ Statement of Robert Haley, Human Resources Subcommittee
hearings, No. 1, p. 252.
According to Dr. Thomas Tiedt, PB inhibits a critical
enzyme, acetylcholinesterase [AchE] which can result in nerve
and muscle degeneration within moments of a single dose, which
may intensify with further doses.\286\ What's more, Tiedt says
the onset of stress makes the blood/brain barrier susceptible
to PB leakage, increasing its ability to cause damage to the
central nervous system. Tiedt cites two examples to support his
assertion: the advent of behavioral changes in veterans within
weeks of ending PB treatment, and the objective signs of nerve
damage in veterans who took the drug.
---------------------------------------------------------------------------
\286\ See supra note 130.
---------------------------------------------------------------------------
Dr. Satu Somani expands Tiedt's conclusion about the mental
or psychological rigors of war to incorporate the physical
aspects of the Gulf, such as heat and exercise, saying:
The adverse effects [of PB] were amplified by
physical stress.\287\
---------------------------------------------------------------------------
\287\ See supra note 136.
Perhaps most disturbing is the revelation that the risks
were well-known before the drug was issued. Dr. Tiedt says the
DOD was aware that the pills were dangerous because the
Department's own research had documented the risks at the time
---------------------------------------------------------------------------
of the war.
The scientific evidence shows that Gulf War Syndrome
was easily predictable . . . DOD established by the
early 1980's that PB causes persisting
`counterproductive consequences . . .' DOD research
also found that at sublethal dosage PB is more
dangerous and more toxic than Sarin nerve gas.\288\
---------------------------------------------------------------------------
\288\ Testimony of Thomas Tiedt, Human Resources Subcommittee
hearings, No. 2, p. 298.
Dr. Myra Shayevitz, an environmental physician at the
Veterans Administration Medical Center [VAMC] in Northhampton,
MA, agrees that risks had already been established, and points
to one of the DOD's own documents as proof. According to her
---------------------------------------------------------------------------
testimony,
The Army Institute of Chemical Defense in their
Doctrine of Use recognized the potential toxicity of
this compound, stating that `If a dose is missed, under
no circumstances should one take two tablets as a make-
up dose.' \289\
---------------------------------------------------------------------------
\289\ Report submitted for the record, ``A Biopsychosocial
Therapeutic Approach for the Treatment of Multiple Chemical Sensitivity
Syndrome in Veterans of Desert Storm: Treatment Protocol,'' Dr. Myra
Shayevitz, May 5, 1995, Human Resources Subcommittee hearings, No. 1,
p. 16.
Nevertheless, U.S. troops were still ordered to take the
pills, and many experts say DOD should have expected a number
of servicemen and women to fall ill. Some scientists have tried
to attribute the sickness to a reaction to the stresses of war,
ignoring the intake of PB, but Dr. Miller says some veterans
started feeling ill in August--before the advent of the war,
but after taking PB.\290\
---------------------------------------------------------------------------
\290\ Testimony of Stephanie Miller, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 531.
---------------------------------------------------------------------------
Furthermore, veterans didn't even have to make it into the
Gulf region to feel the effects. As noted in the Background
section, James B. Green became sick without ever setting foot
in the theater. Green was given shots and a series of PB pills
while he was stationed in Germany, in preparation for going to
the Gulf, but another group was assigned to that post instead
and he was sent home. Before going into the service, Mr. Green
was in excellent health--but that changed when he started
taking PB pills and his life has never been the same.
After receiving the shots and the PB pills, I
suffered many symptoms . . . I am scared to go to the
VA hospital for treatment. The government thought it
was okay to give us poison once. Why wouldn't they do
it again? I am referring to the shots and the PB pills.
That is what I believe is making me sick with this
illness . . . This disease is obviously not stress
related, as they would like us to believe. I am a
perfect example. My jobs weren't stress related, and I
am experiencing the same symptoms as others. My theory
rests on the inoculations and the PB pills. As
everybody knows, the French troops were not given the
experimental pills, and not many of them are sick.\291\
---------------------------------------------------------------------------
\291\ Testimony of James Green, Human Resources Subcommittee
hearings, No. 1, p. 303-304.
Unfortunately the uncontrolled manner in which the drug was
distributed, and poor records thereof, make it extremely
difficult to draw any conclusions about PB and undiagnosed
illnesses. Veterans have testified DOD did nothing to protect
against over-medication. Rather, they were simply ordered to
take the pills with little or no supervision other than to make
sure the pills were swallowed. Dr. Myra Shayevitz says some
veterans ingested more than 30 tablets.\292\ This reported lack
of oversight is consistent with Staff Sgt. Wood's experience.
---------------------------------------------------------------------------
\292\ See supra note 289.
The full dosage was given--enough for 2 weeks, I do
believe. Each soldier had their own in a blister pack .
. . It's highly possible that someone that was scared
could have taken more . . . They did not check on
it.\293\
---------------------------------------------------------------------------
\293\ See supra note 283, p. 76.
Testimony from scientists indicated the military had funded
and conducted research which concluded that PB, combined with
other similar compounds and/or physical stress, could produce
long term health consequences, including nerve damage. The idea
that DOD would proceed to administer PB in light of this
research is disturbing, made more so by the fact that DOD
administered the drug without providing the written information
on PB the FDA required be provided to the troops. In light of
these facts, the subcommittee believes DOD and VA should
consider potential health effects of PB far more seriously.
Finding 5: VA and DOD health registry diagnosis protocols rely on the
unfounded conclusion there were no chemical, biological or
other toxic exposures to U.S. troops in the Gulf War theater.
For years, the DOD and CIA falsely or mistakenly maintained
U.S. troops were not subject to any chemical, biological or
other toxic exposures during their tour in the Gulf War
theater. Rather than starting with a blank slate and an open
mind, health officials at VA and DOD then used this
misinformation to shape health registry diagnosis protocols,
perpetuating the myth.
While military and intelligence officials would eventually
concede there was a potential for toxic exposures from the
detonations at Khamisiyah, they spent several years denying the
existence of such a possibility. According to DOD's Bernard
Rostker, the CIA made that argument as late as September 1996.
The CIA reports said that the analysis and computer
models indicate chemical agents released by aerial
bombing of chemical warfare facilities did not reach
United States troops in Saudi Arabia.\294\
---------------------------------------------------------------------------
\294\ See supra note 272, p. 182.
Trained to look for irrefutable proof as opposed to the
mere possibility of exposures, field commanders had apparently
not given any credence to the sounding of 14,000 M8A1 alarms.
According to the December 3, 1996 edition of the New York
---------------------------------------------------------------------------
Times:
General Powell, the Chairman of the Joint Chiefs of
Staff at the time in 1991, said in an interview that
while chemical detection alarms had sounded repeatedly
during the war, American commanders in the Gulf had
been unable to confirm the detections and had believed
them to be false alarms.\295\
---------------------------------------------------------------------------
\295\ Statement of Representative Bernard Sanders (I-VT) quoting
the New York Times of December 3, 1996, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 135.
Despite mounting testimonials and other evidence suggesting
the alarms were not false but indicative of actual toxic
exposures, VA and DOD health registry officials did not include
specific questions about chemical warfare and toxic exposures
in its Persian Gulf Registry Code Sheet until late 1995.\296\
Even after DOD and the CIA conceded exposures were likely
during the detonation at Khamisiyah, VA Secretary Jesse Brown
saw no reason to change protocols, saying the VA had ``always
accepted the possibility'' of exposures and therefore had no
need to change its diagnosis, treatment or compensation
policies in the absence of a definitive diagnostic test and
specific treatments.\297\
---------------------------------------------------------------------------
\296\ Supra note 227.
\297\ See supra text of Secretary Brown's letter in Background
section entitled, ``Exposures and VA Medical Protocols for Gulf
Veterans.''
---------------------------------------------------------------------------
However, passively accepting a possibility is not the same
as actively pursuing it. Nowhere is this distinction more
evident than in the testimony of Dr. Susan Mather. As noted in
the Background section, in December 1996, Dr. Mather testified
that questions about veterans' interaction with the physical
environment of the Gulf were not revised until ``this past
year,'' \298\ 5 years after the war had ended.
---------------------------------------------------------------------------
\298\ See supra note 170, p. 246.
---------------------------------------------------------------------------
Faced with conflicting evidence, VA and DOD health registry
officials chose to put more faith and stock in military and
intelligence officials, who assured them there was no toxic
exposure, than in numerous veterans who expressed concerns that
they had been poisoned as a result of their service. Had VA and
DOD health registry officials listened to the 93 percent of
veterans who reported exposure to toxic contaminants \299\ and
aggressively pursued it as a legitimate hypothesis back in
1992, science--and many veterans--would be 5 years ahead of
where they are now.
---------------------------------------------------------------------------
\299\ See supra note 227.
---------------------------------------------------------------------------
Finding 6: VA and DOD health registry diagnosis protocols rely on the
unwarranted conclusion that, unless there is an immediate and
acute reaction, exposures to chemical weapons and other toxins
do not cause delayed or chronic symptoms.
VA and DOD health registry diagnosis protocols wrongly
assumed that in the absence of an immediate and acute reaction
to a toxic exposure, such an exposure will not cause delayed or
chronic symptoms. Given the notable lack of data on the
subject, there is no way to know that this is true.
Nevertheless, officials in charge of the diagnosis protocols
refused to give veterans the benefit of the doubt, saying they
required incontrovertible proof that toxins can cause delayed
or chronic symptoms without an immediate and acute reaction,
while lifting the burden of proof on researchers who were
unable to demonstrate the opposite.
VA Secretary Jesse Brown planted his feet squarely in the
camp of officials who made this choice. While conventional
wisdom says absence of proof is not proof of absence, Secretary
Brown would not yield to subcommittee requests to consider the
opposing position. In fact, in a December 10 letter to the
subcommittee, Brown displayed an active reluctance to open the
subject up for discussion again:
In VA's view, the published literature, while
limited, does not demonstrate the development of
readily identifiable, long-term adverse health effects
due to nerve agent exposures in human subjects who have
not shown signs of acute toxicity or poisoning . . .
Because there are so few studies on this question, we
believe that additional research is needed to determine
whether exposure to low-levels of chemical warfare
nerve agents can cause long-term health effects,
including chronic or delayed onset of a characteristic
set of symptoms, signs or medical conditions.\300\
---------------------------------------------------------------------------
\300\ Attachment to chairman's opening statement, Human Resources
and Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 11.
Secretary Brown and others who share his opinion have asked
veterans and veterans' advocates to establish something which,
by virtue of its terms, is inherently vague and therefore
difficult to prove. Scientists do not seem to have agreed upon
what comprises an ``immediate and acute'' reaction. Many
veterans have reported a variety of symptoms that, under normal
conditions, would probably qualify as immediate and acute but
were dismissed as a circumstantial by-product of the harsh Gulf
environment. These include but are not limited to: chest and
joint pains, chronic coughing, memory loss, rashes, the
appearance of pustules, muscle atrophy, nausea, diarrhea,
vomiting and bloody stools, among others.
As has already been noted, PB is capable of masking the
symptoms of chemical nerve agent intoxication.\301\ As a
result, veterans may have experienced immediate and acute
reactions and not known it.
---------------------------------------------------------------------------
\301\ See supra note 284.
---------------------------------------------------------------------------
Another reason military officials may have been blind to
the possibility that toxic exposures, which do not produce an
immediate and acute reaction, may still engender delayed or
chronic illness is that it makes their work easier. According
to the former senior policy analyst on the staff of the
Presidential Advisory Commission, Dr. Jonathan Tucker, the
pressures of war and the need for maximum mobility encourage
military personnel to underestimate the threat of toxicity as a
way of avoiding having to wear the constricting and bulky MOPP
4 protective gear.
The goal of chemical defense doctrine has been to
minimize the impact of an enemy's use of chemical
weapons on the tempo and effectiveness of U.S. military
operations, and they have done this by setting up the
so-called MOPP scale--mission oriented protective
posture . . . The idea is to calibrate the level of
protection to the assessed chemical threat, because
when people are in MOPP-4, the full ensemble, they are
almost incapacitated . . . To deal with this problem,
the Army has sought to minimize the level of protection
that troops wear in combat and calibrate it to the
assessed level of threat. As a result of this, there
has been a kind of all-or-nothing mindset that has
viewed chemical weapons exposures as either severe, if
they produce acute effects if they're sub-acute,
they're just discounted, they're viewed as harmless . .
. I believe that, later on, after the war, when large
numbers of troops began getting sick, the same
commanders who wished to avoid accountability for
serious errors of judgment, such as blowing up many
bunkers that may have contained chemical weapons, just
refused to acknowledge the problem, hoping it would
simply go away.\302\
---------------------------------------------------------------------------
\302\ Testimony of Jonathan Tucker, Human Resources Subcommittee
hearings, No. 2, p. 349.
Health registry diagnosis protocols wrongly assumed that
toxic exposures which did not produce immediate and acute
reactions would not generate delayed and chronic symptoms.
However, there is no logical reason to believe this should be
the case, only explanations for why registry officials believed
it to be true. While scientists have yet to prove that these
exposures could incite delayed and chronic effects, no one has
proved they could not. Moreover, that assumption is refuted by
the experiences of many people with common environmental toxins
such as asbestos and lead. Consistent exposure in small
quantities may not be enough to spark a sharp reaction in the
average person, but exposure over time may damage internal
organs. Had health registry diagnosis protocols been more prone
to explore new theories and hypotheses, the medical community
might not have accepted the Pentagon's unfounded assurances
quite so easily. Nonetheless Secretary Brown and others chose
to give the military and medical establishments the benefit of
the doubt over the numerous veterans who complained of delayed
and chronic effects, again perpetuating a myth with growing
implications for future research and treatment procedures.
Finding 7: Prematurely ruling out toxic exposures as causative, VA and
DOD doctors relied on diagnoses of somatoform disorder and Post
Traumatic Stress Disorder [PTSD] to explain Gulf War veterans'
illnesses.
DOD assumed, in the absence of definitive medical evidence
in support of this position or to the contrary, that many PGW
illnesses were attributable to PTSD and stress, and they did
not consider toxic exposures. The predominant diagnosis of
patients in the DOD Comprehensive Clinical Evaluation Program
[CCEP] was psychological disorders, 18 percent, followed by:
signs, symptoms, ill-defined conditions, 18 percent;
musculoskeletal disorders, 18 percent; healthy, 10 percent;
respiratory, 7 percent; GI, 6 percent; skin, 6 percent; nervous
system, 6 percent; and other, 11 percent.\303\
---------------------------------------------------------------------------
\303\ Statement of Stephen Joseph, Human Resources and
Intergovernmental Relations Subcommittee hearings, No. 1-4, p. 223.
---------------------------------------------------------------------------
Veterans have described their painful experiences with the
VA medical system, which has disregarded their symptoms and
labeled their ailments as ``stress.'' Kimo Hollingsworth
described experiences many Persian Gulf War veterans have had
with the VA medical system. ``The VA Hospital in Washington, DC
performed a complete physical and concluded that I was in
excellent health. The VA doctor informed me that the dark green
chunks of sputum and pain in the center chest were normal in
some people. I was then directed to a social worker who
discussed the issue of Post Traumatic Stress Disorder. The VA
also provided me a brochure outlining psychological counseling
services to Persian Gulf veterans.'' \304\
---------------------------------------------------------------------------
\304\ Statement of Kimo Hollingsworth, Human Resources and
Intergovernmental Relations Subcommittee hearing, No. 1-4, p. 29.
---------------------------------------------------------------------------
Private Stacy testified about VA arbitrarily denying his
claim for Persian Gulf illnesses. ``I have a claim pending for
chronic fatigue. It has been pending for 2 years. My records
are being shuffled back and forth from Nashville, TN to
Muskogie. They believe that all of my complaints are due to
stress . . . The doctor says in my records, `I believe the
patient is exaggerating symptoms, I believe the patient has
been coached, and I believe he is here to try to get increased
disability.' '' \305\
---------------------------------------------------------------------------
\305\ See supra 266, p. 93.
