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                                                 Union Calendar No. 228
105th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES

 1st Session                                                    105-388
_______________________________________________________________________


    GULF WAR VETERANS' ILLNESSES: VA, DOD CONTINUE TO RESIST STRONG 
        EVIDENCE LINKING TOXIC CAUSES TO CHRONIC HEALTH EFFECTS

                                _______
                                

November 7, 1997.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

_______________________________________________________________________


  Mr. Burton of Indiana, from the Committee on Government Reform and 
                   Oversight, submitted the following

                             SECOND REPORT

    On October 31, 1997, the Committee on Government Reform and 
Oversight approved and adopted a report entitled ``Gulf War 
Veterans' Illnesses: VA, DOD Continue to Resist Strong Evidence 
Linking Toxic Causes to Chronic Health Effects.'' The chairman 
was directed to transmit a copy to the Speaker of the House.

                               I. Summary

    Responding to requests by veterans, the subcommittee in 
March 1996 initiated a far-reaching oversight investigation 
into the status of efforts to understand the clusters of 
symptoms and debilitating maladies known collectively as ``Gulf 
War Syndrome.'' We sought to ensure sick Gulf War veterans were 
being diagnosed accurately, treated effectively and compensated 
fairly for service-connected disabilities, despite official 
denials and scientific uncertainty regarding the exact causes 
of their ailments. We also sought to determine whether the Gulf 
War research agenda was properly focused on the most likely, 
not just the most convenient, hypotheses to explain Gulf War 
veterans' illnesses.
    After 19 months of investigation and hearings, the 
subcommittee finds the status of efforts on Gulf War issues by 
the Department of Veterans Affairs [VA], the Department of 
Defense [DOD], the Central Intelligence Agency [CIA] and the 
Food and Drug Administration [FDA] to be irreparably flawed. We 
find those efforts hobbled by institutional inertia that 
mistakes motion for progress. We find those efforts plagued by 
arrogant incuriosity and a pervasive myopia that sees a lack of 
evidence as proof. As a result, we find current approaches to 
research, diagnosis and treatment unlikely to yield answers to 
veterans' life-or-death questions in the foreseeable, or even 
far distant, future.
    We do not come to these conclusions lightly. Nor do we 
discount all that has been done to care for, cure and 
compensate Gulf War veterans. But lives have been lost, and 
many more lives are at stake.
    Six years and hundreds of millions of dollars have been 
spent in the effort to determine the causes of the illnesses 
besetting Gulf War veterans. Yet, when asked what progress has 
been made healing sick Gulf War veterans, VA and DOD can't say 
where they've been and concede they may never get where they're 
supposed to be going. The CIA continues to resist broader 
declassification of Gulf War records. The FDA meekly chastises 
the Defense Department for the failure to observe agreed-upon 
rules for the humane use of experimental drugs.
    Sadly, when it comes to diagnosis, treatment and research 
for Gulf War veterans, we find the Federal Government too often 
has a tin ear, a cold heart and a closed mind.
    Our hearings convinced us the journey from cause to cure 
for Gulf War veterans runs through the pools, clouds and plumes 
of toxins in which they lived and fought. It is a journey VA 
and DOD might never have taken but for persistent pressure from 
this subcommittee, and other House and Senate panels, that 
forced the Pentagon to acknowledge a ``watershed event''--the 
probable exposure of United States troops to chemical weapons 
fallout at Khamisiyah, Iraq.
    With that first admission, the three pillars of Government 
denial--no credible detections, no exposures, no health 
effects--began to crumble. As the number of U.S. troops 
presumed exposed grew from 400 to almost 100,000, as the 
credibility of other chemical detections was sustained, and as 
private research probed the parallels between Gulf War 
illnesses and the known symptoms of chemical poisoning, some 
significant role for toxins in causing, triggering or 
amplifying neurological damage and chronic symptoms could no 
longer be denied.
    Before Khamisiyah, voluminous and compelling, albeit 
circumstantial, evidence regarding neurotoxic exposures had 
been ignored, denied or discredited, while far less abundant 
evidence and far less plausible psychological theories of 
causation were pursued with vigor. As a result, diagnostic 
protocols were insensitive to exposure effects, treatments were 
limited and vital research was delayed.
    Only recently were VA and DOD health registry 
questionnaires modified to consistently capture the best and 
only remaining evidence of toxic exposures: veterans' 
recollections. Only recently was research funded to measure the 
health effects of sustained, low-dose exposure to the 
combinations of chemicals, pharmaceuticals and environmental 
toxins to which Gulf War veterans were exposed.
    Those denials and delays are symptomatic of a system 
content to presume the Gulf War produced no delayed casualties, 
and determined to shift the burden of proof onto sick veterans 
to overcome that presumption. That task has been made 
difficult, if not impossible, because most of the medical 
records needed to prove toxic causation are missing or 
destroyed. Nevertheless, VA and DOD insist upon reaping the 
benefit of any doubts created by the absence of those records.
    The subcommittee believes the current presumptions about 
neurotoxic causes and effects should be reversed and the 
benefit of any doubt should inure to the sick veteran.
    Finally, we reluctantly conclude that responsibility for 
Gulf War illnesses, especially the research agenda, must be 
placed in a more responsive agency, independent of the DOD and 
the VA.
    Fortunately for Gulf War veterans, excellent research into 
Gulf War illnesses has taken place outside Government 
sponsorship. This research has advanced a case definition for 
some illnesses, an important step toward improved diagnosis and 
treatment. Some experimental treatments have brought relief to 
afflicted veterans and their families. The subcommittee 
believes this work must be included within the scope of that 
agency made responsible for Federal efforts to solve the puzzle 
of Gulf War illnesses.
    We note with approval efforts at the National Institute of 
Environmental Health Sciences [NIEHS] and other public health 
agencies to study exposure effects and genetic susceptibility 
to environmental toxins. Funding for this research would be an 
important first step in the effort to have an independent 
agency, with significant expertise in environmental hazards, 
involved in the solution to Gulf War veterans' health problems.
    There is no ``silver bullet'' to explain or cure so-called 
Gulf War Syndrome, which is not a discrete syndrome at all, but 
a variable cluster of symptoms and disease states with 
different triggers and susceptibilities. The battle to cure 
Gulf War illnesses must be fought at the cellular, molecular 
and genetic levels if we hope to heal the delayed wounds of 
that war and protect future warriors. Absent precise exposure 
data which can never be recaptured, the best evidence linking 
toxic causes to chronic effects lies within the bodies and 
minds of Gulf War veterans. That evidence has been too long 
ignored.

                          A. Findings in Brief

Diagnosis

    1. VA and DOD did not listen to sick Gulf War veterans as 
to possible causes of their illnesses.
    2. The presence of a variety of toxic agents in the Gulf 
War theater strongly suggests exposures have a role in causing, 
triggering or amplifying subsequent service-connected 
illnesses.
    3. Gulf War troops were not trained to protect themselves 
from the effects of exposure to depleted uranium dust and 
particles.
    4. Pyridostigmine bromide [PB] can have serious side 
effects and interactions when taken in combination with other 
drugs, vaccines, chemical exposures, heat and/or physical 
exercise.
    5. VA and DOD health registry diagnostic protocols relied 
on the unfounded conclusion there were no chemical, biological 
or other toxic exposures to U.S. troops in the Gulf War 
theater.
    6. VA and DOD health registry diagnosis protocols continue 
to be based on the unwarranted conclusion that, unless there is 
an immediate and acute reaction, exposures to chemical weapons 
and other toxins do not cause delayed or chronic symptoms.
    7. Prematurely ruling out toxic exposures as causative, VA 
and DOD doctors relied on diagnoses of somatoform disorder and 
Post Traumatic Stress Disorder [PTSD] to explain Gulf War 
veterans' illnesses.
    8. There is no credible evidence that stress or PTSD causes 
the illnesses reported by many Gulf War veterans.
    9. Accurate diagnosis of veterans' illnesses remains 
difficult due to inadequate or missing personal medical 
records, missing toxic detection logs, and unreleased 
classified documents.
    10. Accurate diagnosis of veterans illnesses was also 
hampered by the VA's lack of medical expertise in toxicology 
and environmental medicine.
    11. Exposures to low levels of chemical warfare agents and 
other toxins can cause delayed, chronic health effects.

Treatment

    12. Neither the VA nor the DOD has systematically attempted 
to determine whether sick Gulf War veterans are any better or 
worse today than when they first reported symptoms.
    13. Treatment of sick Gulf War veterans by VA and DOD to 
date has largely focused on stress and PTSD.

Compensation

    14. Compensation ratings for sick veterans are minimized 
due to inadequate personal medical records, missing toxic 
detection logs, and unreleased classified documents which could 
help veterans establish service-connection of post-war 
disabilities.
    15. Compensation ratings are also minimized by over-
reliance on somatoform disorder and PTSD as the basis of 
disability claims.

Research

    16. Federal research strategy has been blind to promising 
hy-potheses due to reliance on unfounded DOD conclusions 
regarding chemical exposures.
    17. Institutional and methodological constraints make it 
unlikely the current research structure will find the causes 
and effective treatments for Gulf War veterans' illnesses in 
the short term.
    18. The FDA was passive in granting and failing to enforce 
the conditions of a waiver to permit use of PB by DOD.

                      B. Recommendations in Brief

Diagnosis

    1. Congress should enact a Gulf War toxic exposure act 
establishing the presumption, as a matter of law, that veterans 
were exposed to hazardous materials known to have been present 
in the war theater.
    2. The VA should contract with an independent scientific 
body composed of non-Government scientific experts 
representing, at a minimum, the disciplines of toxicology, 
immunology, microbiology, molecular biology, genetics, 
biochemistry, chemistry, epidemiology, medicine and public 
health for the purpose of identifying those diseases and 
illnesses associated in peer-reviewed literature with singular, 
sustained, or combined exposures to the hazardous materials to 
which Gulf War veterans are presumed to have been exposed.
    3. The VA Gulf War Registry and the DOD Comprehensive 
Clinical Evaluation Program should be re-evaluated by an 
independent scientific body which shall make specific 
recommendations to change both programs from crude research 
tools into effective clinical diagnosis and outcomes monitoring 
efforts.
    4. The VA should refer all Phase II Registry examinations 
to Gulf War Referral Centers.
    5. The VA should add toxicological and environmental 
medicine expertise to the staff resources dedicated to Gulf War 
illnesses.
    6. DOD and VA should make every effort to find, and where 
necessary re-create through veterans' testimony, individual 
Gulf War medical records to reflect vaccines administered, PB 
use, and exposure to DU, pesticides and other hazardous 
materials.
    7. The President should order an intensified effort to 
declassify Gulf War documents in any way related to Gulf War 
veterans' illnesses and should personally certify to the 
appropriate committees of Congress when he deems 
declassification of such documents to be against the national 
interest.
    8. DOD failure to adhere to recordkeeping requirements or 
clinical protocols under an informed consent waiver should 
result in the presumption of service-connection for any 
subsequent illness(es) suffered by service personnel to whom 
the drug or protocol was administered.

Treatment

    9. VA and DOD should systematically and effectively monitor 
the clinical progress of Gulf War veterans to determine the 
most effective treatments.
    10. VA and DOD clinicians should be encouraged to pursue, 
and be trained in, new treatment approaches to suspected 
neurotoxic exposure effects.
    11. The diagnoses for somatoform disorders and Post 
Traumatic Stress Disorder [PTSD] should be refined to insure 
that physiological causes are not overlooked.

Compensation

    12. Denials of Gulf War veterans' compensation claims 
attributable in any way to missing medical records should be 
reviewed and veterans given the benefit of any doubt regarding 
the presumptive role of toxic exposures in causing post-war 
illnesses and disability.
    13. For purposes of compensation determinations, 
disabilities associated with presumed exposures should be 
deemed service-connected without any limitation as to time.

Research

    14. Congress should create or designate an agency 
independent from the Departments of Defense and Veterans 
Affairs as the lead Federal agency responsible for coordination 
of all research into Gulf War veterans' illnesses and 
allocation of all research funds.
    15. The lead Federal agency on Gulf War veterans' illnesses 
should focus research on the evaluation and treatment of the 
common spectrum of neuroimmunological disorders known as Gulf 
War Syndrome, multiple chemical sensitivity, chronic fatigue 
syndrome and fibromyalgia.
    16. DOD and VA medical systems should augment research and 
clinical capabilities with regard to women's health issues and 
the health effects of combat service on women's health.
    17. VA, in collaboration with NIH, CDC, FDA and other 
public health agencies should establish an interdisciplinary 
research and clinical program on the identification, prevention 
and treatment of environmentally induced neuropathies.
    18. FDA should grant a waiver of informed consent 
requirements for the use of experimental or investigational 
drugs by DOD only upon receipt of a Presidential finding of 
efficacy and need.

                             II. Background

    Since the Gulf War ended in 1991, there has been a growing 
number of reports of chronic illnesses among the nearly 700,000 
United States troops who served in Saudi Arabia, Kuwait, and 
Iraq. Although the illnesses are most common among reservists 
and National Guardsmen who served in the Gulf, full-time 
active-duty soldiers have also complained about various 
maladies.\1\
---------------------------------------------------------------------------
    \1\ Status of Efforts to Identify Persian Gulf War Syndrome, 104th 
Cong., 2d sess., p. 48 (1996) (``Human Resources and Intergovernmental 
Relations Subcommittee hearings, Nos. 1-4'') (statement of Major Thomas 
Cross, Gulf War veteran and member of the Presidential Advisory 
Committee on Gulf War Veterans' Illnesses).
---------------------------------------------------------------------------
    Health complaints by Gulf veterans from Canada, Great 
Britain, Kuwait, Australia, Czech Republic, Hungary, New 
Zealand and Norway have also begun to surface. There has also 
been an increased incidence of similar illnesses in the 
civilian populations of Kuwait, Iraq, and Saudi Arabia, 
according to a report to the Human Resources Subcommittee by 
chemical/biological weapons expert Dr. Jonathan Tucker, 
director of the chemical and biological nonproliferation 
project, Monterey (CA) Institute for International Studies.\2\
---------------------------------------------------------------------------
    \2\ A report submitted to the subcommittee by Jonathan Tucker, 
``Chemical/Biological Weapons Exposure and Gulf War Illness,'' January 
29, 1996, p. 1. [Hereinafter ``Tucker Report''] (in subcommittee 
files).
---------------------------------------------------------------------------
    Listed in the Persian Gulf health registries of the 
Departments of Defense [DOD] and Veterans Affairs [VA] are 
about 113,000 Gulf War veterans [DOD's Comprehensive Clinical 
Evaluation Program with 44,900 names as of August 1997, and 
VA's Gulf Health Registry with 67,989 names as of May 1997].\3\ 
Most participants in the registries have been diagnosed, 
approximately 20 percent remained undiagnosed, and roughly 10 
percent of those listed had no detectable symptoms.\4\ Many 
veterans have reported flu-like symptoms, chronic fatigue, 
rashes, joint and muscular pain, headaches, memory loss, 
reproductive problems, depression, loss of concentration, 
gastroin-testinal problems, and other maladies.\5\
---------------------------------------------------------------------------
    \3\ Memorandum to the subcommittee from the Department of Defense 
dated September 10, 1997 (in subcommittee files).
    \4\ Congressional Research Service Report, ``Gulf War Veterans' 
Illnesses,'' 95-450 SPR, April 11, 1997, p. 2.
    \5\ Statement of Lennox E. Gilmer, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 95.
---------------------------------------------------------------------------
    According to American Legion: ``One of the key questions 
that arises from evaluating [VA Health] Registry data is: What 
is happening to those veterans that complain of the most common 
symptoms? What is the outcome of their visit to the VA? Are 
they getting better, or are they slipping through the cracks? 
Our hypothesis is that these veterans who complain of the 
symptoms are not receiving the proper follow-up and treatment 
they deserve.'' \6\
---------------------------------------------------------------------------
    \6\ Statement of Matt Puglisi, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 81.
---------------------------------------------------------------------------
    Many Gulf War veterans are concerned that their medical 
problems are chronic and disabling, and are the result of 
exposures to one or more chemical, biological or nuclear agents 
present in the theater of operations. Health problems of Gulf 
veterans may stem not only from chemical and biological warfare 
agents but from other sources such as: pesticides and insect 
repellants; leaded diesel fuel; depleted uranium; oil well 
fires; infectious agents; and the anti-nerve agent drug, 
pyridostigmine bromide.\7\
---------------------------------------------------------------------------
    \7\ Status of Efforts to Identify Persian Gulf War Syndrome: Recent 
GAO Findings, 105th Cong., 1st sess., pp. 42-43 (1997) (``Human 
Resources Subcommittee hearings, No. 3'') (statement of Donna Heivilin, 
GAO).
---------------------------------------------------------------------------
    In 11 hearings \8\ since March 1996, the Human Resources 
Subcommittee has examined issues dealing with veterans' 
symptoms and complaints about the handling of their health 
problems by the VA, especially about inappropriate medical 
treatment or denial of treatment, missing or inadequate 
personal medical records, compensation issues, and lack of 
valid and timely Government research conclusions about the 
causes of their illnesses. The subcommittee also sought to 
ensure that any research programs conducted by the Departments 
of Defense [DOD], Health and Human Services [HHS], and the 
Environmental Protection Agency [EPA] were well-focused and 
coordinated.
---------------------------------------------------------------------------
    \8\ Human Resources Subcommittee hearings on Gulf War illnesses in 
the 104th & 105th Congresses: March 11 and 28, June 25, September 19, 
December 10 and 11, 1996; January 21, April 24, June 24 and 26, 1997. A 
hearing on informed consent issues, including DOD's use of PB tabs 
under an informed consent waiver, was held on May 8, 1997.
---------------------------------------------------------------------------
    The subcommittee has examined studies of effects of low 
level chemical exposures on humans and animals, and probable 
exposures of large numbers of troops to chemical warfare agents 
and other toxins during and after the war. Typical complaints 
of Gulf veterans are similar to known effects on humans who 
have been exposed to organophosphates, such as pesticides and 
other chemical agents.\9\ Organophosphates are chemically 
related to Sarin and other warfare agents present in the Gulf 
War theater.
---------------------------------------------------------------------------
    \9\ Persian Gulf Veterans' Illnesses, 104th Cong., 2d sess., p. 280 
(1996) (``Human Resources and Intergovernmental Relations Subcommittee 
hearings, Nos. 5-6'') (statement of Charles Jackson).
---------------------------------------------------------------------------
    Not listening to veterans' health complaints, many military 
and VA doctors--often unable or unwilling to diagnose veterans' 
illnesses as the after-effects of possible neurotoxic 
exposures--have insisted veterans suffered instead from stress, 
or post-traumatic-stress-disorder [PTSD].\10\ Many private 
physicians and researchers believe DOD and VA doctors have 
relied too heavily on psychological theories of causation while 
discounting the possibility of neurotoxic exposures.\11\
---------------------------------------------------------------------------
    \10\ Statement of Kimo Hollingsworth, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 29; 
statement of Brian Martin, Human Resources and Intergovernmental 
Relations Subcommittee hearings, Nos. 1-4, p. 324; statement of Julia 
Dyckman, Human Resources and Intergovernmental Relations Subcommittee 
hearings, Nos. 5-6, p. 195; statement of Michael Donnelly, Human 
Resources Subcommittee hearing, No. 2, p. 40. Also correspondence from 
Gulf veterans (in subcommittee files).
    \11\ Statement of William Baumzweiger, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 500; 
statements attributed to Eula Bingham and Claudia Miller, NY Times, 
November, 21, 1996, p. B11. See also, Streich, et al., ``Symptomatology 
of Gulf War Era Service,'' Military Medicine, Walter Reed Army 
Institute of Research, Bethesda, MD, March 1995.
---------------------------------------------------------------------------
    The Human Resources Subcommittee has listened carefully to 
hundreds of Gulf War veterans who have written and called the 
subcommittee since hearings began in March 1996. The 
subcommittee has also listened to the testimony of 23 Gulf 
veterans who testified in the 11 hearings held.

                   A. Listening to Gulf War Veterans

    Among Gulf veterans testifying before the subcommittee were 
Steven Wood, Barry Kapplan, Chris Kornkven, Julia Dyckman, and 
Brian Martin, all of whom reported health complaints typical of 
the range of maladies often called the ``Gulf War Syndrome.''
    Army S/Sgt. Steven Wood testified that during the first 
week of March 1991, he drove through ammunition storage sites 
destroyed by U.S. forces. Near a bombed out bunker, he 
inspected artillery rounds on the ground which he identified in 
an Army manual as chemical weapons. ``Later that day,'' Sgt. 
Wood stated, ``I started to get very sick with symptoms I 
suffer still today. I sought medical assistance that day . . . 
[and] . . . never once received any comprehensive, much less 
compassionate, treatment from the Army. I was told it was `all 
in my head.' ''
    Transferred back to Germany following the war, his symptoms 
continued. In 1994, Sgt. Wood, unable to get treatment from 
Army doctors and unable to perform his duties, contacted a 
German physician. ``This German doctor did more tests in 2 
hours than the Army did in 5 years. When my wife and I left the 
[German] doctor's office, we were told that I `had been 
poisoned.' These findings were immediately dismissed [by Army 
doctors] as being worthless since they did not come from a 
military doctor. Then it was stated to me by this military 
doctor that they did not like Gulf War veterans [complaining] 
with health problems.'' \12\
---------------------------------------------------------------------------
    \12\ Statement of Steven Wood, Human Resources Subcommittee 
hearings, No. 2, pp. 49-50, 52.
---------------------------------------------------------------------------
    Major Barry Kapplan, a career Army pilot who had passed 15 
flight physicals in the 11 years prior to deployment to the 
Gulf War, ``began to feel increasingly ill'' in April 1991 but 
dismissed the symptoms as related to the harsh desert 
environment. On May 8, he reported ``violent nausea, vomiting, 
diarrhea attack.'' On May 28, now back in Germany, he was 
admitted to a military hospital with ``cardiac arrhythmias . . 
. severely bleeding gums, cough with sputum production, 
shortness of breath, severe fatigue, diarrhea, hair loss, skin 
rashes/lesions, and abdominal discomfort.'' Military doctors 
diagnosed Major Kapplan with ``just post traumatic stress.'' 
With severe brain, nerve, heart and gastrointestinal problems 
but still being diagnosed with ``somatoform disorder,'' he was 
given a discharge by the Army ``due to unemployability'' in 
October 1995.\13\
---------------------------------------------------------------------------
    \13\ Statement of Barry Kapplan, Human Resources Subcommittee 
hearings, Nos. 1-4, pp. 328-330, 332.
---------------------------------------------------------------------------
    Major Kapplan's wife Nancy, a registered nurse, testified 
about ``the medical issues facing our family'' since her 
husband's return from the Gulf. Her four children have suffered 
from continual chronic infections and one child has ``. . . 
esophagitis, gastritis and gastroesophageal reflux disease . . 
. with little relief of her symptoms.'' Mrs. Kapplan reported 
that she has similar chronic symptoms since her husband came 
home from the war.\14\
---------------------------------------------------------------------------
    \14\ Statement of Nancy Kapplan, Human Resources Subcommittee 
hearings, Nos. 1-4, pp. 337, 339.
---------------------------------------------------------------------------
    S/Sgt. Chris Kornkven, an Army Reservist, reported, ``While 
still in the Gulf I began experiencing symptoms that continue 
to this day. I had difficulty remembering significant events 
that happened days earlier . . . my knees and shoulders [were] 
especially painful . . . and fatigue stayed with me 
constantly.'' After the war, his symptoms worsened and included 
intestinal problems and headaches. He sought treatment in 1992 
from VA doctors who--without any physical exam, testing or 
treatment--referred him to the mental health clinic where he 
was diagnosed ``PTSD.'' \15\
---------------------------------------------------------------------------
    \15\ Gulf War Syndrome: To Examine New Studies Suggesting Links 
Between Gulf Service and Higher Rates of Illnesses, 105th Cong., 1st 
sess., pp. 268-269 (1997) (``Human Resources Subcommittee hearings, No. 
1'') (statement of Chris Kornkven).
---------------------------------------------------------------------------
    ``I reported blinding headaches with only offers of 
aspirin. I reported memory loss . . . dismissed as stress. I 
reported skin problems . . . and was told `it's not cancer yet 
. . . come back as needed.' I reported breathing problems . . . 
no diagnosis. I reported intestinal problems . . . and rectal 
bleeding . . . dismissed [and] no follow-up. I reported joint 
pain . . . diagnosed as fibromyalgia . . . no treatment other 
than Motrin. I reported chest pains . . . and racing heart 
beats . . . [and] was told it was due to an abnormal heart 
valve . . . [which] was hereditary,'' a point which S/Sgt. 
Kornkven says ``nicely avoids VA's rating guidelines.'' \16\
---------------------------------------------------------------------------
    \16\ Ibid., p. 271.
---------------------------------------------------------------------------
    During the war, thousands of troops, including S/Sgt. 
Kornkven, climbed on Iraqi vehicles destroyed by depleted 
uranium [DU] rounds which leave a residue of dangerous 
radioactive dust particles when inhaled or ingested. He was 
tested by the VA and told he ``had a higher DU count than those 
[troops] carrying around [DU] fragments in their bodies . . . 
[but] it was nothing for me to worry about.'' \17\
---------------------------------------------------------------------------
    \17\ Ibid., p. 270.
---------------------------------------------------------------------------
    ``My wife had a miscarriage in which the fetus had to be 
surgically removed. She has as much trouble with fatigue as I 
do. She was diagnosed by a private physician as having 
fibromyalgia. My son, who is 2 years old, has not slept a 
complete night since being born. He appears to have intestinal 
problems, his stools are very acidic, he is VERY light 
sensitive, and has the exact same rashes on his legs as I do.'' 
\18\
---------------------------------------------------------------------------
    \18\ Ibid.
---------------------------------------------------------------------------
    As far as the VA's emphasis on stress as a cause of Gulf 
veterans' illnesses is concerned, S/Sgt. Kornkven stated that 
while stress may play some part in his malady, he believes that 
``. . . veterans are subjected to much more stress by trying to 
navigate the bureaucracy of the VA, and with worrying how to 
cope with medical conditions that are ignored. All the while 
being unable to work, and wondering how to feed or house a 
family.'' \19\
---------------------------------------------------------------------------
    \19\ Ibid., p. 272.
---------------------------------------------------------------------------
    Gulf War and Vietnam War veteran Reserve Navy Captain Julia 
Dyckman is a registered nurse who was in charge of the 
emergency room and the out-patient clinic of Combat Zone Fleet 
Hospital 15 near Al Jubayl, Saudi Arabia, an area often under 
SCUD missile attacks. Her unit took care of 8,211 out-patients, 
697 in-patients, and 90 combat admissions. In her hearing 
statement, she identified the following medical conditions 
reported by troops in-theater and treated by her hospital 
personnel: respiratory problems; unexplained fevers; vomiting; 
diarrhea; various rashes; numerous reactions to immunizations; 
unexplained stomach and abdominal pains; and cardiac 
problems.\20\
---------------------------------------------------------------------------
    \20\ Statement of Julia Dyckman, Human Resources Subcommittee 
hearings, Nos. 5-6, p. 192.
---------------------------------------------------------------------------
    On returning to the United States, Captain Dyckman was 
assigned to interview returning Gulf veterans. She stated: 
``Many personnel voiced concerns over long term health effects, 
current health conditions, and numerous pay and family 
situations. The Readiness Commander did not like the results of 
my interviews . . . interfered with my medical care . . . [and] 
. . . records of interviews I conducted were discarded. For 
most Gulf reservists, the only avenue available for medical 
care was civilian or possibly the VA. Some veterans were too 
ill to hold down a job and therefore had no medical insurance 
to cover civilian care.'' \21\
---------------------------------------------------------------------------
    \21\ Ibid., p. 194.
---------------------------------------------------------------------------
    ``During this time my health continued to deteriorate. I 
was released from active duty even though my medical problems 
were not resolved. I sought care at the VA [for the following]: 
hearing loss; bronchitis; chronic cough; hypertension; rashes; 
foot and joint pain; stomach ulcer; diarrhea; headaches; 
abdominal pain. I was diagnosed with gout (although the gout 
test was negative); offered Tylenol; and told, `Nothing is 
wrong with you, get it through your head!' '' \22\
---------------------------------------------------------------------------
    \22\ Ibid., p. 195.
---------------------------------------------------------------------------
    ``For over 2\1/2\ years I was shuffled from one VA clinic 
to another, each investigating a different body system. No 
coordinated treatment or diagnostic effort was ever 
experienced. It has been a problem with records [needed] for 
disability claims . . . [which were] . . . lost in the VA 
system. Disability and claims procedures are complicated and 
time consuming. In order to obtain VA treatment for Gulf 
illness, you have to first have a service connected illness or 
injury which is difficult to prove even when you were treated 
in-theater. Also, the VA only considers military and VA medical 
records for service connection, excluding expert civilian 
records. Additionally, they only use selected parts of records 
that agree with the VA and disregard any positive findings.'' 
\23\
---------------------------------------------------------------------------
    \23\ Ibid., pp. 196-197.
---------------------------------------------------------------------------
    ``You might ask what it is like to be a Persian Gulf war 
veteran after 6 years. Each day starts with uncertainty. When 
you eat you are constantly sick and have intermittent diarrhea. 
Mobility is difficult due to swollen joints and muscle aches. 
Severe headaches are intermittent. Sometimes you forget what 
you are doing and what you were going to do. Pain and fatigue 
are constant companions. You are forced to deal with constant 
denials from the Pentagon that `nothing happened' during the 
war. These statements confuse medical providers who then doubt 
your credibility. What is needed is recognition, though not 
coded by the CDC, that Gulf war illness is a combination of 
unique symptoms and outcomes. This is why specific protocols 
need to be run before the VA says that this illness `doesn't 
exist' or is `all in your head.' '' \24\
---------------------------------------------------------------------------
    \24\ Ibid., p. 198.
---------------------------------------------------------------------------
    Sgt. Brian Martin was a former member of the 37th Airborne 
Engineer Battalion, a unit which detonated and destroyed the 
Iraqi ammunition depot at Khamisiyah containing 100 bunkers and 
43 warehouses. He videotaped the event and made it available to 
the subcommittee and television networks in the summer of 1996. 
Sgt. Martin testified: ``On March 4th, 1991, we entered the 
depot area, placing explosives in and around 33 bunkers. We set 
time charges for detonation, then moved south 3 miles to what 
we considered a `safe zone.' At no time whatsoever did we fear 
. . . chemical exposure. We were told . . . there were no 
chemicals in the area. Our commanders knew nothing about 
chemicals in the bunkers. Seven minutes later the destruction 
of Khamisiyah began.''
    ``Witnessing these awesome explosions was a remarkable 
sight. The explosions blew straight into the air, then would 
spread at the top . . . [it was] . . . the closest thing to a 
nuclear mushroom we would ever see. Our excitement quickly 
turned to fear when `cook offs' or fallout from the explosions 
began showering down on us. Several missiles landed underneath 
our trucks, spinning and taking off until blowing up. Men were 
running everywhere for cover. Giant clouds . . . were covering 
us. The 82d Airborne [12 miles away] asked us to stop the 
detonation because of `cook-offs' penetrating their area. Our 
battalion moved into convoy formation and proceeded to vacate 
the area. Twenty miles later we found an area with no signs of 
`cook-offs.' ''
    ``For the next 3 days it rained harder than any of us had 
seen in the 6 months we were there. Our commanders joked about 
us `putting something into the air to change the weather.' For 
the next 5 days it was unsafe for us to return to Khamisiyah to 
finish destroying the remaining 67 bunkers. The skies were 
dark, gray and cloudy for those 5 days.''
    ``Since Khamisiyah, I suffer from . . . blood in vomit and 
stools, blurred vision, shaking and trembling . . . muscles 
weakening . . . chest pounding like my heart was going to 
explode. My symptoms were simply written off [by Army doctors] 
as a `stomach viral infection of an unknown origin.' My medical 
conditions were ignored. In December 1991, I put in for an 
`early out' from the military. I did not receive an exit exam 
nor did I know I was supposed to.''
    ``I suffer from excruciatingly painful headaches, memory 
loss, and severe diarrhea . . . mood swings . . . I violently 
vomit if I smell perfumes, vapors or chemicals. I get lost and 
forget where I am sometimes. I am an ex-paratrooper who needs a 
cane and wheelchair to get around. My joints . . . swell, burn 
and hurt.''
    ``Today . . . I have some clearly defined diagnoses from 
the VA of multiple chemical sensitivity, inflammatory bowel 
disease with scarring of the colon and stomach due to chemical 
exposure, temporal lobe brain damage also with scarring due to 
chemical exposure, Reiter's Syndrome, chronic fatigue syndrome, 
and tinnitus. I have abnormally high platelets around my blood 
cells, and recently I began testing for Lupus and Alzheimer's 
Disease. I am worn out all the time, yet I am an insomniac. For 
all of this, except [for] the chemical injuries . . . the VA 
rated me in 1994 at 100 percent compensation . . . then in 1996 
added Permanent and Total [disability, following DOD's 
announcement about Khamisiyah].'' \25\
---------------------------------------------------------------------------
    \25\ Statement of Brian Martin, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 320-
322.
---------------------------------------------------------------------------
    Other Gulf veterans testified before the subcommittee about 
life-threatening illnesses such as cancers, heart and lung 
problems, and Amyotrophic Lateral Sclerosis [ALS].
    Colonel Gilbert Roman, U.S. Army Reserve, volunteered for 
active duty in the Gulf War and was named Deputy Commander of 
the 311th Evacuation Hospital, Army Medical Service Corps. He 
stated [in spite of profuse nasal bleeding from pre-cancerous 
polyps during testimony]: ``I arrived in Theater on January 6, 
1991 . . . [and] . . . during official visits to strategic 
military cities there were frequent SCUD attacks during which I 
heard chemical alarms sound. When I asked if these alarms meant 
chemicals had been detected, I was told that the chemical 
alarms had malfunctioned. I [soon] became ill and was treated 
for nausea, headaches, vomiting, diarrhea and high temperature. 
Rashes I had over my body I thought were normal and expected 
since I spent most days in the sand, wind and sun with all the 
attendant fleas, flies and desert parasites. Headaches I 
attributed to fatigue and lack of sleep.'' \26\
---------------------------------------------------------------------------
    \26\ Status of Efforts to Identify Gulf War Syndrome: Multiple 
Toxic Exposures, Human Resources Subcommittee hearing of June 26, 1997. 
(Statement of Gilbert Roman, p. 2) (in subcommittee files).
---------------------------------------------------------------------------
    ``The symptoms . . . continued after I returned home and 
got progressively worse. In 1993, I registered at [a] veterans' 
hospital after receiving an invitation from the VA to come in 
for an examination if I was a Gulf veteran. They recorded all 
of the ailments I indicated . . . [but] . . . no treatment was 
offered. The VA hospital billed me for my supposed `free 
examination' and they ended up attaching my next year's meager 
tax return.'' \27\
---------------------------------------------------------------------------
    \27\ Ibid., pp. 3-4.
---------------------------------------------------------------------------
    ``To date, although I have now had three official 
examinations since 1993, I still continue to receive requests 
for more and more information from the VA claims office. 
Materials sent are never acknowledged as received, phone 
numbers given are not to any VA recognized exchange, and the 
name given for contact is not a true VA employee. Frustration . 
. . [I've been] in the VA `system' 4 years with no real contact 
from a person; just requests for more information.'' \28\
---------------------------------------------------------------------------
    \28\ Ibid., pp. 4-5.
---------------------------------------------------------------------------
    ``In 1996, I was hospitalized three times and treated by my 
private physician for a respiratory ailment. I could not walk 
more than 25 steps without having to stop, out of breath and 
fatigued. This ailment, which was life threatening, would not 
allow me to lie on my back to sleep as I would begin to drown . 
. . as my lungs filled with fluid. I was forced to sit up for 
sleep and was constantly fatigued due to lack of sleep and no 
energy.'' \29\
---------------------------------------------------------------------------
    \29\ Ibid., p. 5.
---------------------------------------------------------------------------
    ``My [private] cardiologist, Dr. Peter Steele, diagnosed me 
as having `cardiomyopathy with congestive heart failure.' Dr. 
Steele stated [in a letter]: `What is clear is that he served 
in the Middle East and that he has a cardiomyopathy. I would 
submit that this may well be part of the Gulf War Syndrome.' '' 
\30\
---------------------------------------------------------------------------
    \30\ Ibid.
---------------------------------------------------------------------------
    Major Michael Donnelly, USAF retired, who flew 44 combat 
missions during the Gulf War, often flying through plumes from 
bombed Iraqi munitions manufacturing and storage facilities, 
stated: ``Upon return from the Gulf, I was reassigned to 
Florida . . . [where] . . . I first started to experience 
strange health problems. I didn't feel as strong as I once had 
or as coordinated . . . [and] . . . always fighting a cold or 
the flu. By the summer of 1995 . . . [and] . . . stationed in 
Texas . . . I was exposed to malathion fogging, an 
organophosphate pesticide used for mosquito control, while 
jogging in the evenings. I started to have serious health 
problems.''
    ``Schetoma, or blind spots, in front of my eyes and my 
heart would beat irratically. Palpitations, night sweats, 
sleeplessness, trouble concentrating and remembering, and 
trouble taking a deep breath. Extremely tired much of the time. 
By December, I had trouble walking and experienced weakness in 
my right leg. In January 1996, I explained my symptoms, and 
mentioned I had been in the Gulf War, to a flight surgeon who 
immediately talked about the effects of stress. I was referred 
to a neurologist.''
    ``During the first visit with the neurologist, I heard the 
line that I would hear throughout the whole Air Force medical 
system: `There's no conclusive evidence that there's any link 
between service in the Gulf and any illness.' '' \31\
---------------------------------------------------------------------------
    \31\ Statement of Michael Donnelly, Human Resources Subcommittee 
hearings, No. 2, pp. 39-40.
---------------------------------------------------------------------------
    Major Donnelly, in his 20's during the war, was diagnosed 
in January 1996 with ALS or ``Lou Gehrig's Disease.'' ALS, a 
rare fatal disease which generally affects people between the 
ages of 40 to 70, is ``a progressive wasting of muscles that 
have lost their nerve supply.'' \32\
---------------------------------------------------------------------------
    \32\ Report by the National Organization for Rare Disorders, ALS 
Report #57, April 1997 (in subcommittee files).
---------------------------------------------------------------------------
    DOD's Special Assistant for Gulf War Illnesses Dr. Bernard 
Rostker, an economist, has admitted that nine cases of ALS 
among Gulf veterans have been confirmed, and stated under oath 
that ``for the population that served in the Gulf, we would 
expect to see roughly between 7 and 11 cases of ALS. And we're 
looking at nine cases of ALS.'' \33\
---------------------------------------------------------------------------
    \33\ Statement of Dr. Bernard Rostker, Human Resources Subcommittee 
hearing, No. 2, p. 100.
---------------------------------------------------------------------------
    However, [in response to Dr. Rostker's claim] the director 
of the Cecil B. Day Laboratory for Neuromuscular Research at 
Massachusetts General Hospital and an ALS expert, Robert H. 
Brown, Jr., M.D. and Ph.D., stated in a letter to the Human 
Resources Subcommittee:
    ``The incidence of new cases of ALS is about 1/100,000 
individuals in our [overall] population. Thus, it is true to 
say that a group of 700,000 individuals might, in the 
aggregate, be expected to show 7 or so new cases of ALS over a 
year's time. However, these statements about aggregate 
populations must be interpreted carefully. In particular, they 
assume an age-spread that reflects an entire population 
[emphasis added]. If one looks at the age of onset of ALS, the 
mean onset age is 55 years. The number of cases showing onset 
below the age of 40 [emphasis added] is probably no more than 
20-25 percent or so of the total. Thus, one might expect 0.20-
0.25 cases/100,000 individuals [or an estimated 1.4-1.7 cases 
of ALS in the 18-40 age range]. As I understand it, there are 
now 9 or 11 cases of ALS in the Gulf War veterans population. 
This seems excessive to me [emphasis added].'' \34\
---------------------------------------------------------------------------
    \34\ Letter from Robert Brown, director, Cecil B. Day Laboratory 
for Neuromuscular Research, Massachusetts General Hospital, to Mr. 
Robert Newman, subcommittee staff, September 15, 1997 (in subcommittee 
files).
---------------------------------------------------------------------------
    According to a study by Dr. Will Longstreth, professor of 
neurology at the University of Washington School of Medicine, 
people exposed to organophosphate compounds, such as pesticides 
and other chemicals, may be at twice the risk of developing 
ALS.\35\
---------------------------------------------------------------------------
    \35\ Reuters News Service, ``Gehrig's Disease Tied to Chemicals,'' 
June 24, 1997.
---------------------------------------------------------------------------
    Another Gulf veteran with ALS is Marine Major Randy Hebert, 
also a subcommittee witness, who testified that he may have 
been contaminated from a reported exploding chemical mine near 
his vehicle when the Kuwait invasion began February 24, 1991. 
Major Hebert stated: ``I recall my right hand feeling cool and 
tingling'' \36\ as he struggled into his protective clothing 
and gear. After removing his mask when told it was a false 
alarm, he received another radio message: ``Your lane is dirty, 
chemical mine has gone off, go to MOPP 4 [full protective 
equipment].'' Major Hebert testified, ``I now feel that 
[removing his mask] was a mistake.'' Shortly after, Major 
Hebert said, ``he felt funny'' and had trouble breathing.\37\
---------------------------------------------------------------------------
    \36\ Statement of Randy Hebert, Human Resources and 
Intergovernmental Relations Subcommittee hearings, No. 5-6, p. 109.
    \37\ Ibid., pp. 110-111.
---------------------------------------------------------------------------
    Returning home in May 1991, Major Hebert reported symptoms 
of memory loss, mood swings, vomiting, diarrhea, depression, 
and severe daily headaches. By the fall of 1994, he experienced 
uncontrollable coughing, throat muscle constriction, and 
atrophy in the right arm and hand. In October 1995, after more 
than 4 years of undiagnosed symptoms, he was finally diagnosed 
with ALS. ``I believe the medical problems I have discussed are 
due to low level chemical exposure over an extended period,'' 
\38\ Major Hebert concluded.
---------------------------------------------------------------------------
    \38\ Ibid., pp. 112-113.
---------------------------------------------------------------------------
    Nick Roberts, a subcommittee witness, was a Seabee with 
Naval Mobile Construction Battalion 24 stationed near the Port 
of Al Jubayl, Saudi Arabia--an area reportedly hit by SCUDs. He 
stated: ``On January 20, 1991, I was awakened by a loud 
explosion. Running to the bunker, I heard a second explosion 
and noticed a large fireball. I put my gas mask on. We sat 
there for approximately 20 minutes and then the all-clear was 
given. We went outside. I estimate that half of the unit 
returned to their tents and the other half remained outside 
talking.''
    ``I was one of the men outside talking. Within just a few 
minutes, my arms, neck and face were stinging, my lips felt 
numb and I had a strange taste in my mouth, like a copper penny 
. . . a metallic taste. Some say a mist came over the camp . . 
. [it seemed] more of a fog. Chemical alarms began sounding. 
Alarms going off everywhere. Marines camped nearby began to 
yell, `Go back to your bunkers. We have been gassed.' We were 
ordered to MOPP level 4. Radio transmissions were coming in, 
`Confirmed gas attack. Repeat, confirmed gas attack.' ''
    ``We were given the all-clear once again. Afterwards, many 
of us went to the water tank and washed ourselves down to stop 
the stinging. My first symptoms were redness of the skin and 
welts on my chest that afternoon.''
    Petty Officer Roberts reported that ``in the days and weeks 
that followed my symptoms began to grow in number: rashes and 
small blisters, fever, night sweats, and flu-like symptoms, 
just to mention a few. After a month, my lymph glands were 
swollen and my joints hurt. Once home . . . we were turned over 
to the VA . . . the Navy said they were not set up to take care 
of our medical needs. I never got any medication from the VA, 
nor was I ever diagnosed by the VA.''
    Petty Officer Roberts reported that after 1\1/2\ years of 
no help from the Navy or VA, ``I sought private medical help. 
Within 6 weeks of testing and a biopsy of my lymph gland, I was 
diagnosed with non-Hodgkin's lymphoma, a cancer, in stage 
three. I started on chemotherapy 2 days later.''
    ``The cause of my symptoms is very obvious. I stand by my 
charge--as I have from the very beginning--of chemical 
[warfare] exposure, not to mention the overall exposure from 
fallout due to intensive [United States] bombing of [Iraqi] 
chemical and biological plants, radiation fallout from 
thousands of depleted uranium rounds used by the United States, 
exposure to vaccines and nerve gas pills, and months of 
breathing smoke from more than 300 oil well fires. I don't see 
how you can call it anything else. Gulf veterans are suffering 
[from] chemical poisoning.'' \39\
---------------------------------------------------------------------------
    \39\ Statement of Nick Roberts, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 345.
---------------------------------------------------------------------------
    Petty Officer Roberts concluded: ``By the end of 1993, 
[there were] 399 men out of 758 [in Battalion 24] who had been 
put out of the service because they were medically unfit.'' 
\40\
---------------------------------------------------------------------------
    \40\ Ibid., p. 346.
---------------------------------------------------------------------------

                  B. Chemical Detections and Exposures

    According to Gulf veterans who testified before the Human 
Resources Subcommittee, thousands of chemical alarms sounded 
and numerous chemical detections by trained U.S. chemical 
specialists with state-of-the-art equipment were made only to 
be ignored by American commanders. Czech chemical warfare 
experts recorded numerous detections, including detections 
along the Saudi border where hundreds of thousands of United 
States troops were massed for the invasion.
    DOD has admitted that ``the Czech detections were valid.'' 
\41\
---------------------------------------------------------------------------
    \41\ U.S. Department of Defense, Assistant Secretary of Defense 
(Public Affairs), News Briefing, Czechoslovakian Chemical Report, 
November 10, 1993, p. 2.
---------------------------------------------------------------------------
    In May 1994, DOD Secretary William Perry and Joint Chiefs 
Chairman John Shalikashvili signed a memorandum to Gulf 
veterans declaring: ``There have been reports in the press of 
the possibility that some of you were exposed to chemical or 
biological weapons agents. There is no information, classified 
or unclassified, that indicates that chemical or biological 
weapons were used in the Persian Gulf.'' \42\
---------------------------------------------------------------------------
    \42\ U.S. Department of Defense, Assistant Secretary of Defense 
(Public Affairs), News Release No. 323-94, Department of Defense Letter 
of Gulf War Veterans, May 26, 1997.
---------------------------------------------------------------------------
    In October 1994, however, the Senate Banking Committee 
released a staff report which compiled official documents and 
eyewitness testimony suggesting that U.S. troops had been 
exposed to chemical warfare agents during the Gulf War.\43\
---------------------------------------------------------------------------
    \43\ Staff Report No. 3, Senate Committee on Banking, ``Chemical 
Warfare Agent Identification, Chemical Injuries, and Other Findings,'' 
October 7, 1994, pp. 1-24 and appendix materials (in subcommittee 
files).
---------------------------------------------------------------------------
    In March 1995, another event cast some doubt on DOD's 
insistence that there were no chemical or biological warfare 
agent exposures. In a television interview, John Deutch, then 
Deputy Secretary of DOD repeatedly qualified his statements 
regarding chemical weapons exposures in the Gulf War:

          Mr. Deutch. Our most thorough and careful efforts to 
        determine whether chemical agents were used in the Gulf 
        lead us to conclude that there was no widespread use of 
        chemicals against U.S. troops.
          Bradley. Was there any use? Forget widespread.
          Mr. Deutch. I--I do not believe . . .
          Bradley.  . . . was there any use?
          Mr. Deutch. I do not believe there was any offensive 
        use of chemical agents by Iraqi military troops. There 
        was not . . .
          Bradley. Was there any--any accidental use. Were our 
        troops exposed in any way?
          Mr. Deutch. I do not believe that our troops were 
        exposed in any widespread way to chemical . . .
          Bradley. In any narrow way? In any way?
          Mr. Deutch. The Defense Science Board did an 
        independent study of this matter and found, in their 
        judgment, that there was not confirmation of chemical 
        weapon widespread use in the Gulf.\44\ (emphasis added)
---------------------------------------------------------------------------
    \44\ Statement made to CBS News, 60 Minutes, March 12, 1995; also 
see supra note 2, Tucker Report, p. 5.

