Hearing of the Subcommittee on Oversight and Investigations of the House Veterans Affairs Committee - "Gulf War Illness Research: Is Enough Being Done?"

Statement

Chaired By: Rep. Harry Mitchell (D-AZ)

Witnesses: Panel I: James A. Bunker, President, National Gulf War Resource Center, Topeka, Kansas (Gulf War Veteran); Paul Sullivan, Executive Director, Veterans for Common Sense; Richard F. Weidman, Executive Director for Policy and Government Affairs, Vietnam Veterans of America; Roberta F. White, Ph.D., Scientific Director, Research Advisory Committee on Gulf War Illnesses, Professor and Chair, Department of Environmental Health, Associate Dean for Research, Boston University School of Public Health; Lea Steele, Ph.D., Former Scientific Director, Research Advisory Committee on Gulf War Veterans Illnesses, Adjunct Associate Professor, Kansas State University School of Human Ecology; Panel II: Robert D. Walpole, Former Special Assistant for Persian Gulf War Illnesses Issues, Office of the Assistant Director of Central Intelligence, Central Intelligence Agency; Loren J. Fox Jr., Former Senior Analyst for Gulf War Illness Issues, Central Intelligence Agency; R. Craig Postlewaite, DVM, MPH, Deputy Director, Force Readiness and Health Assurance, Force Health Protection and Readiness Programs, Office of the Assistant Secretary of Defense (Health Affairs), Department of Defense; Lawrence Deyton, MSPH, M.D., Chief Public Health and Environmental Hazards Officer, Veterans Health Administration, Department of Veterans Affairs; Joel Kupersmith M.D., Chief Research and Development Officer, Veterans Health Administration, Department of Veterans Affairs; Mark Brown, Ph.D., Director, Environmental Agents Service, Office of Public Health and Environmental Hazards, Veterans Health Administration, Department of Veterans Affairs

Copyright ©2009 by Federal News Service, Inc., Ste. 500, 1000 Vermont Ave, Washington, DC 20005 USA. Federal News Service is a private firm not affiliated with the federal government. No portion of this transcript may be copied, sold or retransmitted without the written authority of Federal News Service, Inc. Copyright is not claimed as to any part of the original work prepared by a United States government officer or employee as a part of that person's official duties. For information on subscribing to the FNS Internet Service at www.fednews.com, please email Carina Nyberg at cnyberg@fednews.com or call 1-202-216-2706.

REP. MITCHELL: Good morning. And welcome to the Subcommittee on Oversight and Investigations of the Veterans' Affairs Committee. And this is a hearing on Gulf War Illness Research: Is Enough Being Done? This is May 20 -- excuse me, May 18th, and this meeting will come to order. (Sounds gavel.)

Mr. Kucinich -- oh, Mr. Kucinich is here. I will ask for him to sit at the dais.

Unfortunately, Dr. Roberta White could not be in attendance today. I ask unanimous consent that her statement be submitted for the record. Hearing no objections, so ordered.

Thank you everyone for attending today's Oversight and Investigations Subcommittee hearing entitled, "Gulf War Illness: Is Enough Being Done?" We meet today to shed light on a topic that is critically important to the House Committee on Veterans' Affairs; the health and care of our Gulf War veterans. This hearing is not the first to address Gulf War illness, and it certainly will not be the last. Today's is the first in a series of Oversight and Investigations subcommittee hearings, examining the impact of toxin exposures during the 1990-1991 Persian Gulf War and the subsequent research and response by government agencies including the Department of Defense and Veterans Affairs. It has been almost 19 years since the United States deployed some 700,000 service members to the Gulf in support of Operation Desert Shield and Desert Storm. When these troops returned home, some reported symptoms that were believed to be related to their service. Still today, these same veterans are looking for answers about proper medical treatment and the benefits that they bravely earned.

While we hear about numerous studies and millions of dollars spent on the Gulf War illness research, many questions remain unanswered. In the end, we still don't know how to respond to Gulf War veterans who ask: "Am I sick or will I get sick?"

Today, we'll attempt to establish an understanding of the research that has been conducted and the actions that have been taken in relation to the Gulf War illness. To better assess Gulf War illness and its impact on veterans, we will look at another at-risk population, veterans who were exposed to the harmful toxins, Agent Orange, in Vietnam.

In the past, we have seen service-related illnesses ignored, misunderstood, or swept under the rug. We must learn from these mistakes, and ensure that our research and conclusions are accurate so that Gulf War Veterans are assured of the right diagnosis and the care and benefits they richly deserve.

Subsequent hearings on this issue will take a multi-level of methodology and conclusions of Gulf War illness research, and how the review of information was compiled and why certain methods were employed. With a growing chorus of concern over the accuracy of existing research, and with the new administration leading the VA, it is time for us to make a fresh and comprehensive assessment of this issue and the body of research surrounding it.

We will hear testimony today from a Gulf War veteran, Veterans Service Organizations, a distinguished researcher from the Research Advisory Committee on Gulf War illness, as well as government officials. I would like to thank all of our witnesses for appearing here today. I'd also like to extend my thanks to Jim Binns, who chaired the Research Advisory Committee on Gulf War Veterans' Illness, for his contribution to this hearing and to this issue.

I trust this hearing will provide useful insight to begin our evaluation of the existing research on toxic exposure and the work being done to care for Gulf War veterans and protect future generations of war fighters.

Before I recognize Ranking Republican Member for his remarks, I would like to swear in our witnesses. I ask all of our witnesses from both panels that they would please stand and raise their right hand.

(The witnesses were sworn.)

REP. MITCHELL: I ask unanimous consent that Mr. Kucinich not only be invited to the dais for the subcommittee hearing today. If you'll -- he's joined us, and if there's no objections -- so ordered. Thank you, Mr. Kucinich.

I'd like to now recognize Dr. Roe for his opening remarks.

REP. DAVID P. ROE (R-TN): Thank you, Mr. Chairman, for yielding. My understanding is that this will be the first in a series of hearings on Gulf War illness to be held by our subcommittee. It's my hope that we will not ignore other pressing oversight issues previously agreed upon in our oversight plan in order to flush out issues already discussed previously by other committees and subcommittees over the past 12 (years) to 13 years.

This first hearing will focus on the historical context of the war in the Persian Gulf, Operation Desert Shield, Operation Desert Storm, which occurred from August 1990 through July of 1991. This will be a review of the conflict and overview of the types of exposures and assistance made available to veterans from that conflict.

The ranking member of the full committee Congressman Steve Buyer of Indiana is a veteran of the Gulf War, and has invaluable historical and personal knowledge of the conflict and what Congress has done since the early 1990s to assist veterans of the Persian Gulf. I'm sure he will be watching these proceedings with great interest.

Much of the historical background of the Gulf War veterans can be found in the wealth of materials available through printed hearings held by the committee as well as the body of legislative work that has been done by Congress through the past two decades. Over the past 20 years, Congress has held numerous hearings and passed several public laws, extending back as far as 103rd Congress to address the needs of these particular veterans.

These efforts include mandating a study by VA through the non- partisan National Academy of Sciences and their Institute of Medicine in the effects of various chemical compounds, pesticides, solvents and other substances on human -- humans in particular, how these compounds may've affected veterans who participated in the Persian Gulf conflict.

Ranking Member Steve Buyer led the efforts of the 105th Congress for offering an amendment, which ultimately was included in Public Law 105-85, the National Defense Authorization Act for Fiscal Year 1998. Mr. Buyer's amendment authorized $4.5 million to establish a cooperative DOD/VA program of clinical trials to evaluate treatments which might relieve the symptoms of Gulf War illnesses, and required the secretaries of both the Department of Defense and the Veterans' Affairs to develop a comprehensive plan for providing health care to all veterans, active duty members and reservists who suffer from symptoms of Gulf War illnesses.

I've been informed that the authority to conduct these studies mandating the law to be completed by the National Academy of Sciences Institutes of Medicine will expire this year. I believe, this committee should look at the -- these hearings with an emphasis on whether the study should be continued. And if so, what the parameters of any new studies on Gulf War illness should be.

I look forward to our hearing of our panel of witnesses today and anticipate the next hearing in this series. And Mr. Chairman, I bring a unique perspective being a physician -- being a battalion surgeon, and also really looking at this completely objectively -- I haven't had any testimony one way or the other, so I can listen to these participants today completely objectively. I yield back the balance of my time.

REP. MITCHELL: Thank you. Next, Mr. Walz.

REP. TIMOTHY J. WALZ (D-MN): Thank you, Mr. Chairman. In the interest of time, I'll just submit my opening statement to the record. And I yield back.

REP. MITCHELL: Thank you. Mr. Hall.

REP. JOHN J. HALL (D-NY): Thank you, Mr. Chairman, Ranking Member Roe. I also look forward to the testimony of our witnesses, but note with interest that after -- I mean, after the Vietnam War passed, it reached a point where the VA decided that there was a need to provide a presumed stressor to connect Agent Orange caused illnesses automatically to the exposure caused by being in theater.

Currently, I'm sponsor and our subcommittee is looking at legislation to establish the same thing currently for OIF/OEF connections to post traumatic stress and other traumas that come from that particular type of conflict. And it may be that the same thing will be shown from the testimony here.

So I'm looking forward to finding out exactly what kind of sacrifice and exposure our service men and women did -- were exposed to, and I look forward to our doing best -- doing right by them.

And thanks again for holding this hearing.

REP. MITCHELL: Thank you. Mr. Kucinich.

REP. DENNIS KUCINICH (D-OH): Thank you very much, Mr. Chairman. I want to thank you and Ranking Member Roe for affording me the opportunity to give a statement today, and more importantly, for doing a thorough examination into this topic.

At least one out of every four of the 700,000 soldiers sent to fight in the first Gulf War, suffers from Gulf War Veterans' Illnesses. One out of every four bears the permanent burden of at least one of the following; persistent memory and concentration problems, chronic headaches, widespread pain, gastrointestinal problems and other choric abnormalities that are difficult to define, let alone treat.

One out of every four is faced with trying to work, sleep, love, learn, and grow, despite not being able to think clearly, not being able to get rid of the pounding in their heads, and despite being in a nearly constant state of general pain.

As these veterans begin to age we're starting to see that they suffer elevated rates of ALS, Lou Gehrig's Disease. It's a disease that rewards their dedication to country with a long, slow, painful, physical demise in which they watch their own arms and legs become increasingly -- decreasingly functional. And their dependence on a caregiver grows.

The toll is far more than physical. I'm sad to say that it's not entirely surprising, as has been the case again and again, our heroes are celebrated in time of war. They're elevated for their willingness to risk their lives for hundreds of millions of people, the vast majority of whom they've never met, never seen. But several years down the road, if we're not still at war, they tend to be forgotten.

Such was the case with the Gulf War veterans. They endured years of denial that they even had a health problem. They then endured years of insistence from the very agencies that thrust them into war, that their problem was psychological. Then when it was finally admitted that Gulf War veterans' illnesses were real, and more than a result of mental trauma, they continued to be denied care.

By that time they'd been forgotten. The tens of millions of dollars in research funds that were focused almost entirely on a wrong cause, mental trauma, began to dry up. Only the assiduous efforts on the part of my former colleagues in the House, Congressman Shays (ph) and Sanders, kept a trickle of money flowing through the Department of Defense's congressionally directed medical research program.

When my time came to pick up the mantel in 2005 and increase these funding levels, I was more than happy to do so. Though the amount we have won through our bipartisan efforts is nowhere near where we need to be, the money was well spent attracting national research talent and dozens of exciting proposals.

With each passing year, I'm more optimistic that treatment options will be identified for our Gulf War veterans. This research will have the added benefit of informing efforts to treat and cure civilians who suffer from similar diseases. Because we have the epidemiological luxury of knowing some of the main unique exposures these soldiers endured, we've already been able to identify two definite causes of Gulf War veterans' illnesses, exposure to pesticides and a drug given to troops to protect them from nerve gas.

