Table Of Content.
3 HEALTH CARE PROBLEMS AND CONCERNS OF PERSIAN
GULF WAR VETERANS: THE RESPONSE OF THE DEPART-
MENT OF VETERANS AFFAIRS AND THE DEPARTMENT
OF DEFENSE AND RELATED ISSUES
^Y 4. V 64/3: 103-33
Health Care Problens and Concerns o. .
HEARING
BEFORE THE
SUBCOMMITTEE ON
0\^RSIGHT AND IM^STIGATIONS
OF THE
COMMITTEE ON VETERANS' AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRD CONGRESS
FIRST SESSION
NOVEMBER 16, 1993
Printed for the use of the Committee on Veterans' Affairs
Serial No. 103-33
U.S. GOVERNMENT PRINTING OFFICE
3-904CC WASHINGTON 1995
:
ForsalebytheU.S.GovernmentPrintingOffice
SuperintendentofDocuments.CongressionalSalesOffice,Washington.DC 20402
ISBN 0-16-046657-1
] HEALTH CARE PROBLEMS AND CONCERNS OF PERSIAN
GULF WAR VETERANS: THE RESPONSE OF THE DEPART-
MENT OF VETERANS AFFAIRS AND THE DEPARTMENT
OF DEFENSE AND RELATED ISSUES
Y 4, V 64/3: 103-33
Health Care Problens and Concerns o...
HEARING
BEFORE THE
SUBCOMMITTEE OX
OVERSIGHT AND IM^STIGATIONS
OF THE
COMMITTEE ON VETERANS' AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRD CONGRESS
FIRST SESSION
NOVEMBER 16, 1993
Printed for the use of the Committee on Veterans' Affairs
Serial No. 103-33
-?
s
U.S. GOVERNMENT PRINTING OFFICE
0-904CC WASHINGTON 1995
:
ForsalebytheU.S.GovernmentPrintingOffice
SuperintendentofDocuments.CongressionalSalesOffice.Washington,DC 20402
ISBN 0-16-046657-1
COMMITTEE ON VETERANS' AFFAIRS
G.V. (SONNY) MONTGOMERY, Mississippi, Chairman
DON EDWARDS, California BOB STUMP, Arizona
DOUGLAS APPLEGATE, Ohio CHRISTOPHER H. SMITH, New Jersey
LANE EVANS, Illinois DAN BURTON, Indiana
TIMOTHY J. PENNY, Minnesota MICHAEL BILIRAKIS, Florida
J. ROY ROWLAND, Georgia THOMAS J. RIDGE, Pennsylvania
JIM SLATTERY, Kansas FLOYD SPENCE, South Carolina
JOSEPH P. KENNEDY, II, Massachusetts TIM HUTCHINSON, Arkansas
GEORGE E. SANGMEISTER, Illinois TERRY EVERETT, Alabama
JILL L. LONG, Indiana STEVE BUYER, Indiana
CHET EDWARDS, Texas JACK QUINN, New York
MAXINE WATERS, Cahfomia SPENCER BACHUS, Alabama
BOB CLEMENT, Tennessee JOHN LINDER, Georgia
BOB FILNER, California CLIFF STEARNS, Florida
FRANK TEJEDA, Texas PETER T. KING, New York
LUIS V. GUTIERREZ, Illinois
SCOTTY BAESLER, Kentucky
SANFORD BISHOP, Georgia
JAMES E. CLYBURN, South Carolina
MIKE KREIDLER, Washington
CORRINE BROWN, Florida
Mack Fleming, StaffDirector and ChiefCounsel
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
LANE EVANS, Illinois, Chairman
MAXINE WATERS, CaUfomia THOMAS J. RIDGE, Pennsylvania
BOB FILNER, California SPENCER BACHUS, Alabama
LUIS V. GUTIERREZ, Illinois TERRY EVERETT, Alabama
JAMES E. CLYBURN, South Carohna JACK QUINN, New York
MIKE KREIDLER, Washington
JILL LONG, Indiana
(II)
CONTENTS
Page
OPENING STATEMENTS
Chairman Evans 1
Hon. Jack Quinn 2
Prepared statementofCongressman Quinn 103
Hon. Thomas J. Ridge 5
Hon. Mac CoUins 6
Prepared statement ofCongressman CoUins 106
Hon. Joseph P. Kennedy II 6
Hon. Spencer Bachus 11
Prepared statement ofCongressman Kreidler 104
Prepared statement ofCongresswoman Brown 105
WITNESSES
Albuck, Troy, accompanied byKelUAlbuck, Barrington, IL 19
Prepared statement ofTroy and Kelli Albuck 168
