Messrs. Chairmen and Distinguished Members of the Committees:
The American Legion would like to take the opportunity to submit testimony concerning the exposure of US military personnel to low levels of chemical warfare agents during the Persian Gulf over five years ago. We will address the effects that the Department of Defense's inflexible policy concerning these exposures has had on the health care of ill Gulf War veterans, and the research of Gulf War illnesses. We would also like to propose a medical initiative that would address this issue in a manner consistent with the lessons learned from the experience of Vietnam veterans exposed to the herbicide Agent Orange.
The American Legion realizes that today's hearing will focus on Defense Department and intelligence reports of exposure of US soldiers to chemical agents during the Persian Gulf War. However, The American Legion would like to recommend that Congress address the inadequacy of the United States military's chemical and biological warfare agent detection and protection capabilities. This national security issue is extremely important to veterans' health issues, especially since DoD has been reluctant to address the "gapping hole"in the nation's chemical and biological warfare defensive capabilities. The American Legion is concerned because DoD continues to purchase and deploy protection and detection equipment which will not fully protect US military personnel from unhealthy low levels of chemical warfare agents. The inadequate chemical warfare protection and detection equipment is currently deployed with US forces in the Middle East, Korea and Bosnia were large stock piles of chemical warfare agents are known to exist.
Over five years ago, while forcefully evicting the world's fourth largest army from Kuwait, American troops were exposed to chemical warfare agents. The evidence of these exposures is overwhelming. DoD, however, continues to insist that American troops were not exposed to chemical warfare agents in the Persian Gulf.
The American Legion can only guess as to the reason for DoD's policy statements. But we do not have to spend much time in determining the effects that DoD's policy has had on the health and well being of Gulf War veterans.DoD's Comprehensive Clinical Evaluation Program (CCEP), a medical examination program for Gulf War veterans on active duty, diagnoses 18% of its participants with a psychological condition. This can be compared with 7.1% of the general population who seek medical care in the United States (CCEP Report on 18,598 Participants, April 2, 1996). Are we to believe that Gulf War veterans on active duty, after passing entrance physicals, psychological screenings, and deployment physicals, are over twice as likely to suffer from a psychological disorder as the average American civilian. DoD has found an epidemic of psychological disorders in its ranks, an epidemic found only among those who come forward with health problems caused by their service in the Persian Gulf.
The group of psychological disorders most commonly diagnosed in the CCEP are Somatoform Disorders. According to the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, Washington, DC, 1994), "the common feature of the Somatoform Disorders is the presence of physical symptoms that suggest a general medical condition, and are not fully explained by a general medical condition [or] by the direct effects of a substance." (American Psychiatric Association, 1994, p. 445) The American Legion believes DoD's policy on exposures has encouraged it's medical doctors to assign Somatoform Disorder diagnoses. One exposure that many Gulf War veterans claim to have encountered, chemical warfare agents, was not present in the Persian Gulf according to DoD. The periodic pronouncements from DoD concerning the nonexistence of "Gulf War syndrome," combined with it policy on exposures, has created an environment where DoD medical doctors believe that Somatoform Disorders are more common among Gulf War veterans.
One illustrative example of the CCEP and DoD medical doctors' bias is that of a Gulf War veteran from Connecticut. This veteran was diagnosed with between nine and eleven diseases between 1991 and 1994 by the Army, and the Department of Veterans Affairs, after his service as a helicopter pilot during the Gulf War. Yet, when he underwent a CCEP examination during August of 1994, he was diagnosed with Somatization Disorder. That was his only diagnosis. This one example illustrates what DoD's own statistics demonstrate: the CCEP is biased against diagnosing disease in Gulf War veterans who suffer from poor health as a result of their service in the Persian Gulf.
DoD's policy has affected more than today's active duty servicemembers and veterans, and their treatment by DoD medical doctors. It has affected how Gulf War illnesses is being studied, the answers being sought, and our preparedness for future wars.
Exposed to many environmental hazards in the Gulf to include: smoke from oil well fires; investigational medications; indigenous parasites; organophosphate pesticides, and stress, thousands of Gulf War veterans have complained of poor health since their return from the Gulf. Their complex of health complaints has become popularly known as "Gulf War syndrome." One, many or all of the environmental hazards American troops were exposed to in the Gulf could be the cause, of this illness, or illnesses. Dozens of well designed scientific studies are underway to determine the role of these hazards in Gulf Warillnesses. One environmental hazard, however, is not currently under study. That one hazard is low level chemical warfare agent exposure, its association with Gulf War illnesses, and with disease in general. It is not being studied because the Department of Defense has insisted that no American troops were exposed.
Due to lack of coordination between the three federal agencies most responsible in determining the definition and etiology of Gulf War illnesses, DoD, VA and the Department of Health and Human Services created the Persian Gulf Veterans Coordinating Board. The Coordinating Board is responsible for selecting scientific studies that examine the relationship between service in the Persian Gulf and illness in Gulf War veterans. The Coordinating Board reviewed proposals this past winter, proposals from respected scientists from around the nation, who wanted to examine specific exposures to American troops in the Persian Gulf, and these exposures' association with disease. Proposals for studies examining low level exposures to chemical warfare agents and disease were not funded because DoD insisted that such exposures did not occur. We have now learned that Gulf War veterans were fight all along, and that these exposures did occur. As of today, however, none of these studies are being funded, or are underway.
