SPEAKERS CONTENTS INSERTS
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PERSIAN GULF WAR ILLNESSES
TUESDAY, FEBRUARY 11, 1997
House of Representatives,
Committee on Veterans' Affairs,
Washington, DC.
The committee met, pursuant to call, at 1 p.m., in room 334, Cannon House Office Building, Hon. Bob Stump (chairman of the committee), presiding.
Present: Representatives Stump, Smith of New Jersey, Bilirakis, Everett, Quinn, Bachus, Stearns, Moran, Cooksey, Hutchinson, Chenoweth, Evans, Kennedy, Filner, Gutierrez, Bishop, Mascara, Peterson, Reyes, and Snyder.
OPENING STATEMENT OF CHAIRMAN STUMP
The CHAIRMAN. The meeting will please come to order. Let me say before we start today that we have urged all members not to take their time in offering a 5-minute opening remark. If you do have a statement you would like to make, please do so at the time you ask questions.
We'll allow that at the end of each panel. But we will abide by the 5-minute rule. We have a very, very long agenda, and I know that there's a big dinner tonight at the VFW that most people would like to attend.
Today's hearing on health concerns of Persian Gulf veterans is our 11th such hearing and far from our last on this subject. We won't get all the answers or resolve all the issues today, but we will follow these issues wherever it takes us. If additional legislation is needed, we will take it up and move it very swiftly.
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This afternoon we will hear testimony from scientists, government officials, and spokesmen for our veterans' organizations. Testimony from individual veterans will also remind us of the importance of providing empathetic care, timely benefits, and ultimately, real answers.
Finding answers has been slow and elusive. Hopefully these hearings will help us understand the limitations as well as importance to these issues of scientific inquiry.
Concerns regarding Persian Gulf veterans' illnesses have sparked many theories regarding both cause and cure. We will not help our veterans, however, by substituting our own judgment for that of the experts in determining the most fruitful avenues for further research. And we must not let our frustrations regarding the search for answers overtake our responsibility for judicious decisionmaking.
In that regard, the Presidential Advisory Committee on Gulf War veterans' illnesses has accomplished important work, as has the Institute of Medicine. I hope the work of these expert panels will help us agree on where we go from here.
At this time I'm happy to recognize the ranking member, Lane Evans.
OPENING STATEMENT OF HON. LANE EVANS
Mr. EVANS. Thank you, Mr. Chairman. I appreciate you holding the hearing today. We have some important witnesses before us. So I'll keep my remarks very short.
I commend President Clinton for establishing the advisory committee and its members and staff for all the important services they have provided to our country. By all accounts, their work has been thorough, competent, effective, and candid. I hope future government advisory committees will conduct the people's business in the same manner in carrying out their mandate as well.
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Mr. Chairman, I anticipate some members of the Committee may have additional questions for some of the witnesses following the conclusion of this hearing. I request all members be given the opportunity to submit questions in writing to witnesses and those questions and their responses to them would be included in today's hearing record.
The CHAIRMAN. Without objection and also encouraged.
Mr. EVANS. I appreciate your holding the hearing, Mr. Chairman. Thank you.
The CHAIRMAN. Thank you, Lane.
Our first panel today will be Major Marguerite Knox, a member of the Presidential Advisory Committee on Gulf War Illnesses who also served during the Gulf War; and Dr. Russell, a member of the Institute of Medicine Committee which reviewed these issues. Major Knox, if you'd like to lead off?
And let me say to the members we are not discriminating against the members. We'd also ask the witnesses to try to hold their remarks to 5 minutes, please, each, if you would. Ms. Knox.
Ms. KNOX. Good afternoon. How are you all?
STATEMENTS OF MAJ. MARGUERITE KNOX, PRESIDENTIAL ADVISORY COMMITTEE ON GULF WAR VETERANS' ILLNESSES, ACCOMPANIED BY HOLLY L. GWIN, DEPUTY DIRECTOR/COUNSEL, AND MARK A. BROWN, PH.D., SENIOR POLICY ANALYST; AND DR. PHILIP K. RUSSELL, PROFESSOR OF INTERNATIONAL HEALTH, SCHOOL OF HYGIENE AND PUBLIC HEALTH, JOHNS HOPKINS UNIVERSITY, AND MEMBER, PRESIDENTIAL ADVISORY COMMITTEE ON GULF WAR VETERANS' ILLNESSES
STATEMENT OF MARGUERITE KNOX
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Ms. KNOX. Mr. Chairman, members of the Committee, thank you for this opportunity to appear before you today. We have submitted written testimony for the record. As you requested, I will now summarize this material.
First, there should be no question that the Presidential Advisory Committee on Gulf War Veterans' Illnesses recognizes that many veterans are experiencing medical problems connected to their service in the Gulf.
In the near term, the Government needs to fine-tune some specific efforts in follow-up clinical care and risk communication. Overall, the advisory committee found that the Government had learned some lessons from our experience with Vietnam in responding to the range of health-related problems experienced by Gulf War veterans.
Regarding research, the committee found that the current research portfolio is for the most part appropriately balanced. Clearly, the broad array of ongoing studies will improve our understanding of Gulf War veterans' illnesses.
To close the gaps in the current knowledge base, we recommended additional research in three specific areas: number one, on the long-term health effects of low-level exposures to chemical warfare agents; number two, on the synergistic effects of pyridostigmine bromide with other Gulf War risk factors; and, number three, on the body's physical response to stress.
In addition, the committee noted the importance of continuing to ensure that resources are devoted to mortality studies since some health effects, such as cancer, would not be expected to appear until a decade or more after the end of the Gulf War.
In reviewing the data available for our December 1996 report, the advisory committee was able to reach some conclusions about the nature of Gulf War veterans' illnesses. In this regard, we have three findings as well.
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First, as I noted earlier, many veterans have illnesses connected to their service in the Gulf.
Next, the committee conducted a comprehensive review based on results subjected to peer review of the health effects of pesticides, chemical warfare agents, biological warfare agents, vaccines, pyridostigmine bromide, infectious illnesses, and depleted uranium, oil well fire/smoke, and petroleum products. Current scientific evidence does not support a causal link between the symptoms and illnesses that veterans report today and exposures to any environmental risk factor of the commonly suspected Gulf War hazards that we assessed.
And, finally, stress which is known to affect the brain, the immune system, cardiovascular system, and various hormonal responses is likely to be an important contributing factor to Gulf War veterans' illnesses.
As I just noted, prudence requires further research in this area as well as on the synergistic effects of PB and long-term health effects of low-level exposure to chemical warfare agents.
As you know, the advisory committee had one significant caveat about the Government's performance related to Gulf War veterans' health concerns. We took strong issue with the Department of Defense's efforts to assess possible exposures of U.S. troops to chemical warfare agents in the Gulf. An atmosphere of government mistrust now surrounds every aspect of Gulf War veterans' illnesses because of DOD's mishandling of this issue. This atmosphere of mistrust is regrettable.
Our investigation of DOD's efforts in this area led us to conclude the department's early efforts were superficial and lacked credibility. We found substantial evidence of site-specific low-level exposures to chemical warfare agents. Moreover, we found DOD's investigations had been superficial and were unlikely to provide credible answers to veteran's and public's questions.
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The advisory committee also noted that DOD's failure to seriously investigate these issues also adversely affected decisions related to funding research and to possible health effects of low-level exposures to chemical warfare agents. DOD's intransigence in refusing to fund such research until late last year has done veterans and the public a disservice.
Before concluding my oral remarks, I do want to mention that during the course of the advisory committee's deliberations on Gulf War veterans' illnesses, we judged that the Government could do a better job in the future of avoiding post-conflict health concerns. Thus, we made several recommendations to address the need for better communication, better data collection, and better services.
I would be happy to discuss these recommendations in greater detail should you have questions, but I especially want to note a strong need to improve data collection and handling. The Government has a significant amount of ground to recover with Gulf War veterans and the American public because they have come to question whether a lack of data—for example, on the possible exposures, on the pre- and post-deployment health of veterans, or on the location of troops in theatre—actually indicates a lack of commitment to veterans' health.
Mr. Chairman and members of the Committee, the Nation has just begun to pay its debt to Gulf War veterans in many important ways. It is essential now to move swiftly toward resolving their principal remaining concerns.
Thank you again for the opportunity to review the committee's work with you. I or committee staff members Holly Gwin or Mark Brown would be happy to answer questions about our work.
On a personal note, however, I would like to add that I hope DOD and VA will respond quickly and compassionately and sincerely in providing the state-of-the-art health care that any veteran seeks in any institution within DOD and VA. Veterans need timely health care and timely receipt of benefits and compensation. I am pleased that the President supported Secretary Brown's reexamination of the presumptive period for undiagnosed illnesses. And I hope this review will be completed as soon as possible.
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Finally, to quote fellow committee member Dr. Philip Landrigan in his recent editorial in the Journal of American Medical Association, he states, ''Despite the limitations of current epidemiological studies and clinical investigations and regardless of the unanswered questions surrounding the hazards of potential exposures during the Persian Gulf War, these veterans will need all the resources and all of the care that they are owed by this Nation that they have so generously and gallantly served.''
Thank you. We'll be glad to address any questions.
[The prepared statement of Major Knox appears on p. 316.]
The CHAIRMAN. Thank you, Major Knox.
Now we'll hear from Dr. Russell, who was a committee member on the committee to review the health consequence of service during the Persian Gulf War for the Institute of Medicine. Is that correct, Doctor?
STATEMENT OF DR. PHILIP K. RUSSELL
Dr. RUSSELL. Mr. Chairman, members of the Committee, thank you for the opportunity to discuss some aspects of the health problems faced by veterans of Desert Shield and Desert Storm. I'm here in place of Dr. John Bailar, the chair of the IOM Committee to review the health consequences of service during the Persian Gulf War.
Dr. Bailar's formal statement has been submitted earlier, and I fully support his statement and am very happy to speak on behalf of the committee and answer questions about the statement.
The charge to our committee was to assess the actions taken by the Secretary of Veterans Affairs and the Secretary of Defense to collect and maintain information and generate databases useful for addressing the health consequences of service in the Gulf.
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Another charge was to recommend means to improve collection and maintenance of relevant information and to determine whether there is a sound basis for epidemiologic studies of the health consequences of service in the Gulf and make recommendations regarding the studies.
Our committee met 16 times over a period of 3 years and received information from a wide variety of sources, including veterans, physicians, epidemiologists, research scientists, and military experts.