Blanck, Maj. Gen. Ronald R., Commanding General, Walter Reed Army Medi-
cal Center 72
Brown, Hon. Jesse, Secretary, Department ofVeterans Affairs; accompanied
by Dr. John T. Farrar, Acting Under Secretary for Health; Dr. Susan
H. Mather, Assistant Chief Medical Director, Environmental Medicine and
Public Health; Dr. Susan Ritter, Ph.D., MPH, Persian GulfFamily Support
Program Coordinator, Persian GulfHealth Advisory Clinic Co-Director, VA
Medical Center, Birmingham, AL, R.J. Vogel, Deputy Under Secretary for
Benefits; J. Gary Hickman, Director, Compensation and Pension Service,
Veterans BenefitsAdministration; and Mary Lou Keener, General Counsel 82
CuUinan, Dennis, Deputy Director, National Legislative Service, Veterans.
ofForeign Wars ofthe U.S., accompanied by Brian Martin, Niles, MI 31
Prepared statement ofMr. Cullinan 176
Egan, Paul S., Executive Director, Vietnam Veterans ofAmerica 33
Prepared statement ofMr. Egan appears 184
Gelband, Hellen, Senior Associate, Health Program, Office ofTechnology As-
sessment, accompanied by Maria Hewitt, Senior Analyst, Health Program,
and Clyde J. Behney, Assistant Director, Health, Life Sciences and the
Environment 3
Prepared statementofMs. Gelband 157
Hollingsworth, Kimo S., Assistant Director, National Legislative Commission,
TheAmerican Legion 31
Prepared statementofMr. Hollingsworth 179
Jackson, Dr. Charles, Environmental Physician, StaffPhysician, StaffPhysi-
cian, VA Medical Center, Tuskegee, AL 58
Prepared statement ofDr. Jackson 218
Martin, Brian, Niles, MI 25
Shayevitz, Dr. Myra B., Director, Cardio-Pulmonary Laboratory, Pulmonary
Rehabilitation Program, VA Medical Center, Northampton, MA 56
Striley, TimothyJames, Fulton, IL 22
Prepared statement ofMr. Striley 171
(III)
IV
MATERIAL SUBMITTED FOR THE RECORD
Documents:
Analysis and amendment to H.J. Res. 15 44
Written committee questions and their responses:
Chairman Evans to DepartmentofVeterans Affairs 221, 223
Congresswoman Long to DepartmentofVeterans Affairs 237
Chairman Evans to Dr. Myra Shayevitz 238
Chairman Evans to Department ofDefense 243
Chairman Evans to Veterans ofForeign Wars 263
Chairman Evans to Dr. CharlesJackson 265
HEALTH CARE PROBLEMS AND CONCERNS
OF PERSIAN GULF WAR VETERANS: THE
RESPONSE OF THE DEPARTMENT OF VET-
ERANS AFFAIRS AND THE DEPARTMENT OF
DEFENSE AND RELATED ISSUES
TUESDAY, NOVEMBER 16, 1993
House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Veterans' Affairs,
Washington, DC.
The subcommittee met, pursuant to call, at 9 a.m., in room 334,
Cannon House Office Building, Hon. Lane Evans (chairman of the
subcommittee) presiding.
Present: Representatives Evans, Montgomery, Gutierrez, Ken-
nedy, Long, Kreidler, Ridge, Bachus, and Quinn.
Also Present: Representatives Browder and Collins.
OPENING STATEMENT OF CHAIRMAN EVANS
Mr. Evans. The hearing will come to order.
On June 9, the Subcommittee on Oversight and Investigations
conducted a nine-hour marathon hearing on the health care prob-
lems and concerns of Persian Gulf War veterans. From veterans
and their loved ones, we learned that many who served are now
chronically ill.
