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Hearing Transcript on Gulf War Illness: The Future for Dissatisfied Veterans.
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GULF WAR ILLNESS: THE FUTURE FOR DISSATISFIED VETERANS
HEARING BEFORE THE SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION JULY 27, 2010 SERIAL No. 111-94 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
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Malcom A. Shorter, Staff Director SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined. |
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C O N T E N T S
July 27, 2010
Gulf War Illness: The Future for Dissatisfied Veterans
OPENING STATEMENTS
Chairman Harry E. Mitchell
Prepared statement of Chairman Mitchell
Hon. David P. Roe, Ranking Republican Member
Prepared statement of Congressman Roe
Hon. Zachary T. Space
WITNESSES
U.S. Department of Veterans Affairs:
Hon. Charles L. Cragin, Chairman, Advisory Committee on Gulf War Veterans
Prepared statement of Mr. Cragin
John R. Gingrich, Chief of Staff
Prepared statement of Mr. Gingrich
American Legion, Ian C. de Planque, Deputy Director, Veterans Affairs and Rehabilitation Commission
Prepared statement of Mr. de Planque
Hauser, Stephen L., M.D., Professor and Chair of Neurology, University of California, San Francisco, School of Medicine, and, Chair, Committee on Gulf War and Health: Health Effects of Serving in the Gulf War, Update 2009, Board on the Health of Selection Populations, Institute of Medicine, The National Academies
Prepared statement of Dr. Hauser
Research Advisory Committee on Gulf War Veterans' Illnesses, James H. Binns, Chairman
Prepared statement of Mr. Binns
Veterans for Common Sense, Paul Sullivan, Executive Director
Prepared statement of Mr. Sullivan
Veterans of Modern Warfare, Donald D. Overton, Jr., Executive Director
Prepared statement of Mr. Overton
SUBMISSIONS FOR THE RECORD
Disabled American Veterans, Adrian Atizado, Assistant National Legislative Director, statement
Desert Storm Battle Registry, Crawford, TX, Kirt P. Love, Director, statement
Gold Star Wives of America, Inc., Vivianne Cisneros Wersel, Au.D., Chair, Government Relations Committee,
National Gulf War Resource Center, James A. Bunker, President, letter
National Vietnam and Gulf War Veterans Coalition, Major Denise Nichols, RN, MSN, USAFR (Ret.), Vice Chair, statement
Research Advisory Committee on Gulf War Veterans' Illnesses, Anthony Hardie, Member, Gulf War Steering Committee, U.S. Department of Veterans Affairs; and Gulf War Illness Research Program Integration Panel, Congressionally Directed Medical Research Program, U.S. Department of Defense, statement
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Questions and Responses for the Record:
GULF WAR ILLNESS: THE FUTURE FOR DISSATISFIED VETERANS
Tuesday, July 27, 2010
U. S. House of Representatives,
Subcommittee on Oversight and Investigations,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:08 a.m., in Room 334, Cannon House Office Building, Hon. Harry E. Mitchell [Chairman of the Subcommittee] presiding.
Present: Representatives Mitchell, Space, Walz, and Roe.
OPENING STATEMENT OF CHAIRMAN MITCHELL
Mr. MITCHELL. Good morning, ladies and gentlemen. The Committee on Veterans' Affairs' Subcommittee on Oversight and Investigations' hearing on Gulf War Illness: The Future of Dissatisfied Veterans will come to order. This meeting is held on July 27, 2010.
I ask unanimous consent that all Members have 5 legislative days to revise and extend their remarks and that statements may be entered into the record. Hearing no objection, so ordered.
Last year, this Subcommittee held two hearings on Gulf War illness. Our first gave us an overview of the purpose, research, and methodology that the U.S. Department of Veterans Affairs (VA) utilized to determine the parameters relating to Gulf War illness.
Our second hearing evaluated the scientific information and analyzed the different schools of thought on Gulf War illness research.
In both of these hearings, it has become clear that veterans are suffering from symptoms related to service in the Gulf and that they are continuing to struggle for the health care, treatment and benefits they deserve.
For our third, and hopefully final, hearing today, we will hear from the Department on how they plan to move ahead and implement the culture, care, benefits, research, outreach, and education efforts for our Gulf War veterans.
Next month will mark the 20th anniversary since the United States deployed almost 700,000 troops to the Persian Gulf. With a growing number of these veterans developing undiagnosed and multi-symptom illnesses, they have looked to the people who promised them the care worthy of their sacrifice when they returned home. Still to this day, many of our Gulf War veterans have yet to see this care and are finding themselves fighting the VA for service-connected claims and proper compensation.
Under the new leadership of Secretary Shinseki, a new vision and a new mission has been created at the Department. I know that Members on both sides of the aisle are eager to see how the VA will use this new vision to ensure that our veterans are receiving the best possible care.
As part of this new vision, Secretary Shinseki's creation of the Gulf War Veterans Illness Task Force in 2009 is bold and shows the Department's dedication to our Gulf War veterans.
However, with this new task force, we need to begin to see results. Even though the VA has put forward motions to better serve our veterans, it is not a substitute for results.
We all understand the arduous task of ensuring that the proper research and data is collected, but our veterans have waited too long. While I appreciate the VA's attempt to change the culture at the Department regarding Gulf War illness, there must also be strides to change the care and compensation these veterans have waited so long for.
The Department of Veterans Affairs is the second largest agency in our system of government and they must be held accountable for the timely care of our Nation's veterans. There is a culture of complacency that does not serve anyone, especially our men and women in the Armed Forces.