---------------------------------------------------------------------------
Mr. Stacy told the subcommittee, ``I am 40 percent
disabled. I receive $467 a month. I left the Post Office after
3 years. My house payment is $500 a month. I do not even have
money to drive or put gas in my car. We are literally starving
to death. We receive no help from nobody.'' \306\
---------------------------------------------------------------------------
\306\ Ibid., p. 50.
---------------------------------------------------------------------------
Finding 8: There is no credible evidence that stress or PTSD causes the
illnesses reported by many Gulf War veterans.
Although physicians at VA and DOD are more likely to
diagnose veterans as having PTSD, the medical community has
been unable to establish a causal link between stress or PTSD
and most veterans' illnesses. There is simply no irrefutable
evidence that such a link exists. As a result, any conclusion
that so-called ``Gulf War Illnesses'' are rooted in stress or
PTSD involves an unwarranted leap of faith.
After reviewing the Government's research strategy, the GAO
did not concur with DOD's and VA's attribution of PGW illnesses
to somatoform disorders and PTSD. In its June 1997 report,
``Gulf War Illnesses: Improved Monitoring of Clinical Progress
and Reexamination of Research Emphasis are Needed,'' the GAO
concluded that:
While stress can induce physical illness, the link
between stress and these veterans' physical symptoms
has not been firmly established.\307\
---------------------------------------------------------------------------
\307\ U.S. General Accounting Office, Gulf War Illnesses: Improved
Monitoring of Clinical Progress and Reexamination of Research Emphasis
Are Needed, GAO/SNIAD-97-163, June 1997, p. 8.
---------------------------------------------------------------------------
Dr. Daniel Clauw, a rheumatologist, testified:
My personal experience is that in some cases the VA
Medical Centers are not well-versed in the treatment of
these conditions,\308\ perhaps in part because these
illnesses occur more frequently in females (and so few
women are seen within the VA system), and perhaps
because there is a cultural bias within the VA system
to quickly refer these patients to psychiatrists. If a
physician or other health care provider does not
believe that these individuals are suffering from a
real disease, they will likely be ineffective in
treating this group of patients.\309\
---------------------------------------------------------------------------
\308\ Neuro-immunological disorders such as fibromyalgia, chronic
fatigue syndrome, and multiple chemical sensitivity.
\309\ Statement of Daniel Clauw, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 188-
189.
---------------------------------------------------------------------------
He added:
Most of the experts on these types of illnesses in
this country are not in the VA or military
systems.\310\
---------------------------------------------------------------------------
\310\ Ibid., p. 189.
The sole evidence physicians have offered as proof that
stress or PTSD is the source of most Gulf War sicknesses is the
assumption that most veterans must have suffered from stress by
virtue of the stressful environment in which they found
themselves during the war. According to an article from the
---------------------------------------------------------------------------
Annals of Internal Medicine:
Poorly understood war syndromes have been associated
with armed conflicts at least since the U.S. Civil War.
Although these syndromes have been characterized by
similar symptoms . . . no single recurring illness that
is unrelated to psychological stress is apparent . . .
but one unifying factor stands out: A unique population
was intensely scrutinized after experiencing an
exceptional, life-threatening set of exposures. As a
result, research efforts to date have been unable to
conclusively show causality.\311\
---------------------------------------------------------------------------
\311\ Hyams, et al., ``War Syndromes and Their Evaluation: From the
U.S. Civil War to the Persian Gulf War,'' Annals of Internal Medicine,
September 1, 1996, Vol. 125, No. 5, p. 398.
As the article notes, while it is difficult if not
impossible to say sick veterans do not suffer from any stress
or PTSD at all, it is also unwarranted to say stress or PTSD is
the driving force that actually triggered the onset of so-
called ``Gulf War Illnesses.'' All of the evidence that has
been presented up until now suggests while they may have
contributed to veterans' being sick, stress and PTSD alone are
an insufficient explanation. According to VA Under Secretary
---------------------------------------------------------------------------
for Health Dr. Kenneth Kizer:
VA and DOD studies demonstrate that although PTSD
rates among Persian Gulf veterans who were exposed to
violence and carnage are elevated, post-traumatic
stress disorder does not explain the majority of health
problems in Persian Gulf veterans.\312\
---------------------------------------------------------------------------
\312\ Statement of Kenneth Kizer, Human Resources Subcommittee
hearings, No. 1, p. 138.
Dr. Haley agrees and uses his own research to support his
---------------------------------------------------------------------------
point.
We found no evidence that the veterans had post-
traumatic stress disorder, none, zero. We found no
evidence that combat stress, the ones that had high
levels of combat stress had the same risk of the
syndrome as those with low levels of stress.\313\
---------------------------------------------------------------------------
\313\ Testimony of Robert Haley, Human Resources Subcommittee
hearings, No. 1, pp. 241-242.
Dr. Garth Nicolson, Chief Scientific Officer with the
Institute for Molecular Medicine, concurs. He believes the
symptoms are indicative of something else--not stress or PTSD,
---------------------------------------------------------------------------
but exposure to a combination of chemical or biological agents.
We do not feel that Post-Traumatic Stress Disorder is
a major cause of the Gulf War illnesses. We think,
again, that it is combinations of chemical and
biological agents that produce these very complex signs
and symptoms. We do not see how it could be produced
any other way.\314\
---------------------------------------------------------------------------
\314\ Testimony of Garth Nicolson, Human Resources Subcommittee
hearing of June 26, 1997, original transcript, pp. 117-119, in
subcommittee files.
Unfortunately, too few tests and studies have been
completed to establish Dr. Nicolson's or anyone else's theory
as fact. It is a similar problem Dr. Murphy acknowledges with
---------------------------------------------------------------------------
regard to low-level exposures to nerve agents.
We recognize there is a gap in the scientific
knowledge. It is very hard to prove a negative. The
evidence does not exist in the scientific literature at
this time that clearly says asymptomatic exposures to
low-level nerve agents cause this recognized group of
signs and symptoms, physical findings.'' \315\
---------------------------------------------------------------------------
\315\ Testimony of Frances Murphy, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 255.
And yet despite any scientific proof that stress or PTSD
has caused, triggered, or amplified veterans' undiagnosed
illnesses, many VA and DOD physicians continue to diagnose
veterans as having PTSD--by default. While the VA and DOD have
opted to accept a lapse of evidence in this regard, they refuse
to give veterans' contentions that toxic exposures are to blame
the same courtesy. This attitude places the burden of proof
squarely on the shoulders of the veterans, a grossly unfair and
impossible task, especially given the magnitude of the job,
their ailing health, and the little power they exert over the
scope and focus of scientific research.
Finding 9: Accurate diagnosis of veterans' illnesses remains difficult
due to inadequate or missing personal medical records, missing
toxic detection logs, and unreleased classified documents.
While our military may be the most powerful, efficient, and
best equipped armed forces in the world, its management and
bookkeeping in the Gulf War were deplorable. Just a few years
after the war, personal medical records and scientific toxic
detection logs are missing, and many documents are still
classified as secret. Unfortunately, many of these records,
logs, and documents may be critical in diagnosing veterans'
illnesses.
For example, with regard to the role of PB in illnesses,
Dr. Heivilin of GAO says the records were so poorly maintained
that the government does not even know who took the pills--an
oversight DOD readily admits.
DOD has acknowledged that the records of the use of
PB and vaccinations to protect against chemical and
biological warfare exposures were inadequate. There is
research going on right now to try to find the majority
of the records, which seem to be missing.\316\
---------------------------------------------------------------------------
\316\ Testimony of Donna Heivilin, Human Resources Subcommittee
hearings, No. 3, p. 38.
Furthermore, even if DOD could determine which veterans
took the pills, the distribution of the drug was so poorly
planned that there is no guarantee the doses and frequency of
doses would be comparable and of any scientific value.
---------------------------------------------------------------------------
According to Dr. Rostker:
There was poor quality control in terms of the
regimen of PB. In some units it was careful. In other
units it was not careful. We don't have records that
would definitively establish who had PB. It was not
done the way any of us would have liked to have seen it
done. There's no question about that.\317\
---------------------------------------------------------------------------
\317\ Testimony of Bernard Rostker, Human Resources Subcommittee
hearings, No. 2, p. 249.
According to Major Randy Hebert, the poor management did
not stop at the border, or with the end of the Persian Gulf
conflict. He says he knows of hospitals that have lost records
of veterans' tests, even records documenting the fact of their
---------------------------------------------------------------------------
visits.
I have spoken to a Marine who was evaluated with
several other Marines from his squad upon their return
from the war. They were told they were being studied
for adverse effects from the desert sun. They were told
this by someone whom he believes was a civilian doctor.
They all were observed for 1 week. The following week
the Marines went back to the hospital to find the
results. They were told that they were never there.
Also, there is not an indication in their records they
were ever there.\318\
---------------------------------------------------------------------------
\318\ Testimony of Randy Hebert, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 107.
Mr. Tuite says health reports are not the only kinds of
records that were lost. Chemical and biological warfare logs
also seem to have been misplaced or else never maintained. Mr.
Tuite told the subcommittee that Senate Banking Committee
Chairman Donald Riegle (D-Michigan) had requested logs of
chemical and biological warfare activity from the Secretary of
Defense, only to be notified by the General Counsel's office
that the command element during the Gulf War (CENTCOM) could
not locate any such document.\319\
---------------------------------------------------------------------------
\319\ Testimony of James Tuite, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 438.
---------------------------------------------------------------------------
Still more disturbing is the alleged falsification of toxic
detection logs and the secret classification of medical records
for the entire 330th Ordinance Company. According to former CIA
analyst Patrick Eddington, they were allegedly made secret to
conceal the fact that DOD sent troops to the Gulf knowing there
were risks associated with low-level chemical exposure and did
so without alerting the soldiers to the dangers. Eddington says
Sergeant First Class Michael Morrissey's unit was charged with
removing more than 170,000 chemical weapons and nerve agent
munitions from an American depot in Germany. Sgt. Morrissey
apparently saved the relevant unit logs, despite orders to
destroy them. When he noticed that reports that went up the
chain of command noted an absence of chemical incidents, he
concluded they had been deliberately altered.
In my presence, Morrissey pulled out a log entry for
July 10, 1990 showing that an M-8 alarm had gone off at
one of the chemical storage bunkers. There were no
other contaminants in the area and the device was fully
functional and working normally. Additional detection
equipment was dispatched to the bunker and, according
to the log extract, the air sample readings appeared to
indicate a slight trace of nerve agent in the air. `I
was told to overlook' such incidents, Morrissey noted.
The 10 weeks of logs that Morrissey retained appear to
have several such incidents to include some personnel
who displayed pin-point pupils and other telltale signs
of nerve agent exposure. . . . What upset Morrissey the
most was that his chain of command clearly understood
the potential risks.\320\
---------------------------------------------------------------------------
\320\ Testimony of Patrick Eddington, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 143-
144.
Eddington then noted a startling declassified document
entitled General Information: Nerve Agent Intoxication and
Treatment. The document is basically a disclaimer. It
explicitly states serious cognitive problems may result from
low-dose exposure even though there is no scientific proof that
this may be so, alludes to the possibility of birth defects
from organophosphate pesticides, and includes an acknowledgment
that the reader (soldier) understands the risks. It is then
signed by the soldier (in this case, Sgt. Morrissey) and a
---------------------------------------------------------------------------
medic.
Signs and symptoms of chronic, low dose exposure:
memory loss, decreased alertness, decreased problem
solving ability, and language problems are suspected
but have not been proven by scientific study . . .
Teratogenicity (ability to cause birth defects):
although some organophosphate pesticides have been
shown to be teratogenic in animals, these effects have
not been shown in carefully controlled experiments
using nerve agents . . . I have read and understood the
above information. All questions have been explained to
my understanding and satisfaction. Soldier/Employee
(Michael Morrissey's signature), Medical Personnel
(Richard W. Kramp, M.D.-initials), Date January 19,
1990.\321\
---------------------------------------------------------------------------
\321\ Document submitted for the record, ``General Information,
Nerve Agent Intoxication and Treatment,'' Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, pp. 163-
164.
Eddington concluded DOD had reason to suspect chronic low
level nerve agent exposure could produce serious chronic health
problems in exposed personnel a full year before the detonation
at Khamisiyah. Every member of Sgt. Morrissey's unit was
reportedly required to sign an identical document. Eddington
concludes that DOD's classifying this information sheet and the
entire Company's medical records as secret is ``irrefutable
evidence'' that DOD knowingly placed U.S. troops at risk and
---------------------------------------------------------------------------
did not want to be found out.
In my opinion they lied. I spent 11 years in the Army
Reserve and National Guard. I have never seen a
document like this. You classify something like this
and you classify medical records secret, when clearly
you are telling people that they could suffer long-term
effects, serious long-term effects, from chronic low-
level exposures? . . . This document makes it very
clear that they understood the risks these people were
facing.\322\
---------------------------------------------------------------------------
\322\ Testimony of Patrick Eddington, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 177.
While Mr. Eddington's suspicions may or may not be
accurate, DOD's tendency to classify information that
scientists and other investigators believe ought to be released
is not new, as Dr. Tucker, director of the chemical and
biological weapons nonproliferation project the Monterey
Institute of International Studies, pointed out to the
---------------------------------------------------------------------------
subcommittee.
A crucial untapped source of information about
possible toxic exposures during the Gulf War is the
large volume of environmental and biomedical samples
that U.S. technical intelligence teams collected
throughout the war zone during and after Desert Storm .
. . It was coordinated by a unit called--a rather
shadowy unit--called the JCMEC, based in Dhahran.
Despite requests under the Freedom of Information Act,
the results of these analyses have never been made
public.\323\
---------------------------------------------------------------------------
\323\ Testimony of Jonathan Tucker, Human Resources Subcommittee
hearings, No. 2, p. 350.
---------------------------------------------------------------------------
Finding 10: Accurate diagnosis of veterans illnesses was also hampered
by the VA's lack of medical expertise in toxicology and
environmental medicine.
One of the reasons the VA has been unable to determine
potential role of toxins in causing veterans' ailments is the
lack of toxicological and environmental medicine expertise
among the staff. While the VA initially refuted the argument,
it has since acknowledged its deficiencies and has taken steps
to buttress its expertise in areas where it was lacking.
Asked point-blank how many toxicologists work for the
Department full-time, Dr. Murphy was only able to come up with
the name of one physician out of a total full-time staff of
8,000. When asked why that was, Dr. Murphy simply said:
In general, toxicologists don't work in health care
organizations. They're often in research laboratories
or in organizations like the EPA.\324\
---------------------------------------------------------------------------
\324\ Testimony of Frances Murphy, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, pp. 259-
260.
Dr. Haley believes regular physicians are poor substitutes
for toxicologists because they may not explore diagnoses like
organophosphate-induced delayed polyneuropathy [OPIDP] that
---------------------------------------------------------------------------
would come naturally to an expert focused on toxicology:
Since these cases are usually treated by
toxicologists, few regular physicians are familiar with
OPIDP. This probably explains why no one explored this
diagnosis earlier.\325\
---------------------------------------------------------------------------
\325\ Statement of Robert Haley, Human Resources Subcommittee
hearings, No. 1, p. 251.
Dr. Haley says the medical toxicologist on staff in his
department, Dr. Tom Kurt, is such a leader on the issue that he
proposed the OPIDP mechanism for the Gulf War syndrome as early
as 1994.
Following the hearing on December 11, 1996, Dr. Kizer wrote
to Subcommittee Chairman Shays, saying the discussion prompted
him to find out how the VA's personnel office obtains and
tracks information about the specialty certifications of VA
physicians. Dr. Kizer concluded the VA's database needed
improvement, and efforts are reportedly being made to ensure
this comes to pass.
In addition, Dr. Kizer directed the Office of Academic
Affiliations to improve the VA's toxicology and occupational
medicine expertise by initiating efforts to support 12 new
medical toxicology fellowships and 25 residency positions for
occupational medicine. While Dr. Kizer noted the response was
somewhat disappointing, the VA will fund three additional
medical toxicology fellowships and five new occupational
medicine residency positions in the 1997-1998 school year, with
more expected in the years ahead.
