


                                                                          1

                        UNITED STATES OF AMERICA


                                  - - -

                     PRESIDENTIAL ADVISORY COMMITTEE

                     ON GULF WAR VETERANS' ILLNESSES

                                  - - -


                             PUBLIC MEETING

                                  - - -

                         Monday, August 14, 1995


                                  - - -



                      The Advisory Committee met in the

          Congressional Room, Capital Hilton, 16th and K Street,


          N.W., Washington, D.C., at 9:30 a.m., Dr. Joyce

          Lashof, Chair, presiding.

          PRESENT:


                      JOYCE  LASHOF, Chair

                      JOHN BALDESCHWIELER

                      ARTHUR L. CAPLAN

                      DONALD CUSTIS


                      DAVID A. HAMBURG

                      MARGUERITE KNOX

                      PHILIP J. LANDRIGAN


                      ELAINE L. LARSON

                      ROLANDO RIOS

                      ANDREA KIDD TAYLOR


                                                                          2

          DESIGNATED FEDERAL OFFICIAL:


                      CATHERINE WOTEKI

          STAFF PRESENT:

                      ROBYN NISHIMI

                      THOMAS McDANIELS


                                                                          3

                             C O N T E N T S


                                                          PAGE

          Hillary Rodham Clinton                             8

          The Honorable Donna E. Shalala                    18

          The Honorable Jesse Brown                         21


          The Honorable John P. White                       28

          The Honorable Stephen C. Joseph                   53

          The Honorable Kenneth W. Kizer                    66


          Dr. Henry Falk                                    68

          Dr. Robert H. Roswell                             78

          Public Comment                                   129


                                                                          4

     1                    P R O C E E D I N G S


     2                                            (9:34 a.m.)

     3                MS. WOTEKI:  Good morning, everyone.  My

     4    name is Catherine Woteki.  I'm the Acting Associate

     5    Director for Science at the White House's Office of


     6    Science and Technology Policy.  I'm also the

     7    designated federal official for this very important

     8    committee.


     9                I would like to welcome all of the

    10    committee members to this, the first meeting, and also

    11    to thank them for their willingness to embark on the

    12    endeavor that you will be embarking upon.


    13                I'd also like to welcome all of the people

    14    who are going to speak and give testimony today,

    15    veterans, members of their families, and also to


    16    welcome all of you who are observers.

    17                In my capacity as designated federal

    18    official, I also have the responsibility for opening

    19    and closing all of the meetings of the committee, and


    20    at this point this meeting is now open.

    21                I'd like to introduce to you Dr. Joyce

    22    Lashof, who is the Chair of the committee.


    23                CHAIR LASHOF:  Thank you very much.  thank

    24    you, Ms. Woteki.

    25                It's my pleasure to be able to chair this


                                                                          5

     1    Advisory Committee, and I want to join Cathy Woteki in


     2    thanking all of the members for their willingness to

     3    participate in this endeavor.

     4                As you know, the concerns of the illness

     5    of the Gulf War veterans is a high priority for both


     6    the President and the First Lady, and the appointment

     7    of this committee really represents their commitment.

     8                Our charge is to review all of the


     9    activities that are ongoing to get to the bottom of

    10    the problem, to assure that veterans are receiving

    11    adequate care, and eventually to make recommendations

    12    about how future such studies or problems can be dealt


    13    with.

    14                At this point, I would like to introduce

    15    or, rather, ask each member of the Advisory Committee


    16    to introduce themselves, and we'll just go around the

    17    table here and just ask each of them to identify

    18    themselves and just briefly their current positions.

    19                Dr. Hamburg.


    20                DR. HAMBURG:  David Hamburg, President of

    21    Carnegie Corporation of New York, which is a general

    22    purpose foundation.


    23                MS. WOTEKI:  Could you use your

    24    microphones.

    25                CHAIR LASHOF:  Push the button on your


                                                                          6

     1    mikes.


     2                MS. KNOX:  I'm Marguerite Knox.  Can you

     3    hear me now?

     4                CHAIR LASHOF:  Yes.

     5                MS. KNOX:  Okay.  I'm Marguerite Knox. 


     6    I'm a captain in the South Carolina Army National

     7    Guard.  I'm also a clinical assistant nursing

     8    professor at the University of South Carolina in


     9    Columbia.

    10                DR. LANDRIGAN:  I'm Philip Landrigan.  I'm

    11    a physician, Chairman of the Department of Community

    12    Medicine at Mt. Sinai Medical Center in New York.


    13                MS. LARSON:  My name is Elaine Larson. 

    14    I'm the dean of the School of Nursing at Georgetown

    15    University here in D.C.


    16                MR. RIOS:  My name is Rolando Rios.  I'm

    17    a public interest lawyer.  I'm a Vietnam veteran and

    18    a disabled veteran.

    19                MS. TAYLOR:  I'm Andrea Kidd Taylor.  I'm


    20    with the United Auto Workers Health and Safety

    21    Department in Detroit.  I'm an industrial hygienist.

    22                DR. BALDESCHWIELER:  I'm John


    23    Baldeschwieler.  I'm a professor of chemistry at the

    24    California Institute of Technology.

    25                DR. CAPLAN:  I'm Art Caplan.  I'm


                                                                          7

     1    professor of bioethics at the University of


     2    Pennsylvania.

     3                DR. CUSTIS:  I'm Dr. Don Custis, retired,

     4    previous Chief Medical Director of the Veterans'

     5    Administration and previously a career in the Navy.


     6                CHAIR LASHOF:  Thank you very much.

     7                As you can see, this Advisory Committee

     8    does represent many disciplines, many areas of


     9    expertise, and I believe that we have a committee well

    10    able to address the complexity of the problems that we

    11    face.

    12                At this point the committee comes


    13    completely with an open mind.  They've been provided

    14    with a briefing book of material of previous reports,

    15    but the purpose of this meeting is to initially hear


    16    from the major departments that have been actively

    17    involved in the work and then we will be proceeding to

    18    developing a plan of action and strategies by which we

    19    will undertake our work.


    20                It is our goal to have a report ready for

    21    the President as an interim initial report in six

    22    months and a final report by the end of December of


    23    1996.

    24                This meeting will also enable us to hear

    25    directly from veterans and others who have been


                                                                          8

     1    concerned for some time, who have specific statements


     2    they wish to make to the Committee about the Gulf War

     3    veterans' illnesses.

     4                I'm obviously waiting for the signal that

     5    the First Lady has arrived and will be able to


     6    introduce her to you momentarily.

     7                All right.  As many of you know, the

     8    President's commitment to the Gulf War veterans is


     9    shared by the First Lady and, thus, as we embark on

    10    this effort, it is my distinct pleasure and honor to

    11    introduce the First Lady, Hillary Rodham Clinton.

    12                (Applause.)


    13                MRS. CLINTON:  Thank you very much.

    14                I am delighted to be here at this first

    15    meeting, and on behalf of the President, I want to


    16    thank the Chair and members of the President's

    17    Advisory Committee on Gulf War Veterans' Illnesses for

    18    your willingness to perform this public service.

    19                I also want to welcome all of the


    20    veterans, their friends and families, who are here to

    21    talk about their personal experiences and to hear from

    22    the administration officials who have been working


    23    diligently on the issues raised in the President's

    24    executive order creating this committee.

    25                I want to start by emphasizing again how


                                                                          9

     1    proud we all are of our victory in the Gulf War. 


     2    Because of the enormous skill and bravery of American

     3    troops, an end was put to Saddam Hussein's brutal and

     4    illegal occupation of Kuwait.  Because of the strength

     5    of U.S. leadership, the international community came


     6    together to stop and reverse unprovoked aggression

     7    against an innocent nation.

     8                This Presidential Advisory Committee is an


     9    important example of the President's commitment to

    10    leave no stone unturned in the administration's

    11    efforts to understand Gulf War veterans' illnesses and

    12    to make sure that the government is responsive to


    13    veterans' needs.

    14                In his announcement, the President assured

    15    Gulf War veterans that we are grateful for their


    16    bravery, and we are as proud of them today as all of

    17    us were when they returned victorious in 1991, and

    18    most important, the President made it clear that just

    19    as we relied on our troops when they were sent to war,


    20    we must assure them that they can rely on us now.

    21                The President and I have heard from many

    22    Gulf War veterans and their family members about their


    23    illnesses.  We have received letters from all over the

    24    country and have had the privilege of meeting with

    25    many veterans and family members in person.  Some of


                                                                         10

     1    these men and women, such as Steve Robertson and Nancy


     2    Kapplan, will be speaking to you this afternoon.

     3                Veterans have told me about their

     4    frustrating efforts to find out why they are ill and

     5    how their illnesses can be treated.  They have shared


     6    moving stories of the devastating effects on families

     7    when fathers and mothers become disabled and unable to

     8    work.  They have described what it was like to serve


     9    their country in a desert land where oil well fires

    10    turned the day to night and where sand storms made it

    11    difficult to breathe.  Some describe SCUD missile

    12    attacks, were told of frequent use of insecticides to


    13    protect them from insect-borne diseases.  

    14                Many Gulf War veterans have been outspoken

    15    in seeking and providing information about their


    16    illnesses.  This Advisory Committee will determine

    17    whether the experiences these veterans describe in the

    18    Persian Gulf and in receiving medical care have been

    19    adequately addressed or whether there are additional


    20    actions that need to be taken.

    21                When Secretary Jesse Brown and I met with

    22    veterans at the local VA hospital here in Washington,


    23    and when then Deputy Secretary of Defense John Deutsch

    24    and I met with active duty soldiers at Walter Reed

    25    Hospital, the stories we heard touched us deeply and


                                                                         11

     1    provided important information as well.  I know you


     2    will be working closely with veterans who will be an

     3    invaluable resource in your deliberations, and I am

     4    pleased you will begin by hearing directly from Gulf

     5    War veterans today.


     6                I have also met with the physicians,

     7    nurses, and other health care professionals from the

     8    VA and DOD who have worked with Gulf War veterans who


     9    are ill.  They, too, express great frustration about

    10    the difficulties they have faced in helping some of

    11    the veterans and their family members whose illnesses

    12    remain undiagnosed.  I know you will also work closely


    13    with these dedicated men and women and learn from

    14    their experiences.

    15                When the men and women of the U.S.


    16    military reserves and National Guard were called to

    17    war in 1990, our nation knew that we could rely on

    18    them, and they served our nation honorably.  When we

    19    look back to the euphoric parades for returning U.S.


    20    troops in 1991, we can still remember a great feeling

    21    of relief.  We had won the war, and most Americans had

    22    returned home safely, but through 1991 and 1992 there


    23    was increasing concern about some of our Gulf War

    24    veterans.

    25                There were veterans who described symptoms


                                                                         12

     1    that did not respond to treatment and did not go away


     2    as expected.  When my husband became President and

     3    learned that the numbers of veterans with chronic

     4    symptoms seemed to be increasing, he took an active

     5    interest in helping our veterans.


     6                Because of the leadership and dedication

     7    of the Departments of Veterans' Affairs, Defense, and

     8    Health and Human Services, this administration has


     9    already made unprecedented efforts to help Gulf War

    10    veterans.  For example, never before has an

    11    administration moved so quickly to conduct research

    12    aimed at helping returning soldiers who are ill.  This


    13    year alone, the three departments will spend

    14    approximately $15 million to study possible

    15    environmental hazards, to determine whether illnesses


    16    have been transmitted to spouses and children, and to

    17    develop improved treatment programs.

    18                With the leadership of the VA, this

    19    administration strongly supported laws to insure that


    20    compensation is available to those who are disabled,

    21    even if the direct causes of the illnesses stemming

    22    from their military service are unknown.


    23                The VA is also providing priority medical

    24    care to Gulf War veterans, and both VA and the Defense

    25    Department have established special treatment centers


                                                                         13

     1    to help veterans whose illnesses are particularly


     2    difficult to diagnose.

     3                The Defense Department has also recently

     4    initiated a new program that will declassify documents

     5    and other information about the Gulf War and make them


     6    available on Internet.

     7                All of these efforts will serve our

     8    veterans well, and most were accomplished with


     9    bipartisan support from the 103rd Congress under the

    10    leadership of then Chairman of the Veterans' Affairs

    11    Committees, Senator Jay Rockefeller and Representative

    12    Sonny Montgomery and their committee members.


    13                As President Clinton stated when he first

    14    announced this Advisory Committee, he is determined to

    15    do whatever it takes to respond to the concerns of the


    16    Gulf War veterans. 

    17                This administration has already convened

    18    several other panels of outside experts to examine

    19    various issues pertaining to Gulf War veterans'


    20    illnesses, but it came to realize that the issues are

    21    so complex they require a more comprehensive,

    22    sustained effort, and so the President established


    23    this Advisory Committee, to be independent and

    24    appropriately staffed, with the relevant experience

    25    and expertise that the members represent.


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     1                This Advisory Committee is unique because,


     2    as the President outlined in his executive order, you

     3    will review all aspects of the federal government's

     4    programs and policies that affect Gulf War illnesses,

     5    telling us what we are doing right and what we should


     6    be doing better.

     7                The executive order specifies that you

     8    will provide advice and recommendations based on your


     9    review of the following:  research, medical treatment,

    10    risk factors from service in the Gulf War, including

    11    possible environmental factors and drugs and vaccines,

    12    reports of the possible detection of chemical and


    13    biological weapons, coordinating efforts that have

    14    been established by federal agencies, external reviews

    15    by other expert panels, and outreach to veterans.


    16                As you can see from that list, the mandate

    17    is broad.  In your efforts to review all of these

    18    programs and policies, the Secretaries are pledged to

    19    assist you, and you will find their doors open to you,


    20    and the President has made it absolutely clear in his

    21    executive order and in his announcement of this

    22    Advisory Committee that when you consider your task,


    23    no issue is off limits and every reasonable inquiry

    24    should be pursued.

    25                There are many opinions about how many


                                                                         15

     1    Gulf War veterans are ill, what has caused those


     2    illnesses, and how they can best be treated.  In

     3    talking to veterans and to those who are trying to

     4    serve them, it is clear that those opinions are as

     5    strongly held as they are diverse, and so your task is


     6    a difficult one.  There are many unanswered questions,

     7    and we are counting on you to make sure that this

     8    administration is doing all it can to catalog relevant


     9    questions and insofar as possible answer them.

    10                For that reason, you were selected on the

    11    basis of your wide range of expertise in medical

    12    issues, scientific research, policy, and military


    13    matters.  The veterans on the panel will contribute

    14    their invaluable perspectives from their military

    15    experiences, and it is particularly important that two


    16    of you served in the Gulf War.

    17                You all were selected because you do not

    18    have preconceived notions about the scope of the

    19    problem of Gulf War illnesses or the causes and


    20    treatments.   

    21                None of us knows what the research now

    22    being conducted or called for in the future will tell


    23    us.  So far the research that the government has

    24    conducted indicates that thousands of veterans who

    25    were healthy when they left for the Gulf War are now


                                                                         16

     1    ill.  Many veterans believe that these symptoms


     2    clusters together into a Gulf War syndrome that is

     3    unique.

     4                Based on the research to date, however,

     5    experts have concluded that there is not enough


     6    evidence to call this a syndrome.  This is an issue

     7    that will continue to be studied as more research is

     8    completed.


     9                There are disagreements about the likely

    10    causes and the best treatments for these symptoms. 

    11    These issues also will continue to be studied as more

    12    research is completed.


    13                The President has appointed this Advisory

    14    Committee because we do not yet have the answers to

    15    these important questions.  These are complicated,


    16    scientific questions that deserve careful scientific

    17    scrutiny.

    18                In his executive order, the President has

    19    entrusted you to make sure that the federal government


    20    is supporting appropriate research and that whenever

    21    possible, the results are being used to inform

    22    treatment, compensation, and priorities for future


    23    research.

    24                You are also entrusted to examine the wide

    25    array of federal programs and policies to make sure


                                                                         17

     1    that they not only make sense, but also that they are


     2    being administered effectively and humanely.

     3                I want to leave you with the image of an

     4    open door.  Perhaps your most important tool as you

     5    serve on this committee is your ability to be open


     6    minded, to take advantage of our open door policy to

     7    seek out the information you need, to evaluate all

     8    existing programs and policies, and to make


     9    recommendations to insure that this administration

    10    will continue to be responsive and responsible to our

    11    veterans.  We owe them that much and more, and all of

    12    us are grateful for your willingness to take on this


    13    important public service.

    14                Thank you very much, Madame Chairman.

    15                (Applause.)


    16                (Pause in proceedings.)

    17                CHAIR LASHOF:  Now, I think we're all very

    18    appreciative of the First Lady coming to join us and

    19    of her remarks.  The challenge she has given us is


    20    certainly a major one that we are willing to

    21    undertake.

    22                And now it's my pleasure to introduce --


    23    I guess we're going to take a brief break while

    24    there's some logistic changes here.  We have to

    25    rearrange things for the first panel.


                                                                         18

     1                Would the audience just remain seated and


     2    wait a few minutes while we move the barriers and get

     3    a table up here so we can get the first panel started?

     4                (Whereupon, a short recess was taken.)

     5                CHAIR LASHOF:  I believe we're ready to


     6    proceed, and it is my pleasure to introduce the first

     7    panel, the Honorable Donna Shalala, Secretary of the

     8    Department of Health and Human Services; the Honorable


     9    Jesse Brown, Secretary of the Department of Veterans'

    10    Affairs; and the Honorable John P. White, Deputy

    11    Secretary, Department of Defense.

    12                You may proceed.  Thank you.


    13                SECRETARY SHALALA:  Thank you very much.

    14                I want to join my colleagues in thanking

    15    all of you for your dedication and your energy and


    16    your expertise for our veterans and our country.

    17                Five years ago thousands of American men

    18    and women left their families and their friends and

    19    their jobs and their homes behind to defend freedom


    20    halfway around the world.  I knew dozens of them

    21    because they were my students, my staff, and my

    22    faculty at the University of Wisconsin.


    23                While most returned safely from the

    24    Persian Gulf War, the journey for some has been

    25    fraught with pain and illness.  Today we in the


                                                                         19

     1    administration are renewing our promise to these


     2    Americans and to their families.  We're committed to

     3    finding the answers.  All of us, whether we serve on

     4    the panel or in the cabinet, are here because the

     5    President and the First Lady are determined to get to


     6    the bottom of these medical issues.

     7                The President has made it very clear that

     8    we must leave no stone unturned in our efforts to


     9    identify what these illnesses are, how we can help the

    10    victims and their families, and what we can do to

    11    prevent similar diseases or illnesses from afflicting

    12    veterans in the future.


    13                At the Department of Health and Human

    14    Services, we have taken these challenges very

    15    seriously.  Our involvement with this issue began when


    16    we examined the environmental impact of the oil well

    17    fires that occurred in the early days of the war. 

    18    Since that time we have supported the VA and the DOD

    19    for laboratory diagnosis of leishmania infection. 


    20    Through the National Institutes of Health, we convened

    21    a scientific panel to review the health effects of the

    22    Gulf War and carefully lay out this country's research


    23    needs.

    24                We've conducted studies of illnesses

    25    reported by some Gulf War veterans in a Pennsylvania


                                                                         20

     1    Air National Guard unit, and we've investigated birth


     2    defects reported by others in two National Guard units

     3    from Mississippi.

     4                Today we are proud to be part of the

     5    Inter-agency Persian Gulf Veterans' Coordinating


     6    Board, and I'm pleased to say that the department

     7    through the Centers for Disease Control and Prevention

     8    will soon be collaborating with the Iowa Department of


     9    Public Health to conduct an extensive telephone survey

    10    examining the health of Iowa Gulf War veterans and

    11    their families.

    12                In a few minutes Dr. Henry Falk of the


    13    National Center for Environmental Health at the CDC

    14    will provide you with more details of our work.  All

    15    of these important steps are essential, but we need


    16    you to help us do even more.

    17                The commemoration of the 50th anniversary

    18    of World War II and the dedication of the Korean War

    19    memorial remind all of us of the enormous


    20    contributions of our veterans in every war.  Time and

    21    time again they have sacrificed their lives so that

    22    others could be free.  Our veterans must know that


    23    long after the battle has ended, long after the

    24    mission has been accomplished, long after the last

    25    enemy stronghold has been captured, and long after the


                                                                         21

     1    flag of victory has been planted that their country


     2    will be there for them and their families.

     3                Again, I want to thank members of the

     4    committee for helping us give our veterans and their

     5    families the answers and the assistance they deserve,


     6    and I want to pledge our entire arsenal at the

     7    Department of Health and Human Services, from the

     8    Indian Health Service to FDA, to the National


     9    Institutes of Health, to the Centers for Disease

    10    Control, and the entire Public Health Service to this

    11    effort.

    12                Thank you very much.


    13                CHAIR LASHOF:  Thank you.

    14                The Honorable Jesse Brown.

    15                SECRETARY BROWN:  Dr. Lashof and


    16    distinguished members of the committee, colleagues

    17    from other department and agencies, fellow veterans,

    18    honored guests, ladies and gentlemen, I'm very happy

    19    to be here today, but more importantly, I'm very happy


    20    that you are here.

    21                This is a very significant moment for our

    22    veterans and their families.  Today's meeting elevates


    23    the departments' dealing with the problems of our

    24    Persian Gulf veterans to the highest possible level.

    25    Your work has been given top priority.


                                                                         22

     1                The facts you find and the recommendations


     2    you make will be presented to three cabinet members

     3    and through them to the President of the United

     4    States.  That is the kind of consideration our

     5    veterans and their families need and deserve, and it


     6    is a level of response that is different from another

     7    time and another problem, a time when the problems

     8    related to Agent Orange were allowed to manage us. 


     9    This President and his administration will not allow

    10    history to repeat itself.

    11                Over the past two years I have been

    12    pleased to authorize VA compensation for several new


    13    conditions presumed related to exposure to herbicides

    14    in Vietnam.  We who fought for these benefits never

    15    again want to see our nation fail to respond to the


    16    health problems of our citizen soldiers.  That is why

    17    we are being proactive in responding to the needs of

    18    our Persian Gulf veterans who are suffering from

    19    unexplained illnesses.


    20                We know that the Persian Gulf War was a

    21    dirty word environmentally speaking.  Our warriors

    22    were exposed to stressful combat conditions, smoke


    23    from oil fires, a hot, dusty climate, leishmaniasis,

    24    carp, toxic petroleum products, and depleted uranium.

    25                It is very important that the Advisory


                                                                         23

     1    Committee look into all of these risk factors.  This


     2    includes reports of a possible detection of chemical

     3    or biological agents.  VA, for instance, will continue

     4    to investigate whether any of our veterans are

     5    suffering from health problems that might be the


     6    result of exposure to these agents.

     7                We are also looking into the vaccinations

     8    and medications they received to protect them from


     9    chemical and biological weapons, and we are concerned

    10    about the long-term effects of stress that many of our

    11    Persian Gulf veterans experience.

    12                It is clear in retrospect that there are


    13    many reasons for concern.  Many veterans are reporting

    14    symptoms.  Some have undiagnosed illnesses, and nearly

    15    all have questions.  All of us have been looking for


    16    answers, but the information is incomplete and some

    17    answers have been illusive.

    18                When I made this issue a top priority

    19    nearly two and a half years ago, only one thing was


    20    known for sure.  Persian Gulf veterans were suffering. 

    21    They were suffering from fatigue, memory loss, painful

    22    joints, and other physical and psychological problems. 


    23    That is why I committed VA to doing everything

    24    possible to assist them.

    25                We have initiated our own research


                                                                         24

     1    efforts.  This will allow us to team up with other


     2    agencies in order to find scientific answers.  We are

     3    taking a comprehensive approach to the problem.  The

     4    first step is evaluating immediate problems and

     5    providing care.  We offer a special health


     6    examination, which includes a complete physical

     7    examination with appropriate laboratory studies.  This

     8    is available to all Persian Gulf veterans concerned


     9    about their health, whether they are ill or not. 

    10    Forty-eight thousand veterans have been examined so

    11    far, and the results have been entered into our

    12    Persian Gulf registry.


    13                We continue to monitor the registry, to

    14    identify patterns of illnesses and complaints, and

    15    this centralized registry allows us to provide


    16    veterans with current information on health issues,

    17    research findings, and new compensation policies.

    18                We have four Persian Gulf referral centers

    19    where experts evaluate the cases which are difficult


    20    to diagnose.  They are located in Washington, D.C.,

    21    Houston, L.A., and Birmingham.  We obtained special

    22    authority to offer veterans priority access to VA care


    23    for any disability that might be related to service in

    24    the Gulf.

    25                Following evaluation and treatment, our


                                                                         25

     1    second step deals with disability compensation.  We


     2    supported and worked hard to enact legislation to pay

     3    compensation to Persian Gulf veterans with chronic

     4    disabilities even though their conditions are

     5    undiagnosed and have not been traced to their military


     6    service.  We felt veterans deserved the benefit of the

     7    doubt.  The Congress agreed, and the President signed

     8    this law late last year.


     9                In February I was proud to join President

    10    Clinton in presenting the first compensation check

    11    awarded under the new law to a veteran from my home

    12    State of Illinois.  We are contacting all Persian Gulf


    13    veterans who have had a VA registry examination, and

    14    we're inviting all of them to file a claim for

    15    compensation benefits.


    16                We are also reviewing claims for every

    17    Persian Gulf veteran who had filed a claim based on

    18    environmental hazards.

    19                The third step is one which I believe will


    20    concern this committee, the question of getting

    21    definitive answers.  This obviously involves research. 

    22    We have already begun a large and ambitious effort in


    23    this direction.  There are now over 30 government

    24    research projects.  They are looking into areas like

    25    general health, environmental effects, and  toxic


                                                                         26

     1    exposures.  VA and the Defense Department have


     2    contracted with the National Academy of Sciences to

     3    review existing information on the problem.  

     4                VA is also moving forward with our own

     5    research.  For example, we established three special


     6    research centers.  They will focus on the effects of

     7    exposure to environmental hazards.  Our mortality

     8    study will compare causes of death for Persian Gulf


     9    veterans with the cause of death for veterans serving

    10    in the same era who were not deployed to the Gulf.

    11                Another study will survey symptoms,

    12    illnesses, and exposures of 15,000 Persian Gulf


    13    veterans.  It will compare their experiences with

    14    those of a similar size group who served at the same

    15    time, but did not go to the Gulf.  This study will


    16    also evaluate the health status of their family

    17    members.

    18                The final step in our approach is getting

    19    the word out.  We're working very closely with our


    20    nation's veterans' organizations to reach out to

    21    Persian Gulf veterans and their families.  Our Persian

    22    Gulf Information Center operates a nationwide toll


    23    free information line staffed by trained operators. 

    24    We also provide information through electronic

    25    bulletin boards 24 hours a day, seven days a week. 


                                                                         27

     1    The Persian Gulf newsletter goes out periodically to


     2    everyone on the Persian Gulf registry, providing them

     3    with the latest information on research and other

     4    developments.

     5                We are conducting a series of Persian Gulf


     6    health days at some of our medical centers.  These

     7    seminars allow concerned veterans to get direct

     8    answers to their questions, and finally, VA officials,


     9    from myself and Deputy Secretary Gober, to facility

    10    directors have participated in hundreds of media

    11    interviews describing VA programs for Persian Gulf

    12    veterans.


    13                There are too many things going on for me

    14    to describe them all today.  However, I believe that

    15    we are managing the problem as opposed to allowing the


    16    problem to manage us.  The Persian Gulf Coordinating

    17    Board, which includes the VA, the Department of

    18    Defense, and HHS, continues to coordinate extensive

    19    work on research, clinical issues, and disability


    20    compensation.

    21                In the end, as the President has promised,

    22    no stone will be left unturned, but I want to state in


    23    the strongest terms possible something that I have

    24    said on many occasions.  If there is anything that we

    25    are not doing that you would like to see us do, let us


                                                                         28

     1    hear from you.  Your counsel is very important to us. 


     2    Our veterans have offered their very lives for the

     3    nation and peace in the world.  It is only right that

     4    we serve them as they have served us.

     5                I personally believe that the way a


     6    society treats its veterans is an indication of who we

     7    are as a nation, and as a result, we cannot break the

     8    moral obligation the nation has to its veterans.  That


     9    is why, ladies and gentlemen, you have a very, very

    10    important responsibility, and that is why I pledge to

    11    you VA's total cooperation.  Any records or

    12    information you need will be made available to you. 


    13    All you need do is ask.  We will respond fully and

    14    promptly.

    15                I wish you good luck and Godspeed in your


    16    very important work.

    17                Thank you so very much.

    18                CHAIR LASHOF:  Thank you very much,

    19    Secretary Brown.


    20                And now we will hear from the Honorable

    21    John White.

    22                DEPUTY SECRETARY WHITE:  I thank you,


    23    Madame Chairman and distinguished members of the

    24    committee.

    25                First, let me thank Secretary Brown and


                                                                         29

     1    Secretary Shalala for their leadership and hard work


     2    as all three departments have been working

     3    aggressively on these efforts in order to fulfill the

     4    President's and Mrs. Clinton's commitment, which we of

     5    course take very, very seriously.


     6                I want to take the opportunity today to

     7    just outline for you what we at Defense are doing. 

     8    First of all, as to goals our first and, of course,


     9    fundamental goal is to take care of our service

    10    members, and we want to do that openly because people

    11    have a right to know.

    12                Thirdly we want to do it openly because


    13    we're looking for other information and help.  We do

    14    not have a corner on the knowledge in this perplexing

    15    problem.  Dr. Stephen Joseph, my colleague and the


    16    Assistant Secretary of Defense for Health Affairs,

    17    will brief you on more details in our program in the

    18    next hour.  Secretary Perry has asked me personally to

    19    make this one of my highest priorities, and I am doing


    20    so.

    21                Many veterans of the Gulf War are ill, and

    22    they believe it's the result of their service, and


    23    that's enough for us to recognize that we must provide

    24    them with the medical attention which they deserve. 

    25    Marcel Proust has said, "Pain we obey," and in this


                                                                         30

     1    case the pain of our veterans we will obey.  It is the


     2    least we can do for them.  It's our responsibility,

     3    and it's the right thing to do.

     4                Now, Secretary Perry and General

     5    Shalikashvili communicated to all of our service


     6    members on active duty who served in the Gulf War

     7    urging them to come forward and report any illnesses,

     8    and as a result of that, we have a four-part program.


     9                First and most importantly, to treat the

    10    illnesses.  This is, of course, fundamental and out

    11    initial emphasis.  Last June we launched a

    12    comprehensive clinical evaluation program for Gulf War


    13    veterans.  We had some 23,000 veterans respond to the

    14    Secretary's and the Chairman's encouragement, and on

    15    August 1st we issued our initial report, a review of


    16    10,020 such veterans and the in-depth medical exams

    17    which have been provided to these veterans.  So far

    18    they show no evidence of unique Persian Gulf illness,

    19    but rather a range of illnesses and symptoms.


    20                Now, these studies are clinical.  They're

    21    not perfect research, nor the final word, but they're

    22    certainly very valuable and necessary, and we will


    23    continue to conduct the research and to provide the

    24    information.

    25                Secondly, we're all trying to understand


                                                                         31

     1    these illnesses.  The three departments that are


     2    represented here have funded in-depth medical research

     3    into these problems.  In fiscal '95, DOD alone

     4    dedicated $15 million to this effort.  Research is

     5    being done both in the government and by


     6    nongovernmental researchers.

     7                Thirdly, we need to investigate the

     8    illnesses, and again, all three departments are


     9    aggressively working at clinical information.  We have

    10    established an investigative team to analyze Persian

    11    Gulf classified and unclassified documents, DOD and

    12    otherwise, all related to the actions and the


    13    incidents that occurred, to find out where and why

    14    there might be some impact on individual's health.  We

    15    set up an 800 number for people to provide us with any


    16    incidents they know of or theories or other

    17    information.

    18                We are declassifying and analyzing

    19    information from the war, and we're trying, based on


    20    all of this, to inform people about the illnesses and

    21    the possible causes and to ask for their cooperation

    22    in dealing with these problems.


    23                We will be making operational and

    24    intelligence documents available once they are

    25    declassified.  On August 3rd of this year, we


                                                                         32

     1    announced an initial release of 3,700 pages of


     2    records, including Defense intelligence and captured

     3    Iraqi documents.  We are now up to 4,200.  We have

     4    literally millions more to go, but an aggressive

     5    program of declassification, and we expect to be


     6    complete and have all of this information by December

     7    '96.

     8                We are making this information public via


     9    a special program that has been established called

    10    Gulf Link.  It is a database that is on the Internet. 

    11    It's directly accessible.  I've used it myself.  It's

    12    very easy to use.  It has two fundamental parts to it. 


    13    First, it has the declassified documents, and it will

    14    provide all of those documents, and secondly, it

    15    provides the relevant medical reports, journal


    16    articles, newspaper clippings, and other information

    17    that we think are important in terms of getting to the

    18    bottom of this problem.

    19                Now, Dr. Joseph, as I said, will


    20    illuminate on these initiatives in the next panel, but

    21    I want to reiterate our bottom line, and that is that

    22    we are doing as we have done over the past.  We are


    23    continuing to be aggressive in our effort to treat, to

    24    investigate, to understand, and to inform people about

    25    the illnesses.  We are committed most of all, of


                                                                         33

     1    course, to caring for our veterans.


     2                Let me end with a personal note, Madame

     3    Chairman.  My son served as a junior officer in the

     4    Marine Corps and a platoon commander in the Gulf for

     5    nine months.  So I know from him the environment in


     6    which our young people lived and the environment in

     7    which they fought.  So this is not an abstract issue

     8    for me.  This is a very real issue, a personal family


     9    issue, and one in terms of my obligation to all of the

    10    veterans who fought there.

    11                So I can assure you, again, that we are

    12    doing all that we can to get to the bottom of this


    13    problem.

    14                Thank you very much.

    15                CHAIR LASHOF:  Thank you very much.


    16                Now, the panel is open for questions, and

    17    any member of the Advisory Committee is free to ask

    18    them.  I would just hope that you will indicate to me

    19    so that I can call on you as you wish.  Your mike,


    20    please remember that you push the button down, and

    21    once you push it down it will stay on.  You don't have

    22    to hold it and then release it.


    23                Are there questions that any of you would

    24    like to address to the panel?

    25                MS. KNOX:  I would like to ask.  You


                                                                         34

     1    mentioned that there was a Gulf Link on the Internet. 


     2    Are there computers available to veterans maybe at

     3    local VAs so that they can go and access the Internet?

     4                SECRETARY BROWN:  That is really a very

     5    interesting question.  The answer I'm told is yes.


     6                (Laughter.)

     7                MS. TAYLOR:  I have a question for the

     8    last panelist.  You mentioned that some of the


     9    documents will be made available as soon as they're

    10    cleared.  How soon do you think that will take?

    11                DEPUTY SECRETARY WHITE:  Well, we have

    12    already cleared over 4,000 documents, and they've been


    13    made available.  We will not wait to make them

    14    available.  As soon as they are cleared, we're doing

    15    it in batches, but as soon as they are cleared, we


    16    will put them on the Gulf Link Internet and so they

    17    will be periodically regularly updated and expanded.

    18                In fact, even since I made the

    19    announcement a couple of weeks ago, we've added more


    20    documents to that list.

    21                DR. HAMBURG:  I guess this goes to all

    22    three or whoever who'd want to respond.  We have read


    23    very impressive material on ways of tackling this

    24    problem.  As Secretary Brown said, it has a very

    25    different feel to it than the Agent Orange situation,


                                                                         35

     1    which I well remember.


     2                Nevertheless, it's impossible for us to

     3    tell from these documents, sound and thoughtful as

     4    they are, what is likely to be the fate of the

     5    recommendations in those documents.  How can you see


     6    to it that these good plans will actually be

     7    implemented?

     8                I assume that the Coordinating Board has


     9    an important role in that, but perhaps we could hear

    10    a bit more about the Coordinating Board and any other

    11    mechanisms you may have in mind to actually implement

    12    these thoughtful recommendations.


    13                SECRETARY SHALALA:  We do have a

    14    coordinated process, and one of the characteristics of

    15    actually the Clinton administration is our ability to


    16    work across agencies effectively, and we do put

    17    together and have an implementation process, David,

    18    but I guess we're as concerned about our ability to

    19    anticipate these issues as we are of finding


    20    everything we can about the illnesses that are related

    21    to participation in the Gulf War.

    22                It is just not possible in future wars or


    23    future activities by the American military not to

    24    expect that our soldiers will go out to areas in the

    25    world that are environmentally unsafe, and therefore,


                                                                         36

     1    it's not simply responding after the fact, but our


     2    ability to anticipate in the future as veterans go to

     3    other parts of the world.

     4                I personally know this area of the world. 

     5    I served as a Peace Corps volunteer in southern Iran,


     6    and I actually intimately know that area of Iraq

     7    around the Persian Gulf, and I can tell you from

     8    personal experience about the sand storms and the


     9    burning off of oil wells and all of the other things

    10    that one faces there.

    11                So that I guess my point would be not only

    12    do we have an inter-agency effort and an ability to


    13    work across, but we need from all of you an ability to

    14    anticipate for the future so that we're better

    15    prepared.


    16                SECRETARY BROWN:  I happen to agree with

    17    my colleague on her assessment, but I would like to

    18    carry it a little bit farther.  I'm basically

    19    concerned about making sure that our veterans are not


    20    adversely impacted upon as a result of having served

    21    the nation and served it well.  In that regard, we

    22    have to look to see what impact that their service


    23    actually has on their ability to get on with their

    24    lives, to make that transition back from military

    25    service into mainstream America.


                                                                         37

     1                And to make that assessment, we look at


     2    three areas basically.  One is what impact did it have

     3    in terms of medical problems, and we are thinking

     4    we're responding to that, but there are many gaps in

     5    that whole process in the sense that we are kind of


     6    like just responding to the symptoms because we really

     7    don't understand the etiology of this process, and out

     8    of that etiology once we understand it, we can shift


     9    those resources from treating the symptoms to actually

    10    providing a cure, and that's really where I think

    11    Donna's point comes in because then we can share that

    12    information with the entire world.


    13                The other part of it has to do with

    14    compensation benefits.  We know that when you are

    15    sick, it has an adverse effect on your ability to


    16    provide for your family, for your wife, your children,

    17    and your family members, and so we want to make sure

    18    that we understand exactly what is happening so that

    19    we can compensate them fairly.


    20                We're moving in that direction.  I don't

    21    think that we are there.  We made great progress last

    22    year, but we must continue to look forward to what's


    23    going to come out of this year's committee so that we

    24    can make further improvements in the process.

    25                And then finally, for those that are sick,


                                                                         38

     1    we need to have an understanding so that we can help


     2    design a vocational rehabilitation program for our

     3    veterans so that they can move on.

     4                Now, once we pull all of these together

     5    and have a good understanding, then, of course, we


     6    will not hesitate in pushing for legislation that will

     7    give us the authority to begin to actively move

     8    forward on these three initiatives that have, quite


     9    frankly, been time tested.  We at the VA have a lot of

    10    experience on it.  During the history of our nation,

    11    we have lost over a million men and women serving

    12    their country and the country and a million and a half


    13    of them have come back home suffering from all kinds

    14    of problems.

