[Senate Hearing 107-792]
[From the U.S. Government Publishing Office]
S. Hrg. 107-792
MILITARY EXPOSURES: THE CONTINUING CHALLENGES OF CARE AND COMPENSATION
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
__________
JULY 10, 2002
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
JOHN D. ROCKEFELLER IV, West Virginia, Chairman
BOB GRAHAM, Florida ARLEN SPECTER, Pennsylvania
JAMES M. JEFFORDS (I), Vermont STROM THURMOND, South Carolina
DANIEL K. AKAKA, Hawaii FRANK H. MURKOWSKI, Alaska
PAUL WELLSTONE, Minnesota BEN NIGHTHORSE CAMPBELL, Colorado
PATTY MURRAY, Washington LARRY E. CRAIG, Idaho
ZELL MILLER, Georgia TIM HUTCHINSON, Arkansas
E. BENJAMIN NELSON, Nebraska KAY BAILEY HUTCHISON, Texas
Mary J. Schoelen, Deputy Staff Director, Benefits Programs/General
Counsel
William F. Tuerk, Minority Chief Counsel and Staff Director
(ii)
C O N T E N T S
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July 10, 2002
SENATORS
Page
Nelson, Hon. Bill, U.S. Senator from Florida, prepared statement. 4
Rockefeller Hon. John D., IV, U.S. Senator from West Virginia,
prepared statement............................................. 8
Specter, Hon. Arlen, U.S. Senator from Pennsylvania, prepared
statement...................................................... 1
WITNESSES
Cole, Leonard A., Ph.D., Adjunct Professor, Department of
Political Science, Rutgers University, Newark, NJ.............. 55
Prepared statement........................................... 57
Cooper, Hon. Daniel L., Under Secretary for Benefits, Department
of Veterans Affairs; accompanied by Robert Epley, Associate
Deputy Under Secretary for Policy and Program Management,
Veterans Benefits Administration, and Susan Mather, M.D., Chief
Officer, Public Health and Environmental Hazards............... 9
Prepared statement........................................... 11
Schwartz, Linda Spoonster, Chair, VVA Healthcare Committee,
Vietnam Veterans of America, joint prepared statement.......... 42
Smithson, Steven R., Assistant Director, National Veterans
Affairs and Rehabilitation Commission, The American Legion..... 50
Prepared statement........................................... 52
Weidman, Richard F., Director of Government Relations, Vietnam
Veterans of America; accompanied by Linda Spoonster Schwartz,
Ph.D., Chair, Vietnam Veterans of America Healthcare Committee. 39
Joint prepared statement..................................... 42
Winkenwerder, William, M.D., Assistant Secretary for Health
Affairs, U.S. Department of Defense; accompanied by Ellen
Embrey, Deputy Assistant Secretary for Defense for Force Health
Protection and Readiness, and Michael E. Kilpatrick, M.D.,
Director, Deployment Support, Force Health Protection and
Readiness...................................................... 14
Prepared statement........................................... 16
APPENDIX
Campbell, Hon. Ben Nighthorse, U.S. Senator from Colorado,
prepared statement............................................. 61
Hayden, Paul A., Deputy Director, National Legislative Service,
Veterans of Foreign Wars of the United States, prepared
statement...................................................... 70
Ilem, Joy J., Assistant National Legislative Director, Disabled
American Veterans, prepared statement.......................... 61
Love, Kirt P., President, Desert Storm Battle Registry, joint
prepared statement............................................. 64
Lyons, Paul, President, Desert Storm Justice Foundation, joint
prepared statement............................................. 64
National Gulf War Resource Center, prepared statement............ 66
Wolf, Dannie, President, American Veteran Justice Foundation,
joint prepared statement....................................... 64
(iii)
MILITARY EXPOSURES: THE CONTINUING CHALLENGES OF CARE AND COMPENSATION
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WEDNESDAY, JULY 10, 2002
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The committee met, pursuant to notice, at 9:42 a.m., in
room SR-418, Russell Senate Office Building, Hon. Arlen
Specter, presiding.
