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House Committee on Veterans Affairs Subcommittee on Health Statement by Ms.
Ellen Embrey Deputy
Assistant Secretary of Defense for
Force Health
Protection and Readiness Department
of Defense Mr.
Chairman, I appreciate the opportunity to appear before the
Subcommittee on Health to report on the Department of Defense’s
continuing efforts related to the illnesses and undiagnosed physical
symptoms of veterans of the Gulf War and to provide information on the
status of some deployment health surveillance programs. First,
let me emphasize that the
Department of Defense is committed to providing a world-class health
care system for its servicemembers and their families.
This commitment is especially strong today when our soldiers,
sailors, airmen, Marines and Coast Guardsmen are deployed throughout
the world in support of Operation Enduring Freedom and other
contingencies. As America's sons and daughters serve and protect our nation,
I recognize they may encounter unique challenges from operational or
environmental conditions as well as from combat.
The Gulf War and subsequent deployments to Somalia, Bosnia, and
Kosovo provided the Department of Defense insights into the importance
of deployment health protection.
In response, we have changed processes, revised procedures, and
invested heavily in research to develop more effective force health
protection measures and equipment for our people; but our work
continues. We are
assessing and monitoring current deployments and are committed to
provide for all who have health concerns related to deployments. The
experiences of the Gulf War focused our attention on traditional and
non-traditional challenges to deployment health.
Recognizing the seriousness of these challenges, the Department
of Defense sought the assistance of the Institute of Medicine.
In a comprehensive three-year study, titled “Strategies to
Protect the Health of Deployed U.S. Forces,” the Institute of
Medicine validated the challenges facing us and recommended strategies
to better protect the health of the forces in the future.
We have addressed many of these challenges and continue now to
build the broad and integrated systems that will enhance prevention
of, accelerate surveillance for, and increase effectiveness of
treatment for deployment-related illnesses and injuries. In
2000, the Joint Staff created and established a vision for Force
Health Protection to support Joint Vision 2020.
This vision encompasses a set of health programs that provide
an integrated and focused approach to protect and sustain the
Department’s most important resources—its servicemembers and their
families. Force Health
Protection is built on these pillars—promoting and sustaining a fit
and healthy force, casualty prevention and casualty care and
management. Based on lessons of the Gulf War and subsequent deployments,
this vision takes a life‑cycle, long-term approach to protecting
the health of those who serve.
However, this vision places its most intense focus on
continuous improvement to the Military Health System’s doctrine,
organizations, people, equipment, and technology to support the
readiness and effectiveness of the fighting forces when they deploy.
It requires the monitoring and surveillance of threats and the
forces in military operations, enhancing commanders’ and
servicemembers’ awareness of threats before they affect the
health of the force, and
providing essential care of injured and ill in a theater as well as
evacuation for definitive medical care.
These key areas are being rapidly implemented in Afghanistan
and in other deployments today. Health
Affairs, the Joint Staff, combatant commanders, and the military
services are indivisible partners within the Department of Defense in
this effort. The
events of the Gulf War also caused the Department to take a hard look
at occupational and environmental health surveillance issues with a
focus on casualty prevention. To
that goal, we have designated the U.S. Army Center for Health
Promotion and Preventive Medicine as the Department’s lead agency to
provide a comprehensive environmental surveillance program that: -
Identifies risks for diseases and injuries for deployed forces; -
Identifies significant environmental and occupational hazards; -
Determines the impact of disease or non-battle injury (DNBI) on
readiness; -
Provides support for commanders, policy makers, and others who
can act to prevent diseases and injury; and -
Monitors the
effectiveness of prevention strategies and programs. Another
area where we focused attention was medical logistics. Before the Gulf War, the depot system was the primary means
of obtaining medical supplies. Since
then, the Department has observed tremendous improvement through the
implementation of the tri-service Defense Medical Logistics Standard
Support system, which standardizes
numerous medical logistics systems used by the Services’ medical
departments. This system improves support to deployed forces and
maximizes cost savings by taking advantage of business practices of
the commercial community. As
a result, today, the Department is better prepared to meet the medical
materiel requirements of deployed forces. Issues
and concerns from the Gulf War remain and we intend to continue our
vigorous efforts to address and resolve these issues.
We are equally committed to broaden those efforts to include
issues and concerns arising from current and future deployments.
Dr. Winkenwerder takes seriously his role as the Special
Assistant for Gulf War Illnesses, Medical Readiness, and Military
Deployments and has begun to focus on deployment health issues as they
affect the entire Military Health System. Dr.
Winkenwerder, as the Assistant Secretary of Defense for Health
Affairs, has aligned the former staff of the Office of the Special
Assistant into a Deployment Health Support Directorate, which will
continue to provide support and outreach to all those with issues
associated with any deployment. Through
my office, that directorate, in cooperation with the Joint Staff and
the military services, will provide critical assessments of deployment
health-related processes and issues.