VA needs to take action to begin to implement a plan to provide transparency and answers to our Gulf War veterans. Without a unified central VA effort to provide appropriate care to this population, these veterans and their families will have to wait that much longer and grow that much sicker.
I trust that this hearing will begin to lay out a unified plan for the care of our Gulf War veterans as well as instill hope that these veterans are not forgotten and that the promises we made to care for them are kept.
Before I recognize the Ranking Republican Member for his remarks, I would like to swear in our witnesses.
[The prepared statement of Chairman Mitchell appears in the Appendix.]
Mr. MITCHELL. I would ask that all witnesses stand from all panels and raise their right hand.
[Witnesses sworn.]
Mr. MITCHELL. Thank you.
Now I recognize Dr. Roe for opening remarks.
OPENING STATEMENT OF HON. DAVID P. ROE
Mr. ROE. Thank you, Mr. Chairman.
And I noticed in the back of the room here, we have some guests. The Boy Scouts are having their 100th anniversary. I being an Eagle Scout would like to welcome you to our hearing today and thank the leaders for the leadership that you give these young men. Thank you for being here.
Thank you, Mr. Chairman.
It is fitting as we approach the 20th anniversary of the start of Operation Desert Storm and the beginning of the Gulf War that we proceed with this final hearing in our three-part series on Gulf War illness.
On this day, it is important for us to look to the future of care for our veterans who fought and served in this conflict and now suffer from various illnesses from unknown causes.
I believe it will be interesting to listen to the views of each of the panels and what they perceive is the cultural perception of Gulf War illness as well as both the medical and benefit side of the equation on the care for these veterans.
On April 9th, 2010, the Institute of Medicine (IOM) issued its most recent report on Gulf War and health which made additional recommendations on how we can best support the veterans from this conflict.
I look forward to hearing from Dr. Hauser who Chaired the Committee on Gulf War and Health, Health Effects of Serving in the Gulf War on how the VA can use the information in this report to improve care to these veterans and also to hear what progress VA has made since we last met in July.
I am curious to hear the VA's response to the Research Advisory Committee's (RAC) September 2009 report and what changes are coming about as a result of our hearings as well as the Advisory Committee's report.
We must never forget the reason that we are having these hearings. It is to help our Nation's veterans.
In the past, we have explored the research behind presumptions, the medical indicators leading to the diagnosis or lack thereof and we learned most importantly that the documentation of undiagnosed illnesses is a large contributor leading to a presumption of Gulf War illness.
I believe we can use the information we have compiled through these hearings to really come to a better understanding of Gulf War illness and through that knowledge better serve these veterans who have sacrificed so much for our country.
The information gleaned from the upcoming report from the Secretary's Gulf War Veterans Illness Task Force as well as the reports issued by the Research Advisory Council and the Institute of Medicine will help us serve those veterans from the Gulf War.
It is my hope that we will also take the lessons learned through these hearings as well as the reports and apply them to the current Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans and future veterans down the road to better serve their needs.
I am pleased that the VA Chief of Staff, John Gingrich, has brought with him representatives from both the Veterans Health Administration (VHA) and the Veterans Benefits Administration (VBA) who can respond to the type of care and benefits being provided to our Gulf War veterans.
And I look forward to the hearing and the testimony of all witnesses.
And, again, Mr. Chairman, thank you for holding this hearing.
[The prepared statement of Congressman Roe appears in the Appendix.]
Mr. MITCHELL. Thank you.
Mr. Space?
OPENING STATEMENT OF HON. ZACHARY T. SPACE
Mr. SPACE. Thank you, Mr. Chairman.
I want to thank the witnesses for coming and talk about this topic of immense importance to our veterans.
Gulf War illness is a serious issue plaguing thousands of veterans in this country. And I sincerely hope that this hearing will bring to light steps that the VA is and has been taking in working for the best quality care for the men and women who fought in the Gulf War.
For years, the seriousness of this condition was unfortunately overlooked because of the lack of understanding. I want to commend Secretary Shinseki for dedicating new resources to redefine how veterans suffering from Gulf War illness are compensated and to begin getting them the services they need.
This war has been over for 19 years. And I believe that the VA is finally on the right track toward alleviating the source of the debilitating effects that the Gulf War has had on our veterans.
I encourage the Veterans Administration to continue taking all steps necessary to provide assistance for veterans suffering from this illness and I would like to ensure that we will do all we can to make the necessary tools available to you so that you can fulfill your mission in taking care of our Nation's heroes.
And with that, I yield back. Thank you, Mr. Chairman.
Mr. MITCHELL. At this time, I would like to welcome panel one to the witness table. Joining us on our first panel is Donald Overton, Jr., Executive Director for the Veterans of Modern Warfare (VMW); Ian de Planque, Deputy Director of the Veterans Affairs and Rehabilitation Commission for the American Legion; and Paul Sullivan, Executive Director for the Veterans for Common Sense (VCS).
I ask that all witnesses stay within 5 minutes of their opening remarks. Your complete statements will be made part of the hearing record.
I would like to recognize Mr. Overton.
STATEMENTS OF DONALD D. OVERTON, JR., EXECUTIVE DIRECTOR, VETERANS OF MODERN WARFARE; IAN C. DE PLANQUE, DEPUTY DIRECTOR, VETERANS AFFAIRS AND REHABILITATION COMMISSION, AMERICAN LEGION; AND PAUL SULLIVAN, EXECUTIVE DIRECTOR, VETERANS FOR COMMON SENSE
STATEMENT OF DONALD D. OVERTON, JR.