    The Pentagon, after 5 years of denial that United States 
troops were exposed to chemical weapons, finally admitted in 
June 1996 that 300 to 400 soldiers were ``presumed exposed'' to 
chemical warfare agents from fallout following detonation of 
Iraqi munitions bunkers at Khamisiyah. The number of ``presumed 
exposed'' continued to rise rapidly and by July 1997 the 
Pentagon had raised the number of exposed to 98,900.\45\
---------------------------------------------------------------------------
    \45\ Shenon, Philip, ``Study Sharply Raises Estimate of Troops 
Exposed,'' New York Times, July 24, 1997, p. A18. See also, statement 
to the Presidential Advisory Committee on Gulf War Veterans' Illnesses 
by Bernard Rostker, Special Assistant for Gulf War Veterans's 
Illnesses, U.S. Department of Defense, July 29 and July 30, 1997.
---------------------------------------------------------------------------
    In a January 1996 report to the Human Resources 
Subcommittee, Dr. Jonathan Tucker stated, ``Considerable data 
[exists] suggestive of such exposures during the Gulf War. 
During 1993-94, the staff of the U.S. Senate Banking Committee 
issued three reports compiling extensive circumstantial 
evidence for both direct and indirect exposures to U.S. troops 
to CBW [Chemical/Biological Warfare] agents during the war. In 
addition, a workshop sponsored by the National Institutes of 
Health [NIH] in April 1994 found that despite the lack of hard 
evidence, the possibility of CBW exposures should not be ruled 
out prematurely. The NIH report concluded, `Until it can be 
unequivocally established that chemical and/or biological 
weapons were not used and that troops were not exposed to 
plumes of destroyed stockpiles, the possibility remains that 
some symptoms are chronic manifestations of such exposure.' '' 
\46\
---------------------------------------------------------------------------
    \46\ See supra note 2, pp. 4-5, citing National Institutes of 
Health, Office of the Director, Persian Gulf Experience and Health: 
Technology Assessment Workshop Statement, April 27-29, 1994 (Bethesda, 
MD, National Institutes of Health), p. 12.
---------------------------------------------------------------------------
    Dr. Tucker pointed out that in the last few years 
considerable information in the public domain--including press 
accounts, interviews, declassified Government documents under 
the Freedom of Information Act or posted on GulfLink \47\ --
presents a variety of evidence indicating Coalition troops were 
exposed to low levels of chemical warfare agents. He stated 
that while these exposures had no influence on the war's 
outcome, ``they appear to have resulted in delayed health 
problems in many of the exposed troops.'' In addition to 
``affected United States troops, Gulf War illness has been 
reported among Australian, British, Canadian, Czech, Hungarian, 
Kuwaiti, New Zealander, and Norwegian veterans.''
---------------------------------------------------------------------------
    \47\ GulfLINK is the Internet website maintained by the Department 
of Defense containing information on Gulf War issues. It can be found 
at URL http://www.dtic.dla.mil.gulflink/.
---------------------------------------------------------------------------
    Chemical detections during the war were also reported by 
French and Czech forces, Dr. Tucker stated. Among detections by 
the French were nerve and mustard vapors near King Khalid 
Military City during the air bombing campaign. Among the Czech 
detections were some along the Saudi border where hundreds of 
thousands of United States ground troops were massed for the 
invasion of Iraq.
    According to a General Accounting Office [GAO] report, ``It 
is important to note that detections of the nerve agent Sarin 
occurred on January 19, 1991, and of mustard gas on January 24, 
1991, by Coalition partners from Czechoslovakia in areas near 
Hafir al Batin. DOD has verified the reliability of the Czech 
equipment but has never identified the source [emphasis added] 
of these detections, although both DOD and CIA have deemed the 
detections credible. One cannot rule out the possibility that 
these detections were the result of fallout from Coalition 
bombing.'' \48\
---------------------------------------------------------------------------
    \48\ U.S. General Accounting Office, ``Gulf War Illnesses,'' GAO/
NSIAD-97-163, June 1997, p. 63.
---------------------------------------------------------------------------
    A recent NY Times report, following an interview in Prague 
with Defense officials and Gulf War veterans, stated: ``Czech 
detection teams patrolling the northern Saudi Arabian desert in 
January 1991 were convinced that nerve gas detected in the 
early days of the war had been released from Iraqi chemical 
plants bombed by the United States.''
    ``Yet despite the reputation of Czech soldiers and their 
chemical equipment for reliability, combat logs compiled by 
officers working for Gen. Norman Schwarzkopf show that American 
commanders ignored Czech warnings that low levels of nerve and 
mustard gas had been detected in the vicinity of American 
troops,'' The Times reported. ``Czech soldiers recalled that 
even as they hurriedly pulled on their gas masks and rubberized 
chemical warfare suits after detecting chemical agents in the 
northern Saudi desert, the Americans who were stationed only 
several hundred feet away remained unprotected.'' \49\
---------------------------------------------------------------------------
    \49\ Shenon, Philip, ``Czechs Say They Warned U.S. of Chemical 
Weapons in Gulf,'' New York Times, October 19, 1996, p. A1.
---------------------------------------------------------------------------
    According to the Tucker Report, ``Although DOD officials 
insist that all chemical agent detections by United States 
forces in the Gulf were false, they have reluctantly admitted 
that detections by Czech chemical defense detachments operating 
under contract to the Saudi government appear to have been 
authentic.'' \50\
---------------------------------------------------------------------------
    \50\ See supra note 2, Tucker Report, p. 18.
---------------------------------------------------------------------------
    ``In addition to chemical alarms not associated with any 
obvious military activity, which were presumably triggered by 
chemical fallout from the bombing campaign,'' Dr. Tucker 
stated, ``many sick Gulf War veterans describe incidents in 
which they believe they were directly exposed to a chemical 
attack. Although most of these accounts are based exclusively 
on eyewitness testimony, in some cases the veterans' accounts 
have been corroborated by the available documentary record. A 
number of direct chemical exposures reported by veterans were 
associated with attacks by Iraqi SCUD or Frog ballistic 
missiles.'' \51\
---------------------------------------------------------------------------
    \51\ Ibid., p. 23.
---------------------------------------------------------------------------
    One such exposure cited by Dr. Tucker included the 
statement: ``Testifying in March 1994 before a subcommittee of 
the House Armed Services Committee, Sgt. George Vaughn . . . 
described a SCUD attack . . . in which he claimed he was 
exposed to some toxic chemical. During an alert, Vaughn 
experienced a problem with sealing his gas mask and the lens 
fogged up . . . but in the heat of the moment . . . [he] took 
the mask off his head. He immediately experienced a bitter 
almond taste and began choking. Within a day or two, Vaughn and 
three other members of his unit began to experience nausea, 
diarrhea, and severe fatigue. The gastrointestinal symptoms 
persisted after the four men returned from the Gulf. All four 
also developed fatty skin tumors called angiolipomas, which 
were surgically removed but have grown back repeatedly. Vaughn 
testified that the tumors have caused numbness in his arms and 
limited his motor skills.'' \52\
---------------------------------------------------------------------------
    \52\ Ibid., p. 23-24.
---------------------------------------------------------------------------
    Among numerous detection devices and equipment used in the 
war by U.S. forces were M8A1 detector/alarms and the FOX 
detection vehicles. The Tucker report states that each of the 
nearly 14,000 M8A1 alarms deployed in the war went off an 
average of two or three times a day.\53\
---------------------------------------------------------------------------
    \53\ Ibid., p. 16.
---------------------------------------------------------------------------
    ``The alarms went off so frequently, day and night, that 
some commanders ordered their troops to disregard or even 
disable them because no obvious symptoms of nerve-agent 
poisoning had been observed. DOD officials contend that every 
one of the tens of thousands of chemical agent alerts during 
the Gulf War was a false alarm,'' \54\ Dr. Tucker reported.
---------------------------------------------------------------------------
    \54\ Ibid.
---------------------------------------------------------------------------
    The most sophisticated CW agent detection system deployed 
in the Gulf was the German-made FOX Nuclear/Biological/Chemical 
[NBC] Reconnaissance Vehicle, an air-tight detector vehicle 
designed to detect chemical contamination on the ground so that 
advancing troops can avoid those areas. It carries a crew of 
four.
    Two detection experts in the Gulf War, Army Major Michael 
Johnson and Marine Gy/Sgt. George Grass, appeared before the 
Human Resources and Intergovernmental Relations Subcommittee on 
December 10, 1996. Though still on active duty, they agreed to 
testify despite concerns about their military careers.
    Major Johnson was commander of a FOX troop of detection 
vehicles. In testimony before the Human Resources Subcommittee, 
he stated: ``On 7 August 1991, the 54th Chemical Troop received 
the task of confirming the presence of a suspect liquid 
chemical agent at the Sabahiyah High School for Girls [Kuwait]. 
I led the mission . . . [with] two FOX vehicles. The mass 
spectrometer showed the presence of H-Agent (Mustard, a highly 
volatile blister agent) in the soil. Simultaneously, a 
dismounted collection team, in full chemical over garments, 
moved to the container (estimated to be 800-1,000 liter 
capacity) with chemical agent monitors [CAM] and chemical 
detection equipment. The dismounted collection team employed 
detection paper and the CAM . . . the detection paper 
[registered] H-Agent detection; the CAM registered H-Agent.'' 
\55\
---------------------------------------------------------------------------
    \55\ Statement of Michael Johnson, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, pp. 79-81.
---------------------------------------------------------------------------
    Major Johnson indicated that additional tests by both FOX 
vehicles registered the same results--H-Mustard agent. He also 
reported that while withdrawing liquid from the container, a 
British soldier and member of team, had liquid drops make 
contact with his wrist. He was in extreme pain immediately and 
going into shock. He was decontaminated and taken to the 
hospital. The tapes and samples were turned over to personnel 
wearing camouflage with no rank or patches. It is unknown what 
happened to the tapes and samples [or the British soldier], 
according to Major Johnson.\56\
---------------------------------------------------------------------------
    \56\ Ibid., pp. 82-83.
---------------------------------------------------------------------------
    ``I would like to emphasize that these are the facts and 
not speculation of what actions we took,'' stated Major 
Johnson. ``I know that my unit . . . did in fact detect and 
confirm the presence of toxic chemical warfare agents in 
Kuwait.'' \57\
---------------------------------------------------------------------------
    \57\ Ibid., p. 84.
---------------------------------------------------------------------------
    Gy/Sgt. Grass, a FOX vehicle commander, also reported 
confirmed detections to the Human Resources Subcommittee. One 
detection reported was near an ammunition storage area outside 
Kuwait City. He testified: ``The alarm sounded on the mass 
spectrometer with a full and distinct spectrum across the 
monitor and a lethal vapor concentration of S-Mustard. We drove 
the FOX closer to the dug-in ammo bunkers and fully visible 
were the skull and crossbones on yellow tape with red 
lettering, and scull and crossbones on boxes [of ammo] and on 
signs. As we continued driving through the same ammo storage 
area the alarm sounded again . . . HT-Mustard in lethal dose 
came across the monitor . . . again with skull and cross bones. 
Another alarm sounded showing positive readings of Benzine 
Bromide.'' \58\
---------------------------------------------------------------------------
    \58\ Statement of George Grass, Human Resources and 
Intergovernmental Relations Subcommittee hearing, Nos. 5-6, p. 103.
---------------------------------------------------------------------------
    Gy/Sgt. Grass stated: ``I gave my superior officers all the 
mass spectrometer tickets from the Al Jaber Airfield 
[detections in the oil fields] and the ammo storage area . . . 
I never saw the tickets I had given them again. When the EOD 
[ordnance disposal team] arrived, I escorted them to where the 
chemical weapons were detected [in the ammo storage area] . . . 
they donned full protective equipment . . . [and later] . . . 
verbally acknowledged the presence of chemicals weapons in the 
storage area.'' \59\
---------------------------------------------------------------------------
    \59\ Ibid., p. 104.
---------------------------------------------------------------------------
    ``Since returning from the Gulf War, I have spoken to 
almost every FOX vehicle commander from both the 1st and 2d 
Marine Divisions,'' Gy/Sgt. Grass concluded, ``and every one of 
them has verbally acknowledged the positive identification of 
chemical agents in their area of operations.'' \60\
---------------------------------------------------------------------------
    \60\ Ibid.
---------------------------------------------------------------------------
    A DOD report on the Gy/Sgt. Grass' detection stated: 
``Based on the information available thus far in this 
investigation, the presence of a chemical warfare agent in this 
area . . . is judged to be `Unlikely.' Although two members of 
the FOX crew believe that their mass spectrometer detected 
something, the MM-1 did not sound an alarm. Senior NBC officers 
said that there was no report of chemical warfare agents at 
this time. Finally, there is no physical evidence--no spectrum, 
no sample, et cetera.'' \61\
---------------------------------------------------------------------------
    \61\ Report by the U.S. Department of Defense, Office of the 
Special Assistant for Gulf War Illnesses, ``Case Narrative: U.S. Marine 
Corps Minefield Breaching,'' CMAT Control #7/29/97, 1997191-0003-330, 
July 29, 1997, p. 13 (in subcommittee files).
---------------------------------------------------------------------------
    When a subcommittee Member asked Major Johnson and Gy/Sgt. 
Grass if they were suffering any physical effects from their 
Gulf War service, both men answered yes. Major Johnson said he 
began to have problems after he returned home . . . ``changes 
in my blood pressure, headaches, burning eyes, joint pain, a 
mysterious growth in my left knee, chest pains, and 
gastrointestinal bleeding.'' \62\
---------------------------------------------------------------------------
    \62\ Testimony of Michael Johnson, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 90.
---------------------------------------------------------------------------
    Gy/Sgt. Grass said, ``I have rashes on my ankle and other 
parts of my body. My wife has been diagnosed with multiple 
sclerosis, and there are just numerous cases of illnesses that 
people have from something that went on over there, whether 
that was the exposure of chemical weapons or the biological 
weapons or both.'' \63\
---------------------------------------------------------------------------
    \63\ Testimony of George Grass, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 97.
---------------------------------------------------------------------------
    Dr. Tucker, in testimony before the Human Resources 
Subcommittee, stated: ``Low level exposures to chemical weapons 
appear to have resulted from three sources: Chemical fallout 
from the aerial bombardment of Iraqi field munitions depots 
containing chemical weapons; explosive demolition of munitions 
bunkers by United States combat engineers; and sporadic and 
uncoordinated Iraqi use of chemical weapons in the ground 
campaign. The Pentagon would have us believe that the 
Khamisiyah incident is the whole story, I will argue that it is 
just the tip of the iceberg.'' \64\
---------------------------------------------------------------------------
    \64\ Statement of Jonathan Tucker, Human Resources Subcommittee 
hearings, No. 2, p. 269.
---------------------------------------------------------------------------
    Dr. Tucker, in his statement, identified over 55 specific 
chemical weapons detection or exposure incidents, and their 
locations, from January 13 to March 26, 1991.\65\ In addition, 
he cites a U.S. Marine Corps survey of 1,600 chemical-defense 
specialists from Marine units who served in the Gulf War. A 
declassified Marine report stated that 221 respondents (about 
13 percent) reported some contact with or detection of Iraqi 
chemical weapons during the ground war.\66\
---------------------------------------------------------------------------
    \65\ Ibid., pp. 280, 286.
    \66\ Ibid., p. 270 citing Captain T.F. Manley, ``Marine Corps NBC 
Defense in Southwest Asia,'' Research Paper No. 92-0009, Marine Corps 
Research Center, Quantico, VA, July 1991, p. 11.
---------------------------------------------------------------------------
    In addition, the possibility is raised by Dr. Tucker that 
the Iraqi saboteurs who ignited the Kuwaiti oil well fires may 
have deliberately contaminated some of them with chemical 
warfare agents. He cites a captured top-secret Iraqi military 
record which gives detailed instructions for sabotaging 31 oil 
wells with explosives. The record includes an attached letter 
from the commander of the 29th Infantry Battalion which states 
in part: ``Please send an assigned person from your personnel 
to the Chemical Rank Command of Battalion 14 to receive the 
chemical preparations (Tucker emphasis) distributed to your 
units according to the directions of the command above.'' Part 
of the document also makes reference to the use of individual 
chemical protective gear and decontamination stations for 
equipment and vehicles.\67\
---------------------------------------------------------------------------
    \67\ Ibid., pp. 271-272 citing ``Captured Iraqi Military Record,'' 
December 2, 1990, at GulfLink file #20tr2__6.j17.
---------------------------------------------------------------------------
    ``This document raises the possibility that Iraqi troops 
deliberately contaminated the oil well fires with chemical 
warfare agents, generating clouds of poison-laced smoke with 
the intent of debilitating Coalition forces downwind,'' \68\ 
Dr. Tucker stated.
---------------------------------------------------------------------------
    \68\ Ibid., p. 272.
---------------------------------------------------------------------------
    In that connection, FOX vehicle operator Gy/Sgt. Grass also 
testified about detections at Kuwait's Al Jaber Airfield during 
the oil well fires: ``As the mass spectrometer was monitoring 
for chemical agent vapor contamination with the usual readings 
from the oil fires, the alarm went off and the monitor showed a 
lethal vapor concentration of the chemical agent S-Mustard.'' 
Gy/Sgt. Grass noted that when he reported the detection to the 
Division NBC officer, he was told the reading was false and had 
been produced by oil well vapors. ``We explained to him [NBC 
officer] that we already know what the oil fire vapors looked 
like on the monitor and the readings were clearly distinct with 
the words S-Mustard printed across the screen and on the tape 
printed out as evidence of the contamination the Marines were 
exposed to. Division still insisted we had false readings and 
abruptly signed off the radio.'' \69\
---------------------------------------------------------------------------
    \69\ Statement of George Grass, Human Resources and 
Intergovernmental Relations Subcommittee hearing, Nos. 5-6, p. 102.
---------------------------------------------------------------------------
    Dr. Tucker's hypothesis about Iraqi disbursement of toxic 
agents in the updraft and high downwinds of the oil well fires 
is supported by the experience of ex-CIA agent Dr. David 
Morehouse. While in the Gulf theater, Dr. Morehouse and other 
CIA agents found multiple empty canisters or metal cylinders 
about 20 inches long and 4 inches in diameter placed upright in 
the sand [and] ``leaned like the Tower of Pisa,'' downwind of 
numerous well-head fires. In his book ``Psychic Warrior,'' he 
writes: ``It's obvious that the Iraqis placed the canisters 
next to the fires to mask the plume from the canisters. So I 
think they released a slow-acting toxin to poison the Coalition 
forces, and they covered it up with oil well fires. Every 
soldier downwind of those fires must've inhaled the bug of 
whatever it was. The heroes had been poisoned.'' \70\
---------------------------------------------------------------------------
    \70\ David Morehouse, Psychic Warrior (St. Martin's Press, 1996), 
pp. 168-171.
---------------------------------------------------------------------------
    Dr. Tucker's subcommittee statement concluded: ``Evidence 
in the public domain from a variety of sources indicates a far 
larger number of credible chemical weapons detection and 
exposure incidents than DOD or CIA have thus acknowledged. 
Eyewitness accounts, declassified intelligence records, and 
operational logs all suggest that Iraq deployed chemical 
weapons into the Kuwait Theater of Operations [KTO] prior to 
the Gulf War and may have employed them in a sporadic and 
uncoordinated manner against the Coalition forces during the 
ground war. U.S. troops also appear to have been exposed to low 
level chemical warfare agents from the air bombardment and 
ground detonations of chemical facilities.'' \71\
---------------------------------------------------------------------------
    \71\ Statement of Jonathan Tucker, Human Resources Subcommittee 
hearings, No. 2, pp. 275-276.
---------------------------------------------------------------------------
    Dr. Tucker, a former senior policy analyst to the 
Presidential Advisory Committee on Gulf War Veterans' Illnesses 
[hereinafter ``PAC''], was dismissed summarily from the PAC in 
December 1995, allegedly for his research on chemical exposures 
to U.S. troops and gathering the views of people inside and 
outside the Government who also believed that Gulf veterans 
were suffering from toxic exposures. His dismissal with only 1 
hour's notice was in spite of high performance review 
ratings.\72\
---------------------------------------------------------------------------
    \72\ Ibid., p. 275.
---------------------------------------------------------------------------

                 C. Toxic Exposures in Gulf War Theater

    U.S. troops who served in the Gulf War were exposed to 
multiple toxins, any one of which--alone or a combination of 
toxins producing a synergistic interaction--may well be 
responsible for the illnesses reported by thousands of 
veterans.
    According to a GAO report, ``U.S. troops might have been 
exposed to a variety of potentially hazardous substances. These 
substances include compounds used to decontaminate equipment 
and protect it against chemical agents, fuel used as a sand 
suppressant in and around encampments, fuel oil used to burn 
human waste, fuel in shower water, leaded vehicle exhaust used 
to dry sleeping bags, depleted uranium, parasites, pesticides, 
drugs to protect against chemical warfare agents (such as 
pyridostigmine bromide), and smoke from oil-well fires. DOD 
acknowledged in June 1996 that some veterans may have been 
exposed to the nerve agent Sarin following post-war demolition 
of Iraqi ammunition facilities.'' \73\
---------------------------------------------------------------------------
    \73\ See supra note 48, pp. 1-2.
---------------------------------------------------------------------------

Chemical Weapons

    After 5 years of denial that United States troops were 
exposed to any chemical weapons, DOD disclosed on June 21, 1996 
that some 400 soldiers were ``presumed exposed'' to Iraqi nerve 
agents. This event occurred when the 37th Army Combat Engineers 
detonated enemy munitions bunkers at Khamisiyah, Iraq in March 
1991, sending plumes of nerve gas wafting into the atmosphere 
and dispersing over unprotected soldiers.\74\
---------------------------------------------------------------------------
    \74\ U.S. Department of Defense, Assistant Secretary of Defense 
(Public Affairs), News Briefing, June 21, 1996, p. 4.
---------------------------------------------------------------------------
    The number of exposed troops began to rise in following 
months as the DOD and CIA reconsidered modeling results 
pertaining to wind direction and other factors. In September 
1996, DOD raised the number to 5,000 exposed; in October, to 
nearly 21,000 exposed.\75\
---------------------------------------------------------------------------
    \75\ U.S. Department of Defense, Assistant Secretary of Defense 
(Public Affairs), News DOD News Briefing, September 19, 1996, p. 1, and 
October 22, 1996, p. 2.
---------------------------------------------------------------------------
    On July 24, 1997, results of a new computer modeling study 
were revealed by the DOD and CIA suggesting that 98,900 United 
States troops must be ``presumed exposed'' to chemical weapons 
from the Khamisiyah bunker detonations. Original CIA computer 
modeling estimates released in June 1996 stated the plumes 
carried northerly for perhaps 25 miles. New modeling estimates 
stated the plumes carried southerly for perhaps 300 miles from 
the blast site, producing fallout over some 100,000 troops 
positioned in southern Iraq, Kuwait, and northern Saudi 
Arabia.\76\
---------------------------------------------------------------------------
    \76\ See supra note 45.
---------------------------------------------------------------------------
    In April 1997, the CIA released 41 declassified documents, 
1 of which stated the CIA had warnings starting in 1984 that 
thousands of chemical weapons were stored in Khamisiyah 
bunkers.\77\ According to news accounts, the CIA claims they 
notified the Pentagon before the war of the presence of these 
weapons at Khamisiyah. The DOD had denied it until February 25, 
1997, when the Pentagon disclosed that the CIA had in fact 
warned the Army but it never reached commanders of the 37th 
Army Engineers Battalion that detonated the Khamisiyah 
depot.\78\
---------------------------------------------------------------------------
    \77\ Document released by the U.S. Central Intelligence Agency to 
accompany the report, ``Khamisiyah: A Historical Perspective on Related 
Intelligence,'' April 9, 1997, p. 3.
    \78\ Dana Priest, ``CIA Warned of Chemical Arms in '91,'' 
Washington Post, February 26, 1997, p. A1.
---------------------------------------------------------------------------
    The United Nations Special Commission on Iraq [UNSCOM] 
testified on July 29, 1997 at the Presidential Advisory 
Committee [PAC] meeting in Buffalo, NY that the aerial 
bombardment during the war of the Ukhaydir, Iraq chemical 
weapons storage depot, and possibly the Mymona depot, sent 
toxins into the air that may have produced fallout over United 
States troops stationed in Saudi Arabia.\79\ The CIA, also in 
testimony at the PAC meeting, stated: ``CIA and DOD now assess 
that there may have been a release of chemical agent from the 
Ukhaydir Ammunition Depot as a result of aerial bombing . . .'' 
The CIA is continuing exposure modeling of this event.\80\
---------------------------------------------------------------------------
    \79\ Report of the United Nations Special Commission [hereinafter 
``UNSCOM''], ``Investigation of Deployment of Chemical Weapons,'' July 
1997.
    \80\ Statement of Robert Walpole, Special Assistant for Gulf 
Illnesses, U.S. Central Intelligence Agency, to the Presidential 
Advisory Committee on Gulf War Veterans' Illnesses, ``Probable Release 
of Mustard Agent From the Ukhaydir Ammunition Storage Depot,'' July 29, 
1997.
---------------------------------------------------------------------------
    In August 1997, it was reported that a 1990 study by the 
Lawrence Livermore National Laboratory informed the U.S. Air 
Force--3 months before the Gulf War began--that bombing of 
Iraqi chemical weapons manufacturing facilities would release 
deadly nerve agents over U.S. troops who were massing several 
hundred miles to the south. This report predicted a dispersion 
of chemical warfare agents over an area 10 times greater than 
subsequent DOD and CIA studies would show.\81\
---------------------------------------------------------------------------
    \81\ ``Chemical Risk to Gulf Troops was Forecast,'' USA Today, 
August 14, 1997, p. 1.
---------------------------------------------------------------------------
    According to testimony before the Human Resources 
Subcommittee by Gulf War expert James Tuite, director of the 
Gulf War Research Foundation, the Livermore Laboratory study 
proved to be prophetic. He stated: ``Up to now, the missing 
element . . . has been the mystery of how the [chemical] agents 
were transported from the research, production and storage 
sites in Iraq to [Coalition] troops.'' This has been an 
especially difficult issue given that it has been the long-held 
assertion of DOD, DIA, and the CIA that the winds were blowing 
in the wrong direction [northerly] during the detection events.
    ``The report I submit today [I believe] solves the mystery 
of the [chemical] detections that occurred after the initial 
wave of Coalition bombings of these chemical warfare agent 
storage facilities during the first 2 days of the air war. 
Using available visible and infrared meteorological satellite 
imagery from NOAA [National Oceanic and Atmospheric 
Administration], which was available to military planners [but 
not used] during the war--a war before which they expressed 
deep concern over the fallout effects from these bombings--I 
have been able to determine that a thermal plume rose into the 
atmosphere over the largest Iraqi chemical warfare agent 
research, production, and storage facility at Muthanna after 
Coalition aircraft and missile bombardment.''
    ``Seventeen metric tons of Sarin were reportedly destroyed 
during these attacks, which began on January 17, 1991. These 
thermal and visual plumes extended [southerly] directly toward 
the areas where those same chemical warfare agents were 
detected and confirmed by Czechoslovak chemical specialists. 
Hundreds of thousands of U.S. servicemen and women were in the 
area where these detections occurred, assembling for the 
upcoming ground invasion of Iraq and the liberation of 
Kuwait.'' \82\
---------------------------------------------------------------------------
    \82\ Statement of James Tuite, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 439.
---------------------------------------------------------------------------

Biological Weapons

    According to Dr. Jonathan Tucker's 1996 report to the 
subcommittee, Iraq had initially denied possession of 
biological weapons following the war. Over the next 5 years, 
however, persistent detective work by UNSCOM personnel 
gradually forced Iraqi authorities to admit the existence of an 
offensive biological warfare program, an extensive and 
sophisticated effort led by Ph.D. scientists trained in the 
West.
    Dr. Tucker stated: ``As the centerpiece of this effort, 
Iraq mass-produced and weaponized three [biological] agents on 
a large scale: the bacterial agent that causes the disease 
anthrax, which is nearly always fatal within 4 days; botulinum 
toxin, an exceedingly potent bacterial toxin; and aflatoxin, a 
fungal toxin that is a liver carcinogen but can also serve as 
an incapacitating agent. In addition . . . Iraq experimented 
with a range of other lethal and incapacitating agents.'' \83\
---------------------------------------------------------------------------
    \83\ See supra note 2, Tucker Report, p. 1.
---------------------------------------------------------------------------
    Dr. Tucker reported that Iraq conducted field trials of 
biological agents in bombs, rockets and aerosol generators from 
1988 until Iraq invaded Kuwait in August 1990. At this point, 
their research and development [R&D;] program shifted to a 
``crash'' effort on large-scale production and weaponization.
    ``Even if Iraq was deterred from a large-scale or overt use 
of chemical and biological weapons [as a result of United 
States warnings of massive retaliation], it may still have 
engaged in covert or insidious (i.e., low-level) operations. 
Certainly, Iraq would have nothing to gain by admitting that it 
had employed chemical or biological weapons during the Gulf 
War, and much to lose politically and economically, since such 
as admission would make it even less likely that the UN 
sanctions would be lifted. Thus, Iraq's denials [of chemical 
and biological weapons use] should not be taken at face-value, 
especially in view of the evidence for Iraqi chemical weapons 
use.''
    Dr. Tucker cites Iraqi military manuals on the use of 
chemical and biological weapons. An Iraqi Air Force Academy 
manual on nerve agents notes that these poisons ``have a 
cumulative effect; if small doses are used repeatedly on a 
target, the damage can be very severe.'' \84\ An Iraqi Chemical 
Corps manual states: ``It is possible to select anti-personnel 
biological agents in order to cause lethal or incapacitating 
casualties in the battle area or in the enemy's rear areas . . 
. [and] incapacitating agents are used to inflict casualties 
which require a large amount of medical supplies and treating 
facilities, and many people to treat them. Thus it is possible 
to hinder the opposing military operations.'' \85\
---------------------------------------------------------------------------
    \84\ U.S. Department of Defense, Defense Intelligence Agency, 
(translation of) Iraqi field manual, ``A Course in Nuclear, Biological 
and Chemical Protection,'' August 23, 1991, p. 5.
    \85\ U.S. Department of Defense, Armed Forces Medical Intelligence 
Center, (translation of) Iraqi manual, ``Chemical, Biological and 
Nuclear Operations,'' January 12, 1992, p. 6.
---------------------------------------------------------------------------
    A report by the U.S. Navy's Biological Defense Research 
Program, which performed BW detection and analysis for U.S. 
forces during the Gulf War, concluded: ``No agents (including 
anthrax and botulinum toxin) detected during Desert Shield/
Storm despite fielding of state-of- the-art detection 
methods.'' \86\
---------------------------------------------------------------------------
    \86\ Report of the Naval Medical Research Institute, U.S. Navy, 
``BW Detection Capabilities'' Biological Defense Research Program, 
Naval Medical Research Institute, Bethesda, MD, September 3, 1997, 
Summary page (in subcommittee files).
---------------------------------------------------------------------------
    A recent GAO report stated: ``DOD has consistently denied 
that Gulf War veterans were intentionally or unintentionally 
exposed to biological warfare agents, and prior to June 1996, 
it denied any exposure to chemical warfare agents. If 
servicemembers were exposed, exposure would have occurred in 
one of three ways: 1) through intentional Iraqi use of chemical 
or biological warfare agents; 2) through theaterwide 
contamination resulting from air war bombings of Iraq, or 3) 
through site-specific events. DOD has taken the position that 
chemical and biological agent exposures can be confirmed only 
through evidence of mass [and immediate] incidents of morbidity 
and mortality. Since there were no such instances, DOD asserted 
that Gulf War veterans were not exposed.'' \87\
---------------------------------------------------------------------------
    \87\ See supra note 48, p. 62.
---------------------------------------------------------------------------
    The GAO report observed: ``According to the CIA . . . the 
Iraqis had weaponized several biological agents at the time of 
the Gulf War, including anthrax, botulism, and aflatoxin (a 
potent liver carcinogen). . . . [Aflatoxin's] effects may not 
be observed until decades after low-level exposure . . .'' \88\
---------------------------------------------------------------------------
    \88\ Ibid.
---------------------------------------------------------------------------

Infectious Diseases

    According to the PAC December 1996 report, ``Infectious 
diseases endemic to the Gulf region include shigellosis, 
malaria, sandfly fever, and cutaneous leishmaniasis. Along with 
these infectious diseases, DOD medical personnel also monitored 
troops for dengue, Sindbis, West Nile fever, Rift Valley fever, 
and Congo-Crimean hemorrhagic fever. The documented low rates 
of infection among U.S. troops suggest exposures were minimal 
and/or preventive measures were ineffective.'' \89\
---------------------------------------------------------------------------
    \89\ Final Report of the Presidential Advisory Committee on Gulf 
War Related Illnesses, (U.S. Government Printing Office, Washington, 
DC, 1996) [hereinafter ``PAC Report''], pp. 98-99.
---------------------------------------------------------------------------
    Microbiologist and immunologist Dr. Howard Urnovitz, 
chairman of the Calptye Biomedical Corp., testified before the 
Human Resources Subcommittee on the Gulf War Syndrome. He 
stated: ``One of my research efforts is focused on how chemical 
and infectious agents interact to initiate and maintain a 
chronic disorder. The symptoms [of Gulf War Syndrome] are 
similar to those of over a dozen unexplained epidemics over the 
last 60 years . . . including headache, muscle pain, slight 
paralysis, damage to the brain, spinal cord or peripheral 
nerves, mental disorders . . .''
    ``Recent studies have found that prolonged and aggressive 
antibiotic therapy appears to abate many of the symptoms 
associated with Gulf War Syndrome. Usually the therapy takes 
longer than ordinary treatments (i.e., 6 to 9 weeks instead of 
less than 3 weeks) and in many cases the symptoms return when 
the therapy is discontinued. It is not clear whether this 
response is directly due to the control of some antibiotic-
sensitive microorganisms or a direct action on an inflammatory 
or neurologic process or some placebo effect.''
    ``It is known that the Gulf War was one of the most toxic 
battlefields in the history of modern warfare. Syndromes 
associated with organophosphate-induced delayed neuropathy 
[OPIDN] could explain many of the observed and unexplained 
illnesses. However, it may not be mutually exclusive to have 
tissue damage resulting from toxic exposures, which leads to 
inflammatory responses in critical tissues with ensuing 
opportunistic bacteriological, viral, and fungal infections. 
The continued presence of these pathogens may greatly impair a 
possible healing process. All of these risk factors need to be 
considered in trying to understand the underlying pathology of 
Gulf War Syndrome.'' \90\
---------------------------------------------------------------------------
    \90\ Statement of Howard Urnovitz, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 194-
196.
---------------------------------------------------------------------------
    Dr. Garth Nicolson, chief scientific officer and research 
professor at the Institute for Molecular Medicine, states that 
some illnesses can be explained by exposure of veterans to 
various biological agents, called chronic pathogenic 
infections, in combination with chemicals and then transported 
home to family members. Dr. Nicolson, who has studied 650 Gulf 
veterans and their immediate family members, discounts stress 
as a major factor in causing Gulf veterans' illnesses.
    In testimony before the Human Resources Subcommittee, Dr. 
Nicolson stated: ``Gulf War illness [GWI] is not caused by 
stress, it is caused by multiple exposures to chemical, 
environmental, radiological and/or biological agents that cause 
chronic multisystem signs and symptoms that for the most part 
can be diagnosed as existing diseases. We have been 
particularly interested in veterans with GWI whose family 
members are now also sick with similar signs and symptoms, 
suggesting that many GWI patients suffer from biological, not 
chemical or radiological, origins for their illnesses. 
Illnesses caused by chemical or radiological exposures should 
not be transmitted to family members. GWI in immediate family 
members is officially denied by DOD and VA.'' \91\
---------------------------------------------------------------------------
    \91\ Prepared statement of Garth Nicolson, Human Resources 
Subcommittee hearing of June 26, 1997, p. 1 (in subcommittee files).
---------------------------------------------------------------------------
    ``After examining GWI patients'' blood for the presence of 
chronic biological agents, the most common infection found was 
an unusual microorganism, Mycoplasma fermentans (incognitus 
strain), a slow-growing mycoplasma located deep inside blood 
leukocytes (white blood cells) of slightly under one-half of 
GWI patients studied. When they are in the blood, similar to 
other bacteria, they can cause a dangerous system-wide or 
systemic infection. In addition, cell-penetrating mycoplasmas, 
such as Mycoplasma fermentans, may produce unusual autoimmune-
like signs and symptoms . . .'' \92\
---------------------------------------------------------------------------
    \92\ Ibid., p. 3.
---------------------------------------------------------------------------
    ``In GWI patients that tested positive for mycoplasmal 
infections in their blood, we have found that this type of 
infection can be successfully treated with multiple courses of 
specific antibiotics, such as doxycycline. Multiple treatment 
cycles are required, and patients relapse often after the first 
few cycles, but subsequent relapses are milder and patients 
eventually recover.'' \93\
---------------------------------------------------------------------------
    \93\ Ibid., pp. 4-5.
---------------------------------------------------------------------------
    ``Chemical exposures can cause toxicological effects and 
produce many but not all of the signs and symptoms of GWI. In 
addition, chemical exposures can result in immunosuppression 
and leave an individual susceptible to infections.'' \94\
---------------------------------------------------------------------------
    \94\ Ibid., p. 7.
---------------------------------------------------------------------------
    Leishmaniasis is also an infectious disease and is caused 
by a microscopic parasite that invades certain types of white 
blood cells. The disease is transmitted by sandflies, and a 
number of different leishmania species are known to infect 
humans. Disease that involve low levels of parasite infection 
can be particularly difficult to diagnose. It is rarely seen in 
the United States; however, more than 30 cases have been 
diagnosed among Gulf veterans. Accurate diagnosis of 
leishmaniasis, which can have a long latency period, is 
important because effective treatment involves the use of 
potentially toxic drugs in clinical trials but not yet approved 
by the Food and Drug Administration [FDA].\95\
---------------------------------------------------------------------------
    \95\ See supra note 48, p. 60.
---------------------------------------------------------------------------

Depleted Uranium

    Depleted uranium [DU] is a highly, toxic, radioactive by-
product of the uranium enrichment process.\96\ DU is used in 
munitions as armor-piercing rounds fired at enemy tanks, and as 
protective armor on U.S. tanks. When a DU penetrator impacts a 
hard target, most of the round burns up, scattering uranium 
dust and shrapnel in and around the target. In the Gulf War, DU 
is credited with destroying over 1,400 Iraqi tanks, as well as 
other equipment and weapons storage facilities.\97\
---------------------------------------------------------------------------
    \96\ U.S. General Accounting Office, Operation Desert Storm: Army 
Not Adequately Prepared to Deal With Depleted Uranium Contamination, 
GAO/NSIAD-93-90, p. 1.
    \97\ Report by the National Gulf War Resource Center, Inc., 
Washington, DC. ``Gulf War Syndrome,'' Fall 1996, p. 5 (in subcommittee 
files).
---------------------------------------------------------------------------
    ``Exposure to DU armor and/or penetrators is dangerous, but 
DU poses the greatest risk to those who: breathe smoke or dust 
from a burning vehicle hit by DU rounds; climb on or enter a 
vehicle hit by DU rounds; or were in a friendly fire incident 
involving DU rounds.'' \98\
---------------------------------------------------------------------------
    \98\ Ibid.
---------------------------------------------------------------------------
    One of the more severe DU exposure events occurred in July 
1991 in Doha, Kuwait when a major U.S. Army ammunition depot 
and motor pool exploded and burned for 2 days. DU armor on 
vehicles and 9,000 pounds of DU rounds were oxidized to powder 
exposing 3,500 soldiers in the vicinity to radiation and DU 
aerosol particles that were widely distributed by high winds. 
Soldiers involved in the cleanup several days after the fire 
were not warned of DU contamination and, therefore, wore no 
protective gear.\99\
---------------------------------------------------------------------------
    \99\ International Action Center, Metal of Dishonor (Depleted 
Uranium Action Project, International Action Center, New York, NY, 
1997), pp. 33-35. [Abstract 5, ``How U.S. Troops Were Exposed to DU'']
---------------------------------------------------------------------------
    According to the booklet ``DU: The Stone Unturned,'' 
published by Swords to Plowshares: ``Even after the [Doha] 
fire, soldiers were never told about the presence of DU 
contamination. Soldiers swept the compound with brooms, picked 
up debris with their bare hands, and were never issued 
respiratory masks or other protective clothing.'' \100\
---------------------------------------------------------------------------
    \100\ Report by Dan Fahey, ``DU: The Stone Unturned,'' Swords to 
Plowshares, March 28, 1997, p. 10 (in subcommittee files).
---------------------------------------------------------------------------
    ``Like most soldiers,'' the DU publication continues, ``S/
Sgt. Chris Kornkven was unaware of the use of DU munitions 
during the war. Due to his exposure to DU dust on destroyed 
Iraqi vehicles, he has since tested positive for internalized 
depleted uranium.'' [S/Sgt. Kornkven testified before the Human 
Resources Subcommittee on January 21, 1997.] \101\
---------------------------------------------------------------------------
    \101\ Ibid., p. 11.
---------------------------------------------------------------------------
    Radiation exposure expert Dr. Asaf Durakovic, a medical 
unit commander in the Gulf War and most recently the chief of 
nuclear medicine at the VA Medical Center in Wilmington, DE was 
a witness at the Human Resources Subcommittee hearing on June 
26, 1997. Dr. Durakovic reported that his expertise was never 
used because he and his staff were never informed of the 
intended use of DU before the war or during the war.\102\
---------------------------------------------------------------------------
    \102\ Prepared statement of Asaf Durakovic, Human Resources 
Subcommittee hearing of June 26, 1997, p. 2 (in subcommittee files).
---------------------------------------------------------------------------
    In late 1991, following the war, 24 ill soldiers from the 
144th Transportation & Supply Company in New Jersey were 
referred to Dr. Durakovic at the VA Medical Center in 
Wilmington for diagnosis and treatment. These soldiers had 
worked on battle damaged tanks and vehicles in the Gulf from 
January to March 1991 without protective equipment or clothing. 
In March, a Battle Damage Assessment Team arrived in full 
radioprotective clothing, inspected the vehicles, declared them 
``hot'' and off-limits.\103\
---------------------------------------------------------------------------
    \103\ Ibid.
---------------------------------------------------------------------------
    Preliminary testing showed 14 of 24 veterans ``contained 
decay products of radioactive uranium.'' According the Dr. 
Durakovic, urine samples sent to the Army Radiochemistry Lab in 
Aberdeen, MD, disappeared. Dr. Durakovic recommended 
additional, more comprehensive testing--including tests to 
determine if the 24 veterans had also inhaled DU particles--but 
further tests and treatments were denied by the VA. Of the 14 
veterans, 2 have since died, and the remaining members of the 
144th Company have scattered around the country making medical 
follow-up unlikely.\104\
---------------------------------------------------------------------------
    \104\ Ibid., pp. 2-3.
---------------------------------------------------------------------------
    ``None of my recommendations was ever followed. Every 
conceivable road block was put in my line of management of 
those patients. I was ridiculed. There were obstacles 
throughout my attempt to properly analyze the problems of those 
patients. My plan failed because of total lack of interest on 
the part of the VA to do anything for those unfortunate 
patients. I [even] received phone calls from DOD suggesting 
that this work is not going to yield meaningful information and 
should be discontinued.'' \105\
---------------------------------------------------------------------------
    \105\ Testimony of Asaf Durakovic, Human Resources Subcommittee 
hearing of June 26, 1997, original transcript, pp. 135-136 (in 
subcommittee files).
---------------------------------------------------------------------------
    Dr. Durakovic was later terminated by the Wilmington VA 
hospital, he alleges for his outspoken views of the VA 
concerning the diagnosis and treatment of sick Gulf War 
veterans.
    Physicist and DU expert Leonard Dietz, who testified before 
the Human Resources Subcommittee, writes and speaks frequently 
on the dangers of depleted uranium. In a recent abstract he 
stated, ``A large number of unprotected Gulf War veterans could 
easily have acquired dangerous quantities of DU in their 
bodies. We refer to scientific measurements that have been made 
of the atmospheric wind-borne transport of uranium aerosols up 
to 25 miles from their sources. Micrometer particles of DU can 
spread over a large region and poison many people both 
radiologically and chemically.'' \106\
---------------------------------------------------------------------------
    \106\ See supra note 98, p. 135. [Abstract 20, ``DU Spread & 
Contamination of GW Veterans.'']
---------------------------------------------------------------------------
    ``A comprehensive epidemiological study should be made of 
all Gulf War veterans and their families,'' Dietz said, 
``searching for evidence of residual DU in their bodies and for 
causes of genetic defects in their children. The health issues 
associated with DU munitions should be investigated and 
evaluated by independent medical and scientific experts 
separated completely from the DOD, VA, National Laboratories, 
U.S. military services and their contractors.'' \107\
---------------------------------------------------------------------------
    \107\ Ibid., p. 149.
---------------------------------------------------------------------------
    Dr. Michio Kaku, nuclear physics professor at City 
University of New York, stated, ``Ultimately, the Gulf War 
Syndrome will be traced to a variety of factors, simply because 
the Pentagon released so much firepower on the Iraqis during 
that war that large quantities of materials were sent into the 
atmosphere, including DU and chemicals stored in warehouses. 
Ultimately, when the final chapter is written, DU will have a 
large portion of the blame.'' \108\
---------------------------------------------------------------------------
    \108\ Ibid., p. 114. [Abstract 17, ``DU: Huge Quantities of 
Dangerous Waste.'']
---------------------------------------------------------------------------
    ``The Pentagon should release all its classified 
information concerning the Gulf War Syndrome and depleted 
uranium,'' Dr. Kaku said. ``It is a national embarrassment that 
the Pentagon, even at this late date, is still withholding 
vital information about precisely what happened during the Gulf 
War.'' \109\
---------------------------------------------------------------------------
    \109\ Ibid., p. 115.
---------------------------------------------------------------------------
    A 1993 report by the GAO concluded, ``Although the Army's 
stated policy is to minimize personnel's exposure to radiation, 
it has not effectively educated its personnel in the hazards of 
DU contamination and in proper safety measures appropriate to 
the degrees of hazard. What little information is available is 
not widely disseminated and training on DU is basically limited 
. . .'' \110\
---------------------------------------------------------------------------
    \110\ U.S. General Accounting Office, ``Operation Desert Storm: 
Army Not Adequately Prepared to Deal With Depleted Uranium 
Contamination,'' GAO/NSIAD-93-90, January 1993, p. 2.
---------------------------------------------------------------------------
    The DOD did not properly train Gulf troops to the dangers 
of DU before and during the war, according to Dr. Bernard 
Rostker, DOD's Special Assistant for Gulf War Illness. He made 
this statement in a July 1997 meeting on depleted uranium with 
Human Resources Subcommittee staff. Dr. Rostker advised the 
Human Resources staff that steps were being taken to educate 
troops, who may fight future wars, on the toxic effects of DU 
exposure.