    15                And so what we want to do is to make sure


    16    that we continue our time honored tradition of

    17    responding to their needs, and with your help we will

    18    do just that.

    19                DEPUTY SECRETARY WHITE:  May I just make


    20    one comment?

    21                While this is obviously a special program

    22    with a great deal of intense care and scrutiny, we


    23    have taken care to make sure that the people involved,

    24    starting with myself and with Dr. Joseph, are people

    25    who are in operating management policy positions in


                                                                         39

     1    the department.  So this is not something off to the


     2    side of what we are doing.  We're deeply involved. 

     3    The Surgeons General of the services are deeply

     4    involved so that the information gets put back into

     5    the regular chains where it ought to be used in terms


     6    of future issues.

     7                MR. RIOS:  This question is for Secretary

     8    White.


     9                Do we have a final count as to how many

    10    troops we lost during the war, a list, and how many

    11    have died since as a result of the exposure to the

    12    elements?


    13                DEPUTY SECRETARY WHITE:  I think we have

    14    a count as to the first part.  I don't think we

    15    probably have a count as to the second, but I would


    16    have to be able to go back.

    17                MR. RIOS:  What was the count for the

    18    first part?

    19                DEPUTY SECRETARY WHITE:  We'll get that


    20    for you.

    21                SECRETARY BROWN:  I just have just one

    22    additional question or response that I'd like to make


    23    with respect to David's question.  I think that for

    24    the purpose of clarity so we do not end up getting

    25    confused as we move to try to find solutions to these


                                                                         40

     1    very difficult problems, we should view the illnesses


     2    that our Persian Gulf veterans are suffering from in

     3    the same manner as we would view a gunshot wound to

     4    the head or a gunshot wound to the chest or a person

     5    who has lost an arm or a leg because they are just as


     6    serious as that.  It is just simply we do not

     7    understand it, but in terms of how it interferes with

     8    a person's ability to socialize and interact in our


     9    society and how it interferes with their ability to

    10    make an industrial adjustment, it is just as

    11    devastating.

    12                So if we kind of keep that focus, I think


    13    it would help us get through this whole process.

    14                MS. LARSON:  I'd like some clarification

    15    on a comment, Dr. Shalala, that you made because I


    16    think it's a little different than our charge.  If I

    17    heard you correctly, you were suggesting that one of

    18    the things this commission might do would be to look

    19    at how, if and when there are future armed conflicts


    20    or wars the government should anticipate an approach

    21    that would provide the safeguards necessary.  In other

    22    words, as you said, it's safe to assume that every


    23    armed conflict or war is environmentally unsafe, and

    24    so how do we in the future also look at this in a

    25    proactive way rather than treating each war as we have


                                                                         41

     1    in the past as unique and isolated?


     2                And I thought that you were saying that

     3    you wanted us to look at the process as well.  Is that

     4    correct?

     5          SECRETARY SHALALA:  Not completely correct.  I'm


     6    simply interested in the implications, in drawing out

     7    the implications here.  I'm not sure that your charge

     8    involved anything as extensive as that, but we're as


     9    interested in the implications of this because it's

    10    very clear in the world we're going into in the future

    11    that there are many areas of the world that raise some

    12    serious issues about the environment as we send in not


    13    only troops in terms of wars, but also in terms of

    14    peace, and we simply need to think that through, and

    15    we will learn some things out of this review, it seems


    16    to me.

    17                CHAIR LASHOF:  I think I can respond a

    18    little bit further on that.  As I understand our

    19    charge, and we'll be discussing that a great deal more


    20    tomorrow and make sure we all clearly understand the

    21    charge, and that's on the agenda, but at this point I

    22    can say that we certainly hope to be able to make


    23    recommendations concerning how one would follow up on

    24    veterans when they come back in the future so that

    25    we're not this many years down the line and now trying


                                                                         42

     1    to decide what epidemiology and so on, and I think


     2    that is an issue we will clearly look at.

     3                Whether we can anticipate everything you

     4    need to do when you send troops out, that's another

     5    story, but it's something we can discuss in our


     6    strategies and objectives.

     7                Are there other questions?  Dr. Custis?

     8                DR. CUSTIS:  I think you've just


     9    identified what we feel our responsibility to be.  I

    10    think it would be interesting to hear from the panel

    11    what they expect from us.  In other words, there was

    12    a question in that regard, but in the larger context,


    13    what do you expect from this committee?

    14                SECRETARY SHALALA:  We helped write your

    15    charge.  So I think that the charge as outlined both


    16    by Mrs. Clinton and in the letters you got is

    17    completely consistent with our conversations within

    18    the administration.

    19                We are enthusiastic participants in this


    20    process, and we're very much involved in the decision

    21    making and the thinking that went behind it.  I don't

    22    know whether Jesse or John want to add to that.


    23                SECRETARY BROWN:  Dr. Custis, I'm looking

    24    for answers from you.  I know that's kind of a broad

    25    statement, but the bottom line is that we are now


                                                                         43

     1    operating in a grey area.  The rules and regulations


     2    that govern, for instance, VA compensation mandate us

     3    to provide disability payments only in the presence of

     4    injury or disease.  Many of our veterans returning

     5    from the Persian Gulf cannot be classified in any one


     6    of those categories, neither an injury nor a disease. 

     7    We need to understand what that means so that we can

     8    have a better feel on how to deal with it.


     9                Now, we think that we've made progress,

    10    but we haven't made progress based on understanding. 

    11    So we need to understand mechanically exactly what is

    12    happening to these people, and we are looking to the


    13    science to give us that information.

    14                Let me give you one example based on

    15    history.  Many of our veterans returned from Vietnam


    16    suffering from various types of problems that were

    17    associated with their service.  It took us 20 years

    18    for the science to catch up with us, and as a result,

    19    we are now, for instance, providing compensation and


    20    medical care for life for disabilities that are a

    21    direct result of having served in Vietnam and having

    22    been exposed to Agent Orange, and these problems


    23    include cloagnin, non-Hodgkins, lymphoma, soft tissue

    24    sarcoma, Hodgkins disease, multiple myeloma, and

    25    respiratory cancers, and the list goes on and on.


                                                                         44

     1                And so what we want to do, we don't want


     2    to wait another 20 years to be able to respond to the

     3    needs of people who have been hurt carrying out the

     4    policies of the nation, and that is why we're trying

     5    to be proactive.  We're getting our best minds up


     6    front to look at this, to see if we can figure out

     7    exactly what is going on so that we can take immediate

     8    action and not have to wait until thousands of people


     9    have died and whole families just disintegrated

    10    because we simply didn't have enough information on

    11    which died.

    12                MS. KNOX:  Secretary Brown, I'd like you


    13    to address if you could and help me to understand.  I

    14    know there are veterans from the Gulf War who are

    15    still going today to have their exit physicals from


    16    the VA system, and they're providing that for them. 

    17    Do the regulations state that the illness has to have

    18    occurred within the first two years after the war?

    19                SECRETARY BROWN:  Yes.  The symptoms and


    20    the illness as we define it because we can't classify

    21    it as a disease must have occurred within two years

    22    after having left the Persian Gulf.  Now, that does


    23    not mean that that is the only vehicle by which we can

    24    service connect, but that is part of the provision,

    25    legislative provision, that was enacted last year.


                                                                         45

     1                CHAIR LASHOF:  Let me ask Secretary White. 


     2    You talked about the declassification schedule.  It's

     3    my understanding that some of the material won't be

     4    declassified until 1996.  Our charge and our final

     5    report is due at the end of '96.  What would it take


     6    to speed up the declassification?

     7                DEPUTY SECRETARY WHITE:  It would probably

     8    take more resources than we have on it today.  I don't


     9    think -- and I recognize your concern -- I don't think

    10    that's necessarily a problem, and I would suggest to

    11    you that we look at it in three or four months, and

    12    the reason I say that is that we are trying, first of


    13    all, to do it as rapidly as we can.  It's millions of

    14    pages; secondly, to do it in so-called bulk.  That is,

    15    we're not sitting there going through it in a slow,


    16    methodical way; thirdly, to do it intelligently in

    17    terms of looking at that information that is most

    18    likely to be of value to you first.

    19                So I think, you know, what we end up with


    20    is this huge undifferentiated documentation, and we,

    21    of course, are organizing it and differentiating it in

    22    ways which we hope will be responsive.  So I think we


    23    ought to look at this in terms of what the yield will

    24    be after three or four months, and then we can see

    25    whether or not we need a different strategy.


                                                                         46

     1                CHAIR LASHOF:  Thank you very much.


     2                Yes.

     3                DR. LANDRIGAN:  Secretary Brown, I'd like

     4    to address a question to you.  I concerns the matter

     5    you were just discussing of the two-year limitation,


     6    statute of limitations, if you will.  We know in the

     7    field of environmental medicine that many diseases

     8    that are triggered by environmental exposures, the


     9    diseases that are caused by asbestos, the cancers that

    10    are caused by Agent Orange, to give just two examples

    11    of many, don't develop in some cases until decades

    12    have passed between exposure and onset of symptoms.


    13                In the event that we conclude at the end

    14    of our deliberations that certain disease entities

    15    have to be considered potentially related to the


    16    Persian Gulf Syndrome, but these -- Persian Gulf

    17    exposures, sorry -- but these are disease that may be

    18    associated with long latency, how is that going to

    19    come together?


    20                SECRETARY BROWN:  That would be wonderful. 

    21    That is exactly the kind of information that I'm

    22    looking for.  The two-years that we used in the


    23    legislation is really kind of an arbitrary number,

    24    arbitrary in the fact that we used it because many of

    25    the symptoms that we had been able to gather


                                                                         47

     1    information on developed within two years, but that


     2    doesn't mean that, as you pointed out, there are other

     3    conditions that will develop later on or manifest

     4    themselves later on, maybe three, four, five, six,

     5    seven years.


     6                With respect to Agent Orange, we know that

     7    the cancers are up to 30 years.  So those are the

     8    kinds of things that we're looking at, and also you're


     9    going to be able to help us because you're going to be

    10    able to assist us in bringing some peace to many of

    11    our veterans and their families' minds.  For instance,

    12    many of them are worried about having children because


    13    they're worried about birth defects.

    14                So that is why the work that you are going

    15    to do is so important, because it has a tremendous


    16    impact on the quality of life of those who have given

    17    a lot for the nation.

    18                DR. CAPLAN:  This is to any of the panel. 

    19    I was just curious that as we look in our briefing


    20    books and hear your presentations about the many

    21    activities that you're undertaking to establish the

    22    nature of these problems, if you could share with us


    23    either what you feel might be going faster, where you

    24    feel things are weak looking at this massive set of

    25    activities to collect information and find things out,


                                                                         48

     1    and what ideally you want to do if you could add


     2    additional information gathering capacities.

     3                In other words, where do you, having

     4    started this process, see things to be, if you will,

     5    perhaps not quite where they ought to be in terms of


     6    gaining information?

     7                SECRETARY BROWN:  We have about 48,000 men

     8    and women on our register.  Not all of them have


     9    complained about problems, but they at least have

    10    expressed some concern.  I want to be able to respond

    11    to any of their needs.  If a person is sick as a

    12    result of having done what the nation asked him to do,


    13    I want to provide them with lifetime medical care.  I

    14    want to provide them with vocational rehabilitation. 

    15    I want to provide them with compensation.


    16                And so what I'm looking for is all of the

    17    support, scientific support, that we can get so that

    18    I can move forward aggressively in recommending

    19    legislation that will allow us to do the right thing


    20    for our veterans.

    21                SECRETARY SHALALA:  I think that in part

    22    the panel was convened to help us answer that


    23    question, and you're going to get detailed

    24    presentations from the scientific leaders at the

    25    Department of Health and Human Services, for example,


                                                                         49

     1    and what we'd like, in particular, is some of your


     2    feedback about the kind of strategy we've embarked

     3    upon, some of which is legislatively driven and some

     4    of it is driven by our inter-agency group.  So I think

     5    I would hold off and see what the panel wants to say


     6    to us about the approaches that we're taking up until

     7    now.

     8                DEPUTY SECRETARY WHITE:  I would second


     9    what Donna said, and also in the next hour I would

    10    urge you to ask that question to the people who will

    11    be here who are much more intimately involved in

    12    managing these programs.


    13                DR. HAMBURG:  A question for Secretary

    14    Shalala.  You have in your department two of the most

    15    respected agencies in the world with respect to health


    16    matters, the CDC and the NIH, and they both will be

    17    very important, both for the work of this committee

    18    and also more fundamentally for dealing with the

    19    problem in the long run.


    20                I wonder if you'd say a word about the

    21    extent to which you think it's appropriate for the CDC

    22    and the NIH to be involved in this, and if so, what


    23    sort of channel is the appropriate one for us to use

    24    to stimulate their activity in this field.

    25                SECRETARY SHALALA:  You'll hear from CDC


                                                                         50

     1    people and see where we are in terms of NIH research


     2    at the same time, David.  So I think it's not only

     3    appropriate; it's mandatory for both of them to be

     4    involved in this effort, particularly in the case of

     5    NIH in a long-range effort, because of the point that


     6    was made earlier about environmental health.  We're

     7    going to need long-term studies to give us some

     8    answers, and I think that as you take a look at what's


     9    going on, we'll be interested in your suggestions, but

    10    both of those agencies, plus the FDA and the Indian

    11    Health Service has obviously some responsibility here,

    12    as well as the entire Public Health Service, and Phil


    13    Lee actually has been leading the coordinating effort

    14    within the department.

    15                DR. BALDESCHWIELER:  The issue of Gulf War


    16    illnesses, of course, has been explored by a very

    17    large number of distinguished panels and advisory

    18    groups already.  What do you hope that we can add to

    19    this already enormous existing base of review and


    20    analysis that is aware of the issues where you are not

    21    satisfied?

    22                SECRETARY BROWN:  Doctor, one of the


    23    things that I think that you can do is you can bring

    24    all of this information together for us.  As you

    25    mentioned, a lot of research has been done all across


                                                                         51

     1    the country in different areas.  One of the things, I


     2    think you can bring it together and present it in a

     3    way that it really makes sense that will allow us to

     4    understand it so that we can act upon it.  I think

     5    that's one of the things that's very, very important


     6    here.

     7                There is a lot of information that's out

     8    there, and so we need to figure out how we can use


     9    that information, and I think we can go to and I have

    10    already pledged from the VA that you have carte

    11    blanche to all of our records and information.

    12                So if I were just to answer briefly, I


    13    would just say that you can bring all of the

    14    information together and present it to us in a way

    15    that it makes sense so that we can make some use of


    16    it.

    17                SECRETARY SHALALA:  I think that just

    18    because something is complex and we're in grey areas

    19    doesn't mean that there are not answers, and a good,


    20    strong citizen review of people that understand the

    21    issues and can speak clearly to the American public

    22    about what we know and what we don't know and what we


    23    can find out and what we may never be able to find

    24    out, and that combined with our own response, which

    25    thus far, I believe, under Jesse's leadership has been


                                                                         52

     1    very strong, along with new strategies for the future


     2    is exactly what the President has requested.

     3                But I think that sometimes when we say

     4    that something is complex and there are no single

     5    answers it sounds like we're backing off and covering


     6    up an issue as opposed to sorting it out very

     7    carefully and understanding that in the future all of

     8    the answers may be very much like this, so that we've


     9    got to be educated as we go through; that we may never

    10    again be able to have a single answer to what seems

    11    like a straightforward question.

    12                So anything we can do to sort this out for


    13    all of us, not just for the American people, but the

    14    government itself is asking for a strong review.

    15                CHAIR LASHOF:  Any other member of the


    16    committee have a question for this panel?

    17                If not, I want to thank you all very much,

    18    and we appreciate your coming and sharing your

    19    insights with us, and we look forward to working with


    20    you.

    21                (Pause in proceedings.)

    22                CHAIR LASHOF:  If the next panel will come


    23    forward and take their place at the table, we can move

    24    right along.

    25                I'm pleased to welcome our second panel


                                                                         53

     1    this morning.  It is composed of the Honorable Stephen


     2    Joseph, Assistant Secretary of Health Affairs,

     3    Department of Defense; the Honorable Kenneth Kizer,

     4    Under Secretary for Health, Department of Veterans'

     5    Affairs; Dr. Henry Falk, Director of the Division of


     6    Environmental Hazards and Health Effects from the

     7    Centers for Disease Control; and Robert Roswell,

     8    Executive Director of the Persian Gulf Veterans


     9    Coordinating Board.

    10                We're anxious to hear your testimony, and

    11    I'm sure we'll have questions for you.  So I think we

    12    can proceed promptly with Dr. Joseph.


    13                ASSISTANT SECRETARY JOSEPH:  Thank you. 

    14    Dr. Lashof, members of the Advisory Committee,

    15    distinguished guests, ladies and gentlemen, especially


    16    those veterans of the Persian Gulf, good morning.

    17                I appreciate this opportunity to describe

    18    for you how the Department of Defense, in cooperation

    19    with the Departments of Veterans' Affairs and HHS, is


    20    responding to the President's direction.  I think

    21    three times this morning the phrase "leave no stone

    22    unturned" has been used.  It's in my text as well. 


    23    It's probably in Ken's.  That is really our objective,

    24    and that's the spirit with which we've been

    25    proceeding, to leave no stone unturned.


                                                                         54

     1                If I may have the second slide, I think


     2    these slides are also in your book.  So you may not

     3    need to turn around.

     4                Encouraged by the President's commitment

     5    and building on the department's activities to


     6    register and care for returning service members, we

     7    now have in place in DOD a comprehensive four-part

     8    program as just outlined by Secretary White.


     9                The four components are:  care and

    10    treatment; medical research; incident investigation;

    11    and document declassification.  I want to highlight

    12    the details of these extensive and in some cases


    13    unprecedented initiatives for you over the next few

    14    minutes.

    15                Above all, our bottom line really is to


    16    focus and provide the best care possible for those who

    17    return from the Gulf War and who today are ill.  When

    18    we began our clinical program for active duty Persian

    19    Gulf vets and their family members, we wanted to do it


    20    right.  We began, therefore, by looking and focusing

    21    on the individual patient, each patient's condition,

    22    individually evaluating, examining, and testing to try


    23    and find the source of his or her illness.

    24                Patient by patient our military medical

    25    teams reached diagnoses, developed treatment plans,


                                                                         55

     1    and for the majority helped them to recover.  Some


     2    patients continue to receive care, and we still have

     3    others who are coming into the stream of our

     4    comprehensive clinical evaluation program.

     5                If I may see the next slide, we set up the


     6    so-called CCEP -- and I think you may want to have

     7    this in much more detail at a later briefing; I'll

     8    give you the highlights now -- in the early summer of


     9    1994.  It was set up essentially as a clinical program

    10    whose first objective was to enhance access to care

    11    for our active duty Persian Gulf veterans and their

    12    family members, but also to attempt to gain insight


    13    into the nature of their symptoms and diagnoses.

    14                We developed a very comprehensive tertiary

    15    protocol, virtually identical to those used in the


    16    Department of Veterans' Affairs, and through the

    17    Persian Gulf's Coordinating Board, we share our

    18    findings across the agencies in an attempt to have the

    19    greatest clinical information available to everyone


    20    who's working on this problem.

    21                Right now in DOD we have over 23,000

    22    active duty veterans and their family members on our


    23    Persian Gulf registry.  This is a registry that's

    24    activated either by coming to a military treatment

    25    facility or calling, accessing a 1-800 hotline number


                                                                         56

     1    which has been widely publicized.


     2                We've had 17,000 of those 23,000 ask to be

     3    evaluated through the clinical evaluation program.  We

     4    have completed examinations of over 13,000 people and

     5    have assessed and entered into the database records


     6    for 10,020 participants.  That's the report that we

     7    issued several weeks ago, and I believe you have that

     8    in your packet in front of you.  I think that's


     9    probably the most extensive published medical

    10    examination of this type ever performed.  Included in

    11    those 10,000 participants are 136 spouses and 81

    12    children.


    13                The 10,000 comprehensive patient

    14    evaluations which we've completed clearly represents

    15    the most substantial analysis of Persian Gulf related


    16    clinical information that has been reported, but of

    17    course, again, as John White said earlier, we

    18    understand it is not perfect.  It is not what one

    19    would describe as a formal research study.


    20                It was undertaken as a clinical

    21    investigation from which we could formulate research

    22    hypotheses and learn what we could.  Nevertheless,


    23    there are findings in these data which will assist in

    24    guiding our ongoing and future research efforts.  

    25                Very importantly, as soon as we get the


                                                                         57

     1    privacy concerns, considerations worked out, we are


     2    going to make this entire database available for

     3    scientific researchers in the civilian sector to do

     4    further analyses and studies with, and we hope to

     5    accomplish that in the next few months.


     6                If I may have the next slide, there are

     7    three findings that I want to highlight from this

     8    report.  First, among the 10,000 participants, we have


     9    as yet found no evidence for a single, unique illness. 

    10    Instead we find a range of symptoms and diagnoses

    11    which are indicative of multiple causes.

    12                I want to emphasize, however, that these


    13    clinical evaluations are primarily designed to provide

    14    care and treatment rather than definitive research

    15    aimed at determining causation.  Nevertheless, what we


    16    find is a very broad spectrum of symptoms and

    17    diagnoses.

    18                Next slide.

    19                Second, as we considered the clinical


    20    profile of our program participants, we found that

    21    severe disability does not affect large numbers of our

    22    patients.  The measure we used in making that


    23    determination is the commonly used one of the number

    24    of missed work days in the 90-day period prior to

    25    initial evaluation.


                                                                         58

     1                Of course, in making this finding we


     2    recognize that it's been four years since the Gulf War

     3    and that many who may be severely ill would no longer

     4    be on active duty.  Even for those on active duty,

     5    this finding in no way suggests that our patients are


     6    not suffering.  They are.

     7                About seven percent of participants

     8    reported missing more than a week of work due to


     9    illness, and for these patients and all other CC

    10    participants, we will continue to provide the care and

    11    treatment they need to relieve their suffering. 

    12    Nevertheless, the data stand as they are.


    13                If I may have the next slide, the third

    14    finding, multiplicity of diagnosis, a large percentage

    15    without missed work days, and the third finding I want


    16    to emphasis is that many of these Gulf War veterans

    17    have multiple and chronic symptoms.  For example,

    18    approximately one third to one half report symptoms

    19    such as fatigue, joint pain, headaches, and memory


    20    loss.

    21                If I may have the next slide, here you see

    22    a comparison of those symptoms in our CCEP population


    23    with the three large community based studies that we

    24    could find in the literature.  Although these symptoms

    25    are also common among the general population, the


                                                                         59

     1    frequency of some of the symptoms for our Gulf War


     2    veterans differs when compared to other studies of

     3    U.S. out-patient populations.  In some cases, the

     4    frequency is greater while in other categories, it is

     5    less.


     6                We made comparisons with several published

     7    studies in order to provide a general context for

     8    preliminary interpretation of our CCEP findings.  Of


     9    course, the groups in these other studies are not

    10    strictly comparable to CCEP patients who tend to be

    11    younger and mostly male.  In fact, there is no genuine

    12    comparison group that one can use.


    13                Still there are useful insights to be

    14    drawn in the comparisons.  These are all self-selected

    15    clinic populations.


    16                Our formal research efforts, which I'll

    17    discuss in a few moments, include appropriate control

    18    or comparison groups.  Generally and for preliminary

    19    descriptive purposes, we found the pattern though not


    20    necessarily the frequency of symptoms of our CCEP

    21    participants to be quite similar to patients seeking

    22    primary care in community-based studies.


    23                Next slide.

    24                Among our findings has emerged an

    25    important perspective that I would like to call to the


                                                                         60

     1    attention of the committee.  As you look into the


     2    issue of Persian Gulf illnesses, keep in mind the

     3    differentiation between disease diagnosis and symptom

     4    diagnosis.  As I just mentioned, some of our patients

     5    have presented with a number of symptom clusters that


     6    do not fit neatly into a defined category or into a

     7    standard diagnostic classification scheme.  This

     8    situation reflects a limitation in medicine's ability


     9    to exactly define each set of symptoms, a situation

    10    that is also very common in civilian populations.

    11                We will continue to conduct the intensive

    12    CCEP evaluations for those remaining on the registry


    13    and those who continue to sign up.  Additionally,

    14    we've established a specialize care center in

    15    Washington, D.C., designed to offer the full array of


    16    special evaluations, and we will open a similar center

    17    in San Antonio if it's needed.

    18                Next slide, please.

    19                Let me say a word now about medical


    20    research.  With the VA and HHS, we have a coordinated

    21    and intensive scientific research program underway to

    22    assess the spectrum of health consequences of service


    23    while deployed to the Persian Gulf.  These research

    24    efforts involve epidemiologic studies, analysis of

    25    hospitalizations, review of pregnancy outcomes,


                                                                         61

     1    assessment of current health status, descriptions of


     2    symptomatology, and determining the risk of potential

     3    environmental exposures.

     4                Many of these first truly epidemiologic

     5    studies will be coming off line, beginning to produce


     6    data, towards the end of this calendar year.

     7                If I may have the next slide, for fiscal

     8    '95, the DOD had dedicated $12 million for medical


     9    research focused on Persian Gulf health issues. 

    10    Ongoing internal Defense research efforts include a

    11    series of epidemiologic studies, studies of infectious

    12    and parasitic disease, and analyses of pyridostigmine


    13    bromide.  

    14                Also in response to some of the comments

    15    that were made particularly by Secretary Shalala and


    16    the panel, we have begun and actually are fairly far

    17    along in making changes in our pre-deployment and

    18    post-deployment health assessments, preventive

    19    medicine, epidemiology teams on the ground during


    20    deployment, information and education furnished to the

    21    individual soldier, et cetera, as a way to try to get

    22    ahead of the current problem and thinking about the


    23    future.

    24                This perhaps is also a point in which I

    25    might give you the numbers I think that Dr. Landrigan


                                                                         62

     1    asked for -- I'm sorry -- that were asked for earlier,


     2    the numbers of deaths actually in the Gulf.  Battle

     3    deaths were 148, and what we call DNBI, disease non-

     4    battle injuries, that is, other deaths not directly

     5    the result of armed conflict, were 145.  So that adds


     6    in my math to 293.

     7                Next slide.

     8                Just recently with the Department of


     9    Veterans' Affairs, we announced the availability of $5

    10    million for nongovernment, independent research

    11    projects, and we are seeking additional proposals from

    12    both the public and private sectors for other Persian


    13    Gulf health research.

    14                The close coordination among our

    15    departments serves to foster cooperation, avoid


    16    duplication of effort, and insure effective approaches

    17    in our research projects.  I think my answer to Art

    18    Caplan's question of what could we do if we could do

    19    more than we're doing it would be both to get others


    20    to understand the time that it takes actually to

    21    receive data out of the kind of research projects that

    22    give you definitive answers.  You don't do double


    23    blind, prospective, clinical trials, and you don't do

    24    epidemiologic studies and have answers in three or

    25    four months.  I think we're about at the horizon of


                                                                         63

     1    starting to see some of those bear fruit.


     2                Next slide.

     3                The third component of the DOD'S Persian

     4    Gulf illnesses program expands our previous efforts to

     5    identify all information pertaining to the health


     6    problems experienced by veterans of the Persian Gulf

     7    War and their families.  In March of this year, the

     8    DOD created an investigation team dedicated to


     9    tracking down and analyzing all reasonable links

    10    between service in the Persian Gulf and possible

    11    illnesses related to that service.

    12                This team is charged with aggressively


    13    investigating all reported incidents, anecdotes,

    14    theories, and documentation that could shed light on

    15    possible causes of the illnesses being experienced by


    16    our Gulf War veterans.

    17                We've set up another hotline which was on

    18    my first slide.  We have the one hotline for clinical

    19    registration, if you want to come through the medical


    20    examination process, and another if you have a theory

    21    or an incident to report that we can then follow down.

    22                That, of course, is closely linked with


    23    the declassification effort, and the investigation

    24    team will have 12 members, mostly health

    25    professionals, but also include representatives from


                                                                         64

     1    the intelligence, special investigations, and


     2    operational community.  They have begun work.

     3                My next slide lists some things about the

     4    fourth component, the declassification effort that

     5    Secretary White referred to.  You can see that the


     6    investigative team and the declass. effort need to be

     7    and are intimately linked together.

     8                As we review and declassify the


     9    documentation, we are making it available on the

    10    Internet.  The home page, which is called Gulf Link,

    11    is up now to around 4,000 pages.  

    12                I think it's important for you to think


    13    about as you start your work what this information

    14    looks like.  This is buckets and baskets and boxes of

    15    everything from after action reports to hospital


    16    records to unit reports scrawled on pieces of paper,

    17    in the form of electronically transmitted messages. 

    18    It's a mass of information that is classified during

    19    wartime and quite complex to sort out and sift


    20    through.

    21                As John White said, we're attempting to do

    22    it in bulk as rapidly as possible, and going where the


    23    money is first, in a sense, looking for documents that

    24    might bear on medical information.  This is an

    25    enormous task, but just as with the clinical


                                                                         65

     1    examination database, we are going to make this fully


     2    available and open to the public.

     3                I believe that our four-part program, in

     4    coordination with the VA and HHS, strongly supports

     5    the spirit and intent of the President's commitment to


     6    all veterans of the Persian Gulf War.  These programs

     7    hold the promise of providing all of us with a

     8    comprehensive assessment of the health consequences of


     9    Persian Gulf service, and certainly will contribute to

    10    our ability to protect the health of military

    11    personnel during future deployments.

    12                Keeping America's armed forces healthy is


    13    the very core mission of military medicine.  I've seen

    14    first hand the compassion and caring of our military

    15    physicians and nurses, and I hope that among the


    16    things you do as a committee will be to visit and see

    17    some of the people who are doing the work in the VA

    18    and in DOD, the docs and nurses and other health

    19    professionals who are caring for the patients.


    20                Thank you for the opportunity to speak

    21    this morning.  We in Defense welcome the thoughts and

    22    ideas of this presidential commission, and stand ready


    23    to assist in whatever way we can.

    24                Let me repeat Secretary Brown's offer. 

    25    Anything you want, all you need to do is ask for it. 


                                                                         66

     1    We will put it together and see that you get it.


     2                Thank you.

     3                CHAIR LASHOF:  Thank you very much, Dr.

     4    Joseph.

     5                Dr. Kizer.


     6                UNDER SECRETARY KIZER:  Dr. Lashof,

     7    distinguished members of the committee, I'm pleased to

     8    be here this morning to make a very brief opening


     9    comment and hopefully to respond to your questions and

    10    engage in some dialogue as we go along.

    11                You've heard a number of statements this

    12    morning and many others are scheduled for over the


    13    course of the day, including some from my staff.  Many

    14    of the points that I might normally make in this

    15    setting have already been made, and I'm not going to


    16    repeat all of those things here.

    17                Indeed, I'm going to depart from tradition

    18    and make this opening statement very brief.  I would

    19    just reaffirm that our four-pronged effort to deal


    20    with the Persian Gulf War veterans' illnesses was

    21    described by Secretary Brown earlier.  This approach

    22    includes providing compassionate and high quality


    23    medical care, carrying out necessary research to fill

    24    in some of the answers that we don't have at this

    25    time, carrying out public as well as caregiver


                                                                         67

     1    outreach and education, and providing compensation


     2    benefits.

     3                I provided in your briefing booklets and

     4    in my written statement additional details about some

     5    of the specific activities in this regard, both about


     6    the registry program, our clinical protocols, and a

     7    number of other things, and I'm not going to repeat

     8    all of that here.


     9                Indeed, having sat on your side of the

    10    table on other occasions and recognizing that this is

    11    the first meeting of the committee, and mindful of

    12    having time for discussion and the fact that there are


    13    two other members of the panel to make comments, as I

    14    say, I'm going to make this statement very brief.

    15                Let me just reaffirm what Secretary Brown


    16    has already said, that it is the VA's intent to

    17    respond to the problem of our Persian Gulf War

    18    veterans in a proactive and progressive and productive

    19    manner, and when other panel members have given their


    20    opening statements this morning, I'll be happy to

    21    answer your questions, and as I said at the outset,

    22    engage in some dialogue.


    23                Thank you.

    24                CHAIR LASHOF:  Thank you very much, Dr.

    25    Kizer.


                                                                         68

     1                I did neglect to state that obviously


     2    we'll go through all members of the panel presenting

     3    and then have an open period for discussion back and

     4    forth. 

     5                Dr. Falk, would you proceed?


     6                DR. FALK:  Thank you very much.  I

     7    appreciate the opportunity to be here this morning to

     8    meet with the committee, to review our efforts at CDC,


     9    and those of Department of Health and Human Services

    10    in evaluating the health status of Persian Gulf War

    11    veterans.

    12                The health of our military personnel and


    13    veterans is an important issue with HHS and with this

    14    administration, as demonstrated by our many responses

    15    to the veterans' concerns, including the establishment


    16    of this presidential committee.  As you may know, CDC

    17    has a long history of involvement in veterans' issues,

    18    dating back to the formation of CDC as a public health

    19    agency.


    20                In fact, CDC evolved from an agency

    21    established during World War II to help control

    22    malaria among soldiers training in the southern United


    23    States. 

    24                Although CDC has no clinical

    25    responsibilities defined within its mission, support


                                                                         69

     1    of the clinical mission of the Departments of Defense


     2    and Veterans' Affairs, particularly through the

     3    provision of laboratory services, an important

     4    resource provided by both CDC and the NIH.  For

     5    Persian Gulf veterans, this support is focused on our


     6    testing for evidence of leishmania infection.

     7                From December of '91 through February '95,

     8    over 1,600 serum specimens from persons who served in


     9    the Persian Gulf region were referred to CDC for

    10    testing for evidence of antibodies to the parasite

    11    that causes leishmaniasis.  We also cultured bone

    12    marrow, liver, spleen, and skin specimens.


    13                The support of clinical services also

    14    includes communication and education activities. 

    15    After military personnel returned from Operation


    16    Desert Storm, CDC published an article in the February

    17    '92 issue of the morbidity and mortality weekly report

    18    that described cases of leishmaniasis identified in

    19    persons who had served in the Persian Gulf region.


    20                In addition, CDC staff have worked with

    21    staff of the Walter Reed Army Medical Center and

    22    others to distribute information to medical, public


    23    health, and lay communities about the risk of

    24    leishmaniasis in persons who have traveled to the

    25    Middle East.


                                                                         70

     1                The preponderance of current knowledge


     2    about types of illness among Persian Gulf War veterans

     3    has come from registries established by the DOD and VA

     4    that you have heard considerably about this morning. 

     5    They were designed primarily to provide clinical


     6    evaluation and treatment for veterans with health

     7    concerns.

     8                However, a number of other studies have


     9    been complete or are underway that should provide

    10    critically needed information.  HHS, along with DOD

    11    and VA, is responsible for the conduct of some of

    12    these epidemiologic studies.


    13                Our initial involvement with the impact of

    14    the Gulf War began in response to concerns about the

    15    health impact of exposures to smoke from the burning


    16    oil wells.  More than 600 oil wells were set on file

    17    or damaged throughout Kuwait in February of '91.  In

    18    response to a request from the Department of State

    19    regarding concerns about the health impact of the


    20    burning oil fields, the Public Health Service issued

    21    a preliminary health advisory in March of '91

    22    describing the emissions from the fires, and beginning


    23    in April '91, CDC participated with EPA, DOD, the

    24    Agency for Toxic Substances and Disease Registry in

    25    HHS, and NOAA, the National Oceanic and Atmospheric


                                                                         71

     1    Administration, in the design of surveillance and


     2    research projects to assess potential health effects

     3    of the oil well fires.

     4                These projects included the initiation of

     5    a health alert system and the initiation of disease


     6    surveillance in selected emergency rooms in Kuwait

     7    City.  This provided information on the quality of air

     8    during 1991 in Kuwait City and areas nearby.  It


     9    looked at pollutants, in particular TSPs, which were

    10    elevated in Kuwait City.  Monitors in Kuwait City were

    11    approximately ten kilometers from the file, from the

    12    site of the fires.  Pollutants were carried upwards to


    13    high altitudes and dispersed so that the other

    14    criteria pollutants were not elevated for most of the

    15    people in the region.


    16                In a study of oil well firefighters,

    17    elevated levels of volatile organic compounds, VOCs,

    18    were found in their blood.  These chemicals are known

    19    to be quickly excreted by the body.  Among non-


    20    firefighting personnel, VOC concentrations were equal

    21    to or lower than levels from in a U.S. reference

    22    group, suggesting that smoke from the oil well fires


    23    did not pose a significant health threat to

    24    individuals working in the Kuwait area away from the

    25    immediate vicinity of the fires.


                                                                         72

     1                Another area in which CDC has been


     2    involved is in assessing birth outcomes among Persian

     3    Gulf War veterans.  Starting in December of '93, CDC

     4    and the Mississippi Department of Health assisted the

     5    VA Medical Center in Jackson, Mississippi in an


     6    investigation of an apparent cluster of infant health

     7    problems among children born to Persian Gulf War

     8    veterans from two National Guard units in Mississippi.


     9                This investigation found no increase over

    10    the expected rates of birth defects or frequency of

    11    premature birth and low birth weight.  The frequency

    12    of other health problems, such as respiratory


    13    infections, gastroenteritis, and skin diseases among

    14    children born to these veterans also did not appear to

    15    be elevated.


    16                However, due to the small number of births

    17    investigated, this study was not able to examine

    18    individual categories of birth defects.  In addition,

    19    this study was not able to account for confounding by


    20    the many well known factors that can increase the risk

    21    for conceiving and giving birth to a baby with a

    22    congenital malformation.


    23                In December of '94, CDC was requested to

    24    conduct an investigation of a suspected cluster of

    25    illnesses among members of an Air National Guard unit


                                                                         73

     1    in Pennsylvania.  All of these persons had been


     2    deployed to the Persian Gulf during Operations Desert

     3    Shield/Desert Storm.  This investigation has been

     4    conducted in three phases.

     5                Phase one described the clinical


     6    manifestations and health concerns among a sample of

     7    ill Persian Gulf War veterans served by the Lebanon

     8    Veterans Affair Medical Center.   The objective was to


     9    evaluate and characterize the existence of illnesses

    10    and search for possible risk factors.

    11                Phase two was a survey of the index Air

    12    National Guard unit and comparison military units to


    13    document the prevalence of health problems.  The

    14    objectives of this phase were to determine if illness

    15    rates were unusually high in the index Air National


    16    Guard unit and determine if illnesses were related to

    17    Persian Gulf War service.

    18                In this study, we found a pattern of

    19    symptom complaints similar to that found in the VA


    20    Persian Gulf registry and in the DOD comprehensive

    21    clinical evaluation program.  The two symptoms

    22    identified as most bothersome were fatigue and


    23    diarrhea.  No consistent abnormalities were identified

    24    among the participants on standardized physical

    25    examination or by review of medical records and


                                                                         74

     1    accompanying laboratory studies.


     2                In all units surveyed in phase two, the

     3    prevalence of specific chronic symptoms was

     4    significantly greater among persons deployed to the

     5    Persian Gulf War than among those not deployed.  The


     6    prevalence of five symptom categories, chronic

     7    diarrhea, other gastrointestinal complaints,

     8    difficulty remembering or concentrating, word finding


     9    problems, and fatigue, were significantly greater

    10    among deployed personnel from the index unit than

    11    among deployed personnel from each of the other units. 