Mr. OVERTON. Thank you, Chairman Mitchell, Ranking Member Roe, and distinguished Members of the Subcommittee on Oversight and Investigations.
On behalf of Veterans of Modern Warfare, a 501(c)(19) National Wartime Veteran Service Organization, I thank you for the opportunity to present our views on Gulf War Illness: The Future for Dissatisfied Veterans.
My name is Donald Overton and I testify today from a dual perspective, first as Executive Director for VMW, also as a 100 percent service-connected combat-disabled veteran of the first Gulf War.
Nearly 20 years have passed since the start of the deployment and combat operations. Since then, an estimated 250,000 veterans of our conflict have endured adverse health consequences and suffer from the potentially debilitating consequences of undiagnosed multi-symptom illness.
We contend these are distinct illnesses and the large numbers of veterans affected have been disenfranchised and under-served by the Department of Veterans Affairs.
To date, VA has historically failed to recognize our conditions, opting to emphasize stress or other psychiatric disorders in its research funding, clinician training materials, and public statements, although scientific research clearly indicates otherwise.
We must work with due diligence in order to stop allowing the lives of Gulf War veterans to be stolen and make no mistake about it, that is exactly what is taking place.
Last year, the VA impeded, and then canceled, a Congressionally mandated contract for unparalleled Gulf War illness research at the University of Texas Southwestern (UTSW).
This year, VA used those funds to buy an $11 million piece of lab equipment of dubious value to Gulf War veterans.
The recent announcement by VA to fund yet another stress management study and portray it as somehow providing meaningful treatment to Gulf War veterans is discouraging.
VMW urges Congress to work with the VA to reinstate the UTSW study, which would be highly regarded by all Gulf War veterans as well as advancing funding towards effective treatments of Gulf War illness.
The area of greatest controversy for Gulf War veterans remains our inability to obtain disability compensation. Currently there are only three ill-defined presumptive conditions for Gulf War veterans, chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome.
Our written testimony clearly illustrates the contorted rules Gulf War veterans face regarding these disability claims. VMW urges Congress to consider expanding VA regulations which could authorize extra scheduler ratings for Gulf War veterans suffering from undiagnosed multi-symptom illness.
Clearly defining the conditions, which constitute undiagnosed illness as well as preventing generic labeling of conditions based on closely-related symptoms must be mandated.
Additionally, VMW urges Congress to enact legislation granting indefinite presumptive eligibility for undiagnosed illness.
Please consider removing all sunset provisions in title 38 of the United States Code at sections 1117 and 1118 so health care and benefits are for the life of every Gulf War veteran and every surviving beneficiary.
VMW strongly endorses granting a presumption of service-connection for our Gulf War veterans who deployed to the war zone and are diagnosed with autoimmune diseases such as multiple sclerosis and Parkinson's disease based on their unusual prevalence amongst our cohort.
Establishing tiger teams within the Veterans Benefits Administration comprised of highly-trained environmental exposure claims specialists would expedite and enhance the myriad claims-related issues plaguing the Agency.
Due to significant limitations in the VA's Gulf War Veterans Information System, it is extremely difficult to accurately portray the experiences of Gulf War veterans, let alone our respective disability claims or health care issues.
Based on this fact, it would appear that the recently completed Gulf War Veterans Illness Task Force report was based solely on the presumptions of task force members which unfortunately limits the credibility of the report's findings.
Overcoming the VA's established culture towards Gulf War veterans will not be an easy task, but under Secretary Shinseki's bold leadership and cultural transformation, it can and must be accomplished now. Acknowledging the relevance of Gulf War veterans within VA would serve to reinvigorate research and medical care. Enhancing education of benefits counselors, medical staff, and various stakeholders will serve to increase the effectiveness of this cultural transformation.
Gulf War veterans swore by a common creed as do all members of our Armed Forces to leave no one behind. We are proud to proclaim we left no one behind. Unfortunately, our country has abandoned us.
Those charged with our care and well-being continue to neglect us. We have been lost in the shuffle. Now our fate rests in the hands of Congress, in your hands. Please help us as we continue to struggle to get all the way back home after our military service.
Mr. Chairman, VMW thanks you for this opportunity to express our views today and we will be pleased to answer any questions you or your distinguished colleagues may have. Thank you.
[The prepared statement of Mr. Overton appears in the Appendix.]
Mr. MITCHELL. Thank you.
Mr. de Planque?
STATEMENT OF IAN C. DE PLANQUE
Mr. DE PLANQUE. Good morning, Mr. Chairman and Members of the Committee. I would like to thank you on behalf of the American Legion for the opportunity to testify today on the future of this Nation's policy towards Gulf War veterans.
Traditionally, servicemembers are called upon to place themselves in hazardous situations to protect our country. While it is easy to think of these hazards in simple terms of bullets and bombs, over the last half of the previous century, we have learned many hard lessons about the environmental hazards faced as well.
Of course, these are not new lessons. On the battlefields of World War I, the world learned lessons about the terrifying effects of chemical weapons. Through World War II and the Cold War, we slowly began to understand the devastating effects of ionizing radiation.
Over 40 years after the Vietnam War, we still struggle to keep pace with the after effects of the chemical herbicide Agent Orange. Throughout this time, the American Legion has fought for a better understanding of these effects and to ensure that those veterans affected by these hazards receive the treatment and compensation that is their due for their service under these conditions.