DoD's position has also prevented the scientific study of this issue by the federal government. The federal government is conducting dozens of scientific studies of its own that have been underway for over a year. None of these studies are examining the association between low level chemical warfare exposure and disease except one, and that is in spite of DoD's policy.
In 1995, The Department of Veterans Affairs' Portland Environmental Hazards Center proposed to the Coordinating Board that it conduct a study examining the association between nerve agents and disease, but were dissuaded after the National Institutes of Health Panel, in 1994, concluded that such exposures did not occur. The NIH Panel based its conclusion solely on reports from DoD about such exposures. Today, we are all well aware of the credibility and validity of DoD's prior reports concerning these exposures. Portland did display some independence by choosing to study the association between mustard gas and disease because, they concluded, DoD could not detect it well with its equipment, and therefore, could not make reasonable claims that such exposures did not occur (Testimony of Dr. Peter S. Spencer, Ph.D., FRCPath, before the Presidential Advisory Committee on Gulf War Veterans' Illnesses in Boston, MA March 26, 1996).
Clearly, DoD's inflexible policy concerning exposures has adversely affected the medical care of Gulf War veterans, and the scientific study of Gulf War illnesses. DoD coming forward with information it has possessed for over five years, after denying that this information existed, is shameful after one assesses the damage that their actions, or lack of action, has done. Worst of all, after determining that as many as 5,000 Gulf War veterans may have been exposed to chemical warfare agents near the Kamisiyah bunker alone, DoD proposes that these veterans seek CCEP examinations. These are the same exams that diagnose Gulf War veterans with psychological conditions at twice the national average. Clearly, DoD's reaction to its recent admissions falls far short of the mark for Gulf War veterans.
The American Legion does not offer this testimony merely to point out problems. We offer this testimony with a solution that will address this issue in a bold manner, based on sound science and medicine. We offer it in light of the lessons we all have learned from our experience with veterans exposed to Agent Orange. The American Legion proposes the following:
1. The Department of Veterans Affairs should collect tissue samples (blood and fatty tissue) from those believed to have been exposed to chemical warfare agents in the Persian Gulf. Participation would be voluntary, however, it would be encouraged through extensive and comprehensive outreach. The tissue samples would be stored so that well designed studies could occur in the future to determine the existence of markers in those exposed to such agents.
2. Congress should establish a commission to investigate American troops' exposure to chemical and biological warfare agents during or as a result of the Gulf War. This commission would also monitor the collection of tissue samples from those suspected of exposure, the storage of these samples, and the approval of any methods for examining these samples in the future.
This recommendation is consistent with the one offered to the Presidential Advisory Committee on Gulf War Veterans' Illnesses by its staff on September 5, 1996. The staff noted that DoD's policy and approach to chemical and biological warfare agent exposure in the Persian Gulf has so undermined its credibility that an independent commission should be created to investigate the issue. We recommend not only the creation of the commission, but that it oversee the tissue collection effort.
Previous experience compels us to recommend the collection, storage and later reexamination of these tissue samples. Despite early, widely quoted negative scientific publications, retrospective estimates of exposure for both Ranch Hands and Vietnamese civilians correlated reasonably well with recently developed biological markers. Such markers and exposure estimates provide scientific strength to epidemiological studies, even though specimens were not collected until ten years later. These results raise the question whether biological specimens should be collected, stored, frozen in liquid nitrogen, under the assumption that biological markers will be determinable at some future date.
Of importance to The American Legion, the federal government, and Gulf War veterans is the implication of improved exposure assessment. Because of the length of time since their most recent exposure, exposure assessment of Vietnam veterans will remain difficult: no tissue bank was established. This fact, and the recent scientific developments concerning the identification of biomarkers due to past exposure to chemicals makes the case that Gulf War veterans should have tissue and blood stored. This would allow atsome time in the future documentation or validation of exposure if a biological marker is identified. Early attempts at developing such markers are underway. Human subjects considerations become of great interest and may generate controversy. Stored samples of biological tissue may be examined for the substance of interest to exposure assessment but, at least theoretically, also for other substances such as drugs of abuse or for genetic testing. These latter two may generate appropriate concerns for protection of privacy. The commission proposed above would oversee the handling and testing of these samples, alleviating the privacy concerns of the participants.
Tissue sampling will assess exposure levels without any smoke and mirrors from any group or federal agency. The federal government, and the Congress, want what is best for our veterans, while they wisely spend the taxpayers' money. Tissue sampling will one day help determine who was exposed to chemical warfare agents in the Persian Gulf, and at what levels they were exposed. In conjunction with well designed scientific studies that examine the relationship between low level exposure to chemical warfare agents and disease, we will be able to determine who from the Gulf War was exposed, and know what effects that exposure has, or will have. We may also be able to treat these veterans at some future date based on this research.
Looking to the future, we have not seen the last of American troops and chemical warfare agents. Unless the U.S. withdraws completely from the world, its troops will once again face an adversary armed with chemical warfare agents. Now is the time to address the lack of preparedness to fight such an adversary, and maintain the health of the troops that do the fighting. Congress has an opportunity to address future challenges to tomorrow's veterans, today. The American Legion encourages you to do so.