Present: Senators Rockefeller, Wellstone, Nelson, and
Specter.
Also present: Senator Nelson of Florida.
Senator Specter [presiding]. Good morning, ladies and
gentlemen. Senator Rockefeller, who is en route, has asked that
I begin these proceedings.
This morning the Committee on Veterans' Affairs will hold a
hearing on so-called Project SHAD, an acronym for Shipboard
Hazard and Defense, a U.S. Navy project in the 1960's. This
program was designed to test effectiveness of both delivery and
protective systems relating to chemical weapons, and it was
comprised of many tests, more than a hundred.
A number of issues have arisen as to the propriety of
subjecting U.S. naval personnel to these tests: whether there
were deadly biological agents to which they were exposed;
whether such exposures were intended, or merely incidental to
collecting data on animal subjects; whether VX and sarin--very
lethal agents--were used; and whether the U.S. personnel were
really, in effect, guinea pigs, which the Department of Defense
has denied.
There is a problem in the present of identifying the people
who were subjected to these exposures, and this committee has
decided to convene this hearing to try to make a determination
as to what the facts are, whether the action taken by the
Department of Defense was proper, what exposures there were,
and what were the circumstances of those exposures. There has
been an assertion that consent was given, but no formal written
consent forms have been located.
[The prepared statement of Senator Specter follows:]
Prepared Statement of Hon. Arlen Specter, U.S. Senator From
Pennsylvania
Thank you, Mr. Chairman, for convening this important
hearing. You have done so, at least in part, at my request. I
appreciate that consideration.
With this hearing, the Chairman and I hope to shed some
light on an episode in the history of the Cold War--so-called
``Project SHAD''--that has, at minimum, some unfortunate
features. Project SHAD--an acronym referring to ``Shipboard
Hazard and Defense''--was part of a larger Department of
Defense effort--labeled Project 112--designed to identify and
test defenses against potential chemical and biological
weapons.
Of course, the identification and testing of potential
defenses against potential chemical and biological weapons was
a salutary goal--one that has relevance to this day.
Unfortunately, the way DOD went about Project SHAD testing
appears to have been, at minimum, less than salutary. Based on
material we have seen--and I hasten to add we have seen
information related to only 12 of 103 tests, and that
information has been ``scrubbed'' by the Pentagon to include
only information that DOD deems to be ``medically relevant''--
we are not looking at a ``horror story'' here; it does not
appear that, as a general proposition, DOD used Naval crews as
``guinea pigs'' to test the efficacy of highly dangerous
weapons or of protective devices.
It is clear, however, that Naval crews were exposed--
likely, needlessly exposed--to the deadly chemical warfare
agents sarin and VX. It is clear, further, that Naval personnel
were directly and intentionally exposed to biological agents--
ones less deadly, it appears, than sarin or VX, but agents that
are hardly harmless. Finally, Naval crews were exposed to
supposedly harmless ``simulants''--agents designed to mimic the
properties of sarin and VX.
These exposures raise significant questions relating to
informed consent. Was consent actually sought and gained? Was
it truly ``informed'' and freely given? Was consent properly
documented? And perhaps most importantly, was it proper to
conduct these experiments at all--even with consent? These are
questions I look forward to exploring with our DOD, and other,
witnesses.
I am pleased, also, to see that VA is present today. For
whatever judgments might be made on the propriety of DOD
actions in the 1960s, the Federal Government surely must
rectify the situation now. And just as it was the case after
Vietnam and after the Gulf War, VA is--once again--the agency
left to pick up the pieces. I am interested to learn of VA's
assessment of the health status of Project SHAD veterans. I am
also interested in learning of VA's experience in notifying
them, treating them, and in processing their claims for
compensation.