Throughout history when soldiers have gone to war, the mission comes first and little thought is given to the after effects. Complete the mission, engage and destroy the enemy, these are the driving motivations of war fighting. Whatever tools exist at our disposal are employed to that end and it is only later in retrospect that we begin to understand the impact that will resonate throughout the lives of these veterans.
To this end, the American Legion supports several considerations for these Gulf War veterans. The current presumptive period for Persian Gulf War undiagnosed illnesses under title 38 of the Code of Federal Regulations, section 3.317 will expire on January 1st, 2012. It is well within appropriate authorities to extend this deadline and the American Legion recommends extending this period indefinitely.
As has been shown through the hard lessons still being learned with relation to Agent Orange, medical science will continue to identify and isolate new conditions as after effects of exposure to environmental hazards. There stands no reason that an arbitrary period should be enforced for the cessation of these presumptive periods. An indefinite period will ensure that research of the effects of the Gulf War will continue to provide meaningful treatment and compensation to these veterans.
Perhaps most concerning is the finding of the Research Advisory Committee on Gulf War Veterans’ Illness November 2008 report that, "The Federal Gulf War research effort has yet to provide tangible results in achieving the ultimate objective, that is to improve the health of Gulf War veterans."
This must be the driving goal of our government's efforts. To this end, the American Legion recommends several parts to an attack to achieve this goal.
First, we fully support robust funding for scientific research to continue to track the effects of Gulf War exposure. Sound scientific study is the priority to develop a medically-based understanding for the treatment of these veterans. Continued funding for all research in this area must remain a top priority.
Second, the American Legion encourages the VA to continue to provide appropriate medical examinations and treatment including follow-up treatment to all veterans of the Gulf War who report signs or symptoms that may be associated with diseases endemic to that war region and other conditions related to the experience.
To this end, the American Legion has long advocated for Congress to reinstate Gulf War veterans' status in Priority Group 6 for medical treatment. Eligibility for Gulf War veterans in Priority Group 6 of the Department of Veterans Affairs health care system established by the Veterans Healthcare Eligibility Reform Act of 1996 expired in 2002. Although VA has continued to treat ill Gulf War veterans despite the expiration of its authority to do so, lack of Congressionally-mandated authority to treat these veterans could mean abrupt discontinuation of the treatment that is currently available.
Continuation of care for ill Gulf War veterans would provide invaluable data that could be used to examine the nature of Gulf War illness, provide for better care for all other Gulf War veterans, and provide preparation for treatment of future servicemembers who may become ill after deployments in the southwest Asia theater of operations.
As a final note, the American Legion wishes to stress that there are growing concerns regarding the specific Gulf War effects on women veterans and research into these areas must not fall by the wayside. Because the health concerns of women can in some cases differ from a more generalized conception of veterans, research must ensure that these areas are specifically addressed and remain a fundamental part of Gulf War illness analysis.
As always, the American Legion thanks the Committee for the opportunity to provide testimony today and we would be happy to answer any questions the Committee may have.
And we would like to add one final note. As I mentioned earlier, we stand 40 years, over 40 years after our deployments to Vietnam and we are still struggling with the after effects of Agent Orange. We are now looking at 20 years with continued deployments to the Gulf War theater of operations. The clock is ticking for these veterans and we cannot afford to make the same mistakes we did with Agent Orange.
Thank you.
[The prepared statement of Mr. de Planque appears in the Appendix.]
Mr. MITCHELL. Thank you.
Mr. Sullivan?
Mr. SULLIVAN. Veterans for Common Sense thanks Subcommittee Chairman Mitchell and Ranking Member Roe, and Members of the Subcommittee for inviting us to testify here today.
VCS is here to present our recommendations for improving VA policies for our Nation's 250,000 ill Gulf War veterans.
Before I begin, I want to recognize Steve Robinson, a fellow Gulf War veteran, in the audience, Thomas Bandzul, our Associate Counsel, and with me is my daughter, Megan, to learn how Washington works.
Why are we here today, Mr. Chairman? We are here today because Gulf War veterans are deeply dissatisfied and disappointed with VA staff actions for the past 2 years. We concur with the comments of Veterans of Modern Warfare and the American Legion and their specific points and much of them are repeated in our written statement, so I am going to cut those parts out of my oral testimony to focus on a couple of new things.
Let me put this to you simply, Mr. Chairman. VA staff does not listen to our concerns. VA staff does not listen to advisory panels or expert scientists. VA staff does not even listen to Congress. VA staff actions for about the last 20 years have been, and remain, disastrous for our veterans.
I am here today sending up a red star cluster. That is an emergency. That is a warning. VCS is urging VA's new leadership here in the room today to stop and listen to the veterans, as you pointed out, before time runs out.
Why, sir? It is because VA's bureaucratic delays are slowly killing us veterans. The mismanaged research prevents us from finding answers about why we are ill and obtaining care.
Today, VCS officially petitioned VA to issue regulations so our 250,000 Gulf War veterans can learn why we are ill, obtain medical care, and receive the disability benefits that we need for our conditions linked to service in the Gulf War.
The two things we do not want, Mr. Chairman, are more false promises and more stress research from VA.
Today if VA's Chief of Staff, who is here today, fails to deliver assurances to veterans and this Subcommittee that VA will begin comprehensive research and reform, then VCS is asking you here today to take action.