Finally, Dr. Kizer said he plans to establish occupational
and environmental health as a VHA strategic healthcare group
[SHG]. According to Kizer:
The SHG is a multidisciplinary group organized to
support the delivery of a continuum of care to a
defined population or care in a particular setting. The
SHG functions by integrating data, skills and best
practices into a systemwide policy, planning and
service delivery through the development of clinical
care strategies . . . and decision support
mechanisms.\326\
---------------------------------------------------------------------------
\326\ Letter from Kenneth Kizer to Chairman Shays, June 6, 1997, p.
2 (in subcommittee files).
Accurate diagnosis of veterans' illnesses was hindered by
the lack of relevant expertise at the VA. Rather than challenge
either the lack of expertise or the impact it has on diagnosis,
as well as research and treatment, the VA decided to firm up
its toxicological and environmental medicine resources by
expanding its fellowship and residency staff.
Finding 11: Exposures to low levels of chemical warfare agents and
other toxins can cause delayed, chronic health effects.
Dr. Claudia Miller, a University of Texas Southwest Health
Sciences Center at San Antonio scientist, whose research
focuses on low-level chemical exposures, told the subcommittee
at a September 19, 1996 hearing, ``There are now several
studies, in addition to our own, linking chronic, multi-system
symptoms to [low level] organophosphate/carbamate exposure.''
\327\
---------------------------------------------------------------------------
\327\ Statement of Claudia Miller, Human Resources and
Intergovernmental Relations Subcommittee hearings, No. 1-4, p. 271.
---------------------------------------------------------------------------
It is apparent that DOD and FDA did not evaluate and
recognize the importance of the existing body of scientific
literature on chronic health effects resulting from chemical
warfare exposure and resulting delayed neurotoxicity. Dr. Satu
Somani told the subcommittee that, ``The literature suggests
that Sarin can be responsible for delayed neurotoxic effects
which may not appear until years after a low level of exposure.
Although pyridostigmine is not normally taken up by the brain,
it crosses blood brain barrier under conditions of physical
stress and causes central nervous system effects. Insecticides,
inspect repellants and other chemicals can also contribute to
neurotoxic effects of nerve agents as Sarin, soman, tabun and
Vx and they are important weapons of chemical warfare. . . .
Although we have a treatment for a single dose toxicity, there
is no treatment, however, for the delayed neurotoxicity.
Delayed neurotoxicity was first reported in the 1950's.'' \328\
---------------------------------------------------------------------------
\328\ Statement of Satu Somani, Human Resources Subcommittee
hearings, No. 2, p. 317.
---------------------------------------------------------------------------
Dr. Myra Shayevitz, an environmental physician, in material
inserted in the hearing record by Representative Bernard
Sanders, described the relationship between chemical warfare
agents and toxic health effects. ``One clinically useful
theoretical model of MCS holds that each individual has a total
tolerable load of chemical, physical and emotional stress,
which, when exceeded, may lead to MCS in susceptible
individuals.'' \329\
---------------------------------------------------------------------------
\329\ See supra note 289, p. 15.
---------------------------------------------------------------------------
Multiple low-level chemical exposures could result in a
synergistic effect. The symptoms of low level exposure may not
appear for several years. Dr. Thomas Tiedt described the
genetic basis of variations in response to chemical exposure in
testimony before the subcommittee's April 24, 1997 hearing.
``Due to the principle of biological variation, different cells
and different individuals will experience different degrees of
acute and chronic effects.'' \330\
---------------------------------------------------------------------------
\330\ Statement of Thomas Tiedt, Human Resources Subcommittee
hearings, No. 2, p. 303.
---------------------------------------------------------------------------
Dr. Satu Somani testified ``based on the recent
experimental evidence and the similarities of the symptoms of
the delayed neurotoxicity reported by workers in the
organophosphate industry and also by Desert Storm veterans, I'm
inclined to suggest that the Gulf War syndrome may be due to
low-level exposure to Sarin. . . . The symptoms are due to low-
level exposure to Sarin. Pyridostigmine in combination with
physical exercise can contribute to neurotoxic effects.
Finally, the simultaneous exposure to insecticides and other
chemicals under physical stress may have initiated the
neurotoxicity.'' \331\
---------------------------------------------------------------------------
\331\ See supra note 328, pp. 318-319.
---------------------------------------------------------------------------
The effects of low level chemical warfare agent exposure is
a legitimate line of inquiry for DOD and VA to have pursued.
The Federal agencies possessed a research bias against the
possibility of chemical warfare exposure and did not initiate
any research into this area until 1997. Results will not be
available until the year 2000 or beyond, fully 9 years after
the Gulf War.
Treatment
Finding 12: Neither the VA nor the DOD has systematically attempted to
determine whether sick Gulf War veterans are any better or
worse today than when they first reported symptoms.
Scientific analysis requires the ability to draw
conclusions based on objective and accurate scientific data,
but without a systematic means of comparison, the data is
useless. Unfortunately, neither the VA nor the DOD has made any
effort to track veterans' progress and treatment on a
methodical, uniform basis. As a result, doctors have no way to
gauge which is the best treatment for veterans' different
symptoms.
While the VA has developed a means of collecting an initial
assessment of veterans' conditions, problems have surfaced
regarding its implementation. The 65,000 veterans who signed up
for a Persian Gulf Registry Exam were provided a review of
their medical history, physical examination, and laboratory
tests. The results were then entered into a database containing
information on all Persian Gulf veterans who received the
examination.\332\ However, the objective value of these
assessments is weakened by various factors. Stephen Backhus of
GAO has noted medical centers have experienced scheduling
backlogs of up to 6 months,\333\ which can have two effects.
One, a late Registry Exam risks missing the more subtle
symptoms common in the early stages of illness, preventing
doctors from treating them before they become worse. Two,
awareness of long scheduling delays may discourage veterans
from registering for the exams, preventing veterans from
receiving the diagnosis and treatment they deserve, as well as
making the tests less representative of veterans at large and
therefore less worthwhile. Finally, veterans have complained of
poor feedback and communication with health care personnel
following completion of the exam, as well as ``a lack of
postexamination treatment.'' \334\
---------------------------------------------------------------------------
\332\ See supra note 227, p. 1.
\333\ Ibid., p. 2.
\334\ Ibid.
---------------------------------------------------------------------------
According to Army Reservist Chris Kornkven, even when
veterans were given feedback, no effort was made to pursue the
VA's own recommendations for further diagnosis and treatment.
Eventually I was told I may have post traumatic
stress disorder and I would be tested and possibly be
followed with counseling. Several weeks passed with no
other medical testing or treatment. I began asking
questions in the mental health clinic when any
appointment would take place and was told they were too
booked up to get me in any time soon.\335\
---------------------------------------------------------------------------
\335\ Testimony of Chris Kornkven, Human Resources Subcommittee
hearings, No. 1, pp. 269-271.
GAO's research and analysis confirms Kornkven's experience
---------------------------------------------------------------------------
is not an isolated case. As Dr. Heivilin concludes:
DOD and VA have made no provisions to follow up on
the condition of the Gulf War veterans. We found
neither DOD nor VA have any means of knowing whether
the Gulf War veterans who are ill are better or worse
off than when they were first examined.\336\
---------------------------------------------------------------------------
\336\ Testimony of Donna Heivilin, Human Resources Subcommittee
hearings, No. 3, p. 34.
More importantly, this inability to determine if the
conditions of sick veterans are improving prevents the DOD and
---------------------------------------------------------------------------
VA from assessing the value of its diagnoses and treatments.
We found [DOD and VA] had no monitoring mechanisms
for determining the quality, the appropriateness or the
effectiveness of the care that [veterans] are getting
after the initial examinations.\337\
---------------------------------------------------------------------------
\337\ Ibid., p. 37.
Dr. Murphy claims the absence of a particular follow-up
protocol is not indicative of a lack of interest in how
veterans are doing. Rather, Dr. Murphy says the VA's policy is
designed to ensure veterans receive the appropriate amount and
quality of care by catering to the needs of each veteran
---------------------------------------------------------------------------
individually.
We do not have a protocol, and the reason we do not
have a protocol is that the therapy and the follow up
needs to be tailored to the individual veteran.
Clearly, there are some people who need to be seen
every couple of weeks or every month. Some might be
seen every 3 months, some every 6 months, depending on
the severity of their illness and how well they are
responding to the treatments they are being given.\338\
---------------------------------------------------------------------------
\338\ Testimony of Frances Murphy, Human Resources Subcommittee
hearing of June 26, 1997, original transcript, p. 232 (in subcommittee
files).
However, this response is problematic for two reasons. As
noted in Finding 1, the GAO has pointed out several failings at
the VA regarding followup testing, diagnosis and treatment,
including: failure to give veterans without a clearly defined
diagnosis additional baseline laboratory tests and
consultations; failure to evaluate veterans suffering from
undiagnosed illnesses at VA's referral centers (only 390 out of
15,000 referrals were evaluated); and failure to provide
personal counseling between veterans and their physicians.\339\
---------------------------------------------------------------------------
\339\ See supra note 232, pp. 4-5.
---------------------------------------------------------------------------
Second, if doctors are assessing the progress of veterans
on an individual basis, researchers will be unable to draw
general conclusions about which treatments may have appeal for
other sick veterans with similar symptoms. As a result, even if
certain treatments are found to work, they will have little
impact on medical research as a whole and thus limited
significance for future veterans.
VA's argument that its performance of a Registry Exam for
any veteran who requests one followed by an appropriate
diagnosis, treatment, and follow-up is sufficient to assess
veterans' progress over time still fails to address the need
for a systemwide and systematic comparison which is crucial for
any kind of major advance in medical science and treatment.
Finding 13: Treatment of sick Gulf War veterans by VA and DOD to date
has largely focused on stress and PTSD.
Through counseling and other forms of therapy, the medical
community has established an accepted treatment for stress and
PTSD that has been available for some time. Over a number of
years, physicians have been able to determine that counseling
can help veterans overcome these syndromes and resume their
normal life. VA and DOD doctors, under pressure to come up with
a diagnosis and treatment for Gulf War veterans suffering from
mysterious illnesses, have prematurely prescribed treatment for
stress and PTSD, even when evidence strongly suggests their
illnesses are more likely to stem from exposure to toxic
agents.
Examples of Gulf veterans who were urged to undergo
treatment for stress are plentiful.
Private Stacy testified that he has tried counseling and
other forms of treatment for stress, but has found that they do
not work.\340\ Nevertheless:
---------------------------------------------------------------------------
\340\ See supra note 266, p. 90.
For the past year I have been pushed and pushed
towards mental health.\341\
---------------------------------------------------------------------------
\341\ Ibid., p. 108.
Veteran Julia Dyckman remembers smelling and hearing
evidence of SCUD attacks during the war.\342\ Soon afterward,
she experienced a rash of unusual health problems,\343\ yet
according to Dyckman:
---------------------------------------------------------------------------
\342\ Testimony of Julia Dyckman, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 189.
\343\ Ibid.
Self reporting is ignored and a psychiatric diagnosis
is often given.\344\
---------------------------------------------------------------------------
\344\ Ibid., p. 190.
As noted in the Background section, Army Reservist Chris
Kornkven suffered from a variety of physiological symptoms,
including intestinal problems and headaches. However, when he
sought treatment from the VA, he was not given anything for his
---------------------------------------------------------------------------
stomach or head.
I was referred to the mental health clinic, although
I was not told why . . . It was suggested I go to the
Vet Center for any counseling. At this point, much of
the medical testing or treatment had stopped, with
emphasis placed on PTSD and possible treatment in the
mental health clinic.\345\
---------------------------------------------------------------------------
\345\ Testimony of Chris Kornkven, Human Resources Subcommittee
hearings, No. 1, pp. 269-271.
Doctors have since discovered a nasal mass after doing an
MRI, as well as other symptoms such as skin problems and rectal
bleeding, neither of which has been treated to date.\346\
---------------------------------------------------------------------------
\346\ Ibid.
---------------------------------------------------------------------------
In order to justify treatment for stress and PTSD, VA and
DOD health care personnel have pushed those diagnoses, often
without any support from tests or logic.
Major Michael Donnelly was exposed to a known toxin,
malathion, and experienced serious health problems immediately
afterward, suggesting his exposure may be the source of his
ailments, yet an Air Force physician did not hesitate to
diagnose, or at least strongly suggest, stress upon hearing
that he had served during war.
I went in to the flight surgeon at Sheppard Air Force
Base. When I finished explaining my symptoms to him I
mentioned that I had been in the Gulf War. He
immediately started to talk to me about the effects of
stress and delayed stress.\347\
---------------------------------------------------------------------------
\347\ Testimony of Michael Donnelly, Human Resources Subcommittee
hearings, No. 2, p. 35.
Private Green, who was never in the Gulf region let alone
the Gulf War theater during combat, was also diagnosed and
---------------------------------------------------------------------------
treated for stress.
The doctor asked what was wrong and asked me to
describe the symptoms. I was then sent for a series of
blood work and referred to the mental health clinic for
stress-related problems. Seems awful funny to me that
my illness is stress related and I was not even in the
theater.\348\
---------------------------------------------------------------------------
\348\ See supra note 182.
Sgt. Sumpter-Loebig had a similar experience. She spent a
large amount of time in and around a ``noxious fuming gas that
burned'' with no protective clothing. She later discovered it
was a combination of DS, CS, and super-topical bleach. Soon
afterward, she experienced a series of health problems ranging
from dry mouth and hair loss to heart palpitations. Despite her
exposure to known toxins, the VA says she has PTSD and the
problem is in her head.\349\
---------------------------------------------------------------------------
\349\ Testimony of Susan Sumpter-Loebig, Human Resources
Subcommittee hearings, No. 2, p. 44.
---------------------------------------------------------------------------
If war were not considered a stressful environment, VA and
DOD doctors would have been hard-pressed to match veterans'
physiological symptoms with physiological treatments. However,
because stress is difficult if not impossible to eliminate as a
cause of their ailments, VA and DOD doctors can diagnose and
treat health problems as symptoms of stress without fear of
being glaringly wrong or being perceived as incapable of coming
up with any answer at all.
Compensation
Finding 14: Compensation ratings for sick veterans are minimized due to
inadequate personal medical records, missing toxic detection
logs, and unreleased classified documents which could help
veterans establish service-connection of post-war disabilities.
The absence of medical records and detection logs, as well
as the classification of certain documents, have increased the
burden on veterans who need to establish a causal link between
service in the Gulf and their post-war ailments. Unable to
prove the war responsible for their pains, many sick veterans
are thereby rendered incapable of holding the United States
fully accountable for their illnesses, leading their
compensation ratings to be unfairly diminished.
Still, some Gulf War veterans seeking compensation face an
easier task than veterans of previous wars. In the past, the VA
had required compensation to be based on clearly diagnosed
diseases. In 1994, Congress enacted unprecedented legislation
changing this requirement. The Persian Gulf War Veterans'
Benefits Act (Public Law 103-446) allows the VA to pay
compensation benefits to Gulf War veterans suffering
undiagnosed illnesses.\350\
---------------------------------------------------------------------------
\350\ Congressional Research Service Report, ``Gulf War Veterans'
Illnesses,'' 97-450 SPR, April 11, 1997, p. 5.
---------------------------------------------------------------------------
However, although this legislation relieves some of the
burden on veterans, they still must prove they are disabled and
trace their disabilities directly to their service in the Gulf.
It is in making the latter argument that the classification,
disappearance, or inadequacy of medical and toxic detection
records come into play.\351\
---------------------------------------------------------------------------
\351\ See finding 9.
---------------------------------------------------------------------------
Sadly, when veterans try to bring these shortcomings to the
attention of the evaluating board, they are summarily dismissed
and the evidence, discounted. In the words of Sgt. Sumpter-
Loebig:
This so-called board is a sham, disgrace, and
basically a sold-out jury of three officers who have
found an excellent loophole for the military to escape
responsibility to their soldiers. This physical
evaluation board says that I am not fit for duty or my
civilian job title. But they aren't going to admit that
there is a problem caused by our Southwest Asia
service, because we are no longer of any use to them.