Forty-five recommendations from our committee are contained in the two published reports. Our recommendations emphasize the urgent need for improved medical record systems and compatible medical databases in the armed services and the Department of Veterans Affairs.
We made a series of recommendations directed at improving ongoing research programs, and we emphasized the need for additional efforts in several areas, including stress management in military operations, stress-related disorders, excess accident mortality in veterans, and longitudinal studies of veterans' health and causes of morbidity and mortality.
We made several recommendations aimed at improving the capability of the armed forces to relate experiences and potential environmental exposures during deployment to medical outcomes.
We supported the continuation of ongoing epidemiologic and toxicologic research, including studies of the long-term effects of chemical warfare agents.
In the course of our studies, we reviewed information in 14 different hypotheses, which have been put forward as possible explanations for illnesses in veterans of the Gulf War or causes of the Gulf War Syndrome.
We found no convincing evidence to support any of the proposed explanations. Our committee found no convincing evidence for a definable or unique new medical condition among Gulf War veterans and no direct evidence for environmental exposures causing adverse physical or physiologic consequences.
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More recent information regarding potential exposures to chemical weapons from destruction of captured munitions raises questions about documenting exposure and defines a population deserving further study. However, it does not alter our conclusions or recommendations. Our conclusions and recommendations were based on an assumption that low-level exposure was a possibility that had not been excluded and may never be adequately determined.
The Presidential Advisory Committee on Gulf War Illnesses addressed several of the same issues as the Institute of Medicine committee. In those areas, there's almost complete agreement. Differences are really very minor and a matter of emphasis and perspective, matter of tone.
Both committees recognized the profound impact that service in the Gulf War had on the health of the deployed military population. Although battle injuries and infectious disease casualties were low, stress-related illnesses and ill-defined symptoms and symptom complexes has created a serious disease burden.
Access to care problems and adverse determinations regarding service-connected illnesses created serious social and medical consequences as well as confounding early epidemiologic consequences.
Both committees as well as earlier groups which addressed the problem came to the same conclusion regarding the lack of convincing evidence for a causative role for the suspected environmental toxins, oil fire/smoke, petroleum products, depleted uranium, chemical and biologic weapons, vaccines, medications, repellents, and insecticides.
In closing, let me say that I have become very doubtful that after almost 6 years of intense study, investigation, and debate, we will ever come to a conclusion about the existence of Gulf War Syndrome or that we will ever find convincing evidence of long-term health effects resulting from exposure to a specific causative agent or combination of agents. There are still very important areas for additional study and research, but I have very little optimism that we will find definitive answers or agree on the answers.
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The most important actions in my view are in the areas of assuring optimal medical care and support for this group of veterans and for veterans of future conflicts. We should give high priority to developing epidemiologically sound medical record systems and accurate deployment records. We should strengthen the capability of the armed forces to rapidly and thoroughly investigate all medical problems related to future deployment.
Thank you very much for the opportunity to be here.
[The statement of Dr. John Bailar appears on p. 322.]
The CHAIRMAN. Thank you, Doctor.
I have one quick question of either of you or maybe both. A report suggesting that Persian Gulf veterans' family members have been getting sick and that their offspring have had birth defects has been alarming. Does the available research offer any reassurance on this? Would either of you care to?
Dr. RUSSELL. The studies that were available to our committee were in early stages of their producing results, but the data that we saw did not indicate any excess problems of birth defects within the population. There are ongoing studies that will continue to address this.
The CHAIRMAN. Thank you.
Ms. KNOX. Our conclusion was essentially the same about both of those.
The CHAIRMAN. Thank you. Mr. Evans.
Mr. EVANS. Thank you, Mr. Chairman.
I'd like to ask the panel about stress. Stress has been cited repeatedly as a possible factor in the continuing health problems of our Persian Gulf veterans. Is stress considered a leading cause because knowledge of other possible causes is lacking?
Ms. KNOX. I don't think that's so at all. I think that stress is definitely a contributing factor to anybody who participates in war. And, having been there, it's a very stressful environment. Just like we know that many people have hypertension due to stress-related complications in their lives, stress can cause, may not be the only cause, but it's a contributing factor to certain disease processes.
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Do you want to add something?
Dr. RUSSELL. Stress casualties are an expected outcome of war. They have been since we have been keeping medical records of casualties during wartime.
The Gulf War was a very stressful war, and it wasn't a short war for most of the deployed troops. They were there for many months. The stress levels were very high on a continuous basis. And it was expected that we would have stress casualties from that kind of an operation. Management of stress is a continued, ongoing problem for military leadership and military medical support.
I think we were led to underestimate the impact of stress because the casualties due to hostile fire were low, the casualties due to infectious diseases were unexpectedly low. But the stress casualties were not mitigated.
Mr. EVANS. What could the military do to best reduce stress symptoms in the future?
Dr. RUSSELL. It's a complex problem. Some of the best ways of reducing stress are to prepare the troops for the environment and the hazards they have to face. Leadership is incredibly important. Unit cohesion is incredibly important in avoiding stress casualties. The better leadership, the better trained the organization, the lower the stress casualties.
Mr. EVANS. All right. Thank you, Mr. Chairman.
The CHAIRMAN. Thank you, Lane.
The gentleman from Alabama, Mr. Everett.
Mr. EVERETT. Thank you, Mr. Chairman.
Major Knox and Dr. Russell, our veterans seem to be asking two questions, basically, ''What caused me to get sick?'' and ''How can I be cured?'' Are these two separate research areas?
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Dr. RUSSELL. I would say so, yes, sir. The search for etiology may involve the toxicology, epidemiology, may involve other disciplines. Treatment of illness may involve dealing with the patients' total problems and medical management. They are two entirely different problems.
Mr. EVERETT. I notice from the testimony submitted that a lot of research is indicated. How are we going to ensure that the research and what happened do not interfere with us treating our veterans and trying to get a cure to them or can we do that? And how long are we talking about here?
Ms. KNOX. You know, it may be impossible to ever find a cure since veterans were exposed to so many different risk factors during the Gulf War. Just finding out about low-level chemical exposure is 5 years after the fact, so research has been delayed. So until that time, legislation will have to approve recommendations for veterans to get the care that they deserve in the VA.
Mr. EVERETT. I'm sorry, Major Knox. Did you want to add something else?
Ms. KNOX. I'm going to let Holly Gwin add to that.
Ms. GWIN. One thing that the committee found is that neither DOD nor VA is waiting until we know the precise cause or a particular cure for undiagnosed illness before they're treating the veterans. There are extensive clinical programs in place to diagnose and to treat veterans who complain of symptoms related to the Gulf War.
Mr. EVERETT. Dr. Russell, speaking of the 4-year delay, what loss has that caused us in the ability to find out exactly what happened?
Dr. RUSSELL. I think the problem is not the delay. It's that we've been at it for so many years and have exhausted—we've intensively investigated multiple proposed hypotheses. And each one of them proved not to have sufficient evidence to be a convincing candidate for suspect etiology.
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I think also as time goes on, the ability to relate symptoms and illness to something in the remote past becomes more and more difficult from a medical and epidemiologic basis.
Mr. EVERETT. Could you say that DOD's inaction for 4 years on this and not allowing funding to go through at the level that it should have has caused any effect on it?
Dr. RUSSELL. We probably did not start early enough and vigorously enough with our epidemiologic investigations. Yes, sir.
Mr. EVERETT. Let me ask you a final question, please. Dr. Bailar's testimony raises a question of whether the frequency of diminished symptoms in some very serious diseases is higher for Gulf War veterans and their non-deployed counterparts. Have you found any evidence of an increase of such frequency?
Dr. RUSSELL. I haven't. I've reviewed the same data that Dr. Bailar has. And there is evidence of increased illnesses of several types among Gulf War veterans compared to their colleagues that did not deploy. There's evidence of increased mortality due to automobile accidents.
That still doesn't help us very much in determining exactly what the cause of these illnesses is.
Mr. EVERETT. Thank you. Thank you, Mr. Chairman.
The CHAIRMAN. Thank you.
The gentleman from California, Mr. Filner.
OPENING STATEMENT OF HON. BOB FILNER
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Mr. FILNER. Thank you, Mr. Chairman. And thank you for holding these hearings.
I appreciate, Major Knox, your comments. I, too, was disturbed at some of the early reactions, the defensiveness of the Defense Department. I guess Defense Department doesn't mean you have to be defensive on these kinds of issues and on administration and reluctance to admit either error or wrongdoing or even ignorance, which is part of our condition and seemingly to focus on, ''Well, since we can't pinpoint an exact cause, therefore, there is no responsibility here.'' I found those statements very disconcerting, as I think you indicated.
And, of course, now I think, as most of the questions preceding me I think were pointing to, that, regardless of whether we have that answer, it is our responsibility to assure that the health care is provided and also compensation to those individuals whose health problems are associated with this service.
Obviously we have to continue that research, but I don't think we should wait for all this complex science involved with this to come forward with a national responsibility toward our fighting men and women in the Persian Gulf. So I don't think they can wait any longer. We have to accept that responsibility and move forward, even if we never find a, quote, ''exact'' cause.
I'm still disturbed by people who seem to think that that's what this issue is all about since they can't find the one or because they can't find anybody at fault or we didn't do it on purpose. I mean, I saw General Schwartzkopf say, ''Well, we didn't do it on purpose.'' Well, nobody ever said that that was.
Obviously that's not the issue here. The issue is we have thousands and thousands of people suffering. And we need to deal with that.
I read with some interest another study—I think it followed yours—by the University of Texas.
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Ms. KNOX. Right.
Mr. FILNER. Are you familiar with that one, which seemed to—I mean, it took away some of the concentration on stress and looked at other syndromes that involved brain and nerve damage caused by exposure? Did you look at that and is that— —
Ms. KNOX. You are speaking of Dr. Robert Haley's study out of Southwest Texas?
Mr. FILNER. I think so, yes.
Ms. KNOX. Yes. In fact, one of our members, Philip Landrigan, did the editorial on that particular issue. I think that was a good study that Dr. Haley did. And I think more studies need to be done to find out what the effects of low-level chemical exposure could have been.
However, his study still does not show a cause and effect relationship. He did a multivariate statistical analysis. And he actually wrote three articles in that particular journal, but it still does not show a cause and effect on low-level chemical exposure.
Did you want to add to that, Dr. Russell?
Dr. RUSSELL. Yes. I fully agree with Dr. Landrigan's analysis of those studies. They were ambitious, sophisticated. They raised questions, but they had substantial epidemiologic and methodologic weaknesses and limitations of the study population. They raised interesting and worthy questions, but they're not conclusive.