Why are we making such specific requests in our petition to VA and to this Subcommittee? It is pretty clear. We have waited 20 years for answers about why we are ill, for treatment, and for benefits. We will no longer tolerate waiting and watching our friends die. I have been to too many funerals, listened to too many of my friends talk to me over the phone over the years about problems. And there seems to be VA promises and then they disappear like fog when the sun comes up. That needs to stop.
The VA and military policy about delay and deny actually began in March 1991, the day of the Gulf War cease fire. That is when the military wrote a memo urging staff to hype the military effectiveness of depleted uranium (DU). The same military memo urges the government to downplay adverse health impacts of DU, a toxic and radioactive waste used as ammunition in the Gulf War.
This is very important today because on August 19, 1993, then Army Brigadier General Eric Shinseki signed a memo confirming medical testing was, in fact, ordered for hundreds of thousands of Gulf War veterans exposed to DU. Unfortunately, Dr. Roe, the military never did the DU medical testing for the 700,000 soldiers.
VCS has written VA. We have spoken with VA's Chief of Staff and urged them to launch DU research and they have not done so.
Of particular note is that in 1999, the U.S. Department of Defense (DoD) and VA leaders met in private and confirmed that Gulf War veterans are, in fact, sick from DU inhalation and embedded fragments. Some of the members of that meeting are here today.
So what we are trying to get to the bottom of is we need depleted uranium research and other toxic exposure research so we can find the answers and get treatment.
The real coup de grace came just last week, Mr. Chairman, when VA announced $2.8 million in stress research. Now, the research may be good and well-intended to help some veterans, but it sent the message that VA staff was still in control, that the message was that Gulf War illness is stress and VA is not going to move forward on this issue.
So we are asking you here today if Secretary Shinseki and the VA Chief of Staff will not launch aggressive research, especially into DU, then Congress needs to intervene. We need to end VA's policy of do not look, do not find. That is where VA will not look for a problem because that way, they do not have to do anything if they find something.
We want you to please hold more hearings on this subject to see how VA implements whatever policies they may announce today because, yes, time is running out.
And I'd like to ask one last comment and VA will be the last panel here. I think it would be very constructive if the Chairman and Ranking Member ask some Gulf War veterans here today to comment on what VA is announcing after they have made their announcements so we can close the loop and we do not walk away from here today saying, well, VA offered all this new stuff, everything looks fine. We need some feedback for VA immediately so they know if they are going in the right direction and they do not have to wait months for another hearing, Mr. Chairman.
Thank you. That concludes my comments.
[The prepared statement of Mr. Sullivan appears in the Appendix.]
Mr. MITCHELL. Thank you.
The first question I have is for Mr. de Planque. In your written testimony, you state that people are looking for the cause and not the solution, that even to this day, everyone is looking for the diagnosis rather than the successful treatment.
Why do you believe this is mutually exclusive and how will the VA know when it reaches the point of successful treatment for this generation of veterans?
Mr. DE PLANQUE. Well, there are twofold reasons for looking at it that way. And certainly finding the causes is not unimportant because that can help to protect future generations of veterans who may be exposed to things. And those are important.
But the ultimate reasoning behind it, you need to treat the people who have the conditions. And in some cases, if you can find an effective treatment, even if you do not know the exact cause, it is far more important to be actually utilizing that treatment and improving the quality of life of the veterans who are suffering from that.
Now, you know, obviously as a medical expert, you can sit there and debate about the specifics of this causes this and so that is how we eliminate that. But rather than getting too far down into the weeds and spending all of the effort chasing the ghost of what exactly caused it when it could be, in fact, a combination of seven, eight, ten different things in combination with each other rather than one specific root cause, if you look to actually treating the people with the problems, that is where we feel that it needs to be a priority.
Ultimately the veterans are the people who are suffering and if we can find causes and eliminate them from future exposures to veterans, then that is certainly very helpful because that protects future generations.
But right now there is an immediate focus because veterans are suffering from these conditions and finding a treatment for those conditions is to us far more important than actually arguing about what the blame is for them.
Mr. MITCHELL. Thank you.
Mr. Sullivan, if the VA does not do the things that it states it will do to make progress in finding the solution to Gulf War illness, what would you like to see Congress do?
Mr. SULLIVAN. Mr. Chairman, Congress would need to do a couple of things. Congress would first need to bring VA in and ask what are you doing, what are the results. Also bring in veterans and say what are your impressions, what are the results of VA’s actions.
And then Congress would also need to introduce legislation to fill in the areas where VA failed to act. Let me give you examples.
First, VA did not want to keep track of Gulf War veterans. Congress legislated the creation of reports to monitor veterans. What has VA done? They have stopped producing the reports.
Congress ordered VA to conduct research into Gulf War illness with the University of Texas Southwestern contract money after VA refused to do the research. That was in 2005.
In 1998, Congress had to act with the Persian Gulf Veterans Act because VA refused to listen to any outside scientists. We had to call in the Institute of Medicine, the National Academy of Science. We had to create the Research Advisory Committee. All of those things happened, Mr. Chairman, because VA refused to act. It is a few staff stuck in key positions that are blocking change.
So if the current Administration, which is now promising to make improvements, to bring change, is not able to do it, we have to find out who exactly in the VA staff is preventing it from happening. And that can happen when you bring in VA, call them on the carpet, and say what is going on. So oversight hearings and legislation, Mr. Chairman.
Mr. MITCHELL. Mr. Sullivan, you mentioned a couple of areas where Congress forced or passed legislation for the VA.
What were the results of those? What did the VA do with those?