Oil Well Fires and Petroleum Contamination

    Iraqi troops, in a deliberate act of sabotage and revenge, 
ignited hundreds of Kuwaiti oil wells during the Gulf War. 
According to a Defense Science Board Report, ``On February 23, 
1991, Iraqi forces began to destroy and set fire more than 700 
oil wells throughout Kuwait.'' \111\ The date is challenged by 
the University of Arizona's Environmental Research Laboratory, 
concluding that, ``Solar radiation data indicate that the first 
oil well fires were most likely set on or around January 17, 
1991'' \112\ [an important date because it suggests an 
additional month of troop contamination]. The last of the 749 
oil well fires, including storage tanks and refineries, were 
extinguished 10 months later, in November 1991.\113\
---------------------------------------------------------------------------
    \111\ Final Report of the Defense Science Board, U.S. Government 
Printing Office, 1994, p. 50.
    \112\ Riley, et al., ``Effect of Kuwait Oil Field Fires on Human 
Comfort and Environment in Saudi Arabia,'' International Journal of 
BioMeteorology, 1992, pp. 36-38.
    \113\ Report prepared by Craig Stead, ``Oil Fires, Petroleum and 
Gulf War Illnesses,'' June 1997, at tab J, citing testimony of Gary 
Friedman, Texas Lung Institute to the PAC (in subcommittee files).
---------------------------------------------------------------------------
    Oil well fires and petroleum related exposures are another 
possible cause of the Gulf War Syndrome. In testimony submitted 
to the Presidential Advisory Committee [PAC], chemical engineer 
and expert on health effects of petroleum exposure, Craig Stead 
stated: ``Petroleum was a major Gulf War environmental 
exposure. American troops were exposed to petroleum from oil 
well fires, oil contaminated drinking and shower water, oil 
soaked clothing, and use of petroleum for dust suppression, 
pesticide application, and fuel. Petroleum inhalation, 
ingestion and skin absorption causes illness. The symptoms of 
petroleum illness are consistent with symptoms reported by Gulf 
War veterans.''
    ``Clinical techniques exist to diagnose petroleum 
illness,'' Mr. Stead said. ``These techniques include broncho 
alveolar lavage [BAL], computed tomography, and magnetic 
resonance imaging. Known treatments for petroleum include the 
use of anti-inflammatory steroids, expectoration of oil in the 
lungs, and diet. Left untreated, petroleum illness is a 
progressive disease which can lead to emphysema and cancer as 
endpoints.'' \114\
---------------------------------------------------------------------------
    \114\ Statement of Craig Stead to the PAC, March 26, 1996, p. 2 
(excerpt in subcommittee files).
---------------------------------------------------------------------------
    Sick Gulf War veterans testified about their experiences 
before the Presidential Advisory Committee and a National 
Institutes of Health Gulf War workshop. Testimony included:
    ``When they blew the oil well fires, it was unlike anything 
I ever seen in my life. It was like being in a locked closet in 
the dark. We are in the middle of 500 oil well fires. And the 
only thing that they [U.S. military] gave us was a white T-
shirt and [said] `Put it over your face.' When they brought in 
the civilian contractors to put out these oil well fires, they 
had self-contained breathing apparatus. They had chemical 
suits. They had everything. Members of my team did [get ill].'' 
\115\
---------------------------------------------------------------------------
    \115\ Statement of Scott Russell to the PAC, August 6, 1996 
(excerpt in subcommittee files).
---------------------------------------------------------------------------
    ``[I] was in the center of the oil fires in Kuwait City 
with no capability of distinguishing the sun from the moon for 
the first 6 weeks after the liberation of Kuwait. [My] body was 
so oil and soot covered that a black watch band was camouflaged 
on [my] wrist. The scarf [I] wore around [my] face did not 
filter out the air borne debris. [My] spit looked like oil and 
when [I] sneezed [my] mucus looked like axle grease.'' \116\
---------------------------------------------------------------------------
    \116\ Statement of Herb Smith to the National Institutes of Health 
Gulf War Workshop, April 27-29, 1994, (excerpt in subcommittee files).
---------------------------------------------------------------------------
    ``We were by the oil well fires for 2 weeks and we camped 
right next to them.'' \117\
---------------------------------------------------------------------------
    \117\ Statement of Kevin Jenson to the PAC, August 6, 1997 (excerpt 
in subcommittee files).
---------------------------------------------------------------------------
    ``I developed severe nasal problems from the oil smoke. I 
got breathing problems.'' \118\
---------------------------------------------------------------------------
    \118\ Statement of Michael Lanning to the PAC, August 6, 1997 
(excerpt in subcommittee files).
---------------------------------------------------------------------------
    ``I lived six city blocks from the fires for almost 2 
weeks. I flew in the stuff every day.'' \119\
---------------------------------------------------------------------------
    \119\ Statement of Ronald Matthews to the PAC, February 27, 1996 
(excerpt in subcommittee files).
---------------------------------------------------------------------------
    ``For 7 months, my husband's ship chartered through burning 
oil derricks in the water. They were on the oil spill. They 
ingested oil-infested water. They cooked with it. They showered 
in it. He has chemical sensitivity. He has asthma. He got it in 
the service.'' \120\
---------------------------------------------------------------------------
    \120\ Statement of Betty Zuspan to the PAC, February 7, 1996 
(excerpt in subcommittee files).
---------------------------------------------------------------------------
    ``We suffered chemical ingestion when our drinking, 
cooking, washing, and bathing water became heavily contaminated 
with some sort of chemical that burned our mouth, throat, 
esophagus, and stomach. When we took our showers, we smelled of 
petrochemicals as well as the freshly washed clothes we put on. 
The food tasted of kerosene. We were in a 100 percent 
contaminated environment. I became very sick with digestive 
problems that same day that the contamination came aboard ship 
in our drinking water. The Navy ships' distilling plants . . . 
cannot filter out chemicals.'' \121\
---------------------------------------------------------------------------
    \121\ Statement of Antonio Melchor to the PAC, February 7, 1996 
(excerpt in subcommittee files).
---------------------------------------------------------------------------
    Gulf War veteran Debbie Judd, an Air Force nurse, testified 
before the PAC on a survey completed in 1995 by the Operation 
Desert Storm Association on 10,051 sick Gulf veterans. She 
reported the following results: ``Specific to the oil in the 
environment there, those breathing or enveloped in oil fire 
smoke was 96 percent; within clear visual area of the oil fires 
was 90 percent; worked in, lived in, or made travel through the 
burning oil fields was 72 percent; washed in water with an oily 
sheen was 68 percent. Those having oily taste to their food was 
66 percent, and those with oily taste to the drinking water was 
65 percent.'' \122\
---------------------------------------------------------------------------
    \122\ Statement of Debbie Judd to the PAC hearing, November 7, 
1995, (excerpt in subcommittee files).
---------------------------------------------------------------------------
    A study, ``Kuwait Oil Fire Health Risk Assessment,'' by the 
U.S. Army's Environmental Health Agency concluded: ``Results of 
this [report] indicate the potential for significant long-term 
adverse health effects for the exposed troop or civilian 
employee populations is minimal . . .'' \123\
---------------------------------------------------------------------------
    \123\ Final Report, Kuwait Oil Fire Health Assessment, Department 
of the Army, U.S. Environmental Hygiene Agency, Report No. 39-26-L192-
91, February 1994, p. 1. [Executive Summary].
---------------------------------------------------------------------------
    Craig Stead provided a statement to the Human Resources 
Subcommittee in which he said the Army study was flawed: ``In 
1994, the Army issued the final Kuwait Oil Fire Health Risk 
Assessment. The Assessment used Gulf air pollution data 
gathered in May through November 1991. Air pollution from the 
oil field fires during this time was much less than during the 
Gulf War for the following reasons: The months of May through 
November [when the study was done] have the Shamal winds 
blowing from the northwest causing the smoke plume from the oil 
field fires to disperse widely and ascend to great heights. 
During the Gulf War (February and March) low wind speeds and 
air inversions were common. Under these conditions the smoke 
plume was on the ground, creating high localized levels of air 
pollution to which the troops were exposed.'' \124\
---------------------------------------------------------------------------
    \124\ Prepared statement of Craig Stead, Human Resources 
Subcommittee hearing of June 26, 1997, p. 3 (in subcommittee files).
---------------------------------------------------------------------------
    An Institute of Medicine [IOM] document confirms Mr. 
Stead's statement: ``The Army Health Risk Assessment could not 
launch a successful air-sampling effort until the beginning of 
May, after the more stagnant air conditions of the winter 
months had passed. Those who undertook the sampling efforts did 
so with this knowledge.'' \125\ Principal author of the Army 
report, Dr. Jack Heller, also confirmed the Stead statement: 
``What we measured at the time we were there starting in May 
when the Shamal winds were strongly blowing and there was a lot 
of thermal lofting of the pollution. We didn't have those 
ground level impacts [present during the war]. In fact the 
whole time I was there I had [only] one ground level impact.'' 
\126\
---------------------------------------------------------------------------
    \125\ National Academy of Sciences, Institute of Medicine, Health 
Consequences of Service During the Gulf War, [``IOM Report''] (National 
Academy Press, 1996) p. 45.
    \126\ See supra note 113, statement of Jack Heller to the NIH 
Workshop: ``Persian Gulf Experience and Health, April 27-29, 1994, tab 
I (in subcommittee files).
---------------------------------------------------------------------------
    Mr. Stead stated: ``Dr. Heller did not factor into the 
Assessment study the high levels of wartime air pollution to 
which the troops were actually exposed. The Assessment is 
seriously flawed . . . [and] . . . is a primary document relied 
upon by DOD, PAC, VA and IOM in concluding the oil field fires 
presented no health hazard to the troops.'' \127\ Mr. Stead 
also said the study was additionally flawed because it 
neglected to include troop exposures to contaminated rain 
during the fires, oil contamination in water for drinking, 
cooking and showering.\128\
---------------------------------------------------------------------------
    \127\ See supra note 124, p. 4.
    \128\ Ibid.
---------------------------------------------------------------------------
    Also, a January 1991 study by the U.S. Army Intelligence 
Agency, issued on the eve of the invasion, forewarns of the 
threat of the oil well fires and tends to refute the U.S. Army 
Environmental Health Agency's Risk Assessment. The Army 
Intelligence report stated: ``Owing to Iraq's defensive 
`scorched earth' plan for Kuwait, the overall Kuwaiti oil 
infrastructure presents a serious hazard to advancing ally 
ground forces. There is overwhelming evidence that once 
ordered, the Iraqi forces will initiate demolition of oil 
wells, oil-gathering centers, oil-storage depots, pumping 
stations, large tank farms, refineries, and oil/product loading 
terminals. Demolition of these facilities and complexes will 
result in massive fires--`Burning Kuwait.' ''
    ``The danger of oil fires, toxic gas, and smoke in the 
Kuwaiti Theater of Operations [KTO] is very serious [emphasis 
added]. These dangers . . . are as follows: 1) Associated toxic 
and highly flammable gas from spilled raw sour crude oil from 
nonburning oil wells; 2) Intense heat of oil-well fires, 
possible natural-gas wells, and fire trenches; 3) Dense smoke 
and superheated gases from these fires. By far the greatest 
danger is from dissociated hydrogen sulfide gas and highly 
volatile light ends [gases] released from wellhead blowouts. In 
the KTO, the prevailing winds generally blow from the north-
northwest southward toward Saudi Arabia [emphasis added]. Smoke 
and gases from Kuwaiti fires and blowouts most likely will be 
blown in the face of northerly advancing [United States] forces 
along the southern front of the KTO.'' \129\
---------------------------------------------------------------------------
    \129\ Report of the U.S. Army Intelligence Agency, U.S. Army 
Foreign Science Center, ``Kuwait: Serious Oilfire, Gas and Smoke 
Dangers,'' AST-2660Z-148-90, January 9, 1991, pp. iii, 1 (in 
subcommittee files).
---------------------------------------------------------------------------

Experimental Drugs and Vaccines

    In December 1990, a month before the war, the Food and Drug 
Administration [FDA] agreed to issue a waiver to the DOD 
allowing the military to issue experimental drugs and vaccines 
to U.S. personnel in the Gulf without first obtaining informed 
consent. A factor possibly contributing to the illnesses of 
Gulf veterans was the ingestion of anti-nerve gas pills, 
pyridostigmine bromide tablets [PB tabs]. Troops were required 
to take the experimental drug to counter the effects of 
potential exposure to chemical warfare agents.
    PB expert Dr. Thomas Tiedt, a neuroscientist and former 
pharmaceutical industry researcher, testified before the Human 
Resources Subcommittee that ``evidence shows that Gulf War 
Syndrome was easily predicted. The symptoms largely match those 
of cholinergic syndrome, which results from inhibition of the 
life-critical and development-critical enzyme 
acetylcholinesterase [AchE]. Pyridostigmine bromide, Sarin, and 
organophosphate pesticides are examples of AchE inhibitors . . 
. [which] cause stunning nerve and muscle degeneration moments 
after a single dose, which worsens with multiple doses.'' \130\
---------------------------------------------------------------------------
    \130\ Statement of Thomas Tiedt, Human Resources Subcommittee 
hearing, No. 2, p. 301.
---------------------------------------------------------------------------
    ``My team's research at the University of Maryland during 
the mid-1970's about physiological and microscopic AchE 
toxicity was comprehensive,'' Dr. Tiedt stated. ``Our work was 
followed by an explosion of research by DOD during the 1980's, 
the most relevant of which was produced by my co-authors and 
colleagues at Maryland and the [Army's] chemical-warfare R&D; 
center in Aberdeen [MD]. DOD [research] established by the 
early 1980's that: 1) PB would be harmful in healthy 
individuals; 2) PB was worthless, even counterproductive, as a 
protectant against chemical warfare; and 3) PB was more toxic 
than sub-lethal doses of chemical warfare agents. I understand 
PB was taken by about 500,000 soldiers . . . [and] it has been 
reported that 50-60 percent of soldiers taking PB have acute 
side effects.'' \131\
---------------------------------------------------------------------------
    \131\ Ibid., p. 303.
---------------------------------------------------------------------------
    Dr. Tiedt concluded: ``More attention is needed on the long 
record by the military to conduct involuntary, meritless, and 
hazardous experiments on soldiers. The Nuremberg Code [signed 
following World War II] states, `No experiments should be 
conducted where there is an a priori reason to believe that 
death or disabling injury will occur.' The use of PB was an 
experiment. It was the first time we used PB for such a 
purpose. There were no data supporting its use or the way it 
was used. Sadly, no records remain or were kept.'' \132\
---------------------------------------------------------------------------
    \132\ Ibid., p. 306.
---------------------------------------------------------------------------
    Researcher and pharmacologist Mohamed Abou-Donia of Duke 
University has conducted research on animals using 
pyridostigmine bromide and other chemicals. Dr. Abou-Donia fed 
groups of hens with the anti-nerve agent PB, the insecticide 
permethrin, and the insect repellant DEET--all routinely used 
by the military in the Gulf War theater. Each chemical was 
administered alone and in various combinations.
    According to Dr. Abou-Donia: ``This study shows that 
relatively high doses of PB, DEET, and permethrin appear to 
cause minimal health risk when used individually. It 
demonstrates, however, the increased neurotoxicity associated 
with coexposure to the same doses of test compounds. Although 
this study was not intended to simulate actual exposure 
conditions that may have existed during the Persian Gulf War, 
nor was it designed as a dose-response study, from it one can 
hypothesize why co-exposure to test compounds may have 
contributed to Gulf War veterans' illnesses. The variety of 
symptoms reported by veterans make it unlikely that a single 
etiologic cause is responsible for producing the Gulf War 
illnesses.'' \133\
---------------------------------------------------------------------------
    \133\ Mohamed Abou-Donia, et al., ``Neurotoxicity Resulting from 
Co-Exposure to Pyridostigmine Bromide, DEET, and Premethrin: 
Implications of Gulf War Chemical Exposures,'' Journal of Toxicology 
and Environmental Health, 1996, 48:pp. 35-56.
---------------------------------------------------------------------------
    Dr. Satu Somani, PB expert and professor of pharmacology 
and toxicology at Southern Illinois University's School of 
Medicine, also testified before the Human Resources 
Subcommittee on the health effects of pyridostigmine bromide. 
Dr. Somani stated:
    ``Years after Desert Storm, many veterans continue to 
suffer from medical problems such as fatigue, headache, joint 
pain, gastrointestinal disorders, and other ailments. This 
testimony is based on the premise that Gulf veterans were 
taking pyridostigmine as a precautionary measure against 
potential exposure to nerve agents (e.g., Sarin) and they were 
exposed to insecticides and other harmful chemicals. They were 
also under physical stress that modified the effects of such 
exposure. The toxic, harmful or poisonous nature of nerve 
agents is exacerbated by the fact, even if an individual were 
provided pre- or post-treatment, there is still a strong 
potential for such effects to continue because of delayed 
neurotoxicity [Somani emphasis]. Further, while acute toxicity 
can be treated with atropine, oxime and diazepam, no treatment 
is available for delayed neurotoxicity.'' \134\
---------------------------------------------------------------------------
    \134\ Statement of Satu Somani, Human Resources Subcommittee 
hearing, No. 2, p. 321.
---------------------------------------------------------------------------
    ``Delayed neurotoxicity, first reported in the 1950's, can 
occur 5 or 10 years after exposure to nerve agents. Studies 
have shown that organophosphate-induced delayed neurotoxicity 
[OPIDN] is due to inhibition of neurotoxic esterase enzyme in 
the nervous system, and histopathological axonal degeneration. 
This also produces muscular weakness and ataxia (difficulty in 
movement).'' \135\
---------------------------------------------------------------------------
    \135\ Ibid.
---------------------------------------------------------------------------
    Dr. Somani concluded: ``Based on recent experimental 
evidence and the similarities of symptoms of delayed 
neurotoxicity reported by workers in the organophosphate 
industry and also by Desert Storm veterans, the author 
concludes that GWS may be due to low-level exposure to Sarin [a 
chemical warfare agent] exposure, intake of pyridostigmine 
[bromide], and exposure to pesticides and other chemicals. The 
adverse effects of such exposures were amplified by physical 
stress conditions.'' \136\
---------------------------------------------------------------------------
    \136\ Ibid.
---------------------------------------------------------------------------
    Vaccines were also given to Gulf War troops. Anthrax was 
tested and approved by the FDA for limited use, and was 
administered to about 150,000 troops in the Gulf region. 
Botulinum toxoid vaccine was approved by the FDA for use with a 
waiver of informed consent, and about 8,000 troops were given 
this vaccine. It is also not known if side effects could occur 
with these vaccines when combined with PB or other 
chemicals.\137\
---------------------------------------------------------------------------
    \137\ See supra note 97, p. 5.
---------------------------------------------------------------------------
    The PAC report was critical of the FDA and DOD handling of 
experimental drugs and vaccines. It stated: ``The Committee 
also found that DOD and FDA deliberated carefully before 
enabling, through rulemaking, DOD to require troops to take 
pyridostigmine bromide [PB] and botulinum toxoid [BT] vaccine 
as pretreatments for possible CBW agents without FDA approval 
of the products for that purpose. We were concerned that FDA 
had failed, in the 5 years since the Gulf War, to devise better 
long-term methods governing military use of drugs and vaccines 
for CBW defense. We also found DOD's inability to produce 
records of who received PB or BT indicative of much need for 
wholesale improvement in the government's performance on 
medical recordkeeping during military engagements.'' \138\
---------------------------------------------------------------------------
    \138\ PAC Report, p. 18.
---------------------------------------------------------------------------

Pesticides and Multiple Chemical Sensitivity [MCS]

    Multiple chemical sensitivity is a disease that is being 
debated throughout the medical field. While a number of leading 
medical organizations have published papers that question the 
existence of multiple chemical sensitivity its diagnosis and 
its possible treatments,\139\ a growing number of physicians 
and scientists have accepted the basic premise that exposure to 
a wide range of chemicals existing in the modern world can 
produce synergistic effects and cause a variety of health 
problems.
---------------------------------------------------------------------------
    \139\ These organizations include the American Academy of Allergy 
and Immunology, the American College of Physicians, the American 
College of Occupations Medicine and the Council of Scientific Affairs 
of the American Medical Association. See also supra note 97, p. 7.
---------------------------------------------------------------------------
    MCS expert Dr. Claudia Miller of the University of Texas 
Southwest Medical Center at San Antonio has focused her 
research, and co-authored several books over the past 9 years 
on patients who report developing chronic illnesses and 
chemical intolerances. These illnesses follow low level 
exposure to various chemicals, including pesticides, solvents, 
and combustion products. In subcommittee testimony, she stated: 
``In 1995, we published a study of 37 patients who had been 
exposed to pesticides . . . who subsequently reported 
developing multi-system symptoms and new-onset chemical, food 
and drug intolerances. Eighty percent of these individuals . . 
. were no longer able to work or could only work part-time 
because of their health problems.'' \140\
---------------------------------------------------------------------------
    \140\ Statement of Claudia Miller, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 511.
---------------------------------------------------------------------------
    Dr. Miller testified that common symptoms reported by these 
patients at the time they were exposed were often flu-like 
illnesses, fatigue, concentration difficulties, headaches, 
shortness of breath, musculoskeletal pain, and gastrointestinal 
symptoms. The patients also reported, according to Dr. Miller, 
``new and unusual intolerances for common chemicals such as 
fragrances, traffic exhaust, gasoline, and household cleaning 
products. In addition, many found they could no longer tolerate 
alcoholic beverages, various foods, caffeine, and 
medications.'' \141\
---------------------------------------------------------------------------
    \141\ Ibid.
---------------------------------------------------------------------------
    Beginning in 1992, Dr. Miller was asked by the Houston VA 
Medical Center to consult on the first group of sick Gulf War 
veterans. Dr. Miller evaluated 75 veterans and testified that 
``These veterans' symptoms and their frequent reports of new-
onset intolerances to chemicals, foods, and medications 
reminded me of the civilians we studied with histories of 
exposure to organophosphate or carbamate pesticides or to 
mixtures of solvents at low levels. Comparison of eight symptom 
scales derived by factor analysis revealed similar ordering of 
symptoms in the Gulf veterans and the pesticide-exposed 
civilians.'' \142\
---------------------------------------------------------------------------
    \142\ Ibid., p. 512.
---------------------------------------------------------------------------
    Pesticides and insect repellants were heavily used before, 
during and after the Gulf War, according to Albert Donnay, 
executive director of the MCS Referral & Resources in 
Baltimore. Information he received from the DOD indicates that 
21 different pesticides were used but no records were kept of 
amounts used, what they were used for, or who applied them.
    In a memorandum to the Human Resources Subcommittee, Mr. 
Donnay stated: ``Officials in DOD responsible for pesticide use 
have told me that they kept no records of pesticide use during 
the Persian Gulf deployment. We urge DOD to focus on the 
chronic effects of pesticide exposures, not just the two 
pesticides currently being studied (DEET and Permethrin), but 
all 21 pesticides that the DOD admits sending to and using in 
the Persian Gulf during Operation Desert Shield and Desert 
Storm.'' Mr. Donnay wrote that ``. . . data from the EPA, 
DowElanco and others linking MCS to organophosphate pesticides 
[showed that] . . . of the top 10 pesticides associated with 
MCS reports from 1984-1990 by the EPA-funded National Pesticide 
Telecommunications Network, 7 are on the DOD list of those used 
in the Persian Gulf. Even if the veterans' exposures to nerve 
agent fallout were not enough to induce illness, the DOD failed 
to consider how these may have interacted synergistically 
[emphasis added] with the veterans' extensive exposure to 
chemically similar pesticides. None of the CCEP [DOD's Gulf 
health registry] reports published to date discuss MCS data. We 
are concerned that MCS [data] was abandoned without any 
analysis . . . and data are now being withheld from qualified 
researchers.'' \143\
---------------------------------------------------------------------------
    \143\ Memo from Albert Donnay, executive director, MCS Referral & 
Resources Center to Robert Newman, subcommittee staff, September 18, 
1996 (in subcommittee files).
---------------------------------------------------------------------------
    The PAC report states, ``The Committee concludes it is 
unlikely that health effects and symptoms reported today by 
Gulf War veterans are the result of exposure to pesticides 
during the Gulf War. Lindane is an animal liver carcinogen, but 
it is too early to see an elevated liver cancer rate in Gulf 
War veterans.'' The PAC report draws no conclusion about MCS, 
but comments that ``There is no consensus case definition for 
MCS, although two recent government-sponsored conferences have 
attempted to develop one.'' \144\
---------------------------------------------------------------------------
    \144\ PAC Report, p. 81.
---------------------------------------------------------------------------

      D. Acute v. Chronic Effects of Low Level Chemical Exposures

    In testimony before the subcommittee, Dr. Stephen Joseph, 
formerly DOD's Assistant Secretary for Health Affairs, stated, 
``Current accepted medical knowledge is that chronic symptoms 
or physical manifestations do not later develop among persons 
exposed to low levels of chemical nerve agents who did not 
first exhibit acute symptoms of toxicity.'' \145\ This 
unequivocal statement became the basic medical policy of DOD 
and VA in terms of diagnosis, treatment, compensation and 
research of the illnesses affecting thousands of Gulf War 
veterans.
---------------------------------------------------------------------------
    \145\ Statement of Stephen Joseph, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 221.
---------------------------------------------------------------------------
    Dr. Claudia Miller, an expert on low level chemical 
exposures, stated before the subcommittee that Dr. Joseph's 
statement was not necessarily true. ``I think it is premature 
for anyone to say that low levels of organophosphates cannot 
cause chronic health problems,'' Dr. Miller said. ``There is a 
lot of literature now suggesting that is quite a possibility 
and there are ways to approach that question scientifically.'' 
\146\
---------------------------------------------------------------------------
    \146\ Testimony of Claudia Miller, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 271.
---------------------------------------------------------------------------
    ``Sarin was not the only organophosphate-type exposure 
soldiers may have encountered in the Gulf: pesticides in this 
chemical class and pyridostigmine bromide, a related carbamate 
drug, were also widely used,'' Dr. Miller stated. ``There are 
now several studies, in addition to our own, linking chronic, 
multi-system symptoms to [low level] organophosphate/carbamate 
exposure.'' \147\
---------------------------------------------------------------------------
    \147\ Statement of Claudia Miller, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 511-
512.
---------------------------------------------------------------------------
    Dr. Stephanie Padilla, Environmental Protection Agency 
[EPA] neurotoxicology expert, agrees. In subcommittee 
testimony, Dr. Padilla said, ``Exposure to organophosphates may 
produce residual adverse effects . . .'' and cause ``. . . 
organophosphate-induced-delayed-neuropathy [OPIDN]. Recent 
studies . . . indicate there may be long-term health effects 
associated with exposure . . .'' and ``. . . one [study] 
concluded that `results clearly indicate that there are chronic 
neurological sequelae to acute organophosphate poisoning. . . 
.' '' \148\
---------------------------------------------------------------------------
    \148\ Testimony of Stephanie Padilla, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 252-
254.
---------------------------------------------------------------------------
    In response to Dr. Joseph's statement that chronic symptoms 
from low level chemical exposure do not later develop unless 
acute symptoms first appeared, Dr. Padilla testified that 
pyridostigmine bromide, the anti-nerve gas tablets which the 
troops were required to take, would dampen or ``mask the acute 
effects'' of chemical exposure.\149\
---------------------------------------------------------------------------
    \149\ Ibid., p. 268.
---------------------------------------------------------------------------
    The subcommittee also learned that a 1974 study of low 
level chemical exposures, conducted by Dr. Karlheinz Lohs, then 
director of the Institute of Chemical Toxicology of the East 
German Academy of Sciences, concluded that ``mustard CW agents 
are capable of producing a wide range of mutagenic, 
carcinogenic, hepatotoxic [causing liver damage] and neurotoxic 
effects. It is important to note that even in the case of 
exposure to very slight amounts which do not necessarily bring 
on acute symptoms, toxic reactions may set in. How far this may 
lead to nerve-cell, hematopoietic or parenchymatous lesions 
depends largely on the state of health of the individual (for 
example, previous injury to any particular organ), duration of 
exposure or intervals between exposures and, last but not 
least, on individual `detoxification capacity' (enzymatic 
polymorphism, genetic disposition, and so on.)'' \150\
---------------------------------------------------------------------------
    \150\ Lohs, Karlheinz, Delayed Toxic Effects of Chemical Warfare 
Agents (New York: Almqvist & Wiksel International for the Stockholm 
International Peace Research Institute, 1995), pp. 14-15.
---------------------------------------------------------------------------
    Dr. Joseph was not familiar with the Lohs study.\151\
---------------------------------------------------------------------------
    \151\ Human Resources and Intergovernmental Relations Subcommittee 
hearings, Nos. 1-4, p. 248.
---------------------------------------------------------------------------
    Also in the 1970's, Dr. Frank Duffy, associate professor of 
neurology at Harvard University Medical School, and his 
research associates conducted a study for the U.S. Army's Rocky 
Mountain Arsenal [RMA], a facility where nerve gas containing 
munitions were stored and decommissioned. The Army post 
surgeon, Dr. Maurice Gaon, noted an unusual number of civilian 
employees with a symptom complex including fatigue, sleep 
difficulties, memory loss, trouble concentrating, irritability, 
loss of libido, among others. These symptoms were primarily 
noticed in employees much later following reported exposures to 
the nerve agent Sarin, an organo-phosphate. The Army called on 
Dr. Duffy and his associates to plan and implement a study of 
these exposures.\152\
---------------------------------------------------------------------------
    \152\ Statement of Frank Duffy, Human Resources Subcommittee 
hearings, No. 1, p. 228.
---------------------------------------------------------------------------
    This situation provided Dr. Duffy with an opportunity to 
study the effects of accidental low level Sarin exposures on 
humans after 1 year, comparing their symptoms with symptoms of 
rhesus monkeys after 1 year by injecting the primates with low 
doses of Sarin.
    The results, according to Dr. Duffy, indicated that ``low 
levels of exposure to the nerve agent Sarin can produce long-
lasting effects. It was perfectly clear that not only were 
people, after [low level Sarin] exposure showing long-term 
effects, but it was widely accepted in the pesticide industry 
that exposure to related compounds like malathion and 
parrathion or the chlorinated hydrocarbon insecticides led to 
long-term consequence.'' \153\
---------------------------------------------------------------------------
    \153\ Testimony of Frank Duffy, Human Resources Subcommittee 
hearing, No. 1, p. 226.
---------------------------------------------------------------------------
    Dr. Duffy stated: ``It has been suggested that since Army 
personnel did not appear to suffer acute symptoms which could 
be clearly recognized as resulting from acute Sarin exposure, 
that this explanation for Gulf War Syndrome must be irrelevant. 
This is not necessarily a valid assumption. First, the low 
level exposure to the monkey group demonstrated no symptoms . . 
. and second, most of the exposed Army personnel at RMA 
suffered relatively minor symptomatology.'' \154\
---------------------------------------------------------------------------
    \154\ Statement of Frank Duffy, Human Resources Subcommittee 
hearings, No. 1, p. 230.
---------------------------------------------------------------------------
    According to the NY Times, Dr. Frank Duffy and his research 
colleagues Dr. James Burchfiel of the University of Rochester 
and Dr. Peter Bartels of the University of Arizona, ``said in 
interviews that the Pentagon seemed intent on ignoring or 
dismissing their evidence. Their research, which studied the 
effects of low doses of Sarin on humans and primates, showed 
the exposure resulted in long-term or chronic, perhaps 
permanent, changes in brain waves, which could be connected 
with . . . symptoms common among Gulf veterans.'' \155\
---------------------------------------------------------------------------
    \155\ Shenon, Phillip, ``New Look Urged on Gulf Syndrome: Important 
Evidence Withheld by Pentagon, Scientist Says,'' New York Times, 
December 10, 1996, p. A1.
---------------------------------------------------------------------------
    In a 1987 letter to Robert Hall of the Hawaii Institute for 
Biosocial Research, Dr. Duffy also noted the possible confusion 
between organophosphate-delayed-neuropathy and stress: ``I 
applaud your effort in raising the level of consciousness about 
the serious potential for long-term effects due to exposures to 
these [organophosphate] compounds. It has been our experience 
that the side effects of minimal but continual exposures to the 
compounds mimic the symptoms associated with a stressful life 
[emphasis added]. Accordingly, most individuals are unable to 
determine whether their irritability is related to a stressful 
life or to a recent organophosphate exposure. This is a serious 
issue.'' \156\
---------------------------------------------------------------------------
    \156\ Letter from Frank Duffy letter to Robert Hall, March 26, 1987 
(in subcommittee files).
---------------------------------------------------------------------------
    Results of U.S. Air Force [USAF] studies on the health 
effects of sublethal, low dose exposure to nerve agents, 
published in 1992, bear on the question of acute v. chronic 
symptoms. The study was ordered because some AF personnel 
(e.g., bomb loaders and medical personnel) worked in 
potentially contaminated environments. USAF's Armstrong 
Laboratory conducted the studies of nerve agent behavioral 
toxicity in laboratory rhesus monkeys, and concluded that: 
``Behavioral deficits [in primates] can be reliably detected in 
the absence of any overt [acute] signs of toxicity. This is 
especially important when assessing the effects of low-level 
exposures to extremely toxic compounds such as OP 
[organophosphate] nerve agents.'' The Air Force studies suggest 
that ``. . . repeated low-dose exposure to soman [a nerve 
agent] caused progressive and lasting inhibition of ChE 
[cholinesterase enzyme] . . .'' \157\
---------------------------------------------------------------------------
    \157\ Somani, Satu, Chemical Warfare Agents, (Academic Press, 
1992), containing the study by Hargraves and Murphy, ``Behavioral 
Effects of Low-Dose Nerve Agents,'' pp. 125-154.
---------------------------------------------------------------------------
    Also disputing Dr. Joseph's statement was Dr. Seymour 
Antelman, University of Pittsburgh professor of psychiatry, who 
in a letter to the editor of the New York Times, stated: ``[Dr. 
Joseph's] view . . . is almost certainly wrong. My research, 
published in leading scientific journals and the subject of a 
June 21, 1988, Science Times article, has shown that the 
effects of chemicals can develop and grow over time, and need 
not be present at the time of exposure. Such `time dependent 
sensitization' is more likely after exposure to a low level 
stimulus.'' \158\
---------------------------------------------------------------------------
    \158\ Letter to the editor, Seymour Antelman, New York Times, 
November 15, 1996 (in subcommittee files).
---------------------------------------------------------------------------
    In May 1996, 7 weeks prior to DOD's first admission of 
chemical exposures, Major General Ronald Blanck, commander of 
the Walter Reed Army Medical Center and the Army's chief 
physician, said, ``Clearly there is some evidence of low level 
exposure.'' \159\
---------------------------------------------------------------------------
    \159\ Statement of Ronald Blanck to the PAC, May 2, 1996.
---------------------------------------------------------------------------
    Two VA physicians--Dr. Victor Gordan of the Manchester (NH) 
VA Medical Center and Dr. Charles Jackson of the Tuskegee (AL) 
VA Medical Center--began to suggest soon after the war that the 
sick Gulf veterans they had examined were exposed to chemicals. 
However, their views did not receive much attention from VA 
headquarters, DOD, or the news media.
    In Human Resources Subcommittee testimony, Dr. Gordan, who 
has treated 544 Gulf veterans since 1991, stated, ``What is 
strikingly consistent in these veterans' stories are: 1) a 
drastic change in their health status from very good to 
perfect, as it was before deployment to the Gulf War, to poor 
to fair after their return from the war; 2) the large variety 
and number of symptoms suggesting dysfunction of more than one 
organ system in their bodies; and 3) the very consistent 
history of being exposed to chemicals in the Gulf, including 
the strong belief [by veterans] of being exposed to chemical 
warfare. These consistent stories point very strongly toward 
the environmental hazards as the cause or causes of these 
unexplained illnesses. Unless the science addresses these 
environmental hazards, we will never be able to adequately 
explain and hopefully solve these medical problems.'' \160\
---------------------------------------------------------------------------
    \160\ Testimony of Victor Gordan, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 282.
---------------------------------------------------------------------------
    Dr. Gordan concluded, ``Chemicals . . . are the greatest 
masquerader in the modern medicine . . . because they penetrate 
into all sorts of systems and organs, and those organs get 
dysfunctional, and those dysfunctions bypass symptoms, and 
symptoms can mimic so-called quantifiable disease, including 
arthritis, even PTSD.'' [emphasis added] \161\
---------------------------------------------------------------------------
    \161\ Ibid., p. 291.
---------------------------------------------------------------------------
    In the same hearing, Dr. Jackson, an environmental 
physician covering Agent Orange and Gulf War illnesses, said, 
in reference to the chairman's earlier question to the VA, 
``Well, one of the questions that you asked to Dr. Mather was 
whether or not one person in the VA had made the clinical 
opinion that there was a veteran exposed to chemical and/or 
biological agents, and, yes, there was. We did this back 3 
years ago.'' \162\
---------------------------------------------------------------------------
    \162\ Testimony of Charles Jackson, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 275.
---------------------------------------------------------------------------
    Attributing the illnesses he was seeing to the product of 
multiple chemical exposures, Dr. Jackson said, ``Symptoms of 
the veterans are not inconsistent with those of the farm and 
veterinary workers with chronic low dose exposure to 
organophosphorus insecticides.'' \163\
---------------------------------------------------------------------------
    \163\ Statement of Charles Jackson, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 280.
---------------------------------------------------------------------------
    Dr. Jackson added, ``Recent DOD and CIA revelations 
concerning the destruction of tons of mustard and Sarin in Iraq 
have supported the probability of exposure to the . . . 
agents.'' \164\ ``We have gone on record as saying that we 
believe this is a significant factor. . . . It was not a 
popular opinion, nor was it the official opinion of the VA.'' 
\165\
---------------------------------------------------------------------------
    \164\ Ibid.
    \165\ Ibid., p. 295.
---------------------------------------------------------------------------
    Dr. Frances Murphy, the VA's Director of Environmental 
Agents Service, offered the Department's official opinion, 
which supports Dr. Joseph, in testimony before the Human 
Resources Subcommittee: ``Studies of low level chemical warfare 
agent exposure were not given high priority . . . because 
military and intelligence sources had stated that U.S. troops 
had not been exposed to chemical agents. Current body of 
research proves that low level exposures cannot cause health 
effects [emphasis added].'' \166\
---------------------------------------------------------------------------
    \166\ Testimony of Frances Murphy, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 141, 
109.
---------------------------------------------------------------------------
    The results of a study conducted by Dr. David Schwartz and 
his University of Iowa Medical School research colleagues were 
recently published in the Journal of the American Medical 
Association [JAMA].\167\ The Schwartz study, supported by the 
Centers for Disease Control and Prevention, found that Persian 
Gulf veterans are reporting more medical and psychiatric 
conditions than their military peers who were not deployed to 
the Gulf War. Gulf veterans reported an 11 percent higher 
prevalence of symptoms of cognitive dysfunction or problem 
thinking, but only a 1 percent increase in PTSD.\168\
---------------------------------------------------------------------------
    \167\ Schwartz, et al., ``Self-reported Illness and Health Status 
Among Gulf War Veterans.'' Journal of the American Medical Association, 
January 15, 1977, Vol. 277, No. 3, p. 238.
    \168\ Statement of David Schwartz at National Press Club, January 
15, 1997 pp. 1, 3 (in subcommittee files).
---------------------------------------------------------------------------
    Dr. Robert Haley and his research colleagues at the 
University of Texas Southwestern Medical Center also completed 
a study in early 1997 of Gulf veterans, the results of which 
were published in three articles in JAMA. According to the 
study, ``Some Gulf War veterans may have delayed, chronic 
neurotoxic syndromes from wartime exposure to combinations of 
chemicals'' and that ``clusters of symptoms of many Gulf War 
veterans reflect a spectrum of neurologic injury involving the 
central, peripheral, and autonomic nervous systems.'' \169\
---------------------------------------------------------------------------
    \169\ Haley, et al., ``Is There a Gulf War Syndrome?'' Journal of 
the American Medical Association, January 15, 1997, Vol. 277, No. 3, p. 
215; ``Evaluation of Neurologic Function in Gulf War Veterans,'' 
Journal of the American Medical Association, January 15, 1997, Vol. 
277, No. 3, p. 223; and ``Self-reported Exposure to Neurotoxic Chemical 
Combinations in the Gulf War,'' Journal of the American Medical 
Association, January 15, 1997, Vol. 277, No. 3, p. 231.
---------------------------------------------------------------------------
    People have asked why most Gulf War veterans have not 
reported illnesses while only some veterans were affected. Dr. 
Kenneth Olden, director of the National Institute of 
Environmental Health Sciences, was recently quoted in the 
press: ``We've known for a long time that when several hundred 
people are exposed to the same environmental toxicants, some 
people get sick and others don't. There are a number of enzyme 
systems that detoxify chemicals. If you have too little--that's 
a problem.'' \170\
---------------------------------------------------------------------------
    \170\ Sternberg, Steve, ``Study Seeks Genes That Make People 
Vulnerable to Toxins'' USA Today, September 18, 1997, p. A3.
---------------------------------------------------------------------------
    The results of a second study by Dr. Haley on Gulf veterans 
was published in August 1997 by the National Academy of 
Neuropsychology.\171\ The new study compared the brain-related 
and psychological functions of ill and well Gulf veterans, and 
found no evidence of psychological problems, including PTSD or 
other stress-related illnesses. Some Gulf veterans, the study 
says, suffer from a form of brain damage found in toxic 
poisoning victims.
---------------------------------------------------------------------------
    \171\ Horn, Haley, et al., ``Neuropsychological Correlates of Gulf 
War Syndrome.'' Archives of Clinical Neuropsychology, August 1997, Vol. 
12, No. 6, pp. 531-544.
---------------------------------------------------------------------------
    A New York Times article reported, ``Stephen C. Joseph, the 
Pentagon doctor overseeing the investigation of the Gulf War 
Syndrome, is under attack on the political battlefield. Senator 
John D. Rockefeller 4th (D-WV) has called him arrogant and 
demanded his resignation. ``Dr. Joseph is at the heart of a 
culture that has never looked at this problem seriously 
enough,'' said one senior White House official involved in this 
issue. The uproar involves . . . questions over how the 
Pentagon responded to veterans' health complaints and its 
refusal to acknowledge that the veterans might have reason to 
worry about exposure to chemical or biological agents, anti-
nerve gas pills, or other environmental factors in the Persian 
Gulf.'' \172\
---------------------------------------------------------------------------
    \172\ Shenon, Philip, ``Pentagon Health Chief Fights Claims of Gulf 
Cover-Up,'' New York Times, November 3, 1996, p. 30.
---------------------------------------------------------------------------
    As a result of increased congressional and news media 
attention on issues surrounding the Gulf War veterans' 
illnesses, then DOD Deputy Secretary John White assumed the 
role of DOD spokesman on Gulf issues in October 1996.
    Dr. Joseph resigned in March 1997.
    One of the most frequently asked questions by the veterans, 
public and press is why the DOD for 5 years continued to deny 
that troops were exposed to chemical warfare agents or that low 
level exposures caused illness. The U.S. News & World Report in 
an article ``Gulf War Mysteries'' stated: \173\
---------------------------------------------------------------------------
    \173\ ``Gulf War Mysteries: Why Americans May Never Know What's 
Making These Veterans Sick,'' U.S. News & World Report, November 25, 
1996 [cover story].
---------------------------------------------------------------------------
    ``If exposure to chemicals is ever tied to widespread 
illnesses among veterans, the government may face other 
dilemmas. A link could open the door to thousands of disability 
claims, plus legislation mandating greatly expanded health 
coverage for veterans. The repercussions could reach to future 
battlefields as well. An official determination that chemicals 
have seriously harmed U.S. soldiers would be an admission of 
vulnerability, likely to encourage Iraq and other potential 
foes such as North Korea to use chemical weapons if they ever 
face off against the United States in the future. The next time 
the alarms start going off, the all-clear may not be so quick 
to follow.''