    12    Symptom prevalence among nondeployed personnel were


    13    similar in all units.

    14                It must be pointed out that these findings

    15    are preliminary and are subject to at least two


    16    limitations.  The data on symptom prevalence reflects

    17    self-reported information, and participation rates for

    18    the four units surveyed during phase two varied

    19    widely, ranging from 36 percent to 78 percent.  


    20                Phase three is currently underway and will

    21    include a detailed case control study of risk factors

    22    among ill and health Persian Gulf veterans from the


    23    index unit.

    24                At the request of Congress, CDC is

    25    implementing a survey of Persian Gulf War veterans who


                                                                         75

     1    listed Iowa as their home of record.  This survey,


     2    being conducted in collaboration with the Iowa

     3    Department of Public Health and the University of

     4    Iowa, includes a detailed assessment of Persian Gulf

     5    War veterans' health concerns, as well as questions


     6    about the health of the veterans' family members.

     7                The telephone interview will be conducted

     8    with a random sample of approximately 1,500 military


     9    personnel who served in the Persian Gulf theater of

    10    operations and approximately 1,500 Persian Gulf era

    11    military personnel who served at sites other than the

    12    Persian Gulf.  This survey will assess a wide variety


    13    of self-reported health outcomes and exposure.

    14                Several committees have been established

    15    to provide scientific and public oversight for this


    16    study.  These include a scientific advisory committee

    17    composed of distinguished scientists in the fields of

    18    epidemiology, reproductive health, psychiatry,

    19    environmental medicine, and infectious disease, and a


    20    public advisory committee composed of affected

    21    veterans and representatives from veterans' service

    22    organizations.


    23                Pending approval by the Office of

    24    Management and Budget, we anticipate beginning data

    25    collection in September and having a final report


                                                                         76

     1    prepared by the fall of '96.


     2                In addition to these studies, CDC has been

     3    an active participant in the Persian Gulf Veterans'

     4    Coordinating Board.  As you know, this board is co-

     5    chaired by the Secretaries of Veterans' Affairs,


     6    Defense, and Health and Human Services and is tasked

     7    with overseeing health issues related to Persian Gulf

     8    War veterans.


     9                The Coordinating Board co-sponsored a

    10    scientific panel convened by NIH in April of '94.  The

    11    purpose of the NIH technology assessment workshop was

    12    to bring together an independent, nongovernmental


    13    panel to review the scientific evidence regarding the

    14    health effects of the Gulf War experience and to make

    15    recommendations as to what future research is


    16    necessary to determine the types and magnitude of the

    17    health problems that are associated with military

    18    service in the Persian Gulf War.

    19                The committee's report was published in


    20    the JAMA.  The panel's recommendations have served as

    21    a basis for much important research in clinical work

    22    to date.


    23                In addition to participating in the NIH

    24    technology assessment workshop, HHS participates in

    25    fostering, coordination, and communication among the


                                                                         77

     1    federal agencies involved in Persian Gulf research


     2    through active participation on the Persian Gulf

     3    Veterans' Coordinating Board.

     4                Additionally, CDC staff participate on

     5    Department of Veterans' Affairs Persian Gulf Expert


     6    Scientific Committee, and we look forward to assisting

     7    staff of this Presidential Advisory Committee.

     8                HHS staff participate in the development


     9    of the working plan for research on Persian Gulf

    10    veterans' illnesses and endorse its general strategy. 

    11    All of these studies will contribute to our

    12    understanding of the effects of military service in


    13    the Persian Gulf theater of operations.  However, most

    14    of these studies are limited by their retrospective

    15    nature.  This was also true of previous CDC studies of


    16    military personnel.

    17                Baseline data on the health of military

    18    personnel is often lacking, which limits the ability

    19    to conduct definitive studies.  A more proactive


    20    approach, as has been outlined here this morning, to

    21    evaluate veterans' health concerns will be of value in

    22    the future.


    23                VA and DOD are responsible for the bulk of

    24    the work addressing the concerns of the Gulf War

    25    veterans.  We recognize their contribution and applaud


                                                                         78

     1    the work that has been done to date.  HHS has been


     2    called upon for discrete activities both in support of

     3    the VA and DOD missions and to undertake independent

     4    research.

     5                HHS, working closely with VA and DOD, is


     6    certainly willing to consider any appropriate role in

     7    further efforts on behalf of the veterans.  We believe

     8    that the health of veterans is a very high priority. 


     9    We are taking steps toward continuing and increasing

    10    our collaboration with other federal agencies that

    11    deal with veterans' issues.

    12                Thank you.


    13                CHAIR LASHOF:  Thank you very much, Dr.

    14    Falk.

    15                Dr. Roswell.


    16                DR. ROSWELL:  Dr. Lashof, committee

    17    members, and honored guests, it is my privilege and

    18    honor to appear before you today as you embark upon a

    19    very important task that will directly impact the


    20    welfare of almost 700,000 veterans of the Persian Gulf

    21    War.

    22                In the aftermath of that war, as veterans


    23    returned home to families and loved ones, reports of

    24    illnesses, some of which were not readily explained

    25    began to surface.  Responding to these reports, the


                                                                         79

     1    Departments of Veterans' Affairs, Defense, and Health


     2    and Human Services each became involved in the

     3    evaluation of possible causes of unexplained

     4    illnesses, development of health care services to

     5    treat these illnesses, and compensation programs to


     6    deal with the resultant disabilities.

     7                Recognizing a need to coordinate these

     8    efforts, President Clinton established the Persian


     9    Gulf Veterans' Coordinating Board on January 21st,

    10    1994.  The mission of the Coordinating Board is to

    11    provide direction and insure coordination within the

    12    executive branch of the federal government on all


    13    health issues related to the Persian Gulf War.

    14                The Coordinating Board serves as a single

    15    focal point and clearinghouse for official information


    16    related to the agency's independent and cooperative

    17    efforts to address Persian Gulf veterans' health

    18    questions.

    19                The Coordinating Board has established


    20    three primary objectives:

    21                First, to assure all veterans have timely

    22    access to a complete range of health care services


    23    necessary for the diagnosis and treatment of illnesses

    24    possibly related to their service in the Persian Gulf

    25    War.


                                                                         80

     1                Second, to develop and manage a research


     2    program that will result in an accurate and complete

     3    understanding of the types of health problems

     4    experienced by Persian Gulf veterans and the various

     5    factors that may have contributed to these problems.


     6                And, third, to develop clear and

     7    consistent guidelines for the evaluation, description,

     8    and compensation of disabilities related to Persian


     9    Gulf service.

    10                The Persian Gulf Veterans' Coordinating

    11    Board is co-chaired by the Secretaries of Veterans'

    12    Affairs, Defense, and Health and Human Services.  A


    13    support staff includes two physicians, one a highly

    14    published investigator in the field of infectious

    15    disease, the other directly involved the care and


    16    evaluation of Persian Gulf veterans on a day-to-day

    17    basis.

    18                This support staff also includes a nurse

    19    and two health services administrators and is located


    20    in office space in Washington, D.C., where it assists

    21    in all functions of the board, including daily

    22    operations, handling requests for information,


    23    coordinating responses, and disseminating relevant

    24    information.

    25                The Coordinating Board also provides


                                                                         81

     1    direct support and assistance to the activities of


     2    three working groups established by the Coordinating

     3    Board.  These working groups include the Clinical

     4    Working Group, chaired by Major General Ron Blank of

     5    the Department of Defense; the Research Working Group,


     6    chaired by Dr. Raymond Sphar of the Department of

     7    Veterans' Affairs; and the Compensation Working Group,

     8    co-chaired by Gary Hickman of the VA and Ms. Jeanne


     9    Fites of Department of Defense.

    10                The Clinical Working Group has been

    11    responsible for the development and coordination of

    12    patient registries of which you've heard about this


    13    morning operated by both the VA and the Department of

    14    Defense.  This group also develops continuing medical

    15    education materials to assist clinicians caring for


    16    Persian Gulf veterans.

    17                The Research Working Group provides

    18    guidance and coordination of VA, DOD, and Health and

    19    Human Services research activities to avoid


    20    duplication, focus on high priority questions, and

    21    share research findings between departments in a

    22    timely manner.  This group also provides periodic


    23    reports to federal oversight authorities.

    24                The Compensation Working Group assists in

    25    the establishment of fair, clear, and consistent


                                                                         82

     1    guidelines for VA and DOD disability determinations


     2    and compensation and also monitors the implementation

     3    of new disability compensation rules and procedures

     4    established by law or departmental policy.

     5                Although the Persian Gulf Veterans'


     6    Coordinating Board has existed for less than two

     7    years, it has already accomplished several objectives

     8    that have aided Persian Gulf veterans.  These include


     9    the establishment of clinical evaluation protocols not

    10    utilized by VA and DOD that generate complementary,

    11    comprehensive clinical information, the development of

    12    a cohesive inter-departmental research plan, and a


    13    centralized research database to catalog and

    14    disseminate research findings, and an enhancement of

    15    professional and lay understanding of Persian Gulf


    16    health issues through the publication of scientific

    17    articles, presentation at national scientific and

    18    medical meetings, and a variety of public appearances.

    19                Equally important has been the creation of


    20    a forum for the exchange of ideas within the

    21    government and for the development of inter-

    22    departmental relations that have fostered greater


    23    understanding and cooperation in dealing with the very

    24    complex issues affecting the lives of many Americans.

    25                I would like to conclude my remarks by


                                                                         83

     1    saying that I believe that the Persian Gulf Veterans'


     2    Coordinating Board has effectively focused the

     3    efforts, the talents, and the resources of three

     4    executive branch departments on the common goal of

     5    serving the needs of Persian Gulf veterans.


     6                I would be happy to answer any questions

     7    you have.  Thank you.

     8                CHAIR LASHOF:  Thank you very much, Dr.


     9    Roswell.

    10                I think the panel is now open for

    11    questions.  I think we might just try to move around

    12    the table because I'm sure everybody has got some


    13    questions, and we'll take them in order.

    14                Do you want to?

    15                MS. TAYLOR:  I have a question for Dr.


    16    Joseph.  It was regarding the number of illnesses of

    17    persons who died from illnesses or diseases.  There

    18    were 145 you mentioned.  Do you have the specific

    19    diseases?  


    20                ASSISTANT SECRETARY JOSEPH:  We can

    21    furnish those to you.  I don't have them with me. 

    22    Those would normally be in the normal way that DOD


    23    calculates casualties everything from a person who was

    24    in a vehicular accident to a person who died of

    25    malaria or of pneumonia.  It would be everything


                                                                         84

     1    except direct engagement with the enemy.


     2                CHAIR LASHOF:  Let me just --

     3                If I might, with much of the talk, much of

     4    it correct about the environment in the gulf, the

     5    DNBI, which is a measure of the health of our troops


     6    and our ability to use preventive medicine and medical

     7    care to keep people health and restore them to health,

     8    the DNBI was the lowest in the gulf than it's been in


     9    any conflict that we have been in.

    10                UNDER SECRETARY KIZER:  Just with regard

    11    to the question on mortality, as you have probably

    12    seen in your materials, we are conducting a study


    13    looking at mortality of veterans from the Gulf

    14    conflict compared with those who did not participate

    15    in those hostilities.  Preliminarily, no notable


    16    differences have been found, but I would underscore

    17    that those are preliminary findings at this point.

    18                CHAIR LASHOF:  Mr. Rios?

    19                MR. RIOS:  Dr. Joseph, you said 148 troops


    20    were killed in actual combat while the engagement was

    21    going on?

    22                ASSISTANT SECRETARY JOSEPH:  That's


    23    correct, Mr. Rios.

    24                MR. RIOS:  And 145 died as a result -- of

    25    the 145, what's the time period that those people died


                                                                         85

     1    in?  Over the past year?


     2                ASSISTANT SECRETARY JOSEPH:  I can't give

     3    you the exact time period, but those would be deaths

     4    that were directly related to the deployment so that

     5    while someone might have been injured -- let's take my


     6    example -- while someone might have been severely

     7    injured in an automobile accident but survived and

     8    then died in a hospital six months later back in the


     9    States, they would count in that DNBI.

    10                Those numbers do not count, if I think I

    11    know where you're going; those numbers do not count

    12    Persian Gulf War deployed veterans or active duty who


    13    died since returning from the Persian Gulf of a cause

    14    that was not diagnosed in the Persian Gulf.  Those

    15    figures we will have from the study that Dr. Kizer


    16    referred to.  We are also doing a study comparing

    17    active duty to deployed to the gulf and active duty of

    18    the same era who did not deploy to the gulf.  We'll

    19    have information on comparative mortality, comparative


    20    hospital experience, reproductive health issues, and

    21    the rest, but those results will not be available

    22    until some time towards the end of the year as early


    23    results.

    24                MR. RIOS:  And your research shows that

    25    our troops were, in fact, exposed to chemical war


                                                                         86

     1    agents while they were over there?


     2                ASSISTANT SECRETARY JOSEPH:  No.  In fact,

     3    the finding of every group that has looked at this,

     4    beginning with the Defense Science Board, the so-

     5    called Lederberg report, all the other reports that


     6    have been issued, plus the results of our own

     7    investigations in the department show no evidence of

     8    the use of chemical or biological weapons in the gulf.


     9                MR. RIOS:  In other words, you found

    10    absolutely no chemical war agents that were in the

    11    atmosphere throughout the whole war; is that correct? 

    12    At no levels?  Because I understand that some of these


    13    troops that had devices that measured chemical war

    14    agents, some of them were going on quite a bit, and is

    15    it the government's position that there were no


    16    chemical war agents in the atmosphere at all

    17    throughout the whole war?

    18                ASSISTANT SECRETARY JOSEPH:  Let me

    19    mention three.  You're now deeply into an issue that


    20    I'm sure you're going to be into for some time.  There

    21    were at least three sort of sets of claims or reports

    22    during the gulf conflict.  One was the frequent going


    23    off, setting off of alarms, chemical detection alarms. 

    24    There were hundreds of these incidents where various

    25    alarms were set off.  In each one of those incidents,


                                                                         87

     1    a follow-up investigation failed to confirm the actual


     2    presence of chemical agents.

     3                In part, this is a sensitivity versus

     4    specificity issue.

     5                Secondly, there's a very well publicized


     6    incident where an advanced scout went into a bunker in

     7    the desert, came out -- the bunker was full of vats

     8    and storage tanks -- came out some time later and


     9    sustained a burn on his clothing and on his arm. 

    10    Initially that was reported as a mustard gas exposure,

    11    but in that instance, as well, the chemical,

    12    biological, nuclear detection officers who followed up


    13    and all follow-up testing on that soldier and on the

    14    clothing could not confirm exposure to a chemical

    15    warfare agent.


    16                And finally, there are the reports, the

    17    famous Czech incidents, where a Czech, C-z-e-c-h, a

    18    Czech detection team in the desert allegedly reported

    19    the presence of chemical agents on the battlefield,


    20    and again, those reports have not been able to have

    21    been confirmed, including after visits from our people

    22    visiting with the Czechs and others.  


    23                So the position of the department, and

    24    it's based on a very thorough review of all the data

    25    that we can find and the review by external bodies,


                                                                         88

     1    such as the Defense Science Board, is that there is no


     2    evidence of the use or presence of CBW agents on the

     3    battlefield.

     4                MR. RIOS:  I'm sorry.  Now, what's the

     5    explanation for these meters or devices or whatever it


     6    is that the troops were carrying?  Why were they going

     7    off?

     8                ASSISTANT SECRETARY JOSEPH:  Well, these


     9    devices, one, are not perfect, and (b) they are set to

    10    be more sensitive than specific so that many things

    11    will set off a device besides the presence of the

    12    actual agents.  In fact, one of the findings that has


    13    been repeated in several of the independent groups and

    14    our own internal studies coming out of the gulf is the

    15    urgent need for more specific and reliable battlefield


    16    usable chemical detection agents.

    17                One would expect to have many more false

    18    alarms than real.  It's a little bit like the smoke

    19    alarm in your house.  If you broil your lamb chops a


    20    little too vigorously, you'll set off the smoke alarm,

    21    but you want that to happen because you don't want

    22    there to have to be a fire in your house before the


    23    smoke alarm goes off.

    24                MR. RIOS:  And did DOD ever issue any

    25    report on the actual bombing sites and whether or not


                                                                         89

     1    any of these bombings that the United States did


     2    occurred close to where there were any chemical

     3    weapons or that could have --

     4                ASSISTANT SECRETARY JOSEPH:  I do not

     5    believe so.  I don't have that information with me. 


     6    I'll get you what I think approximates it, but all

     7    that data that has been looked at has come up with the

     8    same conclusion.


     9                MR. RIOS:  So right now so that the panel

    10    knows it's your position and the government's position

    11    that there were no chemical war agents in the

    12    atmosphere and that our troops were not exposed to any


    13    chemical war agents?

    14                ASSISTANT SECRETARY JOSEPH:  That is

    15    correct, Mr. Rios.


    16                CHAIR LASHOF:  General Larson.

    17                MS. LARSON:  Yes, two quick questions. 

    18    First to staff, I don't recall seeing a copy of the

    19    JAMA article that Dr. Falk referred to, and it might


    20    be useful to get copies of that.

    21                MS. NISHIMI:  I thought it was in there,

    22    but if not, then we'll get it.


    23                MS. LARSON:  I just looked through.  I may

    24    have missed it.

    25                MS. NISHIMI:  Okay.


                                                                         90

     1                MS. LARSON:  Second quick question to Drs.


     2    Roswell and Joseph.  I read with interest the report,

     3    Dr. Joseph, on the comprehensive clinical evaluation

     4    program and the reprint from the Archives of Internal

     5    Medicine.  Those are very useful reports for sort of,


     6    if you will, generating hypotheses of disease, but the

     7    real important compelling evidence will come from the

     8    kind of prospective cohort study that you mentioned.


     9                It seems to me we really need that

    10    information, and you're saying it will -- would you

    11    tell us a little bit more about the status of that

    12    prospective cohort and what you're actually studying,


    13    when it started, and as you mentioned, the results

    14    will be available by the end of this year; is that

    15    correct?


    16                ASSISTANT SECRETARY JOSEPH:  Well, let me

    17    just take one point of issue with you.  There are

    18    things that that kind of prospective epidemiologic

    19    study can't tell you.  That study will not give us --


    20    that study will not generate the level and detail of

    21    clinical information that the other studies have, but

    22    the other problem is vice versa.


    23                The most important set of studies for us,

    24    the so-called Gray studies, are studies that are being

    25    carried out by the Navy out of San Diego, and they are


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     1    this family of controlled studies that I mentioned


     2    before:  mortality experience, hospital experience,

     3    and birth outcomes and reproductive health.

     4                Those studies began a good year ago, and

     5    as I said, the first preliminary data we expect to see


     6    in November or December of this year.  I don't think

     7    that's unusual.  It just takes that kind of time to do

     8    these kinds of studies, and I can guarantee you that


     9    no matter how interesting, provocative, or useful the

    10    results of those studies will be, they will lead to

    11    additional questions which then will need to be

    12    studied in an even more refined matter.


    13                It's a little bit like Secretary Shalala

    14    was saying here.  I don't want at all to give the

    15    impression that we're saying this, you know, to back


    16    off and sort of give ourselves cover.  Well, it's very

    17    complex; it takes a long time; it's hard to get

    18    answers.  That's not my purpose.  My purpose is that

    19    it does take a long time.  Those things will give us


    20    very important answers, but I'm not sure they will

    21    give us the kind of single channel, yes/or, red

    22    light/green light answers that some may be expecting. 


    23    Science just does not work that way.

    24                MS. LARSON:  I'm not suggesting that it

    25    does, but I am suggesting that it's very useful to


                                                                         92

     1    have comparison groups which are comparable --


     2                ASSISTANT SECRETARY JOSEPH:  Absolutely.

     3                MS. LARSON:  -- in all other aspects

     4    except deployment to the gulf, and that's what we

     5    don't have in the data now.


     6                ASSISTANT SECRETARY JOSEPH:  That's

     7    correct.

     8                DR. ROSWELL:  The VA study that was


     9    alluded to earlier will actually survey 15,000

    10    randomly selected Persian Gulf veterans and compare

    11    the answers they provide to answers provided by 15,000

    12    randomly selected veterans of the Persian Gulf era who


    13    did not serve in theater.

    14                That questionnaire that will be used in

    15    that process has been evolved with a great deal of


    16    cooperation between the three departments and input

    17    from our Scientific Advisory Committee.  Right now the

    18    questionnaire is pending final approval by the Office

    19    of Management and Budget, a requirement in law.


    20                Once that's obtained, we plan to begin

    21    that survey and hope that results would be available

    22    within 12 to 15 months, but understandably to


    23    aggregate and evaluate that kind of detailed

    24    information, it is a lengthy process, as Dr. Joseph

    25    has alluded to.


                                                                         93

     1                ASSISTANT SECRETARY JOSEPH:  If I might


     2    just take another moment more to describe one other

     3    study that the committee needs to know about, a

     4    terribly important study, the other parameter, of

     5    course, is space and time, and the so-called Army


     6    geographic locator study, which should be finishing up

     7    or at least have usable data early in '96, December

     8    '95, January '96, will provide a map of every unit on


     9    every day in the Gulf so that if and as we turn up

    10    important clinical or epidemiologic information that

    11    seems to cluster around particular units, not

    12    individual soldiers, but particular units, we can look


    13    for patterns of space and time, and that's the other

    14    very important thing.  It just takes a white to get

    15    there.


    16                CHAIR LASHOF:  Dr. Landrigan.

    17                DR. LANDRIGAN:  You know, you must have

    18    been reading my mind, Dr. Joseph, because I was just

    19    going to ask a question along those lines.  One of the


    20    things that we've learned over the years in

    21    environmental and occupational medicine is that all

    22    members of a population are not equal in terms of


    23    their exposure, but typically there are subsets that

    24    have heavier exposure either by virtue of their job

    25    classification or their geographic location or some


                                                                         94

     1    other factor.


     2                And I wanted to talk with you for a moment

     3    about your strategy and also Henry Falk at your

     4    strategy in devising the epidemiologic studies.  I

     5    think it's all well and good, and indeed essential,


     6    that you do the big, broad based studies that you're

     7    doing, but it seems to me there ought to be a

     8    systematic effort afoot to identify groups within the


     9    larger population either by virtue of particular

    10    exposures that were reported or anecdotal events of

    11    disease or other intelligence that you have, and then

    12    focus in on them using either clinical studies, case


    13    control, or whatever methodology seems appropriate.

    14                ASSISTANT SECRETARY JOSEPH:  I won't go

    15    back over the space, time and comparison group


    16    comments that we've all just made, but one of the most

    17    important findings, I think, in the CCEP 10,000 so far

    18    is that those 10,000 patients are distributed over a

    19    very, very large number of units in the gulf, that


    20    were in the gulf, and with a few exceptions, all of

    21    those, the units described, many thousands of units,

    22    had only a very small number each of those who later


    23    became registrants on the CCEP.

    24                That, I think, is one of the strongest

    25    pieces of evidence that whatever these things are we


                                                                         95

     1    are dealing with, we are not dealing with a single,


     2    unique cause of illness over this mass population.

     3                Of course, that does not tell you whether

     4    or not there might be small clusters, particularly in

     5    those units that seem to have a larger number of


     6    individual participants than one might have imagined;

     7    that there might not be some specific things going on

     8    in those clusters; and so another important tool for


     9    focusing these more discrete studies that you've

    10    talked about is now to go back and look at those units

    11    where there have been more than one or two people who

    12    emerge who later turn up as patients in our program,


    13    and also to take all our other clinical data and try

    14    to focus it back on that unit, space, time, and

    15    comparison group map.


    16                DR. LANDRIGAN:  I must say I'm not too

    17    hung up one way or the other on the issue of a single

    18    entity.  It may or may not exist.  I have no opinion

    19    on that, but I'm thinking more in terms of different


    20    subpopulations that have distinctly different

    21    exposures, oil smoke here, some chemical there,

    22    benzene in a third place, and I think of it more as a


    23    checkerboard, I guess.

    24                ASSISTANT SECRETARY JOSEPH:  Both we in

    25    the VA in our registry information ask self-reported


                                                                         96

     1    questions about exposures and so does the CDC, and Dr.


     2    Falk may want to comment on that.

     3                One of the problems, of course, is that

     4    you're talking about memory.  You're talking about

     5    self-selection, and you're talking about events that


     6    now are from some time in the past, and for example,

     7    we have many more people on our registry self-

     8    reporting exposure to various agents than could


     9    possibly be the case from what we know about the way

    10    either insecticides were used or pyridostigmine was

    11    ingested or various vaccines were administered.

    12                DR. FALK:  In response to your question,


    13    I agree with Dr. Joseph in terms of systematically

    14    looking at all the people who are in the CCEP registry

    15    and trying to find pockets of concern.  In addition to


    16    that, several of the things that we have done like in

    17    Pennsylvania or Mississippi are studies that were

    18    generated by concerns from particular units, and I

    19    think that that's something we would be attentive to


    20    in the future, as well.

    21                UNDER SECRETARY KIZER:  I would just make

    22    two additional comments.  When I came to the VA not


    23    that many months ago one of the first things I asked

    24    was about the geographic locator study.  I think that

    25    is going to be of great importance, particularly


                                                                         97

     1    insofar as being able to link that with the folks on


     2    the registry, both DOD's and the VA's registry, and

     3    out of that I would expect a whole number of anecdotal

     4    incidents, as well as perhaps some ideas for case

     5    control studies will emerge.


     6                The second point I wanted to make, and it

     7    goes back to a question that -- I apologize -- I don't

     8    recall who asked it of the prior panel though that


     9    bears on this, and that is the need at least in my

    10    judgment that we work with some of our international

    11    partners to look at their experience as well.  There

    12    were other allied forces, although not as numerous as


    13    the United States, that have populations.  They have

    14    been perhaps slower in recognizing the problem and

    15    dealing with it, but it is a potential reservoir of


    16    information, both anecdotal as well as epidemiologic,

    17    that we should not ignore and that we need to be

    18    looking at their experience collaboratively just as we

    19    look at our own.


    20                DR. ROSWELL:  With regard to study design,

    21    I should also point out that if we look at the 700,000

    22    approximate force that served in the Gulf War, we find


    23    that the composition included seven percent women,

    24    approximately ten percent Reserve troops, and about

    25    six to seven percent National Guard.


                                                                         98

     1                Because each of those subsets within that


     2    larger force are important components, each of those

     3    areas will intentionally be over-sampled in the VA's

     4    epidemiologic study to make sure that we achieve

     5    statistical significance for each of those


     6    populations, as well.

     7                All of these are factors.  The geographic

     8    factors as well as the force composition are factors


     9    that have gone into the experimental design that has

    10    become a part of the inter-agency research plan.

    11                MS. KNOX:  Can you give us some insight

    12    into why the State of Iowa was chosen for the study


    13    that you're going to do?  Is it random?

    14                DR. FALK:  I think we were very directly

    15    asked about doing it in the State of Iowa.  You know,


    16    I think that there will be some differences between

    17    the CDC study and the VA study in the sense that as a

    18    telephone interview survey, we can do interviews

    19    perhaps in more detail in certain aspects.  So I think


    20    we can take advantage of that wherever we do that

    21    study to do it in more detail.

    22                So I think, yes, it could conceivably have


    23    been done someplace else, but we were requested to do

    24    this in Iowa, and I think we can do the study well in

    25    Iowa with active participation from the Health


                                                                         99

     1    Department there and the University of Iowa, and


     2    there's a very good group working on this together

     3    there.

     4                So I think it will actually work well

     5    there, and it's an effort to do something a bit more


     6    intensive in one particular place.

     7                DR. ROSWELL:  I could probably also shed

     8    a little bit of light.  Senator Tom Harkin actually


     9    conducted a field hearing in Iowa where this and other

    10    concerns were discussed, and as a direct result of

    11    that field hearing, actually Dr. Satcher (phonetic),

    12    Director of the Center for Disease Control and


    13    Prevention, made the commitment to initiate the study.

    14                MS. KNOX:  And what's the sample size of

    15    that study going to be?


    16                DR. ROSWELL:  There'll be -- right now it

    17    -- do you want to answer?

    18                DR. FALK:  Oh, it's anticipated that it

    19    will be probably a little over 3,000, 1,500 deployed


    20    to the Persian Gulf, 1,500 not deployed to the Persian

    21    Gulf.

    22                MS. KNOX:  The second question I have is


    23    about the external research.  Is there funding

    24    available from NIH for external researchers?

    25                DR. ROSWELL:  Of course, funding is


                                                                        100

     1    available on a competitive basis through NIH for any


     2    researcher.  I'm not aware of any special earmarked

     3    money available through NIH.  However, earlier this

     4    year the Department of Defense announced  the

     5    availability of over $5 million that would be


     6    available to any investigator in a call for proposals

     7    that would address specific areas of the experience

     8    associated with the Persian Gulf health concerns.


     9                MS. KNOX:  Knowing the publicity of this

    10    committee, has that deadline for those proposals been

    11    set?

    12                DR. ROSWELL:  I believe the deadline for


    13    the call for proposal is August 24th.

    14                (Technical malfunction.)

    15                DR. HAMBURG:  -- diverse set of health


    16    effects.  You might or might not find among them some

    17    unique condition that would be of considerable

    18    intellectual interest.  It isn't obvious to me why it

    19    would necessarily have particularly great medical or


    20    social interest, and maybe you could explain that.

    21                ASSISTANT SECRETARY JOSEPH:  I think it's

    22    the result of the social and political history of the


    23    way this problem came to the fore.  In the earliest

    24    days of concern about this issue, before anyone knew

    25    how many people were suffering, what they were


                                                                        101

     1    suffering from, for example, which we're now beginning


     2    to learn, there was sort of a fascination with what

     3    came to be called "the mystery illness."  Part of it

     4    had to do with conspiratorial theories around chemical

     5    and biological warfare.  Part of it had to do with


     6    virtually everybody in the country seeing the Scud

     7    missile attacks on CNN.  Part of it had to do with

     8    other kinds of special concerns that this or that


     9    particular disease causing agent, the oil well fires,

    10    whatever, might have caused illness in a large group

    11    of people.

    12                And really the idea of a Persian Gulf


    13    illness, a mystery illness, a Persian Gulf Syndrome

    14    was really the driving force in the early days -- I

    15    mean two or three years ago -- of this issue.  I think


    16    that as the data has begun to come in, there is more

    17    understanding of the kind of perspective that you have

    18    put on it, Dave, but the earliest, and still you'll

    19    see in the media from time to time -- as a matter of


    20    fact, one of the newspaper headlines after that report

    21    was issued two or three weeks ago was "No Persian Gulf

    22    Illness Found," which was a total distortion of what


    23    we found and said, but there still is, I think, a

    24    fascination with finding the mystery, of proving the

    25    agent, or whatever, though I think there is a great


                                                                        102

     1    deal of data on the opposite side of that balance.


     2                I would also add or accentuate the point

     3    you made, is nothing that we've said so far can be

     4    taken as an indication that there is not within those

     5    many causes of illnesses and very broad range of


     6    symptoms and diagnoses perhaps specific clusters of

     7    small numbers of things that are unusual.

     8                Well, one we have found, the earliest


     9    found was leishmaniasis, which was talked about, and

    10    we now have, I believe, 32 cases or 37 cases of

    11    leishmaniasis, including about 20 cases of visceral

    12    leishmaniasis, coming out of the Gulf War.  That is a


    13    very unusual finding in American medicine.  You don't

    14    find leishmaniasis being reported in this country to

    15    that extent.


    16                But that's quite a different thing that

    17    the sort of the specter of a mystery illness.  In

    18    fact, early in the history there was quite a bit of

    19    speculation, much of it irresponsible, that


    20    leishmaniasis was the cause of all of these symptoms

    21    that were being seen in all our people.

    22                UNDER SECRETARY KIZER:  Let me just make


    23    a couple of additional comments because I think your

    24    perspective, Dr. Hamburg, is really one that has been

    25    shared from the VA certainly as long as I've been


                                                                        103

     1    associated with the agency.  Whether there is or is


     2    not a single syndrome is merely a question that needs

     3    to be answered, but it really doesn't go to the heart

     4    of the much larger question of whether there are

     5    multiple syndromes or whether exposures or other


     6    things may contribute to the occurrence of these

     7    commonly diagnosed conditions.

     8                I mean there are several tiers of


     9    questioning here.  I think the issue of one syndrome

    10    or not is really a product of the media and has not

    11    colored the investigators' thinking, and there are

    12    other questions that have to be answered as to whether


    13    whatever occurred in the gulf may contribute to the

    14    occurrence of these commonly diagnosed conditions. 

    15    There's a whole train of reasoning out there that a


    16    number of our investigations are looking at.

    17                The other thing that I think should not be

    18    ignored in this whole process also is the fact that

    19    the issues that are being asked or the questions that


    20    are being asked have considerable relevance to issues

    21    that go beyond the gulf.  Indeed, many of the

    22    questions related to industrial, occupational,


    23    environmental exposures occur in the civilian setting

    24    and other settings, and we shouldn't overlook the

    25    opportunity that these investigations and this whole


                                                                        104

     1    effort may have in further elucidating or answering


     2    questions that go far beyond the specific questions

     3    related to the gulf.

     4                DR. ROSWELL:  As we have this very

     5    important discussion about possible causes and whether


     6    or not there exists a single syndrome, I think it's

     7    imperative that we not lose the perspective of the

     8    veteran.  These are the people that deserve a complete


     9    and truthful answer of factors that may be affecting

    10    their health today.  They deserve health care that is

    11    available now, and in most cases, health care can be

    12    very beneficial to veterans of the Persian Gulf War


    13    who are now experiencing medical problems.

    14                They do not, however, deserve to be

    15    stigmatized by incorrect assumptions that they're


    16    harboring some type of mystery illness, and that's why

    17    I think it's imperative that we maintain these open

    18    minded objectivity that we have tried to retain at

    19    this point.


    20                DR. FALK:  May I just make one comment on

    21    that quickly?  I think different diseases oftentimes,

    22    as Dr. Joseph implied, present differently with very


    23    different symptoms, and they're easily teased apart,

    24    and disease from different kinds of exposures will

    25    similarly look differently.


                                                                        105

     1                I think the idea that many of these


     2    symptoms overlap in ways lead for some kind of a

     3    search for a unitary hypothesis, and so I think it's

     4    inherent when many people have similar kinds of

     5    complaints that one always looks for, you know, the


     6    simplest hypothesis.

     7                CHAIR LASHOF:  Any other questions?

     8                Let me ask a few now and then we'll


     9    proceed around.

    10                I wanted to ask you, Dr. Kizer, whether

    11    the locator data, trying to pinpoint where everyone is

    12    -- what it would take to speed that up so that it was


    13    done before the end of this year.  This committee has

    14    less than a year and a half to complete its work.

    15                ASSISTANT SECRETARY JOSEPH:  Let me answer


    16    that.

    17                CHAIR LASHOF:  Oh, I'm sorry.

    18                ASSISTANT SECRETARY JOSEPH:  You addressed

    19    it to Ken because it's a DOD/Army study.


    20                CHAIR LASHOF:  I'm sorry.

    21                ASSISTANT SECRETARY JOSEPH:  The study has

    22    already been speeded up with an additional infusion of


    23    resources that moved it back to, as I said, about

    24    around Christmas, December, January, '95-'96.  I think

    25    now we're at the limitation of data entry, and I'm not


                                                                        106

     1    sure.  I will give you an answer to that question,


     2    Joyce, but I think an increment of resources would not

     3    bring it back further than where we expect to see it

     4    at the end of '95, but I will give you an answer to

     5    that.


     6                CHAIR LASHOF:  On your CCEP study -- well,

     7    I won't call it a "study" -- the protocol and

     8    evaluation, the clinical assessment, you do give us


     9    comparison of the symptom rate with a whole series of

    10    clinical ones.  One that I thought was in there was

    11    the National Ambulatory Medical Care Survey.

    12                Now, isn't it possible to obtain from the


    13    National Ambulatory Medical Care Survey a group that

    14    are comparable in age and sex distribution?  And why

    15    wasn't that comparison made?


    16                ASSISTANT SECRETARY JOSEPH:  I'm sure we

    17    could get a sample from that study that was gender and

    18    age comparable.  You would still have the argument

    19    that no civilian populations is comparable to the


    20    health and fitness and perhaps other characteristics

    21    that you and I can't think of of a military

    22    population.  So we think that there is important


    23    information to be mined out of these comparisons. 

    24    That's why we put them in the report, but we also

    25    caution against anything that we can see as an


                                                                        107

     1    existing database that is truly comparable.


     2                I must tell you also that the thing that

     3    this has done for me most in watching this ride along

     4    is a realization of the limits of our medical

     5    diagnostic "nosology" and capability.  The more you


     6    get into symptom diagnosis and trying to see where

     7    groups of symptoms compare to other groups of

     8    symptoms, the more you find clusters and individual


     9    patients who bear out that experience that we all have

    10    in practicing medicine, that many patients you cannot

    11    pin an ICD-9 definitive diagnostic label upon, and I'm

    12    sure that's true in all the ambulatory care studies,


    13    as well as the CCEP.

    14                DR. ROSWELL:  Work that's actually been

    15    conducted at the Birmingham VA Medical Center did just


    16    what you spoke of, and there we surveyed Persian Gulf

    17    veterans seeking care for symptoms being reported and

    18    then compared the answers they provided with age and

    19    gender match controls, who were also veterans seeking


    20    care at the same VA medical center and compared the

    21    relative ratio.

    22                We did find that certain symptoms, in


    23    fact, many of the symptoms mentioned were reported

    24    more commonly by the Persian Gulf veterans, although

    25    they were quite common in the age and gender match


                                                                        108

     1    controls, as well.


     2                CHAIR LASHOF:  I think there's no question

     3    that these are common symptoms, but I would think that

     4    if you're going to publish any kind of comparable

     5    group, if there is a group that at least is comparable


     6    in age and sex, it would have been more helpful than

     7    a generalized population that comes to a clinic who

     8    basically are much older and sicker people than one


     9    would expect in the veterans, and whether it's worth

    10    going back and doing that now, I don't know.  It

    11    depends on how much work it is, but I would suggest

    12    that you might take a look at that.


    13                I'd also like to ask Dr. Falk and Dr.

    14    Roswell to comment further on the CDC role.  CDC, as

    15    the epidemiologic arm of the government, I was


    16    surprised, frankly, to see that the only epidemiologic

    17    studies that they are actively engaged in are the one

    18    in Pennsylvania, which they're doing at the request of

    19    the Pennsylvania Department of Public Health, and the


    20    one in Iowa that Senator Harkin brought to the fore.

    21                And I'd like to know more about CDC's role

    22    in looking at the protocol of the other epidemiologic


    23    studies.  I'd like to know whether the studies being

    24    done by DOD and VA and any other studies that are

    25    being carried out in the country of an epidemiological


                                                                        109

     1    nature are all comparable so that the data could be


     2    pooled and a meta analysis performed at the end.

     3                DR. FALK:  Let me begin.  Several things. 

     4    One is I think the Coordinating Board has really been

     5    a very important function and has brought the people


     6    from the different agencies together much more so than

     7    at least has been my experience in previous situations

     8    like this.