Mr. SULLIVAN. Well, when Congress ordered the creation of the Research Advisory Committee, VA dragged its feet for about 4 years and it could not put it together. It took Congress writing letters and the intervention of philanthropist Ross Perot to actually have the Research Advisory Committee created.
In another example for undiagnosed illness, Congress passed a law in 1994 to provide benefits for those conditions. VA essentially denied 94, 96 percent of the claims. So the intent of Congress to provide service-connected status for Gulf War veterans so that they get free health care was being thwarted by VA.
There were several hearings about that and now VA approves about 25 percent of the Gulf War claims. It is still a disaster because that means 75 percent of the Gulf War veterans with undiagnosed illness claims do not get the free health care that they need.
So VA over and over again when Congress launches legislation that tells them to do something, they do not do it. And they have to be dragged in here kicking and screaming.
For 20 years, we have been hearing about these promises of change and now we have the Chief of Staff in here. Let us make sure that we hear that he is actually going to deliver on some of the things they are promising because last week, Mr. Chairman, when VA said that they wanted to do more stress research, the phone calls I received from Gulf War veterans were unbelievable.
They were furious that VA appeared to be preempting this hearing by saying Gulf War illness is stress and it looked like VA was doing something. And we have been down that road for almost two decades and it has to stop now. We need assurances from VA in the room that they are going to provide the care and launch the research now.
Mr. MITCHELL. Thank you.
My time has expired. Dr. Roe?
Mr. ROE. Thank you, Mr. Chairman.
And, first of all, thank you all for your service.
Mr. de Planque, just a couple of comments. The way the VA may, and they can speak for themselves, but as a doctor, treating a symptom is very, very difficult. You need to know the etiology of something.
I would argue that if you know what caused something, it is a lot easier to treat it than if you are just treating symptoms because I have done that many times. When you do not have a cause of an illness, it makes it very difficult to give an effective treatment. You cannot.
And I have chased symptoms in patients that I could not diagnose and never felt good about the treatment they were getting. So we do need to do both.
I think a question I would ask, and I certainly would agree with you all 100 percent, and I have forgotten which one in the testimony, but I think Mr. de Planque, by extending this deadline, we need to do that. That is easy to do. And it should be done.
And the reason it should be done is, and Mr. Sullivan is absolutely correct, we are still learning about, I am a Vietnam-era veteran, and we are still learning about things that occurred 40, 50 years ago.
So absolutely we need to do that. That is one talking point I will leave here with today and we will make sure we at least try to get that done for you.
One of the things, and I am not again defending, they will be here in a minute, but a couple of weeks ago, we had a Subcommittee hearing on suicide prevention outreach and we discussed efforts to outreach towards veterans that were contemplating suicide. And obviously that is an issue with veterans across the board if you look at those numbers.
But communicating with veterans should not be just limited to that. And both of you or many of you brought up concerns about the lack of communication from the VA with Gulf War veterans on issues that concern these veterans. Mr. Sullivan, I think, did.
What do you recommend the VA do to better communicate with Gulf War veterans?
Mr. SULLIVAN. Mr. Ranking Member, thank you for raising that subject of outreach to Gulf War veterans.
The first thing VA needs to do is actually sit down and start speaking politely with Gulf War veteran leaders. Then VA can have some focus groups of Gulf War veterans to make sure what it is that Gulf War veterans are looking for and how to have the message tailored.
Then the next thing the VA can do is actually start delivering the outreach message based on professional input, based on input from veterans, and, of course, VA staff to make sure they are saying the right thing to the right audience rather than just throwing something up at the wall and hoping it sticks.
But the first step, Mr. Ranking Member, Dr. Roe, is for VA to bring Gulf War veterans into the room and sit down and speak with us. And, frankly, they have refused to do so.
Mr. ROE. Okay. Well, I think that ought to be easy to do also.
I think one of the things that has bothered me during this whole discussion, that has confused me is to put my finger on exactly what the cause of this is so we know what treatment to do.
Do you all have any numbers about how many Gulf War veterans are currently being treated with undiagnosed illness? How many have been given disability or treated at the VA?
You brought up so many of them could not get in. I think you mentioned of the 690,000, Mr. Overton mentioned that served in his written testimony I read last night, 250,000 veterans are being treated now or, Mr. Overton, did I misread you?
Mr. OVERTON. No, you did not misread me. Right now the current statistical numbers that we see out of the Institute of Medicine is 250,000 that are affected. Unfortunately, many Gulf War veterans left VA care at the onset because every time they entered a VA medical center for care, they were instantly referred to a psychiatrist and it was deemed a psychological condition as well as the limitations of the Gulf War Veterans Information System, we have no statistical numbers to build anything off of. We cannot get that data. It does not seem to exist. There were coding errors and it is just not being made available to us.
So the internal numbers we do not know. Anecdotally we can tell you that most Gulf War veterans left VA care because nobody was providing any care.
Mr. ROE. Well, you know, I mean, I got that. Do you know how many have gone through the Veterans Benefits Administration and are receiving benefits? Do you all have any numbers on that?
Mr. OVERTON. Yeah. I will touch on that briefly because we know that, too, off of the system. But one of the things to keep in mind with that, one of the things that we pulled over the last several years when we could get data is, you know, when you take a Gulf War veteran and you look at receiving benefits, the majority are receiving a ten percent for tinnitus of hearing loss or ringing, roaring, rushing sensation of the ears.