Other possible causes include low level exposure to nerve agents, close proximity to oil well fires, receipt of multiple vaccines and combinations of these exposures. These findings should lead to the reduction of the exposures, many of which are found in our everyday lives in the general population, preventing similar diseases from ever happening.

And this valuable information will help uncover the underlying biological mechanisms which could lead directly to new drug therapy for all who suffer from the same afflictions. Clearly, we need to get the research right. And the need to get it right is urgent and far overdue, which is why this hearing's -- this series of hearings is so critical Mr. Chairman.

I want to commend you for your leadership. I'd also like to offer my gratitude to the scientists, advocates, and public servants giving testimony here today for their tireless work. I'm looking forward to working with all of you to right this wrong.

Thank you, Mr. Chairman, yield back.

REP. MITCHELL: Thank you. I ask unanimous consent that all members have five legislative days to submit a statement for the record. Hearing no objections, so ordered.

At this time I would like to welcome panel I to the witness table. Joining us on our first panel is Jim Bunker, a Gulf War veteran and president of the National Gulf War Resources Center. Paul Sullivan, executive director of Veterans for Common Sense. Rick Weidman, executive director for Policy and Government Affairs. As well as Dr. Lea Steele immediate past scientific director for the Research Advisory Committee and adjunct associate professor at Kansas State University School of Human Ecology.

And I would ask that all witnesses please stay within five minutes of their opening remarks. Your complete statements will be made part of the hearing record.

At this time I would like to recognize first Mr. Bunker then Mr. Sullivan, Mr. Weidman and then Dr. Steele.

Mr. Bunker.

MR. BUNKER: Mr. Chairman and members of the committee, on behalf of the National Gulf War Resource Center and myself, I'd like to thank you for letting me be here. I want to first give you a brief background of myself.

In 1977, I completed high school in three years. In 1984, I received my Bachelor's degree in Mathematics with a minor in Psychology and Computer science. Also I was able to get A's and B's through college without hardly opening a book. I was able to retain most information from class lectures with ease and translate it to exams. Computer and math were my best classes and I started playing chess in the 7 grade and played in tournaments and continued up through and before the war.

After teaching for a few years, I applied for and was accepted to Officer Candidate School, was commissioned as a Field Artillery Officer. I went to Fort Sill for OBC where I was one of the top graduates and brought onto active duty and then stationed at Fort Riley, Kansas. I deployed from Fort Riley, Kansas to the Gulf war.

In the beginning of the war, our M8 alarms sounded many times and we were being told that it was batteries malfunctions and what have you, and that. So we finally just quit putting them up.

At the end of the war, we blew up large amounts of ammunition dumps and I started to get sick. I became so ill I started having convulsion and was treated for -- with atropine and evac'ed out to the 410th Evac Hospital back in Saudi Arabia.

Later on, I found out the symptoms that I was having, the convulsions and all this other symptoms going with it were actually listed in a book for nerve agent stuff -- problems to look for as probable nerve agent poisonings and that. On June 22nd I went to the VA for help with my problems, because I was medically discharged from the Army, I was having problems in the army with my legs -- nerve problems in my legs and that.

And they could not find a problem that was causing it. So they sent me before a medical evaluation board and while my records were before that board, I lost the use of my right hand due to the extreme pain or -- I'm sorry -- my left hand due to the extreme pain that I had in it. And being left-handed, that left me not much I could do.

And then -- so the Army threw me out, which ended my 15-year career of something that I always wanted to do, and I would love to be back in doing again, and that. When I went to the VA, not only did I have problems with my left hand and my legs, I also had -- since had symptoms with numbness and weaknesses and tinglings in my arms and legs, headaches, cognitive dysfunctions, Gastro reflux disease, fibromyalgia, sores, and skin peelings in the roof of my mouth, skin rashes and sinusitis.

My right hip pain wakes me up two hours almost every night. As I lay in bed with this problem, I have troubles with both my arms having that falling to sleep numbing feeling. All of these greatly limit my activities and continues to my desire to ensure that this issue -- I'm sorry, I do have problems when it comes to reading -- my desire to ensure that these issues are addressed and a cure is found.

It is hard to live a life where when you are talking so normally one minute and in the next minute you can't make a sentence to save your life. It is also true when it comes to trying to write things out. When you have my -- when my cognitive problem starts to set in for that day, I may think I'm typing one thing, and then when I read it the next day, it turns out to be something that just doesn't make any sense at all.

I also no longer play chess, a game that I truly love. It's hard to play a game where you have to be able to think three and four moves ahead and now you can barely even think of the move that you're just about to make. Along with many other veterans, we have sensitivities to smells like perfumes, colognes, hairsprays and etc. Often, when I went to test in clinics with the VA, some of the workers had so much of the stuff on, it made me sick.

In January of this year, I had my bedroom painted. I forgot to tell them that I needed them to use low odor paint. The fumes from the paint made me so sick for the next few weeks, I had to stay in my basement, so that I was as far away from the smells as I could.

Often, the VA likes to tell me that this is all in my head, or it's depression. I tried to talk to one of my doctors about my problems and about new studies showing that the depression is not -- and when I tried to give her the first RAC report to point out some of the studies, she told me that "Jim, we need to agree just that we have to disagree on this point." And I told her I needed a new doctor. My psychiatrist, Dr. Rot (ph) who talked to me about PTSD had told me also that I should be like most veterans with PTSD and divorce my wife, which I refused to do.

In 1995, I went to the Gulf War illness clinic in Houston, Texas. This was a place that was to look at everything fresh; to draw its own conclusion. I saw my charts before they even started and they already listed as depression as my main problem. How can we get fair treatment before a doctor sees us they say we're depressed? The same doctor came one day to give me a report on a blood test. Some of the levels was up, but she told me it was because I -- excessive use of alcohol. Now, she was surprised when I told her I don't drink. How can they give us any fair treatments when they are doing diagnoses like this?

At one point I was concerned about medication prescribed to me. With my wife's help, I was able to get off half of the medication, being that they were -- they did not make me any worse when I'm off them.

Over the last few years, veterans called me about getting on the Gulf War registry exam -- many of the veterans were having problems. So I went to my local VA to try and get on the exam and that. I got the run around from my local VA about this exam. The third person I went to on this exam told me he didn't do it either and could send my name and information to who did it. I asked who that person was, he refused to give me the information.

I told him who I was. I was the president for the resource center and investigating as to why veterans are having a hard time getting on this exam. He went off on me and told me to behave myself. So I went to the director and introduced myself. The director assured me things will be taken care of. I had to fight hard and it wasn't -- I would get a call from the patient affairs person, patient representative person who gave me a name and number. I called that name and number over three weeks.

I never got a call back.

When I went to the office, she said she didn't do it either and that. So the director's office called me and I said problem wasn't taken care of. I finally got the exam paperwork. First question on the exam paperwork was "When were you in Vietnam?" Really pissed me off because of the fact I'm sitting there trying to get on the Gulf War exam, and that. The exam itself is a big joke. They asked me questions about the dead, dying and MIA. They don't ask me questions about why -- do I have headaches, if so, how often and how long? They don't ask questions about cognitive dysfunctions and that.

The questions should be addressed differently the way they are. The results of these exams should be kept on file not only of what problems veterans are having under undiagnosed illnesses. They should be also put into listings of what they've been diagnosed with so that -- and given to the VA secretary in the (OIM ?) and the RAC report so that there is a clear file showing the diagnosed illnesses so that presumptive service connections can be also given to us veterans who are having this -- it's like my fibromyalgia and other things.

There are a lot of veterans I know who are having problems with Parkinson's disease and MS, which isn't service connected and it should be. Finally, I deal with a lot of veterans daily who are having problems with their Gulf War claims and that.

My claim went through relatively easy in 1993, when they decided to drop 12 issues I had which are all now listed as part of Gulf War illness and they gave me a 100 percent unemployability and that. If I got veterans whose claims right now are being denied because of chronic fatigue and fibromyalgia, two presumptive service connection for Gulf War veterans and the raters are saying, well you got the claims you got that disease too far out of the time frame and that it's too late to claim to put that in service connection.

Well, the time frame isn't ending -- isn't until December 31, 2011, that's two and a half years from now. You also got other veterans whose claims are being denied, because the raters are telling them that you have to have a combat ribbon or you have to have a 'V' for valor device in their 201 files. That's bull. I'm sorry, I'm getting really personal about this. This is something that's really to me and these are problems that are happening, and not just to me but other veterans, and that.

REP. MITCHELL: Okay, thank you.

MR. BUNKER: Okay. This isn't a requirement for Gulf War illness. It's not. And we need real help and real care. This last commission that you guys passed that the VA is to have that's supposed to look into problems Gulf War veterans are having with their claims, it's not doing its job.

When you have the chairman of that board sitting there in a meeting saying that Congress should never have passed a law dealing with Gulf War illness and compensating veterans for Gulf War illness, how is he going to be really objective in what he has? He's not going to find -- look for problems. He's not going to these VAs that are doing this injustice to the Gulf War veterans.

He is doing though a good job for the returning veterans. I do have to credit him for that. But I think that board needs to be re- looked at and reworked and the people on it need to be kicked off and put on Gulf War veterans and not some of the people that are on that board.

REP. MITCHELL: Thank you.

MR. BUNKER: Thank you.

REP. MITCHELL: Thank you very much. Mr. Sullivan.

MR. SULLIVAN: Veterans for Common Sense thanks Subcommittee Chairman Mitchell, Ranking Member Roe, and members of the subcommittee for asking Veterans for Common sense to testify today about Gulf War illnesses.

We are gathered here today to determine if VA is doing enough to assist our ill Gulf War veterans. The answer is, no. We remain frustrated and angered at our government's lack of action. As a Gulf War veteran, I have personally experienced VA denials and delays.

In 1992, I applied for VA health care and was denied until a newspaper reporter printed my story in a local newspaper. In 1992, I filed a disability claim against VA and VA repeatedly denied disability benefits until 2000. And again in 2007, VA tried to deny me health care one more time. I am here as a Gulf War veteran, because we have three questions where we need answers.

Why are we ill? Where can we get treatment? Who will pay for our medical care and disability benefits? Although we do have some answers why we are ill, there is far more to learn. Worse, there are few treatments for us. And VA disability benefits? They are very difficult to obtain.

While the military and the VA say they assist ill Gulf War veterans, they often fight against veterans. After 18 years of misleading comments, delays, and denials, here are four examples of where the government still tells Congress, VA doctors, and veterans that there really is nothing wrong.

First, VA's website now says, "Experts conclude there is no unique medical condition." This is an attempt to downplay the illness. Second, VA's 2007 congressional testimony says, "Veterans are suffering from a wide variety of common, recognized illnesses."

Third, VA's 2002 training materials for doctors says, "Discussing chronic illness with a Gulf War veteran or a woman with silicone breast implants is a different matter from discussing it with the average patient." Fourth, in a 2008 statement DOD says veterans suffer only minor "wear and tear problems."

However, the scientific facts reveal a critical health crisis. In an April 2009 study, health of U.S. veterans of the 1991 Gulf War, VA concluded "25 percent more deployed Gulf War veterans suffer from multi-symptom illness than non-deployed veterans." I am hopeful the 111th Congress and the new administration will finally take decisive steps now to help resolve these problems and prevent future problems.

First, VA should publicly recognize our illnesses. VA should issue new training materials and a press release that Gulf War illness is real. And we ask that Congress continue oversight on this issue. Second, Congress should fully fund the Congressionally Directed Medical Research Program to find treatments we urgently need. Again, one of our top priorities is finding treatments.

Third, Veterans for Common Sense ask Congress to investigate VA staff manipulation of institutive medicine reports mandated by the Persian Gulf Veterans Act of 1998 to determine veterans' benefits. Documents reveal VA and IOM staff improperly fixed the results of the reports before they were ever written by restricting the evidence to be considered.

If laws were broken then VA must hold accountable those who would fight against our veterans. We urge Congress and VA to remove VA roadblocks so veterans can move forward. Fourth, VA should conduct more research to understand our illnesses, especially, for the experimental anthrax vaccine and depleted uranium.