It is imperative that the Pentagon do better in getting
information to VA relating to Project SHAD, and other,
exposures to dangerous chemical or biological agents by service
members. VA must have this information so that it might provide
Project SHAD veterans with medical treatment and, if
appropriate, compensation. In this regard, I note that of the
approximately 2800 service members who were exposed in 12 of 34
Project SHAD tests--only the tip of the Project 112 iceberg--
just 622 have been notified. For DOD to state that it cannot
usefully identify more than 622 veterans by Social Security
number is wholly inadequate. If DOD has no way of cross-
referencing Service Numbers to Social Security Numbers, it must
find a way--and it must do so now.
Mr. Chairman, I look forward to hearing this testimony and
questioning the witnesses. So let us proceed.
Senator Specter. And now I yield to the distinguished
chairman of this committee, who has arrived.
Chairman Rockefeller. No. You go ahead.
Senator Specter. Now I do not yield to the distinguished
chairman. [Laughter.]
I call on Senator Nelson for an opening statement.
Senator Nelson of Nebraska. Thank you very much, Mr.
Chairman, and I certainly want to thank you, the chairman,
Senator Rockefeller, for holding this hearing today and the
witnesses for appearing to help us understand the hazards which
our men and women have been exposed to during these past
several decades.
As you know, the United States is not only a great country
but a compassionate country, so the men and women who serve in
the military do understand that there are certain risks that
are assumed. But sometimes there are risks that are assumed
unknowingly. And in spite of the risks that are there, the men
and women of the military serve our Nation with distinction and
with great sacrifices. And that is why it is so disheartening
when we hear from veterans today who feel that the country
isn't honoring the commitment that has been made to them when
they pledged to give their lives and their commitment to our
country.
So it is difficult to understand why some veterans aren't
being told what they have been exposed to in order to ensure
that they can get proper treatment. If they don't know, they
can't followup on it.
Additionally, it is important that health care providers
know what these hazards are that their patients have been
exposed to so that they can build a knowledge base on how to
treat their current patients and similar patients in the
future. It is apparent that the veterans service organizations,
the Department of Defense, as well as the Department of
Veterans Affairs need to communicate better and more openly on
this issue of military exposure.
I truly believe that the improved communications will
benefit the veterans who are suffering by allowing them to get
the care that they need and that they deserve. And so I want to
again thank the chairman and ranking member for this hearing
today and look forward to as much of the testimony as I might
hear today, and we will follow the written testimony as well.
So thank you very much, and thank you, Mr. Chairman.
Senator Specter. Senator Wellstone, would you care to make
an opening statement?
Senator Wellstone. Thank you, Mr. Chairman. You know what I
think I will do is I will include my opening statement in the
record and make about 2 minutes of remarks. And I have talked
to Senator Nelson about this, and as I look at this experience
with Project SHAD----
Senator Specter. Which Senator Nelson?
Senator Wellstone. You are right. Both. How about both?
Both of them, both Nelsons, Senator Nelson from Florida, but I
also was listening to the comments of my colleague from
Nebraska, and I agree.
The only thing I want to say besides the statement that is
in the record--and Jay and I have, I think, talked about this
as well--this is--we have this kind of awful record. I mean, I
remember the work with Atomic veterans, and this just reminds
me of Atomic veterans, Gulf veterans, Agent Orange, and it is
this awful record of excessive secrecy and sort of people, you
know, veterans and their families feeling like the Government
is not being honest with them, they are put in harm's way, and,
you know, they keep asking for some recognition of what has
happened. They keep asking for some compensation. They keep
asking for treatment, and over and over again they come up
against this wall of--I don't know whether it is the secrecy or
whether it is just sometimes incompetence. But I really hate to
see this again, and I really believe that this is an extremely
important hearing. Finally, because of Secretary Gober and
Secretary Principi, we are able to get the compensation for the
Atomic veterans.
The other point is it is just an awful thing when veterans
feel like, you know, they haven't been dealt with honestly by
their Government and they were put in harm's way and now no one
is really listening to them.
My other point is, assuming that the scientific evidence,
Mr. Chairman, both chairman and ranking minority member,
remains ambiguous, that you don't know for sure, then it seems
to me the policy question is which side do you err on. And it
seems to me that we have got enough experience here to know
that we ought to err on the side of these veterans and their
families. And that is my second point and last point. It is a
very important hearing, and I thank my colleagues and the Chair
for this.