        E. Exposures and VA Medical Protocols for Gulf Veterans

    In view of DOD's admission on June 21, 1996, after 5 years 
of denial, that Gulf War troops were presumed exposed to 
chemical warfare agents at the Khamisiyah bunker detonations, 
and in view of the missing or inadequate medical records of 
veterans and chemical detection logs, Human Resources 
Subcommittee Chairman Shays wrote to then VA Secretary Jesse 
Brown calling for an immediate re-evaluation of the diagnostic 
and treatment protocols, and compensation practices, for Gulf 
War veterans.
    The chairman's letter follows:


    


    If the VA claims it has ``always accepted the possibility 
of exposures,'' it should be noted that: 1) the VA did not add 
specific questions on chemical warfare exposures to its VA Gulf 
Health Registry until late 1995, 4 years after veterans began 
reporting illnesses; and 2) there is no VA or DOD research on 
the health effects of low level exposure to neurotoxic agents 
yet available.
    In a subcommittee hearing on December 11, 1996, Chairman 
Christopher Shays questioned Dr. Susan Mather, VA's Chief 
Public Health and Environmental Hazards Officer, and Dr. 
Frances Murphy, VA's Director of Environmental Agents Service, 
about when the VA first ``accepted the possibility of chemical 
exposures.'' Their testimony follows:

          Mr. Shays. Do they [VA doctors] listen to that [sick] 
        veteran or do they listen to DOD who says we have had 
        no credible verification of chemicals being used? Who 
        do they listen to?
          Dr. Mather. The veterans.
          Mr. Shays. If you were listening to veterans, why are 
        we still now only beginning to think that maybe 
        exposure to chemicals might in fact be credible?
          Dr. Mather. Our perspective and our emphasis has been 
        on the illness that the veterans had, and we were 
        looking at the illnesses that the veterans had and 
        working back from that.
          Mr. Shays. To help you in this analysis . . . to 
        truly understand the illnesses that are affecting your 
        patients, you would want to know what kind of an 
        environment they were in and what physical 
        confrontation they had with that environment.
          Dr. Mather. Exactly. That's the reason we revised the 
        questions we asked the veteran.
          Mr. Shays. When did you make that revision?
          Dr. Mather. Unfortunately, the revision did not get 
        finished until this past year. It took a long time to 
        get it approved and I apologize for that.
          Dr. Murphy. We began educating our physicians early 
        on about all the exposures that were known. We 
        addressed the whole range of exposures and asked them 
        to question veterans about those exposures.
          Mr. Shays. But the fact is, we have under oath 
        documentation that soldiers weren't asked vital 
        questions dealing with chemical exposures until after 
        Khamisiyah [events were announced]. When did you really 
        start to change your approach? When, if fact, did the 
        form get changed?
          Dr. Murphy. The form was published in September 
        1995.\174\
---------------------------------------------------------------------------
    \174\ Testimony of Susan Mather and Frances Murphy, Human Resources 
and Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 
247.

    In the following Gulf War hearing on January 21, 1997, the 
same subject was raised again by Chairman Shays with the 
---------------------------------------------------------------------------
witness Dr. Kenneth Kizer, VA's Under Secretary for Health:

          Mr. Shays. Dr. Kizer, what mistakes has the VA made 
        in the last 6 years with regard to the Gulf War issue?
          Dr. Kizer. I don't know I would characterize them as 
        mistakes . . . the research agenda . . . was delayed 
        because of information that was provided.
          Mr. Shays. Provided where?
          Dr. Kizer. By the Department of Defense.
          Mr. Shays. So in essence, the only thing you would 
        describe as a mistake, and you wouldn't even describe 
        it as a mistake, is that you relied on information from 
        the DOD that our troops weren't exposed to chemicals . 
        . . ?
          Dr. Kizer. The issue of chemical warfare agents . . . 
        and the investigation into that arena, was delayed, and 
        that investigative focus was given a lower priority 
        because of the information that had been provided by 
        DOD.
          Mr. Shays. So the bottom line is, because the DOD 
        denied . . . any exposure . . . VA made a determination 
        that therefore our troops were not exposed to . . . 
        chemicals?
          Dr. Kizer. No, I don't think that characterizes what 
        I said, Mr. Chairman.
          Mr. Shays. OK. Say it over again in a different way.
          Dr. Kizer. The VA has been consistently . . . open to 
        and have been concerned about the exposure of troops to 
        chemical warfare agents. As far as specific research 
        protocols that were funded, the potential exposure was 
        given lower priority than others.
          Mr. Shays. Because?
          Dr. Kizer. Because of the information that was 
        provided by DOD . . .
          Mr. Shays. So you didn't ever begin to ask our troops 
        until 1995 if they felt they were exposed to chemicals?
          Dr. Kizer. I don't believe that is correct, sir, 
        because our physicians were asking the question before 
        that.
          Mr. Shays. So I will ask the question again. Is it a 
        fact that the Registry did not require these questions 
        [to be asked by VA physicians] until 1995?
          Dr. Kizer. Again, physicians performing the Registry 
        examinations before that time [1995] asked those 
        questions. Did everybody ask it? I can't say they did, 
        no . . .\175\
---------------------------------------------------------------------------
    \175\ Testimony of Kenneth Kizer, Human Resources Subcommittee 
hearing, No. 1, pp. 50-60.

    In the December 11, 1997 hearing, Chairman Shays questioned 
VA's Dr. Mather and Dr. Murphy about research on low level 
---------------------------------------------------------------------------
chemical exposures. Their testimony follows:

          Mr. Shays. The VA has expressed to us that there has 
        not been a focus on low level exposure because the DOD, 
        whose information you rely on, has said there has been 
        no use of chemicals in the Gulf and no exposure.
          Dr. Mather. That is very true in the research arena. 
        I think research into low level exposure has a low 
        priority.
          Dr. Murphy. It was not viewed as high priority to 
        take asymptomatic exposures to chemical warfare nerve 
        agents and look for health effects, because there was 
        no evidence either from what we were being told from 
        DOD . . . [or] that [exposure] was a likely 
        possibility. What we did not address was low level 
        exposures and the potential long-term health effects. 
        Current body of research proves that low level 
        exposures cannot cause health effects [emphasis 
        added].\176\
---------------------------------------------------------------------------
    \176\ See supra note 174, p. 52 (Mather testimony), pp. 80, 99, 109 
(Murphy testimony).

    Veterans and medical witnesses at Human Resources 
Subcommittee hearings maintain that the VA medical protocol 
does not sufficiently address exposure history. In fact, the VA 
Health Registry questionnaire relies on the ability of the 
veteran to recognize toxic exposures by asking such questions 
as: ``Did you witness Chemical Alarms?'' \177\
---------------------------------------------------------------------------
    \177\ U.S. Department of Veterans Affairs, Persian Gulf Registry 
Questionnaire (in subcommittee files).
---------------------------------------------------------------------------
    In addition, VA physicians who examine Gulf veterans for 
the first time are not trained to take toxic exposure 
histories.\178\ This is critical in that many veterans may have 
been exposed in theater but would not have realized it. VA 
physicians trained to ask the right questions can identify 
potential exposures of which the veteran may not have been 
aware.
---------------------------------------------------------------------------
    \178\ Human Resources and Intergovernmental Relations Subcommittee 
staff conference call with Claudia Miller, September 20, 1996.
---------------------------------------------------------------------------
    The issue of trained VA physicians to detect the health 
effects of chemical exposures was also raised in Human 
Resources Subcommittee hearings:

          Mr. Shays. I get the sense that you don't really have 
        the background in chemical exposures. Is that correct?
          Dr. Mather. I'm not a toxicologist. I'm a chest 
        physician.
          Dr. Murphy. I'm a neurologist, sir.
          Mr. Shays. How many doctors work for the VA?
          Dr. Murphy. Over 1,800.
          Mr. Shays. How many toxicologists?
          Dr. Mather. I don't know.
          Dr. Murphy. Physicians are rarely toxicologists. 
        That's a Ph.D. level kind of specialty. Dr. Kizer, for 
        instance, is a medical toxicologist physician. I would 
        have to go back and look specifically.
          Mr. Shays. It would be an estimate. One percent? Ten 
        percent? A half percent?
          Dr. Murphy. I cannot estimate.
          Dr. Mather. I honestly don't know.
          Mr. Shays. Can you name me 10 toxicologists that you 
        know are working for the VA?
          Dr. Mather. No.
          Dr. Murphy. I can't come up with 10 off the top of my 
        head.
          Mr. Shays. Can you name me five?
          Dr. Murphy. Dr. Peter Spencer is a neurotoxicoligist.
          Mr. Shays. That's one. Can you name another?
          Dr. Murphy. No, sir.
          Mr. Shays. You can only name one expert in a field 
        that deals with chemical exposure? What other 
        specialities would there be besides the toxicologists?
          Dr. Murphy. Most of the subspecialities we have in 
        investigating toxic exposures, include neurologists, 
        pulmon-ologists, and occupational health physicians.
          Mr. Shays. So it might not be their primary focus, 
        but they might have some knowledge of chemical exposure 
        and its effect?
          Dr. Murphy. Yes.
          Mr. Shays. It is telling though that you cannot name 
        more than one person in the entire [VA] department [who 
        is a toxicologist.].
          Dr. Murphy. We can provide that for the record.
          Mr. Shays. I would definitely like it for the 
        record.\179\
---------------------------------------------------------------------------
    \179\ See supra note 174, pp. 259-260. See also infra text to 
accompany note 391.

    On February 11, 1997, the VA provided the following 
information:

                  Department of Veterans Affairs (VA)

                  Veterans Health Administration (VHA)

    responses to information request from chairman christopher shays
1. The results of a survey of each VA medical center to gather specific 
        information on specialized professional and research 
        credentials of VIA medical personnel.
    We were aware of your earlier requests for information related to 
the number of toxicologists and other specialists on VA medical staff 
and were in the process of assembling it. Based on our employment 
records, we have found four toxicologists on the research rolls. 
However, the toxicologists do not treat patients. Persian Gulf veterans 
are treated by licensed medical doctors who are internists or primary 
care providers supplemented by specialists. As of Dec. 31, 1996, the 
following number of specialists were on our rolls (note that 
occupational medicine is not a physician specialty category):

                                                                        
------------------------------------------------------------------------
                                                           Full-   Part-
                                                           time    time 
------------------------------------------------------------------------
Neurologists............................................     181     299
Pulmonologists..........................................     175     134
Oncologists.............................................      46      54
Infectious Disease......................................      94     109
Rheumatologists.........................................      33      92
Gastroenterologists.....................................     122     178
Dermatologists..........................................      31     160
Toxicologists (non-physician)...........................       4       0
------------------------------------------------------------------------


    The lack of a specific case diagnostic criteria for Gulf 
illnesses also reflects a flawed approach to these illnesses on 
the part of the VA. Illnesses in Gulf veterans have been 
reported since 1991. A critical factor in identifying 
uncharacterized illnesses is the development of a case 
definition of the illness. Gulf War illnesses include a range 
of symptoms previously mentioned--rashes, headaches, muscle and 
joint pains, neurological and cognitive abnormalities, and 
more.
    Dr. William C. Reeves of the Centers for Disease Control 
and Prevention [CDC], presented results of his epidemiological 
investigation into the Gulf War Syndrome to the PAC in both 
January and September 1996. CDC was able to develop a working 
case definition of Gulf illnesses. CDC defines a case as ``at 
least one chronic (present for 6 months or longer) symptom from 
two or more of the following categories: fatigue; mood and 
cognition related symptoms (feeling depressed, difficulty 
remembering or concentrating, feeling moody, feeling anxious, 
trouble finding words or lack of interest in sex); and 
musculoskeletal related symptoms (joint pain, joint stiffness 
or muscle pain).'' \180\
---------------------------------------------------------------------------
    \180\ Statement of William Reeves to the PAC, January and September 
1996, slides 31-36 (in subcommittee files).
---------------------------------------------------------------------------
    Using this definition, Dr. Reeves showed that Gulf-related 
illnesses are more frequent in Gulf War veterans than non-
deployed troops. If CDC could conduct an epidemiological 
investigation, it would seem logical that the VA could also 
have conducted a similar epidemiological study and achieved the 
same results. Furthermore, CDC did not start its investigation 
until late 1994, whereas VA began receiving complaints from 
Gulf veterans as early as 1991 and could have initiated a 
study.
    VA medical policy may have been biased against findings of 
chemical exposure by relying on DOD assertions and unproven 
theories of toxic causation. VA continues today to maintain 
that chronic symptoms in Gulf veterans cannot be attributed to 
toxic exposures unless acute symptoms first appear at the time 
of exposure.
    There is no credible, scientific evidence to substantiate 
the VA and DOD position that chronic symptoms cannot later 
develop from low level chemical exposures unless acute symptoms 
are observed when the exposure occurred.
    The question of whether delayed or chronic effects result 
from exposure to low level chemical agents without first having 
acute or immediate symptoms is critical to Gulf veterans. The 
answer determines whether or not Gulf veterans will be 
diagnosed and treated properly, as well as compensated 
appropriately for injuries suffered in the war zone. Many sick 
veterans did not report acute symptoms during the war but later 
developed chronic symptoms, thereby being denied appropriate 
compensation for their illnesses.
    On the other hand, many veterans report that they may have 
had flu-like symptoms, rashes, or other reactions during the 
war which they ignored as part of serving in a harsh, desert 
environment or as a reaction to vaccines or drugs. The ``low 
level'' symptoms could be considered acute, but mild, reactions 
to low level chemical agents. The taking of anti-nerve gas 
pills [PB] may also have masked acute symptoms, as Dr. Padilla 
testified.

                F. Impact on Veterans of Missing Records

    Personal medical records of veterans, including sick call 
records, are inadequate or missing. Documents which could help 
verify possible exposures and military unit locations remain in 
DOD files.\181\ Most of the military nuclear-biological-
chemical [NBC] logs, which are records of toxic warfare agent 
detections, are missing or destroyed. Readouts from chemical 
detection equipment have vanished. Many CIA intelligence logs 
concerning Iraqi chemical/biological weapons [CBW] storage 
depots and manufacturing facilities, and documents concerning 
enemy capabilities and intentions to use CBW against U.S. 
troops, have remained unreleased since the war.
---------------------------------------------------------------------------
    \181\ PAC Report, p. 52. See also, supra note 125 [IOM Report], pp. 
6, 7, 10.
---------------------------------------------------------------------------
    All this critical information comprises the complete 
medical history of each Gulf War veteran. In the absence of 
full documentation needed to prove a service-connection, sick 
veterans have a difficult--if not impossible--task of receiving 
proper medical treatment and fair compensation.
    Since no Government low level exposure research is 
available, proof of toxic exposure as a cause of medical 
disability is nearly impossible to obtain. Furthermore, the 
burden of proof that the disability or illness is service-
connected falls on the veteran exclusively under current VA 
regulations. Since the scientific research on the medical 
effects of exposure to low level chemical and biological has 
not been conducted, a veteran cannot prove a service-connected 
disability related to chemical or biological toxic exposure.
    ``Current VBA policies allow compensation for conditions 
which began during or were exacerbated by military service, 
including exposure to chemical warfare agents resulting in 
medically recognized sequelae.'' \182\
---------------------------------------------------------------------------
    \182\ See supra, entire text of Secretary Brown's letter in text 
section entitled, ``Exposures and VA Medical Protocols for Gulf 
Veterans,'' (original in subcommittee files).
---------------------------------------------------------------------------
    If basic scientific research has not been conducted to 
identify medically recognized sequelae produced by toxic 
exposures, compensation for service connected disability cannot 
be proven by the veteran and the VA will not compensate the 
veteran without this proof.
    Congress enacted legislation in 1994 allowing the VA to pay 
compensation benefits to veterans for disabilities related to 
the Gulf War caused by ``undiagnosed'' illnesses.\183\ In the 
past, the VA had always required that compensation be based on 
clearly diagnosed diseases.
---------------------------------------------------------------------------
    \183\ Public Law 103-446.
---------------------------------------------------------------------------
    According to Congressional Research Service [CRS], ``Under 
regulations issued in February 1995 (38 CFR 3.317), a veteran 
can be compensated only for undiagnosed illnesses that manifest 
themselves during Gulf War service or arise within 2 years of 
departing from the Gulf. Veterans must provide objective 
evidence of chronic illness and be at least 10 percent 
disabled. However, as of January 1997, the VA had denied 9,688 
(93.5 percent) of the 10,357 undiagnosed illness claims that 
had been reviewed. Approximately 55 percent of the denied 
claims were rejected because the illness did not manifest 
itself until after the 2-year presumptive period. President 
Clinton [last March] extended the presumptive period by 8 
years, until December 31, 2001. The VA plans to re-evaluate the 
claims that were denied on the basis of a 2-year presumptive 
period to determine if they now qualify for compensation under 
the extended period.'' \184\
---------------------------------------------------------------------------
    \184\ See supra note 4, p. 6.
---------------------------------------------------------------------------

           G. Stress-Related Diagnoses of Veterans' Illnesses

    VA has consistently diagnosed veterans presenting these 
symptoms as stress-related, or PTSD, or other psychological 
conditions, as opposed to conducting the appropriate 
epidemiological investigations to differentiate psychological 
conditions from psycho-neuro-immunological conditions such as 
fibromyalgia, chronic fatigue syndrome and central nervous 
system disorders which may have resulted from toxic exposures.
    Of the 21 sick Gulf veterans--all with symptoms of 
undiagnosed origin--who appeared before the Human Resources 
Subcommittee as witnesses, 13 were diagnosed by VA and/or DOD 
doctors as ``Stress'' or ``PTSD,'' 3 cases as ``Nothing wrong; 
all in the head,'' 3 cases as ``Undiagnosed,'' and only 2 cases 
of ``Chemical exposure.''
    One sick veteran who testified, Air Policeman James Green 
of the Air Force, with orders to ship out to the Gulf War from 
Germany, had taken the vaccines and PB tabs and become sick. 
His orders were canceled at the last moment. ``I signed up for 
the VA Health Registry in 1994. They sent me to the VA hospital 
for an exam. The [VA] doctor asked me what was wrong and to 
describe the symptoms. I was . . . referred to the mental 
health clinic for stress-related problems. Seems awful funny to 
me that my illness is stress and I was not even in the 
theater.'' \185\
---------------------------------------------------------------------------
    \185\ Testimony of James Green, Human Resources Subcommittee 
hearing, No. 1, p. 220.
---------------------------------------------------------------------------
    Dr. Matthew Friedman, a professor of psychiatry at 
Dartmouth Medical School and executive director of the National 
Center of Post Traumatic Stress Disorder, disputes emphasis on 
stress as the principal cause of the illnesses. The NY Times 
quoted Dr. Friedman: ``They [the PAC, DOD and VA] have very 
nicely laid out why this is such an attractive hypothesis 
[stress], but the data are not there to support it.'' The Times 
article stated that Dr. Friedman's research on sick Gulf 
veterans ``showed that only about 10 percent . . . were 
suffering from PTSD . . . an extreme form of stress caused by 
exposure to battle or other forms of trauma.'' \186\
---------------------------------------------------------------------------
    \186\ Shenon, Philip, ``Studies Seem to Back Veterans Who Trace 
Illnesses to Gulf War,'' New York Times, November 26, 1996, p. 1.
---------------------------------------------------------------------------
    Dr. Katherine Murray Leisure, an infectious disease 
specialist formerly at the VA Medical Center in Lebanon, PA, 
who treated more than 700 sick Gulf veterans, said in the same 
Times article it was clear to her that battlefield stress had 
little to do with the veterans' ailments. She said, ``Out of 
the hundreds of people I've seen, there's been fewer than a 
half dozen who had PTSD. It's negligible.'' \187\
---------------------------------------------------------------------------
    \187\ Ibid.
---------------------------------------------------------------------------
    Neurologist and psychiatrist Dr. William Baumzweiger, a 
former fellow at the VA Outpatient Clinic in Los Angeles who 
has examined more than 100 sick Gulf veterans, stated in 
prepared testimony before the subcommittee, ``I do not believe 
that the majority of symptomatic Gulf War participants 
experienced any stress which would be sufficient to precipitate 
PTSD. I concluded they had suffered from environmental 
intoxication . . . and that the disorders are neurological 
illnesses that involve the central nervous system and the 
immune system.'' \188\
---------------------------------------------------------------------------
    \188\ Statement of William Baumzweiger, Human Resources 
Subcommittee hearings, Nos. 1-4, p. 500.
---------------------------------------------------------------------------
    According to Dr. Leisure and Dr. Baumzweiger, both doctors 
were recently released by the VA, allegedly for their outspoken 
views on the cause and treatment of Gulf veterans' 
illnesses.\189\
---------------------------------------------------------------------------
    \189\ Correspondence from William Baumzweiger and Katherine Murray 
Leisure (in subcommittee files). See also, Shenon, Philip, ``VA 
Punishes Doctors for Speaking Out on Gulf Illnesses'' New York Times, 
December 12, 1996, p. A12.
---------------------------------------------------------------------------
    Dr. Eula Bingham, a toxicologist and environmental health 
professor who is chairman of the VA's Gulf War Expert 
Scientific Committee, in an earlier interview with the New York 
Times said, ``It's pretty clear that the veterans who were in 
the gulf have a whole series of symptoms that other veterans 
don't.'' She added, ``Certainly we know that there was 
widespread exposure to chemicals during the war. We really 
don't have good data on what health effects are caused by long-
term, low-level exposure to those agents.'' Dr. Bingham was 
further quoted saying, ``I'm very troubled when any committee 
says, `Well, it's stress.' Have they analyzed it? Why are they 
saying it? I think it's a very poor word to use at this time.'' 
\190\ Dr. Bingham is also the former Administrator of OSHA.
---------------------------------------------------------------------------
    \190\ Shenon, Philip, ``Panel Disputes Studies on Gulf War 
Illness,'' New York Times, November 21, 1996, p. B11.
---------------------------------------------------------------------------
    In the same Times article, Dr. Claudia Miller, a physician 
and environmental research professor who is also a member of 
the VA's Gulf War Expert Scientific Committee, said that 
``stress may be a contributor to these health problems but we 
should be looking at potential chemical causes, particularly 
given the kind of chemical environment that our soldiers faced 
in the Gulf.'' \191\
---------------------------------------------------------------------------
    \191\ Ibid.
---------------------------------------------------------------------------
    A 1993-1994 study of veterans from Pennsylvania and Hawaii, 
sponsored by the Walter Reed Army Institute of Research, 
stated: ``The major conclusion concerning physical health of 
these veterans is that for those who deployed to the Gulf War 
and recently reported physical symptoms, neither stress nor 
exposure to combat or its aftermath bear much relationship to 
their distress; only the fact of deployment differentiates them 
from their less-burdensome counterparts.'' \192\
---------------------------------------------------------------------------
    \192\ Streich, et al., ``Symptomatology of Gulf War Era Service,'' 
Military Medicine, Walter Reed Army Institute of Research, Bethesda, 
MD, March 1995.
---------------------------------------------------------------------------
    Dr. Daniel Clauw, Assistant Professor of Medicine at 
Georgetown University Medical Center, in testimony before the 
Human Resources Subcommittee, stated: ``The problem with 
considering these [Gulf War] illnesses as psychiatric 
conditions: In clinical practice, telling an individual with 
this type of illness that it is `all in their head,' or that 
there is no `organic' basis for their symptoms, will always 
lead to frustration and a sense of abandonment by the 
individual. It is not difficult to see why many of the veterans 
with these illnesses, as well as their families and advocates, 
have become so frustrated with this vicious cycle of no 
diagnoses, no effective treatment, and psychiatric attribution 
of symptoms.'' \193\
---------------------------------------------------------------------------
    \193\ Statement of Daniel Clauw, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 186.
---------------------------------------------------------------------------
    ``Take these veterans seriously. The physical and emotional 
toll of this type of illness is great, and these individuals 
developed these problems while serving our country. View with 
skepticism anyone who might assert that because there are no 
abnormalities on these individuals' blood tests, x rays, or 
other diagnostic studies, that there is nothing wrong, or that 
the individual is suffering from a psychiatric condition. It is 
arrogant of us as scientists to feel that because we cannot 
precisely define a problem, it doesn't exist.'' \194\
---------------------------------------------------------------------------
    \194\ Ibid., p. 189.
---------------------------------------------------------------------------

                       H. Treatment and Research

    The GAO Report on ``Gulf War Illnesses'' responded to the 
mandate of the Fiscal Year 1997 Defense Authorization Act. GAO 
examined three issues and made findings and recommendations 
based on results of the study. The GAO conducted a 6-month 
study on the Government's clinical care and medical research 
programs relating to illnesses that members of the armed forces 
might have contracted as a result of their service in the 
Persian Gulf War.\195\
---------------------------------------------------------------------------
    \195\ See supra note 48, p. 1.
---------------------------------------------------------------------------
    Issue 1: The efforts of DOD and VA to assess the quality of 
treatment and diagnostic services provided to Gulf War veterans 
and their provisions for follow-up of initial examinations.
    Finding: Neither DOD nor VA has systematically attempted to 
determine whether ill Gulf War veterans are any better or worse 
today than when they were first examined.
    Issue 2: The Government's research strategy to study the 
Gulf War veterans' illnesses and the methodological problems 
posed in its studies.
    Finding: The majority of the research has focused on the 
epidemiological study of the prevalence and cause of the 
illnesses rather than diagnosis, treatment, and prevention of 
them.
    Issue 3: The consistency of key official conclusions with 
available data on the causes of the veterans' illnesses.
    Finding: Support for some official conclusions regarding 
stress, leishmaniasis (a parasitic infection), and exposure to 
chemical agents was weak or subject to alternative 
interpretations.
    Dr. Donna Heivilin, Director of Planning and Reporting for 
GAO's National Security and International Affairs Division, 
appeared before the Human Resources Subcommittee on June 24, 
1997, to review results of the GAO study. Concerning the 
quality of medical treatment and diagnostic services, Dr. 
Heivilin stated: ``Over 100,000 of the approximately 700,000 
Gulf War veterans have participated in DOD and VA health 
examination programs [DOD's Comprehensive Clinical Evaluation 
Program or CCEP, and VA's Persian Gulf Health Registry]. Of 
those veterans examined, nearly 90 percent have reported a wide 
array of health complaints and disabling conditions. Officials 
of both DOD and VA have claimed that regardless of the cause of 
veterans' illnesses, veterans are receiving appropriate and 
effective symptomatic treatment. Both agencies have tried to 
measure or ensure the quality of veterans' initial examinations 
through such mechanisms as training and standards for physician 
qualification. However, these mechanisms do not ensure a given 
level of effectiveness for the care provided or permit 
identification of the most effective treatments.''
    ``We found that neither DOD nor VA has mechanisms for 
monitoring the quality, appropriateness, or effectiveness of 
these veterans care or clinical progress after their initial 
examination and has no plans to establish such mechanisms. VA 
officials involved in administering the Health Registry program 
told us they regarded monitoring the clinical progress of 
registry participants as a separate research project, and DOD's 
[CCEP] program made similar comments.''
    Dr. Heivilin said that such monitoring is important 
because: 1) undiagnosed conditions are not uncommon among ill 
veterans; 2) treatment for veterans with undiagnosed conditions 
is based on their symptoms; and 3) veterans with undiagnosed 
conditions or multiple diagnoses may see multiple providers.
    ``Without follow-up of their treatment, DOD and VA cannot 
say whether these ill veterans are any better or worse today 
than when they were first examined.'' \196\
---------------------------------------------------------------------------
    \196\ Statement of Donna Heivilin, Human Resources Subcommittee 
hearing, No. 3, pp. 47-48.
---------------------------------------------------------------------------
    Concerning the Government's research strategy, Dr. Heivilin 
stated: ``Federal research on Gulf War veterans' illnesses and 
factors that might have caused their problems has not been 
pursued proactively. Although these veterans' health problems 
began surfacing in the early 1990's, the vast majority of 
research was not initiated until 1994 or later. This 3-year 
delay has complicated the task facing researchers and has 
limited the amount of completed research currently available. 
Although at least 91 studies have received Federal funding, 
over 70 or four-fifths of the studies are not yet complete, and 
the results of some studies will not be available until after 
the year 2000.'' \197\
---------------------------------------------------------------------------
    \197\ Ibid., pp. 48-49.
---------------------------------------------------------------------------
    ``We found that some hypotheses [about causes of the 
illnesses] received early emphasis, while some hypotheses were 
not initially pursued. While research of exposure to stress 
received early emphasis, research on low level chemical 
exposure was not pursued until legislated in 1996. The failure 
to fund such research cannot be traced to an absence of 
investigator-initiated submissions. According to DOD officials, 
three recently funded proposals on low level chemical exposure 
had previously been denied funds. We found that additional 
hypotheses were pursued in the private sector. A substantial 
body of research suggests that low level exposure to chemical 
warfare agents or chemically related compounds, such as certain 
pesticides, is associated with delayed or long-term health 
effects.'' \198\
---------------------------------------------------------------------------
    \198\ Ibid., p. 49.
---------------------------------------------------------------------------
    Dr. Heivilin said there is evidence from animal 
experiments, studies of accidental human exposures, and 
epidemiological studies of humans that low level exposures to 
certain organophosphorus compounds, including Sarin nerve 
agents to which some of our troops may have been exposed, can 
cause delayed, chronic neurotoxic effects. The ill-defined 
symptoms may be associated with objective brain and nerve 
damage, and due in part to organo-phosphate-induced delayed 
neurotoxicity [OPIDN], according to Dr. Heivilin.\199\
---------------------------------------------------------------------------
    \199\ Ibid., p. 50.
---------------------------------------------------------------------------
    Studies ``further linked the veterans' illnesses to 
exposure to combinations of chemicals [emphasis added],'' Dr. 
Heivilin stated, ``including nerve agents, pesticides, insect 
repellants, and pyridostigmine bromide tablets. Exposure to 
combinations of organophosphates and related chemicals . . . 
has been shown in animal studies to be far more likely to cause 
morbidity and mortality than any of the chemicals acting 
alone.'' \200\
---------------------------------------------------------------------------
    \200\ Ibid., p. 51.
---------------------------------------------------------------------------
    The GAO study found the ongoing epidemiological Federal 
research suffered from two methodological problems: a lack of 
case definition, and absence of accurate exposure data. Without 
valid and reliable data on exposures and the multiplicity of 
[chemical] agents to which the veterans were exposed, 
researchers will likely continue to find it difficult to detect 
relatively subtle effects and to eliminate alternative 
explanations for Gulf War veterans' illnesses. The study found 
that while multiple federally funded studies of the role of 
stress in the illnesses have been done, basic toxicological 
questions regarding the substance to which they were exposed 
remain unanswered.\201\
---------------------------------------------------------------------------
    \201\ Ibid., pp. 52-53.
---------------------------------------------------------------------------
    Dr. Heivilin stated: ``We found that Federal researchers 
have faced several methodological challenges and encountered 
significant problems in linking exposures or potential causes 
to observed illnesses or symptoms. For example:

           Researchers have found it extremely 
        difficult to gather information about exposures to such 
        things as oil well fire smoke and insects carrying 
        infection.
           DOD has acknowledged that records of the use 
        of pyridostigmine bromide and vaccinations to protect 
        against chemical/biological warfare exposures were 
        inadequate.
           Gulf veterans were typically exposed to a 
        wide array of agents, making it difficult to isolate 
        and characterize the effects of individual agents or to 
        study their combined effects.
           Most epidemiological studies on Gulf 
        illnesses have relied only on self-reports for 
        measuring most of the agents to which veterans may have 
        been exposed.
           Information gathered from Gulf veterans 
        gathered years after the war may be inaccurate or 
        biased. There is often no straightforward way to test 
        the validity of self-reported exposure information. As 
        a result, findings from these studies may be spurious 
        or equivocal.
           Classifying the symptoms and identifying 
        illnesses of Gulf veterans have been difficult. From 
        the outset, symptoms reported by veterans have been 
        varied and difficult to classify into one or more 
        distinct illnesses. It has thus been difficult to 
        develop a case definition (that is, a reliable way to 
        identify individuals with a specific disease), which is 
        a criterion for doing effective epidemiological 
        research.''

    ``In summary,'' Dr. Heivilin stated, ``the ongoing 
[Federal] epidemiological research will not be able to provide 
precise, accurate, and conclusive answers regarding the causes 
of veterans' illnesses because of these formidable 
methodological problems.'' \202\
---------------------------------------------------------------------------
    \202\ Ibid., pp. 53-54.
---------------------------------------------------------------------------

     I. Other Executive Agency Actions on Gulf Veterans' Illnesses

DOD and CIA Gulf War Illnesses Investigation Teams

    In November 1996, Deputy Secretary John White appointed 
Bernard Rostker, Ph.D. economist and Assistant Secretary of 
Navy Manpower, to the position of Special Assistant for Gulf 
War Illnesses. Under Dr. Rostker, DOD expanded its Gulf illness 
investigative team from 10 to more than 100 people. It was up 
to an estimated 150 people as of October 1997. To date, the DOD 
team has focused its investigation mainly on troop chemical 
exposures from fallout resulting from the Iraqi bunker 
detonations at Khamisiyah, and on case narratives to disprove 
specific chemical detection incidents reported by military 
specialists such as Human Resources Subcommittee witnesses 
Major Johnson and Gy/Sgt. Grass.
    On March 3, 1997, Deputy Secretary John White directed the 
DOD Inspector General to take over the investigation of what 
happened to the missing nuclear, biological, chemical [NBC] 
logs maintained at U.S. Central Command during the Gulf War. As 
mentioned, in March 1997 Dr. Stephen Joseph resigned. In April 
1997, Secretary Cohen named former Senator Warren Rudman as his 
special advisor on Gulf War illnesses. In July 1997, Deputy 
Secretary White resigned. DOD's former Deputy Assistant 
Secretary for Health Affairs, Dr. Sue Bailey, is expected to be 
nominated by the President to replace Dr. Joseph.
    In March 1997, CIA Director George Tenet formed a Task 
Force on Gulf War Illnesses headed by Robert Walpole. The 
team's assignment is to declassify and make public as many CIA 
documents as possible concerning the controversy about events 
at Khamisiyah. To date, 41 documents have been released,\203\ 1 
of which indicates the CIA had received warnings in the 1980's 
that chemical weapons were stored in Khamisiyah munitions 
bunkers.
---------------------------------------------------------------------------
    \203\ See supra note 77.
---------------------------------------------------------------------------
    According to the Congressional Research Service [CRS], ``On 
April 9 [1997], amid growing tension and charges of a cover-up, 
the CIA released a report showing that the agency had solid 
intelligence in 1986 that thousands of chemical weapons had 
been stored at Khamisiyah. However, the CIA failed to include 
the depot on a list of suspected CW sites provided to the 
Pentagon before the war. The CIA warned the Army of the 
possible presence of chemical weapons at Khamisiyah just days 
before the depot was blown up, but the information was not 
relayed to the engineers who carried out the detonations.'' 
\204\
---------------------------------------------------------------------------
    \204\ See supra note 4.
---------------------------------------------------------------------------

Presidential Advisory Committee on Gulf War Veterans' Illnesses

    President Clinton established the Presidential Advisory 
Committee on Gulf War Veterans' Illnesses [PAC] in May 1995 to 
examine the health concerns related to Gulf War service. The 
Committee, a 12-member panel made up of veterans, scientists, 
health care professionals, and policy experts, held 18 meetings 
between August 1995 and November 1996 to hear witness testimony 
and take public comment. A Final Report of findings and 
recommendations was issued December 31, 1996. However, the 
President extended the panel's investigation until September 
30, 1997. The PAC held additional meetings this year, with 
plans to present its updated Special Report to the President by 
late October 1997.
    While the PAC's December 1996 report found that ``many 
veterans have illnesses likely to be connected to their service 
in the Gulf,'' it did not support a causal link between the 
illnesses and exposures to environmental risk factors.\205\ In 
the face of overwhelming evidence that Gulf War veterans were 
exposed to multiple toxic agents, the PAC instead placed 
emphasis on stress as a cause of these health problems. The PAC 
report stated: ``Stress is likely to be an important 
contributing factor to the broad range of illnesses currently 
being reported by Gulf War veterans.'' \206\
---------------------------------------------------------------------------
    \205\ PAC Final Report, Executive Summary, p. 2.
    \206\ Ibid., p. 125.
---------------------------------------------------------------------------
    The PAC also discounted most environmental risk factors as 
causes of veterans illnesses. The December report stated: 
``Current scientific evidence does not support a causal link 
between the symptoms and illnesses reported by Gulf War 
veterans and exposures while in the Gulf region to the 
following environmental risk factors assessed by the Committee: 
pesticides, chemical warfare agents, biological warfare agents, 
vaccines, pyridostigmine bromide, infectious agents, depleted 
uranium, oil well fires and smoke, and petroleum products.'' 
\207\
---------------------------------------------------------------------------
    \207\ Ibid.
---------------------------------------------------------------------------
    The PAC report did identify DOD and VA ``problems related 
to missing medical records, the absence of baseline health 
data, inaccurate records of troop locations, and incomplete 
data on the health effects of what should have been viewed as 
reasonably anticipated risks.'' \208\
---------------------------------------------------------------------------
    \208\ Ibid., p. 4.
---------------------------------------------------------------------------
    As numbers of troops presumed exposed to chemical weapons 
continued to rise following the events at Khamisiyah, DOD's 
handling of the investigation into the Gulf veterans' illnesses 
came under criticism from PAC members and staff. In September 
1996, the PAC's chief investigator, James Turner, stated in a 
committee hearing that since the Gulf War, DOD's position has 
remained essentially unchanged ``and inflexible . . . in the 
face of growing evidence that there were possible low level 
exposures.'' Turner said DOD's position ``can be summarized in 
three no's . . . there was no use, no exposures, and no 
presence of chemical warfare agents in-theater.''
    Turner stated, ``The slow, reluctant on-again, off-again 
release of information to the public by the . . . [DOD's] 
senior level oversight panel, has also served to undermine 
credibility and confidence in the DOD's efforts. To fulfill the 
government's obligation to tell the truth about chemical 
warfare agent exposures to veterans and the American public, 
DOD's investigations must be timely, thorough, independent, 
credible and public. On each of these counts . . . DOD's 
efforts have fallen short of the mark.''
    Turner's statement found the evidence of chemical agent 
release at Khamisiyah overwhelming, other site-specific 
exposures must be presumed, and DOD has conducted a superficial 
investigation of possible chemical and biological exposures 
``which is unlikely to provide credible answers to veterans' 
questions.'' \209\
---------------------------------------------------------------------------
    \209\ Statement of James Turner, Chief Investigator, Presidential 
Advisory Committee on Gulf War Veterans' Illnesses [PAC], September 4-
5, 1996, p. 5.
---------------------------------------------------------------------------
    In the PAC's final public hearing September 5, 1997, 
monitored by Human Resources Subcommittee staff and covered by 
national news media, the PAC did not amend its conclusions 
about the importance of stress as a cause of Gulf War 
illnesses, nor its rejection of most environmental risk factors 
as possible causes. Some panel members suggested that the 
updated Final Report include a statement acknowledging the 
possibility of low level chemical warfare exposures, but no 
vote on the proposal was taken.
    Members did agree in the final meeting, however, to 
recommend that the Pentagon's investigation of Gulf War 
illnesses be transferred to another agency in view of DOD's 
loss of credibility in the handling of chemical weapons 
exposures.
    ``The Pentagon is failing in a multimillion dollar effort 
to salvage its credibility among ailing Persian Gulf War 
veterans for its investigations into the possible sources of 
their illnesses, according to the draft of a final report by a 
White House advisory committee,'' the Washington Post reported.
    ``The report,'' according to the Post, ``scheduled to be 
presented to President Clinton next month, concludes, `Public 
mistrust about the government's handling of Gulf War illnesses 
not only has endured, but has expanded' in the 10 months since 
the Defense Department, at the panel's urging, agreed to 
intensify its research efforts. It blames the office of the 
Pentagon's special assistant for Gulf War illnesses [Dr. 
Bernard Rostker] for failing to examine reported incidents 
thoroughly and suggests the DOD may be institutionally 
incapable of acknowledging that chemical exposures could have 
occurred.'' \210\
---------------------------------------------------------------------------
    \210\ McAllister, Bill, ``Mistrust of Pentagon on Illness in Gulf 
Grows, Report Concludes,'' Washington Post, September 24, 1997, p. 2.
---------------------------------------------------------------------------
    In a the New York Times article, Defense Secretary William 
Cohen took issue with the PAC's recommendation. ``I think that 
the Pentagon is fully capable of conducting an investigation. 
So I would disagree with that recommendation.'' \211\
---------------------------------------------------------------------------
    \211\ Krauss, Clifford, ``Pentagon Should Retain Role In Illness 
Inquiry, Cohen Says,'' New York Times, September 26, 1997, p. A24.
---------------------------------------------------------------------------
    Others also disagree with the PAC. In a letter to PAC 
Chairman Dr. Joyce Lashof, Congressman Bernard Sanders (I-VT), 
a subcommittee member, called for a reassessment of the PAC's 
conclusions relating to stress and environmental factors in its 
Final Report to the President in view of the growing numbers of 
troops that were exposed to chemical weapons and other toxic 
agents. The letter, signed by more than 80 Members of Congress 
including Subcommittee Chairman Christopher Shays, stated:
    ``We are writing to ask you to reassess your conclusion 
that current scientific evidence does not support a causal link 
between the symptoms and illnesses reported by Gulf War 
veterans and their exposure to a variety of chemicals during 
their service in the Persian Gulf War. In fact, it is our 
belief that more and more scientific evidence suggests that a 
major cause of Persian Gulf illness is the synergistic effect 
of a wide variety of chemicals to which our soldiers were 
exposed. Our hope is that by reassessing your conclusion, you 
will recommend increasing research into and treatment for the 
health effects of chemical exposures experienced in the Persian 
Gulf.'' \212\
---------------------------------------------------------------------------
    \212\ Letter from Representative Bernard Sanders (I-VT) to Joyce 
Lashof, June 20, 1997 (copy in subcommittee files).
---------------------------------------------------------------------------
    In response, Dr. Lashof informed Congressman Sanders that 
``. . . peer-reviewed literature published since the Final 
Report does not, to date, indicate a causal link between the 
commonly cited risk factors and the broad range of illnesses 
currently being reported by Gulf War veterans.'' \213\
---------------------------------------------------------------------------
    \213\ Letter of response from Dr. Joyce Lashof to Representative 
Sanders, July 25, 1997 (copy in subcommittee files).
---------------------------------------------------------------------------
    Concerning the PAC's official conclusions about the causes 
of Gulf veterans' illnesses, GAO's Dr. Heivilin in her June 24, 
1997 statement to the Human Resources Subcommittee hearing 
said: ``Six years after the war, little is known about the 
causes of Gulf War veterans' illnesses. In the absence of 
official conclusions from DOD and VA, we examined conclusions 
drawn in December 1996 by the Presidential Advisory Committee 
on Gulf War Veterans' Illnesses [PAC].''
    ``First, the Committee [PAC] concluded that `stress is 
likely to be an important contributing factor to the broad 
range of illnesses currently being reported by Gulf veterans.' 
While stress can induce physical illness, the link between 
stress and these veterans' physical symptoms has not been 
firmly established. For example, a large-scale federally funded 
study [by Walter Reed Army Institute of Military Medicine, see 
footnote 8] concluded that for those veterans deployed to the 
Gulf War `neither stress nor exposure to combat or its 
aftermath bear much relationship to their distress.' The 
Committee stated that `epidemiological studies to assess the 
effects of stress have found higher rates of PTSD than among 
individuals in nondeployed units.' Our review indicated that 
the prevalence of PTSD among Gulf veterans may be overestimated 
due to problems in the methods used to identify it. 
Specifically, the studies on PTSD to which the Committee refers 
have not excluded other conditions, such as neurological 
disorders that produce symptoms similar to PTSD [emphasis 
added] and can also elevate scores on key measures of PTSD.''
    ``Second, the Committee concluded that `it is unlikely that 
infectious diseases endemic to the Gulf region are responsible 
for long term health effects in Gulf veterans, except in a 
small known number of individuals.' Similarly, the Persian Gulf 
Veterans Coordinating Board [comprised of representatives of 
DOD, VA, and HHS] concluded that because of the small number of 
reported cases `the likelihood of leishmania tropica as an 
important risk factor for widely reported illness has 
diminished.' While this is true for observed symptomatic 
infection with the parasite, the prevalence of asymptomatic 
infection is unknown, and such infection may reemerge in cases 
in which the patient's immune system becomes deficient.''
    ``As the Committee noted, the infection may remain dormant 
up to 20 years. Because of this long latency, the infected 
population is hidden, and because even classic forms of 
leishmaniasis are difficult to recognize, we believe that 
leishmania should be retained as a potential risk factor for 
individuals who suffer from immune deficiency.''
    ``Third, the Committee also concluded that it is unlikely 
that the health effects reported by many Gulf veterans were the 
result of: 1) biological or chemical warfare agents; 2) 
depleted uranium; 3) oil well fire smoke; 4) pesticides; 5) 
petroleum products; and 6) pyridostigmine bromide or vaccines. 
However, our review of the Committee's conclusions indicated:

           While the Government found no evidence that 
        biological weapons were deployed during the war, the 
        United States lacked the capability to promptly detect 
        biological agents, and the effects on one agent, 
        aflatoxin, would not be observed for many years.
           Evidence from various sources indicates that 
        chemical agents were present at Khamisiyah, Iraq and 
        elsewhere on the battlefield. The magnitude of the 
        exposure to chemical agents has not been fully 
        resolved. As we recently reported, 16 of 21 sites 
        categorized by Gulf War planners as nuclear, biological 
        and chemical [NBC] facilities were destroyed. However, 
        the United Nations Special Commission found after the 
        war that not all of the possible NBC targets had been 
        identified by U.S. planners. The Commission has 
        investigated a large number of the facilities suspected 
        by U.S. authorities as being NBC related. Regarding 
        those the Commission has not yet inspected, we 
        determined that each was attacked by Coalition aircraft 
        during the Gulf War. One site is located close to the 
        border, where Coalition ground forces were located.
           Exposure to certain pesticides can induce a 
        delayed neurological condition without causing 
        immediate symptoms.
           Available research indicates that exposure 
        to pyridostig-mine bromide can alter the metabolism of 
        organophosphates (the chemical family of some 
        pesticides used in the war, as well as certain chemical 
        warfare agents) in ways that enhance chronic effects on 
        the brain.\214\
---------------------------------------------------------------------------
    \214\ See supra note 196, pp. 55-58.