     9                We have had active participation with the

    10    Coordinating Board.  We do have efforts that are

    11    underway to look at ways of asking comparable

    12    questions in similar kinds of studies, and comments


    13    back and forth on the different studies.  So there is

    14    active participation in that regard.

    15                I think -- and we very much appreciate, I


    16    think, from our perspective the effort of the

    17    Coordinating Board to bring the groups together and

    18    build that sense of coordination.

    19                I think historically as I look back at CDC


    20    over the years, I've been at CDC for a little over 20

    21    years now, and I have watched several efforts or

    22    participated in them from the soldiers who


    23    participated in the Nevada test site activities to the

    24    Agent Orange activities at CDC, and now Persian Gulf

    25    activities.  We have in each of those incidences


                                                                        110

     1    either responded to a request from a member of the


     2    public in a particular situation or responded to

     3    requests directly from the VA and other groups.

     4                We've not had in a sense a standing unit

     5    working on veterans' affairs.  So it has been in a


     6    responsive mode, and I think in this particular

     7    situation there has been an effort to build a

     8    coordination across agencies.


     9                DR. ROSWELL:  I would certainly endorse

    10    what Dr. Falk has said.  In fact, a CDC representative

    11    serves on the Research Group and, in fact, has had

    12    direct input into the development of the epidemiologic


    13    study that will be conducted by the Department of

    14    Veterans' Affairs.

    15                UNDER SECRETARY KIZER:  Dr. Lashof, I


    16    might also add two points.  One of the things that has

    17    delayed or at least taken more time than I would like

    18    on getting this 15,000 individual study underway has

    19    been the efforts to coordinate and make sure everyone


    20    has looked at the protocols, bought into the

    21    protocols, agreed on the questionnaire, and to assure

    22    the comparability of the data, and when you do that


    23    type of thing, it does take longer to get your studies

    24    underway.

    25                The other point I would make is I have


                                                                        111

     1    discussed with Dr. Richard Jackson, the head of the


     2    National Institute of Environmental Health, the

     3    potentiality of actually having -- at least that part

     4    of CDC having more of an ongoing role in veterans'

     5    issues.


     6                CHAIR LASHOF:  Thank you.

     7                ASSISTANT SECRETARY JOSEPH:  Dr. Lashof,

     8    no one has mentioned so far this morning a fact which


     9    I presume you all know, that there are two Institute

    10    of Medicine committees that are backing up this

    11    effort.  There's what we call the big committee, which

    12    is overseeing the coordinated research portfolio, and


    13    there's the so-called small committee, which is

    14    helping us with the CCEP.

    15                You're going to hear from them tomorrow.


    16                CHAIR LASHOF:  We're going to hear from

    17    them tomorrow.

    18                ASSISTANT SECRETARY JOSEPH:  And we would

    19    welcome anything that comes out of that interaction in


    20    terms of methodologic improvements that we can either

    21    put into current studies or studies which will

    22    undoubtedly be going on in the future.


    23                CHAIR LASHOF:  Let me ask just one more

    24    question and then I'll move it along.  The VA is

    25    looking at the veterans who have been discharged.  DOD


                                                                        112

     1    is looking at those who are still in the service; is


     2    that correct?

     3                ASSISTANT SECRETARY JOSEPH:  And their

     4    dependents.

     5                CHAIR LASHOF:  Pardon?  And their


     6    dependents.

     7                What percentage of the men who served in

     8    the gulf are now veterans discharged and what


     9    percentage -- what are the numbers in the comparable

    10    groups we're looking at?  Who's still on active duty

    11    and who isn't is the question, I guess.

    12                UNDER SECRETARY KIZER:  It's about 50-50. 


    13    I don't have the exact number, but those are the ball

    14    park.

    15                CHAIR LASHOF:  All right.  


    16                DR. CUSTIS:  Just a couple of questions

    17    for whomever cares to answer.  Regarding the early

    18    reports of possible synergistic toxicity of

    19    pyridostigmine in insecticides, do you have a measure


    20    of how many people, how many actually ingested the

    21    pyridostigmine?

    22                ASSISTANT SECRETARY JOSEPH:  We have an


    23    inexact measure because as you know, pyridostigmine

    24    was issued to a significant number of troops in the

    25    gulf, and we have that number and can give it to you,


                                                                        113

     1    but they were told to take it upon the order of their


     2    unit commander.

     3                What we cannot tell you, and this is

     4    again, I think, the kind of lesson we can learn for

     5    improving practice in the future; what we cannot tell


     6    you is who took how much, when they took it, over what

     7    period of time based on the orders that were given by

     8    the unit commander, but we do have rough numbers of


     9    both the actual numbers of people who were given

    10    pyridostigmine and also the vaccines that have been

    11    talked about, and you'll also see in the CCEP some

    12    self-reported exposure information.


    13                With respect to the insecticide, that's

    14    also very complicated because insecticide was

    15    available, but during most of this period for most of


    16    the individuals, there were really very little

    17    problems with insects at that time of year in the

    18    desert.  That's evidenced by the very low rates of

    19    insect borne diseases that we see among the troops.


    20                Again, there's no way to have a clear

    21    understanding of who sprayed what during what period

    22    on which pieces of their clothing.


    23                DR. CUSTIS:  The other question is based

    24    on my ignorance of depleted uranium.  Just how

    25    dangerous is it to have retained imbedded in fragments?


                                                                        114

     1                ASSISTANT SECRETARY JOSEPH:  Well, there's


     2    a study going on to look at that issue right now in

     3    terms of both those who were exposed to depleted

     4    uranium in the handling of munitions and to those

     5    casualties that were involved with depleted uranium


     6    shell heads.

     7                DR. CUSTIS:  Is it very dangerous or not?

     8                ASSISTANT SECRETARY JOSEPH:  I'm not sure


     9    that one can give you a good answer to that question

    10    until the studies are done.

    11                DR. ROSWELL:  Dr. Custis, the Baltimore

    12    VA, in cooperation with Department of Defense, is


    13    following just over 30 individuals who were exposed to

    14    depleted uranium.  Our concern is not so much one of

    15    the radiation.  The radioactivity of depleted uranium


    16    is extremely low.

    17                However, because it is a heavy metal, the

    18    concern was its properties as a heavy metal,

    19    specifically nephrotoxicity, as a possible concern,


    20    and to date we have not seen any decline in creatinine

    21    clearances or any change, any measurable changes in

    22    renal function of those people who are being followed


    23    in this interagency study.

    24                So we do know that trace amounts of the

    25    depleted uranium is being excreted in the urine of


                                                                        115

     1    these individuals, indicating that it's not totally


     2    inert, but so far no measurable changes in physiologic

     3    function have been identified.

     4                DR. LANDRIGAN:  Depleted uranium, about 12

     5    or 13 years ago the National Institute for


     6    Occupational Safety and Health did quite a thorough

     7    study of workers in a plant in Tennessee who were

     8    making armaments out of depleted uranium, and the


     9    focus, as you say, was on renal toxicity, and

    10    hopefully those reports are available to you.  I

    11    believe it was done as a health hazard evaluation from

    12    NIOSH.


    13                I'm not sure if it ever was published in

    14    the open literature.

    15                The other thing that occurs to me about


    16    the depleted uranium, its metabolism, its

    17    toxicokinetics in the human body are at least roughly

    18    similar to those of lead, probably seeks bone, and one

    19    technique that you could apply to study these people


    20    who were exposed to the depleted uranium that would

    21    not have been available to the NIOSH investigators a

    22    decade ago in Tennessee is direct measure of any


    23    uranium that might be in bone, direct noninvasive

    24    measurement using the X-ray fluorescence technique

    25    that a half dozen labs around the country now have


                                                                        116

     1    available.


     2                CHAIR LASHOF:  Thank you very much, Dr.

     3    Landrigan.

     4                Dr. Caplan.

     5                DR. CAPLAN:  Well, my first question is


     6    about outreach, and it's to any of the panel.  Excuse

     7    me.  If you'd care to comment, about a year ago I

     8    moved from Minnesota to Pennsylvania, and I had to get


     9    a new driver's license.  When I went to get the

    10    driver's license, I asked the lady at the desk why she

    11    hadn't asked me about organ donation as an option on

    12    the driver's license, and she said, "Well, we're


    13    supposed to, but you probably wouldn't want to get

    14    involved with that anyway."

    15                I'm curious about your views, given all of


    16    the 800 numbers and efforts that have been made to

    17    seek out symptom reporting.  Are you satisfied?  Do

    18    you think this is working?  Do you think that people

    19    out there who served really do understand that they


    20    can report and that they've been called upon if we did

    21    a sample out there of some thousand people randomly,

    22    they'd tell us, "Yes, we're all aware of this," or,


    23    "Gosh, I didn't know," or what's your read on that?

    24                UNDER SECRETARY KIZER:  This is an area

    25    where we think we need to continue to work on it. 


                                                                        117

     1    Certainly by the nature of some of the veteran


     2    populations that we're focus on, they're sometimes

     3    hard to access.  We've used multiple vehicles.  Using

     4    the Internet is not necessarily one that will reach

     5    many of them.  We've used a variety of mailings and


     6    PSAs.  

     7                I was surprised to hear about three weeks

     8    ago a couple of folks called me from California saying


     9    they had heard me at 12 o'clock or one o'clock in the

    10    morning on a radio station with some of the PSAs that

    11    we've done.

    12                DR. CAPLAN:  You're right.  You're right


    13    after the organ donation.

    14                UNDER SECRETARY KIZER:  No, I think that

    15    came on later, but we've used a variety of instruments


    16    and vehicles to get this out.  We know we need to

    17    continue to intensify this effort.  In some areas we

    18    think it has been covered quite well, and we have had

    19    good success.


    20                Our message has uniformly been to

    21    encourage all veterans to come in whether they have

    22    complaints or not, to seek care, get on the registry. 


    23    Indeed, the majority of the folks on the registry

    24    don't have specific complaints, but this does provide

    25    a baseline for further assessment down the road, and


                                                                        118

     1    as was talked about earlier, ten years, 20 years,


     2    whatever, down the road if questions come up, we would

     3    like to have as much baseline information on folks as

     4    possible.

     5                So your question is absolutely right, and


     6    certainly in my prior experience in other campaigns of

     7    this type you need to use as many vehicles as

     8    possible, and even in doing that and over a prolonged


     9    period of time, you're still not going to reach

    10    everybody that you want to, and you just have to keep

    11    trying.

    12                ASSISTANT SECRETARY JOSEPH:  Our problem,


    13    Dr. Caplan, is a little different at DOD than VA

    14    because in one sense we have an easier population to

    15    access, and I guess the good news is I would say that


    16    the efforts that have been made in DOD to access,

    17    starting with a joint letter from the Secretary of

    18    Defense and the Chairman of the Joint Chiefs of Staff

    19    right down through, have really been extremely


    20    aggressive and very productive.

    21                We have another somewhat different problem

    22    than the VA, however, and I would appreciate as you go


    23    along any thoughts about this that the committee has. 

    24    You will hear persistent reports from active duty

    25    troops that there is under-reporting or under-


                                                                        119

     1    registration because the sergeant or the lieutenant or


     2    the captain in one way or another will discourage

     3    members of the unit from reporting in on this or for

     4    taking sick time.  

     5                That comment you will also hear about our,


     6    I think, very striking data on lack of disability as

     7    measured by work time, and you will hear, I'm sure, as

     8    a committee that there are subtle and indirect and


     9    sometimes more direct pressures placed upon troops not

    10    to come forward.

    11                When you try to run those down, they're

    12    hard to find, and any light you can shed on that as


    13    you go along would be helpful to us because it's an

    14    important part of that denominator obviously.

    15                DR. BALDESCHWIELER:  Two questions for Dr.


    16    Falk.

    17                CHAIR LASHOF:  Oh, I'm sorry.  I didn't

    18    mean to cut you off.

    19                DR. CAPLAN:  I just had two other


    20    questions.  One follows up on this outreach issue, and

    21    we've heard a lot so far today about epidemiological

    22    inquiry to see who is exposed to what.  I'm curious if


    23    you could comment for us again, anybody who cares to

    24    on the panel, about the understanding of basic

    25    science, either animal models or just bench models of


                                                                        120

     1    some of the health effects of things like


     2    pyridostigmine and the insecticides and so on.  It

     3    seems to me as I've followed this issue, basic science

     4    knowledge was pretty poor a few years back about what

     5    the exposure was in terms of health effects for some


     6    of these agents that might have been in play in the

     7    gulf, and I'm just curious about what your thoughts

     8    are as to what's known now, adequacy of funding there,


     9    and so forth.

    10                ASSISTANT SECRETARY JOSEPH:  I think

    11    there's a range ranging all the way from some things

    12    -- for example, the licensed and tested and 30-year


    13    used vaccine in some cases to a great deal of medical

    14    uncertainty about long term and chronic effects of

    15    lots of things, particularly in combinations, and this


    16    is one of the dilemmas in there.

    17                If you say, well, we have very good

    18    evidence that Compound X does not cause this pattern

    19    of illness, particularly over time, and then somebody


    20    says, "Well, what about if you combine Compound X with

    21    Compound Y?"  Well, we have a little bit of data

    22    there, and then somebody says, "Well, maybe it's


    23    Compound X and Y and Z."

    24                It is difficult.  The data isn't there. 

    25    I would doubt very much certainly within the lifetime


                                                                        121

     1    of this inquiry, not just the committee, but the


     2    inquiry, that we will have that kind of perfect data

     3    around combinations, but you look where you think.  I

     4    mean it's, again, Sutton's law.  You go where the

     5    money is, and you look for those things that might be


     6    important.

     7                For example, the depleted uranium studies,

     8    the studies that have been done since the President's


     9    initiative now looking at pyridostigmine and

    10    combinations with other agents, first in animal

    11    models, et cetera, and you pick off the ones that you

    12    think are the ones that are of most concern and where


    13    there might be some payoff.

    14                As of yet I know of no data that has

    15    surfaced on any, starting with the smoke study, oil


    16    plume study.  I know of no data that's surfaced on any

    17    of these questions that has shown a probable

    18    relationship to specific illness in the gulf, but

    19    that's not to say it's not there.


    20                DR. CAPLAN:  I appreciate that, and the

    21    reason I asked about that was keeping in mind this

    22    notion of looking forward as well as back in terms of


    23    making sure that maybe for some of these things it's

    24    going to be necessary to set up an infrastructure to

    25    finally capture some answers to some of these


                                                                        122

     1    questions.


     2                Lastly, on the issue of expertise and

     3    symptoms, one of the things that I've heard already

     4    from some people who've dealt with VA is that maybe

     5    the expertise in listening to symptoms and thinking


     6    about responses to them isn't what it should be in

     7    terms of the kind of population that they're more

     8    familiar in dealing with in terms of health problems


     9    and health difficulties.

    10                So I'm just curious if I could get a

    11    comment maybe from Dr. Kizer about, you know, the

    12    system is a big one; it's got a big population to deal


    13    with; this is a fraction of the population that comes

    14    in with their complaints.  Is the ability to get

    15    information about symptomatology and ideas about what


    16    might be going on through the VA adequate?

    17                UNDER SECRETARY KIZER:  Certainly efforts

    18    have been made to, in fact, do that.  As you note,

    19    it's a large system.  It's the nation's largest


    20    integrated health care system, and it is undergoing a

    21    massive reorganization and transformation for other

    22    reasons, and I think based at least on the feedback


    23    that I've gotten, talking to patients at various

    24    forums, that in some cases it has been excellent and

    25    that the service, the attentiveness, the customer


                                                                        123

     1    service, if you will, to patients has been absolutely


     2    great.  People have been very happy with it.  In other

     3    cases it has not been what we would like to see, and

     4    we're trying to address that.

     5                We have had numerous forums and vehicles


     6    internally to make sure that our clinicians are

     7    approaching the problem in a uniform and standardized

     8    manner; that they are, indeed, listening and being


     9    judicious in what they say, recognizing that there are

    10    many questions that research has yet to answer.

    11                So your point is well taken, and any

    12    system as large as this, there's going to be a


    13    variability in response, but we are certainly making

    14    the effort to assure that folks have the audience and

    15    get the information and are treated the way that we


    16    want them to be.

    17                DR. ROSWELL:  With over 14,000 physicians

    18    in the VA health care system, it is difficult to get

    19    to each and every one of those, as Dr. Kizer alluded


    20    to.  One of the things he did not mention specifically

    21    though was his efforts to appoint a physician

    22    coordinator for Persian Gulf veterans' care at each of


    23    the 172 VA medical centers nationwide.  That physician

    24    serves as a clinical focal point, and in fact, each of

    25    those physicians were recently asked to attend a


                                                                        124

     1    national program in Baltimore where literally the


     2    state of the art, so to speak, of our current

     3    understanding of Persian Gulf issues was discussed in

     4    a three-day workshop.

     5                In addition to that, various materials are


     6    supplied to the physician coordinator, and as Dr.

     7    Kizer alluded, we have had a variety of interactive

     8    video tele-conferences, as well as other written


     9    publications, to disseminate information.  So it's an

    10    imperfect effort, but it's a concerted effort to make

    11    sure that we have that sensitivity, as well as that

    12    clinical expertise when it's needed and where it's


    13    needed.

    14                CHAIR LASHOF:  Dr. Baldeschwieler.

    15                DR. BALDESCHWIELER:  Two questions for Dr.


    16    Falk.  You mentioned serum assays with emphasis on

    17    leishmaniasis.  Did you assay for other pathogens, and

    18    what was the rationale for those that you either did

    19    or did not assay for?


    20                DR. FALK:  I know about the serum assays

    21    for leishmaniasis.  I can't answer specifically what

    22    other things were looked for, but I can check on that


    23    for you.

    24                DR. BALDESCHWIELER:  That would be

    25    extremely useful.


                                                                        125

     1                And, secondly, with regard to


     2    leishmaniasis, there was a hypothesis about a

     3    potential low level of leishmania infection below a

     4    level sufficient to create an assayable antibody

     5    titre.  What is the status of that hypothesis?


     6                DR. ROSWELL:  Well, it's difficult.  One

     7    of the current areas of research is better diagnostic

     8    methods to identify patients who may currently be


     9    having or have previously experienced leishmania

    10    infection.  That's an area of active research both in

    11    the Department of Defense and in the VA and CDC as

    12    well.  We're using the very best diagnostic methods we


    13    have available, but as you accurately point out,

    14    they're imperfect, and so it's an area for research.

    15                With regard to other infectious diseases,


    16    we know that there were infectious diseases in the

    17    gulf.  Most of those were short-term, acute illnesses,

    18    diarrheal illnesses that you expect with any type of

    19    deployment like that.


    20                As far as chronic infectious diseases that

    21    might this be affecting some of the 700,000 people who

    22    served in the gulf, the only known chronic diseases


    23    that we're aware of that may currently be a factor

    24    would include malaria, brucellosis, and Q fever. 

    25    There have been no cases of brucellosis identified,


                                                                        126

     1    one or two cases of Q fever, and a similar number, one


     2    or two cases of malaria identified.

     3                Other than that, we have just not seen

     4    chronic infectious disease.  The leishmania infection,

     5    including the 12 cases of visceral atrophic leishmania


     6    are the most prevalent chronic infectious disease

     7    that's been observed out of the gulf experience.

     8                DR. BALDESCHWIELER:  I understand there is


     9    an initiative to develop a PCR based assay to assay

    10    the pathogen directly.  Has that --

    11                ASSISTANT SECRETARY JOSEPH:  I understand

    12    that there are expected to be scientific difficulties


    13    in bringing that to accomplishment.  That's my

    14    understanding of the current status.  That's not going

    15    to be an easy task.


    16                CHAIR LASHOF:  I have just one final

    17    question for Dr. Roswell, and then we will be breaking

    18    for lunch.  You mentioned that the questionnaire for

    19    the protocol for the broad epidemiologic study is over


    20    still in the Office of Management and Budget waiting

    21    clearance.  Having been in the government before, I

    22    know how long that can take.


    23                How long has it been there, and what can

    24    we do to get it out of there for you?

    25                DR. ROSWELL:  We're anticipating OMB


                                                                        127

     1    approval in the very near future, but we'll certainly


     2    appreciate your support in obtaining that approval. 

     3    Thank you very much, Dr. Lashof.

     4                CHAIR LASHOF:  I want to thank the panel

     5    very much.  I think this morning has been very


     6    productive, very useful to all of us.

     7                We'll stand adjourned for lunch.  We will

     8    meet promptly at 1:45, and we will hear from the


     9    public open comments.

    10                Thank you.

    11                (Whereupon, at 12:30 p.m., the meeting was

    12    recessed for lunch, to reconvene at 1:45 p.m., the


    13    same day.)


                                                                        128

     1                      AFTERNOON SESSION


     2                                            (1:48 p.m.)

     3                CHAIR LASHOF:  I'd like to call the

     4    session to order.

     5                This afternoon we have a series of people


     6    who have requested to present comments for us.  Let me

     7    give the ground rules.  Because there are so many

     8    people who want to present, we probably will run a


     9    little over.  We have some additions to the original

    10    list, and I think they're posted on the board out

    11    there or is there a new list already?

    12                Okay.  Each person has been allotted only


    13    five minutes.  That is the only way we can get through

    14    the time.  The presenter will have five minutes to

    15    present, and then the panel will have an opportunity


    16    to question the presenter.

    17                I will indicate at the end of three

    18    minutes.  When the presenter has two minutes left,

    19    I'll up two fingers, and I will cut them off at the


    20    end of five, but then we'll have time for the panel to

    21    ask questions.

    22                If the presenter goes over, then it makes


    23    it impossible for the panel to ask questions, and I

    24    think that's important that we be able to do that.

    25                So if our first speaker will come forward.


                                                                        129

     1                MR. HOBBS:  My name is George Hobbs.  I


     2    was with the 736th Supply and Service Battalion as the

     3    battalion nuclear, biological, and chemical

     4    noncommissioned officer or as I will refer to my job

     5    as the NBC NCO.


     6                In 1985 I completed the NBC officer and

     7    NCO defense course, and in 1986 DMOS-54 qualifying

     8    course.  I will also offer my DD-214 discharge and


     9    other papers about my background so the committee can

    10    see where I'm coming from.

    11                My unit was stationed at King Klied

    12    Military City in Saudi Arabia.  My unit was


    13    approximately five miles west of the city, one mile

    14    east of the Saudi Engineer Building, and the airport

    15    was about one mile south of our unit.


    16                My testimony is about my experience at

    17    KKMC.  I wish to make it very clear that I do believe

    18    that numerous vets are ill and that they are hurting. 

    19    However, I do not believe that the majority of the


    20    cases are from the effects of chemical weapons.

    21                In the packet I submitted, there is a

    22    letter from the Assistant Commandant of the NBC School


    23    in Alabama and states his findings over there in KKMC;

    24    also some newspaper clippings about findings between

    25    the nerve agent pill and the insect spray.


                                                                        130

     1                I would like to first address the nerve


     2    agent pill.  When the war was over and I had to turn

     3    in the nerve agent pills to a medical unit outside of

     4    KKMC, I asked the sergeant in charge of the medical

     5    unit what was going to happen to the pills.  He told


     6    me that the pills were not FDA approved and that they

     7    were going back to Germany with his unit, and also in

     8    the packet I have in there a public affairs brief from


     9    the Department of Defense where the Department of

    10    Defense said that the pills were FDA approved.  When

    11    we turned them in, we were told they were not FDA

    12    approved.


    13                I also know of two units, the 249th and

    14    the 209th, that took the pills like they were

    15    aspirins, even though we were told to keep the pills


    16    under strict control, and they were not to be used at

    17    any time unless word came down from higher

    18    headquarters.

    19                Second, I would like to address the


    20    chemical question.  First, if the chemicals were used

    21    at KKMC, there would have been reports from the

    22    medical units about people with chemical symptoms. 


    23    There were none.

    24                Secondly, I was in constant contact with

    25    our higher headquarters.  There was not even a rumor


                                                                        131

     1    or a whisper of chemical use.


     2                We had our chemical -- we had our MA

     3    alarms out.  They never registered.  We also had the

     4    M-256 kits out, which would detect chemicals.  None of

     5    them ever registered.


     6                At this time I wish to address the VA.  I

     7    also have problems with my hands, my feet, and my

     8    knee.  I was -- took the physical.  I was told at the


     9    end of the physical if I had any complaints to come

    10    back and get another physical; came back, got another

    11    physical.

    12                My hands were numb.  They set me up and


    13    told me I had to wait four months.  I have in the

    14    meantime gone and seen a specialist.  He has got me on

    15    two drugs.  I spend thousands of dollars of my own


    16    money, and I'm only temporarily what you would call

    17    healed because I can function pretty good as long as

    18    I stay on the pills.

    19                I wish to address the VA. In the packet


    20    that I handed in, you will find out the VA doctor

    21    turned me down even though a specialist said, yes, I

    22    have problems, and in the packet the VA doctor says he


    23    doesn't even understand why I'm seeing a doctor.

    24                I also turned in a statement about my knee

    25    from a specialist who said that while being in Desert


                                                                        132

     1    Storm my knee was irritated.  I spent two weeks


     2    visiting the hospital in Saudi Arabia, and once more

     3    the VA doctor says why was I seeing a specialist for

     4    my knee.

     5                I was one of the lucky ones.  Even though


     6    I have some numbness that comes and goes and I'm

     7    spending my own money seeing a doctor twice a year,

     8    paying for my own medicine, at least I can function. 


     9    There are many vets out there who are not as lucky as

    10    I am, and I hope that this panel can find out what's

    11    wrong. 

    12                I would like to make one suggestion to


    13    this panel.  While you're looking into causes, please

    14    looking into the kerosene being used over there. 

    15    Kerosene was sprayed at least three times a day in


    16    front of our unit.  People in our unit, in my unit,

    17    that has had problems worked with kerosene.  I was one

    18    of them.  I ruined five pairs of gloves working with

    19    the kerosene, and from around about or by word of


    20    mouth, I was told that the kerosene was not a treated

    21    kerosene like we have over here.  So that might be

    22    something that this committee might want to look into.


    23                I would like to thank this committee for

    24    their listening to me.

    25                Thank you.


                                                                        133

     1                CHAIR LASHOF:  Thank you very much.


     2                Does the committee have questions?  We

     3    have five minutes for questioning.

     4                Andrea Kidd Taylor.

     5                MS. TAYLOR:  Mr. Hobbs, you mentioned the


     6    nerve pill that members were taking.  Was that

     7    something different than what we know already?  What

     8    were the contents of the nerve pill?  Do you have any


     9    idea?

    10                MR. HOBBS:  The nerve agent pill was a

    11    pre-treatment pill, and this was in case you were

    12    going to come under chemical attack.  You would take


    13    this hours before.

    14                MS. TAYLOR:  Okay.

    15                MR. HOBBS:  And what it would do, it would


    16    speed up your system to get the chemical rushing

    17    through.

    18                MS. TAYLOR:  That's the other question. 

    19    You mentioned kerosene.  Is this something that our


    20    government used, the kerosene that you mentioned that

    21    was used quite often?  This was something that our

    22    government provided to --


    23                MR. HOBBS:  No.

    24                MS. TAYLOR:  Okay.

    25                MR. HOBBS:  This was from the Saudi


                                                                        134

     1    government.  Where I was at KKMC, it got quite cold


     2    during the winter weeks, not months, but they had

     3    about six weeks of winter, and they would use kerosene

     4    heaters, and we had quite a bit of trouble with them,

     5    and troops even used the kerosene to put on their


     6    wooden floors to keep the dust down.  So it was used

     7    in the heating, in the roads, and to keep dust down in

     8    the tents.


     9                MS. TAYLOR:  And this was provided by the

    10    Saudi government?

    11                MR. HOBBS:  By the Saudi government, yes.

    12                MS. TAYLOR:  That's all.


    13                CHAIR LASHOF:  Mr. Rios.

    14                MR. RIOS:  You mentioned that they were

    15    taking these pills like what did you say, like?


    16                MR. HOBBS:  Like aspirins.

    17                MR. RIOS:  Why?  Were they concerned about

    18    something or why were they taking them?  I thought

    19    they were under order not to take them unless --


    20                MR. HOBBS:  They were, but like the one,

    21    you know, like I alleged, the 209th, I was told by

    22    their NBC NCO that they just started taking them when


    23    they got off the ship.  Why?  I don't know.  From my

    24    understanding, there's quite a few units that took

    25    them.


                                                                        135

     1                MR. RIOS:  They were scared or what?


     2                MR. HOBBS:  Scared.

     3                MS. NISHIMI:  Thank you, Mr. Hobbs, just,

     4    again, for staff making sure that we have all of this

     5    material.  Thank you.


     6                MR. HOBBS:  Thank you.

     7                CHAIR LASHOF:  Thank you very much.

     8                The next person is Teresa Huschart --


     9    Huschart.  I'm sorry.

    10                MS. HUSCHART:  I'm just going to lay that

    11    there.  That's part of my presentation.

    12                Good afternoon, ladies and gentlemen and


    13    distinguished members of the Advisory Committee.  My

    14    name is Teresa Huschart.  I'm from the Medenica Clinic

    15    and the Cancer Immunobiology Laboratory in Hilton


    16    Head, South Carolina.  I will be speaking for Dr.

    17    Medenica who was unable to attend today.

    18                Today I would like to speak to you about

    19    our experience and success with a veteran of the


    20    Persian Gulf War who was suffering from an auto-immune

    21    like disease.  Studies performed in collaboration with

    22    the Adolph Coors Clinic of Immunoregulation have


    23    determined that unexplained symptoms experienced by

    24    our patient are attributable to a disease that may

    25    fall in the group of multiple chemical sensitivity


                                                                        136

     1    syndrome, a chronic immunological disorder that


     2    develops from related exposure to chemicals.

     3                Our clinic has experience with patients

     4    who suffer from chemical sensitivity syndrome.  The

     5    difference between multiple chemical sensitivity


     6    syndrome and the disease from which the veterans of

     7    the Persian Gulf War suffer is that exposure to the

     8    two different types of agents are involved: chemicals


     9    and biologicals.  Although the exact source of the

    10    causative agent or agents has not yet been determined,

    11    the etiology of the syndrome can be explained.

    12                A toxin or toxins which have entered the


    13    body for some reason were not metabolized by the human

    14    detoxification in totality.  These may remain

    15    nonmetabolized ingredients.  While these chemical and


    16    biological molecules are too small to complete

    17    antigens by which the body would elicit immune

    18    response, these particles act as a heptane by

    19    combining with normal proteins, becoming antigenic and


    20    inducing the immune system to produce an immune

    21    antibody.

    22                The combination of heptane and the


    23    patient's proteins form autoantibodies which circulate

    24    within the blood stream.  These are deposited in the

    25    organs, including those of the central nervous system,


                                                                        137

     1    producing a wide variety of symptoms depending on the


     2    tissue localization of the heptane or immune complex. 

     3    This activity initiates an autoimmune phenomenon.

     4                The signs and symptoms manifested depend

     5    on the location of the tissue injury and may mimic


     6    known diseases.  In our experience with this type of

     7    disease from which the veterans are suffering, in

     8    multiple chemical sensitivity syndrome we have seen


     9    Parkinson-like syndromes, porphyria-like syndromes,

    10    multiple skin allergies, rashes, gastrointestinal

    11    symptoms, pulmonary problems out of the 12 patients

    12    that we have studied.


    13                Laboratory findings in these patients

    14    include increased levels of interferon inhibitor

    15    factor, low serum interferon levels, low T helper


    16    lymphocytes, and low suppressor lymphocytes, lower

    17    natural killer cells, and reduced macrophage activity.

    18                Tissue culture of blood and bone marrow

    19    demonstrate an autoimmune phenomenon which indicates


    20    an autoimmune problem.

    21                The source of the toxins can be from a

    22    chemical origin, a biological origin, or from a


    23    combination of chemical and biological sources.  We

    24    have identified crystalline structures in a muscle

    25    biopsy from our patient who fought in the Persian Gulf


                                                                        138

     1    War.  Although not enough of the muscle was received


     2    to definitely identify the crystals, the presence of

     3    the structures in the muscle tissue demonstrate the

     4    toxins are present.

     5                The toxins from biological sources act as


     6    a type of viral disease eventually leading to chronic

     7    fatigue syndrome which the patients have been

     8    suffering from.  The important point to remember is


     9    that no matter the source of the disease as chemical,

    10    biological, or both, an autoimmune response is

    11    elicited by the body and which produces antibodies

    12    that act against our own proteins in our organs.


    13                We can combat this problem in one of two

    14    ways.  The first is with the development of a

    15    monoclonal antibody against this agent which started


    16    the activity in the body.  Since we do not yet

    17    understand the source of the toxin, a monoclonal

    18    antibody would be difficult to develop.

    19                The second way to combat the problem is by


    20    removing the circulating toxins with plasmapheresis. 

    21    We are currently using plasmapheresis in immunological

    22    therapy as the treatment of choice for this disease. 


    23    Various poisons, drugs, and toxins can be removed by

    24    plasma exchange.

    25                Due to restriction of molecular size or


                                                                        139

     1    the protein binding, it is impossible for certain


     2    toxins to cross the dialysis membrane.  So in these

     3    situations plasma exchange has been proven to be

     4    lifesaving by removing these toxins.

     5                The process of plasmapheresis removes the


     6    circulating immune complexes, the combination of

     7    heptane, protein, and autoantibodies, and the

     8    interferon inhibitor factor which works against the


     9    natural function of the patient's immune system and

    10    circulating toxins.  When plasmapheresis is combined

    11    with immunomodulation, the abnormalities of the

    12    circulating cells of the immune system, such as the


    13    circulating lymphocytes, the natural killer cells, and

    14    the macrophages, can be reversed.

    15                The macrophage activity results in the


    16    reduction of chemotaxism and metabolism of

    17    phagocytized antigens.  This approach to combatting

    18    the autoimmune disease experienced by multiple

    19    chemical sensitivity patients and by our Persian Gulf


    20    War patient has been an effective treatment with

    21    minimal side effects.

    22                The constituents removed from the plasma


    23    can be analyzed to determine any common factors

    24    present in patients, possibly leading to the knowledge

    25    of common exposures among the Persian Gulf War.  When


                                                                        140

     1    the causative agent can be removed and is known, it


     2    can be quantitated.  Then the quality available in the

     3    plasma for exchange can be calculated from the

     4    concentration multiplied by the patient's volume.

     5                Samples could be pre- and post-drawn and


     6    can provide information about the percentage of drop

     7    in the plasma factor.  Samples taken from the bags of

     8    the plasma can provide information about the total


     9    quantity of the factor removed.

    10                Our study showed strong results in 12

    11    patients suffering from multiple chemical sensitivity

    12    who were treated with plasmapheresis and


    13    immunomodulatory therapy.  Plasmapheresis was

    14    performed two consecutive days every four weeks for

    15    four cycles.  An immunomodulatory regime, including


    16    interferon, interleuken, and other cytokines, was

    17    given for three consecutive days in conjunction with

    18    plasmapheresis protocol to increase the immune

    19    competent cells.  Four patients demonstrated complete


    20    response, two showed partial response, and two

    21    patients showed progression of their disease.

    22                Levels of the toxins were reduced


    23    dramatically in six patients.  Serum interferon levels

    24    were normalized in eight patients.  The T helper cells

    25    increased in nine patients.  T suppressor levels


                                                                        141

     1    remained stable, and the natural killer cells


     2    increased in ten patients.

     3                With our Persian Gulf War patient, similar

     4    results have been noticed.  Our patient received 19

     5    course of plasmapheresis treatments with


     6    immunomodulatory therapy over a period of one year. 

     7    We have found that the disease has not progressed, and

     8    our patient seems to be improving.


     9                We believe that combination of

    10    plasmapheresis treatments and immunomodulatory therapy

    11    is a successful approach to combatting the illness of

    12    the unexplained Persian Gulf War veterans.


    13                Additionally, a study of the plasma

    14    removed from these patients during treatment can serve

    15    as an indicator of the origin of the symptoms


    16    experienced by these veterans.

    17                Thank you.

    18                CHAIR LASHOF:  Thank you very much.

    19                Questions from the panel?


    20                MS. LARSON:  You're saying that you're

    21    treating 12 patients with this syndrome from the Gulf

    22    War?


    23                MS. HUSCHART:  No, we have -- what I'm

    24    saying is that we have correlated.  We have patients

    25    that we treated with multiple chemical sensitivity


                                                                        142

     1    syndrome, which are patients that are similar to the


     2    category of what this one patient --

     3                MS. LARSON:  Right, and how many were Gulf

     4    War veterans?

     5                MS. HUSCHART:  One.


     6                MS. LARSON:  Of the 12?

     7                MS. HUSCHART:  No, it was a different --

     8    if you want to say a total of 13 then.  It was one


     9    Gulf War and then --

    10                MS. LARSON:  Okay, all right.  How were

    11    the patients referred to your clinic?

    12                MS. HUSCHART:  Usually by other patient


    13    referrals or physicians.  The physician that I work

    14    with had worked over in Europe for a while.  So

    15    there's a large population that comes over from there,


    16    as well.

    17                MS. LARSON:  Okay, and in the other 12,

    18    you have multiple causes or you think there are

    19    multiple causes?


    20                MS. HUSCHART:  That's correct.  We were

    21    measuring their serum samples and sending them out to

    22    referral laboratories to check for certain chemicals


    23    that they had possibly been exposed to.  Some of the

    24    levels were elevated; some of them weren't, but they

    25    were grouped in a category because they had very


                                                                        143

     1    similar type of symptomatology that they were


     2    experiencing.

     3                MS. LARSON:  Thank you.

     4                CHAIR LASHOF:  Anyone else?

     5                I'd like to ask you, the clinic, the


     6    Medenica Clinic and Cancer Immunobiology Laboratory,

     7    is this specific for the treatment of medical --

     8    chemical, multiple chemical sensitivities, or is it a


     9    general medical clinic that does this as well?

    10                MS. HUSCHART:  We are basically an

    11    immunology and cancer clinic, and so we see patients

    12    that have cancer and other related disease processes.


    13                CHAIR LASHOF:  Any others?

    14                Dr. Baldeschwieler.

    15                DR. BALDESCHWIELER:  You mentioned the


    16    observation of crystals in musculature.  Can you

    17    describe those in more detail?

    18                MS. HUSCHART:  Yes.  I had two slides, but

    19    I was afraid with the lighting of the cameras that


    20    they wouldn't show up.  Our patient had, I believe, a

    21    muscle biopsy at Walter Reed Hospital, and they did

    22    send us a sample, and so we were able to get that in


    23    liquid tissue culture and take some pictures of that,

    24    and unfortunately there was not enough of the sample

    25    to actually find out what the crystal is.


                                                                        144

     1                We did send it off to Yale University, and


     2    it came back inconclusive.  Basically it's a striated

     3    muscle that has some crystalline formation on it.

     4                DR. BALDESCHWIELER:  But can you describe

     5    the crystal?  What does it look like?


     6                MS. HUSCHART:  No.  I mean it's unknown at

     7    this time.

     8                DR. BALDESCHWIELER:  No, no, but can you


     9    see the shape of the crystal?