Fifth, VA should send letters to every veteran ever denied an undiagnosed illness benefit advising them of laws expanding eligibility. Sixth, VA should explain why the number of veterans with approved undiagnosed illness claims -- these are Gulf War disability claims from the 1994 law, fell from about 3,000 to about 1,000 during 2008.

Finally, Congress, DOD, and VA must prevent a repeat of the Gulf War illness debacle. We urge Congress to investigate why the military failed to perform mandatory pre-deployment and post-deployment medical exams required under the 1997 force health protection law. DOD has jeopardized the health of our service members, the safety of military units, and the success of the mission by deploying tens of thousands of unfit soldiers to Iraq and Afghanistan.

In conclusion, I ask you to please add the February 9, 2009 memo by James Binns, chairman of the Research Advisory Committee, regarding the VA manipulation of IOM reports as a hearing exhibit. Thank you, Mr. Chairman.

REP. MITCHELL: Thank you.

Mr. Weidman.

MR. WEIDMAN: Mr. Chairman, I thank you for the opportunity to appear here today. Many people have said why in the world are you talking about Gulf War vets being that you're all Vietnam veterans? Our founding principle was never again shall one generation of American veterans abandon another generation of American veterans.

And since 1994, though we are not a wealthy organization, we have provided office space and support for Gulf War veterans for many years and today continue to do so to the veterans of modern warfare, which include Gulf War vets as well as OIF/OEF vets.

The -- we pressed early on, right after the Gulf War, for some answers when it was clear to people we're getting ill. And all you need -- it's not rocket science stuff -- in order to correct the things that are still wrong for Gulf War vets, you could -- pass or enact very prescriptive legislation that attempts to legislate people doing the right thing.

But in fact, all you need is top leadership that says we have a covenant with the men and women who take the step forward pledging life and limb in defense of the constitution that where they're lessened by virtue of military service we're going to do everything humanly possible to find out how they've been lessened and to remediate that whether they've been lessened physiologically, neuropsychiatrically, emotionally or economically. That's all you need.

And if you have that stance then all else flows from that. Unfortunately, the history of the Gulf War illness both with DOD and with VA is one of misdirection, denial, and some would suggest mendacity.

The -- where are we today and what can be done about this situation? First of all, I subscribed and VVA subscribes to the president's judgment that we need a transformational change at VA, and nowhere is that more apparent than in the research and development area, and in the whole way in which the entire agency both Veterans Benefits Administration and Veterans Health Administration deals with the wounds, maladies, and injuries of war particularly, environmental -- adverse health care conditions that derive from environmental exposures while in military service.

So once you have the proper stance then you start to change it. We have great confidence and great hope for the number one and number two persons at the VA now, and very shortly there will be a new undersecretary for health, and from that will flow leadership changes at every level.

What are the -- the timing on this hearing, and I know a lot of people raised some questions about why are we going back to this at this particular time. This set of three hearings is perfectly timed for a number of reasons. Number one, last November the RAC report, which was a complete and extraordinary report was made public. Secondly, just last month the results of the long-term epidemiological study done by Dr. Han Kang, et al. was published.

The article subsequent to that was published in a peer review journal. And third, we are in the process of giving that leadership change and a fresh look with new leadership at where do we need to go from here? Where have we been and where do we need to go? VVA recommends, first of all, the deep brain study done by Dr. Robert Haley at the University of Texas, Arlington, VA must stop interfering with that in an unwarranted way trying to get the UTA to violate the IRBs and breach confidentiality of the people who participate in that study.

Similarly, VA must be warned not to try and get other research institutions who are doing outside research funded by VA, to ask them to breach their medical ethics and their research ethics by violating IRB. Secondly, VA needs to move quickly to modify the computerized patient treatment record to include a military history question, what branch did you serve in? When did you serve? Where did you serve? What were your -- what was your MOS and what actually happened to you?

This needs to be searchable on a nationwide basis so that if I walk in and see Dr. Roe and I have a rare cancer he can search and find out. Do other individuals who served in the same military unit the same time I did, do they have that? And that is classic epidemiological methodology going right back to the original epidemiological study done on cholera in London.

And we would have an invaluable epidemiological tool that costs virtually nothing. Third, VA does not really have a Gulf War I registry. They have a Gulf War I mailing list just like they don't have an Agent Orange registry, they have an Agent Orange mailing list, et cetera. What we need is registries that are set up on the model of the Hepatitis C registry where you can look and track the entire pattern of peoples' behavior, excuse me, medical treatment and medical conditions on an ongoing basis.

And to have a protocol for a Gulf War I medicals exam to get on that registry, same, same -- with a different one for Agent Orange et cetera. Right now it's -- it's a let's not and say we did thing, and we need to be honest about having real registries where we can do good epidemiological work on veterans of every generation.

Fourth, there needs to be a significant increase in VA research dollars. We would suggest more than ($)2 billion and there are several other recommendations. But I just want to mention one, Mr. Chair, because I know I'm out of time, and that is to extend the RAC to 2016. Thank you very much and I look forward to answering any questions, Mr. Chair and ranking member.

REP. MITCHELL: Thank you. Dr. Steele.

MS. STEELE: Good morning, good morning.

I'm Dr. Lea Steele. The RAC that you've heard mentioned a few times is the Research Advisory Committee on Gulf War Veterans' Illnesses. I was formerly scientific director of that committee. The current scientific director was unable to be with us today. So I was scientific director during the period of time that we prepared this extensive in-depth report that was issued last November. And so I will try my best, in the brief time I have, to just touch on some of the highlights of our scientific findings.

The report's primary focus is Gulf War illness or what is also being called "Gulf War Syndrome or Gulf War Undiagnosed Illness." In contrast to diseases like cancer or diabetes, Gulf War illness is not explained by standard medical tests or diagnoses. The hallmark of Gulf War illness is, as you've heard, a characteristic pattern of multiple symptoms typically widespread pain, memory and concentration problems, persistent headache, unexplained fatigue, persistent GI problems and other abnormalities.

For many veterans this illness is quite severe and has persisted for 18 years. Here are our report's major findings on Gulf War illness. First, Gulf War illness is real. Studies from all units in the regions of the U.S. and several coalition countries show the same thing, the same types and patterns of excess symptoms are consistently identified in diverse groups of Gulf War veterans.

Second, Gulf War illness differs fundamentally from trauma and stress syndromes seen after other wars. Studies are consistent in showing Gulf War illness is not the result of combat or stress. In fact, rates of psychiatric disorders like PTSD are low in Gulf War veterans, compared to veterans of other wars.

And studies do not show a similar pervasive unexplained illness in veterans of more recent wars, including current Middle East deployments. So Gulf War illness is a widespread problem. Multiple studies indicate that it affects at least one in four of the nearly 700,000 U.S. military personnel who served in the Gulf War.

What caused Gulf War illness? Well, as you may know, many presumed causes have been suggested over the years from stress, to oil well fires, to depleted uranium. Our review of the extensive evidence related to each of these factors provides a clear conclusion. Scientific evidence points consistently to just two causal factors for Gulf War illness.

The first, pyridostigmine bromide or PB pills were given to protect troops from the effects of nerve agents. PB has only been used on a widespread basis in the 1991 Gulf War. The second factor is extensive use of pesticides in theater. Both PB and pesticides that were used and overused in the Gulf War affect the same enzyme and neurotransmitter system, which act in the brain and the nervous system.

Several other contributing factors can't be ruled out due to limited or conflicting evidence. These include low-level exposure to chemical nerve agents and effects of combinations of neurotoxic exposures in theater like the PB pills and the pesticides.

Also studies from different research teams have begun to provide for us an emerging picture of the biology of Gulf War illness. Dr. White would've explained this in more detail, but what I can share with you is that the identified differences between sick and healthy veterans most prominently affect the brain and the nervous system.

Now, aside from Gulf War illness, the undiagnosed symptom complex, there are other health issues of concern. The most serious diagnosed disease also affects the brain. Studies have found that Gulf War veterans have higher rates of ALS or Lou Gehrig's disease than other veterans. And Gulf War veterans who were downwind from chemical nerve agent releases at Khamisiyah, Iraq have died from brain cancer at twice the rate of other veterans in theater.

Our committee also reviewed, in detail, federal research programs on the health of Gulf War veterans. Historically, these programs have not been managed to address high priority issues. About $400 million have been spent by federal agencies on projects identified as Gulf War research. But a substantial portion of those funds has been used for projects that have little or no relevance to the health of Gulf War veterans and projects focused on stress.

Promising changes have taken place at VA and DOD since 2006 due to congressional actions. But overall, federal funding for Gulf War research has declined dramatically since 2001. Our committee has called for renewed federal research commitment to identify effective treatments and diagnostic tests for Gulf War illness and to address other priority Gulf War health issues.

Now, if I may, I just have one more point about the question of Gulf War illness. In the past, federal officials have tended to obscure or minimize Gulf War illness often focusing on the largely semantic issue of whether or not it should be called a syndrome or a unique disease. Our committee viewed this question as relatively trivial.

From a scientific perspective, the clear result from Gulf War studies is that a large number of veterans suffer from this consistent pattern of illness however it is labeled as a result of their military service in the Gulf War. This is not controversial scientifically. There are no findings to the contrary.

So despite the unusual, and complex, and difficult to diagnose nature of Gulf War illness there is every justification from a scientific perspective for this problem to be clearly acknowledged and addressed in the same way as other long-term health problems that result from wartime injury.

Our committee noted that this remains a national obligation made especially urgent by the many years that Gulf War veterans have waited for answers and for assistance. Thank you.

REP. MITCHELL: Thank you very much.

The first question I have is to Mr. Sullivan. You mentioned in your testimony that there's been a dramatic drop in claims of patients with undetermined illness in 2008 and a dramatic drop in claims approved. Do you have any thoughts of why this has happened?

MR. SULLIVAN: Yes, Mr. Chairman. I would first ask that this committee ask VA to investigate this. But on the list of hypotheses, the first one that comes to mind is a possible computer malfunction, in other words, something is not counting the numbers properly to generate the correct counts for the Gulf War Veteran Information System report.

I also believe that there are other hypotheses. The first is that VA may have ordered new exams. If VA ordered a new exam, Mr. Chairman, and the veteran came in, VA may have found that an undiagnosed condition is gone. And if the condition is gone then the veteran is no longer eligible for those benefits. If there was an exam, maybe, the undiagnosed condition was observed by a doctor to be a diagnosed condition and then the veteran is getting benefits for that.

It's also possible that a VA ordered a new exam the veteran no- showed. We think that an investigation that VA should review the data from each office, not just the national numbers, and look at the number of grants and denials, the rating percentages for the grants, and the dates of those ratings or denials and also take a look at the training and the backlog.

And the reason I can speak to this is because I prepared the Gulf War Veteran Information System reports for six years while I was at VA. I designed them, I prepared them. I briefed them. We did a brief study in about 2002 that showed that offices that had training and a low backlog of claims approved more than 30 percent of the undiagnosed claims.

However in contrast, the VA regional offices that did not have training in processing undiagnosed illness claims and had a large backlog generally approved only about 4 (percent) or 5 percent of the undiagnosed claims.

REP. MITCHELL: Thank you.

Mr. Weidman, sitting here today and listening to all the facts in the discussion revolving around the Gulf War illness, do you think that the VA and DOD have learned from their past mistakes regarding veterans exposed to Agent Orange?

MR. WEIDMAN: No, sir.

REP. MITCHELL: All right.

MR. WEIDMAN: I could elaborate.

REP. MITCHELL: No, no, no that's fine. That's good enough. Right, we'll come back with some of these.

And Dr. Steele, in your expert opinion, do you believe that the Gulf War illness is real? And you kind of alluded to all this and a count between 175,000 and 210,000 still suffering is accurate? And the second part of this, do you believe the published peer reviewed scientific research, especially, Dr. Kang's study supports this new conclusion?