One of the conclusions that was drawn in the study was that the neurologists and the investigators who were blinded to the subject whether they were cases or controls could not differentiate on the basis of clinical laboratory findings between the cases and the controls. The findings were nonspecific and not sufficient to diagnose a known syndrome or in any subgroup.
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So it is useful research, but it doesn't provide us with definitive answers.
Ms. KNOX. However, we welcome further research on that area because we just don't have the answers regarding low-level chemical exposures.
Mr. FILNER. You used a few interesting words in your opening statement, including ''superficial'' and some other ones, which I agreed with, as I said. Has the DOD been responsive to that critique? I mean, have they accepted that or are they still trying to defend what they were doing? I mean, are they on a new path in your view that— —
Ms. KNOX. I think so. I think that Secretary John White was very sincere in his last remarks to our committee. I think the biggest problem that DOD has had is in their communication. Risk communication has been very poor.
I am still employed by DOD. And I would like to think that it acts in the best interests of our veterans. And it is a big organization. So there have been problems.
Mr. FILNER. Thank you. I just hope that your findings, your statement can get us on the path of a constructive dealing with some real human problems. And honesty about what we did or didn't do I think has to be there because I don't care where the chips fall. If we have done something wrong or something stupid or something out of ignorance, we need to know it. I mean, it's in our national interest to be honest here and not to— —
Ms. KNOX. I agree.
Mr. FILNER (continuing). Hide or cover up, be defensive or superficial. I mean, that's what national security to me means in the future: to be honest about what happens here. And I think your report has helped us.
Thank you.
The CHAIRMAN. The gentleman from New York, Mr. Quinn.
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OPENING STATEMENT OF HON. JACK QUINN
Mr. QUINN. Thank you, Mr. Chairman. I want to thank you, Chairman, and the Ranking Member Evans for your interest in holding today's hearing. I'm looking forward to this Committee becoming more and more involved in this issue as we hear testimony today, both from this panel and other members on panels later this afternoon.
I also want to thank the commission for their work in responding to us, not only as members of the U.S. Congress, but also as we try to respond to constituents back home in our states and cities and districts all across the country.
Mr. Chairman, I have a statement that I would like included in the record for later.
The CHAIRMAN. Without objection.
[The prepared statement of Congressman Quinn follows:]
Prepared statement of Hon. Jack Quinn
Mr. Chairman, thank you for holding this important hearing on the illnesses that are facing some our Gulf War veterans. I congratulate the Advisory Commission on their work and I am pleased they will continue their service to America's veterans for several more months.
Mr. Chairman, I approach this issue with an open mind on almost every aspect except the way the Department of Defense has handled the issue.
Veterans are sick. There is no doubt about that. The issue before this committee is to determine how VA is now taking care of sick veterans and what VA is doing in terms of research and how VA is compensating veterans for their service-connected disabilities.
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The Commission makes several interesting recommendations regarding record keeping at DOD and VA. As Chairman of the Subcommittee on Benefits, I am very interested in VA and DOD standardizing medical and personnel records to ensure the most seamless handoff between DOD and VA possible. In addition to easing the data collection in cases like this, it will make VA's job easier in all future benefts cases.
Mr. Chairman, I am also concerned about how VA is handling compensation claims. I understand that VA is in the process of re-evaluating several thousand claims at this time to determine whether VA had processed the claims properly. I urge VA to complete the project as quickly as possible. I am also aware that Secretary Brown is considering adjusting the two year presumptive period for compensation claims. I know that he has been pressed hard by some members of the other body to take an immediate administrative active to lengthen the presumptive period and that he has stated that he needs to see the data before he takes action. I support that approach, and I am pleased that Secretary Brown will make his decision based on available data, not emotional appeal.
To determine how VA has been handling Persian Gulf compensation cases, I will schedule a hearing in the spring. That will allow time for VA to accumulate data from its re-evaluation project to give us a good picture of how veterans are being served. If necessary, I intend to hold an additional hearing this fall on the issue.
Mr. Chairman, that concludes my remarks.
Mr. QUINN. Major Knox, you talked about one of the recommendations that the committee saw fit to include was to talk about better communications. And, clearly, that's one of the things I think we have to work on with the Department of Defense, for example, when we talk about communications and asking questions and receiving straightforward answers and so on and so forth.
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Can you briefly state what recommendations you make in terms of communications, between whom and with whom and how it might be helpful, or are you not able to do that at this time?
Ms. KNOX. I'll let Holly Gwin speak to that since she's deputy counsel.
Ms. GWIN. We made a number of recommendations about communication. The two most forward-looking ones have to do with—well, the first one is DOD and VA need to get together and develop a risk communication plan to explain to veterans, in advance as well as after the fact, to their best ability what are the risks that they face in a wartime situation and what are the possible health consequences of those risks.
Mr. QUINN. I understand.
Ms. GWIN. That seems to be a basic area of misunderstanding right now.
Another area where we thought there needed to be vastly improved communication is in the area of drugs, investigational drugs, that are approved for use under an interim waiver of conformed consent now available from FDA. Drugs like pyridostigmine bromide, although they're approved for one use, are not approved for the use in which they were employed during the war.
We figured there needed to be much better communication, not only to the service members about what they were taking, but a broader public dialogue about whether that is an appropriate use of drugs in this society.
Mr. QUINN. Thank you, Ms. Gwin. Those are both very helpful.
Would it be possible for you to sort of get for me and for the Committee other areas of communication that you looked at? For example, is there any discussion about communication between the various departments and this Committee?
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Now that the event is over, we have a tough time getting some information sometimes. Is that area of communication addressed at all in the report?
Ms. GWIN. No.
Mr. QUINN. Then I'd to suggest to our Committee, the chairman and the ranking member, that maybe after today's discussion that we look into that area of communication.
My other question was for Ms. Gwin as well. You talked in answer to a previous question about some ongoing treatment that's taking place right now, even though we're not going to wait for the culprit or the reason. Extensive treatment everywhere throughout the country? All veterans? Some veterans? Different areas?
Ms. GWIN. The VA Persian Gulf health registry is available to any veteran of the Gulf War who is no longer on active duty. DOD's comprehensive clinical evaluation protocol is available to all active duty members. These provide comprehensive diagnosis and treatment programs for veterans of the war who believe that they have service-connected symptoms.
Mr. QUINN. All across the country?
Ms. GWIN. All across the country. There are hierarchies of care. There is your entrance-level exam and treatment.
Mr. QUINN. That's one of the problems the veterans have, the hierarchy and the bureaucracy, et cetera, not directed at you, but that they have experienced throughout this. And that's what I'm trying to get at.
Ms. GWIN. We did hear a lot in our public hearings from veterans who had experienced lots of difficulties in acquiring care, both initially and in follow-up.
We conducted a series of site visits in 1995 and 1996, which is several years after those programs were initiated. We evaluated those programs at the time. We looked at them as being excellent. That is not to deny that many people had problems with those programs in the beginning.
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Mr. QUINN. Very well. And part of that is mentioned in the report. Thank you. I appreciate that very much.
Dr. Russell, you talked about stress. This is probably more a comment than a question before I finish up. And a couple of the other members, Lane talked about stress and others have. I would just submit to the Committee and to the panel that if you think that stress was a factor in all of this while our veterans served, we ought to consider the stress they're under now not having answers, not being able to access the system once in a while, and the stress on their families and other members of their immediate home situations, so the stress when this whole thing happened, as you point out correctly. And that's a newer problem for us. But I also want to point out that there's a lot of other stress that's going on here.
Lastly—I know my time is up. I have some more questions further, Mr. Chairman. This is housekeeping maybe for the major. We say that the Presidential Advisory Committee on Gulf War Illnesses has been extended through October of 1997 to oversee exposure and implementations and recommendations.
Ms. KNOX. That's correct.
Mr. QUINN. I am not exactly sure about the funding of that until—I mean, that's only a few short, 6 or 7 months away. You're funded and operating up until then?
Ms. KNOX. Yes.
Ms. GWIN. We operate under an executive order.
Mr. QUINN. Right.
Ms. GWIN. The new order extending our life through October as far as producing work and then another 30 days for closeout was just issued.
Mr. QUINN. Okay. Thanks very much. I appreciate your answers. Thank you, Mr. Chairman.
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The CHAIRMAN. The gentleman from Texas, Mr. Reyes, is recognized.
OPENING STATEMENT OF HON. SILVESTRE REYES
Mr. REYES. Thank you, Mr. Chairman. I, too, would like to submit a written statement for the record.
The CHAIRMAN. Yes, sir.
[The prepared statement of Congressman Reyes appears on p. 313.]
Mr. REYES. In the interest of saving time, I represent a district with approximately 60,000 veterans. And there is a deep sense of frustration that I think speaks to part of—as my colleague said, what's interesting to the language that you used, ''superficial'' and ''lacked credibility,'' I think in the context of what we're seeing that's coming out in the Gulf War Syndrome ailments, I guess would be the best way to describe it, and the interrelation to stress, all of these issues I think compound the feeing and the sense of frustration that veterans are feeling because they feel betrayed by their own government.
And, being a veteran myself, I know that combat is very stressful, but you place your trust in the leadership, in the ability of your commanders to provide the information to you. And part of the frustration that I think we're all feeling is the fact that subsequent to the stonewalling that has now come out, we feel that, even now, it's been a situation where it's like pulling teeth from DOD and in some cases from the VA.
I think that one question that I would like to ask, Ms. Knox, is: Do you believe that we will ever have accurate data on the wide range of exposures that our servicemen were exposed to in the Persian War? Is that something that is feasible or possible given what you know about— —
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Ms. KNOX. I don't think so. I don't think we had enough pre-deployment data in order to compare post-deployment relationships. Because we didn't collect that data prior to their service and then again afterwards, it's an epidemiological nightmare. You cannot go back and re-create that situation.
And, in comparison with Vietnam, that just dealt with one agent, Agent Orange, we have multiple risk factors that are involved.
Dr. RUSSELL. I agree with that. I don't think we're going to be able to relate environmental exposure in any precise manner to illnesses.
I might add that the stress of wartime doesn't end when the war is over. The stresses of demobilization and reentry into civilian life can be equally as devastating as the stress of combat.
If you add to that a lack of realization of the relationship between the stress-related illnesses and the service and access to care issues, then we have additional stress placed on this population. So we have a buildup of combat stress, post-deployment stress, and then issues revolving around access to health care and the issues of whether this is or is not related to service.