    10                MS. HUSCHART:  Yeah.  You can't --

    11                DR. BALDESCHWIELER:  Is it colored or is

    12    it clear?


    13                MS. HUSCHART:  It's clear.

    14                CHAIR LASHOF:  Could you submit the

    15    pictures to us?


    16                MS. HUSCHART:  Yes.

    17                CHAIR LASHOF:  All right.

    18                MS. HUSCHART:  Actually in the folder that

    19    I have for the committee, there's pictures in there,


    20    I believe.

    21                CHAIR LASHOF:  Okay.  We'll ask staff to

    22    get that.


    23                Any other questions?

    24                Thank you very much.

    25                MS. HUSCHART:  Thank you very much.


                                                                        145

     1                CHAIR LASHOF:  Nancy and Barry Kapplan. 


     2    I'm not sure.  Both will be presenting.  Please come

     3    forward.

     4                MR. KAPPLAN:  Dr. Lashof, distinguished

     5    committee members, thank you very much for allowing my


     6    wife and I opportunity to present today.  

     7                We would never be able to present

     8    everything.  We have provided a written copy of our


     9    testimony.

    10                My name is Barry Stewart Kapplan.  I'm a

    11    major in the United States Army, retired.  I just

    12    recently retired from the active duty, and one of the


    13    things I'd like to talk to you about is the fact that

    14    my wife, my children, and I are part of no ongoing

    15    litigation.  Also we're not a member, official member,


    16    of any Persian Gulf War illness group.  We're just a

    17    soldier and his family helping other soldiers and

    18    their families that are dealing with some very bizarre

    19    things.


    20                But most importantly, I still retain

    21    command responsibility for the guys that worked for me

    22    during the war who are also sick, members part of the


    23    93rd 227th Aviation Support Battalion of the Third

    24    Armored Division.

    25                Now, it's important to understand that for


                                                                        146

     1    15 years I had perfectly clear blue, 52 flight


     2    physicals, not a thing wrong, ostensibly documented

     3    cardiac, esophageal, Class 1 and Class 2 flight

     4    physicals.  Then in April when I was stationed in

     5    northern Kuwait and southern Iraq around the Soff One


     6    Area, we all became mysteriously ill.  We didn't know

     7    what was happening.

     8                We assumed that it was some sort of


     9    problem with the climatization to 120-plus degree

    10    weather.  Then in approximately about the 8th of May

    11    and when I was leading a convoy back down to KKMC, I

    12    became violently ill with a nausea, vomiting, and


    13    diarrhea attack.  I was admitted to the KKMC Saudi

    14    Arabian military hospital, and I was an in-patient

    15    there for approximately four days.


    16                Since then it has been absolute insanity.

    17                MRS. KAPPLAN:  I would like to speak to

    18    you a little bit about the problems that occurred when

    19    my husband came home.  He came home with numerous


    20    symptoms which are annotated in the documentation that

    21    we've given you.  Some of the more memorable ones were

    22    his bleeding gums, his shortness of breath, his


    23    cardiac arrhythmias which caused him to be

    24    hospitalized right after he came home to rule out a

    25    heart attack.


                                                                        147

     1                At that time, they did rule out a heart


     2    attack, and he had some esophageal studies done.  He

     3    was diagnosed with esophageal dismotility and went on

     4    medication for that.

     5                In December he was hospitalized for a GI


     6    bleed, and he was medivaced to Walter Reed where he

     7    spent three months.  At that time they did an

     8    extensive work-up, which showed lymphadenopathy, an


     9    enlarged liver, an enlarged spleen, elevated liver

    10    function tests, just numerous abnormalities of which

    11    they could not provide a clear-cut medical diagnosis.

    12                They did go ahead and repair his


    13    esophageal sphincter which had a zero sphincter

    14    pressure, put him on medication for his blood

    15    pressure, and sent him on to his next duty assignment.


    16                They have continued to follow him and

    17    identify positive Q fever titres and other issues

    18    outside of the context of the comprehensive clinical

    19    evaluation program.


    20                During the time frame immediately after

    21    him coming home, I had a 16 month old daughter when he

    22    deployed, 22 months old when he came home, who


    23    developed gangrene, necrotizing fascitis, and toxic

    24    shock syndrome.  She has continued to have problems

    25    over the last few years.  She is six years old and


                                                                        148

     1    weighs 36 pounds.  She has had a couple of endoscopies


     2    and colonoscopies which document findings very similar

     3    to what my husband has:  esophagitis, gastritis,

     4    chronic nonspecific inflammation in the colon.

     5                When we were moved here to Fort Meade


     6    where he retired from to participate in the

     7    comprehensive clinical evaluation program at the

     8    recommendation of the infectious disease doctors at


     9    Walter Reed, I entered into the program for an

    10    enlarged spleen and some other problems that I had had

    11    off and on over a period of a couple of years.

    12                At that time they diagnosed


    13    lymphadenopathy, a polygamopathy, an elevated

    14    sedimentation rate, a granuloma in my lung, just

    15    numerous things, abnormal bone marrow, for which at


    16    this time I have no medical diagnosis.  I have no idea

    17    what the causative agents are for my family's

    18    problems.

    19                The other thing that was very interesting


    20    was after the onset of the air war, but prior to the

    21    ground war, while we were in Germany, his bags came

    22    home, and at that time they were soiled.  They were


    23    wet.  They arrived very quickly.  The children helped

    24    me handle them, take them downstairs, wash them. 

    25    Within three weeks of his clothing coming home, we


                                                                        149

     1    were diagnosed with asthma, three of us out of five,


     2    which was I thought kind of bizarre.

     3                We have had continued hospitalizations and

     4    issues that we have not been able to have addressed to

     5    our satisfaction.  I don't expect that they are going


     6    to be able to give us a common diagnosis, but I did

     7    expect a very comprehensive and objective evaluation.

     8                These problems are occurring to veterans


     9    throughout the country, and we do have some

    10    recommendations to make to hopefully make things

    11    better.

    12                MR. KAPPLAN:  In summing up, this really


    13    is a financial issue because this is destroying

    14    American families.  You can't get medical insurance,

    15    can't get life insurance, can't get supplemental


    16    medical insurance for an unknown disease.  Immediately

    17    the insurance companies say, "Uninsurable.  Thank you

    18    very much.  Here's your premium back."

    19                Thank you.


    20                CHAIR LASHOF:  Thank you very much.

    21                Are there questions from the panel?

    22                MS. TAYLOR:  Mr. Kapplan, while you were


    23    stationed in Kuwait, did you notice, other than the

    24    extreme heat, were there any other abnormal

    25    environmental conditions to speak of, say, airborne


                                                                        150

     1    exposures from contaminants or anything of that sort


     2    that you recognized?

     3                MR. KAPPLAN:  Within the 7th Corps and 3rd

     4    Armored Division area during that time period, we were

     5    basically southern Iraq, northern Kuwait, which was


     6    the entire gambit of oil -- we had two major oil

     7    fields that were still ablaze during that time period. 

     8    So environmentally we had that problem.  We had crust


     9    of the desert that wasn't kicked up since biblical

    10    times we were told.  So, you know, you have a lot of

    11    track vehicles in an armored division that are tearing

    12    up the neighborhood.  So there's all kinds of


    13    environmental things that were present during that

    14    time period, yes, and animals devoid of insects, dead

    15    animals.  Excuse me.


    16                It was the whole gamut, and that's all

    17    presented in the written.

    18                CHAIR LASHOF:  Mr. Rios.

    19                MR. RIOS:  Mr. Kapplan, are you a disabled


    20    veteran right now?  Do you have a disability?

    21                MR. KAPPLAN:  I'm going underneath a C&P

    22    evaluation, compensation and pension evaluation, with


    23    the VA at this time.

    24                MR. RIOS:  So you have no determination at

    25    this point?


                                                                        151

     1                MR. KAPPLAN:  No.  I'm in the middle of


     2    the evaluation process.

     3                MR. RIOS:  And what do you think you were

     4    exposed to or do you have any suspicions?  What's your

     5    theory?


     6                MR. KAPPLAN:  If somebody was going to do

     7    everything, I was there.  I really couldn't say.  I

     8    went through bunkers.  I went through T-72 and T-50


     9    and 60 series tanks as we were clearing the areas on

    10    our last battlefields of the 7th Corps and 3rd Armored

    11    Division.  I couldn't say, but whatever it was, it was

    12    low level.  It was a very insidious sort of onset.


    13                CHAIR LASHOF:  Any other questions?

    14                Sorry.  Ms. Larson.

    15                MS. LARSON:  You said you were aware of


    16    other veterans with similar symptoms and syndromes. 

    17                MR. KAPPLAN:  Yes.

    18                MS. LARSON:  Do you have a sense among

    19    those people that you know how many would you say?


    20                MR. KAPPLAN:  Well, within our brigade

    21    there are approximately 5,500 to 6,000 folks,

    22    depending on attachments on a particular day.  I was


    23    the log ops. officer, and I was responsible for taking

    24    care of those folks.

    25                Of my support operation cell, the guys,


                                                                        152

     1    the E-8s, the master sergeants, the guys that worked


     2    for me, of those eight folks, two are medically

     3    retired, one's still on active duty, two retired, and

     4    all of them are in the CCEP.

     5                CHAIR LASHOF:  Yes, Dr. Baldeschwieler.


     6                DR. BALDESCHWIELER:  I wanted to just

     7    confirm that I heard correctly.  Did you say that you

     8    had a Q fever titre?  


     9                MR. KAPPLAN:  That's affirmative.  I'm one

    10    of those one or two that has a positive Q fever from

    11    USAMRID, the Mayo Clinic, and has been reported to the

    12    CDC.


    13                CHAIR LASHOF:  Thank you very much.

    14                MR. KAPPLAN:  Thank you.

    15                CHAIR LASHOF:  We appreciate your coming


    16    forward.

    17                CHAIR LASHOF:  Mr. Steve Robertson.

    18                MR. ROBERTSON:  My name is Steve

    19    Robertson.  I'm the Legislative Director for the


    20    American Legion and an ill Persian Gulf veteran.

    21                Thank you for this opportunity for the

    22    American Legion to participate in the first meeting of


    23    this independent, unbiased committee assembled by the

    24    President.

    25                Since its inception, the American Legion


                                                                        153

     1    has actively worked on behalf of veterans and their


     2    families.  When Persian Gulf veterans initially turned

     3    to the government with their health care problems,

     4    they ran smack dab into the bureaucratic wall of rules

     5    and regulations that turned them away.  They next


     6    turned to the veterans' advocate groups like the

     7    American Legion.

     8                Today the First Lady talked about the


     9    heart wrenching stories that she and the President

    10    have heard from the Persian Gulf veterans and their

    11    families.  I can tell you that the American Legion has

    12    heard the same cries for help.


    13                I can also tell you of the thousands of

    14    phone calls that I have received from ill Persian Gulf

    15    veterans, not one asking me, "How do I get


    16    compensated?"  Every one asked me, "How do I get

    17    well?"

    18                That is why the American Legion has

    19    lobbied Congress for programs and benefits to address


    20    the needs of these veterans and their families. 

    21    Congress has responded truly in a bipartisan nature,

    22    but neither Congress nor the President can legislate


    23    a diagnosis or a cure.

    24                The American Legion greatly appreciates

    25    the dedicated health care professionals who generally


                                                                        154

     1    are concerned about this issue and are working


     2    aggressively trying to identify, treat, and cure the

     3    medical problems of Persian Gulf veterans and their

     4    families.

     5                The American Legion understands the deep


     6    frustration that everyone involved in this issue is

     7    experiencing.  This is not an issue of money.  It's

     8    not an issue of politics.  It's not an issue of right


     9    or wrong.  It is an issue of healthy young men and

    10    women who went to war and are now sick.

    11                These veterans honestly believe that their

    12    medical condition is a result of their service in the


    13    Persian Gulf.  The government says, "Prove that your

    14    medical problems are a result of your service."  The

    15    veterans reply, "Prove that the medical problems are


    16    not as a result of our service."

    17                This is the same dialogue that went on

    18    between the government and atomic veterans and Agent

    19    Orange veterans and other veterans that have been


    20    exposed to environmental hazards.  The simple fact is

    21    that if these symptoms existed prior to deployment,

    22    none of these veterans would have gone to the Persian


    23    Gulf.  In fact, many of them have been discharged

    24    because of these conditions.

    25                To be declared deployable for


                                                                        155

     1    mobilization, you not only have to be healthy


     2    physically.  You have to be physically fit, and you

     3    also have to be emotionally stable.  Military

     4    personnel must pass physical fitness training tests. 

     5    They also are randomly tested for drug use and are


     6    also under the personal reliability program.

     7                What is significant is all the impact that

     8    happened to them while they were in the Persian Gulf,


     9    everything from the inoculations and the medications

    10    to the oil well fires, to living in unsanitary

    11    conditions, to the possibility of biological and

    12    chemical warfare; exposed to the burning landfills,


    13    and the possibility of depleted uranium.  These are

    14    just a few of the problems.

    15                The American Legion entrusts that this


    16    committee will do a few things:  validate that

    17    credible research is being conducted; insist that

    18    statistical data compares apples to apples, not some

    19    diluted, irrelevant population.  The American Legion


    20    would like to see the data compare Persian Gulf

    21    veterans to Persian Gulf era veterans, the ones that

    22    did not go over to the Persian Gulf.  Compare things


    23    like the death rate, the rate of cancers, the birth

    24    rate, miscarriages, medical discharges, administrative

    25    discharges, denial of reenlistment due to various


                                                                        156

     1    medical problems.


     2                We also hope that any evidence, whether

     3    it's classified or unclassified, that might be an

     4    explanation to the medical condition be revealed. 

     5                We need further research on the


     6    inoculations and medications that were administered. 

     7    We would also like to see research on the oil well

     8    fires and particularly focusing on the chemicals that


     9    are used in the oil lines by chemical companies in the

    10    oil field work.  The studies that DOD did were six

    11    months after the fires were started.

    12                We also think that further research needs


    13    to be done on the chemical and biological capabilities

    14    of Iraq.  A good start would be obtaining a list of

    15    all agents that the United Nations inspection team


    16    have identified, especially the ones that are missing,

    17    and it is also important to determine the DOD's

    18    capability to detect and protect us against those

    19    agents.


    20                Thank you for volunteering to accept this

    21    tremendous challenge.  The American Legion is prepared

    22    to help this committee in any way possible.  Please


    23    remember through this entire process Gulf War veterans

    24    are seeking nothing more than the truth, the whole

    25    truth, and nothing but the truth.  These veterans


                                                                        157

     1    answered the nation's call to arms.  Now it's the


     2    nation's turn to answer our call for help.

     3                I ask that you read my entire testimony

     4    which has been submitted to you.

     5                Thank you very much.


     6                CHAIR LASHOF:  Thank you very much.

     7                Are there any questions?  Mr. Rios.

     8                MR. RIOS:  Has the American Legion taken


     9    a formal position as to whether or not it agrees with

    10    the government that there was no exposure to chemical

    11    war agents?  And do you have any documentation to

    12    support your position?


    13                MR. ROBERTSON:  Absolutely not. The

    14    American Legion still believes that there is viable

    15    evidence that we were exposed to possible chemical and


    16    biological agents.  We have submitted in our testimony

    17    the sources that we think that you should review that

    18    includes Senator Reigle's reports that were submitted

    19    and other data.


    20                CHAIR LASHOF:  Thank you.

    21                Other questions?  Dr. Hamburg.

    22                DR. HAMBURG:  You made a passing reference


    23    to the U.N. technical team in Iraq.  Would you expand

    24    a bit more what you had in mind about what you'd like

    25    us to get from them?


                                                                        158

     1                MR. ROBERTSON:  Well, yes, sir.  First of


     2    all, they're doing an inspection to make sure that the

     3    chemical and biological agents are accounted for, and

     4    one thing that has recently come out in the media is

     5    that there is a large quantity of missing biological


     6    agents.  It would seem to me that if we're running

     7    into a brick wall and we can't figure out what's the

     8    problem that it might be a pretty logical thing to


     9    find out what's missing and try to identify it and see

    10    if that's the things we're looking for, and to this

    11    date no one has provided any kind of list that I've

    12    seen of the biological and chemical capabilities, and


    13    especially what's missing.

    14                CHAIR LASHOF:  Any other questions?

    15                MR. ROBERTSON:  May I just make one other


    16    observation --

    17                CHAIR LASHOF:  Yes.

    18                MR. ROBERTSON:  -- on a question that

    19    asked earlier about outreach?


    20                CHAIR LASHOF:  Yes.

    21                MR. ROBERTSON:  The American Legion has

    22    been doing its part to try to encourage veterans to


    23    come forward, and we are constantly contacted by

    24    active duty people that say, "I am afraid to come

    25    forward because of jeopardizing my career," but the


                                                                        159

     1    comment that was made by the Department of Defense


     2    where they said, "Well, we think we're doing a pretty

     3    good job," I think they're doing a damned good job

     4    being the DOD from the start of this thing that said

     5    there were no active duty people that were sick and


     6    now their registry has over 26,000 names on it.  I

     7    think they're doing a pretty good job of outreach with

     8    those that have come forward.


     9                The same thing with the VA registry.  It

    10    is well documented that there's over 40,000 names on

    11    that list.  So I think the outreach is working.

    12                What we need is the evidence that's going


    13    to encourage the troops that are not coming forward to

    14    step forward and say, "I think I may be able to be

    15    part of the solution."


    16                CHAIR LASHOF:  Do you have suggestions of

    17    what it is that makes them fearful to come forward

    18    since so many have come?  What's worrying them and

    19    what can we do to convince them that it's safe to come


    20    forward?

    21                MR. ROBERTSON:  I think Major Kapplan made

    22    a very good statement to me at lunch.  He said that


    23    his salary went from a major's salary to where he's

    24    eligible for most substance assistance programs as a

    25    retired major.  Once you lose your job security, you


                                                                        160

     1    think about what happens when a guy gets discharged. 


     2    He loses his house.  He loses health care for himself

     3    and his family, and he loses half of his salary the

     4    day that he is retired, or if he's discharged without

     5    retirement, he loses all of his salary, as well as the


     6    rest of those things.

     7                Now, he's got to go out and look for a

     8    job.  When they ask him, "What's your health


     9    condition?" what's he going to put on the application? 

    10    When insurance companies ask, "What's your medical

    11    condition?" you're out there.

    12                Now, to me that's pretty scary, and


    13    fortunately I work for an organization that's going to

    14    see this thing through thick and thin, and I have some

    15    job security.  So I can be an advocate for this issue.


    16                CHAIR LASHOF:  Thank you very much.

    17                MR. ROBERTSON:  Thank you.

    18                CHAIR LASHOF:  The Reverend Doctor Barry

    19    Walker.


    20                REV. WALKER:  I want to thank you very

    21    much for this opportunity to be here, the opportunity

    22    to speak to you and this unbiased panel.


    23                My name is Reverend Doctor Barry M.

    24    Walker.  I'm also chaplain, a lieutenant colonel, in

    25    the United States Army and now Reserves.  I want to


                                                                        161

     1    thank you for the opportunity to testify for the


     2    veterans of Desert Shield and Desert Storm.

     3                I am a disabled veteran of the Vietnam

     4    era, as well as the Gulf War era.  I first entered the

     5    service in the Army in January of 1964, spent time on


     6    active duty from 1966 through 1970, the era of Vietnam

     7    and all of its related things.  I was mobilized with

     8    my Reserve unit in September of 1990 with the 475th


     9    Quartermaster Unit, Petroleum.  We are responsible for

    10    theater bulk fuel and water that was handled for all

    11    services.

    12                As a chaplain, and as the senior chaplain


    13    of 475th, I supervise four unit ministry teams which

    14    include chaplains and we needed several more because

    15    we were so large, in both Saudi Arabia and ultimately


    16    in Iraq and in Kuwait.  We had some 4,700-plus troops

    17    under our command, which is made up of active duty,

    18    active Army units, now activated Army Reserves and

    19    National Guard.


    20                I myself was very healthy.  I did have a

    21    slight blood pressure problem before I went over.  I

    22    had no health problems during the first few months


    23    that I was there.  On January 16th, I received the

    24    first of two shots which was not told exactly what

    25    they were.  I'm an inquiring person, and I went and


                                                                        162

     1    did a lot of investigation and found out.


     2                A lot of them do not have the records of

     3    their shots.  I have my record right here and my

     4    assistant's record with me to show the records of A-1

     5    and A-2.  We were not told what A-1 and A-2 were.  We


     6    assumed after a period of time that A-1 was anthrax,

     7    and that's what we were finally told.

     8                We were also told the purpose of this show


     9    was to protect us from the anthrax that possibly was

    10    there.

    11                Also, in January, after the first Scud

    12    attack was launched, we were exactly told and ordered


    13    -- not exactly told, but ordered -- to take the

    14    pyridostigmine pills, though they were not told

    15    exactly what they were for either, and even sometimes


    16    you had to inquire to find out what the names were. 

    17    All we were told about these pills was they were to

    18    protect us against chemical and biological weapons. 

    19    We were told to take the pills, given no choice.  Some


    20    troops were stood there and they watched them take

    21    them.  Other troops took them privately.

    22                I later learned that they were


    23    pyridostigmine, and I took my full dose of what I

    24    needed, quote, unquote, to the Army there.  To my

    25    knowledge, none of my 4,700 troops except for the


                                                                        163

     1    commander and the headquarters were given any real


     2    information as to the risk of that drug and its

     3    vaccines that were there.  We were not shown anything

     4    in writing or told anything other than they were given

     5    to protect us.


     6                Our chemical officer was asked to find out

     7    more about the pills.  She shared the information with

     8    the group commander and some of the staff members and


     9    other commanders.  She said the pills were of no

    10    problem.  

    11                The fact that they were given the vaccine

    12    in the drugs is not recorded in my official Army


    13    medical record, nor in most of my units.  I'm a

    14    stubborn one.  I had my yellow card and forced my

    15    assistants to take it, and that's why we had it


    16    recorded, and that took some persistence to get it

    17    done.

    18                I was a lieutenant colonel.  The one

    19    giving the things was a lieutenant, and I was a


    20    chaplain, and it took some effect, and we finally got

    21    it recorded, and those other troops of mine who came

    22    over with the yellow shot books got it recorded even


    23    though I had to fight for each one of them.

    24                Our names were put on a list.  The list,

    25    we have no idea what happened to it.


                                                                        164

     1                A few of my people did get diarrhea from


     2    the vaccines, but there was no major problems, as

     3    such, at that time.  After the pills were distributed,

     4    more people got serious diarrhea, and they stopped

     5    taking the pills.  Even those who were not sick


     6    stopped taking the pills because of the effects they

     7    had on our fellow soldiers in combat.

     8                Since the pills were taken in privacy in


     9    my particular unit, it was thus possible to not take

    10    them and not know about it.  The fact that the people

    11    got sick from taking the pills was not recorded in

    12    their medical records.


    13                I remember thinking that the vaccine, the

    14    pills I was taking were causing me problems, although

    15    I stopped taking the pills when I saw they seemed to


    16    have a great effect on other people.  However, around

    17    this same time, which is around January after the air

    18    war started, I began to have major problems with

    19    respiratory and allergy problems, as I was told by the


    20    medics that's what they were.  I didn't pay much

    21    attention because I didn't really have time to get

    22    sick.  I had a job to do.  I was an officer, and I


    23    kept going.

    24                I started having problems with my back

    25    after the February 25th of '91 Scud attack upon the


                                                                        165

     1    475th Quartermaster group, and one of my down-link


     2    units, the 14th of Greensburg, PA.  It was probably

     3    from moving bodies, lifting debris, and so on, after

     4    we were blow up.

     5                The attack was horrible.  Soldiers were


     6    killed.  Limbs were lost.  One soldier's head was

     7    partially blown off, and I had to grab one of my

     8    soldiers who had carried her out and just hold him


     9    because he literally went wild, and I can't blame him,

    10    and afterwards my back injury was considerably bad.

    11                I did go to the 85th Medivac Hospital for

    12    treatment, and there I was told -- I told them I had


    13    been moving bodies and cots and we put the bodies

    14    sometimes on the cots to help get them out of the

    15    warehouse where the Scud had hit, and they wrote it


    16    down it was because of my moving cots on the line of

    17    duty.

    18                I also with the Scud attack lost some

    19    hearing and have a ringing constantly in my ears.


    20                We left the Persian Gulf at the end of

    21    May.  I was discharged again the 19th of June 1991. 

    22    I was so happy to get home I wasn't worried about


    23    anything being wrong with me.  I did go down as a

    24    walk-in to the VA hospital in Pittsburgh on June 18th,

    25    1991 because of the pain and injury to my back of


                                                                        166

     1    which I needed something to do.


     2                It wasn't until later that summer when I

     3    went to the Pittsburgh-Oakland VA for further

     4    treatment that I realized that something else was

     5    wrong.  The VA doctor had arranged for an EMG, a CAT


     6    scan, MRI, myelogram, and so on, to try to find out

     7    just what was wrong.

     8                With the EMG they found out that the


     9    nerves from my waist down were not what they should

    10    be, and my right leg was worse than my left.  I now

    11    have problems, including when I came up the stairs to

    12    come in here.  My right leg dragged and I fell down


    13    and a couple of people came running, but I still have

    14    that problem.

    15                Because of my symptoms, I was also checked


    16    for alcohol abuse.  I have a case of beer which I

    17    brought summer a year ago still in my refrigerator,

    18    which is maybe half there, and most of it drunk by my

    19    kids when they came in to visit.  So you can see how


    20    frequently I drink.

    21                I also was checked for diabetes and other

    22    causes, such as lead poisoning, but still nothing was


    23    found.  Now my symptoms include headaches, rashes,

    24    constant fatigue, loss of memory, sweating,

    25    respiratory, occasional urine in my blood.  I'm unable


                                                                        167

     1    to concentrate like I used to.  I have definite


     2    problems sleeping and night sweats like you wouldn't

     3    believe.  

     4                My mother came to visit about eight weeks

     5    ago.  She said she was doing some wash.  I said, "Mom,


     6    would you mind washing these pillows?  You know, do

     7    you have anything to put in?" as I gave her the

     8    pillows.  She said, "How come you have so much blood?" 


     9    Well, you cut yourselves sometimes when you're moving

    10    and hitting things, and you really don't even know

    11    what you're doing, and so I had blood on my pillows,

    12    not much, but more than most people would ever think


    13    about having.

    14                My symptoms also I have occasional blood

    15    in my urine.  I have been evaluated at a two-week


    16    study at the Washington, D.C. VA, and I'll tell you

    17    what.  That's probably the best thing that ever

    18    happened to me.  I was there because of an undiagnosed

    19    cardiac problem.  They know what's not wrong with me,


    20    but they don't know what's wrong with me.

    21                I am now taking l-e-v-o-d lepopa, which is

    22    for nerve damage, which they will not accept or deny


    23    is due to a nerve agent.  Pardon me?

    24                CHAIR LASHOF:  Time.  Can you finish up

    25    quickly for us?


                                                                        168

     1                REV. WALKER:  Okay.  I have dealt with


     2    over 300 veterans' families presumably in taking them

     3    to hospitals and such, taking personally 300 in and

     4    over 1,000 families.  My question is: how long do I

     5    have to live?


     6                I've already had two close calls with the

     7    heart.  This is a progressive disease.  The fear in

     8    the community, the problems such that when a friend of


     9    my daughter's husband at work's kids were infected and

    10    she said, "Dad, please don't kiss your grandchildren. 

    11    Please don't be around them too much."

    12                The fear is there.  It's in the community. 


    13    I spend about one to two days a week being treated at

    14    the VA hospital.

    15                CHAIR LASHOF:  We have your complete


    16    testimony, and I promise you we will read it

    17    thoroughly, but I'm afraid I must ask you to close.

    18                REV. WALKER:  Okay.

    19                CHAIR LASHOF:  I'll give you a couple more


    20    seconds.

    21                REV. WALKER:  A couple more seconds? 

    22    Okay.


    23                The American flag was fought for proudly,

    24    and this is the one that was put on graves of those

    25    who have died.  Our government may be putting them on


                                                                        169

     1    my grave and many others well ahead of time, not in


     2    vain, but the pride of those who survived and the

     3    epithet of those who fell and who are still falling.

     4                CHAIR LASHOF:  Thank you very much.

     5                REV. WALKER:  Thank you for the


     6    opportunity.

     7                CHAIR LASHOF:  We can take a few

     8    questions.  Any questions?


     9                (No response.)

    10                CHAIR LASHOF:  Thank you very much.

    11                Mr. Albert Donnay.

    12                MR. DONNAY:  Thank you, Dr. Lashof and


    13    panel.  I'm very pleased to be able to come and speak

    14    to you today.

    15                My name is Albert Donnay.  I have a


    16    background in environmental health engineering, a

    17    Master's degree from the School of Hygiene and Public

    18    Health at Johns Hopkins, and I've been a public health

    19    researcher for the last 15 years.  I work with a Dr.


    20    Grace Ziem, who sees patients with multiple chemical

    21    sensitivity disorders in her private practice and has

    22    seen several Persian Gulf veterans.


    23                We've been tracking the VA and DOD

    24    response to these Persian Gulf veterans' problems for

    25    the last two years.  We've written six reports of one


                                                                        170

     1    form or another and submitted five to you in July and


     2    the sixth you have in your packet today, and I'd ask

     3    you to please take it out.  It's entitled "Critique of

     4    the DOD's Comprehensive Clinical Evaluation Program

     5    for Gulf War Veterans," the report on their 10,200


     6    participants.

     7                Dr. Joseph said this morning that DOD will

     8    eave no stone unturned, and I'm here to try to turn


     9    over a few stones.  Dr. Joseph told Congress, as has

    10    been reported in the first three reports about the

    11    CCEP -- he told Congress this is March -- that 84

    12    percent of patients have a clear diagnosis or


    13    diagnoses which explain their condition.  Then he

    14    said, quote, about 16 percent of patients with

    15    completed evaluations have ill-defined symptoms that


    16    are also commonly seen in civilian medical practice. 

    17    That was a theme he reiterated again today.  The first

    18    slide he showed you in his presentation, which was in

    19    the handout, listed the primary diagnostic categories


    20    for the conditions they've identified.

    21                Our major criticism of this effort and

    22    this public information is that it focuses completely


    23    arbitrarily on the primary diagnosis of these

    24    patients. As the DOD and the VA are the first to

    25    admit, they have multiple overlapping illnesses and


                                                                        171

     1    symptoms.  To focus on only the primary diagnosis is


     2    to miss all of their other diagnoses, and these

     3    patients have many diagnoses.

     4                In response to our criticisms -- I hope it

     5    was in response to our criticisms -- in this third


     6    report they have for the first time given the overall

     7    frequency of these diagnostic categories.  However,

     8    that's not in the handout.  It wasn't in the slide. 


     9    It hasn't been in any of the materials presented to

    10    the press, but as I show on the cover of our report,

    11    it's on page 14 of the CCEP report.

    12                In their table there on the frequency


    13    distribution of the diagnoses, they include a second

    14    column showing the diagnoses, what they call "any

    15    diagnosis," meaning secondary, third, fourth, fifth,


    16    sixth, et cetera, and they show that contrary to their

    17    claim that only now 17 percent have ill-defined

    18    conditions, the actual number is 41 percent.

    19                As well, they've made a major focus of


    20    their public information on the fact that 19 percent

    21    have psychological conditions as their primary

    22    category, and they suggested that most of the


    23    illnesses may be due to stress or PTSD or some

    24    combination of factors.

    25                In actuality, that figure is 37 percent


                                                                        172

     1    overall, and third behind ill-defined conditions and


     2    musculoskeletal.

     3                The other issue I want to point out to you

     4    has to do with the quality of the data in this

     5    database.  They did not tell you that they are only


     6    collecting in their database the primary diagnoses and

     7    the next six.  They're not paying the contractor to

     8    keypunch any more than that, and the keypunchers will


     9    tell you if you call them up, which is how I found

    10    out, that, indeed, many people have more than seven

    11    diagnoses, and the rest are simply cut off.  They're

    12    not being entered into the database, and they can't be


    13    evaluated.  As we learned in public health school and

    14    I think the rules haven't changed, if you're trying to

    15    identify an ill-defined syndrome, you must look at the


    16    totality of the symptoms and the diagnoses.

    17                They speak of finding no pattern of

    18    illness in these patients.  There is no analysis in

    19    the first, second, or third report of the pattern of


    20    illness.  All they present are the frequency

    21    distributions of each individual symptom and each

    22    individual diagnosis.  


    23                We don't know what the pattern is. 

    24    They're not telling us what the pattern is.  Do they

    25    have Symptoms A, B, and C or D, E, and F or X, Y, and


                                                                        173

     1    Z?  And how do those combinations compare to the


     2    civilian population?  

     3                They did include civilian population

     4    controls in their slide you saw this morning.  We

     5    suggest as you did that there could be better control


     6    groups.  The CDC had a better control when they

     7    published their study of the group in Pennsylvania,

     8    and that data is not in the CCEP report.  They focus


     9    on the civilian data.

    10                In the back of our report on page 5, we

    11    include the CDC comparison in our comparison Table No.

    12    2 to show you that when you do look at nondeployed


    13    Persian Gulf veterans, their rates of reporting these

    14    symptoms, fatigue, joint pains, headache, and sleep

    15    disturbances, are one quarter to one half as great as


    16    those that they allege are seen in the civilian

    17    population.

    18                They had this data.  They're not

    19    presenting it.  I think it's being swept under the rug


    20    and for the obvious reason that if 41 percent of these

    21    people have ill-defined conditions, this is a much

    22    bigger problem than they have admitted to date.


    23                And lastly, I want to address the quality

    24    control.  There's a large problem with ICD codes to

    25    diagnose medical conditions.  There are a great many


                                                                        174

     1    options available to a physician today -- notice these


     2    particular symptoms -- and there's been no guidance

     3    from the DOD or the VA to help physicians use a

     4    standardized set of codes for the standard symptoms

     5    they're seeing.


     6                And there's also a dilution factor of

     7    including the healthy patients.  In no study of a

     8    syndrome would you include healthy patients.  They


     9    came into the CCEP and the VA registry for other

    10    reasons, but they shouldn't be included in these

    11    percent distributions.  As is shown in our table, as

    12    well, they say that 11 percent had a primary diagnosis


    13    of healthy.  Well, 19 percent have an overall

    14    diagnosis of healthy.  How can you have 19 percent who

    15    are healthy in any diagnostic category, first, second,


    16    or third, and 11 percent who are healthy in just their

    17    primary?  It's either 11 or 19, but either way, it's

    18    a major dilution of their overall statistics.

    19                CHAIR LASHOF:  I'm afraid your time has


    20    expired.

    21                MR. DONNAY:  Thank you.

    22                CHAIR LASHOF:  And we do have your full


    23    document, and I assure you it will be reviewed.

    24                Are there questions that the panel wishes

    25    to address to Mr. Donnay?


                                                                        175

     1                Dr. Baldeschwieler.


     2                DR. BALDESCHWIELER:  Let me just ask on

     3    the basis of your analysis is there any interesting or

     4    potentially suggestive pattern?

     5                MR. DONNAY:  We have not been given and


     6    they will not release any data on the pattern. 

     7    There's nothing in their reports about the pattern. 

     8    They only give the individual frequency of each


     9    symptom, and there's no information on which symptoms

    10    are occurring together, and that is what you would

    11    need to define the syndrome, and that is simply not

    12    being analyzed or presented.


    13                I would have not received my degree if I

    14    submitted a report like this, I'm afraid.

    15                CHAIR LASHOF:  Dr. Landrigan.


    16                DR. LANDRIGAN:  You mentioned the

    17    possibility the DOD might offer guidance to physicians

    18    on how to properly diagnose folks through ICD.  Would

    19    you elaborate on that?


    20                MR. DONNAY:  We've urged them to do that. 

    21    Dr. Ziem and other independent physicians met at a

    22    meeting arranged by several Congressmen last year with


    23    high level officials from both the CCEP and the VA

    24    registry programs, and we urged them to work with us

    25    to make some information available that would


                                                                        176

     1    standardize the way these symptoms were being


     2    reported.  They never got back to us.  

     3                They had a three-day meeting in Baltimore

     4    on the VA side to inform their designated Persian Gulf

     5    physicians how to handle these things, but the DOD has


     6    done no similar effort that we're aware of, and the

     7    worst thing is the coding.  I mean we don't have all

     8    the data.  It stops at primary plus six, and these


     9    patients have many more diagnoses than that, and they

    10    have a specific instruction from the DOD to code

    11    undiagnosed conditions last.  So if anything is going

    12    to get cut off at the end of a list, it's most likely


    13    to be those undiagnosed conditions, and that they have

    14    given an instruction for.  That's to be coded 799.9.

    15                CHAIR LASHOF:  Ms. Larson.


    16                MS. LARSON:  I apologize.  I'm not

    17    familiar with MCS referral and resources.  Could you

    18    just tell us a little bit about it, who funds it and

    19    what your mission is, in addition to the -- it's not


    20    just the Gulf War?

    21                MR. DONNAY:  No, it's not just the Gulf

    22    War veterans.  The organization was founded by myself


    23    and Dr. Ziem to address three areas of need in the MCS

    24    community, multiple chemical sensitivity.  We felt a

    25    need to provide professional outreach to physicians


                                                                        177

     1    and other health care professionals who deal with MCS


     2    patients and who are not aware of current research on

     3    MCS.  So we distribute a lot of peer reviewed

     4    literature to them, and we did that also for the DOD

     5    and the VA.


     6                The second need is patient support.  The

     7    organization distributes Dr. Ziem's patient literature

     8    to hundreds of patients who don't even get to go on


     9    her waiting list.  She sees patients from around the

    10    country.

    11                And the third area, public advocacy,

    12    addresses issues of quality of science in MCS


    13    research, and that is my main concern.  I've been such

    14    a watchdog of this effort.  I see so many glaring

    15    problems with the quality of the science.  I can't


    16    even call it "science."

    17                We keep badgering them to do better.  The

    18    oversight committee specifically charged with this

    19    responsibility, which you'll hear from tomorrow, what


    20    they call the small committee, issued a first report

    21    after just two of its members had been briefed by the

    22    DOD.  It said nothing about these problems.


    23                Three reports have been issued since. 

    24    These problems continue in the reports, and the

    25    oversight committee is apparently having no impact on


                                                                        178

     1    correcting them, but they and all of these other


     2    committees have received all of our reports to date. 

     3    We've never even received an acknowledgement of any of

     4    our reports.

     5                CHAIR LASHOF:  Yes.


     6                MS. TAYLOR:  I had one question about the

     7    patients that you've seen.  How many have actually

     8    been Gulf War veterans or is there a number?  And what


     9    symptoms are you seeing?  Are you seeing similar

    10    symptoms?

    11                MR. DONNAY:  Dr. Ziem has seen less than

    12    a dozen, and the reason she's stopped seeing more is


    13    that two thirds of those were diagnosed as having

    14    active  mycoplasma incognitos infection, and given

    15    that that condition is not yet necessarily treatable


    16    or curable, she feels it's too great a risk to bring

    17    those patients into her office to exposure herself and

    18    other patients to that mycoplasma.

    19                I don't know if you will receive reports


    20    today about that or not, but these patients were

    21    tested by Dr. Nicholson in Texas as part of his

    22    current research program into mycoplasma incognitos. 