So when we start trying to look at the other data, I know Paul has probably the closest statistics available, so I will yield to him for some of those additional numbers.
Mr. SULLIVAN. I regret to say, Mr. Ranking Member, that I did not bring my glasses up here, so I cannot see the number in my fine print written statement. So I will get an accurate number to you.
To the best of my knowledge, approximately 300,000 Gulf War veterans who served in 1990 to 1991 have sought care and/or filed a disability claim against the Department of Veterans Affairs.
I was the person who helped create those reports. When I left VA in 2006, they were well-received and reviewed by VHA, the Office of the General Counsel, the Office of Congressional and Legislative Affairs. They all concurred with the methodology and the statistics in the report.
However, after I left VA about 4 years ago, the report fell into disarray, frankly because VA wants this subject to go away.
You know, when there are more hearings on this, more Gulf War veterans go in for care. And if VA does not have funding to provide for additional care for new patients, then VA sees this as a no win situation. They just want this to go away.
So we can sit here and give you all the statistics in the world, Dr. Roe, but here is the bottom line. Gulf War veterans might still be going to VA, but they are not getting treatments for the conditions that we are complaining about mainly because VA never launched the research to find out why we are sick and never really launched the research to provide treatments.
And that is why we are here 20 years later, an enormous staff failure that is continuing to kill our vets. We need to keep our eyes on that. The numbers are huge.
Mr. ROE. I yield back, Mr. Chairman. Thank you.
Mr. MITCHELL. Thank you.
Mr. Walz?
Mr. WALZ. Well, thank you, Chairman and Ranking Member, for this continued series of important hearings. I very much appreciate it.
And point out again, I think we were talking at the first set of hearings, we pointed it out, the Majority Counsel, Colonel Herbert, is a Gulf War veteran himself and was in the midst of many burning oil wells and other things. So we appreciate his insight into this.
I want to thank each of you for being here.
I wanted to hit on, I think that both the Chairman and the Ranking Member brought up the point on this epidemiology, of finding out where this comes from is critically important. I do not want to misstate where you were at, but I think it is important.
And I think the VA is right to explore where things came from for two reasons, as Dr. Roe clearly pointed out, in treatment, but I also think is, is that so it does not happen in the future. If our current warriors in the Middle East are being exposed to the same triggers, knowing where they came from is critically important. So I appreciate where you are all coming from on that.
As frustrated as you are, the one thing I would say, I know, Mr. Sullivan, you spent a lot of time on this. You have been a great voice and we appreciate it. I do not get the same, I guess, feeling from the VA. I think they want to solve this thing. I do not think they want it to go away. I get the feeling they are trying to get it, but I know it is a frustrating situation.
I was going to ask and just factually because I think you can support some of the things and say, well, why is this not happening, why is this not happening. The staff gave me a memo from 1993 in response to a U.S. Government Accountability Office report of exposure to DU. And in here, it said provide that the, this is a Department of the Army memo, would provide adequate training for personnel who may come in contact with DU contaminated equipment, two, complete medical testing of personnel exposed to DU contamination during the Persian Gulf War.
Did that happen?
Mr. SULLIVAN. Congressman, no, it did not happen.
Mr. WALZ. Okay.
Mr. SULLIVAN. And the people responsible for not making it happen are in this room today.
Mr. WALZ. Okay. Now, these are the type of things that I want to get at to try and understand of why this did not happen. It was clearly a directive coming out of the Army.
The one thing I can tell you is that I know happened from being a First Sergeant at the time, I was responsible for pushing the play button on the 15-minute DoD DU exposure video and that was it. That was all that was talked about. And as an artilleryman, that was a big issue. But that was the end of it.
And so I, too, have a concern if any of this is moving forward. I cannot speak recently, but I know from that time of the mid-1990s up until my retirement in 2005, I never broached the subject again that I can recall.
Is that true to the best of your knowledge?
Mr. SULLIVAN. Congressman, you are really close on that. The bigger issue here is that the Department of Defense likes depleted uranium as ammunition. So it hypes the effectiveness of the weapon and really it does not need to be hyped. I was there on the battlefield as a scout in the invasion and I can tell you that DU rounds work. They tore through Iraqi tanks like nobody’s business.
However, the military did not follow-up with the testing. It is their do not look, do not find policy.
Mr. WALZ. I do have a follow-up Department of Defense memo from 1995, a year and a half later, that talked about the allegation of this being totally false, apparently presented in a manner designed to mislead, presented out of context, and exhaustive studies of all materials concluded there was no evidence, yada, yada, so forth.
So your contention on this is is that we never did get at the heart of this? We never made the full effort to try and decide what the exposure looked like even though the directive was made clear in the 1993 memo that we should have done so?
Mr. SULLIVAN. Yes, Congressman, and it still needs to be done today.
Mr. WALZ. Okay. Before my time expires, for each of you on this across the board, and I think maybe, Mr. Sullivan, you have expressed that, but for our other two panelists, what do you feel like? Why are we not moving on this? Why are we not doing it? Have we not made the determination that Gulf War illness is real and why are we not moving satisfactorily in your opinion?
Mr. OVERTON. Two parts, Congressman Walz. I wanted to touch first on the initial point you made on epidemiological studies. You know, we can fix this real easy.
We have new electronic medical records and we can put a full military history inside of that record that could track the trends and patterns of units. It is a simple database concept and it would drop down and we would take the information of who served where, when, how, and why were you in combat operations. And it would provide our primary care providers to track trends, see effective treatment.