Senator Specter. Senator Nelson of Florida has introduced
legislation on this subject, and while he is not a member of
this committee, we welcome him here and invite him to make any
comments at this time as he may choose to make.
STATEMENT OF HON. BILL NELSON, U.S. SENATOR FROM THE STATE OF
FLORIDA
Senator Nelson of Florida. Mr. Chairman, the Nelson boys
are here, and I might say, just prior to my remarks, that this
Nelson is a very honorable Nelson because we both had a stake
in the national championship in the Rose Bowl. [Laughter.]
And we had a little friendly bet: a crate of Florida
oranges versus a box of Omaha steaks. And I am certainly
enjoying those steaks.
Senator Specter. Thank you very much for those relevant
comments. [Laughter.]
Senator Nelson of Florida. I thought you would enjoy that.
Senator Specter. Do you have anything to say on the subject
at hand?
Senator Nelson of Florida. Mr. Chairman, I have quite a bit
to say about this issue. In the 1960's and 1970's, sailors were
gassed on ships in the Pacific. It is unclear as to whether or
not they were told. It is unclear as to whether or not they
were given the protective gear. Thirty and forty years later,
those sailors are now receiving letters saying, ``You may have
some ill health effects, and we want you to go into a veterans'
medical facility.''
As a matter of fact, there were 113 of these tests that
were conducted in those two decades, and only 6 of those 113
tests have been declassified. And of those 6 tests, there is an
approximate population of 4,300 veterans that are to be
notified, but of which only 622 have been notified by mail by
the Veterans Administration. Fifty-one of those 622 happen to
be in the State of Florida, and I would say to each of the
Senators here there is a list of how many veterans have been
notified in your State. I know that in Senator Wellstone's, of
those 622 there are some 14 or 18, and, of course, those
numbers will just increase as the various tests are
declassified and as the notification process continues.
So the question is: What happened? In fact, if the issue
needs to be kept classified, then it can certainly be handled
within the bosom of the appropriate committees. In the DoD
authorization bill that we just passed before the break, Mr.
Chairman, we added an amendment that would require the DoD to
come forth and explain what happened in these tests, not only
in SHAD but in a host of other tests.
For example, in the 1950's, in Boca Raton, FL, there were
tests being conducted on developing a toxin that would destroy
the Soviet wheat crop. And when I inquired as to this, because
there is an 85-acre parcel at the old Boca Raton military air
field, which, by the way, is now the site of Florida Atlantic
University, one of our State universities, and the very busy
Boca Raton Airport, the general aviation airport. But that 85-
acre site is still untouched.
And so when I wrote after having heard a number of the
comments come out of that area, the Department of Defense says
it is classified. So we just added an amendment to the DoD
authorization bill that said if you have to come forth, you are
going to come forth, Mr. DoD, and report to us, and if it has
to be classified, so be it. But we need to know what happened.
We need to know were people exposed, both civilian and
military. And if so, as these first 622 letters have been sent
out by the Veterans Administration on the declassified SHAD
experiments, then what is the medical problem that would now
two and three decades later having the Government suggest that
these veterans come in.
So I just wanted to come, and I thank you for the
opportunity of holding this hearing. It is extremely important
to how we honor the people who wore the uniform of this country
and have protected this country when it was in harm's way, and
we need now, if they are in harm's way, to respond
appropriately.
Thank you, Mr. Chairman.
Senator Specter. Well, thank you, Senator Nelson. I think
it is worth noting that it was not until May of this year that
the Defense Department acknowledged that these tests used real
nerve and biological agents, and I think it is not just a
matter of coincidence--Senator Rockefeller and I were
exchanging notes on this--that yesterday afternoon at 5 o'clock
the Department of Defense announced an expanded investigation
on this issue. That is an anticipatory advantage or an
anticipatory benefit of congressional oversight. Or perhaps it
is just a coincidence.