    Dr. Heivilin concluded her statement with the following: 
``In our report, we recommended that the Secretary of Defense, 
---------------------------------------------------------------------------
with the Secretary of Veterans Affairs:

          1) set up a plan for monitoring the clinical progress 
        of Gulf War veterans to help promote effective 
        treatment and better direct the research agenda;
          2) give greater priority to research on effective 
        treatment for ill veterans and on low level exposures 
        to chemicals and their interactive effects, and less 
        priority to further epidemiological studies; and,
          3) refine the current approaches for diagnosing post-
        traumatic-stress-disorder consistent with suggestions 
        recently made by the Institute of Medicine. The 
        Institute noted the need for improved documentation of 
        screening procedures and patient histories, and the 
        importance of ruling out alternative causes of 
        impairment.\215\
---------------------------------------------------------------------------
    \215\ Ibid., pp. 58-59.
---------------------------------------------------------------------------

                             III. Findings

                               Diagnosis

Finding 1: VA and DOD did not listen to sick Gulf War veterans as to 
        possible causes of their illnesses.

    The subcommittee hearing record is replete with examples of 
veterans who raised legitimate concerns and backed them with 
real information, yet had no effect on VA research, diagnosis, 
treatment or compensation policies.
    Randy Wheeler is one such veteran. He served in the Gulf 
War with the U.S. Marine Corps from August 1990 to March 1991, 
and according to his testimony before the subcommittee, he has 
experienced a rash of health problems since returning from the 
Gulf--including joint and chest pains, shortness of breath, 
headaches, severe blepharitis in both eyes, rashes and 
diarrhea. A private ophthalmologist has diagnosed the burning 
redness and pain in his eyes as chronic blepharitis and a 
cataract. VA doctors have refused to acknowledge and search for 
a real, physiological cause of his ailments.

          The doctor at Eisenhower (Army Medical Center in Ft. 
        Gordon, GA) told me that my eyes were fine . . . The VA 
        and the DOD has not helped my family nor I in any way. 
        I continue to follow up with the VA, and I have 
        completed the CCEP but still haven't been tested for 
        anything that might have caused my health problems or I 
        have not been properly diagnosed.\216\
---------------------------------------------------------------------------
    \216\ Testimony of Randy Wheeler, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 18-19.

    Kimo Hollingsworth, who served in the Persian Gulf as a 
Marine Artillery Platoon Commander, has gone to the VA to seek 
a diagnosis and treatment for his chronic headache and fatigue, 
severe chest, muscle and joint pain, blurred vision, memory 
loss, fever, bladder problems and oral discharge of what he 
calls ``hardened chunks of dark green sputum.'' After a 
physical examination at the Veterans Affairs Medical Center 
[VAMC] in Washington, DC failed to turn up the cause, doctors 
refused to acknowledge there may be a physical source of his 
stress that requires further inquiry and attention. Again, VA 
---------------------------------------------------------------------------
doctors did not listen.

          Despite my symptoms, the VA hospital in Washington, 
        DC . . . concluded that I was in excellent health . . . 
        I was then directed to a social worker who discussed 
        the issue of Post Traumatic Stress Disorder. The VA 
        also provided me a brochure outlining psychological 
        counseling services available to Persian Gulf 
        veterans.\217\
---------------------------------------------------------------------------
    \217\ Testimony of Kimo Hollingsworth, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 28-29.

    Still other veterans, such as Brian Martin, were told by VA 
Medical Center [VAMC] personnel that they were not sick, even 
after they had already been diagnosed with illnesses.\218\ Mr. 
Martin has been rated at 100 percent compensation, yet he told 
the subcommittee that upon arriving at the VAMC in Battle 
Creek, MI with breathing problems and severe abdominal pain, 
his attending physician concluded,
---------------------------------------------------------------------------
    \218\ Statement of Brian Martin, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 11.

          You're not sick. You don't need to be laying around 
        stagnant with all the really sick people.\219\
---------------------------------------------------------------------------
    \219\ Ibid.

    Veterans are not the only ones who believe they were 
ignored. Army Staff Sergeant Steven Wood felt his health 
complaints were being dismissed while he was still on active 
---------------------------------------------------------------------------
duty, under DOD.

          I never found anyone in the Army who was serious 
        about helping me--or anyone else, for that matter. I 
        was told to suck it up and drive on . . . While still 
        on active duty, I never received any real health care. 
        I was told to quit faking, it's all in my head, and my 
        all-time favorite: ``We do not know what's wrong with 
        you, but you will be better in 2 weeks.'' \220\
---------------------------------------------------------------------------
    \220\ Testimony of Steven Wood, Human Resources Subcommittee 
hearings, No. 2, pp. 45-46.

    Sgt. Wood grew so unnerved by the military's lack of 
concern that he sought treatment outside the military 
establishment while he was stationed overseas in April 1996. 
According to Sgt. Wood, the German civilian doctor ``did more 
testing in 2 hours than the Army did in 5 years,'' but because 
the doctor was not a U.S. Army physician, his diagnosis went 
unheeded without so much as a cursory glance. Instead, the Army 
---------------------------------------------------------------------------
neurologist responded:

          `I do not like you Gulf vets that say you're sick. I 
        was there, and I'm not sick.' This doctor then 
        proceeded to tell me she felt I had no neurological 
        problems before even examining me and she flatly 
        refused to even read the German doctor's findings.\221\
---------------------------------------------------------------------------
    \221\ Ibid.

    Other veterans, including Major Barry Kapplan, Staff 
Sergeant Chris Kornkven, Reserve Navy Captain Julia Dyckman, 
Major Michael Donnelly, Marine Major Randy Hebert, and Petty 
Officer Nick Roberts, have relayed similar stories of having 
their symptoms and concerns either ignored or dismissed as 
irrational and therefore insignificant.\222\
---------------------------------------------------------------------------
    \222\ See supra notes 12-31, 36-39.
---------------------------------------------------------------------------
    The Central Intelligence Agency [CIA], the most highly 
trained information-gathering arm of the U.S. Government, 
displayed a similar unwillingness to listen to veterans who 
suspected a physiological cause of their health problems. When 
asked why no one expressed any interest in information 
volunteered by Persian Gulf War veterans, Sylvia Copeland of 
the CIA's Persian Gulf War Veterans Illnesses Task Force 
responded that the pursuit of that information lies outside of 
the Task Force's job description.

          We are not in the business of interviewing U.S. 
        soldiers. That is DOD's job. Going over troop logs, 
        interviewing soldiers is not one of our 
        responsibilities.\223\
---------------------------------------------------------------------------
    \223\ Testimony of Sylvia Copeland, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 416.

    Patrick Eddington, a former CIA analyst, paints a darker 
picture. He suggests the CIA went out of its way to 
deliberately ignore and exclude the opinions of U.S. veterans 
---------------------------------------------------------------------------
from its official investigation.

          There is absolutely no question that the CIA made a 
        concerted effort to exclude entire classes of 
        information from its inquiry . . . The CIA has had, 
        throughout its entire existence, a specific component 
        that is designed to do nothing but contact American 
        citizens about their experiences overseas and their 
        travels overseas. So for the CIA to refuse to talk to 
        American veterans about this issue is a complete 
        departure from standard operating procedure.\224\
---------------------------------------------------------------------------
    \224\ Testimony of Patrick Eddington, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 147.

    Either way, Ms. Copeland acknowledged the CIA was aware of 
---------------------------------------------------------------------------
DOD's research.

          DIA [the Defense Intelligence Agency] did the 
        research, looked at all the intelligence information 
        and we had meetings together on chemical issues and 
        they would brief us on their findings . . . Then we 
        synthesize that with all of our intelligence 
        information.\225\
---------------------------------------------------------------------------
    \225\ Testimony of Sylvia Copeland, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 423-
424.

    These combined statements demonstrate a systematic failure 
to incorporate evidence of toxic exposures into so-called 
``Gulf War Illness'' research, diagnosis, and treatment.
    VA Under Secretary for Health Dr. Kenneth Kizer offered 
only circumstantial proof the Department listened to sick Gulf 
War veterans regarding possible causes of their illnesses. When 
asked if VA physicians made a predetermination that there was 
no scientific basis for many veterans' health complaints and 
consequently refused to pursue their suggestions, Dr. Kizer 
avoided the question--saying only that the investigation into 
chemical warfare agents was:

          delayed and [its] . . . focus given a lower priority 
        because of information that had been provided by 
        DOD.\226\
---------------------------------------------------------------------------
    \226\ Testimony of Kenneth Kizer, Human Resources Subcommittee 
hearings, No. 1, p. 174.

    The dismissal of veterans' concerns also occurred at the 
diagnosis stage. A followup report by the VA's Office of the 
Medical Inspector [OMI] supports this conclusion.
    First, data from the OMI's analysis of the Persian Gulf 
Registry Health Examination Program show VA physicians had good 
reason to pursue contamination hypotheses, given the extremely 
high rates of veterans reporting such exposures. According to 
the final report:

          In 1992 Physician Registry staff documented that 93 
        percent of the Persian Gulf War veterans reported that 
        they had been exposed to 1 or more of the 12 
        contaminants. This percentage declined to a low of 87 
        percent in 1993, and increased to a high of 98 percent 
        by 1996.\227\ \228\
---------------------------------------------------------------------------
    \227\ Final Report: Persian Gulf Registry Health Examination 
Program: Assessment of Exposure History, Office of the Medical 
Inspector, Veterans Health Administration, VA (May 5, 1997) p. 5.
    \228\ A veteran was counted only once regardless of the number of 
contaminants to which he or she had been exposed.

    Second, there is reason to believe the percentage of 
veterans reporting exposures might have been even higher. The 
study states that while Registry physicians had been instructed 
by program officials to ask veterans about possible exposure to 
these contaminants, the list of contaminants was left off the 
Persian Gulf Registry Code Sheet from 1992 to 1995, making it 
easy, if not likely, for physicians to omit this task.\229\
---------------------------------------------------------------------------
    \229\ See supra note 227, p. 7.
---------------------------------------------------------------------------
    Third, the implementation of the Registry protocol was 
sloppy and inconsistent.

          Registry physicians had been instructed . . . to 
        record their findings in the Progress Notes of the CHRs 
        [Consolidated Health Records]. The responses were to 
        include negative as well as positive responses . . . 
        The OMI data collectors found large variations in 
        compliance with the assigned task, that is, recording 
        positive and negative responses to queries about 
        possible exposure to specific contaminants in the 
        Progress Notes. The variations in compliance existed 
        among physicians at a single VA medical center and 
        among different VAMCs.\230\
---------------------------------------------------------------------------
    \230\ Ibid.

    The inability to implement this aspect of the diagnostic 
protocol properly and uniformly is especially significant 
because it renders the resulting data virtually useless and 
indicates an extremely casual attitude toward the pursuit of 
this knowledge.
    The notion that VA employees sometimes disregard or fail to 
implement protocols has been documented elsewhere as well. 
Congress commissioned the U.S. General Accounting Office [GAO] 
to determine the extent to which VA followed its guidelines for 
evaluation and treatment, with damning results. After 
conducting a lengthy investigation that included interviews 
with officials at VA headquarters, VA's Atlanta Veterans 
Integrated Services Network office, medical centers in 
Washington, Atlanta and Birmingham, referral centers in 
Washington and Birmingham, veterans' service organizations, and 
dozens of Persian Gulf veterans, and a review of a sample of 
medical records, GAO noted various discrepancies between VA 
protocols and action. Among the problems cited were: failure to 
give undiagnosed veterans additional baseline laboratory tests 
and consultations; failure to evaluate veterans suffering from 
undiagnosed illnesses at VA's referral centers; \231\ and 
failure to provide personal counseling between veterans and 
their physicians to evaluate the registry exam process.\232\ 
The results led Stephen Backhus, Director of Veterans' Affairs 
and Military Health Care Issues, to conclude:
---------------------------------------------------------------------------
    \231\ Only 390 out of 15,000 referrals were evaluated.
    \232\ Statement of Stephen Backhus before the VA Subcommittee on 
Health, 105th Cong., 1st sess., GAO/T-HEHS-97-158, p. 4-5 (1997).

          On the basis of our review of medical records and 
        discussions with program officials, including 
        physicians, it does not appear that VA's guidance is 
        being consistently implemented in the field.\233\
---------------------------------------------------------------------------
    \233\ Ibid.

    Finally, a former VA health official said many physicians 
displayed an unwillingness to consider veteran's accounts of 
possible toxic exposure when prescribing treatment. Dr. William 
Baumz-weiger worked at the VA in west Los Angeles where he 
witnessed a pervasive lack of interest in accounts of potential 
---------------------------------------------------------------------------
toxicity.

          With the constant denial that there was any agent in 
        the Gulf and with the feeling that you have to have 
        acute toxic symptoms to have problems, no one really 
        pursued it as the leading hypothesis . . . I do not 
        think there was an agency-wide policy against there 
        being Gulf War syndrome or an agency-wide conviction 
        that organophosphates did not matter. I think this is 
        something that just crept into parts of the structure 
        of the organization.\234\
---------------------------------------------------------------------------
    \234\ Testimony of William Baumzweiger, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 530, 
536.

    As many people have attested, warnings were sounded. The 
problem stems from the refusal to listen to them. Taken as a 
whole, the body of evidence suggests what veterans have feared 
all along--the existence of a systematic and chronic disregard 
on the part of physicians and other personnel at the VA, DOD, 
and the CIA for their concerns regarding the severity and 
possible sources of their maladies. What makes this blatant 
disregard even more abhorrent is the fact that it seems to have 
permeated the system despite its potential to worsen the 
already deteriorating health of U.S. veterans and their 
families.

Finding 2: The presence of a variety of toxic agents in the Gulf War 
        theater strongly suggests exposures have a role in causing, 
        triggering or amplifying subsequent service-connected 
        illnesses.

    For the past 6 years, many veterans have been saying they 
believe their illnesses are the result of direct exposure to 
toxic agents in the Gulf War theater. Over those years, 
investigators have amassed a mountain of evidence, primarily 
inferential or circumstantial, that this is, in fact, the case. 
The presence of chemical weapons and other toxins is no longer 
in question, thanks in part to a belated admission by the 
Pentagon. It is also supported by eyewitness accounts of 
veterans who heard, saw, tasted, and felt what they believe to 
be various incidents of toxic exposure. Finally, veterans 
experienced symptoms consistent with current scientific 
conclusions regarding the role various toxins play in causing, 
triggering, or accelerating chronic problems.
    Veterans, scientists, and researchers have long suspected 
the existence of a variety of toxic agents in the Persian Gulf 
during the war. The suspected toxins include: chemical and 
biological warfare agents, organophosphates found in pesticides 
and insect repellents, leaded diesel fuel, depleted uranium, 
oil well fire smoke, leaded vehicle exhaust, contaminated 
drinking water, shower water, and clothing, parasites, and 
pyridostigmine bromide and other drugs to protect against 
chemical warfare agents.\235\
---------------------------------------------------------------------------
    \235\ See supra note 73.
---------------------------------------------------------------------------
    Dr. Theodore M. Prociv, former Deputy Assistant to the 
Secretary of Defense for Chemical and Biological Weapons told 
the U.S. Senate Committee on Banking, Housing and Urban Affairs 
that each of the nearly 14,000 M8A1 detector alarms deployed in 
the theater went off an average of two or three times a 
day.\236\ Given the noise the alarms must have made, most 
veterans had at least some reason to believe they were in a 
toxic environment.
---------------------------------------------------------------------------
    \236\ See supra note 2, p. 16.
---------------------------------------------------------------------------
    For others, the clues were more numerous and specific.
    Major Randy Lee Hebert of the Marine Corps believes he was 
exposed to chemical agents on February 24, 1991, or Ground 
Attack Day, based on what he heard, was told, and felt. Shortly 
after directing his vehicle to Lane Red One following a 
chemical alarm, Major Hebert, who was not wearing protective 
gear, was told a chemical mine had soiled the lane.

          I learned after the war that the chemical mine 
        detonated in Lane Red One was confirmed for the nerve 
        agent Sarin and also for the agent Lewisite Must Gas by 
        FOX vehicle in the lane. I also learned that two 
        Marines in an AMTRAC received chemical burns, and that 
        the chemical mine confirmation was reported by the 
        regimental commander of the Sixth Marines.\237\
---------------------------------------------------------------------------
    \237\ Testimony of Randy Hebert, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 107.

    Major Hebert recalls he ``felt funny'' at the time. His 
health problems started less than 3 weeks later, and by the 
fall of 1994, he had experienced an array of symptoms, 
including throat muscle constriction, lumps, rashes, and 
atrophy in his right arm and hand. As noted in the Background 
section of report, he has since been diagnosed with amyotrophic 
lateral sclerosis [ALS], or Lou Gehrig's disease, which he 
attributes to long-term chemical exposure.\238\
---------------------------------------------------------------------------
    \238\ Ibid.
---------------------------------------------------------------------------
    For veterans such as Sgt. Steven Wood, the awareness of a 
toxic presence was triggered by a visual clue.

          While part of a convoy leaving Kuwait and heading 
        back into Iraq, my driver and I stumbled across . . . 
        an artillery round that was roped off with yellow 
        engineer tape . . . Upon closer examination I saw it 
        was a sort of greenish-blue in color, with green and 
        yellow painted bands . . . Later that same day . . . I 
        now had time to look in my manuals for the markings I 
        had seen earlier on the shell. I was shocked to see it 
        was a perfect match for a Soviet nerve agent.\239\
---------------------------------------------------------------------------
    \239\ Testimony of Steven Wood, Human Resources Subcommittee 
hearings, No. 2, p. 45.

    Still others have noted signs that were more overt. Many 
veterans sensed the approximately 700 oil well fires the Iraqis 
set throughout Kuwait \240\ had contaminated the air and water, 
as well as veterans' bodies. Subcommittee witnesses commented 
that the oil seemed to get into their lungs and skin, making 
them smell of, discharge, and taste kerosene at every 
turn.\241\
---------------------------------------------------------------------------
    \240\ See supra note 111.
    \241\ See supra notes 115-121.
---------------------------------------------------------------------------
    However, the most compelling testimony comes from chemical 
detection experts Army Major Michael Johnson and Marine Gy/Sgt. 
George Grass. Johnson said his unit confirmed the presence of 
H-Agent Mustard using the sophisticated FOX Reconnaissance 
Vehicles, and that their results were supported by additional 
CAM tests. At the same hearing, Gy/Sgt. Grass reported 
registering positive readings for not one but three chemical 
agents: S-Mustard, HT-Mustard, and Benzine Bromide. Grass added 
any doubt he may have had as to the accuracy of the readings 
was eradicated when he noticed the international symbol for 
poison--the skull and crossbones--emblazoned on yellow tape, 
boxes of ammunition, and posted signs.\242\
---------------------------------------------------------------------------
    \242\ Testimony of George Grass, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, pp. 2-4, 
6-9.
---------------------------------------------------------------------------
    Dr. Jonathan Tucker, director of the chemical and 
biological weapons nonproliferation project at the Monterey 
Institute of International Studies, concluded based on his 
research:

          The sheer number and detail of [declassified military 
        intelligence] reports suggests that Iraqi chemical 
        weapons were indeed present in Kuwait before the Gulf 
        War. The CIA, for its part, claims that Iraq . . . 
        withdrew them before the start of the air war in 
        January 1991. Yet it is not logical that Iraq would 
        renounce a potent weapon in the face of a major ground 
        invasion, and then tie up its logistics moving 
        thousands of chemical munitions out of Kuwait. No 
        evidence in the public domain indicates that such a 
        withdrawal took place. On the contrary, according to 
        Charles Duelfer, Deputy Chairman of the UN Special 
        Commission, Iraq transported more than 2,000 rockets 
        filled with nerve gas from the production plant at Al 
        Muthanna in central Iraq to the bunker complex at 
        Khamisiyah during the second week of January 1991.\243\
---------------------------------------------------------------------------
    \243\ Testimony of Jonathan Tucker, Human Resources Subcommittee 
hearings, No. 2, p. 262.

    Dr. Tucker's conclusion that toxic agents--and specifically 
chemical warfare agents--were indeed present in the Gulf War 
theater echoes those of French and Czech detection experts and 
James Tuite, director of the Gulf War Research Foundation and a 
former Senate staffer in charge of investigating Gulf War 
illnesses. However, the detection teams and Tuite take the 
debate even further.
    According to the foreign specialists, chemical warfare 
agents were not just present in the Gulf, but were released 
into the atmosphere where Coalition forces could have been 
exposed to them. The New York Times reported that French and 
Czech detection specialists, who are considered the best in the 
world, have been saying since 1991:

          . . . that nerve gas detected in the early days of 
        the war had been released from Iraqi chemical plants 
        bombed by United States forces.\244\
---------------------------------------------------------------------------
    \244\ See supra note 49.

    Meanwhile, Tuite uses satellite images to show chemical 
warfare agents were not simply emitted into the air, but were 
emitted in the direction of Coalition troops. Tuite presented 
the subcommittee with pictures taken by the National Oceanic 
and Atmospheric Administration [NOAA] before and after the 
January 19, 1991 bombing. The images were recorded on AVHRR 
channels 1 and 2, which measure visible activity, and channel 
4, which measures thermal and infrared activity, and show both 
the direction and nature of a thermal and visible plume. 
---------------------------------------------------------------------------
According to his analysis:

          The images directly contradict several DOD and CIA 
        positions about the direction the fallout moved and the 
        stated position that U.S. forces were not exposed to 
        chemical warfare agents `in any widespread way.' \245\
---------------------------------------------------------------------------
    \245\ Report on the Fallout From the Destruction of Iraqi Chemical 
Warfare Agent Research, Production, and Storage Facilities into Areas 
Occupied by U.S. Military Personnel During the 1991 Persian Gulf War, 
James J. Tuite III, Gulf War Research Foundation (September 19, 1996) 
Human Resources and Intergovernmental Relations Subcommittee hearings, 
Nos. 5-6, p. 63.

    After years of denial, the Pentagon finally acknowledged 
there were some exposures in the wake of the war. On July 24, 
1997, DOD, in conjunction with the CIA, confirmed 98,900 United 
States servicemen and women were ``presumed exposed'' to some 
level of chemical warfare agents as a result of the detonation 
and destruction of Iraqi ammunition bunkers at Khamisiyah.\246\
---------------------------------------------------------------------------
    \246\ Modeling the Chemical Weapons Agent Release, U.S. Central 
Intelligence Agency [CIA], Persian Gulf War Illness Taskforce (July 24, 
1997).
---------------------------------------------------------------------------
    In its Report on Intelligence Related to Gulf War 
Illnesses, the CIA's Office of Weapons, Technology and 
Proliferation confirmed:

          Nerve agent was released as a result of inadvertent 
        United States postwar demolition of chemical rockets at 
        a bunker and probably at a pit area at the Khamisiyah 
        Ammunition Storage Area in Iraq.\247\
---------------------------------------------------------------------------
    \247\ Report on Intelligence Related to Gulf War Illnesses, CIA, 
Human Resources and Intergovernmental Relations Subcommittee hearings, 
Nos. 1-4, p. 390.

    The CIA based this conclusion on a comprehensive review of 
intelligence documents that suggested Khamisiyah had been used 
as a chemical weapons depot, as well as evidence collected by 
the United Nations Special Commission [UNSCOM] during a May 
1996 inspection. The retrieved items included: remnants of 122-
mm rockets believed to have contained a combination of Sarin 
and GF at Bunker 73; several hundred mostly intact 122-mm 
rockets containing nerve agent detected with ``Chemical Agent 
Monitor [CAM] at a pit area about 1 km south of the main 
storage area; and over 6,000 intact 155-mm rounds containing 
mustard agent in an open area several kilometers west of 
Khamisiyah.\248\
---------------------------------------------------------------------------
    \248\ Ibid., p. 391.
---------------------------------------------------------------------------
    The Pentagon had initially estimated only 400 soldiers 
would be affected, but it revisited that estimate after the 
release of computer models showing the nerve gas cloud traveled 
southward, covering parts of southern Iraq, Kuwait, and 
northern Saudi Arabia where approximately 98,900 United States 
troops were stationed.\249\ Officer Kapplan was one of those 
troops and remembers the change in the air:
---------------------------------------------------------------------------
    \249\ See supra note 45.

          We had the smoke coming from the left, smoke coming 
        from the right from the oil fires and we were downwind 
        of the chemical munitions being blown up, approximately 
        30 to 40 kilometers downwind of this operation.\250\
---------------------------------------------------------------------------
    \250\ Testimony of Barry Kapplan, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 327.

    While the Pentagon has only officially admitted the 
existence of presumed exposures during the detonation at 
Khamisiyah, Dr. Bernard Rostker, Special Assistant for Persian 
Gulf War Illnesses at DOD, concedes additional incidents 
---------------------------------------------------------------------------
involving chemical agents and other toxins cannot be ruled out.

          There is a whole range of potential chemical 
        exposures, plus some cross-cutting papers that we're 
        producing on FOX vehicles and other things that cut 
        across.\251\
---------------------------------------------------------------------------
    \251\ Testimony of Bernard Rostker, Human Resources Subcommittee 
hearings, No. 2, p. 252.

    For instance, Dr. Tucker believes chemical agents were not 
released solely as a result of United States bombing of Iraqi 
ammunitions bunkers, but may also have been actively deployed 
---------------------------------------------------------------------------
on occasion.

          The declassified operations logs corroborate numerous 
        veteran reports of detecting low levels of chemical 
        warfare agents during the ground war, including Sarin, 
        lewisite and Mustard Gas. Many of these detections were 
        made with analytical methods that are highly reliable 
        and have a low false alarm rate. Thus, while adverse 
        weather conditions and the speed of the coalition 
        advance precluded the large scale use of Iraqi chemical 
        weapons, there is strong evidence for sporadic, 
        uncoordinated use.\252\
---------------------------------------------------------------------------
    \252\ See supra note 244.

    As for positive confirmation for the presence of other 
---------------------------------------------------------------------------
toxins, there is no shortage of evidence:

           According to GAO, the CIA has determined 
        Iraq possessed several biological weapons agents at the 
        time of the war, including anthrax, botulism, and 
        aflatoxin.\253\
---------------------------------------------------------------------------
    \253\ See supra note 88.
---------------------------------------------------------------------------
           Dr. Garth Nicolson stated undiagnosed 
        veterans have tested positive for the presence of the 
        microorganism Mycoplasma fermentans which can cause 
        dangerous infection.\254\
---------------------------------------------------------------------------
    \254\ Testimony of Garth Nicolson, Human Resources Subcommittee 
hearing of June 26, 1997 (original transcript, p. 149, in subcommittee 
files).
---------------------------------------------------------------------------
           Depleted uranium [DU] was heavily used by 
        DOD as both a means of destroying enemy tanks and 
        protecting our own.
           The Defense Science Board confirmed Iraqis 
        set more than 700 oil well fires in Kuwait, which may 
        cause illness through petroleum inhalation, ingestion, 
        and skin absorption.\255\
---------------------------------------------------------------------------
    \255\ See supra note 111.
---------------------------------------------------------------------------
           Fear of poisoning from the chemical agent 
        soman drove the military to obtain a waiver from FDA 
        allowing them to order immunizations using experimental 
        drugs and vaccines \256\ which may become toxic when 
        used under certain conditions.
---------------------------------------------------------------------------
    \256\ See supra note 130 and accompanying Background text.
---------------------------------------------------------------------------
           Finally, the insect-ridden environment in 
        the Gulf caused veterans to become dependent on 
        pesticides and Government-issued insect repellents of 
        dangerous concentrations.\257\
---------------------------------------------------------------------------
    \257\ Testimony of Robert Haley, Human Resources Subcommittee 
hearings, No. 1, pp. 238-239.

    By all accounts--official, scientific, and first-hand--the 
Gulf War theater was not just a warzone; it was a cesspool of 
toxic substances. While the direct scientific proof linking 
toxic exposures in the Gulf to the onset and exacerbation of 
what has collectively come to be known as ``Gulf War Illness'' 
has yet to be indisputably established, all of the pieces are 
there. What makes the presence of toxins in the Gulf relevant 
and a causal link most likely is the timing, nature, and scope 
of the undiagnosed illnesses that ensued are consistent with 
the known effects of similar exposures in other settings.
    Veterans complaining of so-called ``Gulf War Illness'' 
noticed their symptoms following incidents of presumed 
exposure, which is consistent with a causal relationship to 
their experiences in the Gulf. The onset of the symptoms was 
immediate in some cases, and delayed in others, but they were 
always subsequent to their Gulf War service. Had any of the 
servicemen and women been ill before the war, it is highly 
unlikely that he or she would have been deployed to the region. 
In fact, Dr. Gordan, who has treated more than 500 veterans, 
says nearly all of them reported ``very good to perfect'' 
health before deployment, versus ``poor to fair'' health 
afterward.\258\
---------------------------------------------------------------------------
    \258\ See supra note 160.
---------------------------------------------------------------------------
    To the extent to which they are able to ascertain, 
scientists have confirmed that the nature of the symptoms 
associated with ``Gulf War Illness'' is also consistent with 
presumed exposures during the war. Put conversely, neither the 
VA nor DOD has found evidence that these undiagnosed symptoms 
were not caused by one or several of the toxins that were 
present in the theater. The only argument against a causal link 
is the fact that while many veterans are sick with undiagnosed 
illnesses, most are not. However, as Dr. Kenneth Olden, 
director of the National Institute of Environmental Health 
Sciences, explained:

          We've known for a long time that when several hundred 
        people are exposed to the same environmental toxicants, 
        some people get sick and others don't.\259\
---------------------------------------------------------------------------
    \259\ See supra note 170.

    Olden and other Federal researchers are now pursuing 
research that would suggest the answer lies in the genes that 
control human susceptibility to toxic chemicals and other 
poisons.
    Finally, the scope of so-called ``Gulf War Illness'' is 
also consistent with a causal relationship. Some veterans have 
seen members of their immediate and extended families become 
ill, either upon coming into contact with them or articles they 
sent back from the Gulf War theater. As previously noted in the 
Background section, Major Barry Kapplan's wife Nancy told the 
subcommittee she and her four children handled her husband's 
wet and stained clothing, army gear and war souvenirs, only to 
experience continual chronic infections, with one child 
becoming very ill.\260\
---------------------------------------------------------------------------
    \260\ Testimony of Nancy Kapplan, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 335-
337, 343.
---------------------------------------------------------------------------
    According to Dr. Claudia Miller, Assistant Professor of 
Environmental and Occupational Medicine at the University of 
Texas Health Science Center, the experience of the Kapplan 
family is consistent with those of many agricultural workers 
who come into contact with clothing that has been saturated 
with organophos-phates--the same kind of compounds which were 
present in many pesticides and insect repellents used in the 
Gulf. So far, the clothing and equipment have tested negative 
for organophosphates, but as Dr. Miller notes:

          They may degrade after a period of time and it has 
        been 5 years since the war, so I think there are so 
        many uncertainties.\261\
---------------------------------------------------------------------------
    \261\ Testimony of Claudia Miller, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 532.

    A second example may be seen in the unusually high number 
of cases of ALS among Gulf War veterans. While DOD's Dr. 
Rostker says the nine confirmed cases of ALS are what 
scientists would expect to find given the population of Gulf 
War veterans,\262\ Dr. Robert Brown notes that analysis does 
not take account the relatively young age of veterans. Given 
the fact that the average age for ALS onset is 55, Dr. Brown 
says the number of ALS cases among Gulf War veterans, who are 
typically between 18 and 40 years old, would appear 
``excessive.'' \263\
---------------------------------------------------------------------------
    \262\ See supra note 33.
    \263\ See supra note 34.
---------------------------------------------------------------------------
    A new study by Dr. Will Longstreth at the University of 
Washington School of Medicine in Seattle once again suggests a 
causal link between ALS and the presence of toxic agents. 
According to the study, exposure to agricultural chemicals--
including pesticides--may increase men's chances of developing 
the degenerative disease. Researchers say men whose histories 
showed high exposures to these chemicals are at 2.8 times more 
risk than those who were never exposed.\264\
---------------------------------------------------------------------------
    \264\ Reuters, ``Gehrig's Disease Tied to Chemicals'' (June 24, 
1997).
---------------------------------------------------------------------------
    The existence of a variety of toxic agents in the Gulf is 
well-established, and confirmed by a host of witnesses, 
documents, and facts. While the research has yet to cement the 
link between toxic exposures and delayed, chronic illnesses, 
the timing, nature, and frequency of undiagnosed illnesses 
among Gulf War veterans strongly suggest such a link does exist 
and will, given the appropriate interest, funding and support, 
be confirmed.

Finding 3: Gulf War troops were not trained to protect themselves from 
        the effects of exposure to depleted uranium dust and particles.

    Depleted uranium [DU] maintained a pervasive presence in 
the Gulf War theater. In the form of armor-piercing penetrator 
rounds, DU, upon reaching enemy targets, ignites and becomes a 
toxic agent that could poison anyone who came into contact with 
it, including U.S. troops. The threat might have been minimized 
had Gulf War servicemen and women been trained to protect 
themselves against such exposure, but as numerous veterans, 
Defense and GAO employees have attested, the military 
establishment did not prepare troops for the dangers they would 
encounter or the risks they would incur.
    DU penetrator rounds are credited with destroying more than 
1,400 Iraqi tanks, in addition to other equipment and weapons 
storage facilities during the Persian Gulf War.\265\
---------------------------------------------------------------------------
    \265\ See supra note 97.
---------------------------------------------------------------------------
    Veteran Michael Stacy's eyewitness testimony confirms the 
military depended on DU as a preferred weapon of war, and used 
it to destroy everything from tanks to light-armored vehicles 
to bunkers.

          We wanted to shoot the good stuff and as much as 
        possible. We were at war, with the best equipment out 
        of all the Coalition Forces--no law, no rules, engage 
        at will . . . As you can well expect, we were 
        constantly in contact with this ammo.\266\
---------------------------------------------------------------------------
    \266\ Testimony of Michael Stacy, Human Resources Subcommittee 
hearing of June 26, 1997, original transcript, p. 53-54 (in 
subcommittee files).

    When a DU round hits a hard target such as a tank, most of 
it burns up, spraying uranium shrapnel and pulverized uranium 
dust into the air, where it may be transported up to 25 miles 
by high winds.\267\
---------------------------------------------------------------------------
    \267\ See supra note 106.
---------------------------------------------------------------------------
    According to Leonard Dietz, a retired General Electric 
physicist and DU expert, at least 300 tons of DU munitions were 
fired over a period of 4 days of ground fighting. He says that 
if only 2 percent of the uranium became aerosolized upon 
impacting the tanks, it would generate at least 6 tons of 
depleted uranium aerosol particles.

          This is a huge amount, much of which would have 
        become airborne over the battlefields. This amount in 4 
        days is more than 10,000 times greater than the maximum 
        airborne emissions of depleted uranium allowed in the 
        air over Albany in 1 month.\268\
---------------------------------------------------------------------------
    \268\ Testimony of Leonard Dietz, Human Resources Subcommittee 
hearing of June 26, 1997, original transcript, p. 125 (in subcommittee 
files).

    Another large emission of DU resulted when a United States 
Army ammunition depot and motor pool exploded in Doha, Kuwait 
in July 1991, oxidizing some 9,000 pounds of DU rounds and 
vehicle armor to powder.\269\
---------------------------------------------------------------------------
    \269\ See supra note 99.
---------------------------------------------------------------------------
    When oxidized particles are ingested or absorbed through 
the skin via contact with burned out tankers or the uniforms of 
wounded soldiers, DU can present a serious health hazard. To 
explain its high toxicity, Dietz referred the subcommittee to 
the Handbook of Chemistry and Physics:

          Chronic exposure to small concentrations of uranium 
        is known to cause kidney failure. Depleted uranium is 
        more than 99 percent Uranium-238, just a single 
        isotope, which is always accompanied by two decay 
        daughters that emit penetrating particles and gamma 
        rays.\270\
---------------------------------------------------------------------------
    \270\ See supra note 268, pp. 125-126.

    Mounting scientific and circumstantial evidence suggests 
veterans were not just surrounded by DU, but were in fact 
exposed to it. This has long been the contention of veterans 
such as Michael Stacy, who found himself in ``more than one 
friendly fire incident'' involving tanks with DU armor.\271\ On 
June 26, 1997 Bernard Rostker of DOD confirmed 29 combat 
vehicles were contaminated in this manner, with possible 
additional exposures resulting from the Doha ammunition dump 
explosion.\272\ Out of the 33 veterans who were in Army 
vehicles struck by DU rounds and are now being evaluated, 16 
have DU shrapnel in their bodies.
---------------------------------------------------------------------------
    \271\ See supra 266, p. 46.
    \272\ Testimony of Bernard Rostker, Human Resources Subcommittee 
hearing of June 26, 1997, original transcript, p. 184-185, (in 
subcommittee files).

          The Health Surveillance Program has shown that those 
        who have retained shrapnel identified radioactively are 
        excreting increased amounts of uranium, indicating that 
        the metal particles are not entirely inert.\273\
---------------------------------------------------------------------------
    \273\ Ibid., p. 85.

    Unaware of the toxic dangers they faced from DU exposure, 
U.S. troops did not know that they needed to take special 
precautions to protect themselves, nor what those precautions 
might entail.\274\ As a result, many veterans such as Paul 
Canterbury did not bother putting on MOPP gear when they were 
in and around burned-out tanks and other contaminated 
areas,\275\ while some even slept on the tanks' blowout panels, 
exposing themselves to DU toxins over extended periods of 
time.\276\
---------------------------------------------------------------------------
    \274\ See supra note 266, p. 46.
    \275\ Testimony of Paul Canterbury, Human Resources Subcommittee 
hearing of June 26, 1997, original transcript, p. 29 (in subcommittee 
files).
    \276\ See supra note 266, p. 46.
---------------------------------------------------------------------------
    After the ammunition fire in Doha where approximately 3,500 
troops were based, some servicemen reported cleaning up the 
site using nothing but brooms and their bare hands. According 
to Dietz:

          This is something that would make a qualified, 
        radiological worker shudder.\277\
---------------------------------------------------------------------------
    \277\ See supra note 268, p. 128.

    Considering all the information Pentagon had available at 
the time, there is no reason U.S. servicemen should have been 
allowed to engage in such high-risk behavior. Veteran Michael 
Stacy says the Army had documented the hazards more than a year 
---------------------------------------------------------------------------
before the war.

          In a report from the U.S. Army Ballistics Research 
        Lab, dated December 1989, test results showed that 
        soldiers who came into contact with contaminated 
        vehicles could inhale resuspended, depleted uranium 
        dust or ingest depleted uranium via food intake, 
        cigarette smoking, et cetera prior to not washing hands 
        and face.\278\
---------------------------------------------------------------------------
    \278\ See supra note 266, pp. 45-46.

    In a July 1997 conversation with subcommittee staff, 
Rostker stated DOD had not properly prepared Gulf troops for 
the DU dangers they would encounter--the same conclusion GAO 
reached in 1993.\279\ Rostker said the Pentagon was working on 
producing newer, universal masks as well as taking other steps 
to prevent future troops from facing a similar fate.\280\
---------------------------------------------------------------------------
    \279\ See supra note 110.
    \280\ Bernard Rostker also told the subcommittee that DU has been 
the target of an Iranian-run disinformation campaign because of its 
high effectiveness. He says United States intelligence agencies have 
intercepted diplomatic traffic in and from Iraq. Iraqi embassies were 
reportedly told to downplay the health hazards associated with low-
level chemical exposure and play up the notion of DU as the more severe 
toxin. See supra note 272, pp. 189, 226.
---------------------------------------------------------------------------
    As noted in the ``Background'' section of this report, Dr. 
Michio Kaku believes history will show Gulf War illnesses to be 
the result of a variety of factors, but DU will bear ``a large 
portion of the blame.'' \281\ The post-war experiences of 
veterans who were among the most at-risk of DU exposure suggest 
the same conclusion. Canterbury has been diagnosed with 
hypertropia, large vertical muscle imbalance, and esophoria, 
while Stacy suffers from multiple undiagnosed illnesses 
including respiratory problems, sinus problems, and severe 
memory loss.\282\
---------------------------------------------------------------------------
    \281\ See supra note 108.
    \282\ See supra note 266, p. 47.
---------------------------------------------------------------------------

Finding 4: Pyridostigmine bromide [PB] can have serious side effects 
        and interactions when taken in combination with other drugs, 
        vaccines, chemical exposures, heat and/or physical exercise.