These heroes of the Persian Gulf War are shackled by a wide
array of health problems and symptoms. They had been healthy
and physically fit before their Gulf services. Now, they cannot re-
sume the active and productive lives they led before serving in the
Gulf.
These ongoing health problems were reemphasized last week
when the full committee, at the request of Congressman Joe Ken-
nedy, conducted a special hearing and received added testimony
from more than a dozen individuals.
In June, we also learned veterans and active duty servicemen
and women were not always receiving priority medical attention for
their health problems. In some cases, veterans were reportedly told
they would not receive care until they made a copayment. In other
cases, repeated efforts to get help from their government produced
only repeated failure. Some Gulf War veterans turned elsewhere
for help. Others simply gave up.
Witnesses representing VA and DOD told the subcommittee
some GulfWar veterans did have health problems, but a diagnosis
had been elusive. More research was needed. Gulfveterans' health
(1)
problems were not a mystery to several private physicians who ap-
peared before the subcommittee. But while they identified cause,
diagnosis and treatment, their answers were not the same.
In the 5 months since the June hearing, what has been done and
what has been learned about these health care problems? How
have the VA and DOD responded and how have they worked to-
gether?
What research has been conducted and what new information
has been gained? What treatment is being provided and is it suc-
cessful?
What has been learned from the Gulf War Registry programs?
Do we know what happened in the Gulf and the causes of these
health care problems?
Has all the information which might be essential for effective
treatment been provided?
These and many other related subjects are the issues before the
subcommittee today.
I am very pleased at this point to recognize the distinguished
chairman ofthe full committee, Sonny Montgomery.
Mr. Montgomery. Thank you very much, Mr. Chairman. As you
said in your statement, we need to get all of the information and
all of the facts we can about chemical weapons that could have
been used or not used in the Persian Gulf.
I commend you for having this hearing, and I commend you for
starting on time.
Mr. Evans. Following your leadership, Mr. Chairman.
The gentleman from New York.
OPENING STATEMENT OF HON. JACK QUINN
Mr. QuiNN. Thank you, Mr. Chairman, and thank the chairman
of the full committee, Mr. Montgomery, for reminding the three of
us that we are on time.
Mr. Chairman, I appreciate more than any the work you have
done on this issue, and look forward to hearing testimony this
morning.
It seems that each and every week more information comes to
light on this matter, and the important thing for all of us to recog-
nize and to keep in the forefront of our minds is that we don't fool
around and wait with this thing. Time is of the essence, and the
sooner we get to it the better. I think all ofus agree with that.
I will have an opening statement for the record, but I appreciate
the time
[The prepared statement of Congressman Quinn appears at p.
103.]
Mr. Evans. It will be included in its entirety, and we salute you
for being here at the beginning, as you are regularly.
Mr. Quinn. Thank you.
Mr. Evans. The subcommittee's first witness today is Hellen
Gelband, Senior Associate, Health Program, Office of Technology
Assessment. She is accompanied by Maria Hewitt and Clyde
Behney.
Hellen, your entire statement will be made part of the hearing
record, without objection, and you may proceed when you are
ready. Ifyou care to summarize, you may do so.
STATEMENT OF HELLEN GELBAND, SENIOR ASSOCIATE,
HEALTH PROGRAM, OFFICE OF TECHNOLOGY ASSESSMENT,
ACCOMPANIED BY MARIA HEWITT, SENIOR ANALYST,
HEALTH PROGRAM, AND CLYDE J. BEHNEY, ASSISTANT DI-
RECTOR, HEALTH, LIFE SCIENCES AND THE ENVIRONMENT
Ms. Gelband. Thank you, Mr. Chairman, for the opportunity to
participate in this hearing.
PubUc Law 102-585 charged the Director of OTA with assessing
the potential utihty of the DOD and VA Registries for "scientific
study and assessment of the intermediate and long-term health
consequences ofmilitary service in the Persian Gulf."
Our first report, issued 2 months ago, focused on the Department
of Veterans Affairs Persian Gulf Veterans Health Registry, which
is the examination program initiated by the VA for Persian Gulf
veterans.
We also started to look at how the Defense Department is carry-
ing out its mandate, developing a geographic information system
linking troop locations with exposure to oil well fires.