Chairman Rockefeller. I don't think so.
Senator Specter. And now the chairman speaks. Senator
Rockefeller?
Chairman Rockefeller. Thank you very much, Senator Specter.
I am always a little bit late, as you know, those of you who
come to these meetings. I am not usually this late. But I was
held up by a lot of traffic, and the more I was held up, the
less I cared because my Department of Defense friends--not my
VA friends who have been terrific on this--make people wait,
and you make them wait forever. I don't know where you get the
guts.
I think back to an American hero, General Norman
Schwarzkopf, in one of the more ignominious moments of this
committee's history. He kept diaries on the Persian Gulf War,
including a little incident called Khamisiyah, where a lot of
chemical bombs had been blown up by the Americans, and he went
over to look at them. He was really mad at the committee
because he didn't like the idea of the committee demanding that
he turn over his diaries because, you know, generals and people
who fight wars don't truck or give in to mere politicians. He
considers that an insult to his integrity. He came up here and
he said, you know, I looked at those bombs, and they had these
little yellow ribbons around the front of them. But the
problem, he said, was that everything was written in Arabic.
And how was I meant to know what was going on?
These were his words, if you want to go back and check the
record. And, of course, he probably didn't have more than 30
people surrounding him who could have read those things to him.
But was he willing to admit a single mistake, a single error, a
single anything? Nothing.
And that is my view of DoD. I used to get into this
subject. Now I just get mad about it. VA has been terrific.
Anybody from VA here has been terrific. Tony Principi has been
terrific. They have shoved this, they have pushed this. This
press release that Senator Specter referred to is a joke. And
you are going to answer to it. At 5 o'clock yesterday, DoD
expands SHAD investigation. Well, congratulations, 5 o'clock
yesterday. I am sure that was a coincidence.
Now, I am just a politician, you understand? People like
you don't have to worry about people like me. You can disdain
people like me. Because I represent people, I have to go back
to the Persian Gulf War just like Senator Wellstone and all the
rest of us have. You saw people who couldn't move, who had lost
their wives, who had lost their jobs, who couldn't sleep, who
couldn't pick up a newspaper, who you couldn't touch because
they would scream in agony. Did DoD have anything to say about
it? No.
And we had an atomic war veteran come in. He had been
through these tests earlier in the 1940's and 1950's. He
testified. And you know what he testified about? He testified:
I want to tell you what it is like to die, to be in the process
of dying--which he did shortly thereafter--knowing that the
Government never told us anything, and the Government refuses
to because it said you can't prove you got cancer because of
us. He's a soldier or a sailor and he's dying.
A couple years ago we got something done about that. What
did it take to do something about Agent Orange? You know what
it took to get someone to look into Agent Orange exposures? Not
anybody here, nobody from the Defense Department, I will
guarantee you, because you never make mistakes. You never make
mistakes.
You know what it took? It took Admiral Zumwalt to come in
here because his son was dying, and that got the Congress
finally to wake up. His son was dying from Agent Orange, and
that got Congress to wake up. And then we passed legislation,
20 years too late.
There is a lot of talk about the CIA and the FBI not
cooperating, but there is no talk about either of them not
caring. They just have cultural problems. The FBI investigates
crimes that have already taken place. The CIA is looking
forward to try and prevent crimes. Those are two different
cultures, and they don't mix very well. But nobody doubts that
they care.
I doubt you care unless you can prove to me otherwise this
morning.
Now, you, Dr. Winkenwerder, are a young man. But one of
these days, you are going to be a veteran and you may care how
you are treated, or you may not. You may be rich enough by your
retirement that you don't really care because you can handle it
on your own.
But the State that I come from and the States that most of
us come from have veterans who can't afford to take care of
themselves, and they depend upon the VA, which in this case had
to depend upon you, the DoD. Because the Department of Defense
never makes a mistake, can't make a mistake because they are
over there fighting wars. You can't make mistakes,
psychologically you can't admit mistakes.
And maybe you will just care. Maybe you will be a little
bit nervous. Maybe you will understand what some of these
veterans have to go through.