MS. STEELE: Yes. As I indicated in my testimony, there is no doubt that Gulf War illness is real and that study after study shows the same pattern of illness in all different groups of Gulf War veterans. The estimate of 25 (percent) to 32 percent was found by six of seven large epidemiologic studies showing rates of multi-symptom illness in Gulf War veterans. And so this recent study that was just published verifies that finding, a rate of 25 percent in Gulf War veterans.

REP. MITCHELL: One last question before my time is up. For all the skeptics, what other information do you think is available that if publicized could benefit the public discussion and other scientists' views about the illness?

MS. STEELE: That's an important question. There is an extensive amount of information on both what occurred during the Gulf War and on -- from many, many research studies, that look at the health effects of some of the exposures and epidemiologic studies looking at what the health status of veterans is today.

Veterans, by and large, have not recovered over time; that very few have recovered according to five different longitudinal studies of Gulf War veterans. So our report attempted actually to pull together everything that has been written from government reports, from research studies et cetera. And so in a large part, there is not that much more besides what's in our report.

I think what would be of interest to people that haven't followed this issue over the years is just how much data there are around this issue, how much research has been done, and that the research all points in the same direction, and that is that these two exposures caused veterans to be ill. And their illnesses parallel what you expect with these kinds of exposures.

REP. MITCHELL: Thank you. I'd like to yield to Dr. Roe.

REP. ROE: Thank you, Mr. Chairman.

Mr. Weidman, I understand you served as a combat medic in Vietnam. Thank you for your service.

MR. WEIDMAN: Thank you very much, sir.

REP. ROE: Appreciate that.

Dr. Steele, in --

MS. STEELE: Yes, sir.

REP. ROE: I guess a couple of questions I have. Has anyone in the studies that have been done studied the Kurds or the Iraqi population, indigenous population to see if they have any of these symptoms?

MS. STEELE: There are very few studies of the local populations. We understand that there was one study of Saudi National Guard members. They didn't have increased hospitalizations, but Gulf War veterans in the U.S. for the most part are not hospitalized for these conditions. So we understand there's a study now being done by the Harvard School of Public Health to look at the local, the people in Kuwait, comparing people that stayed in Kuwait to people that left the country during the war.

We don't have results from that yet. We do hear from other coalition countries though that the soldiers from other countries have similar conditions.

REP. ROE: I was just thinking that another control, another model to study would be the indigenous Iraqi population or the Kurdish population to see --

MS. STEELE: Very much so.

REP. ROE: -- what symptoms they had. And I guess, one of the hard problems in studying a syndrome like this if there's no any -- if there's no objective data, it's very difficult to wrap your arms around it. I know when -- you know, I can tell you what the cause of pneumonia is or swine flu or whatever. We have an identifiable source of information. When these tests are done, are there any objective data on PET scan, MRI, nerve conduction studies, CTs --

MS. STEELE: That's right.

REP. ROE: -- any of the typical diagnostic testing that we do?

MS. STEELE: What we find is that when people come in for clinical exams the standard kinds of clinical evaluations they get like a standard MRI or a standard CAT scan of the head, typically don't show anything. You do neuromuscular conduction tests. You don't see anything for the most part. Where you do start to see differences in more specialized testing that is done in research studies.

So now we have multiple studies showing abnormalities in the brain stem, the ganglia, and the hippocampus from brain scans. There are a lot of neuropsych studies showing deficits in cognitive function, memory performance, things like that. So these problems are too subtle for the most part to be detected on standard clinical testing.

But when -- now that more advanced studies have been done we do see objective measures of differences between sick and healthy veterans. The problem, the heart of the problem is that there is no clear diagnostic test yet to identify who has it and who doesn't have it. And that has been the source of so much difficulty both for veterans, and for clinicians, and for researchers.

REP. ROE: No, for instance, in diagnosing ALS there are some -- (inaudible) -- problems and in MS different diagnostic criteria that are in the spinal fluid or in the brain when you find these. But there's been no -- to date, there's been no way you can --

MS. STEELE: It's not -- unlike what we've seen with other neurological diseases that for many of them it takes a long time to find something objective like with Alzheimer's disease how long before we actually were able to diagnose that with objective tests. So effects of chemical exposures are often difficult to identify with objective tests. And that is certainly the case here.

REP. ROE: Do we know how many soldiers, veterans, were treated with the PB and the DEET?

MS. STEELE: Yes, we have numbers for all of those. There have been a different -- several different investigations to try to retrace that and get a handle on that. And multiple sources tell us that about 50 percent of all soldiers from the U.S. used the pyridostigmine bromide pills, some for just a short period, some for longer period. It's the ones that used it for the longer periods that have the most problems.

The number of people that used, what we call personal pesticides, things like DEET, permethrin, things that they put on their skins and their uniforms, that's also in the range of 50 percent. We see higher use of both of these in Army personnel and ground troops generally, lower use in people that were on board ship or in the Air Force.

REP. ROE: Is the data on ALS, for instance, if you go from one to two in a million, you've doubled.

MS. STEELE: Exactly.

REP. ROE: But the statistical odds of getting something are very remote. The chances --

MS. STEELE: And that's --

REP. ROE: Are these data statistically significant when you say that the incidence of ALS or brain cancer, for instance, what kind of numbers are we talking about?

MS. STEELE: Yeah, and that's an important point. Well, ALS and also brain cancer are very serious fatal diseases.

REP. ROE: Okay.

MS. STEELE: The numbers that have these problems are relatively low compared to the very large number with these Gulf War illness problems. So the last count that I had was 60 Gulf War veterans that have ALS. And that is roughly twice as many as non-deployed veterans of the same era.

For brain cancer, I think, we're still in the range of 30 deaths due to brain cancer, which is again twice as high as people who weren't exposed to nerve agents.

REP. ROE: Okay.

Thank you, Mr. Chairman.

REP. MITCHELL: Thank you.

Mr. Walz.

REP. WALZ: Well, thank you, Mr. Chairman and Ranking Member. I very much appreciate you holding this hearing and focusing on getting answers based on data-driven research based and take a look at this research because we're hearing testimony and every single one of us up here have heard from members who are experiencing there is something happening.

And I should point out that the majority council side Lieutenant Colonel Herbert was -- is a Gulf War veteran and was at Khamisiyah and has extensive history in this, and is well versed and has brought us up to speed on this. I just have a couple of questions trying to get at the heart of this.

First, Dr. Steele, you talk about self-reporting being relied on a lot in exposure. Can you explain that a little bit and where you think the pitfalls there are?

MS. STEELE: Yes, there are a lot of pitfalls.

As you probably know, many of the exposures that veterans experienced during the Gulf War weren't measured at the time. People were in war, they weren't writing down how many pesticides they used and things like that. So it's been important to use various sources of information to try to reconstruct what these exposures were.

Initially after the Gulf War there were no efforts and so we really didn't know, but by now there have been multiple very large surveys of Gulf War veterans that have asked them what they did, where they were, things like that. And so we can piece together a look at what we see across the spectrum of multiple studies.

In addition, there have been some very detailed investigations sponsored by DOD that have tried to reconstruct, which pesticides were shipped to theater. They do in-depth interviews, RAND has done these and the Department of Defense as well have done in-depth interviews of pesticide applicators, the professionals in the field that were familiar with the pesticides to find out the patterns of use and things like that.

And surprisingly, the patterns that we see from the epidemiologic surveys that are self-reported are very consistent with what we see with the in-depth investigations. So that's how we have some numbers on what's going on. When we look at the connections with the illness, again, we rely on self-reported exposures often, and these identified patterns, and we see across the spectrum of studies; we see very consistent findings.

REP. WALZ: Very good.

Rick, you mentioned in your testimony very clearly when you said, have we learned anything, you said, no. Something though I think you're hitting on that I think can have us learn something is this idea of incorporating the personnel file into an electronic medical record that transfers down especially for research base.

Could you explain a little bit especially in light of both secretaries and the president and this committee making a real push for this seamless transition and the ability to do that?

MR. WEIDMAN: In 2000, as part of the Veterans' Benefits Improvement Act of 2000, which was -- well, it stretches -- I can't remember the law number, but anyway, this committee when it passed at the House, had a provision in it that VA had to take a complete military history and incorporate that into the VistA system. Unfortunately it was not incorporated on the other side of the Hill and therefore did not become law.

The cost to do it -- we've received piecrust promises every year since 2000, and at the end of the last administration, and that they are going to do it, but it never seems to happen. And so that you have the spectacle that if you want to know how many people have MS who served in the theater who are receiving medical care from VA, you can't tell.

Why? Because they don't have whether or not somebody served in the combat theater of operations keyed in as a field on the computerized patient treatment record. This is nuts. We have a tremendous resource here.

It is a veterans' health care system. It is not a general health care system that happens to be for vets. And we need to refocus on making this a system that focuses on, first and foremost, on the wounds, maladies, injuries, illnesses, and conditions that emanate from military service. That's what the taxpayer is paying for. Thank you, sir.

REP. WALZ: Now, very good, I appreciate it.

Mr. Sullivan, I'm running out of time, but just quickly, because we're looking at the research on this and trying to get to it. And that wasn't shock on my face when you said we did something on this side, and it ended a deadly death on the Senate side. Trust me I'm very appreciative of that.

But, Mr. Sullivan, you talked about -- I want you to elaborate where you think the failures went in some of this research. You talked about that they were predicated on some assumptions before they even began to discount any connection. Can you explain just, you know, briefly how you see that happening?

MR. SULLIVAN: The short answer is, I would defer and ask this committee to call Mr. Binz (ph) and the Research Advisory Committee to fully explain all that. Essentially from the document that I asked be included as an exhibit in this record, it appears that VA and IOM staff manipulated the process so as to exclude information. And I don't have all the documents.

I don't have privy to everything. I do believe that we've asked, Veterans for Common Sense has asked the VA inspector general to investigate. So we hope that someone will find out what's going on.

I don't have all the facts; that's why we want an investigation on this. Because we want to be able to move forward and not have anybody monkeying with the intent of the Persian Gulf Veterans Act of 1998. Because there is -- the bunch of people behind me that walk the halls everyday for months to get that bill passed, and it's a shame that a few people appear to have submarined it.

REP. WALZ: Well, I appreciate that. And I will just end before I yield back.

Mr. Bunker, thank you for your service and please know that no one will minimize what you've given in support of this nation. And everyone in this room, I'm working from the assumption, cares and wants the best quality of care for our veterans.

We've got to make sure that our data is where it needs to be and that it is actually being used to enact policy for that, so from one artilleryman to another, thank you for your service.

And I yield back.

MR. BUNKER: Thank you.

REP. MITCHELL: Thank you.

Mr. Hall.

REP. HALL: Thank you, Mr. Chairman. Thank you, Ranking Member Roe. Mr. Bunker, I would follow-up Congressman Walz by saying, if you remember, or if you have a record of that VA case record or researcher; I'm not sure which it was, who told you to behave yourself, I hope you'll share that with me and my staff, not necessarily right now in an open session, but I'd like to know the name of that person.

MR. BUNKER: I don't remember -- I know his first name.

REP. HALL: Well, maybe the memories will come and go, and if it comes back to you, write it down --

MR. BUNKER: I do -- I will assure you --

REP. HALL: Thank you.

MR. BUNKER: -- that if you get a hold --

REP. HALL: It should never happen.

MR. BUNKER: I know --

REP. HALL: It should never happen to anybody --

MR. BUNKER: The record is very much aware of who it is --

REP. HALL: -- who serves in uniform of this country and comes back with a legitimate problem that needs to be solved and presents themselves to a VA facility anywhere in this country that they're told -- well, bad enough to be told that it's in your head. As Dr. Steele said, you know, that it's a psychiatric problem.

MS. STEELE: It is in your head.

REP. HALL: And -- but if I find out who that was, we're going to do something about it.

MR. BUNKER: But if you read in my testimony, you'll also find out that the person who is supposed to be doing the Persian Gulf exams, sir, doesn't even answer their voicemail phones when you call in.

REP. HALL: I was horrified by the whole thing. I'm sorry. I apologize on behalf of, I guess, on behalf of the country to you and others like you who served and have had so little response to your questions and your needs.