From the moment an ill soldier walks into one of these
military facilities and mentions they were in the Gulf,
the decision and diagnosis are already decided upon. To
cover themselves, they tell us to bring in other
evidence to dispute their doctor. And when we do it is
dismissed as irrelevant and non-admissible. These
boards . . . bring down their judgment swiftly and
without any thought to our well-being.\352\
---------------------------------------------------------------------------
\352\ See supra note 349, p. 62.
Confronted with the impossible task of proving a causal
connection between their sickness and service without the
documents, data, and scientific explanation that may be
necessary to back up their claims, many veterans find
themselves at a loss. They know they are sick, and while all
signs point to their service in the Gulf as the reason, without
some of the key clues to the puzzle--the missing or poorly
maintained medical and toxic detection records and classified
material--many veterans are unable to successfully make their
case to the Veterans' Benefits Administration [VBA].
Julia Dyckman says the burden of proof is made even more
difficult by the VA's refusal to bend its time-limit for
proving disability. Under regulations issued in 1995, a veteran
can only be compensated for undiagnosed illnesses that make
themselves apparent during Gulf War service or within 2 years
of a veteran's departure from the Gulf.\353\ Veterans must also
prove chronic illness and be at least 10 percent disabled. For
the past 2 years, this constraint has proved especially onerous
for undiagnosed Gulf War veterans who do not recognize the
significance of symptoms which may appear mild by themselves
but together are indicative of more serious health problems.
---------------------------------------------------------------------------
\353\ See supra note 352.
When later symptoms are present, it's almost
impossible to have them recognized by the VA. There's
the--you need to change the 2-year limit of at least 10
percent disability. Reporting was difficult, but
symptoms are also sometimes very benign at the
beginning, and even getting them into any kind of
civilian treatment is very difficult. This limit is
unrealistic due to the specific nature of Persian Gulf
illness.\354\
---------------------------------------------------------------------------
\354\ Testimony of Julia Dyckman, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 190.
President Clinton responded by extending the presumptive
period by 8 years, until December 31, 2001. Veterans who were
denied compensation between 1995 and 1997 solely on account of
the old 2-year presumptive period will have their claims re-
evaluated.
However, only 55 percent of the total 93.5 percent of
veterans who were denied compensation for undiagnosed illnesses
fall into this category. The remaining 38.5 percent were simply
denied.
Faced with a dearth of useable data thanks to lost,
destroyed or classified medical, toxic detection, and other
records, veterans are shouldered with a gargantuan task,
proving a causal link between their illnesses and their service
with only limited resources at their disposal. What's more,
veterans are being asked to prove what science and doctors
cannot disprove; an unfair and impossible task for anyone, let
alone disabled and suffering veterans who simply want what they
are due. The Government has eliminated some of the burden,
including the diagnosis and 2-year presumptive period
restrictions, but the other requirements still fall like an
anvil atop the shoulders' of suffering veterans. Sadly, as VBA
records show, those who fail to make what the VBA considers an
incontrovertible argument pay the price in smaller compensation
benefits.
Finding 15: Compensation ratings are also minimized by over-reliance on
somatoform disorder and PTSD as the basis of disability claims.
Veterans suffering from so-called ``Gulf War Syndrome''
face yet another hurdle in acquiring the benefits they are
owed--an over-reliance by VA and DOD on a diagnosis of
somatoform disorder and PTSD as a means of calculating and
processing their claims.\355\
---------------------------------------------------------------------------
\355\ See finding 7.
---------------------------------------------------------------------------
For Julia Dyckman, the VA and DOD's unwillingness to accept
alternative causes of her sickness prevent her from receiving
the full amount she should have coming to her.
After 4 years and the VA's own diagnosis of Persian
Gulf Syndrome, which I got at the VA Center in
Washington, I received 30 percent disability for PTSD.
In 1996, it was finally increased to 80 percent for
chronic fatigue. Persian Gulf Syndrome is not a
recognized illness. According to VA, I am tired and
have a mental problem.\356\
---------------------------------------------------------------------------
\356\ See supra note 354.
Staff Sgt. Steven Wood faced the same problem. His
solution: stay in Germany and receive free health care.
Although the VA has rated him at 100 percent disabled, it owes
him more than $20,000 in back benefits.\357\ A processing
problem in Philadelphia is reportedly causing further delays in
payment.
---------------------------------------------------------------------------
\357\ Testimony of Steven Wood, Human Resources Subcommittee
hearings, No. 2, p. 46.
---------------------------------------------------------------------------
The VA's and DOD's reliance on somatoform and PTSD can make
for added difficulties such as those faced by Michael Stacy.
His experience with VA and DOD is one of disbelief. According
to his medical records, his doctor is convinced he is lying or
otherwise exaggerating his symptoms in order to get more
compensation.
They believe that all of my complaints are due to
stress. I have a copy of my medical records, which I do
not have on me now. But the doctor does say in my
records, ``I believe the patient is exaggerating
symptoms, I believe the patient has been coached, and I
believe he is here to try to get increased
disability.'' \358\
---------------------------------------------------------------------------
\358\ See supra note 266, p. 93.
As a result, many veterans find themselves in the
unenviable situation of Sgt. Sumpter-Loebig, who was told in no
uncertain terms that she could receive a portion of the
benefits she is due, if she accepts a more ``established''
diagnosis of stress or PTSD. For veterans who are at their
wits'' end, the pressure is great. As Sgt. Sumpter-Loebig
---------------------------------------------------------------------------
recalls, she was presented with the following choice:
Send in my results to a board now and be awarded 10
to 20 percent of base pay for 1 year as a settlement or
go through a 4 week physical training program designed
to help me learn to cope with my symptoms--which they
are describing as sympathetic and mind-induced--be
taught how to be socially active with the rest of the
world, how to use P.T. to forget my mind-induced
sympathetic symptoms, and be sent back to duty. This is
regardless if the symptoms are gone or not.\359\
---------------------------------------------------------------------------
\359\ See supra note 349, p. 59.
Private Stacy is rated at 30 percent disabled for service-
connected PTSD, but has been strongly advised to push for 100
percent. He has refused because he does not believe his
sickness stems from stress and does not want to accept a
fraction of what he is owed--which is all he would receive with
a stress or PTSD diagnosis. What's more, Stacy told the
subcommittee he would not have accepted a 30 percent rating if
it were not for his family's financial situation. He says they
have been starving for 1 year now, and that it is only by the
grace of his relatives, friends, and God, they would not have
survived.\360\ According to his testimony, his disability
compensation of $467 a month does not leave enough money for
his monthly house payment of $500, let alone the cost of gas or
food.\361\
---------------------------------------------------------------------------
\360\ See supra note 266, p. 108.
\361\ Ibid., p. 50.
---------------------------------------------------------------------------
The experiences of these and other veterans support the
view that compensation ratings are being reduced based on
inaccurate or at least premature diagnoses of somatoform
disorder and PTSD. Evidence that VA and DOD doctors have over
used diagnoses of somatoform disorder and PTSD have already
been laid out.\362\ Since these psychologically-based
disabilities carry a lower compensation rating other
physiological ailments, it seems only logical that veterans see
their compensation ratings minimized as a result. The pressure
to accept a diagnosis of somatoform disorder or PTSD before
other alternatives have been ruled out shows how this reduction
can sometimes come to pass, and when it does, it is a tragedy.
U.S. troops risked their lives and health for the military. It
is a gross understatement to say they deserve the full amount
of what they are justly owed upon their return.
---------------------------------------------------------------------------
\362\ See finding 7.
---------------------------------------------------------------------------
Research
Finding 16: Federal research strategy has been blind to promising
hypotheses due to reliance on unfounded DOD conclusions
regarding chemical exposures.
In 1996, the DOD admitted for the first time that 300 to
400 PGW troops had likely been exposed to chemical weapons. The
number of affected troops continued to be raised upward until
July 1997, when DOD estimated that the number of exposed troops
was estimated at 98,900.\363\
---------------------------------------------------------------------------
\363\ Statement of Bernard Rostker to the PAC meeting, Buffalo, NY,
July 29 and 30, 1997 (in subcommittee files).
---------------------------------------------------------------------------
VA's Dr. Kenneth Kizer testified on January 21, 1997 that
``the issue of chemical warfare agents . . . and the
investigation into that arena, was delayed, and that
investigative focus was given a lower priority because of the
information that had been provided by DOD.'' \364\ As a result,
the PGW registry didn't require VA physicians to ask sick
veterans detailed questions about potential chemical and
biological weapons exposure until 1995.\365\ In fact, the VA
diagnostic screening protocol failed to identify even one
veteran exposed to chemical weapons agents or other toxins.
---------------------------------------------------------------------------
\364\ Testimony of Kenneth Kizer, Human Resources Subcommittee
hearings, No. 1, pp. 50-60.
\365\ Ibid.
---------------------------------------------------------------------------
VA continues to assert that acute symptoms following
exposure to chemical weapons must be present in veterans
exposed to these agents. In the absence of acute symptoms, the
veteran is presumed by the VA not to be exposed.
Many scientific and medical witnesses have testified that
chemical exposures result in injury to the limbic system at the
brain stem. This injury, in turn, causes neuro-immunological
disorders which are often characterized as chronic fatigue
syndrome, fibromyalgia or multiple chemical sensitivity. These
disorders are thought by many experts to be a spectrum of
neuro-immunological illnesses with a variety of causes and
symptoms.
Dr. William Baumzweiger, a neurologist and psychiatrist,
who was at the time a VA physician in Los Angeles, testified
that organophosphate chemical exposure resulted in ``a syndrome
which has been known since the late 1800's, was very clearly
documented by 1930, and which there have been a number of
accidental exposures, tragedies in the 1930's, 1970's, 1980's.
. . . The signs and symptoms of acute neurotoxicity do not have
to be so dramatic as seizures and death. They can be very mild
and they can consist of headaches, nausea, vomiting, episodes
of psychosis, personality change . . .'' \366\
---------------------------------------------------------------------------
\366\ Testimony of William Baumzweiger, Human Resources
Subcommittee hearings, No. 1-4, p. 480.
---------------------------------------------------------------------------
However, the January 15, 1997 issue of the Journal of the
American Medical Association was devoted to PGW research. A
study conducted by Dr. Robert Haley and colleagues at the
University of Texas Southwestern Medical Center at Dallas
concluded that PGW veterans illnesses were attributable to
``subtle brain, spinal cord and nerve damage-but not stress.
The damage was caused by exposure to combinations of low-level
chemical nerve agents and other chemicals, including
pyridostigmine bromide in anti-nerve-gas tablets, DEET in a
highly concentrated insect repellant, and pesticides in flea
collars that some troops wore. Different combinations of the
chemicals appear to have caused the 3 different syndromes.'' To
arrive at this conclusion, Dr. Haley and his colleagues
conducted three studies in a group of 249 members of a U.S.
Navy reserve unit. This study could have been just as easily
conducted by DOD or VA.
The Departments also failed to consider historical research
which supported consideration of possible toxic exposures with
delayed onset as the cause of PGW syndrome. Furthermore, DOD
and VA did not consider the possibility that PB could mask the
effects of chemical exposure. If this were the case, delayed
neurotoxicity would not appear for perhaps several years.\367\
---------------------------------------------------------------------------
\367\ See supra note 148 and accompanying text.
---------------------------------------------------------------------------
Finding 17: Institutional and methodological constraints make it
unlikely the current research structure will find the causes
and effective treatments for Gulf War veterans' illnesses in
the short term.
Military institutional biases are adversely affecting the
identification of causes and treatments for PGW illnesses.
Exposure to genotoxic materials was not quantatively monitored
and records of chemical exposures were not maintained. As a
result, data on these subjects will never be available and a
direct proof of a causative relationship between chemical
exposures and PGW illnesses may be unattainable. However, the
circumstantial evidence is overwhelming.
There is also strong existing medical bias against the
spectrum of illnesses described as neuro-immunological central
nervous system disorders. Dr. Clauw said ``it appears that
there is a group of closely related systemic conditions, such
as fibromyalgia and chronic fatigue syndrome, as well as a
group of closely related organ-specific conditions, such as
migraine headaches and irritable bowel syndrome, that form one
large spectrum of illness with common demographics, inciting
factors and treatment.'' \368\
---------------------------------------------------------------------------
\368\ Testimony of Daniel Clauw, Human Resources Subcommittee
hearings, Nos. 1-4, p. 178.
---------------------------------------------------------------------------
Many of the disease conditions of which Gulf War veterans
complain, such as chronic fatigue syndrome, fibromyalgia,
multiple chemical sensitivity are poorly understood and only
recently characterized by standardized diagnostic criteria. Dr.
Clauw testified, ``The countless individuals who were
previously healthy, who returned from the war with severe
symptoms, are compelling evidence that these individuals
developed these illnesses as a result of their military
service.'' \369\
---------------------------------------------------------------------------
\369\ Ibid., p. 179.
---------------------------------------------------------------------------
He added:
much more funding is needed for research into this
whole spectrum of conditions. The problems regarding
the diagnosis and treatment of Persian Gulf veterans
are a symptom of a much bigger problem that we have in
this country. Amazingly enough, despite the very high
prevalence of these illnesses in the population, the
aggregate amount of yearly funding for these
conditions, through all of the institutes at the NIH,
and through other sources such as the DOD, may perhaps
reach $20 million. This spectrum of illnesses cost the
government alone billions of dollars in lost
productivity disability and health care costs. The
costs to the private sector are much larger.\370\
---------------------------------------------------------------------------
\370\ Ibid., p. 180.
GAO testified, ``We found that the bulk of ongoing Federal
research on Gulf War veterans' illnesses focuses on the
epidemiological study of the prevalence and the cause of the
illnesses.'' \371\
---------------------------------------------------------------------------
\371\ See supra note 196, p. 51.
---------------------------------------------------------------------------
GAO concluded, ``the ongoing epidemiological research will
not be able to provide precise, accurate, and conclusive
answers regarding the causes of veterans' illnesses because of
these formidable methodological problems.'' \372\ GAO
recommended that ``the Secretaries of Defense and Veterans
Affairs (1) set up a plan for monitoring the clinical progress
of Gulf War veterans to help promote effective treatment and
better direct the research agenda and (2) give greater priority
to research on effective treatment for ill veterans and on low-
level exposures to chemicals and their interactive effects and
less priority to further epidemiological studies.'' \373\
---------------------------------------------------------------------------
\372\ Ibid., p. 54.
\373\ Ibid., p. 59.
---------------------------------------------------------------------------
VA has not sought a case definition for PGW illness and
this has hampered development of a set of diagnostic criteria
which would enable treating physicians to identify and
correctly diagnose sick veterans.
In 1994, the Center for Disease Control and Prevention's
[CDC] Dr. William C. Reeves, began developing a working case
definition of PGW symptoms. CDC utilized this case definition
to determine epidemiologically that Gulf-related illnesses are
more frequent in PGW veterans than non-deployed troops. VA did
not initiate action to determine a case definition when it
began receiving reports of PGW illnesses in 1991. As a result,
3 valuable years were lost.
Finding 18: The FDA was passive in granting and failing to enforce the
conditions of a waiver to permit use of PB by DOD.
Immediately prior to Operation Desert Shield, the Assistant
Secretary of Defense for Health Affairs requested that HHS
waive the requirement to obtain informed consent from military
personnel for use of non-approved drugs and biologics because
under military combat exigencies it was not feasible. The
Pentagon argued that the policy of individual informed consent
is not feasible in battlefield conditions and runs counter to
the needs of the unit as a whole. If the military gave soldiers
the choice of accepting or refusing to take an Investigational
New Drug [IND], those who chose not to take the drugs would
violate their overriding obligation both to their unit and to
the military, and the military would violate its obligation to
protect the soldiers. Soldiers who refused to take an
Investigational New Drug would place themselves at risk and
expose others in their unit to harm as well.
On December 21, 1990, FDA issued an interim regulation to
amend its current informed consent regulations to permit the
Commissioner of Food and Drugs to make the determination that
obtaining informed consent from military personnel for the use
of an investigational drug or biologic is not feasible in
certain battlefield or combat-related situations.
The regulation had an immediate effective date because of
the urgency created by Operation Desert Shield.