    Pyridostigmine bromide [PB] pills were distributed to and 
ingested by U.S. personnel under the threat of court-
martial,\283\ as a means of protecting them against the nerve 
agent soman.
---------------------------------------------------------------------------
    \283\ Testimony of Steven Wood, Human Resources Subcommittee 
hearings, No. 2, p. 55.
---------------------------------------------------------------------------
    According to Dr. Stephanie Padilla, who works at the 
Neurotoxicology Division of the U.S. Environmental Protection 
Agency [EPA], PB produces some of the same reactions as the 
very nerve agent it is intended to protect against, making it 
difficult to determine its effectiveness:

          It is my understanding that pyridostigmine, the idea 
        is to mask the effects of the nerve agent, but also 
        they would produce some of the same effects that the 
        nerve agent would produce and so you either have an 
        extremely high baseline or it would mask the effect of 
        the nerve agent.\284\
---------------------------------------------------------------------------
    \284\ Testimony of Stephanie Padilla, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 528.

    Dr. Robert Haley of the University of Texas Southwestern 
Medical Center points out another danger. When introduced to 
the human body after exposure to a neurotoxin such as soman has 
taken place, PB can trigger a side effect from an otherwise 
---------------------------------------------------------------------------
safe agent:

          Research published since the war has shown that 
        giving a protective drug after the exposure can 
        paradoxically promote brain damage from even a low dose 
        of a neurotoxic chemical that might not have caused a 
        problem otherwise.\285\
---------------------------------------------------------------------------
    \285\ Statement of Robert Haley, Human Resources Subcommittee 
hearings, No. 1, p. 252.

    According to Dr. Thomas Tiedt, PB inhibits a critical 
enzyme, acetylcholinesterase [AchE] which can result in nerve 
and muscle degeneration within moments of a single dose, which 
may intensify with further doses.\286\ What's more, Tiedt says 
the onset of stress makes the blood/brain barrier susceptible 
to PB leakage, increasing its ability to cause damage to the 
central nervous system. Tiedt cites two examples to support his 
assertion: the advent of behavioral changes in veterans within 
weeks of ending PB treatment, and the objective signs of nerve 
damage in veterans who took the drug.
---------------------------------------------------------------------------
    \286\ See supra note 130.
---------------------------------------------------------------------------
    Dr. Satu Somani expands Tiedt's conclusion about the mental 
or psychological rigors of war to incorporate the physical 
aspects of the Gulf, such as heat and exercise, saying:

          The adverse effects [of PB] were amplified by 
        physical stress.\287\
---------------------------------------------------------------------------
    \287\ See supra note 136.

    Perhaps most disturbing is the revelation that the risks 
were well-known before the drug was issued. Dr. Tiedt says the 
DOD was aware that the pills were dangerous because the 
Department's own research had documented the risks at the time 
---------------------------------------------------------------------------
of the war.

          The scientific evidence shows that Gulf War Syndrome 
        was easily predictable . . . DOD established by the 
        early 1980's that PB causes persisting 
        `counterproductive consequences . . .' DOD research 
        also found that at sublethal dosage PB is more 
        dangerous and more toxic than Sarin nerve gas.\288\
---------------------------------------------------------------------------
    \288\ Testimony of Thomas Tiedt, Human Resources Subcommittee 
hearings, No. 2, p. 298.

    Dr. Myra Shayevitz, an environmental physician at the 
Veterans Administration Medical Center [VAMC] in Northhampton, 
MA, agrees that risks had already been established, and points 
to one of the DOD's own documents as proof. According to her 
---------------------------------------------------------------------------
testimony,

          The Army Institute of Chemical Defense in their 
        Doctrine of Use recognized the potential toxicity of 
        this compound, stating that `If a dose is missed, under 
        no circumstances should one take two tablets as a make-
        up dose.' \289\
---------------------------------------------------------------------------
    \289\ Report submitted for the record, ``A Biopsychosocial 
Therapeutic Approach for the Treatment of Multiple Chemical Sensitivity 
Syndrome in Veterans of Desert Storm: Treatment Protocol,'' Dr. Myra 
Shayevitz, May 5, 1995, Human Resources Subcommittee hearings, No. 1, 
p. 16.

    Nevertheless, U.S. troops were still ordered to take the 
pills, and many experts say DOD should have expected a number 
of servicemen and women to fall ill. Some scientists have tried 
to attribute the sickness to a reaction to the stresses of war, 
ignoring the intake of PB, but Dr. Miller says some veterans 
started feeling ill in August--before the advent of the war, 
but after taking PB.\290\
---------------------------------------------------------------------------
    \290\ Testimony of Stephanie Miller, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 531.
---------------------------------------------------------------------------
    Furthermore, veterans didn't even have to make it into the 
Gulf region to feel the effects. As noted in the Background 
section, James B. Green became sick without ever setting foot 
in the theater. Green was given shots and a series of PB pills 
while he was stationed in Germany, in preparation for going to 
the Gulf, but another group was assigned to that post instead 
and he was sent home. Before going into the service, Mr. Green 
was in excellent health--but that changed when he started 
taking PB pills and his life has never been the same.

          After receiving the shots and the PB pills, I 
        suffered many symptoms . . . I am scared to go to the 
        VA hospital for treatment. The government thought it 
        was okay to give us poison once. Why wouldn't they do 
        it again? I am referring to the shots and the PB pills. 
        That is what I believe is making me sick with this 
        illness . . . This disease is obviously not stress 
        related, as they would like us to believe. I am a 
        perfect example. My jobs weren't stress related, and I 
        am experiencing the same symptoms as others. My theory 
        rests on the inoculations and the PB pills. As 
        everybody knows, the French troops were not given the 
        experimental pills, and not many of them are sick.\291\
---------------------------------------------------------------------------
    \291\ Testimony of James Green, Human Resources Subcommittee 
hearings, No. 1, p. 303-304.

    Unfortunately the uncontrolled manner in which the drug was 
distributed, and poor records thereof, make it extremely 
difficult to draw any conclusions about PB and undiagnosed 
illnesses. Veterans have testified DOD did nothing to protect 
against over-medication. Rather, they were simply ordered to 
take the pills with little or no supervision other than to make 
sure the pills were swallowed. Dr. Myra Shayevitz says some 
veterans ingested more than 30 tablets.\292\ This reported lack 
of oversight is consistent with Staff Sgt. Wood's experience.
---------------------------------------------------------------------------
    \292\ See supra note 289.

          The full dosage was given--enough for 2 weeks, I do 
        believe. Each soldier had their own in a blister pack . 
        . . It's highly possible that someone that was scared 
        could have taken more . . . They did not check on 
        it.\293\
---------------------------------------------------------------------------
    \293\ See supra note 283, p. 76.

    Testimony from scientists indicated the military had funded 
and conducted research which concluded that PB, combined with 
other similar compounds and/or physical stress, could produce 
long term health consequences, including nerve damage. The idea 
that DOD would proceed to administer PB in light of this 
research is disturbing, made more so by the fact that DOD 
administered the drug without providing the written information 
on PB the FDA required be provided to the troops. In light of 
these facts, the subcommittee believes DOD and VA should 
consider potential health effects of PB far more seriously.

Finding 5: VA and DOD health registry diagnosis protocols rely on the 
        unfounded conclusion there were no chemical, biological or 
        other toxic exposures to U.S. troops in the Gulf War theater.

    For years, the DOD and CIA falsely or mistakenly maintained 
U.S. troops were not subject to any chemical, biological or 
other toxic exposures during their tour in the Gulf War 
theater. Rather than starting with a blank slate and an open 
mind, health officials at VA and DOD then used this 
misinformation to shape health registry diagnosis protocols, 
perpetuating the myth.
    While military and intelligence officials would eventually 
concede there was a potential for toxic exposures from the 
detonations at Khamisiyah, they spent several years denying the 
existence of such a possibility. According to DOD's Bernard 
Rostker, the CIA made that argument as late as September 1996.

          The CIA reports said that the analysis and computer 
        models indicate chemical agents released by aerial 
        bombing of chemical warfare facilities did not reach 
        United States troops in Saudi Arabia.\294\
---------------------------------------------------------------------------
    \294\ See supra note 272, p. 182.

    Trained to look for irrefutable proof as opposed to the 
mere possibility of exposures, field commanders had apparently 
not given any credence to the sounding of 14,000 M8A1 alarms. 
According to the December 3, 1996 edition of the New York 
---------------------------------------------------------------------------
Times:

          General Powell, the Chairman of the Joint Chiefs of 
        Staff at the time in 1991, said in an interview that 
        while chemical detection alarms had sounded repeatedly 
        during the war, American commanders in the Gulf had 
        been unable to confirm the detections and had believed 
        them to be false alarms.\295\
---------------------------------------------------------------------------
    \295\ Statement of Representative Bernard Sanders (I-VT) quoting 
the New York Times of December 3, 1996, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 135.

    Despite mounting testimonials and other evidence suggesting 
the alarms were not false but indicative of actual toxic 
exposures, VA and DOD health registry officials did not include 
specific questions about chemical warfare and toxic exposures 
in its Persian Gulf Registry Code Sheet until late 1995.\296\ 
Even after DOD and the CIA conceded exposures were likely 
during the detonation at Khamisiyah, VA Secretary Jesse Brown 
saw no reason to change protocols, saying the VA had ``always 
accepted the possibility'' of exposures and therefore had no 
need to change its diagnosis, treatment or compensation 
policies in the absence of a definitive diagnostic test and 
specific treatments.\297\
---------------------------------------------------------------------------
    \296\ Supra note 227.
    \297\ See supra text of Secretary Brown's letter in Background 
section entitled, ``Exposures and VA Medical Protocols for Gulf 
Veterans.''
---------------------------------------------------------------------------
    However, passively accepting a possibility is not the same 
as actively pursuing it. Nowhere is this distinction more 
evident than in the testimony of Dr. Susan Mather. As noted in 
the Background section, in December 1996, Dr. Mather testified 
that questions about veterans' interaction with the physical 
environment of the Gulf were not revised until ``this past 
year,'' \298\ 5 years after the war had ended.
---------------------------------------------------------------------------
    \298\ See supra note 170, p. 246.
---------------------------------------------------------------------------
    Faced with conflicting evidence, VA and DOD health registry 
officials chose to put more faith and stock in military and 
intelligence officials, who assured them there was no toxic 
exposure, than in numerous veterans who expressed concerns that 
they had been poisoned as a result of their service. Had VA and 
DOD health registry officials listened to the 93 percent of 
veterans who reported exposure to toxic contaminants \299\ and 
aggressively pursued it as a legitimate hypothesis back in 
1992, science--and many veterans--would be 5 years ahead of 
where they are now.
---------------------------------------------------------------------------
    \299\ See supra note 227.
---------------------------------------------------------------------------

Finding 6: VA and DOD health registry diagnosis protocols rely on the 
        unwarranted conclusion that, unless there is an immediate and 
        acute reaction, exposures to chemical weapons and other toxins 
        do not cause delayed or chronic symptoms.

    VA and DOD health registry diagnosis protocols wrongly 
assumed that in the absence of an immediate and acute reaction 
to a toxic exposure, such an exposure will not cause delayed or 
chronic symptoms. Given the notable lack of data on the 
subject, there is no way to know that this is true. 
Nevertheless, officials in charge of the diagnosis protocols 
refused to give veterans the benefit of the doubt, saying they 
required incontrovertible proof that toxins can cause delayed 
or chronic symptoms without an immediate and acute reaction, 
while lifting the burden of proof on researchers who were 
unable to demonstrate the opposite.
    VA Secretary Jesse Brown planted his feet squarely in the 
camp of officials who made this choice. While conventional 
wisdom says absence of proof is not proof of absence, Secretary 
Brown would not yield to subcommittee requests to consider the 
opposing position. In fact, in a December 10 letter to the 
subcommittee, Brown displayed an active reluctance to open the 
subject up for discussion again:

          In VA's view, the published literature, while 
        limited, does not demonstrate the development of 
        readily identifiable, long-term adverse health effects 
        due to nerve agent exposures in human subjects who have 
        not shown signs of acute toxicity or poisoning . . . 
        Because there are so few studies on this question, we 
        believe that additional research is needed to determine 
        whether exposure to low-levels of chemical warfare 
        nerve agents can cause long-term health effects, 
        including chronic or delayed onset of a characteristic 
        set of symptoms, signs or medical conditions.\300\
---------------------------------------------------------------------------
    \300\ Attachment to chairman's opening statement, Human Resources 
and Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 11.

    Secretary Brown and others who share his opinion have asked 
veterans and veterans' advocates to establish something which, 
by virtue of its terms, is inherently vague and therefore 
difficult to prove. Scientists do not seem to have agreed upon 
what comprises an ``immediate and acute'' reaction. Many 
veterans have reported a variety of symptoms that, under normal 
conditions, would probably qualify as immediate and acute but 
were dismissed as a circumstantial by-product of the harsh Gulf 
environment. These include but are not limited to: chest and 
joint pains, chronic coughing, memory loss, rashes, the 
appearance of pustules, muscle atrophy, nausea, diarrhea, 
vomiting and bloody stools, among others.
    As has already been noted, PB is capable of masking the 
symptoms of chemical nerve agent intoxication.\301\ As a 
result, veterans may have experienced immediate and acute 
reactions and not known it.
---------------------------------------------------------------------------
    \301\ See supra note 284.
---------------------------------------------------------------------------
    Another reason military officials may have been blind to 
the possibility that toxic exposures, which do not produce an 
immediate and acute reaction, may still engender delayed or 
chronic illness is that it makes their work easier. According 
to the former senior policy analyst on the staff of the 
Presidential Advisory Commission, Dr. Jonathan Tucker, the 
pressures of war and the need for maximum mobility encourage 
military personnel to underestimate the threat of toxicity as a 
way of avoiding having to wear the constricting and bulky MOPP 
4 protective gear.

          The goal of chemical defense doctrine has been to 
        minimize the impact of an enemy's use of chemical 
        weapons on the tempo and effectiveness of U.S. military 
        operations, and they have done this by setting up the 
        so-called MOPP scale--mission oriented protective 
        posture . . . The idea is to calibrate the level of 
        protection to the assessed chemical threat, because 
        when people are in MOPP-4, the full ensemble, they are 
        almost incapacitated . . . To deal with this problem, 
        the Army has sought to minimize the level of protection 
        that troops wear in combat and calibrate it to the 
        assessed level of threat. As a result of this, there 
        has been a kind of all-or-nothing mindset that has 
        viewed chemical weapons exposures as either severe, if 
        they produce acute effects if they're sub-acute, 
        they're just discounted, they're viewed as harmless . . 
        . I believe that, later on, after the war, when large 
        numbers of troops began getting sick, the same 
        commanders who wished to avoid accountability for 
        serious errors of judgment, such as blowing up many 
        bunkers that may have contained chemical weapons, just 
        refused to acknowledge the problem, hoping it would 
        simply go away.\302\
---------------------------------------------------------------------------
    \302\ Testimony of Jonathan Tucker, Human Resources Subcommittee 
hearings, No. 2, p. 349.

    Health registry diagnosis protocols wrongly assumed that 
toxic exposures which did not produce immediate and acute 
reactions would not generate delayed and chronic symptoms. 
However, there is no logical reason to believe this should be 
the case, only explanations for why registry officials believed 
it to be true. While scientists have yet to prove that these 
exposures could incite delayed and chronic effects, no one has 
proved they could not. Moreover, that assumption is refuted by 
the experiences of many people with common environmental toxins 
such as asbestos and lead. Consistent exposure in small 
quantities may not be enough to spark a sharp reaction in the 
average person, but exposure over time may damage internal 
organs. Had health registry diagnosis protocols been more prone 
to explore new theories and hypotheses, the medical community 
might not have accepted the Pentagon's unfounded assurances 
quite so easily. Nonetheless Secretary Brown and others chose 
to give the military and medical establishments the benefit of 
the doubt over the numerous veterans who complained of delayed 
and chronic effects, again perpetuating a myth with growing 
implications for future research and treatment procedures.

Finding 7: Prematurely ruling out toxic exposures as causative, VA and 
        DOD doctors relied on diagnoses of somatoform disorder and Post 
        Traumatic Stress Disorder [PTSD] to explain Gulf War veterans' 
        illnesses.

    DOD assumed, in the absence of definitive medical evidence 
in support of this position or to the contrary, that many PGW 
illnesses were attributable to PTSD and stress, and they did 
not consider toxic exposures. The predominant diagnosis of 
patients in the DOD Comprehensive Clinical Evaluation Program 
[CCEP] was psychological disorders, 18 percent, followed by: 
signs, symptoms, ill-defined conditions, 18 percent; 
musculoskeletal disorders, 18 percent; healthy, 10 percent; 
respiratory, 7 percent; GI, 6 percent; skin, 6 percent; nervous 
system, 6 percent; and other, 11 percent.\303\
---------------------------------------------------------------------------
    \303\ Statement of Stephen Joseph, Human Resources and 
Intergovernmental Relations Subcommittee hearings, No. 1-4, p. 223.
---------------------------------------------------------------------------
    Veterans have described their painful experiences with the 
VA medical system, which has disregarded their symptoms and 
labeled their ailments as ``stress.'' Kimo Hollingsworth 
described experiences many Persian Gulf War veterans have had 
with the VA medical system. ``The VA Hospital in Washington, DC 
performed a complete physical and concluded that I was in 
excellent health. The VA doctor informed me that the dark green 
chunks of sputum and pain in the center chest were normal in 
some people. I was then directed to a social worker who 
discussed the issue of Post Traumatic Stress Disorder. The VA 
also provided me a brochure outlining psychological counseling 
services to Persian Gulf veterans.'' \304\
---------------------------------------------------------------------------
    \304\ Statement of Kimo Hollingsworth, Human Resources and 
Intergovernmental Relations Subcommittee hearing, No. 1-4, p. 29.
---------------------------------------------------------------------------
    Private Stacy testified about VA arbitrarily denying his 
claim for Persian Gulf illnesses. ``I have a claim pending for 
chronic fatigue. It has been pending for 2 years. My records 
are being shuffled back and forth from Nashville, TN to 
Muskogie. They believe that all of my complaints are due to 
stress . . . The doctor says in my records, `I believe the 
patient is exaggerating symptoms, I believe the patient has 
been coached, and I believe he is here to try to get increased 
disability.' '' \305\
---------------------------------------------------------------------------
    \305\ See supra 266, p. 93.
---------------------------------------------------------------------------
    Mr. Stacy told the subcommittee, ``I am 40 percent 
disabled. I receive $467 a month. I left the Post Office after 
3 years. My house payment is $500 a month. I do not even have 
money to drive or put gas in my car. We are literally starving 
to death. We receive no help from nobody.'' \306\
---------------------------------------------------------------------------
    \306\ Ibid., p. 50.
---------------------------------------------------------------------------

Finding 8: There is no credible evidence that stress or PTSD causes the 
        illnesses reported by many Gulf War veterans.

    Although physicians at VA and DOD are more likely to 
diagnose veterans as having PTSD, the medical community has 
been unable to establish a causal link between stress or PTSD 
and most veterans' illnesses. There is simply no irrefutable 
evidence that such a link exists. As a result, any conclusion 
that so-called ``Gulf War Illnesses'' are rooted in stress or 
PTSD involves an unwarranted leap of faith.
    After reviewing the Government's research strategy, the GAO 
did not concur with DOD's and VA's attribution of PGW illnesses 
to somatoform disorders and PTSD. In its June 1997 report, 
``Gulf War Illnesses: Improved Monitoring of Clinical Progress 
and Reexamination of Research Emphasis are Needed,'' the GAO 
concluded that:

          While stress can induce physical illness, the link 
        between stress and these veterans' physical symptoms 
        has not been firmly established.\307\
---------------------------------------------------------------------------
    \307\ U.S. General Accounting Office, Gulf War Illnesses: Improved 
Monitoring of Clinical Progress and Reexamination of Research Emphasis 
Are Needed, GAO/SNIAD-97-163, June 1997, p. 8.

---------------------------------------------------------------------------
    Dr. Daniel Clauw, a rheumatologist, testified:

          My personal experience is that in some cases the VA 
        Medical Centers are not well-versed in the treatment of 
        these conditions,\308\ perhaps in part because these 
        illnesses occur more frequently in females (and so few 
        women are seen within the VA system), and perhaps 
        because there is a cultural bias within the VA system 
        to quickly refer these patients to psychiatrists. If a 
        physician or other health care provider does not 
        believe that these individuals are suffering from a 
        real disease, they will likely be ineffective in 
        treating this group of patients.\309\
---------------------------------------------------------------------------
    \308\ Neuro-immunological disorders such as fibromyalgia, chronic 
fatigue syndrome, and multiple chemical sensitivity.
    \309\ Statement of Daniel Clauw, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, pp. 188-
189.

---------------------------------------------------------------------------
    He added:

          Most of the experts on these types of illnesses in 
        this country are not in the VA or military 
        systems.\310\
---------------------------------------------------------------------------
    \310\ Ibid., p. 189.

    The sole evidence physicians have offered as proof that 
stress or PTSD is the source of most Gulf War sicknesses is the 
assumption that most veterans must have suffered from stress by 
virtue of the stressful environment in which they found 
themselves during the war. According to an article from the 
---------------------------------------------------------------------------
Annals of Internal Medicine:

          Poorly understood war syndromes have been associated 
        with armed conflicts at least since the U.S. Civil War. 
        Although these syndromes have been characterized by 
        similar symptoms . . . no single recurring illness that 
        is unrelated to psychological stress is apparent . . . 
        but one unifying factor stands out: A unique population 
        was intensely scrutinized after experiencing an 
        exceptional, life-threatening set of exposures. As a 
        result, research efforts to date have been unable to 
        conclusively show causality.\311\
---------------------------------------------------------------------------
    \311\ Hyams, et al., ``War Syndromes and Their Evaluation: From the 
U.S. Civil War to the Persian Gulf War,'' Annals of Internal Medicine, 
September 1, 1996, Vol. 125, No. 5, p. 398.

    As the article notes, while it is difficult if not 
impossible to say sick veterans do not suffer from any stress 
or PTSD at all, it is also unwarranted to say stress or PTSD is 
the driving force that actually triggered the onset of so-
called ``Gulf War Illnesses.'' All of the evidence that has 
been presented up until now suggests while they may have 
contributed to veterans' being sick, stress and PTSD alone are 
an insufficient explanation. According to VA Under Secretary 
---------------------------------------------------------------------------
for Health Dr. Kenneth Kizer:

          VA and DOD studies demonstrate that although PTSD 
        rates among Persian Gulf veterans who were exposed to 
        violence and carnage are elevated, post-traumatic 
        stress disorder does not explain the majority of health 
        problems in Persian Gulf veterans.\312\
---------------------------------------------------------------------------
    \312\ Statement of Kenneth Kizer, Human Resources Subcommittee 
hearings, No. 1, p. 138.

    Dr. Haley agrees and uses his own research to support his 
---------------------------------------------------------------------------
point.

          We found no evidence that the veterans had post-
        traumatic stress disorder, none, zero. We found no 
        evidence that combat stress, the ones that had high 
        levels of combat stress had the same risk of the 
        syndrome as those with low levels of stress.\313\
---------------------------------------------------------------------------
    \313\ Testimony of Robert Haley, Human Resources Subcommittee 
hearings, No. 1, pp. 241-242.

    Dr. Garth Nicolson, Chief Scientific Officer with the 
Institute for Molecular Medicine, concurs. He believes the 
symptoms are indicative of something else--not stress or PTSD, 
---------------------------------------------------------------------------
but exposure to a combination of chemical or biological agents.

          We do not feel that Post-Traumatic Stress Disorder is 
        a major cause of the Gulf War illnesses. We think, 
        again, that it is combinations of chemical and 
        biological agents that produce these very complex signs 
        and symptoms. We do not see how it could be produced 
        any other way.\314\
---------------------------------------------------------------------------
    \314\ Testimony of Garth Nicolson, Human Resources Subcommittee 
hearing of June 26, 1997, original transcript, pp. 117-119, in 
subcommittee files.

    Unfortunately, too few tests and studies have been 
completed to establish Dr. Nicolson's or anyone else's theory 
as fact. It is a similar problem Dr. Murphy acknowledges with 
---------------------------------------------------------------------------
regard to low-level exposures to nerve agents.

          We recognize there is a gap in the scientific 
        knowledge. It is very hard to prove a negative. The 
        evidence does not exist in the scientific literature at 
        this time that clearly says asymptomatic exposures to 
        low-level nerve agents cause this recognized group of 
        signs and symptoms, physical findings.'' \315\
---------------------------------------------------------------------------
    \315\ Testimony of Frances Murphy, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 255.

    And yet despite any scientific proof that stress or PTSD 
has caused, triggered, or amplified veterans' undiagnosed 
illnesses, many VA and DOD physicians continue to diagnose 
veterans as having PTSD--by default. While the VA and DOD have 
opted to accept a lapse of evidence in this regard, they refuse 
to give veterans' contentions that toxic exposures are to blame 
the same courtesy. This attitude places the burden of proof 
squarely on the shoulders of the veterans, a grossly unfair and 
impossible task, especially given the magnitude of the job, 
their ailing health, and the little power they exert over the 
scope and focus of scientific research.

Finding 9: Accurate diagnosis of veterans' illnesses remains difficult 
        due to inadequate or missing personal medical records, missing 
        toxic detection logs, and unreleased classified documents.

    While our military may be the most powerful, efficient, and 
best equipped armed forces in the world, its management and 
bookkeeping in the Gulf War were deplorable. Just a few years 
after the war, personal medical records and scientific toxic 
detection logs are missing, and many documents are still 
classified as secret. Unfortunately, many of these records, 
logs, and documents may be critical in diagnosing veterans' 
illnesses.
    For example, with regard to the role of PB in illnesses, 
Dr. Heivilin of GAO says the records were so poorly maintained 
that the government does not even know who took the pills--an 
oversight DOD readily admits.

          DOD has acknowledged that the records of the use of 
        PB and vaccinations to protect against chemical and 
        biological warfare exposures were inadequate. There is 
        research going on right now to try to find the majority 
        of the records, which seem to be missing.\316\
---------------------------------------------------------------------------
    \316\ Testimony of Donna Heivilin, Human Resources Subcommittee 
hearings, No. 3, p. 38.

    Furthermore, even if DOD could determine which veterans 
took the pills, the distribution of the drug was so poorly 
planned that there is no guarantee the doses and frequency of 
doses would be comparable and of any scientific value. 
---------------------------------------------------------------------------
According to Dr. Rostker:

          There was poor quality control in terms of the 
        regimen of PB. In some units it was careful. In other 
        units it was not careful. We don't have records that 
        would definitively establish who had PB. It was not 
        done the way any of us would have liked to have seen it 
        done. There's no question about that.\317\
---------------------------------------------------------------------------
    \317\ Testimony of Bernard Rostker, Human Resources Subcommittee 
hearings, No. 2, p. 249.

    According to Major Randy Hebert, the poor management did 
not stop at the border, or with the end of the Persian Gulf 
conflict. He says he knows of hospitals that have lost records 
of veterans' tests, even records documenting the fact of their 
---------------------------------------------------------------------------
visits.

          I have spoken to a Marine who was evaluated with 
        several other Marines from his squad upon their return 
        from the war. They were told they were being studied 
        for adverse effects from the desert sun. They were told 
        this by someone whom he believes was a civilian doctor. 
        They all were observed for 1 week. The following week 
        the Marines went back to the hospital to find the 
        results. They were told that they were never there. 
        Also, there is not an indication in their records they 
        were ever there.\318\
---------------------------------------------------------------------------
    \318\ Testimony of Randy Hebert, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 107.

    Mr. Tuite says health reports are not the only kinds of 
records that were lost. Chemical and biological warfare logs 
also seem to have been misplaced or else never maintained. Mr. 
Tuite told the subcommittee that Senate Banking Committee 
Chairman Donald Riegle (D-Michigan) had requested logs of 
chemical and biological warfare activity from the Secretary of 
Defense, only to be notified by the General Counsel's office 
that the command element during the Gulf War (CENTCOM) could 
not locate any such document.\319\
---------------------------------------------------------------------------
    \319\ Testimony of James Tuite, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 438.
---------------------------------------------------------------------------
    Still more disturbing is the alleged falsification of toxic 
detection logs and the secret classification of medical records 
for the entire 330th Ordinance Company. According to former CIA 
analyst Patrick Eddington, they were allegedly made secret to 
conceal the fact that DOD sent troops to the Gulf knowing there 
were risks associated with low-level chemical exposure and did 
so without alerting the soldiers to the dangers. Eddington says 
Sergeant First Class Michael Morrissey's unit was charged with 
removing more than 170,000 chemical weapons and nerve agent 
munitions from an American depot in Germany. Sgt. Morrissey 
apparently saved the relevant unit logs, despite orders to 
destroy them. When he noticed that reports that went up the 
chain of command noted an absence of chemical incidents, he 
concluded they had been deliberately altered.

          In my presence, Morrissey pulled out a log entry for 
        July 10, 1990 showing that an M-8 alarm had gone off at 
        one of the chemical storage bunkers. There were no 
        other contaminants in the area and the device was fully 
        functional and working normally. Additional detection 
        equipment was dispatched to the bunker and, according 
        to the log extract, the air sample readings appeared to 
        indicate a slight trace of nerve agent in the air. `I 
        was told to overlook' such incidents, Morrissey noted. 
        The 10 weeks of logs that Morrissey retained appear to 
        have several such incidents to include some personnel 
        who displayed pin-point pupils and other telltale signs 
        of nerve agent exposure. . . . What upset Morrissey the 
        most was that his chain of command clearly understood 
        the potential risks.\320\
---------------------------------------------------------------------------
    \320\ Testimony of Patrick Eddington, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 143-
144.

    Eddington then noted a startling declassified document 
entitled General Information: Nerve Agent Intoxication and 
Treatment. The document is basically a disclaimer. It 
explicitly states serious cognitive problems may result from 
low-dose exposure even though there is no scientific proof that 
this may be so, alludes to the possibility of birth defects 
from organophosphate pesticides, and includes an acknowledgment 
that the reader (soldier) understands the risks. It is then 
signed by the soldier (in this case, Sgt. Morrissey) and a 
---------------------------------------------------------------------------
medic.

          Signs and symptoms of chronic, low dose exposure: 
        memory loss, decreased alertness, decreased problem 
        solving ability, and language problems are suspected 
        but have not been proven by scientific study . . . 
        Teratogenicity (ability to cause birth defects): 
        although some organophosphate pesticides have been 
        shown to be teratogenic in animals, these effects have 
        not been shown in carefully controlled experiments 
        using nerve agents . . . I have read and understood the 
        above information. All questions have been explained to 
        my understanding and satisfaction. Soldier/Employee 
        (Michael Morrissey's signature), Medical Personnel 
        (Richard W. Kramp, M.D.-initials), Date January 19, 
        1990.\321\
---------------------------------------------------------------------------
    \321\ Document submitted for the record, ``General Information, 
Nerve Agent Intoxication and Treatment,'' Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, pp. 163-
164.

    Eddington concluded DOD had reason to suspect chronic low 
level nerve agent exposure could produce serious chronic health 
problems in exposed personnel a full year before the detonation 
at Khamisiyah. Every member of Sgt. Morrissey's unit was 
reportedly required to sign an identical document. Eddington 
concludes that DOD's classifying this information sheet and the 
entire Company's medical records as secret is ``irrefutable 
evidence'' that DOD knowingly placed U.S. troops at risk and 
---------------------------------------------------------------------------
did not want to be found out.

          In my opinion they lied. I spent 11 years in the Army 
        Reserve and National Guard. I have never seen a 
        document like this. You classify something like this 
        and you classify medical records secret, when clearly 
        you are telling people that they could suffer long-term 
        effects, serious long-term effects, from chronic low-
        level exposures? . . . This document makes it very 
        clear that they understood the risks these people were 
        facing.\322\
---------------------------------------------------------------------------
    \322\ Testimony of Patrick Eddington, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 177.

    While Mr. Eddington's suspicions may or may not be 
accurate, DOD's tendency to classify information that 
scientists and other investigators believe ought to be released 
is not new, as Dr. Tucker, director of the chemical and 
biological weapons nonproliferation project the Monterey 
Institute of International Studies, pointed out to the 
---------------------------------------------------------------------------
subcommittee.

          A crucial untapped source of information about 
        possible toxic exposures during the Gulf War is the 
        large volume of environmental and biomedical samples 
        that U.S. technical intelligence teams collected 
        throughout the war zone during and after Desert Storm . 
        . . It was coordinated by a unit called--a rather 
        shadowy unit--called the JCMEC, based in Dhahran. 
        Despite requests under the Freedom of Information Act, 
        the results of these analyses have never been made 
        public.\323\
---------------------------------------------------------------------------
    \323\ Testimony of Jonathan Tucker, Human Resources Subcommittee 
hearings, No. 2, p. 350.
---------------------------------------------------------------------------

Finding 10: Accurate diagnosis of veterans illnesses was also hampered 
        by the VA's lack of medical expertise in toxicology and 
        environmental medicine.

    One of the reasons the VA has been unable to determine 
potential role of toxins in causing veterans' ailments is the 
lack of toxicological and environmental medicine expertise 
among the staff. While the VA initially refuted the argument, 
it has since acknowledged its deficiencies and has taken steps 
to buttress its expertise in areas where it was lacking.
    Asked point-blank how many toxicologists work for the 
Department full-time, Dr. Murphy was only able to come up with 
the name of one physician out of a total full-time staff of 
8,000. When asked why that was, Dr. Murphy simply said:

          In general, toxicologists don't work in health care 
        organizations. They're often in research laboratories 
        or in organizations like the EPA.\324\
---------------------------------------------------------------------------
    \324\ Testimony of Frances Murphy, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, pp. 259-
260.

    Dr. Haley believes regular physicians are poor substitutes 
for toxicologists because they may not explore diagnoses like 
organophosphate-induced delayed polyneuropathy [OPIDP] that 
---------------------------------------------------------------------------
would come naturally to an expert focused on toxicology:

          Since these cases are usually treated by 
        toxicologists, few regular physicians are familiar with 
        OPIDP. This probably explains why no one explored this 
        diagnosis earlier.\325\
---------------------------------------------------------------------------
    \325\ Statement of Robert Haley, Human Resources Subcommittee 
hearings, No. 1, p. 251.

    Dr. Haley says the medical toxicologist on staff in his 
department, Dr. Tom Kurt, is such a leader on the issue that he 
proposed the OPIDP mechanism for the Gulf War syndrome as early 
as 1994.
    Following the hearing on December 11, 1996, Dr. Kizer wrote 
to Subcommittee Chairman Shays, saying the discussion prompted 
him to find out how the VA's personnel office obtains and 
tracks information about the specialty certifications of VA 
physicians. Dr. Kizer concluded the VA's database needed 
improvement, and efforts are reportedly being made to ensure 
this comes to pass.
    In addition, Dr. Kizer directed the Office of Academic 
Affiliations to improve the VA's toxicology and occupational 
medicine expertise by initiating efforts to support 12 new 
medical toxicology fellowships and 25 residency positions for 
occupational medicine. While Dr. Kizer noted the response was 
somewhat disappointing, the VA will fund three additional 
medical toxicology fellowships and five new occupational 
medicine residency positions in the 1997-1998 school year, with 
more expected in the years ahead.
    Finally, Dr. Kizer said he plans to establish occupational 
and environmental health as a VHA strategic healthcare group 
[SHG]. According to Kizer:

          The SHG is a multidisciplinary group organized to 
        support the delivery of a continuum of care to a 
        defined population or care in a particular setting. The 
        SHG functions by integrating data, skills and best 
        practices into a systemwide policy, planning and 
        service delivery through the development of clinical 
        care strategies . . . and decision support 
        mechanisms.\326\
---------------------------------------------------------------------------
    \326\ Letter from Kenneth Kizer to Chairman Shays, June 6, 1997, p. 
2 (in subcommittee files).

    Accurate diagnosis of veterans' illnesses was hindered by 
the lack of relevant expertise at the VA. Rather than challenge 
either the lack of expertise or the impact it has on diagnosis, 
as well as research and treatment, the VA decided to firm up 
its toxicological and environmental medicine resources by 
expanding its fellowship and residency staff.

Finding 11: Exposures to low levels of chemical warfare agents and 
        other toxins can cause delayed, chronic health effects.

    Dr. Claudia Miller, a University of Texas Southwest Health 
Sciences Center at San Antonio scientist, whose research 
focuses on low-level chemical exposures, told the subcommittee 
at a September 19, 1996 hearing, ``There are now several 
studies, in addition to our own, linking chronic, multi-system 
symptoms to [low level] organophosphate/carbamate exposure.'' 
\327\
---------------------------------------------------------------------------
    \327\ Statement of Claudia Miller, Human Resources and 
Intergovernmental Relations Subcommittee hearings, No. 1-4, p. 271.
---------------------------------------------------------------------------
    It is apparent that DOD and FDA did not evaluate and 
recognize the importance of the existing body of scientific 
literature on chronic health effects resulting from chemical 
warfare exposure and resulting delayed neurotoxicity. Dr. Satu 
Somani told the subcommittee that, ``The literature suggests 
that Sarin can be responsible for delayed neurotoxic effects 
which may not appear until years after a low level of exposure. 
Although pyridostigmine is not normally taken up by the brain, 
it crosses blood brain barrier under conditions of physical 
stress and causes central nervous system effects. Insecticides, 
inspect repellants and other chemicals can also contribute to 
neurotoxic effects of nerve agents as Sarin, soman, tabun and 
Vx and they are important weapons of chemical warfare. . . . 
Although we have a treatment for a single dose toxicity, there 
is no treatment, however, for the delayed neurotoxicity. 
Delayed neurotoxicity was first reported in the 1950's.'' \328\
---------------------------------------------------------------------------
    \328\ Statement of Satu Somani, Human Resources Subcommittee 
hearings, No. 2, p. 317.
---------------------------------------------------------------------------
    Dr. Myra Shayevitz, an environmental physician, in material 
inserted in the hearing record by Representative Bernard 
Sanders, described the relationship between chemical warfare 
agents and toxic health effects. ``One clinically useful 
theoretical model of MCS holds that each individual has a total 
tolerable load of chemical, physical and emotional stress, 
which, when exceeded, may lead to MCS in susceptible 
individuals.'' \329\
---------------------------------------------------------------------------
    \329\ See supra note 289, p. 15.
---------------------------------------------------------------------------
    Multiple low-level chemical exposures could result in a 
synergistic effect. The symptoms of low level exposure may not 
appear for several years. Dr. Thomas Tiedt described the 
genetic basis of variations in response to chemical exposure in 
testimony before the subcommittee's April 24, 1997 hearing. 
``Due to the principle of biological variation, different cells 
and different individuals will experience different degrees of 
acute and chronic effects.'' \330\
---------------------------------------------------------------------------
    \330\ Statement of Thomas Tiedt, Human Resources Subcommittee 
hearings, No. 2, p. 303.
---------------------------------------------------------------------------
    Dr. Satu Somani testified ``based on the recent 
experimental evidence and the similarities of the symptoms of 
the delayed neurotoxicity reported by workers in the 
organophosphate industry and also by Desert Storm veterans, I'm 
inclined to suggest that the Gulf War syndrome may be due to 
low-level exposure to Sarin. . . . The symptoms are due to low-
level exposure to Sarin. Pyridostigmine in combination with 
physical exercise can contribute to neurotoxic effects. 
Finally, the simultaneous exposure to insecticides and other 
chemicals under physical stress may have initiated the 
neurotoxicity.'' \331\
---------------------------------------------------------------------------
    \331\ See supra note 328, pp. 318-319.
---------------------------------------------------------------------------
    The effects of low level chemical warfare agent exposure is 
a legitimate line of inquiry for DOD and VA to have pursued. 
The Federal agencies possessed a research bias against the 
possibility of chemical warfare exposure and did not initiate 
any research into this area until 1997. Results will not be 
available until the year 2000 or beyond, fully 9 years after 
the Gulf War.

                               Treatment

Finding 12: Neither the VA nor the DOD has systematically attempted to 
        determine whether sick Gulf War veterans are any better or 
        worse today than when they first reported symptoms.

    Scientific analysis requires the ability to draw 
conclusions based on objective and accurate scientific data, 
but without a systematic means of comparison, the data is 
useless. Unfortunately, neither the VA nor the DOD has made any 
effort to track veterans' progress and treatment on a 
methodical, uniform basis. As a result, doctors have no way to 
gauge which is the best treatment for veterans' different 
symptoms.
    While the VA has developed a means of collecting an initial 
assessment of veterans' conditions, problems have surfaced 
regarding its implementation. The 65,000 veterans who signed up 
for a Persian Gulf Registry Exam were provided a review of 
their medical history, physical examination, and laboratory 
tests. The results were then entered into a database containing 
information on all Persian Gulf veterans who received the 
examination.\332\ However, the objective value of these 
assessments is weakened by various factors. Stephen Backhus of 
GAO has noted medical centers have experienced scheduling 
backlogs of up to 6 months,\333\ which can have two effects. 
One, a late Registry Exam risks missing the more subtle 
symptoms common in the early stages of illness, preventing 
doctors from treating them before they become worse. Two, 
awareness of long scheduling delays may discourage veterans 
from registering for the exams, preventing veterans from 
receiving the diagnosis and treatment they deserve, as well as 
making the tests less representative of veterans at large and 
therefore less worthwhile. Finally, veterans have complained of 
poor feedback and communication with health care personnel 
following completion of the exam, as well as ``a lack of 
postexamination treatment.'' \334\
---------------------------------------------------------------------------
    \332\ See supra note 227, p. 1.
    \333\ Ibid., p. 2.
    \334\ Ibid.
---------------------------------------------------------------------------
    According to Army Reservist Chris Kornkven, even when 
veterans were given feedback, no effort was made to pursue the 
VA's own recommendations for further diagnosis and treatment.

          Eventually I was told I may have post traumatic 
        stress disorder and I would be tested and possibly be 
        followed with counseling. Several weeks passed with no 
        other medical testing or treatment. I began asking 
        questions in the mental health clinic when any 
        appointment would take place and was told they were too 
        booked up to get me in any time soon.\335\
---------------------------------------------------------------------------
    \335\ Testimony of Chris Kornkven, Human Resources Subcommittee 
hearings, No. 1, pp. 269-271.

    GAO's research and analysis confirms Kornkven's experience 
---------------------------------------------------------------------------
is not an isolated case. As Dr. Heivilin concludes:

          DOD and VA have made no provisions to follow up on 
        the condition of the Gulf War veterans. We found 
        neither DOD nor VA have any means of knowing whether 
        the Gulf War veterans who are ill are better or worse 
        off than when they were first examined.\336\
---------------------------------------------------------------------------
    \336\ Testimony of Donna Heivilin, Human Resources Subcommittee 
hearings, No. 3, p. 34.

    More importantly, this inability to determine if the 
conditions of sick veterans are improving prevents the DOD and 
---------------------------------------------------------------------------
VA from assessing the value of its diagnoses and treatments.

          We found [DOD and VA] had no monitoring mechanisms 
        for determining the quality, the appropriateness or the 
        effectiveness of the care that [veterans] are getting 
        after the initial examinations.\337\
---------------------------------------------------------------------------
    \337\ Ibid., p. 37.

    Dr. Murphy claims the absence of a particular follow-up 
protocol is not indicative of a lack of interest in how 
veterans are doing. Rather, Dr. Murphy says the VA's policy is 
designed to ensure veterans receive the appropriate amount and 
quality of care by catering to the needs of each veteran 
---------------------------------------------------------------------------
individually.

          We do not have a protocol, and the reason we do not 
        have a protocol is that the therapy and the follow up 
        needs to be tailored to the individual veteran. 
        Clearly, there are some people who need to be seen 
        every couple of weeks or every month. Some might be 
        seen every 3 months, some every 6 months, depending on 
        the severity of their illness and how well they are 
        responding to the treatments they are being given.\338\
---------------------------------------------------------------------------
    \338\ Testimony of Frances Murphy, Human Resources Subcommittee 
hearing of June 26, 1997, original transcript, p. 232 (in subcommittee 
files).

    However, this response is problematic for two reasons. As 
noted in Finding 1, the GAO has pointed out several failings at 
the VA regarding followup testing, diagnosis and treatment, 
including: failure to give veterans without a clearly defined 
diagnosis additional baseline laboratory tests and 
consultations; failure to evaluate veterans suffering from 
undiagnosed illnesses at VA's referral centers (only 390 out of 
15,000 referrals were evaluated); and failure to provide 
personal counseling between veterans and their physicians.\339\
---------------------------------------------------------------------------
    \339\ See supra note 232, pp. 4-5.
---------------------------------------------------------------------------
    Second, if doctors are assessing the progress of veterans 
on an individual basis, researchers will be unable to draw 
general conclusions about which treatments may have appeal for 
other sick veterans with similar symptoms. As a result, even if 
certain treatments are found to work, they will have little 
impact on medical research as a whole and thus limited 
significance for future veterans.
    VA's argument that its performance of a Registry Exam for 
any veteran who requests one followed by an appropriate 
diagnosis, treatment, and follow-up is sufficient to assess 
veterans' progress over time still fails to address the need 
for a systemwide and systematic comparison which is crucial for 
any kind of major advance in medical science and treatment.

Finding 13: Treatment of sick Gulf War veterans by VA and DOD to date 
        has largely focused on stress and PTSD.