I feel that if we took more comprehensive, better care of the post-deployed population without attempting to determine up front whether they had a service-connected disability or not but just recognize that they were going to have illnesses post-deployment and deal with those illnesses and with whatever the state-of-the-art medicine is at the time, that we would mitigate a lot of these kinds of problems.
Mr. EVANS. Would the gentleman yield? Would the gentleman from Texas yield?
Mr. REYES. Yes.
Mr. EVANS. Ms. Knox, you said that there was a lack of pre-deployment data?
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Ms. KNOX. Right.
Mr. EVANS. For future deployments, what kind of data should we be collecting during the pre-deployment period?
Ms. KNOX. I think in defense of DOD, they have done some of that pre-deployment data collection in Bosnia. They have done some environmental testing in the area that troops were deployed, and they have also done a better job of collecting, say, for instance, serum specimens prior to their service. And troops can be checked again following their service for any type of exposures.
Mr. EVANS. Thank the gentleman for yielding. Thank you.
Mr. REYES. Just as a matter of a follow-up and I think in the context of what we're doing here today and what has occurred before in these types of hearings, one of the comments we heard this morning from Commander Nier from the VFW this morning was an expressed desire that in issues that affect our veterans, that we err on the side of the veteran, instead of against them.
As a result of the information that you have been able to secure as a result of the committee findings, are you in a position to make a formal recommendation that we do that as a matter of practical policy in treatment and dealing with our veterans? Because I think that's a very important issue in the context of how our veterans, including those that are serving in the military now that are keeping us free as a nation—that's something in a way of reassurance to repair I think the damage that has been done by virtually what we have since found out regarding the Gulf War Syndrome.
Ms. KNOX. I am going to refer to Holly Gwin on that. I don't think that's in our charter.
Ms. GWIN. Well, in our final report, the committee does not make a specific recommendation that you err on the side of the veteran. But I think that if you look at our work, you will find that the staff as well as the committee approached all of the issues like that and emphasized the importance of providing care, even in the absence of knowledge about the cause. And in our presumptions that we made about chemical warfare exposure, we always thought that you should err on the side of the veteran.
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Mr. REYES. Thank you, Mr. Chairman.
The CHAIRMAN. Thank you, sir.
The gentleman from Louisiana, Dr. Cooksey, is recognized.
OPENING STATEMENT OF HON. JOHN COOKSEY
Dr. COOKSEY. I can't help but notice that there has been more exposure to more chemicals in this war. Do you think it's related, number one, to the fact that we have more ability to find chemicals than we did in my era, in the Vietnam War era? Number two, when did veterans first come forward with these symptoms? My third question:—and you can divide these up as you see fit—How many deaths have been attributed to this syndrome or have there been any? First, the chemicals; second, the earliest symptoms; and, third, the number of deaths.
Dr. RUSSELL. I think the environmental exposures are not different in this war except for the nerve agents and the pyridostigmine bromide. Otherwise, I think the exposure in our era, sir, was equally great.
I'm sorry. I've forgotten— —
Dr. COOKSEY. When did veterans first come forward with these symptoms?
Dr. RUSSELL. I think the 93rd ARCOM study was the first one. That was about 6 months after the— —
Ms. GWIN. Nineteen ninety-two.
Dr. RUSSELL. Yes.
Ms. GWIN. Spring of 1992.
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Dr. COOKSEY. And the third questions: deaths. How many deaths can you attribute to this?
Dr. RUSSELL. Since we can't define the syndrome, since there is no definition of a Gulf War syndrome, there are no deaths due to it. And the studies of mortality in the veterans population show equivalent mortality to a controlled population except for accidental deaths, which are elevated, which is true of all military post-deployment populations.
Dr. COOKSEY. Thank you, Mr. Chairman.
The CHAIRMAN. Thank you, Doctor.
The gentleman from Arkansas, Dr. Snyder.
OPENING STATEMENT OF HON. VIC SNYDER
Mr. SNYDER. Thank you, Mr. Chairman.
Could we talk a little more about the Haley study? Are you all dismissing it or is it leading to ask further questions? What's the next step for research? I guess is what I'm saying. And what direction is that going on right now?
Dr. RUSSELL. We are not dismissing that. I don't believe anybody is. That's a very serious study. And these are good scientists, good physicians.
Mr. SNYDER. If I were a Gulf War veteran and I were having problems and I read that study, I think I would kind of get the sense of ''Thank God. Somebody is finally getting on to something.'' So that's why— —
Dr. RUSSELL. The problem is that the findings in the epidemiologic part of the study are based on subjective data and not objective data. And they're subject to serious problems with the population, series of—I'm not an epidemiologist. So I can't critique it in detail, but it does have epidemiologic— —
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Mr. SNYDER. If I can interrupt now, of course, this kind of study with those types of—I can't say the word either—those kinds of problems, a lot of times that's a funding problem in terms of being able to track down enough people from the unit, the ones that just didn't self-report, but kind of track down everybody. Is that what you're getting at?
Dr. RUSSELL. Well, I think there are very large epidemiologic studies ongoing. I think the other side of the issue is the toxicologic and neurophysiologic abnormalities that are found at a very low level.
Further studies of neurophysiology and following low-level exposure to the agents, argon phosphorus and similar agents, are definitely indicated. And there is a variety of experimental and medical ways of following up on these studies.
Mr. SNYDER. Are those ongoing now?
Dr. RUSSELL. I can't answer that.
Mr. SNYDER. Is funding adequate for that?
Dr. RUSSELL. I don't know. Probably.
Ms. KNOX. DOD has given a great deal of funding for that since they recognized that veterans were exposed to chemical munitions at Khamisiyah. Do you know the amount right off? I don't know.
Dr. BROWN. Yes. There are a number of studies that DOD has funded and is just starting to fund in the next fiscal year that are looking at this. I think, just to say again what Major Knox mentioned, the committee made a finding, a recommendation, that to answer some of the questions about low-level exposure and the combination of exposures from different agents, particularly the pyridostigmine bromide and chemical agents, for example, that there should be further studies done on this issue.
Mr. SNYDER. When I read your report— —
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Dr. BROWN. Haley's study is just the first, I think. I think there is going to be a whole slew of studies coming down the pipeline.
Mr. SNYDER. Probably with some dead ends along the way. When I read your report earlier today and you made that reference, was that your reference to the Haley study? Is that kind of an acknowledgment of that type of interest, the type of things that that study looked at and need to look at laundry detergents and insect repellents and flea collars and— —
Ms. KNOX. Actually, Haley's report was not published until after we had completed our final report.
Mr. SNYDER. I got you. And just a couple of things that you all or one thing that you all said there, you said that you were only dealing with one agent in Vietnam. And you made the comment that you thought there were several and that somebody remembers slapping on insect repellent. And God knows what our clothes were washed in.
I'm just wondering. Was there a little bit of disagreement between the two of you? I guess we didn't take antimalarial medicines and parasitic diseases were present. Was there a little disagreement between the two of you on Vietnam? I don't think that Vietnam was a controlled study with only one agent, I guess.
Ms. KNOX. No, it wasn't.
Dr. RUSSELL. No, it was not.
Ms. KNOX. Well, I think the veterans' complaint, though, was about Agent Orange during that era.
Mr. SNYDER. It was complaining about one chemical.
Ms. KNOX. Yes.
Mr. SNYDER. Thank you, Mr. Chairman.
The CHAIRMAN. Thank you.
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Mr. Mascara, the gentleman from Pennsylvania, is recognized.
OPENING STATEMENT OF HON. FRANK MASCARA
Mr. MASCARA. Thank you, Mr. Chairman.
I happen to have been touched personally by this problem. A constituent of mine by the name of Mary Rhoads came to me. And we had quite an extensive conversation about her problems. They were very real. In the final analysis, we were able to get her 100 percent disability, but she's still out there fighting for others who have similar symptoms.
I'll just read here for a moment. She was 39 years old and served with the 14th Quartermaster Detachment in Greensburg, Pennsylvania, a community that I represent. She survived an Iraqi scud missile attack on her barracks which killed 13 members of her unit.
Since coming home, she has undergone a hysterectomy. She had her gallbladder removed. She has lesions from time to time that separate her from 12-year-old. She has vaginal bleeding, vomiting, and chest pains. She has a swollen stomach. In fact, I came to Washington, DC to introduce her to the President's commission. She testified here in Washington, DC.
I'm disturbed by the findings. The only thing you can find is psychosomatic, a stress syndrome that causes these diseases. I'm not a doctor. So I can't say that that is the case or not and how important that is to the issue before us.
The prior gentleman who asked you about the mortality rate among those people who served in the Gulf, I think your response was that nobody has died from that because you really don't know what the Gulf War Syndrome is. So you have no fatalities.
My question is it's my understanding that three individuals, all in the age 30 bracket, have died from myocardial infarctions. One 60-year-old died. Is the Department of Defense tracking those veterans who served in the Gulf War to see if there's any clustering of deaths in order to assist you in coming up with an answer?
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I mean, 30-year-olds dying from heart attacks is not usual. So it's unique. Is the DOD tracking all 690-some thousand veterans to see who's dying, what they're dying from?
Dr. RUSSELL. There have been two published reports on follow-up mortality in this population. And I assume that this population will be followed very carefully from the point of view of excess mortality. So far with the exception of the accidental deaths, the mortality is not greater than a non-deployed similar population.
Mr. MASCARA. There is no concern about the three people serving in the Gulf who died from heart attack?
Dr. RUSSELL. I don't know. The heart attacks in young people are rare, but they do occur in all populations. And whether it's a statistically significant difference, I can't say.
The problem we have is—and your constituent is one of the problems—a 39-year-old person deployed will have post-deployment the expected illnesses of a 39 or 40-year-old person plus whatever exacerbation might be due to the stresses of the deployment.
Obviously she was in a very stressful situation. She may also have had some other medically important events occur in the Gulf, but they're very hard to separate from what happens in an ordinary population. It's a challenge of epidemiology.
Mr. MASCARA. It's not ordinary for me to be asked to help somebody in Florida but because Mary Rhoads had been given 100 percent disability, the Congress person from that district asked me if our staff would look into it. This woman suffered from similar kinds of problems. She eventually received 100 percent disability, a young lady from Florida.
I have one more question—perhaps Ms. Knox might be able to answer it—about the question of funding for the ongoing research and tracking of problems associated with the Gulf War Syndrome. Is the Department of Defense spending at a level that you feel is sufficient to do the job? And have there been instances where the money was available and the Department of Defense did not spend that money? And is there presently a commitment by the DOD to spend and to ask for whatever it takes so that we can maybe bring this thing to closure.