I wanted to ask you also, Mr. Bunker, if you would -- if you're aware of any websites, hotlines, or other outreach measures that are being taken by your groups or other groups to educate veterans about this or the public about this problem.

MR. BUNKER: There is our website called the National Gulf War Resource Center ngwrc.org, Paul Sullivan's site Veterans for Common Sense, which is working on --

REP. HALL: Ngwrc.org?

MR. BUNKER: Yes.

REP. HALL: Okay, thank you.

MR. BUNKER: National Gulf War Resource Center, Paul Sullivan's site Veterans for Common Sense, and the Veterans for Modern Warfare site.

REP. HALL: Okay.

MR. BUNKER: Those are the only ones right now.

REP. HALL: That's good. Mister --

MR. WEIDMAN: VMW site is vmwusa.org.

REP. HALL: Okay. And they all have information about Gulf War syndrome?

MR. BUNKER: Yes, we also have a self-help guide for veterans with Gulf War illness and also Gulf -- veterans who have PTSD problems.

REP. HALL: Thank you. That's terrific.

I'm curious, Dr. Steele, are you aware if the RAND Corporation did a study on Gulf War syndrome?

MS. STEELE: They did a series of reports. I don't remember. It's eight or nine reports on different topics related to the Gulf War issue, things like depleted uranium, oil well fire smoke, nerve agent exposures; things like that. So they did a whole series. It was RAND that actually helped tease out what kind of pesticides were used in the Gulf War.

REP. HALL: Okay, so those were useful?

MS. STEELE: Very much so.

REP. HALL: One of the doctors who worked on that, a retired Major General, who is actually in my district worked on one of those if not all of them. And he is a WMD specialist for three former secretaries of Defense. I'm curious, besides the two main causes of the illness, the PB pills, and the overuse of pesticides. I mean, is it the synergistic effect of other chemicals, can you reel off some of those other chemicals?

MS. STEELE: Well, as I say, the two main things that evidence points to are those two. And then we have sort of limited evidence related to several other exposures. Those include low level exposure to nerve agents, which we know occurred during the Gulf War. Also high level exposure to the oil well fire smokes. So we have some conflicting information about people who were close in to the oil well fires for an extended period of time.

There also are some indications that receiving a large number of vaccines for deployment could have contributed to this illness and also the synergistic effects of the neurotoxins. And the leading neurotoxins are the PB, the pesticides, and the low-level nerve agents.

There are a number of other things that people have suggested may have caused Gulf War illness, but we didn't find evidence to support a link with depleted uranium, solvents exposure, fuel exposure, or the anthrax vaccine.

REP. HALL: Mr. Weidman, what would you say is the deviation from one area of, let's say, Kuwait or Iraq to another in terms of the intensity of these -- how local were the effects or were they pervasive throughout the theater?

MR. WEIDMAN: I would defer to Dr. Steele on that, but I will tell you that just what I do know is that is -- there was a big difference depending on where you were. I mean, one example is, there is a -- there was a medical unit that the former president of Veterans of Modern Warfare, Julie Mock, was in. And 7 of those young people out of 150 -- I think it's 7 out of 150 have MS.

I mean, it's astronomical. I mean, it doesn't happen by chance. I mean, the odds against it are billion is to one. Whereas just 75 miles away, there people don't have problems and it had to do with the wind, with, we believe, the cloud from Khamisiyah.

They were directly in the path and were one of the heaviest exposed -- most exposed units. And therefore that's what caused those degenerative nerve conditions to diseases to come about, so it made a big different precisely where you were and when.

REP. HALL: And last question, overtime anyway, but this could go I guess to Mr. Sullivan and to Dr. Steele if you would, Mr. Chairman, indulge me.

I wanted to ask, Mr. Sullivan, you mentioned depleted uranium. And I know there is, you know, one can figure out half-life and how much -- how long it would take for the diminution of radiation.

But in regards to these other substances, do they break down in the environment and are they at the same level of risk to our soldiers who are there now or a diminished risk, because this is something that we can identify how long it takes for them to degrade in the environment?

MR. SULLIVAN: There is about 10 questions there, Mr. Chairman.

REP. HALL: I'm sorry.

MR. SULLIVAN: The first question on depleted uranium, the biggest concern is that it's a toxic heavy metal as opposed to the radiological effects. And our president of Veterans for Common Sense, Dan Fahey, provided some briefing papers to the full committee staff on this in 2007, and has testified about this extensively to the Institute of Medicine.

So what I would do is offer to provide that material to you and your staff. I would say that there is less of a depleted uranium exposure; number and amount of exposure for the current Iraq war than it was for the Gulf War. And our biggest concern on depleted uranium is the failure of the Department of Veterans Affairs to actually do a study on it.

They quote, "monitored," unquote, in a very weak manner, only a handful of service members. And then, when some of those veterans came up with cancer and other problems, VA was quick to deny it or ignore it. So there are some questions -- more questions about DU than answers is what we say now.

MS. STEELE: I concur with that. While we didn't find evidence linking depleted uranium specifically to Gulf War illness, there are still a lot of questions about whether it may contribute to cancer, birth defects, genetic things. There really has not been a comprehensive study of this in any generation of veterans.

And because we don't see this Gulf War illness problem in current OIF and OEF veterans, you know, we don't see a link with Gulf War illness with depleted uranium for them either. But there are still so many questions.

There are a lot of animal studies, for example, showing effects on the brain, effects on tumors, things like that.

REP. HALL: Thank you, Doctor.

I yield back.

REP. MITCHELL: Thank you.

Mr. Adler.

REP. JOHN H. ADLER (D-NJ): Chairman and Ranking Member, I join the other members of the subcommittee in their sense of frustration, even outrage, at the testimony of people who'd want better for our brave heroes that have fought overseas in the Gulf War, and previous wars, and in our ongoing wars for freedom.

I'd like to start with Mr. Bunker and ask you to tell me what you feel could be done to address the need for a culture change, the need to take place regarding our Gulf War veterans and their health care providers at the VA.

MR. BUNKER: I think there are some people at the top of the VA system that needs to be replaced, who has been there for years on this, who I feel have been blocking a lot of the dissemination of the information in that.

I feel that every care provider whoever sees the veteran should be trained, treated, and given information about Gulf War illness, and especially briefing on the Iraq report that -- so that they fully understand that this is not a psychiatric problem. That this is not from PTSD, that there are real causes behind this, such as what Dr. Steele has said, the nerve agents, and everything.

And the researchers also need to be able to get a hold of veterans to do the proper research. One of the biggest problems in doing research with Gulf War veterans is they want them to come like to Washington, where I came back in November, to George Washington University to have a Gulf War study done with me. But we have to pay for this out of our own pocket. You're dealing with veterans, who doesn't have the expense -- the money to travel.

The other thing is this thing for the Gulf War exam like we all have said, it's not worth anything. But there is a follow-on clinic that specializes for Gulf War veterans. And the hardest part is for these VAs to send these veterans. I was told at the clinic in the Topeka VA that if they say I had one thing, then I wouldn't be eligible to go to a follow-on clinic and that.

And it has only been in these follow-on clinics that veterans have gotten real help and real diagnosis, or are being told that it is undiagnosed, and which helps their claims to get the compensation they need to help support their family. But first is training for the care provider themselves.

REP. ADLER: Respectfully, the more you speak the more confused and dismayed I am. Maybe somebody could explain why the VA is not doing as you suggest, Mr. Bunker, in training all of its professionals --

MR. BUNKER: It is the old model, like I was talking about on that one board right now, that is supposed to be looking at problems that we have with our compensation; don't look don't find.

REP. ADLER: Now, that's just not good enough. Any other panelists want to comment about the culture change that seems to be so desperately needed to meet the medical needs of our Gulf War heroes.

MR. WEIDMAN: I just want to say as an aside, and I don't think that Jim meant is -- what he seemed to imply is that neuropsychiatric diagnoses are not real. Neuropsychiatric diagnoses including PTSD as very real and there are many of us who believe that ultimately research will lead to the understanding that it's a permanent change in the electrical, chemical reactions of the body to perceived threats.

So I don't think Jim meant to imply that if somehow it wasn't real if it was PTSD. But I just wanted to correct that for the record.

In regard to what doesn't happen at the service delivery point, it's -- every single resident and intern who comes to the VA for training gets a military history card that also lists the conditions that you should be looking for depending on period of service. Most residents and interns don't get it.

The reason why they develop that for residents and interns by Dr. David Stevens before he left VA as a head of Academic Affiliations to head of the American academy of medicals schools and colleges was that everybody else was already asking these questions. And, in fact, nobody else is already asking these questions.

So I had mentioned before that there is not a protocol for a Gulf War illness protocol if you will. For those who served in the Gulf, prior to going on a, quote, unquote, "registry," which isn't really a registry. We need to have a protocol. And we need to have a real registry at least for those who use VA.

The reason why they don't follow through is to minimize the problem. If you don't have stats, you ain't got a problem. And the attitude is, and I mentioned earlier that this is not rocket science stuff. What you need is understanding and the attitude that these are men and women who have pledged their life and limb in defense of their country, and took that very seriously, often at great cost.

And the -- that's a covenant between the people of the United States and the men and women who take that step forward, that where injured or lessened by virtue of that military service, we do everything humanly possible. Now if you get that attitude at the very top, and we do have that attitude with General Shinseki, and you start to permeate it down through the structure, then the training follows as a natural consequence.

And what we need is to get it at that third, and fourth, and fifth levels within the VA leadership down to the local medical center, and chief of staff, and chief of service level. And that can be done and we believe that with Scott Gould as the number two, who is an expert in organizational transformation that we at least have a shot over the next whatever many years we get in this administration to begin that transformation, Mr. Adler.

REP. ADLER: I thank you, sir.

Mr. Chairman, my time has expired, but I thank you for convening this hearing. You and the ranking member deserve enormous credit for focusing attention of this outrage that we have to address.

REP. MITCHELL: Thank you.

At this time, I would like to excuse the panel and get to panel two. We're running out of time. And I want to thank you again for coming today and your service to this country.

MR. WEIDMAN: Thank you.

MS.STEELE: Thank you.

MR. BUNKER: Thank you, sir.

REP. MITCHELL: Thank you.

I welcome panel two to the witness table at this time. For our second panel, we will hear from Dr. Robert Walpole, the principal deputy director for National Counter Proliferation Center and former special assistant for Gulf War Illnesses Issues at the Central Intelligence Agency. Mr. Walpole is accompanied by Mr. Loren Fox, the senior technical analyst for the Central Intelligence Agency and former senior analyst for Gulf War Illness Issues.

Also joining us is Dr. R. Craig Postlewaite, the deputy director of Force Readiness and Health Assurance at the Department of Defense and Dr. Lawrence Deyton, Chief Public Health and Environmental Hazards Officer at the Veterans Health Administration accompanied by Dr. Joel Kupersmith, chief research and development officer and Mark Brown, director of Environmental Agents Service at the Veterans Health Administration.

At this time I would like to recognize Dr. Walpole, and Dr. Postlewaite who will be second, and third, Dr. Deyton. Please keep it to five minutes, as your complete testimony is part of the record. Thank you.

Mr. Walpole.

MR. WALPOLE: Chairman Mitchell, Ranking Member Roe, and members of the subcommittee, I'm pleased to appear before you today to review the Intelligence community's support to the Departments of Veterans Affairs and defense on Gulf War veterans' illnesses issues. It has been a dozen years since I appeared before this subcommittee on the issue.

We knew then, and we know now, how important this is to our veterans and that our support has been important to ascertaining what happened during that war. Before I move into a lot of technical assessments, I want to underscore the human side of our effort to help the veterans.

Our workforce includes veterans from the Gulf War and other conflicts. We have sincerely tried to uncover any intelligence that could help with veterans' illnesses. In March 1995, as concern over the issue mounted, Acting DCI Studeman directed CIA to review relevant intelligence. CIA subsequently recognized the soldiers that conducted demolition at Khamisiyah and notified DOD, the Presidential Advisory Committee, and the public.