    Through counseling and other forms of therapy, the medical 
community has established an accepted treatment for stress and 
PTSD that has been available for some time. Over a number of 
years, physicians have been able to determine that counseling 
can help veterans overcome these syndromes and resume their 
normal life. VA and DOD doctors, under pressure to come up with 
a diagnosis and treatment for Gulf War veterans suffering from 
mysterious illnesses, have prematurely prescribed treatment for 
stress and PTSD, even when evidence strongly suggests their 
illnesses are more likely to stem from exposure to toxic 
agents.
    Examples of Gulf veterans who were urged to undergo 
treatment for stress are plentiful.
    Private Stacy testified that he has tried counseling and 
other forms of treatment for stress, but has found that they do 
not work.\340\ Nevertheless:
---------------------------------------------------------------------------
    \340\ See supra note 266, p. 90.

          For the past year I have been pushed and pushed 
        towards mental health.\341\
---------------------------------------------------------------------------
    \341\ Ibid., p. 108.

    Veteran Julia Dyckman remembers smelling and hearing 
evidence of SCUD attacks during the war.\342\ Soon afterward, 
she experienced a rash of unusual health problems,\343\ yet 
according to Dyckman:
---------------------------------------------------------------------------
    \342\ Testimony of Julia Dyckman, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 189.
    \343\ Ibid.

          Self reporting is ignored and a psychiatric diagnosis 
        is often given.\344\
---------------------------------------------------------------------------
    \344\ Ibid., p. 190.

    As noted in the Background section, Army Reservist Chris 
Kornkven suffered from a variety of physiological symptoms, 
including intestinal problems and headaches. However, when he 
sought treatment from the VA, he was not given anything for his 
---------------------------------------------------------------------------
stomach or head.

          I was referred to the mental health clinic, although 
        I was not told why . . . It was suggested I go to the 
        Vet Center for any counseling. At this point, much of 
        the medical testing or treatment had stopped, with 
        emphasis placed on PTSD and possible treatment in the 
        mental health clinic.\345\
---------------------------------------------------------------------------
    \345\ Testimony of Chris Kornkven, Human Resources Subcommittee 
hearings, No. 1, pp. 269-271.

    Doctors have since discovered a nasal mass after doing an 
MRI, as well as other symptoms such as skin problems and rectal 
bleeding, neither of which has been treated to date.\346\
---------------------------------------------------------------------------
    \346\ Ibid.
---------------------------------------------------------------------------
    In order to justify treatment for stress and PTSD, VA and 
DOD health care personnel have pushed those diagnoses, often 
without any support from tests or logic.
    Major Michael Donnelly was exposed to a known toxin, 
malathion, and experienced serious health problems immediately 
afterward, suggesting his exposure may be the source of his 
ailments, yet an Air Force physician did not hesitate to 
diagnose, or at least strongly suggest, stress upon hearing 
that he had served during war.

          I went in to the flight surgeon at Sheppard Air Force 
        Base. When I finished explaining my symptoms to him I 
        mentioned that I had been in the Gulf War. He 
        immediately started to talk to me about the effects of 
        stress and delayed stress.\347\
---------------------------------------------------------------------------
    \347\ Testimony of Michael Donnelly, Human Resources Subcommittee 
hearings, No. 2, p. 35.

    Private Green, who was never in the Gulf region let alone 
the Gulf War theater during combat, was also diagnosed and 
---------------------------------------------------------------------------
treated for stress.

          The doctor asked what was wrong and asked me to 
        describe the symptoms. I was then sent for a series of 
        blood work and referred to the mental health clinic for 
        stress-related problems. Seems awful funny to me that 
        my illness is stress related and I was not even in the 
        theater.\348\
---------------------------------------------------------------------------
    \348\ See supra note 182.

    Sgt. Sumpter-Loebig had a similar experience. She spent a 
large amount of time in and around a ``noxious fuming gas that 
burned'' with no protective clothing. She later discovered it 
was a combination of DS, CS, and super-topical bleach. Soon 
afterward, she experienced a series of health problems ranging 
from dry mouth and hair loss to heart palpitations. Despite her 
exposure to known toxins, the VA says she has PTSD and the 
problem is in her head.\349\
---------------------------------------------------------------------------
    \349\ Testimony of Susan Sumpter-Loebig, Human Resources 
Subcommittee hearings, No. 2, p. 44.
---------------------------------------------------------------------------
    If war were not considered a stressful environment, VA and 
DOD doctors would have been hard-pressed to match veterans' 
physiological symptoms with physiological treatments. However, 
because stress is difficult if not impossible to eliminate as a 
cause of their ailments, VA and DOD doctors can diagnose and 
treat health problems as symptoms of stress without fear of 
being glaringly wrong or being perceived as incapable of coming 
up with any answer at all.

                              Compensation

Finding 14: Compensation ratings for sick veterans are minimized due to 
        inadequate personal medical records, missing toxic detection 
        logs, and unreleased classified documents which could help 
        veterans establish service-connection of post-war disabilities.

    The absence of medical records and detection logs, as well 
as the classification of certain documents, have increased the 
burden on veterans who need to establish a causal link between 
service in the Gulf and their post-war ailments. Unable to 
prove the war responsible for their pains, many sick veterans 
are thereby rendered incapable of holding the United States 
fully accountable for their illnesses, leading their 
compensation ratings to be unfairly diminished.
    Still, some Gulf War veterans seeking compensation face an 
easier task than veterans of previous wars. In the past, the VA 
had required compensation to be based on clearly diagnosed 
diseases. In 1994, Congress enacted unprecedented legislation 
changing this requirement. The Persian Gulf War Veterans' 
Benefits Act (Public Law 103-446) allows the VA to pay 
compensation benefits to Gulf War veterans suffering 
undiagnosed illnesses.\350\
---------------------------------------------------------------------------
    \350\ Congressional Research Service Report, ``Gulf War Veterans' 
Illnesses,'' 97-450 SPR, April 11, 1997, p. 5.
---------------------------------------------------------------------------
    However, although this legislation relieves some of the 
burden on veterans, they still must prove they are disabled and 
trace their disabilities directly to their service in the Gulf. 
It is in making the latter argument that the classification, 
disappearance, or inadequacy of medical and toxic detection 
records come into play.\351\
---------------------------------------------------------------------------
    \351\ See finding 9.
---------------------------------------------------------------------------
    Sadly, when veterans try to bring these shortcomings to the 
attention of the evaluating board, they are summarily dismissed 
and the evidence, discounted. In the words of Sgt. Sumpter-
Loebig:

          This so-called board is a sham, disgrace, and 
        basically a sold-out jury of three officers who have 
        found an excellent loophole for the military to escape 
        responsibility to their soldiers. This physical 
        evaluation board says that I am not fit for duty or my 
        civilian job title. But they aren't going to admit that 
        there is a problem caused by our Southwest Asia 
        service, because we are no longer of any use to them. 
        From the moment an ill soldier walks into one of these 
        military facilities and mentions they were in the Gulf, 
        the decision and diagnosis are already decided upon. To 
        cover themselves, they tell us to bring in other 
        evidence to dispute their doctor. And when we do it is 
        dismissed as irrelevant and non-admissible. These 
        boards . . . bring down their judgment swiftly and 
        without any thought to our well-being.\352\
---------------------------------------------------------------------------
    \352\ See supra note 349, p. 62.

    Confronted with the impossible task of proving a causal 
connection between their sickness and service without the 
documents, data, and scientific explanation that may be 
necessary to back up their claims, many veterans find 
themselves at a loss. They know they are sick, and while all 
signs point to their service in the Gulf as the reason, without 
some of the key clues to the puzzle--the missing or poorly 
maintained medical and toxic detection records and classified 
material--many veterans are unable to successfully make their 
case to the Veterans' Benefits Administration [VBA].
    Julia Dyckman says the burden of proof is made even more 
difficult by the VA's refusal to bend its time-limit for 
proving disability. Under regulations issued in 1995, a veteran 
can only be compensated for undiagnosed illnesses that make 
themselves apparent during Gulf War service or within 2 years 
of a veteran's departure from the Gulf.\353\ Veterans must also 
prove chronic illness and be at least 10 percent disabled. For 
the past 2 years, this constraint has proved especially onerous 
for undiagnosed Gulf War veterans who do not recognize the 
significance of symptoms which may appear mild by themselves 
but together are indicative of more serious health problems.
---------------------------------------------------------------------------
    \353\ See supra note 352.

          When later symptoms are present, it's almost 
        impossible to have them recognized by the VA. There's 
        the--you need to change the 2-year limit of at least 10 
        percent disability. Reporting was difficult, but 
        symptoms are also sometimes very benign at the 
        beginning, and even getting them into any kind of 
        civilian treatment is very difficult. This limit is 
        unrealistic due to the specific nature of Persian Gulf 
        illness.\354\
---------------------------------------------------------------------------
    \354\ Testimony of Julia Dyckman, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 190.

    President Clinton responded by extending the presumptive 
period by 8 years, until December 31, 2001. Veterans who were 
denied compensation between 1995 and 1997 solely on account of 
the old 2-year presumptive period will have their claims re-
evaluated.
    However, only 55 percent of the total 93.5 percent of 
veterans who were denied compensation for undiagnosed illnesses 
fall into this category. The remaining 38.5 percent were simply 
denied.
    Faced with a dearth of useable data thanks to lost, 
destroyed or classified medical, toxic detection, and other 
records, veterans are shouldered with a gargantuan task, 
proving a causal link between their illnesses and their service 
with only limited resources at their disposal. What's more, 
veterans are being asked to prove what science and doctors 
cannot disprove; an unfair and impossible task for anyone, let 
alone disabled and suffering veterans who simply want what they 
are due. The Government has eliminated some of the burden, 
including the diagnosis and 2-year presumptive period 
restrictions, but the other requirements still fall like an 
anvil atop the shoulders' of suffering veterans. Sadly, as VBA 
records show, those who fail to make what the VBA considers an 
incontrovertible argument pay the price in smaller compensation 
benefits.

Finding 15: Compensation ratings are also minimized by over-reliance on 
        somatoform disorder and PTSD as the basis of disability claims.

    Veterans suffering from so-called ``Gulf War Syndrome'' 
face yet another hurdle in acquiring the benefits they are 
owed--an over-reliance by VA and DOD on a diagnosis of 
somatoform disorder and PTSD as a means of calculating and 
processing their claims.\355\
---------------------------------------------------------------------------
    \355\ See finding 7.
---------------------------------------------------------------------------
    For Julia Dyckman, the VA and DOD's unwillingness to accept 
alternative causes of her sickness prevent her from receiving 
the full amount she should have coming to her.

          After 4 years and the VA's own diagnosis of Persian 
        Gulf Syndrome, which I got at the VA Center in 
        Washington, I received 30 percent disability for PTSD. 
        In 1996, it was finally increased to 80 percent for 
        chronic fatigue. Persian Gulf Syndrome is not a 
        recognized illness. According to VA, I am tired and 
        have a mental problem.\356\
---------------------------------------------------------------------------
    \356\ See supra note 354.

    Staff Sgt. Steven Wood faced the same problem. His 
solution: stay in Germany and receive free health care. 
Although the VA has rated him at 100 percent disabled, it owes 
him more than $20,000 in back benefits.\357\ A processing 
problem in Philadelphia is reportedly causing further delays in 
payment.
---------------------------------------------------------------------------
    \357\ Testimony of Steven Wood, Human Resources Subcommittee 
hearings, No. 2, p. 46.
---------------------------------------------------------------------------
    The VA's and DOD's reliance on somatoform and PTSD can make 
for added difficulties such as those faced by Michael Stacy. 
His experience with VA and DOD is one of disbelief. According 
to his medical records, his doctor is convinced he is lying or 
otherwise exaggerating his symptoms in order to get more 
compensation.

          They believe that all of my complaints are due to 
        stress. I have a copy of my medical records, which I do 
        not have on me now. But the doctor does say in my 
        records, ``I believe the patient is exaggerating 
        symptoms, I believe the patient has been coached, and I 
        believe he is here to try to get increased 
        disability.'' \358\
---------------------------------------------------------------------------
    \358\ See supra note 266, p. 93.

    As a result, many veterans find themselves in the 
unenviable situation of Sgt. Sumpter-Loebig, who was told in no 
uncertain terms that she could receive a portion of the 
benefits she is due, if she accepts a more ``established'' 
diagnosis of stress or PTSD. For veterans who are at their 
wits'' end, the pressure is great. As Sgt. Sumpter-Loebig 
---------------------------------------------------------------------------
recalls, she was presented with the following choice:

          Send in my results to a board now and be awarded 10 
        to 20 percent of base pay for 1 year as a settlement or 
        go through a 4 week physical training program designed 
        to help me learn to cope with my symptoms--which they 
        are describing as sympathetic and mind-induced--be 
        taught how to be socially active with the rest of the 
        world, how to use P.T. to forget my mind-induced 
        sympathetic symptoms, and be sent back to duty. This is 
        regardless if the symptoms are gone or not.\359\
---------------------------------------------------------------------------
    \359\ See supra note 349, p. 59.

    Private Stacy is rated at 30 percent disabled for service-
connected PTSD, but has been strongly advised to push for 100 
percent. He has refused because he does not believe his 
sickness stems from stress and does not want to accept a 
fraction of what he is owed--which is all he would receive with 
a stress or PTSD diagnosis. What's more, Stacy told the 
subcommittee he would not have accepted a 30 percent rating if 
it were not for his family's financial situation. He says they 
have been starving for 1 year now, and that it is only by the 
grace of his relatives, friends, and God, they would not have 
survived.\360\ According to his testimony, his disability 
compensation of $467 a month does not leave enough money for 
his monthly house payment of $500, let alone the cost of gas or 
food.\361\
---------------------------------------------------------------------------
    \360\ See supra note 266, p. 108.
    \361\ Ibid., p. 50.
---------------------------------------------------------------------------
    The experiences of these and other veterans support the 
view that compensation ratings are being reduced based on 
inaccurate or at least premature diagnoses of somatoform 
disorder and PTSD. Evidence that VA and DOD doctors have over 
used diagnoses of somatoform disorder and PTSD have already 
been laid out.\362\ Since these psychologically-based 
disabilities carry a lower compensation rating other 
physiological ailments, it seems only logical that veterans see 
their compensation ratings minimized as a result. The pressure 
to accept a diagnosis of somatoform disorder or PTSD before 
other alternatives have been ruled out shows how this reduction 
can sometimes come to pass, and when it does, it is a tragedy. 
U.S. troops risked their lives and health for the military. It 
is a gross understatement to say they deserve the full amount 
of what they are justly owed upon their return.
---------------------------------------------------------------------------
    \362\ See finding 7.
---------------------------------------------------------------------------

                                Research

Finding 16: Federal research strategy has been blind to promising 
        hypotheses due to reliance on unfounded DOD conclusions 
        regarding chemical exposures.

    In 1996, the DOD admitted for the first time that 300 to 
400 PGW troops had likely been exposed to chemical weapons. The 
number of affected troops continued to be raised upward until 
July 1997, when DOD estimated that the number of exposed troops 
was estimated at 98,900.\363\
---------------------------------------------------------------------------
    \363\ Statement of Bernard Rostker to the PAC meeting, Buffalo, NY, 
July 29 and 30, 1997 (in subcommittee files).
---------------------------------------------------------------------------
    VA's Dr. Kenneth Kizer testified on January 21, 1997 that 
``the issue of chemical warfare agents . . . and the 
investigation into that arena, was delayed, and that 
investigative focus was given a lower priority because of the 
information that had been provided by DOD.'' \364\ As a result, 
the PGW registry didn't require VA physicians to ask sick 
veterans detailed questions about potential chemical and 
biological weapons exposure until 1995.\365\ In fact, the VA 
diagnostic screening protocol failed to identify even one 
veteran exposed to chemical weapons agents or other toxins.
---------------------------------------------------------------------------
    \364\ Testimony of Kenneth Kizer, Human Resources Subcommittee 
hearings, No. 1, pp. 50-60.
    \365\ Ibid.
---------------------------------------------------------------------------
    VA continues to assert that acute symptoms following 
exposure to chemical weapons must be present in veterans 
exposed to these agents. In the absence of acute symptoms, the 
veteran is presumed by the VA not to be exposed.
    Many scientific and medical witnesses have testified that 
chemical exposures result in injury to the limbic system at the 
brain stem. This injury, in turn, causes neuro-immunological 
disorders which are often characterized as chronic fatigue 
syndrome, fibromyalgia or multiple chemical sensitivity. These 
disorders are thought by many experts to be a spectrum of 
neuro-immunological illnesses with a variety of causes and 
symptoms.
    Dr. William Baumzweiger, a neurologist and psychiatrist, 
who was at the time a VA physician in Los Angeles, testified 
that organophosphate chemical exposure resulted in ``a syndrome 
which has been known since the late 1800's, was very clearly 
documented by 1930, and which there have been a number of 
accidental exposures, tragedies in the 1930's, 1970's, 1980's. 
. . . The signs and symptoms of acute neurotoxicity do not have 
to be so dramatic as seizures and death. They can be very mild 
and they can consist of headaches, nausea, vomiting, episodes 
of psychosis, personality change . . .'' \366\
---------------------------------------------------------------------------
    \366\ Testimony of William Baumzweiger, Human Resources 
Subcommittee hearings, No. 1-4, p. 480.
---------------------------------------------------------------------------
    However, the January 15, 1997 issue of the Journal of the 
American Medical Association was devoted to PGW research. A 
study conducted by Dr. Robert Haley and colleagues at the 
University of Texas Southwestern Medical Center at Dallas 
concluded that PGW veterans illnesses were attributable to 
``subtle brain, spinal cord and nerve damage-but not stress. 
The damage was caused by exposure to combinations of low-level 
chemical nerve agents and other chemicals, including 
pyridostigmine bromide in anti-nerve-gas tablets, DEET in a 
highly concentrated insect repellant, and pesticides in flea 
collars that some troops wore. Different combinations of the 
chemicals appear to have caused the 3 different syndromes.'' To 
arrive at this conclusion, Dr. Haley and his colleagues 
conducted three studies in a group of 249 members of a U.S. 
Navy reserve unit. This study could have been just as easily 
conducted by DOD or VA.
    The Departments also failed to consider historical research 
which supported consideration of possible toxic exposures with 
delayed onset as the cause of PGW syndrome. Furthermore, DOD 
and VA did not consider the possibility that PB could mask the 
effects of chemical exposure. If this were the case, delayed 
neurotoxicity would not appear for perhaps several years.\367\
---------------------------------------------------------------------------
    \367\ See supra note 148 and accompanying text.
---------------------------------------------------------------------------

Finding 17: Institutional and methodological constraints make it 
        unlikely the current research structure will find the causes 
        and effective treatments for Gulf War veterans' illnesses in 
        the short term.

    Military institutional biases are adversely affecting the 
identification of causes and treatments for PGW illnesses. 
Exposure to genotoxic materials was not quantatively monitored 
and records of chemical exposures were not maintained. As a 
result, data on these subjects will never be available and a 
direct proof of a causative relationship between chemical 
exposures and PGW illnesses may be unattainable. However, the 
circumstantial evidence is overwhelming.
    There is also strong existing medical bias against the 
spectrum of illnesses described as neuro-immunological central 
nervous system disorders. Dr. Clauw said ``it appears that 
there is a group of closely related systemic conditions, such 
as fibromyalgia and chronic fatigue syndrome, as well as a 
group of closely related organ-specific conditions, such as 
migraine headaches and irritable bowel syndrome, that form one 
large spectrum of illness with common demographics, inciting 
factors and treatment.'' \368\
---------------------------------------------------------------------------
    \368\ Testimony of Daniel Clauw, Human Resources Subcommittee 
hearings, Nos. 1-4, p. 178.
---------------------------------------------------------------------------
    Many of the disease conditions of which Gulf War veterans 
complain, such as chronic fatigue syndrome, fibromyalgia, 
multiple chemical sensitivity are poorly understood and only 
recently characterized by standardized diagnostic criteria. Dr. 
Clauw testified, ``The countless individuals who were 
previously healthy, who returned from the war with severe 
symptoms, are compelling evidence that these individuals 
developed these illnesses as a result of their military 
service.'' \369\
---------------------------------------------------------------------------
    \369\ Ibid., p. 179.
---------------------------------------------------------------------------
    He added:

          much more funding is needed for research into this 
        whole spectrum of conditions. The problems regarding 
        the diagnosis and treatment of Persian Gulf veterans 
        are a symptom of a much bigger problem that we have in 
        this country. Amazingly enough, despite the very high 
        prevalence of these illnesses in the population, the 
        aggregate amount of yearly funding for these 
        conditions, through all of the institutes at the NIH, 
        and through other sources such as the DOD, may perhaps 
        reach $20 million. This spectrum of illnesses cost the 
        government alone billions of dollars in lost 
        productivity disability and health care costs. The 
        costs to the private sector are much larger.\370\
---------------------------------------------------------------------------
    \370\ Ibid., p. 180.

    GAO testified, ``We found that the bulk of ongoing Federal 
research on Gulf War veterans' illnesses focuses on the 
epidemiological study of the prevalence and the cause of the 
illnesses.'' \371\
---------------------------------------------------------------------------
    \371\ See supra note 196, p. 51.
---------------------------------------------------------------------------
    GAO concluded, ``the ongoing epidemiological research will 
not be able to provide precise, accurate, and conclusive 
answers regarding the causes of veterans' illnesses because of 
these formidable methodological problems.'' \372\ GAO 
recommended that ``the Secretaries of Defense and Veterans 
Affairs (1) set up a plan for monitoring the clinical progress 
of Gulf War veterans to help promote effective treatment and 
better direct the research agenda and (2) give greater priority 
to research on effective treatment for ill veterans and on low-
level exposures to chemicals and their interactive effects and 
less priority to further epidemiological studies.'' \373\
---------------------------------------------------------------------------
    \372\ Ibid., p. 54.
    \373\ Ibid., p. 59.
---------------------------------------------------------------------------
    VA has not sought a case definition for PGW illness and 
this has hampered development of a set of diagnostic criteria 
which would enable treating physicians to identify and 
correctly diagnose sick veterans.
    In 1994, the Center for Disease Control and Prevention's 
[CDC] Dr. William C. Reeves, began developing a working case 
definition of PGW symptoms. CDC utilized this case definition 
to determine epidemiologically that Gulf-related illnesses are 
more frequent in PGW veterans than non-deployed troops. VA did 
not initiate action to determine a case definition when it 
began receiving reports of PGW illnesses in 1991. As a result, 
3 valuable years were lost.

Finding 18: The FDA was passive in granting and failing to enforce the 
        conditions of a waiver to permit use of PB by DOD.

    Immediately prior to Operation Desert Shield, the Assistant 
Secretary of Defense for Health Affairs requested that HHS 
waive the requirement to obtain informed consent from military 
personnel for use of non-approved drugs and biologics because 
under military combat exigencies it was not feasible. The 
Pentagon argued that the policy of individual informed consent 
is not feasible in battlefield conditions and runs counter to 
the needs of the unit as a whole. If the military gave soldiers 
the choice of accepting or refusing to take an Investigational 
New Drug [IND], those who chose not to take the drugs would 
violate their overriding obligation both to their unit and to 
the military, and the military would violate its obligation to 
protect the soldiers. Soldiers who refused to take an 
Investigational New Drug would place themselves at risk and 
expose others in their unit to harm as well.
    On December 21, 1990, FDA issued an interim regulation to 
amend its current informed consent regulations to permit the 
Commissioner of Food and Drugs to make the determination that 
obtaining informed consent from military personnel for the use 
of an investigational drug or biologic is not feasible in 
certain battlefield or combat-related situations.
    The regulation had an immediate effective date because of 
the urgency created by Operation Desert Shield.
    DOD requested waivers from FDA to administer three drugs to 
protect troops from biological or chemical attack. FDA denied 
one of the requests, but granted waivers for an unlicensed 
polyvalent vaccine against botulism and for pyridostigmine 
bromide [PB] as a wartime contingency pretreatment for nerve 
gas exposure. PB was approved by FDA for the treatment of 
myasthenia gravis, a neuromuscular disorder, but not as a 
prophylactic against nerve gas.
    In such situations where informed consent was not feasible, 
FDA's interim regulation required that, ``DOD collect data on 
any use of these products without informed consent. FDA will 
review these data and will revoke or modify the determination 
if the review indicates that the determination is no longer 
appropriate.''
    However, HHS staff members have informed subcommittee staff 
that DOD did not collect the required data and FDA has not 
aggressively pursued DOD's violation of the FDA-DOD agreement.
    DOD has admitted that the information sheets which FDA 
required as a condition of the waiver, were never provided to 
military personnel ordered to take the vaccines and PB. As a 
result, Gulf War veterans did not know to include this 
information in their medical records or to mention the 
exposures when seeking medical care for PGW illnesses.
    FDA's Interim Final Rule permitting waiver of informed 
consent for use of unapproved products in a military exigency 
is still in effect. The Presidential Advisory Committee on Gulf 
War Veterans' Illnesses' [PAC] expressed concern in its 
December 1996 report ``about the amount of time FDA is taking 
to move forward with opening up the Interim Final Rule--which 
was issued almost 6 years ago for public comment.'' \374\
---------------------------------------------------------------------------
    \374\ PAC Report, p. 27.
---------------------------------------------------------------------------
    The PAC recommended, ``If FDA decides to reissue the 
Interim Final Rule as final, it should first issue a Notice of 
Proposed Rulemaking. Among the areas that specifically should 
be revisited are: Adequacy of disclosure to service personnel; 
adequacy of recordkeeping; long-term follow up of individuals 
who receive investigational products; review by an 
institutional review board outside of DOD; and additional 
procedures to enhance understanding, oversight, and 
accountability.'' \375\
---------------------------------------------------------------------------
    \375\ PAC Report, p. 52.
---------------------------------------------------------------------------
    On July 29, 1997, more than 7 years after FDA issued the 
waiver, the agency published a request for comments in the 
Federal Register, soliciting public comments on the following 
issues: whether FDA should revoke or maned the interim rule of 
December 1990 and if the latter, whether and how it should be 
amended; when is it ethical to expose volunteers to toxic 
chemical and biological agents to test the effectiveness of 
products that may be used to provide potential protection 
against those agents; and if the products that may be used for 
protection against toxic substances cannot be ethically tested 
in humans, what evidence would be needed to adequately 
demonstrate their safety and effectiveness.
    The comment period closed October 30, 1997. After 
evaluating the responses, FDA will publish a proposal for 
action.

                          IV. Recommendations

                               Diagnosis

Recommendation 1: Congress should enact a Gulf War toxic exposure act 
        establishing the presumption, as a matter of law, that veterans 
        were exposed to hazardous materials known to have been present 
        in the war theater.

    The premise of both VA and DOD approaches to Gulf War 
veterans illnesses has been that toxic exposures played no role 
in causing the mysterious range of maladies known as ``Gulf War 
Syndrome.'' That presumption is no longer warranted.
    The widespread presence of a host of hazardous substances 
throughout the war theater, including low levels of chemical 
warfare agents in some areas, has been well established.\376\ 
In sufficient doses, each of those substances has been cited as 
a public health threat.\377\ That U.S. troops were widely and 
frequently exposed to one or more of these substances, i.e., 
smoke from oil well fires, PB tablets or ``tabs,'' 
organophosphate pesticides, has never been denied.
---------------------------------------------------------------------------
    \376\ See supra text accompanying note 7.
    \377\ Report to Congress 1993, 1994, 1995, p. 55, U.S. Department 
of Health and Human Services, Agency for Toxic Substances and Disease 
Registry, Atlanta, GA (1997).
---------------------------------------------------------------------------
    What has been so long denied is that the admitted exposures 
were of any long term clinical significance. Yet it is only in 
the long term that a causal link between exposures and 
subsequent health effects in those exposed will be demonstrable 
using standard epidemiological analysis.
    In the meantime, sick veterans and their families bear the 
burden of trying to prove not only that exposures took place, 
but in what quantity and in what combination(s). But in 
attempting to reconstruct their medical histories for this 
purpose, veterans find key records missing or unavailable. 
Inoculation records were not maintained for many. Information 
on the use of PB tabs was not recorded. Troop location data is 
not available below the unit level, making it impossible to 
place individuals in areas known to have been contaminated. NBC 
logs are missing.
    Establishing a presumption of exposure to the hazardous 
substances known to have permeated the war area would lift that 
impossible burden. It would place the onus properly on Federal 
officials to rebut the presumption with peer reviewed research 
and clinical findings. Such a presumption would free the VA and 
DOD of the unworthy task of defending an improbable version of 
what did not happen in the Gulf War, and allow them to support 
veterans in proving what did happen there. It would also serve 
U.S. military doctrine by assuring future combatants that the 
wounds of war, however delayed or difficult to diagnose, will 
be acknowledged and treated.
    In the absence of definitive scientific information, 
reasonable presumptions must be made. Citing just such an 
absence of scientific consensus, the Pentagon and the VA 
continue to presume toxic exposures play no significant role in 
the etiology of Gulf War illnesses. However, given the weight 
of evidence regarding toxic exposures and probable health 
effects, that presumption may never have been, but is certainly 
no longer, reasonable.

Recommendation 2: The VA should contract with an independent scientific 
        body composed of non-Government scientific experts 
        representing, at a minimum, the disciplines of toxicology, 
        immunology, microbiology, molecular biology, genetics, 
        biochemistry, chemistry, epidemiology, medicine and public 
        health for the purpose of identifying those diseases and 
        illnesses associated in peer-reviewed literature with singular, 
        sustained, or combined exposures to the hazardous materials to 
        which Gulf War veterans are presumed to have been exposed.

    Despite subsequent recommendations in this report to divest 
VA and DOD of control over the Gulf War research agenda, this 
proposal is made so the departments have access to the 
objective expertise necessary to implement Recommendation 1. 
While it may have been enough in the past to say the 
Department, ``has always remained open to the possibility that 
PGW veterans were potentially exposed to a wide variety of 
hazardous agents while serving in the Southwest Asia theater of 
operations, including chemical warfare agents,'' \378\ this 
recommendation would transform that passive posture into a more 
active pursuit of information on exposures and health effects.
---------------------------------------------------------------------------
    \378\ Statement of Frances Murphy, Human Resources and 
Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 414.
---------------------------------------------------------------------------
    Particularly in view of the many variables and innumerable 
combinations of likely Gulf War exposures, the VA must be in a 
position to pursue complex, interdisciplinary hypotheses 
regarding toxic stressors.\379\ The list of presumed exposures 
will need to be updated and refined. This recommendation seeks 
to ensure VA maintains adequate scientific breadth in that 
process, and does not fall prey to a static view of exposure 
health effects.
---------------------------------------------------------------------------
    \379\ See also Recommendations 5, 16 and 17, infra.
---------------------------------------------------------------------------

Recommendation 3: The VA Gulf War Registry and the DOD Comprehensive 
        Clinical Evaluation Program should be re-evaluated by an 
        independent scientific body which shall make specific 
        recommendations to change both programs from crude research 
        tools into effective clinical diagnosis and outcomes monitoring 
        efforts.

    The subcommittee found serious weaknesses in the structure 
and implementation of the Gulf War health registry 
programs.\380\ VA officials characterized their Registry as ``a 
very crude health surveillance tool,'' \381\ and a primary 
source of promising hypotheses for subsequent research. 
However, in practice, promising but inconvenient hypotheses 
about the role of chemical exposures were not pursued. Instead, 
they were dismissed as biased by the self-selected nature of 
the Registry cohort. Dr. Murphy told the subcommittee, ``It 
should be remembered that the Registry and other examination 
program data are provided through medical records of self-
selected health care-seeking individuals and is not likely to 
be reflective of the entire population of Persian Gulf War 
veterans.'' \382\
---------------------------------------------------------------------------
    \380\ See findings 5, 6, 7, 10 and 12, supra.
    \381\ Testimony of Frances Murphy, Human Resources and 
Intergovernmental Relations Subcommittee hearings No. 1-4, p. 435.
    \382\ Ibid., p. 412.
---------------------------------------------------------------------------
    Not even near unanimity could overcome VA's resistance to 
drawing conclusions from their own Registry data. ``In 1992 
Physician Registry staff documented that 93 percent of Persian 
Gulf War veterans reported they had been exposed to 1 or more 
of the 12 contaminants. This percentage declined to a low of 87 
percent in 1993, and increased to a high of 98 percent by 
1996.'' \383\ Yet the effects of low level chemical exposures 
did not become a research priority for the VA until after the 
announcement of probable exposures at Khamisiyah.\384\
---------------------------------------------------------------------------
    \383\ See supra note 227, p. 5.
    \384\ See supra note 381, p. 414.
---------------------------------------------------------------------------
    VA was far less constrained about drawing favorable 
inferences, however subtly, from Registry data. After 
appropriate disclaimers about the limitations of Registry data 
as epidemiological tools, Former VA Secretary Jesse Brown 
nevertheless concluded, ``If there were a neurotoxic exposure 
that could cause serious neurologic disease in a high 
proportion of Persian Gulf veterans, it would probably have 
been identified in the 60,000 Registry exams completed to 
date.'' \385\
---------------------------------------------------------------------------
    \385\ See supra text of letter from Jesse Brown to Chairman Shays 
in Background section. See also, attachments to chairman's opening 
statement, Human Resources and Intergovernmental Relations Subcommittee 
hearings, Nos. 5-6, p. 14.
---------------------------------------------------------------------------
    The VA can't continue to have it both ways in the use of 
Registry information--disclaiming unwelcome propositions while 
embracing favorable conclusions grounded in the same data. To 
be of value to veterans, participation in the Registry should 
demonstrably improve his or her health as well as advance what 
can be known about the health of all Gulf War veterans. That 
will require greater use of the VA Referral Centers and the 
addition of outcomes monitoring as an integral part of the 
Registry program.\386\
---------------------------------------------------------------------------
    \386\ See infra Recommendations 4 and 9.
---------------------------------------------------------------------------
    The Institute of Medicine [IOM] is about to complete 
studies of the VA and DOD Registry programs. Perhaps that work 
could be continued to arrive at recommendations for more 
fundamental changes in the design and implementation of the 
programs to address the serious weaknesses noted by the 
subcommittee, GAO and others, and to suggest safeguards against 
the selective use of health registry data.

Recommendation 4: The VA should refer all Phase II Registry 
        examinations to Gulf War Referral Centers.

    Only 2.6 percent of veterans' cases VA reported as having 
undiagnosable illnesses were evaluated at Gulf War Referral 
Centers.\387\ It appears the Uniform Case Assessment Protocol 
used by both the VA and DOD is not being consistently followed, 
and often permits a description of symptoms to serve as a 
diagnosis.\388\
---------------------------------------------------------------------------
    \387\ See supra note 227, p. 5 [390 of 15,000 cases].
    \388\ Ibid., p. 4.
---------------------------------------------------------------------------
    This lack of aggressive inquiry leaves the VA without the 
body of detailed test results and clinical assessments needed 
to discern the subtle manifestations of delayed neuropathies. 
Absent more effective use of the Referral Centers, the Registry 
will remain a mere inventory of inconsistently gathered case 
histories.

Recommendation 5: The VA should add toxicological and environmental 
        medicine expertise to the staff resources dedicated to Gulf War 
        illnesses.

    In the December 11, 1996 subcommittee hearing, Chairman 
Shays asked Dr. Frances Murphy of the VA how many toxicologists 
and environmental medicine specialists were among the estimated 
14,000 VA physicians (approximately 8,000 full-time and 6,000 
part-time).
    Dr. Murphy could not answer the question, other than to 
name two physicians, but did say such experts usually work in 
health care organizations, research laboratories, or agencies 
like the EPA. Dr. Murphy promised to provide an answer for the 
record.\389\
---------------------------------------------------------------------------
    \389\ See supra note 174.
---------------------------------------------------------------------------
    One of the reasons VA doctors have been unable to diagnose 
and treat the illnesses of some Gulf veterans is the lack of 
expertise in the specialties of toxicology and environmental 
medicine. Dr. Robert Haley, University of Texas Medical Center 
researcher, stated in testimony before the subcommittee in 
January 1997, that ``few regular physicians are familiar with 
OPIDPN [organophosphate-induced-delayed-polyneuropathy] . . . 
this probably explains why no one [in the VA] explored this 
diagnosis earlier.'' \390\
---------------------------------------------------------------------------
    \390\ See supra note 325.
---------------------------------------------------------------------------
    In response to Representative Shays' question, the 
following letter was received from Dr. Kenneth Kizer \391\ on 
June 6, 1997:
---------------------------------------------------------------------------
    \391\ Letter in subcommittee files.





    The subcommittee supports the VA's belated effort on this 
matter and encourages an aggressive program to bring such 
expertise into the Department as quickly as possible. Such an 
effort, accompanied by a sincere communications effort on the 
part of VA headquarters to physicians in the field, would help 
restore confidence in the VA's medical protocols among Gulf 
veterans and the Congress.

Recommendation 6: DOD and VA should make every effort to find, and 
        where necessary re-create through veterans' testimony, 
        individual Gulf War medical records to reflect vaccines 
        administered, PB use, and exposure to DU, pesticides and other 
        hazardous materials.

    According to the GAO, ongoing epidemiological research 
sponsored by the VA and DOD is being hampered by the inability 
of researchers ``to gather information about toxic exposures. 
DOD has acknowledged that the records of the use of PB and 
vaccinations to protect against chemical and biological warfare 
exposures were inadequate. There is research going on right now 
to try to find the majority of the records, which seem to be 
missing. Classifying the symptoms and identifying illnesses of 
Gulf War veterans has been difficult. As a result, the findings 
from these studies may be spurious or equivocal. In summary, 
the ongoing epidemiological research will not be able to 
provide precise, accurate, and conclusive answers regarding the 
causes of the illnesses because of these formidable 
methological problems.'' \392\
---------------------------------------------------------------------------
    \392\ Statement of Donna Hevilin, Human Resources Subcommittee 
hearings, No. 3, p. 38.
---------------------------------------------------------------------------
    An IOM report stated: ``The committee has concluded that 
the information on veterans' health that exists in the [DOD and 
VA health] registries cannot serve alone as a basis for 
scientific study of the health effects of the Persian Gulf War. 
Lack of uniform and retrievable medical information concerning 
reserve, National Guard, active, and separated forces has 
greatly inhibited systematic analysis of the health effects of 
mobilization. Neither the DOD nor VA has automated outpatient 
recordkeeping. Current systems are fragmented, disorganized, 
incomplete, and therefore poorly suited to support 
epidemiologic and health outcome studies.'' \393\
---------------------------------------------------------------------------
    \393\ See supra note 125, pp. 6-7.
---------------------------------------------------------------------------
    According to the PAC Final Report, ``We found DOD's 
inability to produce records of who received PB or BT 
[botulinum toxoid] indicative of much need for wholesale 
improvement in the government's performance on medical 
recordkeeping during military engagements. DOD should assign a 
high priority to dealing with the problem of lost or missing 
medical records. A computerized data base is important. 
Attention should be directed toward developing a mechanism for 
computerizing medical data in the field. DOD and VA should 
adopt standardized recordkeeping to ensure continuity.'' \394\
---------------------------------------------------------------------------
    \394\ See supra note 138, pp. 18-19.
---------------------------------------------------------------------------
    Missing or inadequate personal medical records, along with 
missing or destroyed NBC logs, and unreleased CIA intelligence 
logs, comprise the complete medical history of each Gulf War 
veteran. In the absence of this critical information, sick 
veterans have a difficult--if not impossible--task of receiving 
proper medical treatment and fair compensation. DOD and VA 
should make every effort to find these records,\395\ and where 
necessary recreate them through listening carefully to 
veterans' testimony. Under these present conditions, the burden 
of proving a service-connected disability should not fall on 
the sick veteran but upon the government. In other words, the 
sick Gulf War veteran should be given benefit of the doubt.
---------------------------------------------------------------------------
    \395\ See text to accompany note 181. See also, Background section 
entitled ``Other Executive Agency Actions on Gulf Veterans' 
Illnesses.'' [On October 21, 1997, the Department of Defense Inspector 
General informed the subcommittee that the investigation into missing 
nuclear, biological and chemical logs had been completed. Only 37 of an 
estimated 200 pages of log entries are retrievable, all in hard copy 
form. Print-outs of the complete logs, and the computer disks and 
drives on which they were stored, cannot be found. The investigation 
discovered a 20-page document containing 165 missing entries, or 
approximately 15 new log pages. The IG found that regulations and 
guidelines on the preservation and archiving of Gulf War documents were 
not followed by CENTCOM. Although the officer found in possession of 
the mission log extracts is under criminal investigation, the IG did 
not receive any evidence that individuals or organizations conducted a 
concerted effort or conspiracy to destroy or conceal the logs.]
---------------------------------------------------------------------------

Recommendation 7: The President should order an intensified effort to 
        declassify Gulf War documents in any way related to Gulf War 
        veterans' illnesses and should personally certify to the 
        appropriate committees of Congress when he deems 
        declassification of such documents to be against the national 
        interest.

    After 6 years, it should be clear by now that ordinary 
processes of Government inquiry and disclosure will not yield 
solutions to the mysteries of Gulf War veterans illnesses. 
Extraordinary steps must now be taken to declassify and 
disseminate all information in any way pertinent to the health 
of those who served.
    The disclosure of Central Intelligence Agency [CIA] reports 
regarding chemical weapons at the Khamisiyah munitions depot, 
and the apparent loss or destruction of more than three 
quarters of the chemical weapons logs produced during the Gulf 
War, appear to confirm what many have long suspected about a 
systematic, and to date largely successful, effort to minimize, 
discredit or suppress intelligence data on alleged chemical 
exposures.
    To a sick veteran, the missing unit logs, chemical 
detection reports and intelligence analyses are not just 
military records. They are medical records essential to the 
proper diagnosis and treatment of Gulf War-related illnesses. 
The current DOD system of random, unannounced posting of newly 
discovered documents on the Internet simply does not meet 
demands by veterans and Congress for timely, full disclosure.
    The so-called ``firewall'' erected to protect intelligence 
sources and methods must yield in this instance to the 
president's own promise that ``no stone remain unturned'' in 
the search for answers to Gulf War veterans' illnesses. 
Moreover, if the intelligence sources and methods sought to be 
protected also formed the basis of the long-held, but now 
discredited, Pentagon and CIA conclusion that stories of 
chemical weapons at Khamisiyah were an Iraqi ruse, then those 
sources and methods were unreliable, unworthy of continued 
protection, and far less valuable to the national interest than 
the health of United States veterans.
    Therefore, the President should direct an immediate and 
expanded declassification review of all CIA and Defense 
Department intelligence dealing in any way with chemical or 
biological exposures in the Gulf War, and that all such 
information be made available to Congress unless the President 
personally determines disclosure would be harmful to the 
national security.

Recommendation 8: DOD failure to adhere to recordkeeping requirements 
        or clinical protocols under an informed consent waiver should 
        result in the presumption of service-connection for any 
        subsequent illness(es) suffered by service personnel to whom 
        the drug or protocol was administered.

    FDA's Deputy Commissioner Mary Pendergast told the 
subcommittee at a May 8, 1997 hearing on informed consent that 
``Under this regulation, waivers were granted for two products 
during Operation Desert Storm/Shield--pyridostigmine bromide 
and botulinum toxoid vaccine. Although FDA had concluded that 
informed consent was not feasible, FDA did obtain DOD's 
agreement to provide accurate, fair and balanced information to 
those who would receive the investigational products. To do 
this, DOD developed information leaflets on both products with 
FDA's input and these leaflets received final FDA approval.'' 
\396\
---------------------------------------------------------------------------
    \396\ Hearing on Oversight of NIH and FDA: Bio-Ethics and the 
Adequacy of Informed Consent, [hereinafter ``Human Resources 
Subcommittee hearing of May 8, 1997''] (Statement of Mary Pendergast, 
FDA Deputy Commissioner) (prepared statement p. 37, in subcommittee 
files).
---------------------------------------------------------------------------
    FDA has acknowledged that the information sheets were not 
provided to many Gulf personnel who were ordered to take the 
unapproved drug and vaccine. In testimony before the 
subcommittee, Deputy Commissioner Pendergast testified ``were 
we [FDA] even to consider another waiver request, the specific 
standards would have to be much higher and more rigorous 
because of the [DOD] failures.'' \397\
---------------------------------------------------------------------------
    \397\ Testimony of Mary Pendergast, Human Resources Subcommittee 
hearing of May 8, 1997, original transcript, p. 59 (in subcommittee 
files).
---------------------------------------------------------------------------
    It is unfair to require the veteran to prove he or she was 
exposed to either the PB or the vaccine in light of DOD's 
blatant failure to adhere to the notification requirements of 
the FDA waiver.

                               Treatment

Recommendation 9: VA and DOD should systematically and effectively 
        monitor the clinical progress of Gulf War veterans to determine 
        the most effective treatments.

    The June 24, 1997 GAO report found that the VA has no 
program, plans or systematic way of following the clinical 
progress of sick Gulf War veterans. As a result, VA physicians 
treating these veterans have no way of knowing whether the 
veterans who continue to be ill are better off today than when 
they were first examined and treated. Scientific analysis 
requires the ability to draw conclusions based on objective and 
accurate scientific data. The GAO study found that the VA and 
DOD have made no effort to track veterans' progress and 
treatment on a methodical, data-based system.\398\
---------------------------------------------------------------------------
    \398\ See supra text to accompanying note 196.
---------------------------------------------------------------------------
    Dr. Murphy responded there is no protocol because therapy 
and the follow-up need to be tailored to the individual 
veteran. However, evidence shows that veterans are not 
receiving consistent follow-up care. If progress is only 
recorded individually, then those treatments deemed successful 
will have little or no impact on medical research efforts and 
have limited significance for other veterans.\399\
---------------------------------------------------------------------------
    \399\ See supra text to accompanying note 336.
---------------------------------------------------------------------------
    The subcommittee recommends that the VA and DOD immediately 
develop and implement a plan to systematically monitor the 
diagnosis and treatment of all Gulf veterans with reported 
symptoms as well as those who may become ill in the future. 
This action on the part of the VA and DOD would provide a much-
needed medical benchmark against which treatment progress, or 
lack of progress, can be measured for sick Gulf War veterans.