So on that front, I believe that could be highly effective and moving forward, especially for our younger service-conn/OIF cohorts.
I do not think we want the answers. Every time we see a research study that comes close to finding an answer, it seems as if there is some little mechanism that has been buried inside of it to shut it down.
So, again, going along with what Paul says, I mean, we do not want to find this. If we find this, unfortunately, as much as I hate to say it, it becomes a bottom line budget matter. We have to compensate veterans.
My mentality on this is if we can fund the war, we need to fund the war fighter. That is all we can do. We have to take care of those of us that went down range in defense of this great Nation and came home broken.
And it is the cause and the charge of these agencies to provide that care for us. And it cannot be a matter of we do not have the budget. It is not fair. It is unconscionable and it needs to end now.
Mr. WALZ. Who do you think puts pressure on them, and I will let Mr. de Planque finish, but who puts pressure on them to do that because when they come to us, we ask them what do you need, tell us what you need to care for our veterans? And I have heard all of us say that time and time again. Who is putting the pressure on them to not ask for it?
Mr. OVERTON. And is that not the frustration because we sit here and listen to that and walk out just absolutely dismayed when we say why are we hearing that the budget is not there, but we know that the budgets have been provided and put into place.
You know, I do not want to put all this on VA. VA unfortunately gets the aftermath. The Department of Defense has much responsibility here and I would hope to see in the near future that both the House Armed Services Committee and Veterans’ Affairs Committee can come back together to begin to address this because it really does start at active duty. And if DoD, and that is another part of our concern with the report and the way that VA is moving forward is a strong relationship, are they going to be dependent upon DoD to give them the information and DoD has not done that in the past.
Mr. WALZ. Well, this is another problem of lack of seamless transition causing problems?
Mr. OVERTON. That is correct, sir.
Mr. WALZ. Mr. de Planque, if you would finish quickly.
Thank you, Chairman. I am sorry I went over my time.
Mr. DE PLANQUE. And just to finish quickly, and I agree completely that if you are going to fund the war, you have to fund the war fighter and you have to fund all of the after effects.
I think some of the reluctance to address things like this stems from almost an embarrassment. People do not want talk. It is something people do not want to talk about. It is something they do not want to think about and that is in an even generalized sense about people as a whole, society as a whole in that they do not want to focus on what the after effects were to soldiers.
They want to look the other way when they see an amputee soldier struggling through an airport. But at the same time, they want to be sympathetic. They do not know how to deal with it and so they are embarrassed. And so it kind of gets shifted into the fringes and the poor veterans are left sitting out there with questions and they do not know where to turn for answers.
And the information component, getting good, accurate information out to the veterans that was mentioned earlier, that is a key component and telling them it is okay to step forward.
For Gulf War illnesses, we have talked recently about post-traumatic stress disorder (PTSD) and removing the stigma from that and saying it is okay for veterans to go forward and seek help. And I do not want to tie that in and conflate it because I know, you know, we have talked about, you know, mixing it with stress stuff, but it is a similar situation in that it is a situation that nobody wants to talk about and nobody wants to tell people it is okay to be suffering from this. These things happen. We just need to find a treatment for it.
And I agree with what Dr. Roe was saying also about etiology is important. And we are not trying to say that finding the causes of these things are important. What we were trying to say is you can sit around trying to point fingers and find the blame, what is the blame for this, what is the blame for this, and argue about that until you are blue in the face, but you are not looking for the solution.
Sometimes finding the cause of it is a part of the solution and we completely agree with that. But spending all of the time devolving into it has got to be this and subgroups championing that I believe this is the cause and I believe this is the cause. They fight with each other over which should get the lion’s share of the research.
And so the whole approach, how do we fix the veterans, is ultimately that is why we believe it is more important—
Mr. WALZ. I appreciate it.
Mr. DE PLANQUE. Thank you.
Mr. WALZ. Chairman, I am sorry for overusing time.
Mr. MITCHELL. One last question from Dr. Roe.
Mr. ROE. Just one brief question. I know we had many people, Nations in the coalition during the Gulf War, much more than now. And Kuwait is a small country.
Have we studied the population of Kuwait where a lot of this action took place and the southern part of Iraq and the cohort Nations in England, Canada, Australia? Have they shown similar things?
Mr. SULLIVAN. Dr. Roe, I understand that there were some studies in the early 1990s of Kuwaitis who remained in the theater and they showed increases in respiratory problems, heart problems, and other stuff like that when there were scientific research panels in the Middle East. However, when the U.S. Government decided to look at what was going on, it did a very surface review of that.
I do know one thing is that some Nations did not have some of the problems we have because they did not have some of the exposures we had, for example, pesticides, pyridostigmine bromide (PB), depleted uranium, and whatnot.
So you actually have different exposure populations. And that is why it is important to find out which one of these issues or multiple may be behind it because at the end of the day, we want to make sure we are providing the right kind of treatment, so we can do both. That is the perfect world.
And after 20 years of VA saying it is not this or not that and delaying research, we have actually got to do both now. If we do not get that answer from VA that they are going to look into treatments and research for the causes, we have struck out here.
Mr. OVERTON. And I would like to just add briefly I disagree briefly with Paul. We have had coalition forces over attending the Research Advisory Committee meetings seeing similar disease patterns within their soldiers.
The Norwegians were here recently. The interesting thing is it is a much smaller cohort, but also taking the pyridostigmine bromide and having similar exposures and similar conditions.
They look to you and to our Nation as the leaders, as the leaders in science and as
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