In February 1997, George Tenet, then acting DCI appointed me as a special assistant on this issue to run a taskforce to help find answers to why the veterans were sick. We provided intensive aggressive support to numerous efforts. We had 50 officers from across the intelligence community as well as the Department of Defense.

We managed to review all intelligence aspects related to the issue with the goal of getting to the bottom of it, searching, declassifying, and sharing intelligence that could help, modeling support, communications with the government, veterans groups and others, and supportive analysis.

Our April 1997 paper provided details about the intelligence committee's knowledge of Khamisiyah before, during, and after the war, and included warnings to our military about the potential presence of chemical weapons at Khamisiyah before the unwitting destruction.

We also conducted document searches on other Iraqi chemical warfare sites as well as any intelligence related to potential biological warfare, radiological exposure, and environmental issue. Our expanded search efforts generated over a million documents, most of which did not relate. We declassified those that we identified as pertinent and provided DOD the entire volume of files electronically with the means to search as needed.

Our last taskforce paper on the issue was published in April 2002 on CW. I'm aware this subcommittee is very interested in CIA's computer modeling recognizing the physical and chemical processes of the release and its dispersion are complex and have inherent uncertainties.

In 1996, CIA was able to model the events at Bunker 73 at Khamisiyah where U.S. soldiers had unknowingly destroyed nerve-agent- filled-rockets, and Al Muthanna and Muhammadiyat where a coalition bombing released nerve and sulfur mustard agents, largely because we had U.S. test data indicating how the agents would react when bombed or detonated.

But we have significant uncertainties regarding how rockets with chemical warheads would have been affected in open-pit demolitions. We also were uncertain about the events, in the pit and the weather. When I was appointed and discovered these uncertainties we created what I called, "the milk carton announcement," that pictured, "If you recognize this child, please call this number."

We showed pictures of the pit and said, "Please call this number," we got three additional soldiers that were part of the demolition. We conducted several interviews with then five soldiers about the demolition and learned that we should only focus on the 10 March date. We developed tests with DOD at Dugway to destroy rockets containing CW agent simulants in the manner that the soldiers described to provide data on agent reaction in an open-pit demolition.

And a panel of meteorological experts hosted by the Institute for Defense Analysis recommended using several mathematical models and modelers to address uncertainties. Did these efforts eliminate all uncertainties? Absolutely not; in fact, prior to publishing the results of the modeling, we published on and commented on our continuing uncertainties.

We had reduced them, but they were still there. Also the presidential advisory committee had become impatient with the time we were taking to try to reduce the uncertainties. And basically told us if we didn't model in the very short term, they were going to draw a circle around Khamisiyah and be done with it.

Of course, epidemiologists should have ascertained whether veterans reporting illness were clustered in areas around Khamisiyah during the appropriate time frame. They did not need a model or a circle to do that. But they did need troop locations. And the work on the model required DOD to ascertain those locations.

When we briefed the modeling conclusions in '97, I noted even then with the uncertainties involved, we assessed that the models would provide meaningful information to epidemiologists. But we did not intend the modeled area to be used to estimate the absolute number of troops exposed to CW agents.

Subsequent to '97, CIA obtained additional information and was able to provide DOD better data. Additional UNSCOM information from the 1998 inspection indicated that the maximum amount of nerve agent released was about half that modeled in '97. Then we had a CIA- sponsored analysis of daytime sarin and cyclosarin degradation that helped.

And finally, an interview with the senior explosive demolition expert at Khamisiyah helped with the understanding that the placement of the charges was less than optimal. In DOD -- in 2000, DOD remodeled the Khamisiyah pit and the plume was about half the size of what that it was in '97.

Did new information change other efforts? Yes, it did. But even in those efforts, it ended up reducing the amount of agent released, not increasing that agent released. I see that I am out of time, let me just conclude by saying a couple of points.

Intelligence and UNSCOM information provide no basis for suspecting that stores of undiscovered munitions or bulk agents were damaged during the Gulf War. We assess that additional Gulf War-era releases of chemical agents large enough to threaten exposure to U.S. troops are unlikely, although additional small chemical releases are possible.

Extensive previous modeling leads us to conclude that other un- modeled CW releases were too small and distant to expose troops. In our review of intelligence reporting and analysis of Iraq's chemical agent stockpiles, we found no credible evidence of CW use against U.S. troops in the Desert Storm time frame.

In conclusion, I want to reiterate the intelligence community's commitment to the men and the women who served in the Persian Gulf, as well as those who serve our country and the world today. Intelligence support to help our soldiers and veterans is critical.

Thank you.

REP. MITCHELL: Thank you.

Dr. Postlewaite.

DR. POSTLEWAITE: Good morning, Mr. Chairman, and distinguished members of the committee.

Thank you for the opportunity to visit with you today about the DOD's Gulf War Veterans Research Program. During the war, which I will refer to as the Gulf War, nearly 700,000 troops were deployed to the theater. And mortality rates from diseases and non-battle injuries were the lowest for any major U.S. conflict up to that date.

However, beginning, while they were deployed, or after returning from the war, some veterans developed chronic symptoms of a nonspecific nature, such as fatigue, memory loss, difficulty concentrating, pains in muscles and joints, head aches, depression, and anxiety.

The Department of Defense agrees that these symptoms are real and that those veterans affected by them, such as Mr. Bunker, deserve the best care and treatment available. The Department of Defense and Veterans Affairs each established clinical evaluation programs to better understand the nature of these nonspecific symptoms and to provide our veterans with the appropriate treatments.

In 2002, the Departments of Defense and Veterans Affairs collaborated on the development and implementation of a clinical practice guideline for medically unexplained symptoms of chronic pain and fatigue. Today this clinical practice guideline remains a cornerstone of effective medical assessment and management including treatment for these conditions.

Since 1994, the Departments of Defense, Veterans Affairs, and Health and Human Services have managed a coordinated federal, medical research effort to better understand the health concerns of Gulf War veterans. From 1992 to the end of 2007, $340 million were spent on 345 research projects. Of this, the Department of Defense funded 177 projects, totaling $219 million.

The project supported five research areas, brain and nervous system function, symptoms in general health, immune function, reproductive health, and environmental toxicology. Among the 345 research projects, were several treatment studies. One study indicated the cognitive behavioral therapy and aerobic exercise led to modest improvements in memory problems, pain, and fatigue.

A second controlled clinical trial used a 12-month course of an antibiotic known as doxycycline to treat the same three symptoms. Doxycycline however was not effective in its treatment of these symptoms. In 2006, the Institute of Medicine concluded that there were no differences in overall mortality or hospitalization rates in Gulf War veterans compared to non-deployed veterans, nor were there any differences in overall cancer rates between the two groups.

They also determined there was no pattern of higher prevalence of birth defects in the children of male or female veterans of that war. The Institute of Medicine did however conclude that Gulf War veterans might be at a two-fold increased risk of ALS or Lou Gehrig's disease as we've heard, compared to those veterans who did not deploy.

Almost all of the previous studies have shown that Gulf War veterans reported nearly twice the rate of all medically unexplained symptoms compared to service members who did not deploy. However, based on many research studies, the Institute of Medicine concluded there was no unique symptoms, no unique pattern of symptoms, found in Gulf War veterans.

In 2006, the Institute of Medicine recommended that in general, no further epidemiologic study should be performed on Gulf War veterans. The institute did recommend, however, follow-up studies for mortality, cancer, particularly brain cancer and testicular cancer, ALS, birth defects, and other advanced -- excuse me, adverse pregnancy outcomes, and for psychiatric conditions.

In Fiscal Years 2006 to 2009, the Department of Defense funded $23 million specifically for research on illnesses including ($)8 million in 2009. In conclusion, since 1992, the Department of Defense has funded extensive medical research focusing on the nature of medically unexplained symptoms and potential risk factors including environments exposures, and for studies on improved diagnostic techniques and treatments.

These studies have provided critical new information useful in preventing or minimizing illness and injuries of service members who have deployed to the current conflicts in Iraq and Afghanistan. After the military mission itself, the highest priority in the Department of Defense is for the protection of the health of the men and women in uniform and the provision for care for those who become ill or inured.

Mr. Chairman, I thank you for the opportunity to discuss the Department's research program with you this morning.

REP. MITCHELL: Thank you.

Dr. Deyton.

DR. DEYTON: Good morning, Mr. Chairman and Dr. Roe.

Thank you for this opportunity to discuss VA's research and programs to care for veterans of Operation Desert Storm and Desert Shield. I'm here today as you know with Dr. Joel Kupersmith, who is our chief research and development officer, also Dr. Mark Brown who is director of our Environmental Agents Service, and also, Dr. Han Kang who is director of our Environmental Epidemiology Service who is sitting behind us. As you know, Dr. Kang really is one of the world's leaders in the epidemiology of deployment in military populations.

Mr. Chairman, within months of their return from service, some Gulf War veterans began to report a wide array of symptoms and illnesses. Then, and today those veterans, their families, and VA health care providers continue to be concerned about the cause of these symptoms and how they may be related to their service.

Those veteran symptoms and their concern was also VA's call to action. Today my colleagues and I would like to talk with you about VA's multifaceted research and clinical care programs targeted to support these veterans. More than 335,000 Gulf War veterans have come to VA for health care services.

The majority of these veterans have come for routine health care but some have had symptoms and illnesses that despite thorough examinations have eluded easy diagnosis. We have been and continued to be very concern about these unexplained medical symptoms and illnesses.

VA researchers, VA health care providers, and VA leaders have responded in a variety of ways to these veteran's health issues initiating research, clinical programs, education programs, and providing for service-connected benefits for these veterans.

After combat in the Gulf War, VA along with DOD and HHS has engaged in an aggressive research in epidemiology program with one goal, to understand the complaints and symptoms of these veterans in order to deliver to them the best possible care. And between 1992 and 2007, 345 research projects related to the health problems affecting Gulf War veterans had been funded at nearly $340 million devoted to the efforts.

But Mr. Chairman, research is just the first step of the process. By turning that information into action, VA directly used what was learned from research to improve the care of these veterans. VA health care providers received training in addressing the specific health care needs of Gulf War veterans including these difficult to diagnose illnesses.

From our clinical practice guidelines for Gulf War veterans to our veterans' health initiatives study guides and other activities outlined in my written testimony, we are increasing the expertise of our primary care physicians and delivering the best possible care to these veterans.

In addition, VA established the War-Related Illness and Injury Study Centers specifically to provide specialized health care for combat veterans who experienced difficult-to-diagnose or undiagnosed but disabling illnesses.

In addition, VA's post-deployment integrated care initiative is establishing post-combat care teams to integrate the many services required to target returning soldier's needs. I want to close, Mr. Chairman, with the recognition that we, as a nation, and VA as the tool of a grateful nation, continue to look for ways to improve how we can best support our returned and returning soldiers.

I'm pleased to tell you that Secretary Shinseki has challenged VA to become an even better advocate for the veterans we serve. The system for assessment of long-term health effects of deployment and the process for consideration of presumptive service connection for those health effects are based on the scientific method for collection and assessment of a large body of research, which emerges slowly.

The considerations of cost and effect of veteran's health concerns are sometimes not immediately obvious. Thus we rely on the collection of scientifically validated data convening experts, and at some point, concluding if a positive association exists, between the occurrence of an illness and some aspect of military service. The positive association is a term Congress asks us to use in making these determinations.

I think that we can all agree with Secretary Shinseki's assessment that the current procedures allows the objective scientific method to be our guide and that our decisions must be based on good science. That the scientific process, as is now used, can take years or decades to come to conclusion if a positive association exists between an illness and some aspect of military service.

And although veterans with deployment-related health concerns can and do receive their health care from VA during those years and decades, for each veteran who feels he or she suffers from a condition related to their military service, that wait for the scientific process to confirm what she or he already suspects is intolerable.

The amount of time this process takes is both intolerable to veterans, and places VA in an unnecessarily adversarial role with the very people for whom we are entrusted to provide care and comfort. Thus the secretary has charged us to transform VA's process for determination of presumptive service connection into one that is based on good science, is substantially faster, and makes VA an advocate for veterans.