Recommendation 10: VA and DOD clinicians should be encouraged to 
        pursue, and should be trained in, new treatment approaches to 
        suspected neurotoxic exposure effects.

    Private physicians have reported some success in treating 
Gulf veterans--treatment approaches which have been ignored or 
rejected by the VA and DOD medical hierarchies since the 
illnesses were first reported more than 5 years ago. Dr. Howard 
Urnovitz testified: ``Recent studies have found that prolonged 
and aggressive antibiotic therapy appears to abate many of the 
symptoms associated with Gulf War Syndrome.'' \400\
---------------------------------------------------------------------------
    \400\ See supra text to accompanying note 90.
---------------------------------------------------------------------------
    Dr. Garth Nicolson testified that among the Gulf veterans 
he has examined, he found ``. . . a slow-growing mycoplasma 
located deep inside blood leukocytes of slightly under one-half 
of Gulf War patients studied. Mycoplasmal infections, such as 
Mycoplasma fermentans, can be successfully treated with 
multiple courses of specific antibiotics, such as 
doxycycline.'' \401\
---------------------------------------------------------------------------
    \401\ See supra text accompanying note 92.
---------------------------------------------------------------------------
    Dr. William Baumzweiger has reported successful treatments 
of Gulf veterans with calcium channel blockers. Dr. Katherine 
Leisure-Murray also reported improvement in some of her Gulf 
patients with alternative treatments. Both physicians were 
formerly with the VA but terminated, they allege, because of 
their professional opinions as to the cause and treatment of 
Gulf veterans' illnesses, opinions in opposition to VA 
headquarters policy.\402\
---------------------------------------------------------------------------
    \402\ See supra text accompanying note 189.
---------------------------------------------------------------------------
    The subcommittee has received reports from VA doctors in 
addition to Drs. Baumzweiger and Leisure of harassment, 
threats, and denial of certain tests and treatments by their 
supervisors. Such restrictions could be considered a violation 
of medical ethics, if not medical malpractice.
    The subcommittee recommends that the VA and DOD encourage 
their physicians to train in, and actively pursue, new 
treatment approaches to suspected neurotoxic exposure effects. 
This encouragement would also include allowing Government 
doctors to consult with private physicians who have reported 
some successful treatments with Gulf War patients. Such an 
effort by the departments, accompanied by a sincere and ongoing 
communications effort to VA supervisors in the field, would 
help alter a perception by veterans and the subcommittee that 
the VA, in complicity with field supervisors, has conspired to 
stifle VA physicians from fully and freely practicing medicine 
on behalf of their Gulf patients.

Recommendation 11: The diagnoses for somatoform disorders and Post 
        Traumatic Stress Disorder [PTSD] should be refined to insure 
        that physiological causes are not overlooked.

    In the absence of definitive medical evidence to explain 
the mysterious illnesses of Gulf veterans, DOD and VA 
physicians assumed the causes of many of these illnesses were 
stress-related or PTSD. Through subcommittee testimony, letters 
and phone calls, sick veterans have universally rejected 
psychiatric problems as an accurate diagnosis of their physical 
illnesses.\403\ Many private physicians and research experts 
have also rejected stress as an important factor in these 
illnesses.\404\
---------------------------------------------------------------------------
    \403\ See supra text accompanying notes 11-39.
    \404\ See supra text accompanying notes 185-194.
---------------------------------------------------------------------------
    The GAO report recommended: ``The Secretaries of Defense 
and Veterans Affairs refine the current approaches of the 
clinical and research programs for diagnosing PTSD consistent 
with suggestions recently made by the Institute of Medicine.'' 
\405\ The DOD partially concurs with this recommendation; \406\ 
the VA does not concur.\407\ The Persian Gulf Veterans 
Coordinating Board, which includes DOD and VA representatives, 
stated: ``Published findings suggest an increased prevalence of 
PTSD and other psychiatric diagnoses, such as depression . . . 
[and that] stressors during the Persian Gulf conflict were 
sufficient to cause significant psychiatric morbidity.'' \408\ 
The PAC Final Report also states that ``stress is an important 
contributing factor'' in the veterans' illnesses.\409\
---------------------------------------------------------------------------
    \405\ See supra note 48, p. 70.
    \406\ Ibid.
    \407\ Ibid., p. 85.
    \408\ Ibid., p. 57.
    \409\ Ibid., p. 56.
---------------------------------------------------------------------------
    The GAO report stated: ``The link between stress and those 
veterans' physical symptoms has not been firmly established [by 
DOD, VA and the PAC].''\410\
---------------------------------------------------------------------------
    \410\ Ibid., p. 8.
---------------------------------------------------------------------------
    The subcommittee, in view of the fact that there is no 
credible evidence that stress or PTSD is the principal cause of 
the veterans' illnesses, recommends that the DOD and VA re-
evaluate and refine the definition of stress as it applies to 
Gulf veterans' diagnoses. Such a re-definition would create a 
new and much-needed diagnostic and treatment attitude among VA 
field physicians which could translate into improved medical 
care for sick Gulf veterans.

                              Compensation

Recommendation 12: Denials of Gulf War veterans' compensation claims 
        attributable in any way to missing medical records should be 
        reviewed and veterans' given the benefit of any doubt regarding 
        the presumptive role of toxic exposures in causing post-war 
        illnesses and disability.

    Personal medical records of Gulf veterans are missing or 
inadequate. Documents which could help verify possible 
exposures and military unit locations remain in DOD files. Most 
of the military nuclear-biological-chemical [NBC] logs, which 
are records of toxic warfare agent detections, are missing or 
destroyed. Readouts from chemical detection equipment have 
vanished. Many CIA intelligence logs concerning Iraqi chemical/
biological weapons [CBW] storage depots and manufacturing 
facilities, and document regarding enemy capabilities and 
intentions to use CBW against United States troops, have 
remained unreleased since the war.\411\
---------------------------------------------------------------------------
    \411\ See supra text accompanying note 181.
---------------------------------------------------------------------------
    All this critical information represents the complete 
medical history of each Gulf War veteran. In the absence of 
full documentation needed to prove a service-connection, sick 
veterans have a difficult--if not impossible--task of receiving 
proper medical treatment and fair compensation.
    This situation, combined with the fact that overwhelming 
evidence exists of multiple toxic exposures to Gulf War troops, 
has led the subcommittee to strongly recommend that sick 
veterans be given the benefit of the doubt regarding their 
post-war illness and disability. Those sick veterans should be 
considered ``presumed exposed'' and, therefore, entitled to 
full medical treatment and fair financial compensation.

Recommendation 13: For purposes of compensation determinations, 
        disabilities associated with presumed exposures should be 
        deemed service-connected without any limitation as to time.

    Under regulations issued in 1995, a veterans can be 
compensated only for undiagnosed illnesses that manifest 
themselves during Gulf War service or arise within 2 years of 
departing from the Gulf. Veterans must provide objective 
evidence of chronic illness and be at least 10 percent 
disabled. As of January 1997, the VA had denied 93.5 percent of 
the more than 10,000 undiagnosed illness claims that had been 
reviewed. Approximately 55 percent of the denied claims were 
rejected because the illness did not manifest itself until 
after the 2-year presumptive period. In March 1997, President 
Clinton extended the presumptive period by 8 years, until 
December 31, 2001. The VA plans to reconsider those claims 
denied because they were filed after the 2-year presumptive 
limitation.\412\
---------------------------------------------------------------------------
    \412\ See supra text accompanying note 183.
---------------------------------------------------------------------------
    However, veterans and veterans organizations are concerned 
that symptoms from toxic exposures may develop beyond the year 
2001 from diseases with long latency periods, such as some 
forms of cancer, leishmaniasis or other infectious diseases 
that may develop from a weakened immune system. The possibility 
of late-developing illnesses are also feared by some physicians 
and researchers.
    James Tuite, director of the Gulf War Resource Foundation, 
stated to subcommittee staff that veterans of no previous wars 
faced a presumptive period for filing service-connected medical 
claims by veterans.\413\
---------------------------------------------------------------------------
    \413\ Staff notes in subcommittee files.
---------------------------------------------------------------------------
    The subcommittee, mindful of the Agent Orange toxic 
exposure problem which took Congress 20 years to resolve, is 
also concerned about late developing symptoms among Gulf 
veterans. The subcommittee strongly recommends that the 
President lift entirely the presumptive period on filing 
medical claims by Gulf War veterans for specified illnesses 
associated with presumed exposure to certain toxins known to 
have been present in the Gulf theater. This Presidential action 
will assure all veterans that a grateful Nation will not 
abandon its soldiers who suffer long-term health effects 
following its wars.

                                Research

Recommendation 14: Congress should create or designate an agency 
        independent from the Departments of Defense and Veterans 
        Affairs as the lead Federal agency responsible for coordination 
        of all research into Gulf War veterans' illnesses and 
        allocation of all research funds.

    Regrettably for sick veterans, VA research has been 
distorted by reliance on premature, erroneous, and misleading 
conclusions by DOD about the presence and effects of chemical 
weapons in the Gulf War theater. It was not until DOD admission 
of probable exposures at Khamisiyah that the Persian Gulf 
Veterans' Coordinating Board even considered the possibility of 
low level chemical exposures as the cause of PGW illnesses. Dr. 
Frances Murphy, the VA's Director of Environmental Agents 
Service, described the Department's official position on low 
level chemical exposures as the causative agent for PGW 
illnesses, ``studies of low level chemical warfare agent 
exposure were not given high priority . . . because military 
and intelligence sources had stated that U.S. troops had not 
been exposed to chemical agents. Current body of research 
proves that low level exposures cannot cause health effects.'' 
\414\
---------------------------------------------------------------------------
    \414\ See supra note 166.
---------------------------------------------------------------------------
    Testimony presented to the subcommittee strongly suggests 
that VA relied heavily on somatoform and stress-related 
diagnoses in sick PGW veterans. Twenty one Gulf veterans, sick 
with undiagnosed illnesses, testified before the subcommittee. 
Of those 21 veterans, 13 received stress or PTSD diagnoses, 3 
received a diagnosis of no illness or psychosomatic, 3 cases 
were undiagnosed and only 2 were diagnosed with chemical 
exposure.\415\
---------------------------------------------------------------------------
    \415\ See supra note 190.
---------------------------------------------------------------------------
    The VA also failed to heed the advice of its advisory 
committee, the Gulf War Expert Scientific Committee, on the 
possibility of toxic exposures. Both the chairman, Dr. Eula 
Bingham (a toxicologist and former chairman of OSHA) and 
committee member Dr. Claudia Miller (a physician and 
environmental research professor), stated in interviews with 
the New York Times that the VA was relying inappropriately on 
stress diagnoses despite knowledge of toxic exposures during 
the war.\416\
---------------------------------------------------------------------------
    \416\ Ibid.
---------------------------------------------------------------------------
    At the same time the Coordinating Board was denying the 
relationship between chemical exposures and PGW illnesses, it 
also denied funding to Dr. Robert Haley and his colleagues at 
the University of Texas Southwestern Medical Center to study 
chemical exposures in PGW veterans. Dr. Haley found private, 
non-Government funding and published several studies in the 
January 15, 1997 issue of the Journal of the American Medical 
Association, confirming evidence of immunological damage to PGW 
troops produced by combinations of chemical exposures.
    DOD and VA's Persian Gulf Veterans' Coordinating Board has 
performed reactively and to the detriment of the veterans. 
Having demonstrated unwillingness and inability to overcome 
institutional biases and constraints, the DOD and VA should no 
longer control the PGW illness research agenda. Lead 
responsibility for both the research program and research funds 
should go to another agency outside of DOD and VA that can more 
objectively develop a research agenda and treatment protocols 
for sick veterans.

Recommendation 15: The lead Federal agency on Gulf War veterans' 
        illnesses should focus research on the evaluation and treatment 
        of the common spectrum of neuroimmunological disorders known as 
        Gulf War Syndrome, multiple chemical sensitivity, chronic 
        fatigue syndrome and fibromyalgia.

    The Federal Government has numerous agencies conducting 
uncoordinated research on neuroimmunological disorders. HHS has 
established an interagency Chronic Fatigue Syndrome Working 
Group, which is chaired by the Assistant Secretary for Health.
    Many of the National Institutes of Health, including the 
National Institute of Environmental Health Sciences [NIEHS], 
National Institute of Allergy and Infectious Diseases [NIAID], 
National Institute of Arthritis and Musculoskeletal and Skin 
Diseases [NIAMS], National Institute of Child Health and Human 
Development [NICHD], and National Institute of Dental Research 
[NIDR], are conducting research on multiple chemical 
sensitivity, fibromyalgia and chronic fatigue syndrome.
    CDC has an ongoing epidemiological study of Persian Gulf 
War veterans which has resulted in a case definition. CDC's 
National Institute of Occupational Safety and Health [NIOSH] is 
conducting research on exposures to organophosphates. VA and 
DOD are pursuing their own independent research agendas.
    However the neuroimmunological injuries occurred to PGW 
veterans and others affected by similar disorders, the fact 
remains that evaluation criteria are lacking, definitive 
diagnostic tests are not yet accepted, and treatment of these 
disorders remains symptomatic and is often unavailable to 
patients in need.

Recommendation 16: DOD and VA medical systems should augment research 
        and clinical capabilities with regard to women's health issues 
        and the health effects of combat service on women's health.

    The Persian Gulf War was the first military action in which 
women were deployed in large numbers in combat situations. Dr. 
Penny Pierce, a PGW veteran and scientist who has conducted 
comparative studies on the health of female PGW veterans before 
and after deployment, found ``the incidence of gender-specific 
health problems, in particular, warrants further attention and 
points directly to the unique health care needs of military 
women. Specifically there is a need for rigorous follow-up on 
the significant findings concerning changes in breast lumps and 
cervical alterations that are reflected in the two-fold 
increase among women serving in the Persian Gulf. We need to 
know now if there are gynecologic and reproductive problems 
that pose a risk to future generations that are beneficiaries 
of military health care.''
    Dr. Pierce concluded, ``the opportunity to study the health 
consequences of Persian Gulf women in a timely fashion meets a 
critical and long-standing need. The priorities for a national 
agenda of military women's health research should include the 
following: First, we should commit the needed resources to 
establish the prevalence of health problems of Gulf War veteran 
women in well-designed epidemiological studies. Second, we need 
to document and monitor the health effects of occupational and 
environmental extremes found in combat, to better understand 
the effects of gender, menstrual cycle, reproductive 
capability, and the interaction of these factors on the health 
and well-being of American women who serve their country in 
uniform. In this regard we must all recognize that 
environmental and occupational exposures may affect women 
differently than men and we need to have scientific information 
upon which we can reliably determine if they are preventable 
risks that are associated with specific military duties, 
certain deployment locations, or a combination of factors. The 
third priority acknowledges that women play a key role in the 
military readiness of this country and keeping them healthy is 
as vital to our Nation's defense as any other member of the 
armed forces.'' \417\
---------------------------------------------------------------------------
    \417\ Statement of Penny Pierce, Human Resources Subcommittee 
hearings, No. 1-4, p. 193-194.
---------------------------------------------------------------------------

Recommendation 17: VA, in collaboration with NIH, CDC, FDA and other 
        public health agencies should establish an interdisciplinary 
        research and clinical program on the identification, prevention 
        and treatment of environmentally induced neuropathies.

    VA and DOD will have to address environmentally induced 
neuropathies in future deployments.\418\ A research and 
clinical program which addresses treatment issues and exposure 
prevention is long overdue.
---------------------------------------------------------------------------
    \418\ Representative Sanders, joined by Representative Shays, 
pursued an amendment to the 1998 Department of Defense Authorization 
bill for 1998, H.R. 1119. The proposal would direct the Department of 
Defense, in cooperation with the Environmental health laboratory of the 
Centers for Disease Control, to develop a system capable of rapidly 
responding in cases of suspected exposure of members of the Armed 
Forces to toxic substances, in order to conduct laboratory tests to 
quickly and accurately test for the presence of toxic substances. The 
CDC reports it has the technology, like no other laboratory in the 
Government, to test for at least 100 chemicals in blood and urine, 
including heavy metals, PCBs, volatile organic compounds, pesticides 
and others. This is a pro-active, comprehensive approach to address and 
respond to potential chemical exposures during future military 
operations. The amendment was not made in order by the Rules Committee 
and therefore was not permitted to be offered on the floor of the 
House.
---------------------------------------------------------------------------
    The expertise of VA and DOD could be considerably expanded 
through coordination and collaboration with HHS. HHS has 
expertise in toxicology through the Agency for Toxic Substances 
and Disease Registry [ATSDR] and the National Institute for 
Environmental Health Sciences at the National Institutes of 
Health, the National Center for Toxicological Research at the 
Food and Drug Administration [FDA], and in epidemiology through 
the Centers for Disease Control and Prevention [CDC].
    This type of interdisciplinary research has also been 
conducted internationally, particularly in Israel and the 
Netherlands. In March 1997, the VA sponsored a 2-day symposium 
on ``The Health Effects of Low-Level Chemical Warfare Nerve 
Agent Exposure'' featuring presentations from researchers 
studying various aspects of this complex issue. Presenters 
discussed ongoing studies of Organophosphate Induced Delayed 
Polyneuropathies and clinical outcomes from exposures to 
anticholinesterases. Dr. Hermona Soreq, professor and chairman, 
Department of Biological Chemistry, Hebrew University, 
Jerusalem, Israel, described the role of genetic polymorphisms 
in effectuating certain toxic reactions. The preliminary 
results of recent animal studies, conducted in the United 
States and the Netherlands on the effects of low-level 
exposures, were also discussed. According to VA officials, the 
purpose of the conference was to generate research hypotheses 
and study proposals. This is the type of work the subcommittee 
recommends, and encourages continued strengthening of 
interdisciplinary research capacity.\419\
---------------------------------------------------------------------------
    \419\ U.S. Department of Veterans Affairs, The Health Effects of 
Low-Level Chemical Warfare Nerve Agent Exposure, a satellite symposium 
of the 36th Annual Society of Toxicology Annual Meeting, March 7-8, 
1997, Cincinnati, OH (agenda, program notes, speaker index) in 
subcommittee files.
---------------------------------------------------------------------------

Recommendation 18: FDA should grant a waiver of informed consent 
        requirements for the use of experimental or investigational 
        drugs by DOD only upon receipt of a Presidential finding of 
        efficacy and need.

    FDA has the authority under the Federal Food, Drug and 
Cosmetic Act [FFDCA] to determine a drug's safety and efficacy 
for its intended use. In the case of a future DOD request to 
waive informed consent requirements for an experimental or 
investigational drug, biologic or device, FDA can evaluate the 
clinical evidence to determine safety and effectiveness, but 
should not be in a position to evaluate combat conditions.
    FDA Deputy Commissioner Mary Pendergast acknowledged this 
in testimony before the subcommittee on May 8, 1997. ``FDA gave 
considerable deference to DOD's judgement and expertise 
regarding the feasibility of obtaining informed consent under 
battlefield conditions.'' \420\
---------------------------------------------------------------------------
    \420\ Prepared statement of Mary Pendergast, Human Resources 
Subcommittee hearing of May 8, 1997, p. 35 (in subcommittee files).
---------------------------------------------------------------------------
    She added, ``I also think that the FDA, which is an agency 
staffed with doctors and scientists and not soldiers, has a 
very limited ability to second-guess what was going on in the 
Persian Gulf during the time of the war . . .'' \421\ However, 
she acknowledged, ``Each participant in a research effort . . . 
is obliged to protect the interests of the people who are 
taking part in the experiments. The FDA's responsibility is to 
see that the safeguards are met.'' \422\
---------------------------------------------------------------------------
    \421\ Testimony of Mary Pendergast, Human Resources Subcommittee 
hearing of May 8, 1997, original transcript, p. 60 (in subcommittee 
files).
    \422\ See supra note 417, p. 2.
---------------------------------------------------------------------------
    FDA did not safeguard the interests of the PGW veterans by 
ensuring that the waiver was warranted by the protective 
effects of PB and that the conditions of the waiver were 
adhered to by DOD. DOD violated the conditions of the waiver by 
not providing the information sheets so that affected veterans 
would know of their exposures.
    Clearly, FDA should not be in the position of making 
national security determinations or weighing safety and 
efficacy requirements against national security interests. This 
is not the agency's focus and the FDA has admitted it has no 
expertise in these areas.
    The President, as Commander and Chief, should execute a 
Presidential finding of need if a determination is made that 
national security interests outweigh the informed consent 
rights of troops in combat in the future.

                              V. Appendix

                         PGW Hearing Witnesses

    1. ``The Status of Efforts to Identify Persian Gulf War 
Syndrome'' March 11, 1996. Brian Martin, Gulf veteran, Niles, 
MI; William Gleason, Gulf veteran, Syracuse, NY; Randy Wheeler, 
Gulf veteran, Hoover, AL; Kimo Hollingsworth, Gulf veteran, 
Washington, DC; Dr. John Bailar, chair, Committee to Review 
Health Consequences of Service During the Gulf War, Institute 
of Medicine; Thomas Cross, Gulf veteran, member, Presidential 
Advisory Committee on GW Veterans Illnesses; Charles Sheehan-
Miles, executive director, National Gulf War Resources Center; 
Dr. Robyn Nishimi, executive director, Presidential Advisory 
Committee; Matthew Puglisi, assistant director, National 
Veterans Affairs and Rehabilitation Commission, American 
Legion; Kelli Willard-West, director of government relations, 
Vietnam Veterans of America; Dennis Cullinan, deputy director, 
National Legislative Service, Veterans of Foreign Wars; Lennox 
Gilmer, associate national legislative director, Disabled 
American Veterans; and, Scott Vanderhayden, Gulf War Service 
Coordinator, Vietnam Veterans Agent Orange Victims.
    2. ``Status of Efforts to Identify Gulf War Syndrome, Part 
II'' March 28, 1996. Dr. Thomas Garthwaite, Deputy Under 
Secretary of Health, Department of Veterans Affairs; Dr. Daniel 
Clauw, assistant professor, Georgetown University School of 
Medicine; Dr. Penny Pierce, Gulf veteran, University of 
Michigan School of Nursing; and, Dr. Howard Urnovitz, chief 
scientific officer, Calptye Biomedical Corp.
    3. ``Status of Efforts to Identify Gulf War Syndrome, Part 
III'' June 25, 1996. Dr. Stephen Joseph, Assistant Secretary 
for Health Affairs, Department of Defense; Gary Hickman, 
Director of Atlanta Regional Office, Department of Veterans 
Affairs; Diane Dulka, widow of Gulf veteran Joseph Dulka, 
Windsor Locks, CT; and, Dr. William Marcus, toxicologist, 
Washington, DC.
    4. ``Status of Efforts to Identify Gulf War Syndrome, Part 
IV'' September 19, 1996. Brian Martin, Gulf veteran, Niles, MI; 
Barry Kapplan, Gulf veteran, Southington, CT; Nancy Kapplan, 
registered nurse, Southington, CT; Nick Roberts, Gulf veteran, 
Port St. Joe Beach, FL; Denise Nichols, Gulf veteran, Wheat 
Ridge, CO; Sylvia Copeland, Chief, PGW Veterans Task Force, 
Central Intelligence Agency; Dr. Frances Murphy, Director, 
Environmental Agents Service, Department of Veterans Affairs; 
James Tuite, director, Gulf War Research Foundation; Dr. 
William Baumzweiger, neurologist and psychiatrist, Los Angeles, 
CA; Dr. Claudia Miller, assistant professor, Environmental & 
Occupational Medicine, University of Texas Health Science 
Center; and, Dr. Stephanie Padilla, research neurotoxicologist, 
Environmental Protection Agency.
    5. ``Persian Gulf Veterans' Illnesses'' December 10, 1996. 
Major Michael Johnson, U.S. Army, Gulf veteran; Gy/Sgt. George 
Grass, U.S. Marine Corps, Gulf veteran; Major Randy Hebert, 
U.S. Marine Corps (retired), Gulf veteran; Patrick Eddington, 
former Analyst, Central Intelligence Agency; Julia Dyckman, 
Gulf veteran, Harrisburg, PA; and, Robert Larrisey, Gulf 
veteran, Chalphont, PA.
    6. ``Persian Gulf War Veterans' Illnesses'' December 11, 
1997. Dr. Susan Mather, Chief, Public Health & Environmental 
Hazards Officer, Department of Veterans Affairs; Dr. Charles 
Jackson, physician, Tuskegee (AL) VA Medical Center; and, Dr. 
Victor Gordan, physician, Manchester (NH) VA Medical Center.
    7. ``Gulf War Syndrome: To Examine New Studies Suggesting 
Links Between Gulf Service and Higher Rates of Illnesses'' 
January 21, 1997. Dr. Kenneth Kizer, Under Secretary for 
Health, Department of Veterans Affairs; Dr. Bernard Rostker, 
Special Assistant for GW Illnesses, Department of Defense; 
Admiral Donald Custis, M.D. (retired), member, Presidential 
Advisory Committee on GW Veterans' Illnesses; Dr. Robert Haley, 
director of epidemiology, University of Texas Southwestern 
Medical Center; Dr. David Schwartz, professor of internal and 
preventive medicine, University of Iowa School of Medicine; Dr. 
Frank Duffy, associate professor of neurology, Harvard Medical 
School; Chris Kornkven, Gulf veteran, Watertown, WI; James 
Brown, Gulf veteran, Hannibal, MO; and, James Green, Gulf 
veteran, Fishertown, PA.
    8. ``Status of the Department of Veteran's Affairs to 
Identify Gulf War Syndrome'' April 24, 1997. Michael Donnelly, 
Gulf veteran, South Windsor, CT; Susan Sumpter-Loebig, Gulf 
veteran, Hagerstown, MD; Steven Wood, Gulf veteran, 
Grossostheim, Germany; Dr. Bernard Rostker, Special Assistant 
for GW Illnesses, Department of Defense; Robert Walpole, 
Special Assistant for GW Illnesses, Central Intelligence 
Agency; Donald Mancuso, Deputy Inspector General, Department of 
Defense; Dr. Jonathan Tucker, Center for Non-Proliferation 
Studies, Monterey (CA) Institute of International Studies; Dr. 
Satu Somani, professor of pharmacology and toxicology, 
University of Southern Illinois School of Medicine; and, Dr. 
Thomas Tiedt, researcher and neuroscientist, Longboat Key, FL.
    9. ``The Status of Efforts to Identify Persian Gulf War 
Syndrome: Recent GAO Findings'' June 24, 1997. Dr. Donna 
Heivilin, Director, Planning and Reporting, General Accounting 
Office.
    10. ``Status of Efforts to Identify Gulf War Syndrome: 
Multiple Toxic Exposures'' June 26, 1997. Gilbert Roman, Gulf 
veteran, Denver, CO; Paul Canterbury, Gulf veteran, Ashley, OH; 
Michael Stacy, Gulf veteran, Inola, OK; S/Sgt. Mark Zeller, 
U.S. Army, Ft. Rucker, AL; Dr. Thomas Garthwaite, Deputy Under 
Secretary for Health, Department of Veterans Affairs; Dr. 
Bernard Rostker, Special Assistant for GW Illnesses, Department 
of Defense; Dr. Garth Nicolson, chief scientist, Institute for 
Molecular Medicine; Dr. Asaf Durakovic, researcher and 
radiation expert, Silver Spring, MD; and, Leonard Dietz, 
General Electric scientist (retired), Niskayuna, NY.
    11. ``The Oversight of NIH and FDA: Bio-Ethics & the 
Adequacy of Informed Consent'' May 8, 1997. Dr. William Raub, 
Deputy Assistant Secretary, Department of Health and Human 
Services; Dr. David Satcher, Director, Center for Disease 
Control and Prevention; Dr. Harold Varmus, Director, National 
Institutes of Health; Mary Pendergast, J.D., Deputy 
Commissioner, Food and Drug Administration; Dr. Arthur Caplan, 
professor of Bio-Ethics, University of Pennsylvania; Dr. 
Benjamin Wilfond, professor of pediatrics, University of 
Arizona; Dr. Peter Lurie, professor of medicine, University of 
California--San Francisco; and, Laurie Flynn, executive 
director, National Alliance for the Mentally Ill.

  ADDITIONAL VIEWS OF HON. HENRY A. WAXMAN, HON. EDOLPHUS TOWNS, HON. 
PAUL E. KANJORSKI, HON. THOMAS M. BARRETT, HON. ELEANOR HOLMES NORTON, 
 HON. CHAKA FATTAH, HON. ELIJAH E. CUMMINGS, HON. DANNY K. DAVIS, HON. 
             JOHN F. TIERNEY, AND HON. HAROLD E. FORD, JR.

    The text of the majority report entitled ``Gulf War 
Veterans' Illnesses: VA, DOD Continue to Resist Strong Evidence 
Linking Toxic Causes to Chronic Health Effects'' is based on 11 
hearings held by the Committee on Government Reform and 
Oversight's Subcommittee on Human Resources. During those 
hearings, the committee heard testimony and reviewed voluminous 
documents provided by private citizens and the Federal 
Departments.
    Throughout those hearings, the minority repeatedly insisted 
that the Department of Defense was uniquely situated to assist 
in our investigation of chemical weapons exposure. The majority 
report proves that basic point. Therefore, the purpose of these 
additional views is to underscore the role of the DOD and make 
additional suggestions that we believe would assist in the 
ultimate goal of helping the veterans receive the care and 
compensation they deserve.
    Iraq invaded Kuwait on August 2, 1990. In support of United 
Nations Resolution 660, the United States sent troops to the 
Persian Gulf in Operation Desert Shield. About 5 months later, 
Operation Desert Storm began with an air war against Iraq. 
Forty days later, a four day ground war ensued. By the 
conclusion of hostilities, the United States had committed 
approximately 697,000 troops in the Gulf.
    Troops who served in the Gulf were demographically 
different from previous contingents of U.S. Forces, with 7 
percent female troops and 17 percent of the force gathered from 
Reserve and National Guard Personnel. (``Unexplained Illnesses 
Among Desert Storm Veterans'', Archives of Internal Medicine, 
February 13, 1995, volume 155). For reasons that are unknown, 
it appears the Gulf War Syndrome is most common among Reservist 
and National Guardsman, although a small percentage of active 
duty soldiers have complained of similar illnesses.
    The symptoms and ailments associated with Persian Gulf 
service, span the spectrum of illnesses and diseases. Some 
veterans described very specific symptoms, while others report 
more general and non-specific ailments including, chronic 
fatigue, memory and weight loss, joint pain, sleep disturbance, 
rashes, chest pain, and shortness of breath, diarrhea and other 
gastro-intestinal and other unexplained maladies. These 
illnesses have occurred in varying degrees of seriousness and 
do not appear to be fatal, but symptoms may be sufficiently 
debilitating and chronic as to cause long-term suffering and 
disability.
    In response to congressional pressure concerning the 
symptoms experienced by veterans, the Department of Veterans 
Affairs began collecting data and compiling a Persian Gulf 
Registry. The VA published the original Persian Gulf Registry 
program manual (M-10, Part III) in December 1992. The uniform 
case assessment protocol was implemented at VA medical centers 
nationwide in June 1994 and introduced by an Under Secretary's 
Health Information letter on June 22, 1994. VA published a 
revised program manual on September 14, 1995.
    All veterans who identify themselves through the Persian 
Gulf Registry, as having served in the Persian Gulf War theater 
of operations, are given a standard medical examination. 
Seventy-seven percent of veterans who undergo this exam receive 
a diagnosis and are treated at local VA medical centers. If a 
diagnosis is not possible following the preliminary 
examination, a referral for a follow-up exam is given at one of 
the four Persian Gulf Referral Centers. These centers have 
developed expertise in addressing symptoms arising out of 
undiagnosed illnesses. Additional examinations are possible if 
a diagnosis is not found following the second exam. Treatment 
is provided based on the results of the exams.
    To date there are no clear indications of what may cause 
the disparate collection of symptoms appearing in veterans who 
served in the Persian Gulf. However, it is known that while in 
the Gulf states, the troops were exposed to a variety of 
natural and artificial substances which could be hazardous 
alone or in combination with other non-toxic substances. Those 
substances include, but may not be limited to multiple pre-
deployment vaccinations; medical treatments designed to lessen 
effects of potential chemical exposure; \1\ insect and rodent 
repellents; tropical parasites; environmental hazards (such as 
oil fires); and shrapnel from armor and ammunition made of 
depleted uranium.
---------------------------------------------------------------------------
    \1\ Some of these medicines had not been approved by the Federal 
Food and Drug Administration. They were considered ``investigational''.
---------------------------------------------------------------------------
    The VA has embarked upon several studies which consider the 
possible use of biological or chemical agents. However, the 
primary responsibility for potential chemical exposures or the 
possible role of biological contaminants during the pendency of 
the conflict would have belonged to the Department of Defense. 
The DOD was uniquely situated to conduct or commission studies 
to gage the likely interaction of medications or immunizations 
provided soldiers and reservists in combination with air, soil 
or water contaminants encountered by the troops. However, the 
Department of Defense steadfastly maintained that chemical and/
or biological weapons were not used in the Gulf. Because of 
this refusal to acknowledge these exposures, multiple 
government agencies with research funding dedicated to the 
resolution of the illnesses experienced by troops, wasted 
countless dollars and valuable time in focusing on unlikely 
sources of illnesses given the official account of battlefield 
activities rendered by the Pentagon. While there may be a need 
to maintain secrecy for troop protection during times of war, 
that necessity must quickly vanish in the aftermath of a 
conflict. The rationale of troop preservation and protection 
used by the military in times of war to maintain secrecy must 
produce candor in the aftermath of a conflict. Here, that need 
to preserve and protect the health and well-being of troops 
would have mandated a full and complete disclosure of chemical 
and/or biological weapons used in the Gulf. These disclosures 
may have reduced or eliminated needless suffering. 
Unfortunately, that disclosure was not forthcoming. It was not 
until June 21, 1996 that the Department of Defense acknowledged 
that American troops were exposed to fall-out from chemical 
agents. Therefore, we must concur with the findings of the 
final report of the Presidential Advisory Commission (issued 
January 7, 1997) which found that the Department of Defense had 
been ``patronizing and dismissive of veterans'' concerns and 
failed to act in good faith regarding knowledge of the 
existence of documents which suggested chemical weapons 
exposures.
    However, we must note that since the publication of that 
report, the DOD seems to have been chastened by the criticism 
and has endeavored to engage in disclosure concerning chemical 
and biological exposure. However, it appears that those efforts 
may be hampered by internal and bureaucratic turf battles 
between military and civilian Defense employees about the 
necessity and level of disclosure. We trust that the actions of 
this committee communicate a strong message. Those who favor 
disclosure must be victorious in those internal battles. Their 
defeat will mean that those who are charged with the 
responsibility of defending freedom will be engaged in denying 
and stifling the most precious rights of American citizens--the 
right to be informed about governmental activities and to 
demand accountability of public officials. In a democracy, 
accountability cannot be suspended even during times of war.
    The need for candor and openness in the military should be 
self-evident. As a Nation, we cannot expect young people to 
answer the call to war if they cannot expect to be treated 
fairly and with compassion if they are injured in service to 
their country. We commend the veterans who participated in 
these hearings. By testifying before this committee and sharing 
their stories, they have shown their continued belief and faith 
in the democracy that they risked their lives defending. We 
trust that the Department of Defense will follow their example. 
We believe that the candor of the department will assist in the 
diagnosis and treatment of these injured former and current 
armed service personnel.
    In addition to their health concerns, we believe greater 
emphasis should be placed on the claims process. Approximately 
76,000 veterans claims have been processed by the VA for 
service-connected disability and compensation as a result of 
their Persian Gulf experience.\2\ Of that number, approximately 
22,300 have been approved for service-connected disability and 
compensation. Therefore we were pleased that on January 7, 
1996, when President Clinton endorsed a change in disability 
rules for Persian Gulf War veterans that would allow more to 
receive disability payments for ``undiagnosed illnesses''. We 
trust that those veterans whose claims were denied previously 
will be reassessed quickly.
---------------------------------------------------------------------------
    \2\ The VA cannot provide the total number for claims filed only by 
Persian Gulf Veterans, because claims currently in the process are not 
categorized by time or area of service. Unfortunately, they can only 
provide figures on the number of claims by Persian Gulf veterans after 
those claims have gone through the review process.
---------------------------------------------------------------------------
    Finally, we believe that future medical mysteries can and 
should be avoided. In our investigation, we were shocked to 
learn that the Pentagon would spend thousands of dollars 
training and equipping each soldier, but fail to spend any 
money in developing a system that would track their health 
status. Therefore, we would recommend the implementation of a 
baseline health evaluation prior to deployment; the development 
of a computerized central database for medical records during a 
military deployment and the use of a standardized system of 
recordkeeping among the military branches.

                                   Hon. Henry A. Waxman.
                                   Hon. Edolphus Towns.
                                   Hon. Paul E. Kanjorski.
                                   Hon. Thomas M. Barrett.
                                   Hon. Eleanor Holmes Norton.
                                   Hon. Chaka Fattah.
                                   Hon. Elijah E. Cummings.
                                   Hon. Danny K. Davis.
                                   Hon. John F. Tierney.
                                   Hon. Harold E. Ford, Jr.

                ADDITIONAL VIEWS OF HON. BERNARD SANDERS

    I would like to express my appreciation for the time and 
energy which Congressman Shays, Ranking Member Towns and the 
committee staff have put into this investigation and this 
Report. I would also like to express my concurrence with the 
conclusions and recommendations in this report. As it happens, 
it is my opinion that this report represents the most 
comprehensive and accurate assessment of the complexities 
surrounding Gulf War illnesses. I am delighted that the 
Government Reform and Oversight Committee approved this report 
and I believe we should promptly begin working on implementing 
its recommendations in a timely manner. After 6 years of 
virtually no progress in this area, we have no time to lose. 
The U.S. Congress, along with the scientific and medical 
community, the Veterans organizations and other concerned 
bodies, must begin focussing on this issue in a way that has 
not yet occurred. Our goal must be, as soon as possible, to 
discover the causes of Gulf War illnesses and the most 
effective treatments available.
    Chairman Shays and his subcommittee have lead the effort 
during the last 19 months to unravel the complexities 
surrounding Gulf War illnesses. We have heard compelling 
testimony from dozens of sick veterans--at times this testimony 
was not only difficult for them to give, but was also painful 
for the Members and the public to hear. The subcommittee heard 
testimony from high level representatives from the Department 
of Defense, the Veterans Administration, doctors and scientists 
from around the world, the General Accounting Office and many 
others. I would like to stress that the conclusions contained 
in this report were not made lightly. They were drawn by 
gathering of information from 11 subcommittee hearings and 
thousands of pages of documents. Many many people testified at 
these hearings and I would like to thank all of them for the 
tremendous help they gave this committee.
    The bottom line is this. After an exhaustive gathering of 
the evidence, and careful analysis of the information which was 
put before this subcommittee, it is my own conclusion that the 
Department of Defense and the VA have failed miserably in 
solving the problems of Gulf War illnesses and in developing 
effective treatments for the tens of thousands of veterans who 
are hurting--including hundreds in my own State of Vermont.
    It is clear to almost everyone that, from the very 
beginning of this situation, the DOD and the VA have downplayed 
the whole issue of Gulf War illness. In the very beginning they 
actually denied that there was any problem whatsoever. And 
then, after finally acknowledging that there was a problem, 
they concluded that the problem was in the heads of our 
soldiers--of psychological origin. For 5 years, the Pentagon 
denied that our soldiers had been exposed to any chemical 
warfare agents. Finally, after being forced to admit that there 
were exposures, they suggested that the exposures were 
``limited''. The DOD's first estimates were 400 troops exposed, 
then 20,000 troops. In July of this year, the DOD and CIA gave 
us their best estimate--that as many as 98,910 American troops 
could have been exposed to chemical warfare agents due to 
destruction of ``the Pit'' in Khamisiyah, an Iraqi munitions 
facility. I would not be surprised if this estimate is revised 
upward in the not too distant future, as more information is 
gathered regarding other incidents of chemical warfare 
exposure. And on and on it goes. Getting information has been 
like pulling teeth.
    If I were in pain and for 6 years I went to a doctor who 
was unable to effectively diagnose my problem or treat me, I 
would say to that doctor, ``Thank you very much for your 
efforts, but I am going elsewhere.'' And that is the situation 
facing some 70,000 veterans of Gulf War illness. The evidence 
is overwhelming that, for whatever reason, the DOD and the VA 
have not been able to come up with a cause for Gulf War 
illnesses or an effective treatment. It may simply be nothing 
more complicated than the fact that the VA and the DOD simply 
lack the expertise in environmental toxicology that is at the 
root of the problem. I am not casting aspersions on the 
sincerity of the leadership of the VA and the DOD and their 
desire to do the right thing and help our veterans. I am simply 
saying that they have failed, that we must acknowledge their 
failure, and for the sake of the 70,000 veterans who continue 
to hurt, we must go outside of the DOD and VA if we are to come 
up with the cause of this problem and find effective 
treatments.
    As part of this effort, I am happy to report that the 
Labor-HHS appropriations bill, which is currently in 
conference, contains language, that I introduced, which asks 
the National Institute of Environmental Health Sciences to 
study how chemical exposures in the Persian Gulf relate to Gulf 
War illnesses. Additionally through this program, the NIEHS is 
to investigate treatment protocols which are being developed in 
the private sector around the country. Whether or not the NIEHS 
should be the agency given full responsibility for heading up 
the broader independent investigation which this report calls 
for, I can't answer right now. But that is an issue that needs 
to be pursued vigorously and in the very near future.
    As we learned through our subcommittee hearings, the 
military theater in the Persian Gulf was a chemical cesspool. 
Our troops were exposed to chemical warfare agents, leaded 
petroleum, widespread use of pesticides, depleted uranium and 
burning oil wells. In addition, they were given a myriad of 
pharmaceuticals as vaccines. Further, and perhaps most 
importantly, as a result of waiver from the FDA, hundreds of 
thousands of troops were given pyridostigmine bromide. 
Pyridostigmine bromide, which was being used as an anti-nerve 
gas agent, had never been used in this capacity before. In the 
midst of all of this, our troops were living in a hot and 
unpleasant climate and were under very great stress.
    Through our subcommittee hearings we have also learned that 
an increasing number of scientists now believe that the 
synergistic effect of chemical exposures, plus the experimental 
vaccine pyridostigmine bromide, may well be a major cause of 
the health problems affecting our soldiers. Additionally, we 
learned of scientific studies which suggest that stressful 
conditions in combination with taking pyridostigmine bromide 
can lead to neurological problems. Moreover, this subcommittee 
heard from scientists who conclude that exposures to low levels 
of chemical weapons, such as those experienced near Khamisiyah, 
can lead to long-term health problems--contrary to what the DOD 
and VA continue to maintain.
    One of the most important, yet disturbing facets of this 
problem is that health effects from chemical exposures may 
surface years after the initial exposure--and these health 
effects can be very serious, including kidney damage, liver 
damage, neurological damage, reproductive problems, respitory 
problems and cancer. Our government needs to own up to the fact 
that many of the chemical exposures in the Gulf can very well 
lead to long-term and serious health problems for our veterans. 
And because of this we have a responsibility to provide health 
care, treatment and compensation for the health problems which 
stem from service in the Gulf.
    I very much agree with the recommendation in this report 
that Congress enact a law which sets up the presumption that 
Gulf War veterans were exposed to hazardous materials known to 
have been present in the Gulf War theater. As we have learned 
in our hearings, to this point the burden has been on the 
veteran to prove that they were exposed to harmful chemicals 
and that their illnesses stem from that exposure. Because of 
the lack of military records as to administration of 
pyridostigmine bromide, missing logs on chemical and biological 
weapons alarms, and missing data as to which individuals were 
exposed to chemical weapons, it has been impossible for 
thousands of veterans to prove that chemical exposure has 
caused their illnesses. This has resulted in unending 
frustration for thousands of sick veterans--causing many to 
seek medical attention from the private sector and devote 
significant financial resources to treating their illnesses. 
This is simply unacceptable.
    In having passed this committee report, we should not think 
that our work is done. On the contrary, we have really just 
begun. It is my belief that serious and focused scientific work 
can give us an understanding of why tens of thousands of our 
soldiers are suffering a myriad of illnesses, and some 
excellent scientific work--already completed--is paving the way 
for us. It is also my belief that we can come up with effective 
treatments. And it very likely that there are physicians 
throughout the country who have already developed treatments 
that are helpful.
    It seems to me that our committee must remain involved in 
this issue, must, along with our colleagues in both bodies, 
help find the appropriate agency to direct the research, must 
make certain that adequate money is made available, and must 
exercise oversight over that agency to ensure that its mandate 
is carried out. I thank Chairman Shays and Ranking Member Towns 
for their hard work on this issue, and I look forward to 
working with my committee colleagues in the near future, to 
implement its recommendations.

                                              Hon. Bernard Sanders.