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Ms. KNOX. Just a couple of things to comment on your previous discussion with Dr. Russell. We do appreciate you appearing in Arlington October of last year. I particularly remember Mary's testimony because she is also a nurse.
And I think, if I remember correctly, Mary had difficulty right at the time that she took the pyridostigmine bromide tablets. So our committee has recommended that further research be done on pyridostigmine bromide and their synergistic effects. And there are already studies that have looked at the synergistic effects of PB and stress, the Israeli study and then PB and DEET. Dr. Abou Donia out of Duke did that study. So I hope that that will answer some of those unanswered questions that we have about what the cause is.
As far as the appropriate amount of money to spend on this condition, I don't know if it's adequate to— —
Dr. BROWN. Well, the committee found that, as Major Knox mentioned, the Federal Government does have a good mixture of studies ongoing and planned looking at Gulf War health issues and that the mix of studies includes the right studies on epidemiology; that is to say, looking at Gulf War veterans to see if there are illnesses or other problems at a greater rate than they should be and also an emphasis on stress, looking at the long-term health effects, not just the psychosomatic effects, but the real physical health effects of stress. So I think the committee was very encouraged with the overall federal research portfolio on Gulf War veterans' illnesses.
In addition, just recently the Department of Defense released, recently within the last couple of months, a new request for proposals which, depending on how you add it up, has more than $10 million attached to it. I guess I think overall the committee would not fault the amount of research, the emphasis on research that's going on now.
Mr. MASCARA. I see my time has run out, Mr. Chairman, but I hope we're not going down the same path as we did with Agent Orange.
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Thank you, Mr. Chairman.
The CHAIRMAN. Thank you, sir.
The Chair recognizes the gentleman from Minnesota, Mr. Peterson.
OPENING STATEMENT OF HON. COLLIN C. PETERSON
Mr. PETERSON. Thank you, Mr. Chairman.
I'm kind of new to all of this. So I may ask some dumb questions here, but I'd just like to make a comment first that I think that I've got a lot of folks in my office, I have a hospital in my district. And I think that most people out there wish that you'd spend more time studying why people feel like they're not getting adequate care, rather than studying whether they're compared to some other group or not.
I mean, is anybody doing that? Is anybody actually spending time figuring out why so many veterans feel like they're not getting this problem addressed? Has any time been spent on that?
Ms. KNOX. We looked at that a great deal, particularly early on in 1995. In September we held a meeting in Charlotte to look at the care that veterans were receiving, both in DOD and in the VA system, and examined the comprehensive clinical evaluation program that DOD provides for the soldiers and also the physicals that the VA is giving.
And, as Holly stated earlier, we were not able to do that right at the beginning, when they were in their biggest influx of veterans that came into the system. But when we did look at that in 1995 and 1996, we found it to be adequate.
Mr. PETERSON. Well, I can tell you there are still people coming to my office who are not getting the kind of care that they think they ought to get.
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Ms. KNOX. Well, I think— —
Mr. PETERSON. I think that more work needs to be done looking into that.
Ms. KNOX. I think maybe examining that presumptive period, veterans who are now experiencing illness that is beyond the 2-year limit, is an issue as well.
Mr. PETERSON. I'm trying to get a handle on just exactly what these commissions were supposed to do. This testimony here by Dr. Bailar, in here you say that, ''You will note that the charge of our committee did not include the study of the so-called Gulf War Syndrome.''
Dr. RUSSELL. Correct.
Mr. PETERSON. What do you mean by that? It looks like every other place in the study you go in— —
Dr. RUSSELL. We were unable to avoid looking at the Gulf War Syndrome and the science surrounding it, but the Institute of Medicine committees have very narrow charges usually. Ours was convened very early in response principally to the oil well fires.
So our charge was to determine whether the Department of Defense's and the Department of Veterans Affairs' ability to collect and maintain information and generate databases was going to be adequate to study the effects of the oil well fires and, by extension, the effects of health consequences from any environmental— —
Mr. PETERSON. Did it actually say that you are not to study the Gulf War Syndrome in your charge?
Dr. RUSSELL. No. It didn't have any negative in it, but our recommendations were aimed at epidemiologic databases, information systems, epidemiologic investigations, and the quality of the research.
Mr. PETERSON. What confused me, I mean, I read that, and then I went on to read some of your other statements, where it looks like you have.
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Dr. RUSSELL. We could not avoid it. It was impossible to carry out the charge without evaluating the hypotheses that were being put forward as explanations. And they came one after another about—I think there are about 16 different hypotheses now that had—and then we had to look at the quality of the investigations that pertained to those hypotheses, the research quality.
Mr. PETERSON. Well, I'm not a doctor. I have a hard time following all of this stuff. Again, I just would associate myself with some of the comments of my colleagues and just tell you that I think we still have a lot of work to do out there. There are people that I don't think are getting the kind of care.
And we ought to not just worry so much about why this all happened but get focused on getting help to the people who need it.
Ms. KNOX. If I could add, that is one of our recommendations, to look at the clinical follow-up of these veterans. And so the President has given us the authority to do that, to see if our recommendations are being followed.
Mr. PETERSON. Good. Thank you, Mr. Chairman.
The CHAIRMAN. Thank you, sir.
The gentleman from Florida, Mr. Stearns, is recognized.
OPENING STATEMENT OF HON. CLIFF STEARNS
Mr. STEARNS. Thank you, Mr. Chairman. And let me compliment you for having this hearing on the Gulf War Syndrome.
One of the first casualties of this syndrome was a Michael Adcock from my congressional district in Ocala, Florida. He was a 22-year-old young man in prime of health before he went there. He came back. He had played football in high school. And he suffered from nausea, skin rashes, aching joints, hair loss, bleeding gums, blurred vision, lack of energy. And he eventually died of a brain tumor at a very young age. So Mrs. Adcock has been up here.
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Some of my concerns are—is either one of you a scientist?
Dr. RUSSELL. Here.
Mr. STEARNS. Because you mentioned earlier that the immune system—do you have a pretty good detailed background in the immune system and— —
Dr. RUSSELL. I am an internist. And I've spent my career in infectious disease research.
Mr. STEARNS. It seems like some witnesses and people have said that the Presidential Advisory Commission did not have enough scientists on it. I think some of the witnesses today are coming in or have said that they relied too much on government-provided information and not enough scientific studies. Would you care to comment on that?
Dr. RUSSELL. I think the vast bulk of the scientific information we have available is from highly reputable scientists, whether in or out of the Government.
Mr. STEARNS. Weren't most of them in the Government?
Dr. RUSSELL. I don't believe so. I think, for example, that Dr. Haley's study from Texas is. And there's a substantial amount of work that's been done on government contract. There's a spectrum of scientific research capability within the Government that's very highly credible in the Department of Veterans Affairs and within the Department of Defense. And their colleagues in the academic community are contributing I think probably to an equal extent.
Mr. STEARNS. For example, did they check on the veterans coming in for hepatitis C?
Dr. RUSSELL. The issue with hepatitis C has— —
Mr. STEARNS. Every veteran who complained about this, did he or she get an exam for hepatitis C? Can you be assured of that
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Dr. RUSSELL. I can't be certain of that. I know that hepatitis C is being extensively investigated by the DOD.
Mr. STEARNS. It's not just hepatitis C. There's A, B, C, D, E, F, G, and I think they're finding more.
Let me just change— —
Dr. RUSSELL. C is a specific problem because of the gammaglobulin.
Mr. STEARNS. Yes, right. How much money is being spent by DOD presently devoted to the research funding for the Persian Gulf
Dr. RUSSELL. I have no idea. I can't give you a number on that.
Ms. KNOX. Mark can give us that.
Mr. STEARNS. We have been told that it's approximately $30 million. Do you have any way to know about it?
Dr. BROWN. It is something that we have tracked. I think it depends a little bit on how you define research. If you define research the way I define it, which is investigations of health effects and so forth, it's something in the neighborhood of $15 million in fiscal years 1996 and 1997.
Mr. STEARNS. Shouldn't you folks or the VA be involved with this and not just DOD? Shouldn't there be a cross-pollination here or something? Have you been asked anything, the advisory council, asked anything by DOD about how to spend this money or anything?
Dr. BROWN. The group that's overseeing research is not DOD specifically. It's the research working group of the Coordinating Board, which has members at the cabinet level from VA and DOD and HHS. So there is an interagency oversight of this research program now.
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Mr. STEARNS. So you feel that there's enough cross-pollination between DOD and the VA in dealing with the people who are actually coming into the hospitals? I mean, is there feedback from the veterans' hospitals so that DOD knows where to address things?
Dr. BROWN. I guess the best way I can answer that is to say that the research working group of the Coordinating Board has representation from VA and DOD.
Mr. STEARNS. Okay. One last question: Has there been a study of either the British, French, or Canadian particularly soldiers that went over there? Did they suffer the same thing? Has there been a similar type of phenomena of a syndrome?
Dr. RUSSELL. I understand there's an ongoing study in the British forces.
Mr. STEARNS. After all this time, there's no real conclusion that they have the same type of thing or not? From the advisory council, you haven't found that out?
Ms. GWIN. Our report includes information from the British and the Canadian clinical evaluation programs. And, in fact, the early data from those programs is very much like the data from our clinical programs with the same types of symptoms being reported by their veterans.
But the British have just gotten their epidemiologic studies underway. So it will be quite a while before we have any results from those.
Mr. STEARNS. And the French?
Ms. GWIN. We have been trying to get information from the French since we started working for this committee. And it's been— —
Mr. STEARNS. To no avail?
Ms. GWIN (continuing). Slow to come.
Mr. STEARNS. So the French won't give you anything. The British is just starting. And Canada has a similar phenomenon, a syndrome of this type. Is that fair to say?
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Ms. GWIN. I don't know if it's fair to say they have a syndrome. They have reported clinical data that looks very much like the U.S. clinical data.
Mr. STEARNS. Okay. Thank you, Mr. Chairman.
The CHAIRMAN. Thank you, Mr. Stearns.
The gentleman from Massachusetts, Mr. Kennedy, is recognized.
OPENING STATEMENT OF HON. JOSEPH P. KENNEDY II
Mr. KENNEDY. Thank you very much, Mr. Chairman. I want to thank you very much for hosting this hearing today and let you know how much we appreciate it and look forward to many more in the future, Mr. Chairman.
I want to just deal with what I think is sort of an underlying concern that many of the veterans that I think we hear from on a regular basis have about how this whole process has developed.