    23    We think that there's a variety of problems in these

    24    patients, not just MCS, but MCS is a critical symptom,

    25    and it's a symptom that's not being tracked.  It's


                                                                        179

     1    simply not being coded.


     2                You mentioned our funding, Dr. Larson, and

     3    I should say that we have very little funding.  I'm

     4    unpaid.  We have an office manager who's paid by funds

     5    we've raised from our research fees and our


     6    publications.  We are a nonprofit organization, but

     7    without any substantial funding of any kind.

     8                CHAIR LASHOF:  Thank you very much, Mr.


     9    Donnay.

    10                MR. DONNAY:  Thank you.

    11                CHAIR LASHOF:  Gina Whitcomb.

    12                MS. WHITCOMB:  Good afternoon.  My name is


    13    Gina Whitcomb.  I'm a Public Affairs Officer for the

    14    Desert Storm Justice Foundation.  We are a charitable

    15    organization formed to help the Gulf War veterans.


    16                There are tens of thousands of those

    17    veterans that deployed that are now battling for the

    18    proper and adequate health care that they need to

    19    resolve their serious health issues, and that's what


    20    I'm here to address today because Secretary Brown

    21    announced many good programs that are begin trying to

    22    be put out there, and it's not happening.  It's not


    23    happening in Oklahoma City where I'm from.  It's not

    24    happening in a lot of hospitals as I talk to veterans

    25    all over the nation.


                                                                        180

     1                I have brought today and attached a sample


     2    of our database that we have established from

     3    testimonies that we have received from these veterans. 

     4    As a definitive insight regarding comprehensive Gulf

     5    War health issues, these reports are anonymous due to


     6    our membership, spanning all services from the lowest

     7    ranks to the highest ranking officers, both active

     8    duty and the Reserve components.


     9                A brief review of this data reveals that

    10    these reports are coming from all over the nation,

    11    from small towns to large cities.  This indicates the

    12    seriousness that you just apply in your work on these


    13    issues as requested by the President of the United

    14    States.

    15                The enclosed evidence from the DSGF


    16    database outlines the following:  a symptom check

    17    list, when the veteran first realized the problem and

    18    on the scale of one to ten a severity of the problems

    19    at that time.  We find the severities are increasing


    20    as time goes by.

    21                It is interesting to note that many of the

    22    so-called undiagnosed illnesses correlate to the very


    23    symptoms most troubling to our veterans.  We

    24    recognized that very early in our data collection. 

    25    Yet it took the VA until late 1994 to recognize this


                                                                        181

     1    by crafting legislation known as the Veterans' Persian


     2    Gulf Benefits Act of 1994.

     3                Many service members still on active duty

     4    after the Gulf War are being diagnosed after reporting

     5    the same symptoms as many who are no longer on active


     6    duty.  We believe this is a way to remove those

     7    service members from active duty on an ongoing

     8    reduction in forces.  They are the lucky ones in that


     9    their service connected will be well documented.

    10                Those released from active duty soon after

    11    the war do not have that same luxury.  Many must now

    12    fight to obtain the bottles of aspirin being


    13    prescribed for migraine headaches or the Motrin which

    14    slightly eases the pain enough till our veterans use

    15    their arms to cover a crying baby.


    16                Again, this same group of people are

    17    reporting the same symptoms.  Yet only the veterans

    18    still on active duty are generally being diagnosed and

    19    for discharge.


    20                To assist in such problem solving, the

    21    Desert Storm Justice Foundation has formed a working

    22    group with the Oklahoma City VA Medical Center.  The


    23    members of that include the Chief of Staff, Chief of

    24    Ambulatory Care, the Persian Gulf Environmental

    25    Physician, the Persian Gulf Hospital Coordinator, and


                                                                        182

     1    the officers of DSJF.


     2                While this has been helpful in resolving

     3    small issues, we have determined that many major

     4    issues go completely unaddressed to the very poor

     5    communication at all levels of the VA.  Primarily the


     6    Chief of Staff and his colleagues lack knowledge of

     7    the comprehensive clinical evaluation protocol many

     8    months after its inception.  We had to take this


     9    information to them ourselves.

    10                We have further determined that many

    11    programs and issues are not being communicated and

    12    studies are not taking place or being disseminated. 


    13    Because the VA's Persian Gulf review newsletter is

    14    issued so sporadically, the information may not be

    15    accurate or timely, but that is no excuse for the lack


    16    of implementation of major programs mentioned in the

    17    Persian Gulf review.

    18                Ironically after recently going to great

    19    lengths to gather information on specific testing, we


    20    were told not to disclose this to our members.  A

    21    direct quote from Dr. D. Robert McCaffery, Chief of

    22    Staff, Oklahoma City VA Medical Center:  "so we don't


    23    have to test every Tom, Dick, and Harry."

    24                Other problems as evidenced over and over

    25    in the enclosed testimonies are lack of timely


                                                                        183

     1    scheduling of appointments, long waits to see doctors


     2    at scheduled appointments, apathy, and hurried

     3    examinations from doctors, lack of documenting

     4    symptoms in the patient's file, long waits for follow-

     5    up appointments.  I'm talking months.  I'm talking of


     6    one gentleman that waited eight months to have a

     7    follow-up to a cardiac problem that had had three

     8    abnormal EKGs.


     9                Misplacing of records and files

    10    continuously; lack of communications to patients

    11    regarding their results.  One example of receiving

    12    negligent health care through the VA is the case of a


    13    22 year old man, a former combat engineer, 82nd

    14    Airborne, now in a wheelchair.  He is unable to

    15    receive follow-up appointments at his local VA


    16    hospital until his medical file is returned from the

    17    Special Gulf Referral Center in California.  He

    18    returned there from May and still has not received

    19    results from the testing.


    20                After complaining over a year at the

    21    Oklahoma City VA Hospital to no avail about a bladder

    22    condition, he had to undergo bladder surgery at the


    23    Special Referral Center in Houston.  Upon returning

    24    from Houston to Oklahoma City, the doctor there

    25    questioned his wheelchair use and diagnosis from


                                                                        184

     1    Houston.  After he explained, the doctor said, "Oh,


     2    don't listen to those doctors in Houston.  They don't

     3    know what they're talking about."

     4                Another doctor, without even glancing at

     5    his medical file, told him he had tendinitis from


     6    over-use of his joints.  This, after having to walk

     7    with a cane for three years and in a wheelchair for

     8    almost a year.


     9                Although non-VA physicians have given him

    10    medical diagnosis, the VA hospitals continue to focus

    11    on depression and post-traumatic stress disorder. 

    12    What young man wouldn't suffer from depression over


    13    the loss of his health?  However, the depression is

    14    not the cause of his pain and illness.

    15                After his medical discharge, this young


    16    man whose IQ previously tested at 137 has had several

    17    psychological testings.  They reveal that his IQ is

    18    steadily dropping as his illness continues from 126 in

    19    1992 to 112 in 1994, to the present rating of 92. 


    20    From 137 to 92, that's a 67 percent drop.  This has

    21    been explained by a brain scan expert as neurotoxic

    22    damage.


    23                This is my son that I just explained. 

    24    This is his picture before, when he was tall and

    25    straight and healthy.  This is his picture now as he


                                                                        185

     1    sits in his wheelchair, as he walks short distances


     2    with his cane.

     3                The submitted testimonies tell the same

     4    story over and over from every corner of this country. 

     5    The priority health care veterans receive in VA


     6    hospitals would never be tolerated in the private

     7    sector.  The filth that has been reported to me in the

     8    patient's room in VA hospitals would never be


     9    tolerated in private sectors.  I have observed this

    10    first hand.

    11                Why are veterans, the very citizens who

    12    serve our nation in time of war, treated worse than


    13    second class citizens?  The time has arrived and the

    14    time is now to change this inequitable treatment.

    15                I thank you very much.


    16                CHAIR LASHOF:  Thank you.

    17                (Applause.)

    18                CHAIR LASHOF:  Open for questions from the

    19    panel.  Anyone?


    20                (No response.)

    21                CHAIR LASHOF:  Thank you very much.  We

    22    appreciate your --


    23                MS. WHITCOMB:  Okay.  I'd like to take

    24    this opportunity to invite the press and the panel to

    25    a reception following this in the Ohio Room that is


                                                                        186

     1    being sponsored by the Desert Storm Justice Foundation


     2    and the audience in whole.

     3                Thank you.

     4                CHAIR LASHOF:  Thank you.

     5                Captain Julia Dyckman.


     6                CAPT. DYCKMAN:  I'd like to exchange my

     7    time with Jim Tuite.  I will take his time at 4:30 if

     8    that is all right.


     9                CHAIR LASHOF:  Okay.  Jim Tuite; is that

    10    correct?

    11                MR. TUITE:  Yes, Madame Chairman.

    12                CHAIR LASHOF:  The 4:30 time.  Okay.


    13                MR. TUITE:  During the 103rd Congress, the

    14    Senate Banking Committee investigated U.S. export

    15    policies that contributed to Iraqi chemical,


    16    biological, and nuclear weapons development programs. 

    17    One aspect of the investigation focused on the health

    18    consequences of the Gulf War.  I directed that

    19    investigation.


    20                In September 1993, former Senator Donald

    21    Reigle reported the findings of the preliminary study

    22    on the Senate floor.  Shortly after the release of


    23    that report, the Department of Defense took the

    24    position that there were no confirmed detections of

    25    chemical or biological agents in theater, and that no


                                                                        187

     1    chemical or biological munitions were discovered south


     2    of the Euphrates River.

     3                Secretaries Perry, Brown, and Shalala

     4    assured the committee in writing on May 4th, 1994,

     5    that there was no classified information that would


     6    indicate any exposures to or detections of chemical or

     7    biological agents during the war.  This statement was

     8    expanded on May 25th, 1994, when Secretary Perry and


     9    General Shalikashvili wrote that there is no

    10    information classified or unclassified that indicates

    11    that chemical or biological agents were used in the

    12    Persian Gulf.


    13                CIA Director Deutsch has repeatedly said

    14    that there is no convincing evidence of widespread

    15    use.  


    16                While we may debate that there are some

    17    loopholes in these statements, clearly the message

    18    that they are selling is that there is no evidence

    19    that the troops were exposed, and this is absolutely


    20    false.

    21                The committee uncovered documentation that

    22    U.S. firms provided anthrax, clostridium, botulinum,


    23    and nearly all of the other pathogenic materials

    24    discovered in the Iraqi biological warfare program. 

    25    In February 1994, the committee briefed a Defense


                                                                        188

     1    Science Board task force on these findings.  Later it


     2    was learned that the task force director, Dr. Joshua

     3    Lederberg, according to corporate reports, was serving

     4    on the board of directors of one of the principal

     5    suppliers of these pathogens to Iraq.


     6                In some cases, these exports, all licensed

     7    by the U.S. Department of Commerce, were shipped

     8    directly to facilities believed to be involved in the


     9    Iraqi biological warfare program.

    10                In March 1994, the committee requested all

    11    classified and unclassified material related to

    12    possible chemical, biological, or radiological


    13    detections, exposures, or munitions.  The requested

    14    documents were never received by the committee, but

    15    through a series of confidential contacts throughout


    16    the military and intelligence communities, materials

    17    were received that confirmed that DOD was withholding

    18    substantial information.

    19                In January 1995, DOD released CENCOM logs


    20    that confirmed reports of chemical agent detections,

    21    but these log entries corroborate many of the

    22    incidents reported by the veterans.


    23                Other DOD documents confirm that Czech

    24    units reported multiple chemical agent detections

    25    using biochemical nerve agent alarms that detected


                                                                        189

     1    cholinesterase reactivity, and that these detections


     2    were confirmed using another biochemical

     3    cholinesterase reactive test and that the specific

     4    nerve agent was identified in a laboratory using a

     5    series of wet chemistry tests, technology unavailable


     6    to U.S. forces.  

     7                How these agents got there really doesn't

     8    matter.  Cholinesterase was being affected.


     9                Further, on January 23rd, 1991, the CENCOM

    10    logs show that a directive was issued to disregard any

    11    reports coming from the Czechs.  

    12                Marine Corps documents reveal the


    13    discovery of dusty mustard during the ground war. 

    14    Recently declassified documents reveal that Iraq used

    15    these types of chemicals in the Iran-Iraq war; that


    16    the U.S. protective over-garments under certain

    17    conditions are vulnerable to these agents; and that

    18    U.S. chemical agent detectors do not readily identify

    19    them.


    20                This, in my opinion, is information that

    21    should never have been declassified.  It gratuitously

    22    exposes a vulnerability of equipment still in use. 


    23    Other documents reveal that units repeatedly detected

    24    both nerve and blister agent in both the 1st and 2nd

    25    Marine Division area of operations.


                                                                        190

     1                The 1st Marine Division also reported the


     2    discovery of chemical weapons munitions bunker in an

     3    area designated as the 3rd Iraqi Armor Ammo Supply

     4    Point just outside of Kuwait City.  The bunker tested

     5    positive for mustard agent, using the GC mass


     6    spectrometer on the Fox vehicle.  The crates and

     7    munitions were marked with skulls and crossbones.

     8                Recently declassified documents confirm


     9    that Iraq marked their chemical weapons with skulls

    10    and crossbones. 

    11                The committee investigation and follow-on

    12    independent investigation confirmed that in several


    13    cases U.S. soldiers found munitions with skulls and

    14    crossbone markings; that these materials tested

    15    positive for chemical warfare agents with the GC mass


    16    spec. on the Fox vehicle; and that the soldiers who

    17    were present were injured or are now sick.

    18                On numerous occasions during the air and

    19    ground war, U.S. chemical specialists detected and


    20    confirmed chemical agents in the field.  They were

    21    told to run repeated tests until the results were

    22    negative, proper procedure to assure the passing of


    23    the threat, but the findings were recorded as a

    24    negative test.

    25                Official documents also confirmed that


                                                                        191

     1    anthrax was detected after a Scud attack, but these


     2    findings were also later discounted.  Prior to and

     3    during the war, U.S. commanders were warned of the

     4    impact of bombing of chemical weapons facilities and

     5    storage depots by the National Laboratories.  The


     6    commander of the Soviet Chemical Forces, French,

     7    Czech, and U.S. commanders publicly commented that

     8    there were traces of neurotoxins being detected as a


     9    result of the bombing of chemical agents facilities.

    10                The fact is, according to Army safety

    11    standards, the levels detectable by the sensors

    12    deployed are hundreds and even thousands of times


    13    higher than the levels believed to be safe in

    14    sustained or chronic exposures and require the use of

    15    protective equipment.  This is all confirmed in


    16    official documentation received directly from the

    17    United States government.

    18                DOD asserts that there are different

    19    illnesses with overlapping symptoms, whatever that


    20    means.  Further, they say that most have been

    21    diagnosed.  Yet the etiology of the diagnosis remains

    22    unknown in many of these cases.  Their own statistics


    23    reveal that 41 percent of the veterans still have

    24    undiagnosed symptoms, albeit with a primary diagnosis.

    25                Very few of these veterans have received


                                                                        192

     1    sophisticated toxicological, biological, and


     2    neurological tests necessary to identify the effects

     3    of these types of exposures, despite a striking

     4    similarity between the symptoms and the effects of

     5    these types of exposures as reported in much of the


     6    relevant medical literature.  

     7                Our veterans and their families have

     8    traveled here to describe their illnesses and relate


     9    their experiences.  Most, if not all, have traveled

    10    here at their own expenses.  You are the fifth

    11    independent panel that they have come to explain their

    12    problems to.  They have also come to Washington


    13    testify before Congress on several occasions.

    14                Two of the previous panels, the Defense

    15    Science Board Task Force and the Institute of Medicine


    16    study, both relied on individuals who were deeply

    17    involved in the defense and intelligence process to

    18    conduct a review of chemical and biological warfare

    19    related exposures, and the material they received was


    20    regulated by the Department of Defense.

    21                I have come here to tell you today

    22    publicly and with definite knowledge, our veterans and


    23    the U.S. Congress have been repeatedly lied to by the

    24    Department of Defense.  These veterans sit here before

    25    you today as if in a civil court where the government


                                                                        193

     1    is the defendant, the judge, the investigator and has


     2    hand-picked the jury.  Certainly if you have any doubt

     3    as to the nature and causes of their illness, you must

     4    recommend favorably on their behalf.

     5                I ask that the commission permit me to


     6    provide at a later date either in public or private a

     7    complete briefing related to the substance of this

     8    statement. 


     9                The full text of this statement and all

    10    supporting documentation is being submitted for

    11    inclusion in the record.

    12                CHAIR LASHOF:  Thank you very much.  I


    13    assure you we will be in touch, and we will review all

    14    of the documentation you've given us and we'll follow

    15    up to get additional documentation.


    16                MR. TUITE:  Thank you.

    17                CHAIR LASHOF:  Are there other questions

    18    that the panel wishes to address to Mr. Dyckman at

    19    this time.


    20                MR. TUITE:  I'm Tuite.

    21                CHAIR LASHOF:  Sorry.  Yeah, we switched.

    22                (No response.)


    23                MR. TUITE:  Thank you.

    24                CHAIR LASHOF:  If not, thank you very

    25    much.


                                                                        194

     1                The next person who was scheduled to


     2    speak, Wendy Wendler, is going to submit her

     3    testimony, but is not able to speak.

     4                MS. WENDLER:  I had ask that my time be

     5    given to the only active duty officer here today. 


     6    (Inaudible) refused to let me do that, but Captain

     7    Hamden is here and would like to take my (inaudible)

     8    and my statement if you will let him.


     9                CHAIR LASHOF:  Oh, very well.

    10                MS. WENDLER:  We would really appreciate

    11    it.

    12                CHAIR LASHOF:  All right.


    13                MS. WENDLER:  Thank you.

    14                CAPT. HAMDEN:  Good afternoon.  My name is

    15    Captain Charles Hamden, and I do hope that General


    16    Franks is feeling better.

    17                The Persian Gulf War was the largest

    18    opportunity for manufacturers of military hardware to

    19    showcase their latest models, and it was also an


    20    opportunity for the military medical community to try

    21    its new arsenal of preventive inoculations and

    22    chemical precursors.


    23                But unknown to those that were part of

    24    this experiment were the lasting side effects that we

    25    would suffer.  Steve Robertson, the Legislative


                                                                        195

     1    Director of the American Legion, said in an interview


     2    on public radio, along with Dr. Stephen Joseph, that

     3    he did not consider Gulf War vets to be used as guinea

     4    pigs.  The fact of the matter is that we were human

     5    guinea pigs.


     6                Four years after the war ended, the

     7    Department of Defense position searched for an answer

     8    for Gulf War Syndrome.  They have looked at sand


     9    fleas, oil well fires, environmental hazards, and

    10    others looking for a silver bullet.  All of these

    11    factors were present, but no one has begun to look at

    12    the vaccines as the cause of the maladies that


    13    veterans and their families suffer from.

    14                The comprehensive clinical evaluation

    15    program, a series of tests being administered for the


    16    cause of this illness, have been evaluated by civilian

    17    physicians as being superficial and limited.  It would

    18    seem that if you know what you're looking for, you

    19    would know what tests not to run, and with the


    20    scientific research being done by Drs. Garth and Nancy

    21    Nicholson, they wouldn't know where to look.

    22                The Nicholsons have isolated a


    23    microbacterium called mycoplasma incognitos.  That is

    24    communicable between humans and should be considered

    25    moderately infectious.  This finding contradicts the


                                                                        196

     1    Veterans' Administration's claim that there is no


     2    evidence of transmissibility.

     3                This mycoplasma is being spread among

     4    family members and causes clusters just like chronic

     5    fatigue syndrome.  Unfortunately, the antibiotic


     6    treatment that they recommend is only a treatment for

     7    as now there is no cure.  The question that the

     8    Department of Defense needs to answer is:  where did


     9    this mycoplasma come from and was it in vaccines?

    10                Dr. Chi Lowe of the Armed Forces Institute

    11    of Pathology has stated that this mycoplasma is also

    12    found in chronic fatigue syndrome patients and AIDS


    13    patients.  Dr. Lowe has gone on record to say that

    14    this mycoplasma could cause death on its own.  Based

    15    on Drs. Nicholson and Dr. Lowe's finding, we are


    16    suffering from a non-HIV autoimmune deficiency

    17    syndrome or non-HIV/AIDS.

    18                The government has claimed that no

    19    chemicals were used in the gulf.  That may be true to


    20    a certain extent, but they gave it to the soldiers via

    21    pyridostigmine bromide pills.  Senator Jay Rockefeller

    22    in the Senate Veterans' Affairs report dated December


    23    8, 1994, stated that pyridostigmine is a nerve agent

    24    itself and in conjunction with Deet pesticide makes

    25    the Deet seven times more toxic.


                                                                        197

     1                So it doesn't matter if the chemicals are


     2    deployed in the gulf, our leaders chemically altered

     3    the soldiers themselves.  

     4                The injections of anthrax and botulism

     5    that the soldiers received were given investigational


     6    status and were given to soldiers with no warning of

     7    possible side effects.  When I received my

     8    inoculations, I was told what the shot was, but did


     9    not receive any information concerning the vaccine,

    10    and it has not and will not be transcribed in my

    11    medical records.

    12                These vaccines have no history of human


    13    testing and were not FDA approved and should not have

    14    been used on soldiers.  By the Defense Department

    15    saying that they were necessary to protect the


    16    soldiers in case of exposure, it takes responsibility

    17    off those individuals that approved their use.  These

    18    bureaucrats made a decision based on so-called

    19    military intelligence from other officers, and now the


    20    soldiers they were protecting are suffering.

    21                Everyone is avoiding the fact that the

    22    vaccines were tainted.  During Operation Desert Storm,


    23    Pentagon officials had to supplement sources of

    24    vaccines with experimental drugs produced by the

    25    British and Japanese.  These companies are not


                                                                        198

     1    regulated by the FDA and are not subject to their


     2    convoluted approval guidelines.  Whether the vaccines

     3    are made in the United States or in other countries,

     4    the soldiers were guinea pigs, part of a sick

     5    experiment.


     6                Even the federal court system has thrown

     7    soldiers and their freedom against involuntary

     8    participation in medical experiments out.  In early


     9    1991, Public Citizen filed a federal suit, John and

    10    Jane Doe v. Secretaries Chaney and Sullivan, to block

    11    the government from using GIs as unwilling guinea pigs

    12    to experiment with, untested and unproven vaccines to


    13    allegedly protect the soldiers against certain bio

    14    warfare agents.

    15                Also the military has a record of using


    16    unapproved and delicensed vaccines on soldiers.  An

    17    example, as late as 1982, soldiers were still

    18    receiving adenoviruses vaccines delicensed by the FDA

    19    in 1963.


    20                My family as well as thousands of others

    21    are sick.  They are suffering mental, physical, and

    22    financial hardship while our leaders decide which lie


    23    to tell next.  Soldiers throughout the years have

    24    suffered at the hands of the governments, and when

    25    will it stop?  It is time for our leaders to take a


                                                                        199

     1    stand and tell the truth and support our veterans


     2    through actions, not rhetoric.

     3                CHAIR LASHOF:  Thank you very much.  You

     4    are -- 

     5                (Applause.)


     6                CHAIR LASHOF:  I would ask the audience to

     7    hold applause.  It only takes up our time.

     8                You're Captain Charles Hamden?


     9                CAPT. HAMDEN:  Yes, ma'am.

    10                CHAIR LASHOF:  Is that correct?  You were

    11    on the schedule for 4:20 this afternoon.  I don't know

    12    where the mix-up in information was.  So, Wendy


    13    Wendler, if you would like to testify this afternoon

    14    at 4:20 in Captain Hamden's spot, you may do so and

    15    we'll get both of you because we had both of you on


    16    the schedule.

    17                Are there questions for Captain Hamden?

    18                Dr. Baldeschwieler?

    19                DR. BALDESCHWIELER:  Can you tell me


    20    anything more about the mycoplasma incognitos?

    21                CAPT. HAMDEN:  The research that Drs.

    22    Garth and Nancy Nicholson have done, what they do is


    23    they do forensic PCR and gene tracking to go within

    24    the white blood cells, the leukocytes, to find the

    25    mycoplasma that has imbedded itself within the cell


                                                                        200

     1    structure and the nucleus.  So the Nicholsons have


     2    done extensive work with that.

     3                MS. TAYLOR:  Do they have any kind of

     4    scientific reports yet on what they've found?  They do

     5    have something?


     6                CAPT. HAMDEN:  They have preliminary

     7    reports out.  Dr. Garth Nicholson had spoken to

     8    officials of the VA and DOD a week ago last Friday


     9    about some of the work that he's doing.  Dr. Mather

    10    and Dr. Murphy were there.  They might be able to give

    11    you more information on his speech, and also Dr. Lowe

    12    was there.


    13                CHAIR LASHOF:  I'm sure we'll be able to

    14    get that information.

    15                Dr. Caplan.


    16                DR. CAPLAN:  Do you know if there are any

    17    samples of lots of the vaccines still in existence?

    18                CAPT. HAMDEN:  I'm not sure if there are

    19    anthrax and the botulism were gone.  We also received


    20    gamma globulin shots.  When the soldiers were

    21    preparing to go to Saudi Arabia the second time, they

    22    had run out of gamma globulin shots, but one thing


    23    that they also did with the soldiers going there, they

    24    gave doxycycline as a prophylactic measure, and they

    25    did not receive some of the shots.


                                                                        201

     1                Another thing that the problem is having,


     2    people that were prepared for deployment for Desert

     3    Storm received the shots but did not go.  They're also

     4    suffering the same maladies that the people who were

     5    in theater.


     6                CHAIR LASHOF:  Dr. Landrigan?

     7                DR. LANDRIGAN:  Captain, you said your

     8    vaccines were never recorded on your medical record


     9    and never would be.  What do you mean by that?

    10                CAPT. HAMDEN:  When we got our vaccines,

    11    we got our botulism vaccine approximately one month

    12    before the ground war started.  We got our anthrax


    13    injection February 23rd.  We signed our name on a

    14    yellow piece of legal paper, have never seen it in my

    15    medical records.  That piece of paper is probably


    16    sitting in the desert somewhere in Iraq right now for

    17    all I know.  They have never been recorded.

    18                The people that I've seen that were in my

    19    unit in the 101st Airborne Division, theirs have never


    20    been recorded either.

    21                CHAIR LASHOF:  Further questions?  Yes.

    22                MS. KNOX:  Just for the record, I would


    23    like to say that I received anthrax vaccine as well,

    24    and I wanted to see for myself whether or not it was

    25    in my medical record, and it is not recorded.


                                                                        202

     1                CHAIR LASHOF:  It is not.  Okay.  Thank


     2    you very, very much.

     3                CAPT. HAMDEN:  Thank you.

     4                CHAIR LASHOF:  We're just on time and

     5    ready for a break.  We will resume again promptly at


     6    3:30.

     7                (Whereupon, a short recess was taken.)

     8                CHAIR LASHOF:  Can I ask everyone to take


     9    their seats, including my committee?

    10                I think we'll resume.  Major Richard

    11    Haines.

    12                MAJ. HAINES:  I'm getting you a flier, my


    13    report to the White House.  I trust that you received

    14    this.

    15                My name is Richard Haines, President of


    16    Gulf Veterans International.  We became involved about

    17    three years ago when a lot of this started.  We were

    18    the first to amass national statistics on symptoms

    19    from different units, on different exposures, provided


    20    reports to the National Academy of Sciences that was

    21    shocked at the number and different types of

    22    exposures, and I'm going to talk a little bit about


    23    leaded fuels and the benzenes because some of the

    24    other toxics have been covered here so far.

    25                We finished a state-wide meeting in


                                                                        203

     1    Michigan this weekend.  So I got here a little late


     2    this morning, and when I was in Michigan, I was

     3    reminded of a great governor we had, George Romney,

     4    who made a little off-the-cuff remark on the way back

     5    from a flight from Vietnam that maybe we had been


     6    brainwashed, and it was just a little off-the-cuff

     7    thing.  He didn't think it would get out, and what

     8    happened was that remark, that idea was so colossal,


     9    so comprehensive, so significant, economically,

    10    politically, socially, and morally, that it was

    11    unthinkable that such a thing, such a colossal

    12    misrepresentation might have been made.


    13                And Kingston Smith, the veterans' counsel

    14    in the Senate, said to me, "Why would the government

    15    lie?  What reason would they have to do that?"


    16                So as this issue has continued and the

    17    letter we sent to the command, the 123rd ARCOM three

    18    years ago to explain how this illness seemed to fit

    19    one predominant illness, some might call it chronic


    20    fatigue syndrome, an immune dysfunction; some might

    21    call it multiple chemical sensitivity.  They just

    22    said, "Thank you, Major Haines."  So I decided if you


    23    want a battle, you've got the right man.

    24                So after three years and about $100,000 of

    25    my own time and effort, we collected about 1,000 hours


                                                                        204

     1    of interview information around the country, and the


     2    first thing we noticed was the multiple systems nature

     3    of this illness, a characteristic that was, in fact,

     4    noticed in the early 1950s when this multiple systems

     5    disorder was first observed, and there was a common


     6    theme in it, and it was when a person is reexposed to

     7    those incitants to which he has recently acquired

     8    sensitivities or allergies, that he would react.  His


     9    brain waves change.  Sometimes they have

    10    lightheadedness, sudden joint ache, face puffiness,

    11    restrictive airway.

    12                The recent unification conference that met


    13    in Dallas where they're in a treated room and made

    14    them keel over.  Four of them had to be taken to

    15    emergency.


    16                The Yellow Ribbon Committee that met two

    17    weeks ago here in Washington had some kind of pool

    18    chemical, I guess, that had been recently used, and

    19    they had a major problem.


    20                The single characteristic, the single

    21    distinguishing characteristic about this illness and

    22    with all these vets, and all you have to do is ask


    23    them and I hope you will talk to at least ten vets and

    24    take them through a quality symptoms check list

    25    because they've got brain damage, and the tests prove


                                                                        205

     1    that with spec. scans, to help them jiggle their


     2    memory about all their symptoms.

     3                It appeared on me on Channel 4 in Battle

     4    Creek on Friday.  Mike Lawrence, 57 symptoms, and what

     5    is VA getting him?  Motrin for 57 symptoms, and this


     6    is what's happening all over this country, and this is

     7    what these people are doing to these vets, and the

     8    spouses are almost as bad.


     9                And this report I just gave out to you

    10    spells out a linear progression and a logic as to how

    11    and why the spouses are sick, and I'll get back to

    12    that in a moment.


    13                I testified before the Science Board at

    14    the Pentagon with Josh Lederberg.  Dr. Lederberg said,

    15    "I think these allergies are imagined.  I don't think


    16    that these are real," because he's testified against

    17    chemical victims for years.  He's written articles. 

    18    He said, "I think they're just imagined."

    19                Well, I'd like you to explain to me how a


    20    group that can stand in front of 1,000 tanks at

    21    gunpoint are suddenly queasy and nervous about some

    22    few micro parts per million or billion of Pinesol or


    23    Clorox bleach or fragrances and all of the things that

    24    they have become reactive to, because different ones

    25    may react to different toxics, incitants as we call them.


                                                                        206

     1                But whenever you administer or ingest or


     2    expose them to the one that they are reactant to, they

     3    will have the same symptoms, and that's the constant

     4    in this illness, and that's the question to home in

     5    on.


     6                But those are the types of tests which are

     7    validated with sublingual types of tests, with

     8    pinprick tests, with blood tests using the ALCAT


     9    computer that can test chemical and food reactivity,

    10    tests that this group, VA and DOD, will not do, but

    11    which they have known about.  They could clinically

    12    validate it.  They won't do it.  They could have; they


    13    haven't.  All kinds of tests.

    14                Much of the tests that have been done, the

    15    diagnostics, all over this country have come from the


    16    private sector and groups that have pitched in and

    17    tried to help.  Dr. Ruth McGill and I, she's from San

    18    Angelo, Texas, multimillionaire, environmentally

    19    sensitive, retired disabled psychiatrist, did liver


    20    function tests.  Nineteen of the 21 were abnormal.

    21                CHAIR LASHOF:  I'm sorry.  You've gone

    22    over your time.  I will give you another 20 seconds to


    23    finish up.

    24                MAJ. HAINES: Okay.

    25                CHAIR LASHOF:  And we'll have your written


                                                                        207

     1    testimony.


     2                MAJ. HAINES: I was up at Walter Reed, and

     3    on his death bed was Victor Ramis, dying from

     4    pancreatic cancer, and he and his mother and I took a

     5    hair sample off him.  We had it tested, and he was


     6    loaded up with lead, and the military found a lot of

     7    lead in some of their autopsied soldiers.

     8                The 1173rd National Guard Unit from


     9    Michigan, transportation company, found lead in almost

    10    half of those tested of about 30, and maybe some of

    11    these people call it overlapping symptoms.  I call it

    12    medical murder.


    13                Over 4,000 have died, and you should

    14    demand to get the list of the 4,000 that have died

    15    looking not just at the cause of death, but the


    16    illness they had before the death because they are

    17    dying of bizarre cancers, the most bizarre cancers

    18    their doctors say they have ever seen in their medical

    19    career.


    20                So I encourage this committee to look at

    21    these things and dig into this and to understand

    22    multiple chemical sensitivity, to use good symptoms


    23    questionnaires and exposures questionnaires, and to

    24    understand this illness. 

    25                Thank you.


                                                                        208

     1                CHAIR LASHOF:  Thank you.


     2                Are there questions the panel has for

     3    Major Haines?

     4                (No response.)

     5                CHAIR LASHOF:  All right.  We'll move on


     6    to -- thank you very much -- Betty Zuspann.  Wait a

     7    minute.  There's a change.  Go for Veterans of the

     8    Carolinas.  Is there someone here to speak on behalf


     9    of the Go for Veterans of the Carolinas?  Thank you.

    10                MR. MORRIS:  Good afternoon.  My name is

    11    Travis Morris.

    12                I have more relevant issues than I have


    13    time.  So I'll get right to the most relevant one.  At

    14    Mountain Home VA Medical Center in Johnson City,

    15    Tennessee, they have identified a spore,


    16    microsporidia, that is usually only found with people

    17    who have extremely compromised immune systems.  They

    18    found this in every Persian Gulf veteran that they

    19    have tested.


    20                These spores have been found in stool,

    21    urine, in the skin rash itself, in sinus mucuses, eye

    22    mucuses, and sweat.  I'm passing around photographs


    23    that have been taken of slides of some of these

    24    veterans.  Some of those are from myself.

    25                We've been told that if microsporidia goes


                                                                        209

     1    untreated it can be fatal.  It has been successfully


     2    treated in Australia with Australian Persian Gulf

     3    veterans and by Dr. Hymen in Texas.  I don't have a

     4    lot of information on his treatments.

     5                There is some evidence that this could


     6    possibly be a biological weapon.  Based on the

     7    chemical logs that have been declassified from U.S.

     8    Central Command, NBC weapons were quite possibly used. 


     9    There's some evidence to that based on the

    10    declassified chemical log.

    11                 This is a pretty serious illness, and the

    12    VA has given a lot of resistance against recognizing


    13    it.  A man put his career on the line by giving me

    14    those photographs.

    15                I'd like to tell you here that by serving


    16    in the Persian Gulf -- excuse me -- I've lost a

    17    civilian career as well as a military career.  I've

    18    had a marriage fall apart.  My family may quite

    19    possibly be in danger.


    20                People gave their lives for this country

    21    and continue to do so.  We'd like to have a cure, not

    22    compensation and not sympathy, not pity, but be taken


    23    seriously and to be cured.

    24                Public statements have been made recently

    25    that there's no evidence to support that any illness


                                                                        210

     1    exists.  Forty thousand people on the VA registry with


     2    very similar symptoms who were healthy one year,

     3    returned from the Persian Gulf the next year and are

     4    sick seems to be quite a bit of evidence in and of

     5    itself to me, and this evidence, microsporidia, as


     6    well as some of the other evidence that people have

     7    presented here today I feel to be pretty compelling

     8    evidence.


     9                I urge you to look at that evidence, and

    10    I thank you for your time.

    11                CHAIR LASHOF:  Thank you.

    12                Questions for Mr. Morris?


    13                Ms. Larson.

    14                MS. LARSON:  You said your family was in

    15    danger.  Would you clarify if that's because of


    16    disease or what?

    17                MR. MORRIS:  Well, I said they possibly

    18    may be in danger.  I don't know what this is or what

    19    it may do, how I got it.  I know that I didn't have it


    20    when I went to the Persian Gulf and I've had these

    21    problems since I've come back.  There's no definite

    22    information on how contagious this could be or whether


    23    I could transfer this to another person by being in

    24    the room with them if they come in contact with

    25    equipment or clothing that I had in the Persian Gulf. 


                                                                        211

     1    So I'm frightened.


     2                DR. LANDRIGAN:  I don't want you to be a

     3    doctor about how this bug may get spread, but what did

     4    you do in the Persian Gulf?  Could you tell us what

     5    your --


     6                MR. MORRIS:  Well, I served with the

     7    Second Squadron, 17th Calvary, which is an aerial

     8    reconnaissance squadron, in the 101st Airborne


     9    Division.  We moved around through the theater.  I was

    10    an intelligence analyst myself.  I spent quite a bit

    11    of time in several areas in the Kuwaiti-Iraq theater.

    12                We came under some attacks.  We had


    13    chemical alarms go off.  We had tests that tested

    14    positive, repeated tests until they became negative as

    15    was already mentioned here.  We had been told


    16    previously that if you were hit with these chemical or

    17    biological weapons that people would immediately fall

    18    over and die.  That didn't happen.  So at the time we,

    19    you know, "rucked" up and did our job, which is what


    20    we were supposed to do.  It was a combat situation,

    21    and you don't have time to worry.  You just do what

    22    you've got to do.


    23                Looking back on it, I feel certain in my

    24    mind that those times that we were told they're false

    25    alarms, don't worry, move out; I feel certain in my


                                                                        212

     1    mind now that we were attached with chemical and


     2    biological weapons, and I think that the reason that

     3    we had testing that proved to be negative or positive

     4    -- sometimes tests made simultaneously rendered

     5    different results -- is that we're dealing with a


     6    binary agent that's both chemical and biological,

     7    which we have some intelligence information the Iraqis

     8    were working on, and that it was a new type of agent


     9    that our equipment did not test for.

    10                That's a layman's opinion, but as I said,

    11    I was an intelligence analyst, and I have some

    12    knowledge.  I'm by far not an expert.  I have some


    13    knowledge of Iraqi doctrine and weapon systems, and

    14    that's my opinion.

    15                MR. RIOS:  Are you a disabled veteran


    16    right now?

    17                MR. MORRIS:  I have filed a claim that I

    18    filed in November of 1993 with the VA.  It has been

    19    processed since November of 1993 with no results given


    20    to me.  I continually check on it.  The last thing

    21    that they told me was that they were waiting on

    22    medical records from the Army.  I informed them that


    23    they had those medical records in my file already. 

    24    After four months they admitted that, yes, they did,

    25    that there would be some delay, but they were


                                                                        213

     1    continuing to process my claim.


     2                At this point I have received no

     3    compensation, and I'm not listed as a disabled

     4    veteran. 

     5                MR. RIOS:  So it's still pending, in other


     6    words?