DOD requested waivers from FDA to administer three drugs to
protect troops from biological or chemical attack. FDA denied
one of the requests, but granted waivers for an unlicensed
polyvalent vaccine against botulism and for pyridostigmine
bromide [PB] as a wartime contingency pretreatment for nerve
gas exposure. PB was approved by FDA for the treatment of
myasthenia gravis, a neuromuscular disorder, but not as a
prophylactic against nerve gas.
In such situations where informed consent was not feasible,
FDA's interim regulation required that, ``DOD collect data on
any use of these products without informed consent. FDA will
review these data and will revoke or modify the determination
if the review indicates that the determination is no longer
appropriate.''
However, HHS staff members have informed subcommittee staff
that DOD did not collect the required data and FDA has not
aggressively pursued DOD's violation of the FDA-DOD agreement.
DOD has admitted that the information sheets which FDA
required as a condition of the waiver, were never provided to
military personnel ordered to take the vaccines and PB. As a
result, Gulf War veterans did not know to include this
information in their medical records or to mention the
exposures when seeking medical care for PGW illnesses.
FDA's Interim Final Rule permitting waiver of informed
consent for use of unapproved products in a military exigency
is still in effect. The Presidential Advisory Committee on Gulf
War Veterans' Illnesses' [PAC] expressed concern in its
December 1996 report ``about the amount of time FDA is taking
to move forward with opening up the Interim Final Rule--which
was issued almost 6 years ago for public comment.'' \374\
---------------------------------------------------------------------------
\374\ PAC Report, p. 27.
---------------------------------------------------------------------------
The PAC recommended, ``If FDA decides to reissue the
Interim Final Rule as final, it should first issue a Notice of
Proposed Rulemaking. Among the areas that specifically should
be revisited are: Adequacy of disclosure to service personnel;
adequacy of recordkeeping; long-term follow up of individuals
who receive investigational products; review by an
institutional review board outside of DOD; and additional
procedures to enhance understanding, oversight, and
accountability.'' \375\
---------------------------------------------------------------------------
\375\ PAC Report, p. 52.
---------------------------------------------------------------------------
On July 29, 1997, more than 7 years after FDA issued the
waiver, the agency published a request for comments in the
Federal Register, soliciting public comments on the following
issues: whether FDA should revoke or maned the interim rule of
December 1990 and if the latter, whether and how it should be
amended; when is it ethical to expose volunteers to toxic
chemical and biological agents to test the effectiveness of
products that may be used to provide potential protection
against those agents; and if the products that may be used for
protection against toxic substances cannot be ethically tested
in humans, what evidence would be needed to adequately
demonstrate their safety and effectiveness.
The comment period closed October 30, 1997. After
evaluating the responses, FDA will publish a proposal for
action.
IV. Recommendations
Diagnosis
Recommendation 1: Congress should enact a Gulf War toxic exposure act
establishing the presumption, as a matter of law, that veterans
were exposed to hazardous materials known to have been present
in the war theater.
The premise of both VA and DOD approaches to Gulf War
veterans illnesses has been that toxic exposures played no role
in causing the mysterious range of maladies known as ``Gulf War
Syndrome.'' That presumption is no longer warranted.
The widespread presence of a host of hazardous substances
throughout the war theater, including low levels of chemical
warfare agents in some areas, has been well established.\376\
In sufficient doses, each of those substances has been cited as
a public health threat.\377\ That U.S. troops were widely and
frequently exposed to one or more of these substances, i.e.,
smoke from oil well fires, PB tablets or ``tabs,''
organophosphate pesticides, has never been denied.
---------------------------------------------------------------------------
\376\ See supra text accompanying note 7.
\377\ Report to Congress 1993, 1994, 1995, p. 55, U.S. Department
of Health and Human Services, Agency for Toxic Substances and Disease
Registry, Atlanta, GA (1997).
---------------------------------------------------------------------------
What has been so long denied is that the admitted exposures
were of any long term clinical significance. Yet it is only in
the long term that a causal link between exposures and
subsequent health effects in those exposed will be demonstrable
using standard epidemiological analysis.
In the meantime, sick veterans and their families bear the
burden of trying to prove not only that exposures took place,
but in what quantity and in what combination(s). But in
attempting to reconstruct their medical histories for this
purpose, veterans find key records missing or unavailable.
Inoculation records were not maintained for many. Information
on the use of PB tabs was not recorded. Troop location data is
not available below the unit level, making it impossible to
place individuals in areas known to have been contaminated. NBC
logs are missing.
Establishing a presumption of exposure to the hazardous
substances known to have permeated the war area would lift that
impossible burden. It would place the onus properly on Federal
officials to rebut the presumption with peer reviewed research
and clinical findings. Such a presumption would free the VA and
DOD of the unworthy task of defending an improbable version of
what did not happen in the Gulf War, and allow them to support
veterans in proving what did happen there. It would also serve
U.S. military doctrine by assuring future combatants that the
wounds of war, however delayed or difficult to diagnose, will
be acknowledged and treated.
In the absence of definitive scientific information,
reasonable presumptions must be made. Citing just such an
absence of scientific consensus, the Pentagon and the VA
continue to presume toxic exposures play no significant role in
the etiology of Gulf War illnesses. However, given the weight
of evidence regarding toxic exposures and probable health
effects, that presumption may never have been, but is certainly
no longer, reasonable.
Recommendation 2: The VA should contract with an independent scientific
body composed of non-Government scientific experts
representing, at a minimum, the disciplines of toxicology,
immunology, microbiology, molecular biology, genetics,
biochemistry, chemistry, epidemiology, medicine and public
health for the purpose of identifying those diseases and
illnesses associated in peer-reviewed literature with singular,
sustained, or combined exposures to the hazardous materials to
which Gulf War veterans are presumed to have been exposed.
Despite subsequent recommendations in this report to divest
VA and DOD of control over the Gulf War research agenda, this
proposal is made so the departments have access to the
objective expertise necessary to implement Recommendation 1.
While it may have been enough in the past to say the
Department, ``has always remained open to the possibility that
PGW veterans were potentially exposed to a wide variety of
hazardous agents while serving in the Southwest Asia theater of
operations, including chemical warfare agents,'' \378\ this
recommendation would transform that passive posture into a more
active pursuit of information on exposures and health effects.
---------------------------------------------------------------------------
\378\ Statement of Frances Murphy, Human Resources and
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 414.
---------------------------------------------------------------------------
Particularly in view of the many variables and innumerable
combinations of likely Gulf War exposures, the VA must be in a
position to pursue complex, interdisciplinary hypotheses
regarding toxic stressors.\379\ The list of presumed exposures
will need to be updated and refined. This recommendation seeks
to ensure VA maintains adequate scientific breadth in that
process, and does not fall prey to a static view of exposure
health effects.
---------------------------------------------------------------------------
\379\ See also Recommendations 5, 16 and 17, infra.
---------------------------------------------------------------------------
Recommendation 3: The VA Gulf War Registry and the DOD Comprehensive
Clinical Evaluation Program should be re-evaluated by an
independent scientific body which shall make specific
recommendations to change both programs from crude research
tools into effective clinical diagnosis and outcomes monitoring
efforts.
The subcommittee found serious weaknesses in the structure
and implementation of the Gulf War health registry
programs.\380\ VA officials characterized their Registry as ``a
very crude health surveillance tool,'' \381\ and a primary
source of promising hypotheses for subsequent research.
However, in practice, promising but inconvenient hypotheses
about the role of chemical exposures were not pursued. Instead,
they were dismissed as biased by the self-selected nature of
the Registry cohort. Dr. Murphy told the subcommittee, ``It
should be remembered that the Registry and other examination
program data are provided through medical records of self-
selected health care-seeking individuals and is not likely to
be reflective of the entire population of Persian Gulf War
veterans.'' \382\
---------------------------------------------------------------------------
\380\ See findings 5, 6, 7, 10 and 12, supra.
\381\ Testimony of Frances Murphy, Human Resources and
Intergovernmental Relations Subcommittee hearings No. 1-4, p. 435.
\382\ Ibid., p. 412.
---------------------------------------------------------------------------
Not even near unanimity could overcome VA's resistance to
drawing conclusions from their own Registry data. ``In 1992
Physician Registry staff documented that 93 percent of Persian
Gulf War veterans reported they had been exposed to 1 or more
of the 12 contaminants. This percentage declined to a low of 87
percent in 1993, and increased to a high of 98 percent by
1996.'' \383\ Yet the effects of low level chemical exposures
did not become a research priority for the VA until after the
announcement of probable exposures at Khamisiyah.\384\
---------------------------------------------------------------------------
\383\ See supra note 227, p. 5.
\384\ See supra note 381, p. 414.
---------------------------------------------------------------------------
VA was far less constrained about drawing favorable
inferences, however subtly, from Registry data. After
appropriate disclaimers about the limitations of Registry data
as epidemiological tools, Former VA Secretary Jesse Brown
nevertheless concluded, ``If there were a neurotoxic exposure
that could cause serious neurologic disease in a high
proportion of Persian Gulf veterans, it would probably have
been identified in the 60,000 Registry exams completed to
date.'' \385\
---------------------------------------------------------------------------
\385\ See supra text of letter from Jesse Brown to Chairman Shays
in Background section. See also, attachments to chairman's opening
statement, Human Resources and Intergovernmental Relations Subcommittee
hearings, Nos. 5-6, p. 14.
---------------------------------------------------------------------------
The VA can't continue to have it both ways in the use of
Registry information--disclaiming unwelcome propositions while
embracing favorable conclusions grounded in the same data. To
be of value to veterans, participation in the Registry should
demonstrably improve his or her health as well as advance what
can be known about the health of all Gulf War veterans. That
will require greater use of the VA Referral Centers and the
addition of outcomes monitoring as an integral part of the
Registry program.\386\
---------------------------------------------------------------------------
\386\ See infra Recommendations 4 and 9.
---------------------------------------------------------------------------
The Institute of Medicine [IOM] is about to complete
studies of the VA and DOD Registry programs. Perhaps that work
could be continued to arrive at recommendations for more
fundamental changes in the design and implementation of the
programs to address the serious weaknesses noted by the
subcommittee, GAO and others, and to suggest safeguards against
the selective use of health registry data.
Recommendation 4: The VA should refer all Phase II Registry
examinations to Gulf War Referral Centers.
Only 2.6 percent of veterans' cases VA reported as having
undiagnosable illnesses were evaluated at Gulf War Referral
Centers.\387\ It appears the Uniform Case Assessment Protocol
used by both the VA and DOD is not being consistently followed,
and often permits a description of symptoms to serve as a
diagnosis.\388\
---------------------------------------------------------------------------
\387\ See supra note 227, p. 5 [390 of 15,000 cases].
\388\ Ibid., p. 4.
---------------------------------------------------------------------------
This lack of aggressive inquiry leaves the VA without the
body of detailed test results and clinical assessments needed
to discern the subtle manifestations of delayed neuropathies.
Absent more effective use of the Referral Centers, the Registry
will remain a mere inventory of inconsistently gathered case
histories.
Recommendation 5: The VA should add toxicological and environmental
medicine expertise to the staff resources dedicated to Gulf War
illnesses.
In the December 11, 1996 subcommittee hearing, Chairman
Shays asked Dr. Frances Murphy of the VA how many toxicologists
and environmental medicine specialists were among the estimated
14,000 VA physicians (approximately 8,000 full-time and 6,000
part-time).
Dr. Murphy could not answer the question, other than to
name two physicians, but did say such experts usually work in
health care organizations, research laboratories, or agencies
like the EPA. Dr. Murphy promised to provide an answer for the
record.\389\
---------------------------------------------------------------------------
\389\ See supra note 174.
---------------------------------------------------------------------------
One of the reasons VA doctors have been unable to diagnose
and treat the illnesses of some Gulf veterans is the lack of
expertise in the specialties of toxicology and environmental
medicine. Dr. Robert Haley, University of Texas Medical Center
researcher, stated in testimony before the subcommittee in
January 1997, that ``few regular physicians are familiar with
OPIDPN [organophosphate-induced-delayed-polyneuropathy] . . .
this probably explains why no one [in the VA] explored this
diagnosis earlier.'' \390\
---------------------------------------------------------------------------
\390\ See supra note 325.
---------------------------------------------------------------------------
In response to Representative Shays' question, the
following letter was received from Dr. Kenneth Kizer \391\ on
June 6, 1997:
---------------------------------------------------------------------------
\391\ Letter in subcommittee files.
The subcommittee supports the VA's belated effort on this
matter and encourages an aggressive program to bring such
expertise into the Department as quickly as possible. Such an
effort, accompanied by a sincere communications effort on the
part of VA headquarters to physicians in the field, would help
restore confidence in the VA's medical protocols among Gulf
veterans and the Congress.
Recommendation 6: DOD and VA should make every effort to find, and
where necessary re-create through veterans' testimony,
individual Gulf War medical records to reflect vaccines
administered, PB use, and exposure to DU, pesticides and other
hazardous materials.
According to the GAO, ongoing epidemiological research
sponsored by the VA and DOD is being hampered by the inability
of researchers ``to gather information about toxic exposures.
DOD has acknowledged that the records of the use of PB and
vaccinations to protect against chemical and biological warfare
exposures were inadequate. There is research going on right now
to try to find the majority of the records, which seem to be
missing. Classifying the symptoms and identifying illnesses of
Gulf War veterans has been difficult. As a result, the findings
from these studies may be spurious or equivocal. In summary,
the ongoing epidemiological research will not be able to
provide precise, accurate, and conclusive answers regarding the
causes of the illnesses because of these formidable
methological problems.'' \392\
---------------------------------------------------------------------------
\392\ Statement of Donna Hevilin, Human Resources Subcommittee
hearings, No. 3, p. 38.
---------------------------------------------------------------------------
An IOM report stated: ``The committee has concluded that
the information on veterans' health that exists in the [DOD and
VA health] registries cannot serve alone as a basis for
scientific study of the health effects of the Persian Gulf War.
Lack of uniform and retrievable medical information concerning
reserve, National Guard, active, and separated forces has
greatly inhibited systematic analysis of the health effects of
mobilization. Neither the DOD nor VA has automated outpatient
recordkeeping. Current systems are fragmented, disorganized,
incomplete, and therefore poorly suited to support
epidemiologic and health outcome studies.'' \393\
---------------------------------------------------------------------------
\393\ See supra note 125, pp. 6-7.
---------------------------------------------------------------------------
According to the PAC Final Report, ``We found DOD's
inability to produce records of who received PB or BT
[botulinum toxoid] indicative of much need for wholesale
improvement in the government's performance on medical
recordkeeping during military engagements. DOD should assign a
high priority to dealing with the problem of lost or missing
medical records. A computerized data base is important.
Attention should be directed toward developing a mechanism for
computerizing medical data in the field. DOD and VA should
adopt standardized recordkeeping to ensure continuity.'' \394\
---------------------------------------------------------------------------
\394\ See supra note 138, pp. 18-19.
---------------------------------------------------------------------------
Missing or inadequate personal medical records, along with
missing or destroyed NBC logs, and unreleased CIA intelligence
logs, comprise the complete medical history of each Gulf War
veteran. In the absence of this critical information, sick
veterans have a difficult--if not impossible--task of receiving
proper medical treatment and fair compensation. DOD and VA
should make every effort to find these records,\395\ and where
necessary recreate them through listening carefully to
veterans' testimony. Under these present conditions, the burden
of proving a service-connected disability should not fall on
the sick veteran but upon the government. In other words, the
sick Gulf War veteran should be given benefit of the doubt.
---------------------------------------------------------------------------
\395\ See text to accompany note 181. See also, Background section
entitled ``Other Executive Agency Actions on Gulf Veterans'
Illnesses.'' [On October 21, 1997, the Department of Defense Inspector
General informed the subcommittee that the investigation into missing
nuclear, biological and chemical logs had been completed. Only 37 of an
estimated 200 pages of log entries are retrievable, all in hard copy
form. Print-outs of the complete logs, and the computer disks and
drives on which they were stored, cannot be found. The investigation
discovered a 20-page document containing 165 missing entries, or
approximately 15 new log pages. The IG found that regulations and
guidelines on the preservation and archiving of Gulf War documents were
not followed by CENTCOM. Although the officer found in possession of
the mission log extracts is under criminal investigation, the IG did
not receive any evidence that individuals or organizations conducted a
concerted effort or conspiracy to destroy or conceal the logs.]