First of all, I wonder if you could comment, Ms. Knox, on why you feel that this took 6 years for the Government to acknowledge. And, more specifically, I wonder if you might tell us about the extent to which you feel that you have really covered any possible coverup that could occur by the Government with regard to potential chemical or biological exposures.
We have heard about the Khamisiyah exposures that, as I understand it, did not come through your particular organization but, rather, came about as a result of some CIA documentation.
I've been contacted. A number of us have been contacted over the years with regard to sort of incidental kinds of occurrences that took place that have I think created a general atmosphere of mistrust between the veterans and the government.
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And I wonder if you can just address directly whether or not you feel that you have gotten a handle on the extent to which these illnesses could possibly be caused by something other than stress.
Ms. KNOX. To answer your first question, we are not the first committee to look at Gulf War veterans' illnesses. Actually, we are the fifth committee to look at Gulf War veterans' illnesses. Dr. Russell worked with the IOM committee. So it has been studied a great deal.
I do agree that DOD's failure to come forward with chemical exposure at Khamisiyah definitely causes an area of mistrust in the veterans. In addition to that, one of the things that we had tried to find out from the Persian Gulf investigation team was where troops were located so that we could look at the realm of veterans that could have been exposed.
So along with that lack of data as to where troops were located and what chemicals were there and to what degree they were exposed, we cannot answer that.
Mr. KENNEDY. I appreciate your response, Ms. Knox, because I was going to get through and I asked the staff here if they could—you know, you say that it's a number of different committees that you are aware of. There have been more different sort of fits and stops on behalf of the Congress and a number of others that have sort of looked at this whole issue.
I remember going back to a point where we had the fellow who actually did the Agent Orange study, the first fellow who ever came before this Committee to talk about it, said there was absolutely nothing to this whatsoever and that it is just—''malingers'' is a word that he used in terms of describing what the problem was.
I think that if you look at just the whole series, whether it's the group, the symptom of the Pennsylvania Air National Guard or you look at the birth defects in Mississippi, if you look at the individuals who have contacted almost every member of this Committee with a series of complaints, and then you were told that we're supposed to sort of characterize this in general terms as sort of stress-related, it just seems to me that—I don't know if anybody had ever mentioned to you any of the people who fought in War World II and the like that had to land on the beaches in Normandy and all the rest of it, whether or not there were any similar kinds of stress-related problems.
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I mean, I think we're all sort of aware of PTSD and other issues that came as a result of the Vietnam War, but I'm wondering whether or not we ever saw anything like the degree to which we see these kinds of issues just in this particular conflict.
Ms. KNOX. I just want to reiterate that we say stress is a contributing factor. We don't think it's the cause of Gulf War veterans' illnesses. And we recommend that further study needs to be done on the physiological response to stress.
Mr. KENNEDY. I don't mean to cut you off, and I know that Dr. Russell has got something to say. But because my time is running out, what I do want to suggest is that when you are running a presidential commission on this issue, it has the weight of the entire Federal Government and the responsibility to sort of be almost the sort of final say in what has occurred.
And I think that this is an issue that if you are not feeling that you have your arms around every possibly explanation, including whatever secret documents might be available, including every possible lead that should be run down to make the determination as to whether or not there is some kind of cause that has not been fully exposed to all of the veterans and to the American people, there's a responsibility that I think rests squarely on your shoulders. And anything that we can do to help you get that information, I think you should feel like you should come to us and ask for it. And this is an opportunity for you to do that.
So I really want you to make sure that you answer the question whether or not you feel that you have at this time exhausted and have a full sort of accounting of everything that could possibly have contributed to this and whether or not we're at least in a process of having that be completely aired.
Ms. KNOX. Well, I don't think we can ever have a full account of what occurred. Just as it took until 1996, to hear about Khamisiyah, I would think that there might be other things that might evolve or come about that we might discover at a later time. Hopefully we'll discover that before the end of our charge.
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Holly, you might want to add to that. I don't— —
Mr. KENNEDY. Well, Mr. Chairman, I'll finish up.
But I just don't think it's acceptable that we have a circumstance where the presidential commission is not coming in and reporting back to the Congress as to the full extent of what this has been about.
We've spent millions and millions of dollars. We still don't know what's going on. And here's the chairwoman of the committee saying that we're going to hear more and more about this in the future. I just think that this should not be as difficult a job as it seems to be coming across.
The CHAIRMAN. I thank the gentleman.
Dr. Cooksey, did you have a quick question?
Dr. COOKSEY. Mr. Chairman, I know I've already had a question. Just a comment from someone who's older and been around a little bit longer and also is a physician.
Some of us here are old enough to remember the days of polio. There were a lot of unanswered questions about polio. And when I was a kid, my parents did a lot of crazy things to protect me from polio. And we later found out the answers.
I personally feel that veterans, particularly the Persian Gulf veterans, should have everything that they're entitled to in the way of a disability claim. But as physicians, we don't always know the answers to these questions. And I think that needs to be brought into perspective.
Mr. KENNEDY. If the gentleman would yield just briefly?
Dr. COOKSEY. And sometimes it takes the time to get the answers to these questions.
Yes, I will yield.
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The CHAIRMAN. If the gentleman has a direct response very quickly.
Mr. KENNEDY. Yes, very briefly. You've been around on Earth a lot longer than I have, Doctor, but I have been around here long enough to know sometimes it's hard to get straight answers from people who come before this Committee and a lot of other committees. And it's good to keep your left hand high when you're dealing with them.
Dr. COOKSEY. I've been here 10 years longer.
The CHAIRMAN. The gentleman from Alabama, Mr. Bachus, is recognized.
OPENING STATEMENT OF HON. SPENCER BACHUS
Mr. BACHUS. Thank you, Mr. Chairman. I do want to compliment you on holding this hearing. And I appreciate the panelists.
I have a statement, but I don't want to take time on my views. I just want to get right to what y'all think, ''y'all'' being an Alabama express.
Now, we had an ammunition dump that blew up in Iraq in March of 1991. And almost immediately when the Gulf War veterans returned, we had 40 or 50 thousand of them who were sick. And people started asking the question: Was there chemical exposure? And until June of 1996 we were told no. So you're talking about from March of 1991.
There's now been a recognition by the Pentagon last June that as many as 20,000 of our troops were exposed to chemical exposure in the March 1991 incident.
My question is this. Maybe I'll direct it to Major Knox. I want to commend the presidential committee on really coming to the conclusion that the Pentagon knew before June that there had been this exposure but they didn't say anything until June.
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My first question would be to you. This was a concealment for some period of time. Does this constitute a coverup? I know that's a tough question.
[The prepared statement of Congressman Bachus appears on p. 297.]
Ms. KNOX. Well, I certainly think it generated mistrust on both the public and the veterans' view. The CIA was helpful as was UNSCOM in coming to that finding and bringing it to us. So certainly that's one of the biggest issues that has created this atmosphere of mistrust.
Mr. BACHUS. But there was a concealment at the Pentagon of this chemical exposure.
Ms. GWIN. We were able to pull together enough information for the committee to reach a conclusion that there was only a superficial effort, at best, to disclose the information.
Mr. BACHUS. Well, that's a concealment.
Ms. GWIN. Well, we did not go so far as to say there was any attempt to conceal.
Mr. BACHUS. Well, wasn't their foot dragging? I mean, we were constantly asking: Were they exposed chemically? I mean, there was a concealment. What kind of military thinking led to a concealment like this or a coverup?
Let me just ask you personally. Do you think there was a coverup?
Ms. KNOX. Not personally, I don't.
Mr. BACHUS. Do you think there was a concealment?
Ms. KNOX. I think it was ineptness.
Mr. BACHUS. Was what? Ineptness?
Ms. KNOX. Yes.
Mr. BACHUS. Over a major issue that was being debated in this country with 40 or 50 thousand sick veterans, there was just an ineptness?
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Ms. KNOX. That's really difficult for me to answer.
Mr. BACHUS. I can understand I'm putting you in an embarrassing situation, but can you see how we would conclude that there's been a coverup or concealment?
Ms. KNOX. Yes, sir, I understand.
Mr. BACHUS. And now let me move beyond that. Well, let me ask you this: What kind of military thinking led to this ineptness? Is the Pentagon inept?
Ms. KNOX. I just said they were.
Mr. BACHUS. All right. [Laughter.]
Dr. Russell.
Dr. RUSSELL. I have no knowledge of how the information was transmitted from the CIA, the origin of the information, at what level in the civil establishment we call the Defense Department. And I don't know where the fault lies.
I must say our committee was very unhappy about having been kept in the dark.
Mr. BACHUS. Right. Kept in the dark, foot dragging, concealment, coverup, whatever it was, what institutional changes do you think can be made at the Pentagon to see that this doesn't happen again?
Ms. GWIN. This Committee has been extended in part to oversee the activities that DOD has put in place now. They have expanded their investigative team substantially, I guess almost tenfold. They have devoted much more money to the investigative effort as well as— —
Mr. BACHUS. So you're sort of monitoring them and investigating the investigators or— —
Ms. GWIN. We are overseeing their activities as well as trying to conduct some of our independent investigations so that we can make sure— —
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Mr. BACHUS. Okay. Thank you.
Let me ask another question. Now that we've got the chemical exposure and there's proven chemical exposure, now there's a question of the link between that and the illnesses that our veterans have. The University of Texas study that's come out recently appears, at least my thought is, that that conclusively provides a link between some of this exposure and some of these illnesses. Dr. Russell, is that?
Dr. RUSSELL. I don't believe there—what has been proven is a release of chemical agent into the atmosphere when the munitions dumps were destroyed. Whether there was any true exposure or not has yet to be determined.
Whether that population that was exposed has medical outcomes any different than the rest of the population that was in the Gulf anywhere near those dumps, I don't know the relationship between the patients that Dr. Haley studied and that monition dump. But I think I know that they weren't anywhere near there. So we can't draw any cause and effect relationship. No, sir.
Mr. BACHUS. Would you agree that that was a significant study?
Dr. RUSSELL. I think it was a significant study. It will require extensive follow-up and replication by other scientists.
Mr. BACHUS. Thank you.
And, finally, this is my last question. There have been reports that VA doctors who have studied the Gulf War Syndrome have been fired from the VA system. You all may have heard of those reports. They say that this was retaliation. Would you all make any comment? Are you aware of those reports?
Ms. GWIN. We are aware of the reports. We have not reviewed as a committee the basis for them.
Mr. BACHUS. Don't you think that should be done? And who should do that?
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Ms. GWIN. The committee hasn't reached a conclusion about that.
Mr. BACHUS. Would you take a look at that? Thank you.