     7                MR. MORRIS:  That's correct.

     8                MR. RIOS:  And it's your position that


     9    from what you saw and experienced that there were some

    10    chemical war agents used against you by the Iraqi

    11    government.  Is that your testimony?

    12                MR. MORRIS:  That's my belief.


    13                MR. RIOS:  Pardon me?

    14                MR. MORRIS:  That's my belief, yes, sir.

    15                MS. TAYLOR:  I have a follow-up.  When the


    16    chemical alarms went off, were you ordered as well to

    17    take the pills, the pyridostigmine?

    18                MR. MORRIS:  We were ordered immediately

    19    after arriving in country.  We received several


    20    injections that we were told were anti-nerve agent,

    21    and we were immediately ordered to begin taking a

    22    series of pills.  I have no idea what those pills


    23    were, but we were observed by our medics and

    24    commanders.  We had to take them under observation,

    25    and we took them daily, one pill a day, for the entire


                                                                        214

     1    time I was deployed in the theater.


     2                MS. TAYLOR:  And when the alarms would go

     3    off, was there anything present that you were aware of

     4    or you were just told that there was nothing to be --

     5                MR. MORRIS:  We came under artillery fire. 


     6    We received fire from what's called a free rocket

     7    overground 7, which is a piece of Soviet equipment

     8    that the Iraqis have.  It landed within an assembly


     9    area.  So it didn't hit directly on the unit.  There

    10    were two explosions, one of them quite loud, one of

    11    them muffled.  The chemical alarms started going off

    12    immediately throughout the 101st Aviation Brigade


    13    area.  Everybody went to MOP 4.  Everybody began

    14    conducting tests.  Those test results were both

    15    positive and negative at the same time.


    16                We conducted tests for hours.  We

    17    redeployed out of the area.  We were beginning the

    18    decontamination process when we received word from

    19    higher command that this was a false alarm, that they


    20    had entered the area with the division assets to check

    21    for chemical presence and that there was none

    22    detected; that if we were getting negative results at


    23    our location at that time to unmask, to take off our

    24    MOP gear, and go about our business, which we did.

    25                MS. TAYLOR:  I just have one more


                                                                        215

     1    question.


     2                CHAIR LASHOF:  Yes, sure.

     3                MS. TAYLOR:  Are there others in your unit

     4    that you know of that have been affected or have

     5    similar symptoms to what you're having?


     6                MR. MORRIS:  I've only had contact with

     7    one person since I left the Army that was in the same

     8    unit as myself.  He is having some severe problems


     9    that are, again, undiagnosed.  They can't say it's

    10    this, it's that, but he's having a multitude of

    11    problems.

    12                I know of several people who were in the


    13    101st Airborne Division that I've come in contact with

    14    since, while they weren't in the same unit, were in

    15    the same general areas that I was in, and they report


    16    much the same symptoms that I have myself.

    17                CHAIR LASHOF:  Dr. Baldeschwieler.

    18                DR. BALDESCHWIELER:  Excuse me.  Is it

    19    your belief that the microsporidia was part of an


    20    Iraqi biological weapon or that that was an endemic?

    21                MR. MORRIS:  That's my belief.  My belief

    22    is that it was part of a weapon.  As far as the


    23    medical evidence, there is some evidence from a lab

    24    that I believe to be in Texas.  I got this information

    25    last night.  So I don't have it fully, but that they


                                                                        216

     1    had singled -- that in this microsporidia from


     2    equipment that had been brought back from the Persian

     3    Gulf that had single strand DNA rather than dual

     4    strand DNA, and that that was indicative of some kind

     5    of biological tampering.  I'm not a biologist, so I


     6    can't speak to that a whole lot.  I just know what

     7    little I read in the report.

     8                As far as the medical evidence goes, the


     9    microsporidia is there, and it's been there in every

    10    Persian Gulf veteran that they have tested at Mountain

    11    Home VA Center in Johnson City, Tennessee, and

    12    normally they only find it in and it's rare to find it


    13    in people such as AIDS patients or patients who have

    14    received severe chemotherapy.  In fact, that's how it

    15    was discovered.  The chief microbiologist realized he


    16    had these spores in a stool specimen, and he thought

    17    that he had uncovered somebody who had HIV, reported

    18    to that person that they likely had HIV, began testing

    19    him.  The man didn't have HIV.  They conducted some


    20    more tests, couldn't find anything that was wrong with

    21    his immune system, but he had this HIV, but he was

    22    also being processed for the Persian Gulf protocol. 


    23    So just out of curiosity they tested another veteran. 

    24    They continued to test Persian Gulf veterans as they

    25    got positive results on each one they tested, and


                                                                        217

     1    eventually issued a call to all Persian Gulf veterans


     2    to come in for testing that were being seen at

     3    Mountain Home, and every veteran that they've tested

     4    from the Persian Gulf at Mountain Home has shown

     5    positive for microsporidia.


     6                However, they have been told at Mountain

     7    Home not to call it microsporidia, to call it by a

     8    name of unidentified spore.  They keep separate logs


     9    in the microbiology department there because they feel

    10    like it's being negligent not to treat people.

    11                I don't know what all the treatments are. 

    12    I know that I've seen some reports that Australian


    13    gulf veterans have been treated with extensive therapy

    14    of some type of drug that clears this up, and I have

    15    heard that a doctor in Texas has had some success


    16    treating this with the same drug.

    17                You know, again, some of this is

    18    unsubstantiated.  You know, you hear things, and at

    19    this point we're trying to listen to everything that


    20    we can because, quite frankly, we're scared.

    21                CHAIR LASHOF:  Thank you very much.  I

    22    think we'll need to move on.


    23                MR. MORRIS:  Thank you.

    24                CHAIR LASHOF:  The next person is

    25    Christopher Brown.


                                                                        218

     1                MR. BROWN:  Good afternoon.  I want to


     2    thank the President and the members of this committee

     3    for your interest and attention.

     4                I'm a local attorney in the Glen Burnie

     5    area with a lot of contact with the Fort Meade


     6    military personnel.  A lot of what we've heard today

     7    has to do with the interest and concern for the

     8    soldiers.  Well, the interest also was to not leave


     9    any stone unturned, and I have another stone that I'd

    10    like to turn over here.

    11                The soldiers go to fight for their country

    12    and for their friends, but they also go to fight for


    13    their family, and much has been said today about the

    14    soldiers.  Very little has been said today about the

    15    families.


    16                Senator Rockefeller said that the soldiers

    17    take the risk.  They know what they sign up for. 

    18    That's part of the deal.  What's not part of the deal

    19    is what may happen to their families, to their


    20    children, to their spouses.

    21                The soldiers here were injected

    22    experimentally with anthrax and pyridostigmine


    23    bromide.  I, along with the office of Peter Angelos,

    24    represent 30 families that have seriously injured,

    25    disabled children by these experiments.  The drugs


                                                                        219

     1    were used even though they weren't sure of the


     2    effectiveness of the drugs.  They were used without

     3    knowing the long-term effects of them.  The soldiers

     4    were given them without the solders' knowledge or

     5    permission, very often against their will, and we know


     6    that the injections are not always recorded in the

     7    medical records.

     8                I happen to have a copy of an order that


     9    indicated from the Department of Defense that the

    10    anthrax vaccine was not to be recorded in the records

    11    until after the operation, after the theater was

    12    completed, and then it was supposed reannotated back


    13    into the records.  Of course, at that time most of the

    14    soldiers had gone and the records were separated from

    15    them, and it never got done.  So it does not surprise


    16    me to hear that it's just not present in their

    17    records.

    18                The profile of the average client that

    19    we're representing is essentially a healthy couple who


    20    may have had one or two or three healthy children. 

    21    Then they receive these experimental inoculations. 

    22    They fought.  Husband or wife fought overseas.  Some


    23    didn't go.  Some just received the inoculations and

    24    stayed here in the States.  It's a very critical

    25    issue, why we believe that a lot of what's happening


                                                                        220

     1    is from the inoculations and not from any exposure


     2    overseas.

     3                Then we have them coming back.  Then we

     4    have repeated miscarriages, not just one, not just

     5    two, but several miscarriages, unreported


     6    miscarriages.  I personally know that they are

     7    unreported because I tried to report them, and they

     8    would not accept any information of any children that


     9    were not then alive at the time in the VA registry.

    10                I tried to report a child that was one

    11    year old and had just previously died, and they would

    12    not accept the information.  I tried to report a


    13    miscarriage, and they would not accept the

    14    information.  I know that that is being under-

    15    accounted for.


    16                Then after the miscarriage, we have

    17    children born with disabilities, not only here, not

    18    only to our soldiers who fought over there, not only

    19    to our soldiers who stayed here and never went


    20    overseas, but to soldiers in Britain and other places

    21    around the world.

    22                And the disabilities are consistent. 


    23    They're a mirror imagine type of disabilities.  Most

    24    of these families have also had genetic testing done,

    25    which has proven that genetics was not the cause of


                                                                        221

     1    the defects to the children.


     2                The deformities to the children are

     3    startling.  They're very repetitive.  I'll show you

     4    several pictures here.  These involve facial

     5    deformities as well as body deformities.  These are


     6    four separate families, four separate people involved

     7    in receiving the inoculations.

     8                The deformities are bowel, rectum


     9    deformities, kidneys, either enlarged or missing,

    10    multiple ureters or missing ureters, bowel

    11    dysfunctions, diaphragmatic hernias, heart

    12    irregularities, shrunken esophaguses, and then


    13    continuing up the midline up into the facial

    14    deformities, as you see here one side of the face

    15    smaller than the other side, sometimes ears missing,


    16    sometimes jaw missing.  Call it Goldenhar Syndrome,

    17    whatever you want to call it.  It's the repetitive

    18    nature of the type of disabilities that we see in all

    19    these children, and we're hearing constantly from all


    20    the families not only just the physical deformities

    21    that are being operated on and that are being dealt

    22    with, but also immune problems, that the kids are not


    23    recovering well.  They're not receiving antibiotics

    24    well.  They're not snapping back as you would expect

    25    the kids to do.


                                                                        222

     1                My point in being here today is to


     2    indicate that what's missing from what you've heard so

     3    far is the study.  You've received some of the data of

     4    the 36,000 veterans registered, and you have 1,400

     5    showing birth defects.  What are they?  How bad are


     6    they?  Are they all Goldenhar type syndromes?  Are

     7    they all just midline type syndromes?

     8                These things are going unevaluated, are


     9    going missed.  So the point is please in your

    10    investigation while you're making recommendations,

    11    don't forget the children.  They can't wait 20 years. 

    12    It's got to be done now.


    13                CHAIR LASHOF:  Thank you very much.

    14                Questions for Mr. Brown?  Any questions?

    15                (No response.)


    16                CHAIR LASHOF:  No.  Thank you very much.

    17                MR. BROWN:  Thank you.

    18                CHAIR LASHOF:  Oh, I'm sorry.

    19                DR. LANDRIGAN:  Do you have any hypothesis


    20    as to what component of the vaccine might be

    21    responsible?

    22                MR. BROWN:  We have talked with about ten


    23    different doctors, epidemiologists, toxicologists,

    24    teratologists, and what they all tell me is that it's

    25    logically consistent that there's something in the


                                                                        223

     1    inoculations that is affecting the production of male


     2    sperm and that it's causing birth defects because of

     3    the timing of a developing embryo and when these

     4    defects become present, and what they know of the

     5    inoculations.


     6                Unfortunately we don't have any of that

     7    finished.  That's still an ongoing process.

     8                CHAIR LASHOF:  Yes, doctor.


     9                DR. LANDRIGAN:  Have semen analyses, sperm

    10    analyses been done on some of the fathers?

    11                MR. BROWN:  We have been asking for that

    12    to happen.  I don't believe the Veterans'


    13    Administration is doing that as a regular course, and

    14    we have not had it done privately, but that's going to

    15    be the next step.


    16                MS. LARSON:  Point of clarification on

    17    sort of a side issue.  Several people have testified

    18    that they received vaccine not knowing what it is. 

    19    You also said that some people received the vaccine


    20    against their will, and that's the first time we've

    21    heard that.

    22                Can you verify that that's --


    23                MR. BROWN:  From talking with my clients,

    24    they're under orders.  They have to -- they have to

    25    submit.


                                                                        224

     1                MS. LARSON:  So they were not able to say,


     2    "We won't have it"?

     3                MR. BROWN:  That's according to what they

     4    have told me, but that's also borne out in the

     5    Rockefeller report that showed that many of the


     6    veterans were not allowed to decline.

     7                Thank you.

     8                CHAIR LASHOF:  Thank you very much.


     9                David Addlestone, National Veterans Legal

    10    Services.

    11                MR. ADDLESTONE:  My name is David

    12    Addlestone.  I'm the Joint Executive Director of the


    13    National Veterans Legal Services program here in

    14    Washington.  We're a nonprofit institution that is

    15    involved in veterans' law and policy issues.


    16                I've been involved with the military and

    17    veterans' law for 30 years and hope that I could

    18    perhaps offer some suggestions that might guide your

    19    course of inquiry.


    20                Some of the work we're currently doing in

    21    the area of Persian Gulf veterans is included in your

    22    packets, the self-help guide for Persian Gulf


    23    veterans, and I would suggest you compare that to

    24    government publications to see how we're trying to aim

    25    things at the public so they can understand them.


                                                                        225

     1                I have a prepared statement that goes into


     2    some details, and I apologize for not getting it to

     3    you until late today.  I'll just try to hit the high

     4    points in my oral testimony, and my staff would be

     5    certainly available to assist in any way possible in


     6    the future.

     7                One point I'd like to try to make here is,

     8    I mean, we seem to be split.  We have people on one


     9    extreme who think that everything that's wrong with

    10    anybody who went to the Persian Gulf was caused by the

    11    Persian Gulf, and we've got people on the other

    12    extreme that think that everybody that is claiming


    13    they're sick are a bunch of chiselers, and most of us

    14    certainly are somewhere in between and open minded,

    15    but the debate is somewhere between those two poles,


    16    and I hope I'm not preaching totally to the choir, but

    17    I mean the dynamics of all of this are very important.

    18                I'm speak from having spent about 20 years

    19    working on the Agent Orange issue, and there was a


    20    great lack of dialogue among the public, the people

    21    who felt they were affected, and the government and

    22    scientists.


    23                We've got young, healthy people here who

    24    went to war and came home either unhealthy or feeling

    25    not quite as healthy.  Obviously some people have some


                                                                        226

     1    common post-war letdown in their feelings, and there


     2    are some people that imagine that all kinds of things

     3    are wrong with them.  However, most of these folks are

     4    interested in getting well or some sort of reassurance

     5    that they are well, and I've heard all of this today


     6    from all the other witnesses.  So I don't need to

     7    repeat it.

     8                The government is certainly not attempting


     9    to be callous in this regard.  However, the processes

    10    of government are just what they are, and they can

    11    appear to be so.  There are certain institutional

    12    restraints.  Government lawyers tend to demand proof


    13    of things and seek causation, which is not really a

    14    terribly relevant issue here when dealing with perhaps

    15    an epidemiological problem.


    16                Government press people like to put out

    17    positive stories because there's no point if you're a

    18    government press person in putting out a negative

    19    story.  The same thing with government scientists and


    20    doctors.  There are certain institutional mindsets

    21    that make it difficult to resolve issues like this.

    22                But the government sort of sometimes is in


    23    a can't win situation.  There are a lot of very

    24    useful, short-term studies that can be done obviously

    25    to advance science, but you issue a partial study like


                                                                        227

     1    the recent DOD report, and it can be immediately 


     2    attacked depending on how the publicity spin is placed

     3    on it, and it creates a lot of harm.

     4                On the other hand, the government can't

     5    withhold the information from the interested public. 


     6    I don't have a ready solution for this other than

     7    perhaps some sort of centralized control over what are

     8    known to be the normal processes of government.  This


     9    might facilitate the dissemination of information to

    10    the public in a way that won['t create a firestorm of

    11    criticism or a lack of understanding.

    12                I think the recent DOD report was a good


    13    example.  I was in the Pacific Northwest and read the

    14    wire service stories, and basically the wire service

    15    stories said, "Conclusive study of veterans proves


    16    there's no definitive illness."  Well, I suppose

    17    that's one interpretation of it, but from my

    18    standpoint it certainly wasn't a study of veterans. 

    19    It was a study of generally healthy active duty


    20    people.

    21                I looked at the press release.  The press

    22    release is not that bad from DOD, but the press just


    23    jumped on it and ran with something that simply is not

    24    the truth, and of course that first day's news is

    25    over.


                                                                        228

     1                Now, I would suggest that this committee


     2    recommend to the administration that there be some

     3    sort of centralized coordinating agency that can

     4    anticipate these problems.  

     5                In the case of Agent Orange, I think the


     6    problems were intended, but here I think everybody

     7    means well, but by the very nature of the way

     8    government issues press releases and press coverage,


     9    you're asking for problems.

    10                A central oversight mechanism would be

    11    appropriate in our view.  The inter-agency task force

    12    on these issues frequently doesn't work.  I mean


    13    everybody has a dog in the hunt, as we Southerners

    14    say, and I think maybe we're better off with a

    15    centralized mechanism that can oversee the foibles of


    16    agencies, and I don't mean this in a negative sort of

    17    way.  It's just the inherent nature of government

    18    agencies.

    19                CHAIR LASHOF:  Your time is up.  So could


    20    you finish up, please?

    21                MR. ADDLESTONE:  Some of the

    22    recommendations we make are that we focus on health


    23    care first.  Compensation benefits are fine, but most

    24    of the people want to get well and get back to work.

    25                These seem to be illnesses as a family


                                                                        229

     1    problem, and that families cannot be treated under


     2    most legislative schemes currently in existence for

     3    the people affected.

     4                It would be a healthy opportunity of there

     5    could be some forums outside of Washington where


     6    people could express their feelings.  There may be

     7    some way to make health care customers feel like

     8    they're being satisfied.  I mean there are very


     9    negative feelings about people that are going for

    10    treatment.  Whether it's the agencies' fault, I don't

    11    know.

    12                And the chemical and biological warfare


    13    issue is real.  I mean people out there believe it

    14    happened.  I haven't a clue where it did, but from a

    15    lawyer's standpoint of there were 10,000 false alarms,


    16    I'd be curious if the manufacturer who made the alarms

    17    is getting paid for them.  There are probably ways to

    18    deal with that.

    19                I'd be happy to answer or try to answer


    20    any questions.

    21                CHAIR LASHOF:  Thank you.

    22                Dr. Hamburg.


    23                DR. HAMBURG:  You referred to the need for

    24    a central oversight mechanism because of the

    25    wobbliness of inter-agency cooperation.  Do you have


                                                                        230

     1    any suggestions about how that might be done


     2    effectively on this particular problem?

     3                MR. ADDLESTONE:  Well, maybe we could look

     4    back at the Agent Orange experience.  There was a

     5    coordinating council established in the White House,


     6    and they did a pretty good job of keeping the lid on

     7    things because that was -- I mean what I have seen and

     8    read -- their intention was to keep a lid on things,


     9    frankly, and that was not an unreasonable political

    10    decision.  It was going to be a very expensive

    11    proposition to pay people for Agent Orange claims.

    12                It would probably be a very difficult


    13    thing to do.  I've never done it, but it was certainly

    14    done there, and it was staffed at an extremely high

    15    level.  I mean it was at the level where the


    16    President's views were known to the agencies, and it

    17    wasn't just everybody delegating down, down, down to

    18    the same people who are still or generally still

    19    there.


    20                I've tried to touch on a little bit of

    21    that in my written statement.

    22                CHAIR LASHOF:  We will, of course, review


    23    all of the written statements.

    24                Ms. Larson.

    25                MS. LARSON:  No.


                                                                        231

     1                CHAIR LASHOF:  Thank you very much.


     2                MR. ADDLESTONE:  Thank you.

     3                CHAIR LASHOF:  Tom Hennessy.

     4                MR. HENNESSY:  Good afternoon, Dr. Lashof,

     5    panel, esteemed guests.  We very much appreciate you


     6    listening today.

     7                As a person who's been almost totally

     8    disabled for eight years with three out of four of


     9    these conditions here, I am very heartened by the

    10    Presidential Commission, that it happened, and second,

    11    heartened by the quality of the questions that you

    12    have been asking of the presenters today.  You seem to


    13    have an open mind, and that's definitely what we need.

    14                In the interest of time, I did submit a

    15    written statement which most of you have.  It's got


    16    the little RESCIND logo on the front, and also a chart

    17    that shows similarities between Gulf War Syndrome and

    18    chronic fatigue syndrome.  That's going to be pretty

    19    much the heart of my talk.  It's a gray and black


    20    chart.

    21                It was put together by this Dr. Garth

    22    Nicholson, who you have heard mentioned by several


    23    people today.  He called me last week and told me that

    24    he was coming up to give a briefing to the Department

    25    of Defense.  Dr. Chi Ching Lowe, some of General


                                                                        232

     1    Ronald Blank's people, some of Phil Lee's people, and


     2    we were not allowed to attend.  So we are very happy

     3    that you're here today.

     4                I did make one copy for Dr. John

     5    Baldeschwieler of his manuscript, but it is not


     6    published yet, and he asked if you make a copy and

     7    then maybe mail it back to me, and I have a phone

     8    number where he can be reached.


     9                I'm the President of RESCIND, which is a

    10    small organization.  It has members in about 20 states

    11    and about 12 foreign countries.  It is our contention

    12    that there is no one Gulf War illness.  There are


    13    multiple illnesses.  The four major ones we believe

    14    are chronic fatigue immune dysfunction syndrome, which

    15    is on your sheet; myalgic encephalomyelitis, which is


    16    older names for it; Gulf War Syndrome or Gulf War

    17    illness; fibromyalgia syndrome; and multiple chemical

    18    sensitivities.  All four of these overlap, and the way

    19    I describe it is like five blind men describing an


    20    elephant.  If you're holding the tail, you describe it

    21    one way.  If you're holding the trunk, you describe it

    22    another way.  If you're holding one of the feet it's


    23    a totally different description.

    24                But we believe there is a common

    25    biological pathway to all of the insults these people


                                                                        233

     1    talked about, whether it be a pyridostigmine pill,


     2    depleted uranium, chemical virus.

     3                Some of the descriptions that I have used

     4    for up to six years is very simple.  It's a train on

     5    a track.  Think of the engine of the train as your


     6    brain, the body of your train is your body.  It has to

     7    run on two rails to meet its destination.  One is your

     8    immune system, one is your central nervous system.  It


     9    is supported by railroad ties.  We say, number one,

    10    it's how you handle stress.  Most of us are Type A,

    11    workaholics, 14-hour days, seven days a week.  We

    12    internalize stress.


    13                A lot of my friends don't like to admit it

    14    but there's a psychological predisposition.  Most of

    15    us are workaholics.  The whole Army, as far as I know,


    16    in the Gulf was a volunteer army.  It was people who

    17    wanted to serve their country.

    18                Genetic predisposition, they just found

    19    there might be a genetic predisposition for fatness,


    20    for breast cancer, for other cancers.  Maybe there is

    21    a predisposition, and with all of the speed of the

    22    human genome project, we ask you to incorporate some


    23    of that information in your studies.

    24                Environmental toxins, they could be

    25    anything.  I personally got sick after eating a plate


                                                                        234

     1    of bad oysters in Houston, Texas, eight years ago, but


     2    my job was leasing construction equipment to all of

     3    the big refineries and chemical makers and biological

     4    agents, and at the time Saddam Hussein was on our

     5    side, and we were financing a lot of his biological


     6    and chemical weapons, and I think that's one of the

     7    reasons that DOD has been sweating bullets for having

     8    someone like you to come in and ask as many questions.


     9                Vaccines, I don't know the nature of all

    10    these vaccines, but there's still even a discussion

    11    today about the Sabine and the Salk polio vaccine and

    12    others.  What I say is any train can race along a


    13    track.  They can have rotten railroad ties, and you'll

    14    still get to your destination unless there is some

    15    agent that causes the train to buck.  When it hits a


    16    place where there's eight or nine rotten railroad

    17    ties, that's when you get CFIDS, ME, or Gulf War

    18    Syndrome.

    19                I have elucidated ten different points,


    20    and with all due respect to David Letterman, I just

    21    want to go through it.

    22                Your name.  Calling us chronic fatigue


    23    syndrome or Gulf War Syndrome, it's like calling

    24    living a chronic breathing syndrome.  It means

    25    nothing.  Any chronic illness will result in fatigue


                                                                        235

     1    to the people that have it.


     2                Dr. Nicholson's chart which you all have

     3    on your table, it overlaps almost identical with one

     4    exception, and that is sensitivity to light.  I don't

     5    know how these people could stand up here with these


     6    bright lights.   Most of us who have Gulf War Syndrome

     7    or CFIDS are very sensitive to light.

     8                A written instrument.  If they're talking


     9    about going on the Internet, why don't we get ten

    10    questions from the best chemical person, best

    11    biological person, best psychological person?  Then we

    12    put it on there, in the Internet or in doctors'


    13    offices, with a hidden number such as a PIN code plus

    14    your social security number and your mother's maiden

    15    name.  That PIN code would enable these people who are


    16    still fighting to keep their jobs to be honest, but

    17    still have privacy.

    18                Avoid duplication of effort.  There is a

    19    lot of money being spent at the CDC which is in there


    20    now on chronic fatigue syndrome, on multiple chemical

    21    sensitivities.  Let's use the data.  Tens of thousands

    22    of people they've interviewed.  Dr. William Reeves is


    23    one of the people who's in charge of both Go for

    24    Syndrome and CDC.  I can provide you a lot of

    25    information, and the most polite statement I could say


                                                                        236

     1    is he's probably not the best guy for the job.


     2                The degrees of severity.  No one mentioned

     3    that anywhere in the world.  I've research 15,000

     4    pages of information.  There are three levels.  One is

     5    a 40-hour work week, but you're just dragging your


     6    behind.  You can't cook, shop, clean, anything.

     7                Number two, a lot of nurses and teachers

     8    are doing this.  They're sharing a job code with


     9    someone else.

    10                Number three, you're like myself.  Someone

    11    has to drive you, cook, pay your bills.

    12                So a 35 year old person, instead of making


    13    100,000 a year and paying 30 to 40 to Uncle Sam, I'm

    14    a 41 year old person totally bedridden getting 13

    15    grand a year on disability.  It's a double loss, a


    16    blow to Social Security and Medicare.  This same thing

    17    is happening to these people.

    18                Any CDC and NIH cohort studies, absolutely

    19    you have to have age and sex matched controls.  I


    20    think it was Dr. Lashof this morning.  There's no way

    21    they can do a definitive study at DOD without

    22    including age and gender matched controls for young


    23    healthy people.

    24                A lot of these Go for veterans -- I was on

    25    Larry King about four years ago talking about chronic


                                                                        237

     1    fatigue syndrome.  He said, "What do you feel like,


     2    Tom?"

     3                I said, "I feel like this."  Lieutenant

     4    Jeffrey Zahn had just been shot down in an A-6 fighter

     5    plane, and he was all beaten up in front of the


     6    cameras.  I said, "I look okay, but I'm sick as a

     7    dog."

     8                Cutting off?


     9                CHAIR LASHOF:  Do you want to finish up?

    10                MR. HENNESSY:  Okay.  Finishing up,

    11    treatment protocols.  There is no known treatment

    12    protocol.  While you're researching this, we have


    13    bills to pay, food to get on the table, rent to stay

    14    alive.

    15                Nationwide database, we're privacy.  Last


    16    week there's a brand new company, Netscape, $2 billion

    17    market, capitalization on the first day of business,

    18    dealing with the Internet.  Use it.

    19                And last but not least, listen to the


    20    patients.  The database requirement we can go through

    21    later.   I just want to leave with one quote. 

    22    President Clinton has mentioned we'll leave no stone


    23    unturned.  I think just by being here you've turned

    24    over a lot of stones today, but I want to give you our

    25    hero, which is Florence Nightingale, a nurse, over 100


                                                                        238

     1    years ago who had Crimean fever.  But she was also a


     2    contemporary of Dr. Louis Pasteur, and he said, "The

     3    antigen is nothing.  The terrain is everything."

     4                And I have some more things to submit. 

     5    Thank you for your time.


     6                CHAIR LASHOF:  Thank you very much.

     7                Are there questions, please?

     8                Dr. Baldeschwieler?  Oh, I'm sorry.


     9                You indicated that your illness is not

    10    related to the Gulf War; is that correct?

    11                MR. HENNESSY:  Yes, ma'am.  I was a

    12    salesman in Houston, Texas, working in refineries, and


    13    I ate a bad plate of oysters, and I thought it was

    14    food poisoning, but my symptoms are identical, and

    15    after I made the statement on Larry King Live,


    16    veterans started calling me, and they've been calling

    17    me for four years saying, "We've got what you got."

    18                CHAIR LASHOF:  I see.

    19                MR. HENNESSY:  And there's been a lot of


    20    government research.  So I'm saying let's not reinvent

    21    the wheel, and if you do a symptom check list --

    22    remember the gentleman that stood up and said that


    23    it's cut off after six?  They never go to 20.  You've

    24    got to go to at least 20 because it is only driven by

    25    symptoms, and when 93 percent are men, they'll believe


                                                                        239

     1    it more.


     2                Unfortunately when it was nurses and

     3    teachers, 75 percent female, it was hysterical women

     4    who couldn't handle it.

     5                CHAIR LASHOF:  Thank you very much.


     6                MR. HENNESSY:  I'd like to just submit

     7    this videotape of some MacNeil-Lehrer, Larry King

     8    Live, and a two-hour video of snippets for your


     9    perusal.

    10                CHAIR LASHOF:  Fine, thank you.

    11                Okay.  Wendy Wendler, would you like to

    12    take Captain Hamden's spot or have you departed?


    13                Okay.  Carol Picou.

    14                MS. PICOU:  She'll be passing out our

    15    written testimony that was prepared for me by my


    16    husband.  My husband does most of my writing only

    17    because what comes to mind is one time a soldier was

    18    raised through the VA system and he was giving written

    19    testimonies, and the VA told him that if he could


    20    write this well, he's not really that sick.  Well, my

    21    husband helps me prepare all of my reports, and the

    22    soldier never told them that his wife is the one that


    23    helps him to write his also because of the long-term

    24    and short-term memory diagnosis that we had suffered.

    25                But before I begin, I'd like to thank the


                                                                        240

     1    Presidential Advisory Committee and my colleagues and


     2    Wendy Wendler for submitting her time to me.

     3                I am from the MISSION Project.  I'm a

     4    spokesperson today.  MISSION Project stands for

     5    Military Issue Service in our Nation.  This


     6    organization was originally Operation Desert

     7    Shield/Desert Storm.  My husband started this

     8    organization while in San Antonio, Texas, on the


     9    behalf of the returning San Antonio soldiers.  He

    10    started the support group because he saw how ill we

    11    were.

    12                Our mission, currently what we do is we


    13    provide Desert Storm soldiers, family members, anybody

    14    in the public information regarding what's happening

    15    on Capitol Hill, on the testimonies, the NIH hearings,


    16    all the other panels.  We provide soldiers VA numbers

    17    to contact them, and that's our main goal as the

    18    MISSION Project.  We're currently trying to gain some

    19    funding to bring some soldiers and get tested and go


    20    through the testing that I have gone through.

    21                I was an active duty soldier for 15 and a

    22    half years during the Persian Gulf War.  I am now


    23    permanently retired.  Two years ago I stood before a

    24    committee testifying as an active duty soldier.  I

    25    have lost my military career.


                                                                        241

     1                You have repeatedly asked questions why


     2    soldiers refuse to call in and call the 1-800 numbers. 

     3    As the Honorable Stephen Joseph said, it's available,

     4    but because when we do come forward and we speak out

     5    and we talk about our illness, they tell us we're no


     6    longer fit for active duty and we're not worldwide

     7    deployable.

     8                That's what happened to me.  I'm not


     9    worldwide deployable, and my condition had worsened. 

    10    So the best thing they said that was thought to do was

    11    to medically retire me.

    12                A bill was passed a year ago about TDRL


    13    status, that no soldier should be put out unless they

    14    are placed on TDRL status at a 50 percent disability

    15    and to remain on that for the next five years until


    16    they can evaluate their health conditions.  I was on

    17    TDRL status.  I didn't even make it 14 months, and

    18    they said that I was not fit.  My condition hasn't

    19    improved any, and that it would be best if I was


    20    permanently disabled.  They took my rate and didn't

    21    allow me to submit any additional information because

    22    they said it wasn't from my previous board.


    23                I spent a year going through evaluations

    24    through the VA hospital and the Department of Defense

    25    because I had the best of both worlds.  However, they


                                                                        242

     1    lost my records.  The VA never received my active duty


     2    records.  So I am not awarded any disability on 13

     3    outstanding diagnoses until they find my records.

     4                The VA awarded me 100 percent permanent

     5    disability, and looking at me I don't look disabled. 


     6    It's like Dr. Joseph said.  One of the doctors had

     7    said if we would have come back with an arm or a limb

     8    missing, we would have been medically taken care of. 


     9    You can't see my illnesses most of the time.

    10                Today I have the rash from underneath my

    11    arms all the way down to my naval.  I have the

    12    blisters on the back of my legs.  These come and go. 


    13    Unfortunately when they break out by the time I get an

    14    appointment to the VA, the VA can't even biopsy them

    15    because of the fact that they disappear.


    16                So Monday I have an appointment with the

    17    VA and hopefully they'll still be there when they see

    18    me on Monday.

    19                The problem is when you talk about the


    20    depleted uranium issue, I don't stand and neither does

    21    our organization on one cause or effect.  We were

    22    exposed to depleted uranium which was used for the


    23    first time in our battlefields during the Persian Gulf

    24    War.  We inhaled those particles as front line troops. 

    25    I was a nurse in the front lines.  I removed bodies


                                                                        243

     1    from the tanks.  I received those bodies.  We sat in


     2    a convoy for over hours breathing, inhaling the

     3    vehicles that were just burned.

     4                I had served for 15 years.  I was in the

     5    Flugtag disaster in Germany in 1988 where I body


     6    bagged 300 people.  When I saw those bodies in Iraq,

     7    they were as black as this, and this really startled

     8    me because we were not in MOP gear.  We were not


     9    ordered to be in MOP gear, and I said this doesn't

    10    look normal to have these bodies that charred.

    11                So I was driving with my platoon sergeant

    12    and chief ward master.  I said, "Guys, I'm going to


    13    take photos."  I took photos of this because I was

    14    concerned.

    15                Seventeen days sitting in Iraq on our last


    16    day, General McCaffery from the 24th Infantry Division

    17    which we supported came and said, "Why aren't you all

    18    in chemical suits?  This is a contaminated area."  The

    19    last day deploying out of Iraq as we tore down our


    20    hospital, we put our chemical suits on to leave Iraq.

    21                I have photos of me in my just regular

    22    uniform while the military support of the Marines were


    23    around us in full MOP gear. 

    24                My problem was the pyridostigmine.  I have

    25    taken pyridostigmine.  We were ordered to take it


                                                                        244

     1    three times a day, 30 milligram tablets the day of


     2    deployment of the ground war.  We were told every

     3    eight hours.  They woke us up, put us in formation,

     4    and mandatory made us take this pyridostigmine.

     5                One hour after I ingested it, I had


     6    developed the tearing of my eyes, the twitching of my

     7    eyes.  I start drooling.  My nose started running.  I

     8    started having muscle aches and twitches, and I told


     9    my platoon sergeant, "I'm not taking this anymore.  I

    10    think I'm having a severe reaction."

    11                He said, "You have to.  It's mandatory." 

    12    So that kept up one hour after I ingested it.  Finally


    13    the third day as we're driving our convoy he said --

    14    I didn't take it.  I spit it into my Pepsi can.  He

    15    said, "You didn't take your pill, did you?"  I said,


    16    "Well, no."  He said, "Take it."  So I took it; one

    17    hour later, same problems.

    18                When I finally set up our hospital, we got

    19    there at eight o'clock at night.  We were fully


    20    operational at two in the morning.  The next morning

    21    I reported my symptoms, and they said, "Take it and

    22    come see me."  So I showed them my symptoms.  They


    23    told me, "Just keep taking you.  You proved that it

    24    peaked and it's working you the neurological system."

    25                That was the results.  I couldn't rescind


                                                                        245

     1    taking it.  I was still ordered to keep taking it.


     2                Pyridostigmine has never been tested on

     3    healthy women or healthy human beings.  That was my

     4    concern.  They gave the same amount of dosage to the

     5    same men of different height and weight as they did to


     6    women.

     7                As in Senator Rockefeller's hearings, it's

     8    not supposed to be prescribed like that.  It's a nerve


     9    agent that they give for myasthenia gravis, and even

    10    with those patients you still have to watch for levels

    11    of toxicity.

    12                Also Dr. Joseph talked.  You asked about


    13    the levels of uranium, depleted uranium.  I have a

    14    soldier that contacted me two years ago after seeing

    15    me up on Capitol Hill.  He was hit by friendly fire,


    16    and they didn't even know about him.  We sent him to

    17    Dr. Frank Keough in Baltimore, Maryland, who is doing

    18    a depleted uranium study.  

    19                This soldier was tested, and he had


    20    fragments in his shoulders and in his face.  This is

    21    part of the support group.  We try to help soldiers

    22    get to where they need to go.  They removed his


    23    fragments.  However, just recently he had another

    24    urinalysis study and his levels have increased even

    25    though his depleted uranium has been removed.


                                                                        246

     1                They told him he was going to have an in


     2    vitro monitor done in Nevada.  Unfortunately they told

     3    him that the machine was down.  For two years this

     4    soldier is still waiting for the in vitro monitor to

     5    see if it's affected his lungs.


     6                I requested to be tested for depleted

     7    uranium only because when I came back someone called

     8    me up here and they called me and it was an atomic


     9    veteran.  He said, "I'm really concerned about you. 

    10    You have the same symptoms I've had, and they used 238

    11    which is a particle of depleted uranium.  You have

    12    depleted uranium poisoning."


    13                So I requested to be tested.  In March of

    14    1994, through a Congressman, they ordered Fort Sam

    15    Houston to test me for depleted uranium.  I got


    16    tested.  My results came back September 17th.  The

    17    results were levels of uranium.  However, they were

    18    low levels, and the doctor said, "It's just background

    19    radiation from living in San Antonio."


    20                Prior to the war I didn't live there.  I

    21    was in Germany.  I signed in my unit on the first.  I

    22    was alerted for the war on the second.  I was never


    23    exposed to depleted uranium until on the front lines.

    24                Out of my unit was 300 people.  One

    25    hundred fifty went forward, and 150 stayed to the


                                                                        247

     1    rear.  Two years ago I asked the other panels to take


     2    my unit and do a study on them in San Antonio.  We

     3    have thousands of soldiers.  Our babies are born with

     4    birth defects, hypothyroidism.  I asked them to take

     5    our unit.  Out of 150 of us that went forward, 40 of


     6    my comrades are ill.  We were discharged before this

     7    ever became a Desert Storm issue.

     8                So out of these soldiers the rest don't


     9    want to come forward because of their careers.  Most

    10    of us had 15, 17 and 18 years in.  