As a result, we can more closely monitor force deployment
health protection issues. Improving
the adequacy of environmental surveillance, completeness of individual
medical records, and implementation of other lessons learned will
allow the Military Health System to be responsive to the health
concerns of our servicemembers, veterans, and their families. One
area in which we continue to advocate the health concerns of
servicemembers and veterans is through our support of medical
research. As you may
know, Health Affairs and the Deputy Under Secretary of Defense for
Science and Technology participate on behalf of the Department on the
interagency Research Working Group of the Military Veterans’ Health
Coordinating Board. The
Research Working Group facilitates coordination and collaboration of
research among the Departments of Defense, Veterans Affairs, and
Health and Human Services. I
believe the veterans are best served by following accepted scientific
processes for selection and funding of medical research.
We are committed to investigating the possible causes of
illnesses and treatments for medically unexplained physical symptoms
that are affecting veterans. We
have begun research on the health of military personnel over their
entire careers and beyond. A prospective study of U.S. military
forces, called the Millennium Cohort Study, responds to the need for a
longitudinal study to assess the health impact of major elements of
military service, especially deployments and their associated risks.
This study also responds to recommendations from Congress and
the Institute of Medicine to systematically collect population-based
demographic and health data to evaluate the health of servicemembers
throughout their military careers and after leaving military service.
This study will eventually use a cross-sectional sample of over
140,000 military personnel who will be followed prospectively every
three years over a 21‑year period through 2022. Additionally,
in response to veteran concerns and congressional direction, we have
established three centers focused on deployment health issues.
These centers provide research, medical surveillance, and
clinical care services. For
example, the Center for Deployment Health Research in San Diego
has established a DoD birth defects registry and monitors reproductive
outcomes among all military families, including those of personnel who
have deployed. All three centers work closely with their VA
counterparts—two centers for the study of war-related illnesses. The
Department also has taken steps to ensure that we deploy fit and
healthy military personnel, that we monitor their health while they
are deployed, and that we assess their health when they return.
The Center for Deployment Health Surveillance at Walter Reed
Army Medical Center in Washington D.C. is our key to tracking and
analyzing these deployment health data.
Our policy and practice is to assess potential health threats
in areas of deployment and minimize such threats where feasible.
All of these principles are incorporated in DoD policy letters
and directives and into a policy memorandum of the Joint Staff.
The combatant commanders and their component commands, through
the extensive professional efforts of the military services’ medical
departments, execute these policies and directives in the field. Because
we are concerned about the health of veterans, both during their
military service and after they have left active duty, we work closely
with the Department of Veterans Affairs initiating procedures and
programs to facilitate the smooth transition of servicemembers’
records to the VA. As
documented for Gulf War veterans, the majority of ailments found in
deployment participants have been medical conditions seen commonly in
other military, veteran, and civilian outpatient populations.
The Deployment Health Clinical Center at Walter Reed Army
Medical Center, in cooperation with the Department of Veterans
Affairs, has developed and tested a patient-oriented, evidence-based
clinical practice guideline to aid primary caregivers in the
assessment of illnesses that occur after deployments.
Implementation of this guideline will begin next month.
My expectation is that all beneficiaries who have been involved
with deployments – including families of deployed servicemembers –
will receive health care that is fully responsive to any special
health issues that arise after deployments.
I believe this clinical practice guideline will foster an
important partnership between the individual with the health concern
and the caregiver who directs individualized treatment for better
continuity of care. In
addition, the Department continues to work towards fielding medical
information systems to provide complete patient health records
electronically, including all immunizations.
Such systems will greatly facilitate the preservation of
individual health records, epidemiological studies of military health,
and transfer of health records to the Department of Veterans Affairs.
We
will continue our close collaboration with the VA to improve medical
service to our veterans. In
addition to the clinical practice guideline, we have instituted common
separation medical examinations, which efficiently serve the needs of
veterans, the DoD, and the VA.
Another result of the DoD‑VA partnership is “FEDS
HEAL.” This program
establishes a network that links the provider resources of the VA and
the Department of Health and Human Services Division of Federal
Occupational Health to furnish physical examination, immunization,
dental screening, designated dental treatment, and other specified
diagnostic services to units and individuals in the National Guard and
Reserve components. I
fully expect additional successes from our continuing collaboration
with the VA. In conclusion, based on observations during our visits to operational units of the Department of Defense, we believe the military health services are totally committed to ensuring the health of our military forces, and we are committed to doing everything in our power to provide a world‑class health care system for our servicemembers, veterans, and their families. Back to Witness List |