The CHAIRMAN. The gentleman from New Jersey, Mr. Smith, is recognized.
OPENING STATEMENT OF HON. CHRISTOPHER H. SMITH
Mr. SMITH of New Jersey. Thank you very much, Mr. Chairman.
A couple of questions. And many of the more important questions have been asked already. And I appreciate my colleagues zeroing in on those questions. Major Knox, one of our witnesses today, Mr. Ford, will make the comment that a majority of the funded Gulf War studies and nearly half of those completed that were related to stress, that ''It's not surprising,'' to use his words, ''that the Presidential Advisory Committee found stress to be an important contributing factor.''
And also in testimony today the commander-in-chief of the Veterans of Foreign Wars, Mr. Nier, states, ''We, the VFW, find it unfathomable as well as counterproductive to insist that stress is the predominant cause. These elements are nothing more than, in the veterans' heads, an insult.'' And then it goes on to develop that theme.
How do you respond to that?
Ms. KNOX. Well, again, in our report we state that we need to look at stress in more detail, the physiological effects of stress. And that was one of the largest areas of funding that DOD did. Of course, the results of that are not in.
But that was one of the three findings that we made that stress was a contributing factor. We do need to look at PB and the synergistic effects and also low-level chemical exposure.
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Mr. SMITH of New Jersey. Again, Mr. Ford raises a question today—and, again, looking at their testimony, they do raise some questions that ought to be highlighted here—that ''The Presidential Advisory Committee's findings are questionable because it included individuals who are not scientists and because it relied heavily on government-provided information.''
How do you respond to that, particularly the latter part of that?
Ms. KNOX. As I said in my opening statement, all of the panels that we heard had peer-reviewed research included. Our committee includes scientists.
Mr. SMITH of New Jersey. So you believe you had sufficient resources to do the job?
Ms. KNOX. I think we did.
Mr. SMITH of New Jersey. Let me ask one final question. Your committee recommends that the VA should seek statutory authority to treat veterans and their families for reproductive problems caused by their service connection. You don't include abortion in this list of services, do you?
Ms. KNOX. I'll have to refer— —
Ms. GWIN. The service we specifically identify is genetic counseling.
Mr. SMITH of New Jersey. Okay. But what about abortion?
Ms. GWIN. The committee did not consider abortion. We specifically recommended that genetic counseling be included in this.
Mr. SMITH of New Jersey. Okay. Thank you. I yield back the balance of my time.
The CHAIRMAN. Thank you, sir.
The gentle lady from Idaho, Ms. Chenoweth, is recognized for 5 minutes.
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Mrs. CHENOWETH. I won't be using my 5 minutes. I just have one question. But I do have a statement that, with your permission, I'd like to enter into the record.
The CHAIRMAN. Certainly will.
[The prepared statement of Congresswoman Chenoweth appears on p. 314.]
Mrs. CHENOWETH. Thank you, Mr. Chairman.
My question is this to Ms. Knox: Can you foresee that any of the records involving this subject in the Pentagon would be considered classified or would have any other kind of classification on them so that people would hesitate to send them to either us or to people who have been suffering from Gulf War Syndrome, their own records with regard to medical records?
Ms. KNOX. Is your question: Would the medical records be classified?
Mrs. CHENOWETH. Either medical records or procedures that this Committee may want with regards to how things are handled.
Ms. KNOX. Not that I'm aware of.
Ms. GWIN. The only medical records that we came into contact with that had at one time been classified were the records of the vaccines, Anthrax and botulin toxoid vaccines, that were given to the troops.
Mrs. CHENOWETH. Ms. Gwin, do you see any problem with that now? Is it the policy of the Pentagon and the Department of Defense to make sure that any patient who requests medical records or who requests information with regards to procedures or vaccinations or anything be afforded that information?
Ms. GWIN. We believe the policy of DOD and VA is to make medical records available to the individuals to whom those records apply.
Mrs. CHENOWETH. Mr. Chairman, I do have records here that have been stamped that read, ''These documents or records or information contained herein are deemed confidential and privileged under provisions of 38 USC 3305 and VA Regulation 6500 through 6540, which provides for fines up to $22,000 per violation.'' This material shall not be transferred to anyone without proper consent or authorization as provided for by law or regulation.
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And I know that the Committee through the subpoena process can probably eventually get what we need. But I am also concerned that the process is not set up in DOD or the Pentagon. So our veterans cannot get all the records that they need to— —
Ms. GWIN. I am not absolutely sure, but I think that citation is to a Privacy Act concern, not to classification.
Mrs. CHENOWETH. Thirty-eight USC 3305?
The CHAIRMAN. The Chair I think can answer that, I think there's a statute that prevents the VA from releasing these records. It's kind of like the Privacy Act—it does not prohibit the individual from seeing it, but the VA cannot release those records to other people.
Mrs. CHENOWETH. Okay. Mr. Chairman, my concern is that the victims of Gulf War Syndrome had a very difficult time in getting their own records or because this was stamped on their records. And people who would have otherwise issued them didn't want to be fined $20,000.
The CHAIRMAN. In my understanding, that should not be the case for the individual to get his records. He is certainly eligible to get those records.
Mrs. CHENOWETH. Well, Mr. Chairman, that's the reason that I wanted to be sure and bring that up now— —
The CHAIRMAN. Thank you.
Mrs. CHENOWETH (continuing). So that it won't happen in the future.
Mr. EVANS. Mr. Chairman, I also understand, at least during my time, the service said you had all your medical records that you took with you from command to command and when you were discharged, they hold onto them. But you can easily obtain those. If that's a problem, individuals should see their local member of Congress.
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Mrs. CHENOWETH. Thank you. And, Mr. Chairman, I will be entering this also in the record later.
The CHAIRMAN. Thank you.
The CHAIRMAN. Mr. Bachus, you got here just in time to be the last one on this panel. Thank you, sir.
Dr. Russell and Major Knox, Ms. Knox, and Ms. Gwin and Mr. Brown, we thank you for your time this afternoon. There will probably be questions from members and staff of the Committee. We would appreciate a rapid response, if you would, please. And thank you very much.
Dr. RUSSELL. Certainly.
Ms. KNOX. Thank you, sir.
The CHAIRMAN. Our next witness is Commander Nier. And while he's coming up, let me remind the members that this first panel has taken a little over an hour and a half. If you could, please refrain from asking other members to yield so as to not use their time. It would be appreciated if we move very rapidly through this. We have four panels to go.
Commander Nier is the Commander-in-Chief of the Veterans of the Foreign Wars. We're happy to have you with us, Commander. And, if you care to introduce anyone or if you want to proceed, your entire statement will be made a part of the record. If you can summarize, it would be appreciated.
Mr. NIER. Thank you, Mr. Chairman, and members— —
The CHAIRMAN. Let me just give it one second for these members so as not to be interrupted.
Go ahead, sir.
Mr. NIER. Thank you, Mr. Chairman, members of the Committee.
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STATEMENT OF JAMES E. NIER, COMMANDER-IN-CHIEF, VETERANS OF FOREIGN WARS OF THE UNITED STATES; ACCOMPANIED BY KEN STEADMAN, EXECUTIVE DIRECTOR, VFW WASHINGTON OFFICE, AND JOHN GWIZDAK, LEGISLATIVE CHAIRMAN
Mr. NIER. Yes, I would like to introduce the two gentlemen who are with me. On my left and your right, Mr. Ken Steadman, the Executive Director of our Washington office; and on my right and your left, Mr. John Gwizdak, my legislative chairman from the great State of Georgia.
The CHAIRMAN. Thank you, sir.
Mr. NIER. As you are aware, it was my privilege earlier today to express the views of the Veterans of Foreign Wars before a joint hearing on the Committees on Veterans' Affairs regarding veterans programs and entitlements. It is now my honor to come before this Committee on behalf of a very special segment of the veteran population: those brave young men and women who served so honorably and well in the Persian Gulf.
A number of these individuals are suffering from as-yet-undiagnosed disabilities collectively known as Gulf War Syndrome. The VFW is unalterably committed to seeing this Nation spare no effort in coming to the aid of these veterans. We insist that Persian Gulf veterans receive all the health care and compensation that is there due.
Yesterday afternoon the VFW hosted a major forum within the context of our Washington conference addressing Gulf War Syndrome held at the Sheraton Washington Hotel and facilitated by VFW staff. senior representatives from the President's advisory committee, DOD, the VA, Centers for Disease Control, and concerned VSOs took part. I can tell you that this forum was an enormous success. And we fully intend to continue in this vein.
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The VFW has for some time pushed for the extension of the life of the President's Advisory Committee on Gulf War Veterans' Illnesses, which has served so ably in overseeing and coordinating the effort to resolve this issue. We are highly gratified that the President has heeded our request by extending the committee's operation another 9 months.
While Gulf War Syndrome is now fully recognized in the scientific and medical communities as a legitimate disease, its cause and cure have continued to remain elusive. One serious obstacle to properly resolving this issue has been its far-from-adequate handling by the Department of Defense.
At least early on, DOD simply refused to give Gulf War veterans' own reports of ill health symptoms and possible toxics exposure episodes the credence they deserved. Further, DOD's failure to come forward in a timely manner with information showing that a large number of our troops in the Gulf may have come into contact with chemical and biological agents has surely impaired relevant scientific research.
Perhaps even more detrimental, however, is the climate of uncertainty and even distrust this has created among Gulf veterans themselves. Many perceive themselves to have been deliberately deceived and will call will into question almost information that COD now provides. This has rendered an already troublesome issue much more difficult and indeed represents an affront to the sacrifice and service of all of this Nation's veterans.
The VFW demands that all relevant data on the Gulf War experience be provided to the appropriate scientific and public entities as soon as it comes to light.
The VFW is also deeply concerned over the high denial rate for Gulf veterans seeking VA compensation for undiagnosed illnesses. While it is our understanding that some of these veterans now receive compensation for diagnosed disabilities, the 95 disallowance rate for undiagnosed illness claims strikes us as implausibly high.
We insist that no Gulf veteran in need be left out in the cold because of our as-yet inadequate understanding of Persian Gulf Syndrome. An important step in this regard would be the expansion of the current 2-year presumptive period in which Gulf War Syndrome must manifest in order for a veteran to receive VA compensation. In light of the medical, scientific, and factual uncertainty surrounding this issue, this manifestation period is both overly restrictive and scientifically unsound.
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The VFW urges the immediate establishment of an open-ended presumptive period for Gulf War Syndrome. The VFW also supports the establishment of a case definition for Gulf War Syndrome. This would, at the very least, allow veterans benefit administration to take individual symptoms associated with service of the Gulf under consideration collectively.