---------------------------------------------------------------------------
Recommendation 7: The President should order an intensified effort to
declassify Gulf War documents in any way related to Gulf War
veterans' illnesses and should personally certify to the
appropriate committees of Congress when he deems
declassification of such documents to be against the national
interest.
After 6 years, it should be clear by now that ordinary
processes of Government inquiry and disclosure will not yield
solutions to the mysteries of Gulf War veterans illnesses.
Extraordinary steps must now be taken to declassify and
disseminate all information in any way pertinent to the health
of those who served.
The disclosure of Central Intelligence Agency [CIA] reports
regarding chemical weapons at the Khamisiyah munitions depot,
and the apparent loss or destruction of more than three
quarters of the chemical weapons logs produced during the Gulf
War, appear to confirm what many have long suspected about a
systematic, and to date largely successful, effort to minimize,
discredit or suppress intelligence data on alleged chemical
exposures.
To a sick veteran, the missing unit logs, chemical
detection reports and intelligence analyses are not just
military records. They are medical records essential to the
proper diagnosis and treatment of Gulf War-related illnesses.
The current DOD system of random, unannounced posting of newly
discovered documents on the Internet simply does not meet
demands by veterans and Congress for timely, full disclosure.
The so-called ``firewall'' erected to protect intelligence
sources and methods must yield in this instance to the
president's own promise that ``no stone remain unturned'' in
the search for answers to Gulf War veterans' illnesses.
Moreover, if the intelligence sources and methods sought to be
protected also formed the basis of the long-held, but now
discredited, Pentagon and CIA conclusion that stories of
chemical weapons at Khamisiyah were an Iraqi ruse, then those
sources and methods were unreliable, unworthy of continued
protection, and far less valuable to the national interest than
the health of United States veterans.
Therefore, the President should direct an immediate and
expanded declassification review of all CIA and Defense
Department intelligence dealing in any way with chemical or
biological exposures in the Gulf War, and that all such
information be made available to Congress unless the President
personally determines disclosure would be harmful to the
national security.
Recommendation 8: DOD failure to adhere to recordkeeping requirements
or clinical protocols under an informed consent waiver should
result in the presumption of service-connection for any
subsequent illness(es) suffered by service personnel to whom
the drug or protocol was administered.
FDA's Deputy Commissioner Mary Pendergast told the
subcommittee at a May 8, 1997 hearing on informed consent that
``Under this regulation, waivers were granted for two products
during Operation Desert Storm/Shield--pyridostigmine bromide
and botulinum toxoid vaccine. Although FDA had concluded that
informed consent was not feasible, FDA did obtain DOD's
agreement to provide accurate, fair and balanced information to
those who would receive the investigational products. To do
this, DOD developed information leaflets on both products with
FDA's input and these leaflets received final FDA approval.''
\396\
---------------------------------------------------------------------------
\396\ Hearing on Oversight of NIH and FDA: Bio-Ethics and the
Adequacy of Informed Consent, [hereinafter ``Human Resources
Subcommittee hearing of May 8, 1997''] (Statement of Mary Pendergast,
FDA Deputy Commissioner) (prepared statement p. 37, in subcommittee
files).
---------------------------------------------------------------------------
FDA has acknowledged that the information sheets were not
provided to many Gulf personnel who were ordered to take the
unapproved drug and vaccine. In testimony before the
subcommittee, Deputy Commissioner Pendergast testified ``were
we [FDA] even to consider another waiver request, the specific
standards would have to be much higher and more rigorous
because of the [DOD] failures.'' \397\
---------------------------------------------------------------------------
\397\ Testimony of Mary Pendergast, Human Resources Subcommittee
hearing of May 8, 1997, original transcript, p. 59 (in subcommittee
files).
---------------------------------------------------------------------------
It is unfair to require the veteran to prove he or she was
exposed to either the PB or the vaccine in light of DOD's
blatant failure to adhere to the notification requirements of
the FDA waiver.
Treatment
Recommendation 9: VA and DOD should systematically and effectively
monitor the clinical progress of Gulf War veterans to determine
the most effective treatments.
The June 24, 1997 GAO report found that the VA has no
program, plans or systematic way of following the clinical
progress of sick Gulf War veterans. As a result, VA physicians
treating these veterans have no way of knowing whether the
veterans who continue to be ill are better off today than when
they were first examined and treated. Scientific analysis
requires the ability to draw conclusions based on objective and
accurate scientific data. The GAO study found that the VA and
DOD have made no effort to track veterans' progress and
treatment on a methodical, data-based system.\398\
---------------------------------------------------------------------------
\398\ See supra text to accompanying note 196.
---------------------------------------------------------------------------
Dr. Murphy responded there is no protocol because therapy
and the follow-up need to be tailored to the individual
veteran. However, evidence shows that veterans are not
receiving consistent follow-up care. If progress is only
recorded individually, then those treatments deemed successful
will have little or no impact on medical research efforts and
have limited significance for other veterans.\399\
---------------------------------------------------------------------------
\399\ See supra text to accompanying note 336.
---------------------------------------------------------------------------
The subcommittee recommends that the VA and DOD immediately
develop and implement a plan to systematically monitor the
diagnosis and treatment of all Gulf veterans with reported
symptoms as well as those who may become ill in the future.
This action on the part of the VA and DOD would provide a much-
needed medical benchmark against which treatment progress, or
lack of progress, can be measured for sick Gulf War veterans.
Recommendation 10: VA and DOD clinicians should be encouraged to
pursue, and should be trained in, new treatment approaches to
suspected neurotoxic exposure effects.
Private physicians have reported some success in treating
Gulf veterans--treatment approaches which have been ignored or
rejected by the VA and DOD medical hierarchies since the
illnesses were first reported more than 5 years ago. Dr. Howard
Urnovitz testified: ``Recent studies have found that prolonged
and aggressive antibiotic therapy appears to abate many of the
symptoms associated with Gulf War Syndrome.'' \400\
---------------------------------------------------------------------------
\400\ See supra text to accompanying note 90.
---------------------------------------------------------------------------
Dr. Garth Nicolson testified that among the Gulf veterans
he has examined, he found ``. . . a slow-growing mycoplasma
located deep inside blood leukocytes of slightly under one-half
of Gulf War patients studied. Mycoplasmal infections, such as
Mycoplasma fermentans, can be successfully treated with
multiple courses of specific antibiotics, such as
doxycycline.'' \401\
---------------------------------------------------------------------------
\401\ See supra text accompanying note 92.
---------------------------------------------------------------------------
Dr. William Baumzweiger has reported successful treatments
of Gulf veterans with calcium channel blockers. Dr. Katherine
Leisure-Murray also reported improvement in some of her Gulf
patients with alternative treatments. Both physicians were
formerly with the VA but terminated, they allege, because of
their professional opinions as to the cause and treatment of
Gulf veterans' illnesses, opinions in opposition to VA
headquarters policy.\402\
---------------------------------------------------------------------------
\402\ See supra text accompanying note 189.
---------------------------------------------------------------------------
The subcommittee has received reports from VA doctors in
addition to Drs. Baumzweiger and Leisure of harassment,
threats, and denial of certain tests and treatments by their
supervisors. Such restrictions could be considered a violation
of medical ethics, if not medical malpractice.
The subcommittee recommends that the VA and DOD encourage
their physicians to train in, and actively pursue, new
treatment approaches to suspected neurotoxic exposure effects.
This encouragement would also include allowing Government
doctors to consult with private physicians who have reported
some successful treatments with Gulf War patients. Such an
effort by the departments, accompanied by a sincere and ongoing
communications effort to VA supervisors in the field, would
help alter a perception by veterans and the subcommittee that
the VA, in complicity with field supervisors, has conspired to
stifle VA physicians from fully and freely practicing medicine
on behalf of their Gulf patients.
Recommendation 11: The diagnoses for somatoform disorders and Post
Traumatic Stress Disorder [PTSD] should be refined to insure
that physiological causes are not overlooked.
In the absence of definitive medical evidence to explain
the mysterious illnesses of Gulf veterans, DOD and VA
physicians assumed the causes of many of these illnesses were
stress-related or PTSD. Through subcommittee testimony, letters
and phone calls, sick veterans have universally rejected
psychiatric problems as an accurate diagnosis of their physical
illnesses.\403\ Many private physicians and research experts
have also rejected stress as an important factor in these
illnesses.\404\
---------------------------------------------------------------------------
\403\ See supra text accompanying notes 11-39.
\404\ See supra text accompanying notes 185-194.
---------------------------------------------------------------------------
The GAO report recommended: ``The Secretaries of Defense
and Veterans Affairs refine the current approaches of the
clinical and research programs for diagnosing PTSD consistent
with suggestions recently made by the Institute of Medicine.''
\405\ The DOD partially concurs with this recommendation; \406\
the VA does not concur.\407\ The Persian Gulf Veterans
Coordinating Board, which includes DOD and VA representatives,
stated: ``Published findings suggest an increased prevalence of
PTSD and other psychiatric diagnoses, such as depression . . .
[and that] stressors during the Persian Gulf conflict were
sufficient to cause significant psychiatric morbidity.'' \408\
The PAC Final Report also states that ``stress is an important
contributing factor'' in the veterans' illnesses.\409\
---------------------------------------------------------------------------
\405\ See supra note 48, p. 70.
\406\ Ibid.
\407\ Ibid., p. 85.
\408\ Ibid., p. 57.
\409\ Ibid., p. 56.
---------------------------------------------------------------------------
The GAO report stated: ``The link between stress and those
veterans' physical symptoms has not been firmly established [by
DOD, VA and the PAC].''\410\
---------------------------------------------------------------------------
\410\ Ibid., p. 8.
---------------------------------------------------------------------------
The subcommittee, in view of the fact that there is no
credible evidence that stress or PTSD is the principal cause of
the veterans' illnesses, recommends that the DOD and VA re-
evaluate and refine the definition of stress as it applies to
Gulf veterans' diagnoses. Such a re-definition would create a
new and much-needed diagnostic and treatment attitude among VA
field physicians which could translate into improved medical
care for sick Gulf veterans.
Compensation
Recommendation 12: Denials of Gulf War veterans' compensation claims
attributable in any way to missing medical records should be
reviewed and veterans' given the benefit of any doubt regarding
the presumptive role of toxic exposures in causing post-war
illnesses and disability.
Personal medical records of Gulf veterans are missing or
inadequate. Documents which could help verify possible
exposures and military unit locations remain in DOD files. Most
of the military nuclear-biological-chemical [NBC] logs, which
are records of toxic warfare agent detections, are missing or
destroyed. Readouts from chemical detection equipment have
vanished. Many CIA intelligence logs concerning Iraqi chemical/
biological weapons [CBW] storage depots and manufacturing
facilities, and document regarding enemy capabilities and
intentions to use CBW against United States troops, have
remained unreleased since the war.\411\
---------------------------------------------------------------------------
\411\ See supra text accompanying note 181.
---------------------------------------------------------------------------
All this critical information represents the complete
medical history of each Gulf War veteran. In the absence of
full documentation needed to prove a service-connection, sick
veterans have a difficult--if not impossible--task of receiving
proper medical treatment and fair compensation.
This situation, combined with the fact that overwhelming
evidence exists of multiple toxic exposures to Gulf War troops,
has led the subcommittee to strongly recommend that sick
veterans be given the benefit of the doubt regarding their
post-war illness and disability. Those sick veterans should be
considered ``presumed exposed'' and, therefore, entitled to
full medical treatment and fair financial compensation.
Recommendation 13: For purposes of compensation determinations,
disabilities associated with presumed exposures should be
deemed service-connected without any limitation as to time.
Under regulations issued in 1995, a veterans can be
compensated only for undiagnosed illnesses that manifest
themselves during Gulf War service or arise within 2 years of
departing from the Gulf. Veterans must provide objective
evidence of chronic illness and be at least 10 percent
disabled. As of January 1997, the VA had denied 93.5 percent of
the more than 10,000 undiagnosed illness claims that had been
reviewed. Approximately 55 percent of the denied claims were
rejected because the illness did not manifest itself until
after the 2-year presumptive period. In March 1997, President
Clinton extended the presumptive period by 8 years, until
December 31, 2001. The VA plans to reconsider those claims
denied because they were filed after the 2-year presumptive
limitation.\412\
---------------------------------------------------------------------------
\412\ See supra text accompanying note 183.
---------------------------------------------------------------------------
However, veterans and veterans organizations are concerned
that symptoms from toxic exposures may develop beyond the year
2001 from diseases with long latency periods, such as some
forms of cancer, leishmaniasis or other infectious diseases
that may develop from a weakened immune system. The possibility
of late-developing illnesses are also feared by some physicians
and researchers.
James Tuite, director of the Gulf War Resource Foundation,
stated to subcommittee staff that veterans of no previous wars
faced a presumptive period for filing service-connected medical
claims by veterans.\413\
---------------------------------------------------------------------------
\413\ Staff notes in subcommittee files.
---------------------------------------------------------------------------
The subcommittee, mindful of the Agent Orange toxic
exposure problem which took Congress 20 years to resolve, is
also concerned about late developing symptoms among Gulf
veterans. The subcommittee strongly recommends that the
President lift entirely the presumptive period on filing
medical claims by Gulf War veterans for specified illnesses
associated with presumed exposure to certain toxins known to
have been present in the Gulf theater. This Presidential action
will assure all veterans that a grateful Nation will not
abandon its soldiers who suffer long-term health effects
following its wars.
Research
Recommendation 14: Congress should create or designate an agency
independent from the Departments of Defense and Veterans
Affairs as the lead Federal agency responsible for coordination
of all research into Gulf War veterans' illnesses and
allocation of all research funds.
Regrettably for sick veterans, VA research has been
distorted by reliance on premature, erroneous, and misleading
conclusions by DOD about the presence and effects of chemical
weapons in the Gulf War theater. It was not until DOD admission
of probable exposures at Khamisiyah that the Persian Gulf
Veterans' Coordinating Board even considered the possibility of
low level chemical exposures as the cause of PGW illnesses. Dr.
Frances Murphy, the VA's Director of Environmental Agents
Service, described the Department's official position on low
level chemical exposures as the causative agent for PGW
illnesses, ``studies of low level chemical warfare agent
exposure were not given high priority . . . because military
and intelligence sources had stated that U.S. troops had not
been exposed to chemical agents. Current body of research
proves that low level exposures cannot cause health effects.''
\414\
---------------------------------------------------------------------------
\414\ See supra note 166.
---------------------------------------------------------------------------
Testimony presented to the subcommittee strongly suggests
that VA relied heavily on somatoform and stress-related
diagnoses in sick PGW veterans. Twenty one Gulf veterans, sick
with undiagnosed illnesses, testified before the subcommittee.
Of those 21 veterans, 13 received stress or PTSD diagnoses, 3
received a diagnosis of no illness or psychosomatic, 3 cases
were undiagnosed and only 2 were diagnosed with chemical
exposure.\415\
---------------------------------------------------------------------------
\415\ See supra note 190.
---------------------------------------------------------------------------
The VA also failed to heed the advice of its advisory
committee, the Gulf War Expert Scientific Committee, on the
possibility of toxic exposures. Both the chairman, Dr. Eula
Bingham (a toxicologist and former chairman of OSHA) and
committee member Dr. Claudia Miller (a physician and
environmental research professor), stated in interviews with
the New York Times that the VA was relying inappropriately on
stress diagnoses despite knowledge of toxic exposures during
the war.\416\
---------------------------------------------------------------------------
\416\ Ibid.
---------------------------------------------------------------------------
At the same time the Coordinating Board was denying the
relationship between chemical exposures and PGW illnesses, it
also denied funding to Dr. Robert Haley and his colleagues at
the University of Texas Southwestern Medical Center to study
chemical exposures in PGW veterans. Dr. Haley found private,
non-Government funding and published several studies in the
January 15, 1997 issue of the Journal of the American Medical
Association, confirming evidence of immunological damage to PGW
troops produced by combinations of chemical exposures.
DOD and VA's Persian Gulf Veterans' Coordinating Board has
performed reactively and to the detriment of the veterans.