At his direction, we are working rapidly to assess the legal, regulatory, and scientific methods with which we can use to meet this charge. Meeting Secretary Shinseki's charge gives us all the opportunity to strengthen VA's mission and to fulfill our collective promise to our nation's veterans.

Thank you very much, Mr. Chairman. We will be happy to take your questions.

REP. MITCHELL: Thank you. The first question I have is to all three gentlemen who have made a statement this morning. And I would like to ask all of you, do you acknowledge that the Gulf War illness is a real, major health threat affecting at least one in four gulf members. We'll start with you Mr. Walpole and then Dr. Postlewaite and Doctor --

MR. WALPOLE: I don't see that as an intelligence question. I mean, I don't have the expertise to even address that kind of issue. I'm sorry.

REP. MITCHELL: So you have no opinion on whether or not the Gulf War illness is real or not?

MR. WALPOLE: Well, I have a personal opinion on it, but since I'm representing --

REP. MITCHELL: Okay.

MR. WALPOLE: -- an intelligence organization that probably doesn't matter.

REP. MITCHELL: Okay. Dr. Postlewaite?

DR. POSTLEWAITE: Yes, Sir. We do believe that Gulf War illnesses are real, as was indicated in my testimony. We believe that the latest study that was published on health conditions in Gulf War on April 9, that reported significantly higher rates, 25 percent above those who were non-deployed is a good estimate of the prevalence, yes, sir.

REP. MITCHELL: And Dr. Deyton.

DR. DEYTON: Yes, sir. VA has recognized for over 15 years, that the basic fact that continues to be confirmed as recently as Dr. Kang's most recent publication, there does exist a significantly higher rate of unexplained multi-system illnesses among deployed veterans who served in these conflicts when compared to non-deployed veterans.

REP. MITCHELL: Dr. Postlewaite, in your written testimony, it says, in 2006 the IOM recommended that further epidemiological studies should not be performed. And do you concur with that or is that -- the first panel says they should be.

DR. POSTLEWAITE: Yes, sir, I said in general, it should not be performed, and should be concentrated on areas like mortality and cancer, certain psychiatric conditions. We concur with that. We -- DOD actually does have a epidemiologic study, perhaps you have heard of it before, called the Millennium Cohort Study that's being going on for a number of years. There are about 9000 Gulf War veterans in that particular study that we continue to monitor their health.

REP. MITCHELL: Okay. Mr. Walpole, the CIA models are the foundation for DOD's determination that the Gulf War veterans were not exposed to various chemicals, pesticides, and so on, is that correct?

MR. WALPOLE: Were not exposed?

REP. MITCHELL: Yes, to the models that you used.

MR. WALPOLE: The CIA participated in the DOD modeling. Provided information on where releases might have occurred, but in the case of Khamisiyah, we felt that troops would have been exposed, or were likely to have been exposed.

REP. MITCHELL: Okay. One of the things I find interesting is some of the papers I have in front of me, it says -- you stated that there was uncertainty with the models. There were inaccurate logs for very important dates, and still today continuing uncertainties. If you were a Gulf War veteran, would you want the basis of your health care benefits after serving selflessly, to be based on uncertainty?

MR. WALPOLE: I would not. And I would say to those veterans that modeling is only part of a larger equation. I think the public would expect us to model potential terrorist, biological, or radiological effects, knowing that those models are only part of a larger equation to protect the nation.

It's also the case here. Those models are only part of the equation, as I said in my opening remarks. We did not intend for that modeling effort to be an estimate of the absolute number of troops that were exposed.

REP. MITCHELL: Okay. Dr. Postlewaite, in view of all the scientific evidence compiled by the RAC report, the pyridostigmine bromide was a casual factor. Has DOD made any change in its policy regarding the use of PB?

DR. POSTLEWAITE: Sir, we have not made any changes in the use of PB. We view that as a very, very important tool in our armamentaria and to protect our troops against nerve agent exposure. We -- the only changes that we have made is that we are better at our documentation now for all four health protection prescription products so that we can track who was given these medications, so that if we ever need to go back and do an analysis, we will have better data.

REP. MITCHELL: Thank you. I'm about to expire my time, so I would like to defer to Dr. Roe, then I have a few more questions.

Dr. Roe.

REP. ROE: Thank you, Mr. Chairman, just a couple of questions. One is why was doxycycline used. That sounds sort of goofy to me.

DR. POSTLEWAITE: Yes, sir, let me explain. That's a good question. The reason that it was chosen was that there were some indications that our deployed personnel may have been exposed to mycoplasma based on serologic studies, sir, which you'll understand. And it was decided that that was the best indication of a potential infectious agent. And so doxycycline, which is effective for mycoplasma was chosen.

REP. ROE: So that's why this -- initially these symptoms were thought possibly related to mycoplasma.

DR. POSTLEWAITE: I'm sorry, sir?

REP. ROE: The initial symptoms were thought to be related to mycoplasma, right?

DR. POSTLEWAITE: Well, it was one of the theories. One of the possibilities; in terms of nondescript symptoms it seemed to fit.

REP. ROE: And obviously was incorrect.

Now, I can understand it. Now, in your testimony, the issue to medicine and sort of -- it sounded like it contradicted what Dr. Steele said just a minute ago that there wasn't -- in their conclusion there was no Gulf War, am I correct on that?

DR. POSTLEWAITE: That there was no Gulf War illness?

REP. ROE: Syndrome, yeah. You just sound like --

DR. POSTLEWAITE: There was no -- let me clarify, sir. No Gulf War syndrome, you know they found no unique pattern of symptoms, no unique set of symptoms. They acknowledged that the symptoms were there, but they varied among different people who were ill. And there was not a preponderancy of a group of symptoms that would indicate a syndrome.

REP. ROE: I think one of the things that I've done over the years as a physician, and I'm sure you have too, is that when I have a patient that comes to me, and of course, that's different than the -- all the epidemiologic. My -- the way I look at it is, I'm to prove you don't have something. Now, when you come to me and give me your symptoms, I'm going to try to figure it out, and prove you don't have it. And I'm going to assume you do.

And just a couple of things that come to my mind is that I've had patients, I've practiced over 30 years in Johnson City, Tennessee, and I would see patients with vague symptoms, and I would see them back again another year, and I would see them back another year. And then it dawns on you at 10 years that they have MS. And it took you that long to finally figure it out.

And I think that these studies should go on because you don't know the long-term effects of these conditions and what they are ultimately going to be. And then, I was interested, especially, in the ALS and brain cancer data, not did it increase but was a statistically significant increase? That's very, very important.

I know a lot of people don't -- if you have it, it's a 100 percent. I understand that. But when you're dealing with hundreds of thousands of people, a few more may not range outside the standard deviation.

MR. POSTLEWAITE: Yes, sir.

REP. ROE: Is that -- have you looked at that? I asked Dr. Steele that, and I didn't --

MR. POSTLEWAITE: Well, we agree that looking at this data over the long-term is important, and the Institute of Medicine will begin a study here in 2009. In fact, I think they have their first public meeting on it already to review all the health outcome data, once again, to see if there's anything that has transpired looking at the -- all the research studies that have happened in the interim.

So we continue to say, yes, let's re-look at this. We've got our Millennium Cohort Study within DOD. We are not intending to sweep this under the carpet to make it go away.

REP. ROE: Well, I think, and I've had, I guess, a couple of other things. What -- wasn't sarin gas used in Japan?

MR. POSTLEWAITE: Yes, sir.

REP. ROE: Has anyone studied that population?

MR. POSTLEWAITE: They have. There have been a number of studies that have --

REP. ROE: What's that shown?

MR. POSTLEWAITE: Well, it's shown that these individuals who experienced acute symptoms at the time of exposure, did have some long-term health effects. The things missing here with our Gulf War situation, as Mr. Walpole talked about, the modeling; we have no indication of any of those troops that may have been under those plumes that were modeled, that any of them experienced any acute symptoms of sarin exposure or cyclosarin.

REP. ROE: Well, I think we just had a testimony a minute ago that someone did. I mean, I think Mr. Burton (ph) just said he had. I think he was documented to have seizures and so on. That would seem to me be symptoms.

MR. POSTLEWAITE: We have not been able to link that with the actual exposure, sir. We are not -- I'm not controverting his testimony at all that he may have had seizures. As you know, there are a lot of different reasons for seizures. We've been unable to link the Khamisiyah event with the kind of health effects that we would see in the group in Japan that have the acute health effects.

REP. ROE: I think the other thing, I think this does screen for an electronic medical record, where you can more accurately follow these. I think, this is a fascinating epidemiologic study, and I certainly 100 percent agree that we need to be sure that we err on the side of taking care of our veterans. And I know everyone in this room believes that.

Mr. Chairman, thank you for holding this committee hearing, and I look forward to the next too.

REP. MITCHELL: Thank you. I just would like to go a few more questions and you can join in also. I want to get this straight, Mr. Walpole. The CIA's models, were they the -- I think, I asked this, maybe I didn't quite hear it right -- were they the foundation for the DOD's determination about Gulf War veterans who were not exposed? What was the modeling that the CIA did, and who used that model after you created the model?

MR. WALPOLE: Yeah, the -- we modeled several different places. We modeled the bunker at Khamisiyah, and it appeared that with that model, even using the 1997, 1996 data, did not reach troops. When we got better information, it was even less in the plumes, or would not have reached troops.

We modeled the pit at Khamisiyah. We modeled Al Muthanna and Muhammadiyat. And Al Muthanna, Muhammadiyat cases would not have reached troops. The only case where the modeling suggested the troops would have been exposed was the Khamisiyah pit.

Now, we participated in the pit modeling, and then the remodeling of Al Muthanna and Muhammadiyat with DOD with the new information. So yes, they would have used that information. Is that what you were getting at?

REP. MITCHELL: I wanted to ask -- do you think this model, the criteria or the modeling that you used is a good model, would you use it again? Because I keep hearing that there were uncertainties, that there were incomplete data. In fact, in one report I saw here that in '93, DOD and CIA concluded that no troops had been exposed.

Then in '96, the CIA released a report that says, they may have been exposed. And then in 2004, the GAO report, they cannot adequately support. You know, this leaves an awful lot in the air about the modeling. And I'm just curious whether you are going to continue to use those?

MR. WALPOLE: Well, as you noticed in 1995 is when CIA began to become very involved in this effort. So I'm not going to comment on the '93, but post '95, did the modeling at the bunker 73, 1996. And it blew away from the troops. So, I mean, that one is fairly easy. I'm not so concerned about the model there.

The Khamisiyah event was the one that I -- the Khamisiyah pit event was the one I talked about in terms of the uncertainties. In 1997, and then again in 2000, we're trying to model something that happened in the past. We didn't have complete weather information. We didn't have complete plume information.

We had soldiers telling us how they thought they placed the charges and so on. There are uncertainties involved in that. But we felt that that was providing a tool to epidemiologists to work the issue, a better tool than simply a circle drawn around Khamisiyah would have been a lot less work for us, but it's only an input to a larger equation in the picture.

Because as you study this, as somebody studies the symptoms that soldiers are reporting, if a cluster is noticed within one of these plumes or even off to the side of one of the plumes, that would tell you some important information from an analytical perspective.

So we were trying to put together that modeling to help simply in that regard, but not to estimate the absolute number of troops that we're exposed. Your -- last part of your question was would we use modeling today. Absolutely, we continue to use modeling.

We have to model potential effects for -- if a terrorist does something somewhere, not because that model itself is going to stop the terrorist threat, but because it helps us prepare for managing consequences, so on, so yeah, we'll continue to model.

REP. MITCHELL: Dr. Postlewaite, knowing the uncertainties with these -- the models that CIA, what would you base your recommendations on now?

MR. POSTLEWAITE: For that event, sir, for the --

REP. MITCHELL: Well, any future ones. We wanted to go forward too.

MR. POSTLEWAITE: Well, yeah. That's a very good question.