Whereas, when taken individually these disabilities may not fall within their assigned manifestation periods, taken together they may represent a compensable manifestation of Gulf War illness. Further, this would compel VA doctors to more thoroughly assess the etiology of Gulf veterans' disabilities, thereby improving the rating process.
Mr. Chairman, it would be remiss of me if I did not at this time commend the strong bipartisan effort of the Congress as well as the administration in addressing this issue. Standing in stark contrast to the handling of Agent Orange many years ago, this Nation's lawmakers have been swift and vigorous in working to provide veterans suffering from Gulf War Syndrome the care and compensation they need and they deserve.
I thank and congratulate you for your accomplishments thus far. Be assured the Veterans of Foreign Wars will continue to work together with you and will not relent until the Persian Gulf issue is fully resolved.
Thank you very much.
[The prepared statement of Mr. Nier appears on p. 326.]
The CHAIRMAN. Commander, thank you for your statement. We look forward to working with you and your membership.
Do any members have questions? Mr. Evans?
Mr. EVANS. No, Mr. Chairman.
I appreciate the commander's insistence that we extend the filing date. That's very important. I hope we'll work on that in this Congress.
Thank you, Mr. Chairman.
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The CHAIRMAN. Mr. Quinn, I'm just going to bounce back and forth. I don't know. Any questions of the commander?
Mr. QUINN. Thank you, Mr. Chairman.
No questions at this time. We heard your testimony this morning at the hearing, Mr. Commander. We appreciate your time very, very much.
Mr. NIER. Thank you very much, sir.
The CHAIRMAN. Mr. Kennedy.
Mr. KENNEDY. Thank you, Mr. Chairman.
Commander, first of all, I wanted to just apologize for not being able to be with you this morning. I was at a meeting at the White House. And I apologize for not being there, but I look forward to having an opportunity to read your testimony.
Further, I just wanted to ask one brief question, which is whether or not your current sense of the health care that is being provided to the veterans that are a part of your organization that have this particular syndrome is, in fact, being dealt with adequately by the VA.
Mr. NIER. No, sir, we do not. We think it's inadequate. It's our goal to ensure that these veterans receive the care and compensation they deserve. And right now we're not happy with the 95 percent disallowance rate.
Mr. KENNEDY. Can you just explain a little bit more about what you feel the implications of that 95 percent rate are? In other words, why are they being turned down? Is your sense that there is still an attitude by the VA itself of not recognizing this as a legitimate illness or what is your sense of why people are not getting properly cared for?
Mr. NIER. It's my sense, sir, that it's the presumptive period. That's why we want it extended.
Mr. KENNEDY. But the presumptive period because Mr. Evans and I and the Chairman worked on this last year would only cover, as I understand that issue—Mr. Chairman, maybe you can help me if I'm wrong about this, but I thought that that only dealt with those individuals who would be coming forward now who had not previously felt that they had illnesses that related to their service in the Gulf. Is that really the only category of veterans that you're suggesting are not being properly cared for or are there, in fact, others who are just going in and are feeling like they're not getting—you know, they go in and they say, ''Listen, I've got these complaints,'' that they did, in fact, register but they're just not getting the proper care?
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Mr. NIER. Yes. Our concern is, Senator, that it could be when the— —
Mr. KENNEDY. My uncle would not be pleased with that one, Mr.— —
[Laughter.]
Mr. NIER. I'm sorry.
Mr. KENNEDY. The Chairman probably would be just as happy to have me move out, but anyway.
Mr. NIER. Sorry. The coming forth of the veterans with individual symptoms may not have been granted the compensation. We feel that they now should be looked at with collective symptoms. And perhaps they would be eligible for the compensation and care.
Mr. KENNEDY. I could pretend I understood what you just meant by that. Can you just explain that for a second, please?
Mr. NIER. Well, they could have come forth early on with a symptom that was not recognized as compensable by the VA.
Mr. KENNEDY. I see.
Mr. NIER. Later they may have come forth with more symptoms that looked at collectively may— —
Mr. KENNEDY. I see. But it is really the category of veterans that have the requirement or the need to actually declare themselves victims of the syndrome at this stage, rather than people who have been treated in the past who have declared themselves to be victims of the syndrome. You're feeling that those veterans, which I think would be the vast majority of the ones that are being cared for by the VA, are getting adequate care? I'm just trying to get an understanding of what you're suggesting.
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Mr. NIER. I think so, yes, sir.
[The information follows:]
To date, approximately 2000 Guard/Reserve members have completed diagnostic evaluations through the CCEP; however, the number of individuals who may be in need of follow-up care is unknown. Guard/Reserve personnel have limited entitlement to follow-up treatment within the MHSS unless they have a medical condition which can be shown to be service connected according to strict criteria. Provisions of Public Law entitle any Persian Gulf veterans who may have been exposed to a toxic substance or environmental hazard to receive follow-up care through the VA. The Department will be working with VA to make certain that Guard /Reserve personnel evaluated through the CCEP are aware that they may apply for follow-up care through the VA system.
Mr. KENNEDY. Yes.
Mr. NIER. Right.
Mr. KENNEDY. Okay. Thank you very much.
The CHAIRMAN. Dr. Cooksey, do you have questions?
Dr. COOKSEY. No, no questions. Thank you.
The CHAIRMAN. Thank you, sir.
Mr. Peterson, no questions? Who's next? Mr. Bilirakis, do you have a statement?
Mr. BILIRAKIS. Just one, Mr. Chairman. I guess it's more a follow-up to Mr. Kennedy's.
Is it your feeling, your strong feeling—I know you referred to the study, the presumptive period. But is it your strong feeling that if that were extended, that it would probably pick up an awful lot of the disallowances— —
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Mr. NIER. Yes, sir.
Mr. BILIRAKIS (continuing). By the problems?
Mr. NIER. Yes, sir.
Mr. BILIRAKIS. Do you have any feeling as a result of your own research and whatnot as to what that period should be?
Mr. NIER. Yes. We have our own Gulf War registry. And we are really pursuing this issue within our organization.
Mr. BILIRAKIS. Okay. But you have no recommendation to this Congress in terms of whether it should be 3 years, 4 years, or——
Mr. NIER. Open-ended. Yes, sir, we do.
Mr. BILIRAKIS. Open-ended?
Mr. NIER. Open-ended. Yes, sir.
Mr. BILIRAKIS. I see.
Mr. NIER. That's our recommendation.
Mr. BILIRAKIS. All right. Thank you. Thank you, Mr. Chairman.
The CHAIRMAN. Dr. Snyder? No questions. Mr. Peterson? No questions. Bob Filner?
Mr. FILNER. Thank you, Mr. Chairman.
I apologize for missing your statement. I heard you this morning. So I'm sure I agree with everything you said. But let me tell you why I missed your statement. And I'd like to have some advice on this because it seems to exemplify the problems that people are dealing with or having with the establishment, as it were, the folks who are supposed to be helping us out of this.
I was meeting with a couple of your members from California, very serious people, looked to me very credible,—they had one of your hats on; so I assume they were very credible—explaining to me that a set of doctors that they knew working both in Texas and in California had because of relatives who had come down with these symptoms got very personally involved with the research, et cetera, and had developed some laboratory tests that involve tests that most doctors wouldn't either know about or how to do. They have to do with white cell testing, DNA prints, and claim to have been able to diagnose the set of symptoms in some very precise ways and then treat them in very successful ways. And they have case studies now up to 6,000. The way they relayed it to me they have not been able to get an official hearing on what exactly they're doing and the success they've had.
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Now, does that sound credible to you, that story? and what is the problem with people who are seeming to make gains in this not getting a respectful hearing about things that might help thousands and thousands and thousands of people? Does this story sound at all credible?
And what should we do about it? I'd like to ask both you and the Chair: If there is something to this, how do we get these stories out here?
Mr. NIER. I do not know. I can't respond to the credibility. I would think it is, sir, if it came from VFW members. Who were they asking for the hearing with? I'm not quite sure.
Mr. FILNER. I didn't have time to go over the full story because I want to come back and talk to you. But they were explaining their studies had been submitted to the Pentagon and to the commissions. And people were just not paying any attention because these were not doctors within the normal network or the normal establishment, as it were.
Mr. NIER. I am just being told that we have encouraged the VA to look into this. It's a Mr. Garth Nicholson, I believe you said, a microbiologist?
Mr. FILNER. I think so.
Mr. NIER. So that story is, in fact, credible. And we are encouraging the VA to meet with them, sir.
Mr. FILNER. I hope we as a Committee or as a group could encourage that. It sounded to me to be very real. The response that they have encountered sounded to me typical of some of the defensiveness and inability to accept things outside the normal chain of command but might have success. At least it's worthy given what we are dealing with as a nation of some interest.
The CHAIRMAN. Mr. Filner, we have members of the VA here today. And you can ask them that question.
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Mr. FILNER. Thank you very much. I appreciate it.
I yield to Mr. Evans, please.
The CHAIRMAN. Mr. Evans.
Mr. EVANS. I understand Garth Nicholson's concerns are being. investigated by the United States Army at this point, not the VA, that they're looking into it.
Mr. FILNER. I am not certain this is the right name or not, frankly, but we— —
Mr. EVANS. Is that the name?
Mr. FILNER. I'm not sure. That's what they think they— —
Mr. NIER. It is one of several, sir.
Mr. EVANS. The VA is also funding some studies. I think you can direct your questions to them when they come up— —
Mr. FILNER. Fine. Thank you.
Mr. EVANS (continuing). About some studies that they are going to fund in the next fiscal year.
The CHAIRMAN. Are there other questions? Mrs. Chenoweth? Mr. Bachus? Spencer?
Mr. BACHUS. Thank you.
Commander, this 95 percent that we hear, is this of all disability benefits or these are just the mysterious illnesses, undiagnosed, or is this all of them?
Mr. NIER. All of them, sir.
Mr. BACHUS. But that's the total of— —
Mr. NIER. That's correct.
Mr. BACHUS (continuing). Over what? Over 7,000. And we've only had about 400 of them honored?
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Mr. NIER. Right.
Mr. BACHUS. Are you familiar that the GAO took a look at that, the reasons for these denials? Have you all reviewed the GAO's—do you all have any comment maybe on the GAO study?
Mr. NIER. Go ahead, Mr. Steadman.
Mr. STEADMAN. Sir, we are familiar with that. Our staff is reviewing that currently, taking a look at what GAO had to say about it.
Mr. BACHUS. How does this 95 percent f