    11                When the men refused to go to the front,

    12    I was the next highest ranking female.  I recruited


    13    seven other women to go.  We took the units, and we

    14    went in.  We drove five ton trucks.  We set up the

    15    operating room, and we were the first ones to drop on


    16    line.

    17                Those women, six of them, have admitted

    18    their illness and four of them have been discharged,

    19    and the other two won't say anything because of fear


    20    of their careers because they have one year left.

    21                This has been happening to not only

    22    myself, but to the family members.  Three of our


    23    babies in San Antonio have the missing eyes, the ears,

    24    the thyroid.  

    25                I went to the VA hospital in September. 


                                                                        248

     1    My condition was getting worse.  I have the abdominal


     2    distension, the fluid retention.  I have the

     3    neurological damage.  I have an autoimmune deficiency. 

     4    It was all diagnosed by a civilian doctor through my

     5    medical insurance.  Since then my medical insurance


     6    said they're not paying because this is combat

     7    related.  I got discharged noncombat related.  The

     8    Army CHAMPUS said they're not paying because I was


     9    ineligible for CHAMPUS because I was still on active

    10    duty.

    11                This is what's happening to soldiers.  I

    12    had 16 and a half years.  I just got retired this


    13    March.  I was hoping to see 20 years as a commissioned

    14    officer.  I was up for a commission when the war broke

    15    out.


    16                So this is what has happened to my life,

    17    my family.  I have no feelings from my waist down.  I

    18    have to catheterize.   This was the solution the Army

    19    gave me.  Catheterize yourself six to eight times a


    20    day, wear diapers because I have lost all the muscles

    21    in my bladder, my rectum, and my vaginal muscles have

    22    now deteriorated, and this was the solution that they


    23    told me.

    24                At my last medical board in March, it was

    25    the same thing.  Go to Social Security now.  I went to


                                                                        249

     1    Social Security.  Results just came back two weeks


     2    ago.  She has too much education.  She's 38 years old,

     3    and she can still use her hands.  Disability denied.

     4                So this is what soldiers are up against. 

     5    I ask you today if you look in the back, I have


     6    several suggestions on recommendations, to keep

     7    researching.  We challenge this board.  We've gone

     8    through five other boards.  We challenge this board


     9    to, like you said, turn over all the stones and

    10    investigate it and do it with an open heart, and we're

    11    praying and God bless you that you can find an answer

    12    for us before more soldiers die.


    13                Thank you.

    14                CHAIR LASHOF:  Thank you very much.  I

    15    have allowed you to go quite over time, but I will


    16    open it up for any questions.

    17                (No response.)

    18                CHAIR LASHOF:  If not, okay.  Thank you.

    19                MS. PICOU:  Any questions?


    20                CHAIR LASHOF:  I guess not.

    21                MS. PICOU:  Thank you.

    22                (Applause.)


    23                CHAIR LASHOF:  Captain Julia Dyckman.

    24                CAPT. DYCKMAN:  I'm Captain Julia Dyckman. 

    25    I'm a drilling Reservist.  I'm a Vietnam vet, and I


                                                                        250

     1    was recalled for Saudi Arabia for the Persian Gulf. 


     2    I'm a nurse, and I served with Fleet Hospital 15 in El

     3    Jubail, Saudi Arabia.

     4                I thank the committee for the opportunity

     5    to present, but I'm also presenting for Colonel Herb


     6    Smith, who was a recalled Army veteran who was a

     7    practicing veterinarian and is in deteriorating

     8    health.  At this time he is also under care in the


     9    hospital.

    10                You have a copy of his report, and you

    11    have a copy of my report.  I would like to because of

    12    time restraints deal with his conclusion.


    13                He is a Persian Gulf vet who started

    14    having symptoms after he returned and has been

    15    constantly having problems proving his disability and


    16    looking for treatment.  He has gone through extensive

    17    medical tests, some of them very elaborate, and is

    18    still dealing with the Army Evaluation Board on his

    19    medical condition.


    20                I would like to at least read his

    21    conclusions.  The Gulf War Syndrome is controversial

    22    because abnormalities in standard laboratory tests


    23    produce results that do not match the intensity of the

    24    symptoms recorded by the affected veterans.  The

    25    severity of the complaints from a young, healthy, war


                                                                        251

     1    fighter population was not expected.  The


     2    abnormalities anticipated from a tour in the Persian

     3    Gulf did not appear.  A routine office exam and a CBC

     4    very likely will show nothing in most veterans.

     5                Objective findings are few and far


     6    between.  Subjective findings are predominant.  The

     7    physician, especially a military physician, will not

     8    be inclined to verify all of the subjective complaints


     9    or believe the intensity of the complaints.  Doctor-

    10    patient relationships as a result are adversarial.

    11                Consequently, specialized testing that

    12    will reveal a medical problem will not be ordered.  If


    13    specialized testing is ordered, the resultant

    14    deviations are so mild and subtle the physician will

    15    not believe them and will not try to correlate the


    16    results with the radical complaints of the patient.

    17                Also, please remember all of the

    18    specialized testing that was needed to verify that I

    19    had a real problem and not a somatoform disorder, such


    20    as PTSD.  Few Persian Gulf veterans will have the

    21    opportunity for such extensive testing.  I repeat,

    22    most Gulf War veterans have only subtle or mild


    23    laboratory abnormalities that do not match the radical

    24    symptoms which they report.  It is not the character

    25    of the abnormal results of the individual tests, but


                                                                        252

     1    rather the multiplicity of the mild or subtle


     2    abnormalities that should be considered.

     3                The difficult task is in inspiring the

     4    military physician to correlate these subtle and mild

     5    laboratory deviations with the symptoms and the


     6    subjective complaints of the affected veteran.  The

     7    reality is that the veteran and his subjective

     8    complaints are being ignored.  Without a truly hard


     9    look, a look that includes specialized testing, how

    10    can DOD undisputedly hope to find the cause of Gulf

    11    War Syndrome?

    12                I'm making this presentation to explain


    13    the problems that are being encountered in dealing

    14    with the military, VA administration, and various

    15    evaluation programs.  As I said, I served with Fleet


    16    Hospital 15 in El Jubail, Saudi Arabia.  While on

    17    active duty and in the Persian Gulf, I had the

    18    following symptoms:  rashes, open blisters, flu

    19    symptoms, bronchitis, reaction to the anthrax


    20    vaccines, chronic gastritis, rapid heart rate, and

    21    uncontrollable high blood pressure.  They all started

    22    in February of 1991.


    23                Upon my return to the States, I was

    24    discharged from active status and went to the drilling

    25    Reserve status.  I was discharged from active duty


                                                                        253

     1    with conditions not resolved.


     2                After discharge I was ineligible for any

     3    care as a Reservist, and so I was forced to go to VA. 

     4    I went to VA in Harrisburg, Pennsylvania, and Lebanon. 

     5    They constantly disregarded most of the symptoms and


     6    any specialized testing.  So I asked to go to the VA

     7    Medical Center in Washington, D.C.

     8                At that time I was confirmed with Persian


     9    Gulf Syndrome and irritable bowel syndrome.  The

    10    results proved on change in care.  I received no

    11    treatment and was returned to VA Lebanon waiting for

    12    more possible types of treatment, but none was done. 


    13    I constantly had to insist on specialized testing to

    14    prove that I was actually ill.

    15                In 1994, I went to the clinical evaluation


    16    program at Bethesda.  The clinical evaluation program

    17    produced the following diagnosis:  chronic fatigue

    18    syndrome, resting tachycardia, fibromyalgia, 

    19    irritable bowel syndrome, short-term memory loss,


    20    chronic bilateral foot pain, chronic gastritis,

    21    chronic headaches, and chronic sinusitis.

    22                The problem is in some of the coding of


    23    these conditions.  I could not be given Gulf War

    24    Syndrome.  I had to be given a codable illness.  So

    25    the most predominant thing was fatigue.  So it came


                                                                        254

     1    out as chronic fatigue syndrome, but what results with


     2    these codable illnesses is the relationship that these

     3    are all conditions that are found in the general

     4    population and, therefore, difficulty in proving that

     5    they're service connected.


     6                I filed a claim with VA in 1991 for

     7    service connection, and you have the list of all the

     8    things I filed for.  I was denied service connection


     9    except for a foot problem with zero percent

    10    disability.  I appealed the decision, and two months

    11    ago I got a decision saying there is no connection to

    12    any medical condition and 30 percent PTSD.


    13                The reason for the denial was given:  

    14    confirmation of any -- I can't read this --

    15    confirmation of my symptoms was past the two-year date


    16    of service in the Persian Gulf.  The rapid heart rate

    17    was documented in theater, but the evaluation and

    18    confirmation was past the two-year requirement.  Most

    19    of the evaluation programs and access to them were


    20    started after the two-year requirement, which was set

    21    by VA.

    22                Chronic fatigue was denied because without


    23    a finding of chronic fatigue syndrome during active

    24    duty, which was a little hard to get that for the two

    25    months we were there, there's no basis on which to


                                                                        255

     1    have service connection.


     2                I'll close with some of the statements of

     3    concern.  One were the immunizations.  Those

     4    immunizations were given to us.  They were not

     5    recorded.  We had books at our hospital.  They were to


     6    be recorded when we returned.  I had contacted Admiral

     7    Hagen, the Surgeon General for the Navy.  He said they

     8    would be added, but none of those records can now be


     9    found.

    10                One final thing, and that is I have

    11    Persian Gulf disease.  It is not one disease, but a

    12    combination of illnesses.  No other war had veterans


    13    returning  with the combination of symptoms and

    14    illnesses that the Gulf War has produced.  I feel that

    15    the environmental exposure and the immunizations were


    16    a major part in the symptoms that I am now having.

    17                CHAIR LASHOF:  Thank you very much.

    18                Are there questions for Captain Dyckman?

    19                (No response.)


    20                CHAIR LASHOF:  If not, thank you.

    21                I've been allowing some of the people to

    22    go on further since we're cutting out some of the


    23    questioning time.

    24                Aubrey Leager.

    25                MR. LEAGER:  I'd like to thank the


                                                                        256

     1    committee for allowing me to speak today.  My name is


     2    Aubrey Leager. 

     3                In 1974, while on active duty in the

     4    United States Air Force, I received a vaccination

     5    under questionable conditions.  Shortly thereafter,


     6    another unusual event occurred in which I was coerced

     7    into eating a sandwich.  Within 48 to 72 hours later,

     8    I was deathly sick.  In the later stage of the


     9    illness, I had become so ill that I could not even

    10    make it to the phone to call for an ambulance.

    11                I went into a coma for over 18 hours. 

    12    When I awoke I was no longer the same person. 


    13    Whatever it was nearly killed me, and probably should

    14    have.

    15                There were many unusual symptoms during


    16    the initial stage of the illness, and there were more

    17    symptoms that developed later on.  The latter of these

    18    symptoms are known today as chronic fatigue immune

    19    dysfunction syndrome, CFIDS.  The initial symptoms of


    20    the illness I now know today were those of intestinal

    21    anthrax exposure.

    22                Over the years there have been many


    23    questionable incidents that have occurred that I feel

    24    may have been related to my illness.  Medical records

    25    concerning the initial symptoms of my illness


                                                                        257

     1    disappeared.  The Chief of Internal Medicine at


     2    Weisbaden Hospital in Germany, who had been handling

     3    my case, was suddenly reassigned.  These are just a

     4    few.

     5                In 1990, I was diagnosed as having CFIDS


     6    and began researching the disease.  This is when I

     7    first heard about mycoplasma incognitos and Dr. Chi

     8    Ching Lowe of the Armed Forces Institute of Pathology. 


     9    I was able to contact the doctor's lab and requested

    10    to be tested for incognitos.  I was told the doctor

    11    was out of country and that they did not know when he

    12    would be back.  They said if I wanted to get tested


    13    that I would have to keep calling back.

    14                In later calls some sort of cover-up

    15    transpired in which I was told that the Armed Forces


    16    Institute of Pathology did not employ a Dr. Lowe, and

    17    that they had never heard of him.  When I finally got

    18    up with an associate of Dr. Lowe's at the institute,

    19    I was told they could not test me.  I now knew I was


    20    on the right track and began checking into Dr. Lowe's

    21    background.

    22                I was able to find out that Dr. Lowe


    23    specialized in the research of four diseases.  One of

    24    these diseases is anthrax.  Around the same time I

    25    heard about a CFIDS researcher who had discovered a


                                                                        258

     1    spumovirus in CFIDS patients.  This researcher was Dr.


     2    Elaine Dephratis of the Wistar Institute in

     3    Philadelphia.

     4                I contacted her and told her my story

     5    about the military.  She said she wanted to test my


     6    blood, but that if she found anything unusual, that

     7    she could not go against the government as she

     8    depended on grants from them.  She employed PCR and


     9    other high tech methods in her research and told me

    10    that it would take six to eight weeks for the results.

    11                During this time I was still working as a

    12    civilian for the Department of Defense and had a


    13    disability claim in based on my illness.  On several

    14    occasions I was asked questions about what I was being

    15    tested for, who had my blood, and which institute was


    16    involved.  It took several months to get up with Dr.

    17    Dephratis as she would not return my calls.  When I

    18    finally got her, she reminded me of what she had told

    19    me and then stated that she had found nothing.


    20                I later heard stories that Dr. Dephratis'

    21    lab had been broken into and that research work was

    22    destroyed or missing.  I was able to confirm that Dr.


    23    Dephratis had left Wistar.

    24                On Thursday night, August 10th, 1995, I

    25    was able to contact Dr. Dephratis.  She was able to


                                                                        259

     1    confirm that strange things had happened at Wistar. 


     2    She also said that her superiors at Wistar had

     3    received a letter from the CDC discrediting her work. 

     4    She strongly feels that there was government

     5    intervention to purposely discredit her.


     6                When I first made contact with Garth and

     7    Nancy Nicholson in October of 1994, they told me that

     8    that very day they had received calls from the


     9    Pentagon, Department of Defense, and other government

    10    agencies threatening to discredit their work if they

    11    went public.  They also said that their superior at

    12    the institute had received a threatening call from the


    13    CIA.

    14                In March of this year, I had my family's

    15    blood drawn and flew to Houston where the Nicholsons


    16    tested me and my family's blood for mycoplasma

    17    incognitos.  I and my family are positive for

    18    mycoplasma incognitos.

    19                I have been told by researchers in the


    20    field of anthrax, as well as other researchers, that

    21    the possibility of an experimental vaccine against

    22    anthrax causing the creation of a mycoplasma is highly


    23    probable.  It is my opinion that in 1974 an

    24    experimental recombinant DNA vaccine was tested upon

    25    me and others, and that this vaccine caused the


                                                                        260

     1    creation of the original strain of incognitos.


     2                I further believe that this vaccine was

     3    altered by restructuring the DNA sequences to try to

     4    prevent the creation of the mycoplasma and that this

     5    new vaccine was covertly tested on our troops during


     6    the Gulf War with the same unfortunate results.

     7                At a recent Yellow Ribbon Panel conference

     8    on the Gulf War illness, I was able to find out that


     9    a Sergeant Jeff St. Julian and his unit received an

    10    experimental Japanese vaccine.  They were told that it

    11    was an investigational Japanese encephalitis vaccine. 

    12    Sergeant St. Julian was never deployed to the Gulf,


    13    but came down with the Gulf War illness.

    14                This vaccine was produced at Osaka

    15    University in Osaka, Japan.


    16                I am now holding up a book entitled The

    17    Unit 731, Japan's Secret Biological Warfare in World

    18    War II.  This book is a documentary based on secret

    19    Japanese documents that were accidentally discovered


    20    in 1987.  At the end of World War II, it was

    21    discovered that the Japanese had been conducting

    22    secret biological warfare tests in occupied China, and


    23    that they had used American and Allied POWs as human

    24    guinea pigs.

    25                CHAIR LASHOF:  Mr. Leager.


                                                                        261

     1                MR. LEAGER:  Yes.


     2                CHAIR LASHOF:  I'm going to ask you to try

     3    to finish up.  We'll take your full testimony.

     4                MR. LEAGER:  Okay.  To make this short,

     5    one of the researchers at the end of World War II --


     6    they were basically -- a deal was cut in which they

     7    could walk.  One of those researchers went on to a

     8    career at Osaka University in Osaka, Japan.


     9                I guess I won't have time to go on with

    10    the rest of this, but I think I've made my point that

    11    the vaccines --

    12                CHAIR LASHOF:  It's your belief that --


    13                MR. LEAGER:  -- are the most likely cause.

    14                CHAIR LASHOF:  -- the vaccine is the

    15    cause.


    16                Are there questions for Mr. Leager?

    17                (No response.)

    18                CHAIR LASHOF:  If not, thank you very

    19    much.


    20                MR. LEAGER:  Thank you.

    21                CHAIR LASHOF:  Denise Nichols.

    22                MS. NICHOLS:  I know it's late, and I know


    23    all of us Desert Storm veterans are very, very tired,

    24    and so I'll try to just make my comments short and get

    25    us back on time.  I have some prepared materials that


                                                                        262

     1    you'll be able to read in full.


     2                When I got involved with this is by going

     3    to war for my country, and now it seems like a

     4    disaster.  It seems like Armageddon or worse, and the

     5    deeper I took trying to find out something to help


     6    troops, to help myself, to help my family, it just

     7    gets deeper and deeper.

     8                We all love our country.  In this group of


     9    soldiers, the first time I met a lot of them in person

    10    was at the NIH meeting, and I don't know about you,

    11    but I hope that you have some of the reactions I have

    12    when I met them there.  I had served with them, and


    13    when they were coming forward and trying to tell us,

    14    tell all of us -- I was still in denial at times --

    15    what was going on, they are true Americans.


    16                We all swore to defend the Constitution as

    17    all officers and military officers and even the

    18    President.  We need answers.  This is like a dark,

    19    dark story, and I have a hard time sometimes keeping


    20    logical, and we hear all kinds of things, and looking

    21    at other things that we hear, and it's a struggle, and

    22    it's a struggle when you're suffering with memory


    23    problems.  You have low grade fevers.  You're trying

    24    to travel, trying to fight for your own rights, trying

    25    to help others.


                                                                        263

     1                Not anyone in this room has a very low


     2    phone bill.  We've been trying to help each other.  

     3                I got caught on national TV at Senator

     4    Reigle's hearings.  I never dreamed that I would ever

     5    get up to Secretary Dorn and be really mad and telling


     6    him, hey, we're taking care of each other and we're a

     7    family and we're a team.  We went over together and we

     8    did the job.  Now, where is the VA and DOD?


     9                Now I have the question of where is the

    10    President.  What's he going to do?  We cannot keep

    11    suffering.  We cannot.

    12                We lost one of our brave pilots two weeks


    13    ago, Colonel Don Kline, and I want him recognized

    14    today, and I want him recognized by the President. 

    15    Colonel Don Kline was in the first wave of planes into


    16    Baghdad.  He hit biological and chemical facilities,

    17    and then evading another plane, he flew right back

    18    through the plumes.  I had heard about him for a long

    19    time.  In March when I organized and had the meeting


    20    in Dallas, I met the man, a full colonel, highly

    21    decorated like Colonel Herb Smith, a pilot.

    22                I'm a flight nurse or was.  He couldn't


    23    talk.  He was paralyzed.  He was skin and bones.  This

    24    shouldn't be happening.

    25                I told him I'd fight.  I'd fight for the


                                                                        264

     1    ones that didn't have a voice or had already gone on


     2    before us, that I wouldn't stop until we got answers

     3    and got care for our veterans and our families.

     4                He gave me a thumbs up.  We're not giving

     5    up.  We want the truth.  We want action and action


     6    now.  I am tired of handling wives over the phone when

     7    their husbands die.  Some of them their husbands tell

     8    them or their wives -- I don't know if we've lost any


     9    female vets.  It seems like I get the phone calls on

    10    the male vets -- and they put in for benefits and

    11    they're denied.

    12                They're 23 years old.  They have two kids. 


    13    The kids are sick.  What is going to happen?  We've

    14    got to stop this now.  I don't know what has happened

    15    that's wrong, but we've got to stop it and turn it


    16    around because this is a national security item when

    17    your public health of your country is involved.

    18                And we haven't said that word here today,

    19    but it is involved, and we're concerned.  We've been


    20    coming to you and coming to you.  We come a great

    21    distance, and it only makes us suffer more because our

    22    physical bodies start tearing down every time we


    23    travel up to Washington or we try to get together to

    24    share information, to keep in touch with each other. 

    25    We go home and we're tired and we're sicker and it


                                                                        265

     1    takes our bodies a little time.  We dose them up with


     2    vitamins and whatever else to try to keep holding on

     3    and keep getting answers.

     4                Our phone bills are horrendous.  We're not

     5    getting any help from the government, and I'm sorry. 


     6    Today at lunch when you all left and you went across

     7    the hall, I think you had a lunch.  Hey, the veterans

     8    have traveled up here.  We've gone at great expense. 


     9    We've been messed around by the government, pushed

    10    down on  psych. reasons.  We can't afford to eat here. 

    11    If we get a hospitality room we get in trouble if we

    12    bring in food from across the street.


    13                This has not been a user friendly meeting,

    14    and you need to change that.  We're sitting up here,

    15    standing up, holding onto this.  I've had chest pains


    16    today.  I've been sick.  I've been flushed with

    17    whatever my fever is waiting my turn.  You don't even

    18    have a table and a chair for us, and you rush us

    19    through our documentation for you.


    20                So you need to think how you're treating

    21    us, too.  I'm tired of people being labeled

    22    psychiatric patients.  It's like it was pre-termed to


    23    happen.  That's what's scary, when you sit here and

    24    look at things and you know the first thing they

    25    pushed everybody through was get that psych. bill


                                                                        266

     1    through the VA or through the DOD, you know, and then


     2    you can have a neuro. eval., but everybody, almost

     3    everybody had to go to psych.  It was like they were

     4    going to write us off as psych.

     5                I'm sorry.  We were highly trained.  I


     6    don't know what's going on, but it sure is scary out

     7    here, and we want answers and we can't wait much

     8    longer.  We're sick, physically not mentally.  Okay?


     9                CHAIR LASHOF:  Thank you.

    10                Are there questions?

    11                (No response.)

    12                CHAIR LASHOF:  Okay.  Thank you very much.


    13                Reina Duval, Reina Duval.  I guess she has

    14    left.

    15                Robert Slavin.


    16                MR. SLAVIN:  My name is Robert Slavin. 

    17    I'm speaking on behalf of SIC, Save the Innocent

    18    Children, and currently I'm assigned to Fort Meade,

    19    the Fort Meade Military Police.


    20                I'd like to thank the members of the

    21    committee for the opportunity to convey my feelings on

    22    what has been a trying four years.  I would also like


    23    to, due to time, there are other members of this group

    24    that were going to speak, and due to a mis-scheduling

    25    I was put in at the last minute, but there's a


                                                                        267

     1    Sergeant Brad Mins also from Fort Meade who won't get


     2    a chance to speak.  You have his letter along with his

     3    wife's.  Also another family that this is the second

     4    anniversary of a miscarriage of their first child. 

     5    They were unable to make it for emotional reasons,


     6    also staying home taking care of their second child

     7    who is developmentally or born with severe birth

     8    defects known as Goldenhar Syndrome.


     9                In April of 1991, I was deployed to

    10    northern Iraq for Operation Provide Comfort, which has

    11    been overlooked by many people as part of the Persian

    12    Gulf War.  My unit at the time was the 284th MP


    13    Company under the 18th MP Brigade stationed at

    14    Frankfurt, Germany.  Our mission was to provide

    15    humanitarian service and support for the resettlement


    16    of the Kurds out of the northern mountains as well as

    17    security against the Iraqi military.

    18                My time spent in Iraq was very self-

    19    rewarding, in knowing the large numbers of devastated


    20    Kurds that our military assisted.  I am confident in

    21    saying that the majority of people in this room today

    22    will never know first hand the effect our U.S. troops


    23    had on hundreds of thousands of people in need.

    24                For this reason alone I can stand proud

    25    and say I'm glad I was part of this humanitarian


                                                                        268

     1    effort.


     2                My return to Frankfurt, Germany was brief. 

     3    In December of 1991, I returned to CONUS and was

     4    stationed at my present duty station at Fort Meade,

     5    Maryland.  In March of '93, my wife Brenda and I were


     6    blessed with the news of our first child due in the

     7    coming November.  We had everything we wanted and

     8    thanked God for our gifts.  This feeling was soon


     9    shattered with fear after the first ultrasound

    10    revealed the baby had enlarged kidneys.  Additional

    11    ultrasounds later revealed a diaphragmatic hernia.

    12                Our daughter Amanda was born on November


    13    6th, 1993, with multiple birth defects which according

    14    to the geneticist was classified as FRINS syndrome,

    15    which is a parallel syndrome of Goldenhar.


    16                Amanda underwent eight major operations,

    17    approximately seven months of her first year spent in

    18    the hospital.  During this time, Brenda and I stood by

    19    Amanda and watched her overcome every obstacle thrown


    20    at her.  We were anxious to learn every need Amanda

    21    would have, and in doing so we questioned every avenue

    22    of what could have caused Amanda's condition.


    23                The one question of could this have been

    24    Gulf War related was asked several times to a large

    25    number of doctors and geneticists.  Each time the


                                                                        269

     1    answer was immediately answered no.


     2                Amanda's fight ended five days shy of her

     3    first birthday where mismanaged care and misdiagnosis

     4    was too much for her small body.  

     5                During the above time frame and up until


     6    presently  I have undergone testing for various health

     7    reasons.  In 1992 I noticed a cyst on my right

     8    testicle.  An ultrasound revealed the cyst to be


     9    present.  However, it was dismissed by the military

    10    hospital as being of no concern, although recently

    11    I've discovered in the Encyclopedia Britannica that a

    12    cyst on the testicle can be the cause of birth


    13    defects.

    14                I also have a cyst on my left knee, which

    15    again was dismissed by the military hospital as being


    16    in a bad spot so they didn't want to deal with it,

    17    thus having no regard for my pain.  One captain at

    18    physical therapy even mocked my ailment because I

    19    showed good strength in my leg.


    20                I have developed rashes, occasional

    21    burning of semen, pain in my joints, fatigue,

    22    headaches, tiredness, and a loss of vision.  So far my


    23    condition has not hindered my physical ability to

    24    work, although my work performance has suffered.

    25                In the course of the past four years, I


                                                                        270

     1    have seen what I consider a total disregard for the


     2    men and women that fought for our country.  Testing by

     3    a committee that is selective and prejudiced and

     4    finding true answers as opposed to the accurate

     5    answers, answers that suit the government and the


     6    multi-billion dollar pharmaceutical corporations,

     7    leaving the unseen faces of the families behind those

     8    statistical numbers to wonder why they have lost all


     9    sense of security and trust from the so-called

    10    humanitarian government, a government that does not

    11    hesitate to assist a foreign country but in the same

    12    breath fights to dispute the claims of so many of its


    13    own nation.

    14                Although I stand for all the servicemen

    15    and women that answered the call of their country, my


    16    main focus is on the children of those brave men and

    17    women.  These are the victims of total innocence that

    18    are suffering with a total disregard of the

    19    seriousness and urgency of their care.


    20                In February 1994, Brenda and I attended a

    21    committee hearing where I was afforded the opportunity

    22    to speak.  I stated that the programs were not


    23    reaching the people they were meant for, and that

    24    while your studies may take years, people are still

    25    suffering.


                                                                        271

     1                After that hearing several people thanked


     2    my wife and I for coming forward.  One of those people

     3    was a committee representative from the VA.  She

     4    offered her support and stated she would assist in any

     5    way to get my wife and I tested through the VA.  Only


     6    later did we find out that the empty offer fell to the

     7    system, not allowing the VA to test the spouse of an

     8    active duty member.


     9                After the conflict of interest with my

    10    daughter's care at Walter Reed Army Medical Center,

    11    there was no possible way we would go to the same

    12    hospital for Gulf War testing.  This type of pacifying


    13    by officials has been a constant stumbling block for

    14    not only my family, but for the many families we have

    15    met throughout this ordeal.


    16                I would like to leave you with this

    17    thought while you are planning the government's next

    18    course of action.  Since the last committee hearing my

    19    wife and I have learned that we are expecting a second


    20    child.  This child has also been diagnosed with the

    21    same severe birth defects Amanda had with virtually no

    22    foreseen chance of survival.  So for anyone that


    23    thinks because they have children of their own that

    24    they know how we feel, let me remind you that while

    25    your children sit on your lap or on your chair, my sit


                                                                        272

     1    in an urn on my shelf.


     2                You can't possibly know how these families

     3    feel or the day-to-day fear that they live in.  So

     4    please help these families and let these urns in my

     5    house be the last.  You might wish that we'd just go


     6    away, but I want to clarify that parents fighting for

     7    their children will never end.  That's the feeling

     8    that those of you with children might rightfully


     9    understand.

    10                I've got a couple of photos.  One second.

    11                CHAIR LASHOF:  It's okay.

    12                MR. SLAVIN:  Previously the committee


    13    talked about quality care.  You should take a trip to

    14    the hospital in D.C. to see the quality of care they

    15    give.  I'd like you to see the quality they have.  It


    16    stinks.

    17                CHAIR LASHOF:  Thank you very much.  Does

    18    anyone have any questions for Mr. Slavin?

    19                (No response.)


    20                CHAIR LASHOF:  Thank you.  We appreciate

    21    your coming and understand the emotional pain you're

    22    suffering.


    23                I believe Reina Duval has come into the

    24    room, and if so, I would call on her now.  Reina

    25    Duval.


                                                                        273

     1                MS. DUVAL:  Yes, ma'am.  Good afternoon. 


     2    I wanted to first tell you I was with the 4th Civil

     3    Affairs Group.  I was a lieutenant colonel in the

     4    United States Marine Corps Reserves, and it was a

     5    pleasure to go out and serve my country because that's


     6    what I signed up for when the occasion presented

     7    itself.  However, I was very much dismayed and broken

     8    hearted to see the treatment of Reservists while on


     9    active duty.

    10                One of these came across particularly in

    11    the processing out of active duty where a female major

    12    whose duty it was to accelerate the processing came to


    13    do that at El Jubail in Saudi Arabia.  I don't recall

    14    the young lady's name.  I do have a picture of her so

    15    I would be able to find out who she is, but it


    16    appeared that no one was quite concerned with the

    17    medical disposition of individuals as they were

    18    leaving the active service.  Our people were 13 days

    19    away from having 180 days active duty.  We had a lot


    20    of young troops who had various and sundry things

    21    wrong with them, some that happened while they were in

    22    Saudi Arabia, broken bones and operations that didn't


    23    go well, ankles that didn't set properly, who because

    24    they were young were afraid that the Marine Corps

    25    would throw them out or their employer wouldn't --


                                                                        274

     1    they would no longer be employable if they didn't hush


     2    up about it. But they didn't get medical care coming

     3    out.

     4                While I was there, a rather active,

     5    healthy individual -- at least I used to be -- my


     6    hands would get so rigid I couldn't open my sleeping

     7    bag in the morning.  Now, to not be able to open your

     8    sleeping bag when you're under threat is kind of


     9    serious.  I would stand up on my feet and couldn't

    10    feel my feet and would fall down on my face.  This

    11    happened frequently.

    12                Now, I did have a slight bit of arthritis


    13    since 1972, nothing that ever prevented me from doing

    14    anything.  Change my diet; just don't have a lot of

    15    fat and fruits and what have you; never any problems


    16    with it.  I go over there, and all of a sudden

    17    everything is accelerated.

    18                My blood pressure, I ended up with blood

    19    pressure that was well above what my blood pressure


    20    normally is.  It's usually 90-something over 60-

    21    something.  My blood pressure was like 128 over 90-

    22    something.  It stayed that way constantly.  It's been


    23    that way every since.

    24                When I came back I had numbness in my

    25    hands.  I felt as if I had my finger in a light socket


                                                                        275

     1    all the time.  As time went on it dissipated some, but


     2    just this past weekend my hands were numb.  My hands

     3    all the way up to here were numb.  They just go off

     4    and on.  I can't tell you when it's going to happen. 

     5    It just does it, you know.  There's no reason for it.


     6                It wasn't until this past January that I

     7    was able to get more than two hours' sleep at one

     8    time.  For four and a half years I have not been able


     9    to sleep.  I sleep two hours, get up, sleep two hours,

    10    get up, sleep two hours, get up.  I can't sleep, and

    11    I wake up wide awake, and I walk around exhausted,

    12    irritable.


    13                It costs me approximately 50 to $60 a

    14    week, $20 twice a week for shots.  I have arthritis

    15    medicine that doesn't do all that much anymore.  You


    16    know, I lost my voice a couple of days ago, just lost

    17    my voice.  It just goes off and on.

    18                I mean I don't have things that make any

    19    sense.  It's just a bunch of irritating things that


    20    keep me from feeling like a healthy person.  The colds

    21    that I used to get in the winter are now asthma and

    22    allergies and other kinds of things, and that happened


    23    as soon as I came back in the fall.  It says in my

    24    medical plan it is out of plan.  If you're familiar

    25    with that, it means that I have to pay for it out of


                                                                        276

     1    my pocket.  So I'm paying $50 a week out of my pocket,


     2    and my medicine costs me about $320 a month.  Half of

     3    it is not something that the medical plan pays for,

     4    and we have a pretty decent medical plan.

     5                I'm a stock broker in my other life, but


     6    you know, this is just out of pocket all the time, and

     7    I feel like I'm getting something in my chest now.  So

     8    tomorrow I've got to go to the doctor for the shot and


     9    for that.

    10                I have troops who I must say were mentally

    11    very much on an even keel before going to Desert

    12    Storm, and they seemed pretty much like they were on


    13    an even keep when they were there.  They're not on an

    14    even keel anymore.  I know a couple of folks who are

    15    homeless.  I know a couple of folks who tried to


    16    commit suicide, and these were not people who were

    17    slightly off.

    18                I recall, too, getting anthrax shots when

    19    I was overseas.  They refused to put them in our


    20    medical records.  I insisted that something be put in

    21    my medical records since I was being given some kind

    22    of medicine and I didn't know what it was.  I finally


    23    got one corpsman to put one of my three shots in my

    24    medical record.

    25                All of our packages of our medicine was


                                                                        277

     1    collected before we left.  There were just things that


     2    did not make you feel like folks were taking care of

     3    you.  When I came back off of active duty, I was home

     4    about two weeks.  I was called in my office by a

     5    lieutenant colonel Marine who asked me if I wanted to


     6    spend 179 days on active duty.  If you understand the

     7    significance of that, why would someone ask me if I

     8    wanted to spend 179 days of active duty as opposed to


     9    176 or 181?  I think there's an issue of economics

    10    there, but I found it insulting.

    11                In case you don't know what the

    12    significance of that is, it means you don't have any


    13    benefits or what have you if you don't have 180 days.

    14                For my troops not to get full physicals

    15    before they left active duty and they only had 13 days


    16    before they had 180 days, it makes me suspicious.  It

    17    doesn't make you feel like the service that you care

    18    for so much, the country that you care for so much is

    19    taking care of you.


    20                Now, I am not interested in any admin.

    21    discharge.  I'm not interesting in crying any stories. 

    22    I am just not interested in having to pay for a whole


    23    lot of medical bills that I don't think was my own

    24    normal physical way, my own normal health.

    25                I was an extremely healthy, vigorous


                                                                        278

     1    person before, and now I am also seeing a therapist


     2    for irritability.  I have mood swings that go like

     3    this, okay?  One moment I'm fine.  The next moment I'm

     4    doing something else over here.  I was not like that

     5    before.


     6                So I'm trying to find out -- trying to get

     7    an even keel in my life, and on one occasion I spoke

     8    with an individual whose husband had been to Desert


     9    Storm who was in the Air Force who flew, and he was in

    10    Riyadh, and I started talking to her about some of the

    11    -- she asked me did I have any after effects from

    12    Desert Storm, and I told her some of the things I had. 


    13    He had some of the same things also, and he had never

    14    stepped foot in Kuwait.  I thought that was

    15    interesting.


    16                So my own summation was the one thing that

    17    we all did, it was intake nerve pills, anthrax shots

    18    and all these other things that no one could quite

    19    tell us what it was.  I was told that if you did not


    20    take the medicine, if something happened to you and

    21    there was a biological threat, then your relatives

    22    would not get any of the monies from your insurance


    23    and so forth.  So it's kind of like darn if you do,

    24    darn if you don't.

    25                So I kept a log of the pills I took. 


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     1    There were so many of them.  Even if someone was


     2    trying to keep track of it, it's very difficult to be

     3    in a situation where there's a lot of confusion

     4    because of threat of life and to have to keep a log

     5    book to know when to drink what when because it was


     6    extensive, what we have to take, and I dare say

     7    someone who is a private or a lance corporal might

     8    have a little bit more problem trying to keep track of


     9    what kind of medicine they're supposed to take when.

    10                I do think and I feel in talking with my

    11    troops that I served with over in Desert Storm no one

    12    has an interest in bleeding the government.  I know I


    13    don't.  I've had a lot of folks ask me, "Well, why

    14    doesn't the government do something?"  And I said,

    15    "Well, if you have half a million people get sent to


    16    war, that would break the government.  I don't think

    17    anybody is interested in doing that, and I don't think

    18    it's very practical."

    19                At the same time, if you want people to


    20    serve, you take care of them.  I do know for a fact

    21    that my troops were up on the front.  Reservists were

    22    put a lot of times up on the front because they said


    23    since there were going to be a lot of casualties, let

    24    them go, you know, and there was a lot of resentment

    25    for that.  Okay?


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     1                Make it half and half.  Do something


     2    that's equitable.  Don't make people feel that they're

     3    some second class citizen.

     4                It costs me --

     5                CHAIR LASHOF:  Your time is up.


     6                MS. DUVAL:  Right.  It cost me about

     7    $110,000 to go to this war.  Okay?  And it cost a lot

     8    of the troops, I know, who were students.  If you went


     9    a salaried employee, you did not get any salary from

    10    your employer.  If you were a student, some of the

    11    students had to repeat the school.  Some of the

    12    students had to miss a whole semester. 


    13                Some continuity of how that is going to be

    14    taken care of would have been helpful for the troops

    15    that are in school, especially the young ones who


    16    don't have any alternatives. 

    17                Okay.  So I thank you very much for

    18    listening to my comments, and have a good day.

    19                CHAIR LASHOF:  Thank you.


    20                Are there any questions for Major Duval?

    21                (No response.)

    22                CHAIR LASHOF:  If not, thank you very


    23    much.

    24                I think that completes all the testimony

    25    for today.  We will adjourn in just a minute or two. 


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     1    I just want to review the schedule for tomorrow for


     2    any of you.  It's an open meeting.  We will start

     3    against at 9:00 a.m.  We will begin with a briefing

     4    from the Institute of Medicine of the National Academy

     5    of Sciences, who will review their two studies that


     6    they have been doing and reviewing the activities.

     7                Then we will move into a discussion of the

     8    Advisory Committee's goals, our objectives, and our


     9    strategies, and essentially determine our game plan as

    10    we go forward in this study.

    11                Thank you all for coming, and we stand

    12    adjourned.


    13                (Whereupon, at 5:17 p.m., the meeting was

    14    adjourned, to reconvene at 9:00 a.m., Tuesday, August

    15    15, 1995.)