Having demonstrated unwillingness and inability to overcome
institutional biases and constraints, the DOD and VA should no
longer control the PGW illness research agenda. Lead
responsibility for both the research program and research funds
should go to another agency outside of DOD and VA that can more
objectively develop a research agenda and treatment protocols
for sick veterans.
Recommendation 15: The lead Federal agency on Gulf War veterans'
illnesses should focus research on the evaluation and treatment
of the common spectrum of neuroimmunological disorders known as
Gulf War Syndrome, multiple chemical sensitivity, chronic
fatigue syndrome and fibromyalgia.
The Federal Government has numerous agencies conducting
uncoordinated research on neuroimmunological disorders. HHS has
established an interagency Chronic Fatigue Syndrome Working
Group, which is chaired by the Assistant Secretary for Health.
Many of the National Institutes of Health, including the
National Institute of Environmental Health Sciences [NIEHS],
National Institute of Allergy and Infectious Diseases [NIAID],
National Institute of Arthritis and Musculoskeletal and Skin
Diseases [NIAMS], National Institute of Child Health and Human
Development [NICHD], and National Institute of Dental Research
[NIDR], are conducting research on multiple chemical
sensitivity, fibromyalgia and chronic fatigue syndrome.
CDC has an ongoing epidemiological study of Persian Gulf
War veterans which has resulted in a case definition. CDC's
National Institute of Occupational Safety and Health [NIOSH] is
conducting research on exposures to organophosphates. VA and
DOD are pursuing their own independent research agendas.
However the neuroimmunological injuries occurred to PGW
veterans and others affected by similar disorders, the fact
remains that evaluation criteria are lacking, definitive
diagnostic tests are not yet accepted, and treatment of these
disorders remains symptomatic and is often unavailable to
patients in need.
Recommendation 16: DOD and VA medical systems should augment research
and clinical capabilities with regard to women's health issues
and the health effects of combat service on women's health.
The Persian Gulf War was the first military action in which
women were deployed in large numbers in combat situations. Dr.
Penny Pierce, a PGW veteran and scientist who has conducted
comparative studies on the health of female PGW veterans before
and after deployment, found ``the incidence of gender-specific
health problems, in particular, warrants further attention and
points directly to the unique health care needs of military
women. Specifically there is a need for rigorous follow-up on
the significant findings concerning changes in breast lumps and
cervical alterations that are reflected in the two-fold
increase among women serving in the Persian Gulf. We need to
know now if there are gynecologic and reproductive problems
that pose a risk to future generations that are beneficiaries
of military health care.''
Dr. Pierce concluded, ``the opportunity to study the health
consequences of Persian Gulf women in a timely fashion meets a
critical and long-standing need. The priorities for a national
agenda of military women's health research should include the
following: First, we should commit the needed resources to
establish the prevalence of health problems of Gulf War veteran
women in well-designed epidemiological studies. Second, we need
to document and monitor the health effects of occupational and
environmental extremes found in combat, to better understand
the effects of gender, menstrual cycle, reproductive
capability, and the interaction of these factors on the health
and well-being of American women who serve their country in
uniform. In this regard we must all recognize that
environmental and occupational exposures may affect women
differently than men and we need to have scientific information
upon which we can reliably determine if they are preventable
risks that are associated with specific military duties,
certain deployment locations, or a combination of factors. The
third priority acknowledges that women play a key role in the
military readiness of this country and keeping them healthy is
as vital to our Nation's defense as any other member of the
armed forces.'' \417\
---------------------------------------------------------------------------
\417\ Statement of Penny Pierce, Human Resources Subcommittee
hearings, No. 1-4, p. 193-194.
---------------------------------------------------------------------------
Recommendation 17: VA, in collaboration with NIH, CDC, FDA and other
public health agencies should establish an interdisciplinary
research and clinical program on the identification, prevention
and treatment of environmentally induced neuropathies.
VA and DOD will have to address environmentally induced
neuropathies in future deployments.\418\ A research and
clinical program which addresses treatment issues and exposure
prevention is long overdue.
---------------------------------------------------------------------------
\418\ Representative Sanders, joined by Representative Shays,
pursued an amendment to the 1998 Department of Defense Authorization
bill for 1998, H.R. 1119. The proposal would direct the Department of
Defense, in cooperation with the Environmental health laboratory of the
Centers for Disease Control, to develop a system capable of rapidly
responding in cases of suspected exposure of members of the Armed
Forces to toxic substances, in order to conduct laboratory tests to
quickly and accurately test for the presence of toxic substances. The
CDC reports it has the technology, like no other laboratory in the
Government, to test for at least 100 chemicals in blood and urine,
including heavy metals, PCBs, volatile organic compounds, pesticides
and others. This is a pro-active, comprehensive approach to address and
respond to potential chemical exposures during future military
operations. The amendment was not made in order by the Rules Committee
and therefore was not permitted to be offered on the floor of the
House.
---------------------------------------------------------------------------
The expertise of VA and DOD could be considerably expanded
through coordination and collaboration with HHS. HHS has
expertise in toxicology through the Agency for Toxic Substances
and Disease Registry [ATSDR] and the National Institute for
Environmental Health Sciences at the National Institutes of
Health, the National Center for Toxicological Research at the
Food and Drug Administration [FDA], and in epidemiology through
the Centers for Disease Control and Prevention [CDC].
This type of interdisciplinary research has also been
conducted internationally, particularly in Israel and the
Netherlands. In March 1997, the VA sponsored a 2-day symposium
on ``The Health Effects of Low-Level Chemical Warfare Nerve
Agent Exposure'' featuring presentations from researchers
studying various aspects of this complex issue. Presenters
discussed ongoing studies of Organophosphate Induced Delayed
Polyneuropathies and clinical outcomes from exposures to
anticholinesterases. Dr. Hermona Soreq, professor and chairman,
Department of Biological Chemistry, Hebrew University,
Jerusalem, Israel, described the role of genetic polymorphisms
in effectuating certain toxic reactions. The preliminary
results of recent animal studies, conducted in the United
States and the Netherlands on the effects of low-level
exposures, were also discussed. According to VA officials, the
purpose of the conference was to generate research hypotheses
and study proposals. This is the type of work the subcommittee
recommends, and encourages continued strengthening of
interdisciplinary research capacity.\419\
---------------------------------------------------------------------------
\419\ U.S. Department of Veterans Affairs, The Health Effects of
Low-Level Chemical Warfare Nerve Agent Exposure, a satellite symposium
of the 36th Annual Society of Toxicology Annual Meeting, March 7-8,
1997, Cincinnati, OH (agenda, program notes, speaker index) in
subcommittee files.
---------------------------------------------------------------------------
Recommendation 18: FDA should grant a waiver of informed consent
requirements for the use of experimental or investigational
drugs by DOD only upon receipt of a Presidential finding of
efficacy and need.
FDA has the authority under the Federal Food, Drug and
Cosmetic Act [FFDCA] to determine a drug's safety and efficacy
for its intended use. In the case of a future DOD request to
waive informed consent requirements for an experimental or
investigational drug, biologic or device, FDA can evaluate the
clinical evidence to determine safety and effectiveness, but
should not be in a position to evaluate combat conditions.
FDA Deputy Commissioner Mary Pendergast acknowledged this
in testimony before the subcommittee on May 8, 1997. ``FDA gave
considerable deference to DOD's judgement and expertise
regarding the feasibility of obtaining informed consent under
battlefield conditions.'' \420\
---------------------------------------------------------------------------
\420\ Prepared statement of Mary Pendergast, Human Resources
Subcommittee hearing of May 8, 1997, p. 35 (in subcommittee files).
---------------------------------------------------------------------------
She added, ``I also think that the FDA, which is an agency
staffed with doctors and scientists and not soldiers, has a
very limited ability to second-guess what was going on in the
Persian Gulf during the time of the war . . .'' \421\ However,
she acknowledged, ``Each participant in a research effort . . .
is obliged to protect the interests of the people who are
taking part in the experiments. The FDA's responsibility is to
see that the safeguards are met.'' \422\
---------------------------------------------------------------------------
\421\ Testimony of Mary Pendergast, Human Resources Subcommittee
hearing of May 8, 1997, original transcript, p. 60 (in subcommittee
files).
\422\ See supra note 417, p. 2.
---------------------------------------------------------------------------
FDA did not safeguard the interests of the PGW veterans by
ensuring that the waiver was warranted by the protective
effects of PB and that the conditions of the waiver were
adhered to by DOD. DOD violated the conditions of the waiver by
not providing the information sheets so that affected veterans
would know of their exposures.
Clearly, FDA should not be in the position of making
national security determinations or weighing safety and
efficacy requirements against national security interests. This
is not the agency's focus and the FDA has admitted it has no
expertise in these areas.
The President, as Commander and Chief, should execute a
Presidential finding of need if a determination is made that
national security interests outweigh the informed consent
rights of troops in combat in the future.
V. Appendix
PGW Hearing Witnesses
1. ``The Status of Efforts to Identify Persian Gulf War
Syndrome'' March 11, 1996. Brian Martin, Gulf veteran, Niles,
MI; William Gleason, Gulf veteran, Syracuse, NY; Randy Wheeler,
Gulf veteran, Hoover, AL; Kimo Hollingsworth, Gulf veteran,
Washington, DC; Dr. John Bailar, chair, Committee to Review
Health Consequences of Service During the Gulf War, Institute
of Medicine; Thomas Cross, Gulf veteran, member, Presidential
Advisory Committee on GW Veterans Illnesses; Charles Sheehan-
Miles, executive director, National Gulf War Resources Center;
Dr. Robyn Nishimi, executive director, Presidential Advisory
Committee; Matthew Puglisi, assistant director, National
Veterans Affairs and Rehabilitation Commission, American
Legion; Kelli Willard-West, director of government relations,
Vietnam Veterans of America; Dennis Cullinan, deputy director,
National Legislative Service, Veterans of Foreign Wars; Lennox
Gilmer, associate national legislative director, Disabled
American Veterans; and, Scott Vanderhayden, Gulf War Service
Coordinator, Vietnam Veterans Agent Orange Victims.
2. ``Status of Efforts to Identify Gulf War Syndrome, Part
II'' March 28, 1996. Dr. Thomas Garthwaite, Deputy Under
Secretary of Health, Department of Veterans Affairs; Dr. Daniel
Clauw, assistant professor, Georgetown University School of
Medicine; Dr. Penny Pierce, Gulf veteran, University of
Michigan School of Nursing; and, Dr. Howard Urnovitz, chief
scientific officer, Calptye Biomedical Corp.
3. ``Status of Efforts to Identify Gulf War Syndrome, Part
III'' June 25, 1996. Dr. Stephen Joseph, Assistant Secretary
for Health Affairs, Department of Defense; Gary Hickman,
Director of Atlanta Regional Office, Department of Veterans
Affairs; Diane Dulka, widow of Gulf veteran Joseph Dulka,
Windsor Locks, CT; and, Dr. William Marcus, toxicologist,
Washington, DC.
4. ``Status of Efforts to Identify Gulf War Syndrome, Part
IV'' September 19, 1996. Brian Martin, Gulf veteran, Niles, MI;
Barry Kapplan, Gulf veteran, Southington, CT; Nancy Kapplan,
registered nurse, Southington, CT; Nick Roberts, Gulf veteran,
Port St. Joe Beach, FL; Denise Nichols, Gulf veteran, Wheat
Ridge, CO; Sylvia Copeland, Chief, PGW Veterans Task Force,
Central Intelligence Agency; Dr. Frances Murphy, Director,
Environmental Agents Service, Department of Veterans Affairs;
James Tuite, director, Gulf War Research Foundation; Dr.
William Baumzweiger, neurologist and psychiatrist, Los Angeles,
CA; Dr. Claudia Miller, assistant professor, Environmental &
Occupational Medicine, University of Texas Health Science
Center; and, Dr. Stephanie Padilla, research neurotoxicologist,
Environmental Protection Agency.
5. ``Persian Gulf Veterans' Illnesses'' December 10, 1996.
Major Michael Johnson, U.S. Army, Gulf veteran; Gy/Sgt. George
Grass, U.S. Marine Corps, Gulf veteran; Major Randy Hebert,
U.S. Marine Corps (retired), Gulf veteran; Patrick Eddington,
former Analyst, Central Intelligence Agency; Julia Dyckman,
Gulf veteran, Harrisburg, PA; and, Robert Larrisey, Gulf
veteran, Chalphont, PA.
6. ``Persian Gulf War Veterans' Illnesses'' December 11,
1997. Dr. Susan Mather, Chief, Public Health & Environmental
Hazards Officer, Department of Veterans Affairs; Dr. Charles
Jackson, physician, Tuskegee (AL) VA Medical Center; and, Dr.
Victor Gordan, physician, Manchester (NH) VA Medical Center.
7. ``Gulf War Syndrome: To Examine New Studies Suggesting
Links Between Gulf Service and Higher Rates of Illnesses''
January 21, 1997. Dr. Kenneth Kizer, Under Secretary for
Health, Department of Veterans Affairs; Dr. Bernard Rostker,
Special Assistant for GW Illnesses, Department of Defense;
Admiral Donald Custis, M.D. (retired), member, Presidential
Advisory Committee on GW Veterans' Illnesses; Dr. Robert Haley,
director of epidemiology, University of Texas Southwestern
Medical Center; Dr. David Schwartz, professor of internal and
preventive medicine, University of Iowa School of Medicine; Dr.
Frank Duffy, associate professor of neurology, Harvard Medical
School; Chris Kornkven, Gulf veteran, Watertown, WI; James
Brown, Gulf veteran, Hannibal, MO; and, James Green, Gulf
veteran, Fishertown, PA.
8. ``Status of the Department of Veteran's Affairs to
Identify Gulf War Syndrome'' April 24, 1997. Michael Donnelly,
Gulf veteran, South Windsor, CT; Susan Sumpter-Loebig, Gulf
veteran, Hagerstown, MD; Steven Wood, Gulf veteran,
Grossostheim, Germany; Dr. Bernard Rostker, Special Assistant
for GW Illnesses, Department of Defense; Robert Walpole,
Special Assistant for GW Illnesses, Central Intelligence
Agency; Donald Mancuso, Deputy Inspector General, Department of
Defense; Dr. Jonathan Tucker, Center for Non-Proliferation
Studies, Monterey (CA) Institute of International Studies; Dr.
Satu Somani, professor of pharmacology and toxicology,
University of Southern Illinois School of Medicine; and, Dr.
Thomas Tiedt, researcher and neuroscientist, Longboat Key, FL.
9. ``The Status of Efforts to Identify Persian Gulf War
Syndrome: Recent GAO Findings'' June 24, 1997. Dr. Donna
Heivilin, Director, Planning and Reporting, General Accounting
Office.
10. ``Status of Efforts to Identify Gulf War Syndrome:
Multiple Toxic Exposures'' June 26, 1997. Gilbert Roman, Gulf
veteran, Denver, CO; Paul Canterbury, Gulf veteran, Ashley, OH;
Michael Stacy, Gulf veteran, Inola, OK; S/Sgt. Mark Zeller,
U.S. Army, Ft. Rucker, AL; Dr. Thomas Garthwaite, Deputy Under
Secretary for Health, Department of Veterans Affairs; Dr.
Bernard Rostker, Special Assistant for GW Illnesses, Department
of Defense; Dr. Garth Nicolson, chief scientist, Institute for
Molecular Medicine; Dr. Asaf Durakovic, researcher and
radiation expert, Silver Spring, MD; and, Leonard Dietz,
General Electric scientist (retired), Niskayuna, NY.
11. ``The Oversight of NIH and FDA: Bio-Ethics & the
Adequacy of Informed Consent'' May 8, 1997. Dr. William Raub,
Deputy Assistant Secretary, Department of Health and Human
Services; Dr. David Satcher, Director, Center for Disease
Control and Prevention; Dr. Harold Varmus, Director, National
Institutes of Health; Mary Pendergast, J.D., Deputy
Commissioner, Food and Drug Administration; Dr. Arthur Caplan,
professor of Bio-Ethics, University of Pennsylvania; Dr.