REP. MITCHELL: Does the need for more information from the field --

MR. POSTLEWAITE: Yes, sir.

REP. MITCHELL: -- continually, weather and all the things that go into it --

MR. POSTLEWAITE: Yes, sir.

REP. MITCHELL: -- which we had before.

MR. POSTLEWAITE: We would want to reduce that uncertainty and the factors that Mr. Walpole just indicated. And based on the lessons learned from the '91 Gulf War and other conflicts, I can assure you that our environmental surveillance program is much strengthened over what existed in 1991.

We've -- for example, collected over 11,000 air, water, and soil samples in the theatre. We know the conditions, environmental conditions there, in some cases, better than we know here in certain areas of the United States.

We've got better documentation, so that that data is retrievable and it can be analyzable. We can reduce the uncertainties that Mr. Walpole spoke about. We've got better instrumentation, better trained individuals in the theatre to monitor that.

REP. MITCHELL: One of the things mentioned by one of the first panelists was that if you go to the VA, they don't even have records of where some of these soldiers served. So even if you had all that information, if there is no record that goes on to the VA, which should be part of your record, there we have another conflict and a dispute?

MR. POSTLEWAITE: Your point is well taken, sir, and we are working hard to correct that. Three years ago, we put into policy a requirement that each deployed troop will have a daily location documented when deployed.

There's a system out there called the DTAS or the Deployment Theatre Accountability System that's being populated as we speak, services have had a couple of years to implement this. As we move forward, we're going to have much better data on location of our troops.

We want to link that with our electronic medical record as well, and we want to make that available to the VA in the future.

REP. MITCHELL: Perfect, thank you.

Dr. Roe.

REP. ROE: I'll just ask a couple of real quick questions. One is, the PB in pesticides, according to Dr. Steele's testimony, she feels like through her research that this is a causative in Gulf War syndrome. Do you agree with that?

MR. POSTLEWAITE: No, sir, we don't. We --

REP. ROE: You do not agree with that, why do you not? Why don't you?

MR. POSTLEWAITE: We ascribe to the Institute of Medicine's extensive review on all of the exposure agents, including PB and pesticides. We know that the data is conflicting. We know there are lots of confounders in the studies. We know that it's open to interpretation.

We feel that the Institute of Medicine is the preeminent medical institute and group in this country. We rely on their expertise and their conclusions, and we feel like their assessment was complete.

REP. ROE: Now, we're getting down to it. We have two separate -- I thought that's what I heard you say. So we've got Dr. Steele who feels like that, through her research, she has nailed down the causative agents in this problem. And the Institute of Medicine, IOM, says no, their data doesn't support that.

Now, what are we, as -- I've got to obviously dig a little deeper here and read this, because I -- we'll read these papers before the next meeting to come to some conclusion on my own. So the military, you would still recommend using the PB and to get not Atropine.

MR. POSTLEWAITE: Yes, sir. When we need to use PB for the safety of our troops, the operational commanders will indicate when it should be used.

REP. ROE: Even with this potential risk, of course, obviously, risk of dying of a nerve gas right then, you don't have much choice right there in the field?

MR. POSTLEWAITE: Yes, sir.

REP. ROE: Thank you, Mr. Chairman. I yield to Congressman Walz.

REP. MITCHELL: Thank you.

Mr. Walz.

REP. WALZ: Thank you, Mr. Chairman, and thank you all of you for the work you've done.

This one, Mr. Walpole, question to you. Can you explain just briefly to me some of your modeling, maybe take specifically the Khamisiyah pit, how did you do that? How did you model on that?

MR. WALPOLE: I'm going to let Larry Fox who is much more closely associated to the model itself.

REP. WALZ: Very good.

MR. FOX: It's important to understand that a lot of what CIA and the rest of the intelligence community did on this modeling effort was trying to determine from intelligence information how much agent was released, and what was the actual circumstances out in the Gulf at the time.

The actual modeling of the weather and the actual information that came out of that modeling was done primarily by DOD after 1997. So we've worked really hard at trying to determine the actual amount released, the amount absorbed in by the wood, the amount that would degrade over time, and that was in the rockets.

So we were trying to determine, to the best of our knowledge, what were in those rockets. What happened to the agent right after it was released, understanding that there is no way to perfectly know that because the only way to know exactly what happened downwind at that time, where do we have a actual contemporaneous sensor, you know, like --

REP. WALZ: Did you change your modeling variables to indicate what would happen? How much of a change would it take in the variables to have a dramatic change in exposure?

MR. FOX: Quite a bit, to be honest.

If you double the -- we changed the inputs from '97 to 2000, and the reason we changed it was based on information that we got in '98 about the actual placement of charges and things like that that were different than what we had learned in information we got about the agents.

So it was a factor of too smaller. And subsequently the plume that was modeled was a factor of too smaller. But that's still small in comparison to the uncertainty in the weather and the winds and things like that.

So in that, for our input, I think it's a small factor in the overall uncertainty on where this agent went. It's more typical things with weather and understanding where the winds blew the stuff is a larger uncertainty.

REP. WALZ: So you heard Mr. Walpole say, you -- so you are pretty confident in your modeling? I mean, they were confident enough that Mr. Herbert received a letter from DOD that said, however, our analysis that shows exposure levels have been too low to indicate any symptoms that you may be experiencing.

I mean, they were confident enough in their modeling that they send a letter out to a veteran who was at Khamisiyah and said, nope, don't worry about it. Are you that confident in the modeling? Even though you said you went back in and changed them from '97 to 2000, should -- did you get an update on this by the way?

REP. : Yeah -- (off mike.)

REP. WALZ: That said that the new modeling?

MR. WALPOLE: Yeah, actually as I indicated, in my written statement, I indicated at the beginning here and I've also said in one of the questions, we didn't -- in participating in this modeling activity, we did not intend for this to estimate the absolute number of troops that were exposed.

The uncertainties that we've described here, I mean, where would you draw the line on, if I were sending the letter, who does and doesn't get a letter. So that's --

REP. WALZ: Yeah.

MR. WALPOLE: That was our view from the beginning.

REP. WALZ: Okay.

MR. FOX: I think it's important to note that I think there is in the remodeling that happened from '97 to 2000, the position of where the troops were was better refined. I don't want to speak for DOD, but there is other things that ended up causing 30,000 veterans to get a letter that said, well, we thought you might have been exposed before, but now we don't think you were exposed. Those are the things of the letters you are talking about.

REP. WALZ: Yeah.

MR. FOX: In addition, though 30,000 people that previously hadn't gotten a letter, then got a letter. And so it's not that we don't think anybody was exposed anymore. It's these potential exposure letters that went out, changed based on refinements in the models.

REP. WALZ: Okay, thank you.

Dr. Deyton, just one for you. Do you know how many veterans received compensation for Gulf War related symptoms?

DR. DEYTON: Sir, I do not. But we'll happy to go back and ask our colleagues in VBA the benefits to give us the most updated number.

REP. WALZ: Do you know how many are on the registry then, or the same thing?

DR. DEYTON: About 111,000 are on the registry.

REP. WALZ: Would you -- when it was characterized earlier by one of our -- representatives of one of our veterans service organizations as an e-mail list more than a registry, you think that's a fair characterization?

DR. DEYTON: I -- it's a great communication tool. We do -- it's important to reach out to these veterans and their families and communicate to them. What we know and as the medicine and science evolve --

REP. WALZ: But it's not necessarily being used as a research base or universe of research.

DR. DEYTON: I would never characterize the registries as an adequate research base. It -- we do collect information, absolutely, and that information is likely useful for that individual veterans clinician. When we want to amass a population base, we have to go to good standard epidemiology studies like Dr. Kang does.

REP. WALZ: Very good. Thank you for your time.

I yield back, Mr. Chairman.

REP. MITCHELL: I would just like to ask, if you don't mind, just a couple more questions to Dr. Deyton. First of all, how does the VA train its health care providers to address the goal for veterans either unexplained illnesses or symptoms, and would you agree that training material needs to be dramatically revised?

DR. DEYTON: We do have multiple training materials and self- guided, I think, veterans' health initiative which focuses on many aspects of deployment-related health. There are also individual sessions and trainings for providers.

And I'm a practicing physician too. And I think education and training for front-line providers always can be improved. As the science and medicine evolves, these kinds of materials have to be updated. As new diagnostics and new potential treatments are uncovered, updating is always very important. So I agree absolutely that updating is a positive thing to do.

REP. MITCHELL: A kind of a follow-up with that is, how do you propose to change the culture so that the health care providers that are in the field are administering a care and reassuring the Gulf War veterans that they are not crazy, and their complaints are surrounded by some facts?

DR. DEYTON: Well, I think Dr. Steele hit the nail on the head. This really is a complex set of illnesses and symptoms that requires a very intense set of diagnostics and a personal clinician-patient relationship. So the education and training we provide to our doctors, our nurses, our pharmacists, our social workers about what the medicine, what the science says about these syndromes is very important.

So I think continuing to update those educational guides, changing the culture, I think, is -- as several members have said today, is a very important thing. And I think Secretary Shinseki has set us on a very important new course that I alluded to at the end of my opening statement.

And that is to look at the process that we use for determining presumptive service connection, and the scientific evidence and base of that, and determine ways to make that more rapid. And in fact, change the culture of VA so that VA becomes much more an advocate for our veterans as opposed to the current process, which granted, based in good science, but puts VA in an uncomfortable adversarial relationship with the men and women that quite frankly, we are dedicated to serve.

So as we move into that set of discussions with the secretary, I know he will want to come back to this committee and talk about how he is going to be doing that, and if there is any need for legislative change or remedy for to move us into that direction.

REP. MITCHELL: Thank you.

Does any other member have any other comments?

REP. ROE: One brief comment, Mr. Chairman. One of the things, I think, is very important to continue to study the natural history and the epidemiology of this is what patients of mine have feared the unknown. What's -- if you don't know what's going to happen to you. You can prepare for the known.

If you know you have cancer of the thyroid, you can prepare a treatment plan and take care of it. I think the problem here is, is the unknown or what's going to happen in the over time. And I think that's why it's extremely important because right now we don't know.

May be the Institute of Medicine is right. May be Dr. Steele is right. I don't know the answer. But I know that continued studies is absolutely essential to find out what's going to happen, because I think if I'm a veteran out there, and I've been exposed, what's going to happen in my family. Well, we know birth defects are not higher, you do know that. That's a known. You can tell someone they don't have to worry about that.

But there are some other things that are unknown. So I would just simply, just a personal view point, that I would continue the study of this problem.

I yield back, Mr. Chairman.

DR. DEYTON: Yes, may I respond. Dr. Roe, you are absolutely correct. And the power that's -- again, several of the panel members have spoken about the power of the electronic health record. The linkage, the much better granular linkage with the Department of Defense, medical and deployment record, is huge in terms of our power to predict and to understand the evolving nature of these health risks.

So by doing what I call population-based surveillance and the epidemiology, we hope to be able to identify trends, much, much earlier in the process, and then act on those trends to improve and target our veteran's health before bad things really happen.

REP. MITCHELL: I want to thank all of you for being here today, and all of your service to our veterans and to this country. Just one last comment and I know this is a little generalization.

But when I was the mayor of the city that I was in, we decided to self-fund our health care, and all of our liabilities, in that health care liabilities. And so we hired a risk manager. And of course what we did automatically, any claim that came in was no, and then you had to appeal it. It did save the city a lot of money, but it wasn't always the best thing or right thing to do. And sometimes I get the feeling that either the DOD or VA, it's very easy just to say no, and let people appeal it.

And I really am very pleased to hear Dr. Deyton, your comment about we need to be more of an advocate and sort of an advisory for veterans, because that's exactly what I would hope the VA is about, and I think that's what all of us agree with.

So I want to thank all of you for appearing today, our first panel, as well as our second. And this is just, you know, the first. We are going to have a series of hearings, so we can look at the methodology and how we are arriving at this, and because there is a lot of people, when it gets to the human side that are really affected way after the studies come out and it may be too late.

Thank you very much and this concludes the hearing. (Sounds gavel.)

Source