I don't know if there is a disdain in the Department of
Defense for veterans, the people who fought, who kept your
freedom.
I don't know if you care. Really, one of the things I am
going to probe is how you care. How do you insult us with
something like this press release? How do you insult us? You
know, we are elected. You are not. You get appointed. You go,
you apply for a job, and you get a job. You are good enough to
get a job, you pull strings to get a job, you are qualified to
get a job, you get a job and you keep that job. You are
accountable to the person above you, but you are not
accountable to the people. You are not accountable like we are
accountable.
We spend our weekends, we spend our time with people. You
go home at 5, you go home at 7, you play golf on weekends. We
don't. We work. We go back and we spend time with our people.
We are responsible to our people, and we take it seriously.
There is not one person here who doesn't take what we do
seriously. You don't have to face them. They are numbers to
you. They are papers. They are things that come across. You
don't even see veterans. Now, you make policies, or you refuse
to make policies, or you make policies the day before the
hearing because you know you are going to have to testify. You
would have done better not to have put this out, in my
judgment. I would have had more respect for you, to come in and
say, you know, we really haven't done this very well and we are
going to do a better job rather than something like this.
Now, I am a temperate person, believe it or not. But I am
not temperate when it comes to veterans getting shafted by
inattention. And I have about eight questions for you, and I
can't wait to ask them.
Could I give my statement now, Mr. Chairman?
Senator Specter. Yes, we understand that was just an
introduction.
Chairman Rockefeller. Yes. I don't know how much of this I
have to give. It is the same old story, and Bill Nelson pretty
much gave it: waiting, waiting, waiting, refusing to do
anything, getting pressure from the VA, Tony Principi doing a
good job, and then, of course, DoD is too busy to do anything
about it.
You know, you are getting lots of money. You are not under
a restrained budget like veterans health care is under. We
can't stretch our budgets. You can.
So I suppose what we are here is to find out whether
veterans are endangered by all of this. I suspect they are. I
don't know, Doctor, if you were around during the PB
investigations. Were you?
Dr. Winkenwerder. No.
Chairman Rockefeller. OK. Well, that is just too bad. You
know that? Because you might have learned something from that.
Because what the military was doing, they were taking an
investigational drug that had not been approved by the FDA,
forcing soldiers to take it. The smart ones didn't. And the
ones who did may have paid a terrific price for it, many of
them. And then all kinds of studies come up showing that, no,
there is no particular connection, including reports from the
National Academy of Sciences. You know, who am I to talk about
the National Academy of Sciences? I don't buy any of it. I
think there is a direct connection.
And all during this time, we had to fight DoD for
everything we wanted to do, including demanding that the
esteemed General Schwarzkopf make a trip all the way from his
comfortable home in Florida up here to Washington to talk to a
terrible group of politicians who he so totally disdains, who
dared to question the wisdom of the way he won his war, which
is partly how you handle your soldiers and what you do about
them. Do you stand up for your soldiers, your men and women, or
don't you?
Dr. Winkenwerder. I do.
Chairman Rockefeller. I am not asking you. I was talking
about him. And I don't think he did.
Now, he is a big American hero, but when I think of him, I
think of what he did to a lot of veterans by his inaction. He
wouldn't even release the notes he had kept. That is why we had
to threaten to subpoena him, to try and get at his notes. It
wasn't anything about him. It was just trying to get at his
notes. When he finally turned them over, he only gave us a few
pages.
So this is about the Department of Defense attitude. I
mean, do you guys care? I am not sure. I am not sure. It is
just too big a building, too many cultural problems, and you
have got other problems. You are fighting wars. And then there
are veterans. Oh, yes, we have veterans, but you are not
veterans and you are out there fighting the war. Well, VA takes
care of veterans. We try to take care of veterans. We are not a
big and famous committee. But we can get really ticked off
sometimes, and I hope this thing is on television somewhere.
And I hope there are a lot of people listening because you have
got some explaining to do. I will be looking forward to your
statements.