Benjamin Wilfond, professor of pediatrics, University of
Arizona; Dr. Peter Lurie, professor of medicine, University of
California--San Francisco; and, Laurie Flynn, executive
director, National Alliance for the Mentally Ill.
ADDITIONAL VIEWS OF HON. HENRY A. WAXMAN, HON. EDOLPHUS TOWNS, HON.
PAUL E. KANJORSKI, HON. THOMAS M. BARRETT, HON. ELEANOR HOLMES NORTON,
HON. CHAKA FATTAH, HON. ELIJAH E. CUMMINGS, HON. DANNY K. DAVIS, HON.
JOHN F. TIERNEY, AND HON. HAROLD E. FORD, JR.
The text of the majority report entitled ``Gulf War
Veterans' Illnesses: VA, DOD Continue to Resist Strong Evidence
Linking Toxic Causes to Chronic Health Effects'' is based on 11
hearings held by the Committee on Government Reform and
Oversight's Subcommittee on Human Resources. During those
hearings, the committee heard testimony and reviewed voluminous
documents provided by private citizens and the Federal
Departments.
Throughout those hearings, the minority repeatedly insisted
that the Department of Defense was uniquely situated to assist
in our investigation of chemical weapons exposure. The majority
report proves that basic point. Therefore, the purpose of these
additional views is to underscore the role of the DOD and make
additional suggestions that we believe would assist in the
ultimate goal of helping the veterans receive the care and
compensation they deserve.
Iraq invaded Kuwait on August 2, 1990. In support of United
Nations Resolution 660, the United States sent troops to the
Persian Gulf in Operation Desert Shield. About 5 months later,
Operation Desert Storm began with an air war against Iraq.
Forty days later, a four day ground war ensued. By the
conclusion of hostilities, the United States had committed
approximately 697,000 troops in the Gulf.
Troops who served in the Gulf were demographically
different from previous contingents of U.S. Forces, with 7
percent female troops and 17 percent of the force gathered from
Reserve and National Guard Personnel. (``Unexplained Illnesses
Among Desert Storm Veterans'', Archives of Internal Medicine,
February 13, 1995, volume 155). For reasons that are unknown,
it appears the Gulf War Syndrome is most common among Reservist
and National Guardsman, although a small percentage of active
duty soldiers have complained of similar illnesses.
The symptoms and ailments associated with Persian Gulf
service, span the spectrum of illnesses and diseases. Some
veterans described very specific symptoms, while others report
more general and non-specific ailments including, chronic
fatigue, memory and weight loss, joint pain, sleep disturbance,
rashes, chest pain, and shortness of breath, diarrhea and other
gastro-intestinal and other unexplained maladies. These
illnesses have occurred in varying degrees of seriousness and
do not appear to be fatal, but symptoms may be sufficiently
debilitating and chronic as to cause long-term suffering and
disability.
In response to congressional pressure concerning the
symptoms experienced by veterans, the Department of Veterans
Affairs began collecting data and compiling a Persian Gulf
Registry. The VA published the original Persian Gulf Registry
program manual (M-10, Part III) in December 1992. The uniform
case assessment protocol was implemented at VA medical centers
nationwide in June 1994 and introduced by an Under Secretary's
Health Information letter on June 22, 1994. VA published a
revised program manual on September 14, 1995.
All veterans who identify themselves through the Persian
Gulf Registry, as having served in the Persian Gulf War theater
of operations, are given a standard medical examination.
Seventy-seven percent of veterans who undergo this exam receive
a diagnosis and are treated at local VA medical centers. If a
diagnosis is not possible following the preliminary
examination, a referral for a follow-up exam is given at one of
the four Persian Gulf Referral Centers. These centers have
developed expertise in addressing symptoms arising out of
undiagnosed illnesses. Additional examinations are possible if
a diagnosis is not found following the second exam. Treatment
is provided based on the results of the exams.
To date there are no clear indications of what may cause
the disparate collection of symptoms appearing in veterans who
served in the Persian Gulf. However, it is known that while in
the Gulf states, the troops were exposed to a variety of
natural and artificial substances which could be hazardous
alone or in combination with other non-toxic substances. Those
substances include, but may not be limited to multiple pre-
deployment vaccinations; medical treatments designed to lessen
effects of potential chemical exposure; \1\ insect and rodent
repellents; tropical parasites; environmental hazards (such as
oil fires); and shrapnel from armor and ammunition made of
depleted uranium.
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\1\ Some of these medicines had not been approved by the Federal
Food and Drug Administration. They were considered ``investigational''.
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The VA has embarked upon several studies which consider the
possible use of biological or chemical agents. However, the
primary responsibility for potential chemical exposures or the
possible role of biological contaminants during the pendency of
the conflict would have belonged to the Department of Defense.
The DOD was uniquely situated to conduct or commission studies
to gage the likely interaction of medications or immunizations
provided soldiers and reservists in combination with air, soil
or water contaminants encountered by the troops. However, the
Department of Defense steadfastly maintained that chemical and/
or biological weapons were not used in the Gulf. Because of
this refusal to acknowledge these exposures, multiple
government agencies with research funding dedicated to the
resolution of the illnesses experienced by troops, wasted
countless dollars and valuable time in focusing on unlikely
sources of illnesses given the official account of battlefield
activities rendered by the Pentagon. While there may be a need
to maintain secrecy for troop protection during times of war,
that necessity must quickly vanish in the aftermath of a
conflict. The rationale of troop preservation and protection
used by the military in times of war to maintain secrecy must
produce candor in the aftermath of a conflict. Here, that need
to preserve and protect the health and well-being of troops
would have mandated a full and complete disclosure of chemical
and/or biological weapons used in the Gulf. These disclosures
may have reduced or eliminated needless suffering.
Unfortunately, that disclosure was not forthcoming. It was not
until June 21, 1996 that the Department of Defense acknowledged
that American troops were exposed to fall-out from chemical
agents. Therefore, we must concur with the findings of the
final report of the Presidential Advisory Commission (issued
January 7, 1997) which found that the Department of Defense had
been ``patronizing and dismissive of veterans'' concerns and
failed to act in good faith regarding knowledge of the
existence of documents which suggested chemical weapons
exposures.
However, we must note that since the publication of that
report, the DOD seems to have been chastened by the criticism
and has endeavored to engage in disclosure concerning chemical
and biological exposure. However, it appears that those efforts
may be hampered by internal and bureaucratic turf battles
between military and civilian Defense employees about the
necessity and level of disclosure. We trust that the actions of
this committee communicate a strong message. Those who favor
disclosure must be victorious in those internal battles. Their
defeat will mean that those who are charged with the
responsibility of defending freedom will be engaged in denying
and stifling the most precious rights of American citizens--the
right to be informed about governmental activities and to
demand accountability of public officials. In a democracy,
accountability cannot be suspended even during times of war.
The need for candor and openness in the military should be
self-evident. As a Nation, we cannot expect young people to
answer the call to war if they cannot expect to be treated
fairly and with compassion if they are injured in service to
their country. We commend the veterans who participated in
these hearings. By testifying before this committee and sharing
their stories, they have shown their continued belief and faith
in the democracy that they risked their lives defending. We
trust that the Department of Defense will follow their example.
We believe that the candor of the department will assist in the
diagnosis and treatment of these injured former and current
armed service personnel.
In addition to their health concerns, we believe greater
emphasis should be placed on the claims process. Approximately
76,000 veterans claims have been processed by the VA for
service-connected disability and compensation as a result of
their Persian Gulf experience.\2\ Of that number, approximately
22,300 have been approved for service-connected disability and
compensation. Therefore we were pleased that on January 7,
1996, when President Clinton endorsed a change in disability
rules for Persian Gulf War veterans that would allow more to
receive disability payments for ``undiagnosed illnesses''. We
trust that those veterans whose claims were denied previously
will be reassessed quickly.
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\2\ The VA cannot provide the total number for claims filed only by
Persian Gulf Veterans, because claims currently in the process are not
categorized by time or area of service. Unfortunately, they can only
provide figures on the number of claims by Persian Gulf veterans after
those claims have gone through the review process.
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Finally, we believe that future medical mysteries can and
should be avoided. In our investigation, we were shocked to
learn that the Pentagon would spend thousands of dollars
training and equipping each soldier, but fail to spend any
money in developing a system that would track their health
status. Therefore, we would recommend the implementation of a
baseline health evaluation prior to deployment; the development
of a computerized central database for medical records during a
military deployment and the use of a standardized system of
recordkeeping among the military branches.
Hon. Henry A. Waxman.
Hon. Edolphus Towns.
Hon. Paul E. Kanjorski.
Hon. Thomas M. Barrett.
Hon. Eleanor Holmes Norton.
Hon. Chaka Fattah.
Hon. Elijah E. Cummings.
Hon. Danny K. Davis.
Hon. John F. Tierney.
Hon. Harold E. Ford, Jr.
ADDITIONAL VIEWS OF HON. BERNARD SANDERS
I would like to express my appreciation for the time and
energy which Congressman Shays, Ranking Member Towns and the
committee staff have put into this investigation and this
Report. I would also like to express my concurrence with the
conclusions and recommendations in this report. As it happens,
it is my opinion that this report represents the most
comprehensive and accurate assessment of the complexities
surrounding Gulf War illnesses. I am delighted that the
Government Reform and Oversight Committee approved this report
and I believe we should promptly begin working on implementing
its recommendations in a timely manner. After 6 years of
virtually no progress in this area, we have no time to lose.
The U.S. Congress, along with the scientific and medical
community, the Veterans organizations and other concerned
bodies, must begin focussing on this issue in a way that has
not yet occurred. Our goal must be, as soon as possible, to
discover the causes of Gulf War illnesses and the most
effective treatments available.
Chairman Shays and his subcommittee have lead the effort
during the last 19 months to unravel the complexities
surrounding Gulf War illnesses. We have heard compelling
testimony from dozens of sick veterans--at times this testimony
was not only difficult for them to give, but was also painful
for the Members and the public to hear. The subcommittee heard
testimony from high level representatives from the Department
of Defense, the Veterans Administration, doctors and scientists
from around the world, the General Accounting Office and many
others. I would like to stress that the conclusions contained
in this report were not made lightly. They were drawn by
gathering of information from 11 subcommittee hearings and
thousands of pages of documents. Many many people testified at
these hearings and I would like to thank all of them for the
tremendous help they gave this committee.
The bottom line is this. After an exhaustive gathering of
the evidence, and careful analysis of the information which was
put before this subcommittee, it is my own conclusion that the
Department of Defense and the VA have failed miserably in
solving the problems of Gulf War illnesses and in developing
effective treatments for the tens of thousands of veterans who
are hurting--including hundreds in my own State of Vermont.
It is clear to almost everyone that, from the very
beginning of this situation, the DOD and the VA have downplayed
the whole issue of Gulf War illness. In the very beginning they
actually denied that there was any problem whatsoever. And
then, after finally acknowledging that there was a problem,
they concluded that the problem was in the heads of our
soldiers--of psychological origin. For 5 years, the Pentagon
denied that our soldiers had been exposed to any chemical
warfare agents. Finally, after being forced to admit that there
were exposures, they suggested that the exposures were
``limited''. The DOD's first estimates were 400 troops exposed,
then 20,000 troops. In July of this year, the DOD and CIA gave
us their best estimate--that as many as 98,910 American troops
could have been exposed to chemical warfare agents due to
destruction of ``the Pit'' in Khamisiyah, an Iraqi munitions
facility. I would not be surprised if this estimate is revised
upward in the not too distant future, as more information is
gathered regarding other incidents of chemical warfare
exposure. And on and on it goes. Getting information has been
like pulling teeth.
If I were in pain and for 6 years I went to a doctor who
was unable to effectively diagnose my problem or treat me, I
would say to that doctor, ``Thank you very much for your
efforts, but I am going elsewhere.'' And that is the situation
facing some 70,000 veterans of Gulf War illness. The evidence
is overwhelming that, for whatever reason, the DOD and the VA
have not been able to come up with a cause for Gulf War
illnesses or an effective treatment. It may simply be nothing
more complicated than the fact that the VA and the DOD simply
lack the expertise in environmental toxicology that is at the
root of the problem. I am not casting aspersions on the
sincerity of the leadership of the VA and the DOD and their
desire to do the right thing and help our veterans. I am simply
saying that they have failed, that we must acknowledge their
failure, and for the sake of the 70,000 veterans who continue
to hurt, we must go outside of the DOD and VA if we are to come
up with the cause of this problem and find effective
treatments.
As part of this effort, I am happy to report that the
Labor-HHS appropriations bill, which is currently in
conference, contains language, that I introduced, which asks
the National Institute of Environmental Health Sciences to
study how chemical exposures in the Persian Gulf relate to Gulf
War illnesses. Additionally through this program, the NIEHS is
to investigate treatment protocols which are being developed in
the private sector around the country. Whether or not the NIEHS
should be the agency given full responsibility for heading up
the broader independent investigation which this report calls
for, I can't answer right now. But that is an issue that needs
to be pursued vigorously and in the very near future.
As we learned through our subcommittee hearings, the
military theater in the Persian Gulf was a chemical cesspool.
Our troops were exposed to chemical warfare agents, leaded
petroleum, widespread use of pesticides, depleted uranium and
burning oil wells. In addition, they were given a myriad of
pharmaceuticals as vaccines. Further, and perhaps most
importantly, as a result of waiver from the FDA, hundreds of
thousands of troops were given pyridostigmine bromide.
Pyridostigmine bromide, which was being used as an anti-nerve
gas agent, had never been used in this capacity before. In the
midst of all of this, our troops were living in a hot and
unpleasant climate and were under very great stress.
Through our subcommittee hearings we have also learned that
an increasing number of scientists now believe that the
synergistic effect of chemical exposures, plus the experimental
vaccine pyridostigmine bromide, may well be a major cause of
the health problems affecting our soldiers. Additionally, we
learned of scientific studies which suggest that stressful
conditions in combination with taking pyridostigmine bromide
can lead to neurological problems. Moreover, this subcommittee
heard from scientists who conclude that exposures to low levels
of chemical weapons, such as those experienced near Khamisiyah,
can lead to long-term health problems--contrary to what the DOD
and VA continue to maintain.
One of the most important, yet disturbing facets of this
problem is that health effects from chemical exposures may
surface years after the initial exposure--and these health
effects can be very serious, including kidney damage, liver
damage, neurological damage, reproductive problems, respitory
problems and cancer. Our government needs to own up to the fact
that many of the chemical exposures in the Gulf can very well
lead to long-term and serious health problems for our veterans.
And because of this we have a responsibility to provide health
care, treatment and compensation for the health problems which
stem from service in the Gulf.
I very much agree with the recommendation in this report
that Congress enact a law which sets up the presumption that
Gulf War veterans were exposed to hazardous materials known to
have been present in the Gulf War theater. As we have learned
in our hearings, to this point the burden has been on the
veteran to prove that they were exposed to harmful chemicals
and that their illnesses stem from that exposure. Because of
the lack of military records as to administration of
pyridostigmine bromide, missing logs on chemical and biological
weapons alarms, and missing data as to which individuals were
exposed to chemical weapons, it has been impossible for
thousands of veterans to prove that chemical exposure has
caused their illnesses. This has resulted in unending
frustration for thousands of sick veterans--causing many to
seek medical attention from the private sector and devote
significant financial resources to treating their illnesses.
This is simply unacceptable.
In having passed this committee report, we should not think
that our work is done. On the contrary, we have really just
begun. It is my belief that serious and focused scientific work
can give us an understanding of why tens of thousands of our
soldiers are suffering a myriad of illnesses, and some
excellent scientific work--already completed--is paving the way
for us. It is also my belief that we can come up with effective
treatments. And it very likely that there are physicians
throughout the country who have already developed treatments
that are helpful.
It seems to me that our committee must remain involved in
this issue, must, along with our colleagues in both bodies,
help find the appropriate agency to direct the research, must
make certain that adequate money is made available, and must
exercise oversight over that agency to ensure that its mandate
is carried out. I thank Chairman Shays and Ranking Member Towns
for their hard work on this issue, and I look forward to
working with my committee colleagues in the near future, to
implement its recommendations.
Hon. Bernard Sanders.