When Congress directed the VA to create a Registry for health
examinations of Gulf veterans, the greatest potential hazard ap-
peared to be the smoke pouring from hundreds ofoil wells that had
been set on fire by the Iraqis. The Defense Department mandate
also centered on assessing the risk to health posed by the fires.
Once completed, the DOD system may be used in various ways
to consider possible health damage from oil fire smoke. DOD will
be able to tell individual veterans about his or her level ofexposure
by using daily company locations and modeled estimates of air pol-
lutant concentrations, although it will be difficult to explain just
what those exposures mean in terms of the veteran's health. The
DOD system also could be used to identify cohorts of individuals
with relatively high and relatively low exposures to the oil fire pol-
lutants should it be decided that it is necessary to do in depth stud-
ies.
The emphasis on oil fires as the exposure around which both
DOD and VA conducted their activities, however, means that it will
be much less useful for exploring other potential hazards. The limi-
tations ofDOD's and VA's mandated activities are worth noting.
The VA Registry can provide only descriptive information about
the individuals who requested an examination either because they
are sick or because they fear potential ill effects of their Gulf serv-
ice. The hope is that the individuals who do come will serve as sen-
tinels for health problems that might be emerging among Persian
Gulf veterans more widely, but no valid conclusions about cause
and effect can be made on the basis of the Registry population
alone.
The task ofdeciding whether to pursue a possible health problem
in a separate study will be the big challenge and one for which
there is no set ofrules to follow. The judgments ofexperts in medi-
cine and epidemiology will have to be relied on and strong dif-
ferences ofopinion about what to do are guaranteed.
The DOD system will be used mainly for studying the effects of
oil fires and possibly also for other geographic variables, but al-
ready there are concerns about inoculations, depleted uranium, ve-
hicle paint, diesel fumes, and chemical warfare agents to name a
few, and these will benefit relatively little from DOD's Registry ac-
tivity.
Whether or not these represent real threats, they must at least
be acknowledged and considered for further evaluation and that
work will have to proceed on an ad hoc basis in addition to the
mandated Registry.
Decisions about whether epidemiologic studies should be under-
taken will be made ultimately on the basis ofexpert opinion offered
by the Institute of Medicine's Medical Follow-up Agency, and, of
course, also by VA and DOD. But there is no neat formula for them
to make those decisions.
The lOM's job could be made easier however, by making sure
that they have an accurate historical record of troop activities in
the Persian Gulf and that there is a clear idea ofwhat information
about possibly hazardous exposures exist in personnel and other
military records. This information is not now easily available, as
we found out when we were asking to get records ofthat sort.
OTA's report includes the following suggestions: (1) that specific
changes be made in the Department of Veterans Affairs' examina-
tion protocol; (2) that coordination between DOD and VA be
strengthened, perhaps by appointing a single advisory board to
oversee both activities, which would be independent of VA and
DOD and would include technical experts and veterans representa-
tives; (3) that the Department of Defense assemble information
about the Persian Gulf Conflict, including the specific activities of
military units and the distribution ofother potential exposures and
experiences.
Next, that DOD and VA each catalog and describe other medical
information available for Persian Gulfveterans from before, during
and after their tours of duty, such as their intake examinations,
blood samples that may have been stored and other medical exami-
nations.
And finally, that VA and DOD standardize the terminology that
they are using in their activities. We believe that that is relatively
simple and should be happening now.
We are working on our second mandated report which will focus
on DOD's Oil Fire Modeling Project. This includes the development
of a geographic information system which comprises satellite map-
ping, atmospheric monitoring, modeling of contaminant concentra-
tions, and health risk assessment, all being carried out currently
in a pilot phase by the Army Environmental Hygiene Agency.
The Army expects to report on the pilot project at the end of the
calendar year, and OTA's report is due in February. Those efforts
will eventually incorporate troop location data being assembled by
the U.S. Army and Joint Services Environmental Support Group.
OTA will report on the technical merit of each major component
and on how the system will work together.
A particular concern and one that requires coordinated effort be-
tween VA and DOD now is how information about individual risks
will be communicated to veterans.
Thank you again for the opportunity to appear here, and we will
be happy to answer any questions.
[The prepared statement ofMs. Gelband appears at p. 157.]
Mr. Evans. Thank you very much.