[The prepared statement of Chairman Rockefeller follows:]
Prepared Statement of Hon. John D. Rockefeller IV, U.S. Senator From
West Virginia
Good morning. I wish that I could say that this is the
first time the Committee has gathered in this room to talk
about the struggles of veterans who might have been exposed to
hazardous agents during their military service. I wish that it
were the first time that veterans and officials from the
Departments of Defense and Veterans Affairs have met to talk
about the legacy of battles and tests long over but still not
resolved. Unfortunately, it is not.
First, I want to acknowledge that my colleague, Ranking
Member Arlen Specter, requested this hearing based on his
outrage over the Project SHAD revelations to date. I was
pleased to accommodate his request, especially given my long
history of investigating military exposures and the
consequences for veterans.
In 1994, I chaired a hearing in this room on the legacy of
military research, on the double battle that veterans must wage
with illnesses that may have resulted from service and with the
shroud of secrecy that bars them from the care and the benefits
they so desperately needed. We talked about the hazards that
military research posed to veterans' health, and the lessons we
have learned from World War II until today. The transcript from
that hearing is in front of me, and contains a lot of good
ideas and good intentions and regrets about the way veterans
have been treated in the past. Eight years later, we still
haven't learned those lessons.
DOD recently released information on Project SHAD--
Shipboard Hazard and Defense--tests that took place in the
1960's. That information was released only after pressure from
veterans and Congress spurred VA to look for answers, and after
VA in turn pressed DOD for details that had remained quietly
hidden for decades. Two years after VA asked for information on
SHAD, for a simple list of who and what hazards might have been
involved, DOD finally released information on one-third of
those tests.
While a delay of thirty years for this trickle of
information is appalling, sadly it is no longer shocking.
Veterans have had to struggle to learn about the consequences
of exposures that were no secret at all--the tests that exposed
American forces to radiation during and after World War II,
Agent Orange in Vietnam, and the myriad chemical and biological
hazards of the Gulf War.
We are here to learn whether Project SHAD endangered
veterans' health, but we are also here to address the military
culture that still fails to keep good medical records and to
share those records with servicemembers and veterans in a clear
and timely way. When confronted with questions from veterans,
VA, and Congress, DOD first obfuscates, and then delays. This
is unacceptable.
I don't want to hear about difficulties in sorting and
declassifying records, I want to hear about how we can
streamline that process so that veterans do not have to wait
years for answers. I know that SHAD took place decades ago on
somebody else's watch, but I want to hear what we are doing to
understand whether veterans are now at risk because of those
tests, and what we can do to help them if they are at risk.
Most importantly, I want to hear what all of us can do to
guarantee that we don't perpetuate this cycle of delay and
dismay again.
We are not sitting in this room today because I want
answers to these questions, or because Congress wants answers,
but because veterans want--and deserve--answers.
Senator Specter. Our first witness is Daniel Cooper, Under
Secretary for Benefits of the Department of Veterans Affairs.
So let us proceed. We have a long list of witnesses. We will
hear from you, Mr. Secretary.
STATEMENT OF HON. DANIEL L. COOPER, UNDER SECRETARY FOR
BENEFITS, DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY ROBERT
EPLEY, ASSOCIATE DEPUTY UNDER SECRETARY FOR POLICY AND PROGRAM
MANAGEMENT, VETERANS BENEFITS ADMINISTRATION, AND SUSAN MATHER,
M.D., CHIEF OFFICER, PUBLIC HEALTH AND ENVIRONMENTAL HAZARDS
Mr. Cooper. Yes, sir. Thank you. I will make a brief
statement if I may.
Mr. Chairman, members of the committee, I am pleased to be
here to talk about SHAD and the services that VA must provide
our veterans to ensure they are given proper notification,
necessary claims filing assistance, and medical attention, when
required.
Having just recently studied the situation and attempting
to define a path that we can follow, I will state that the
process has been developed in fits and starts and must be
improved. The problem is, as you know, greatly exacerbated by
classification of the operations. That has severely hampered
our getting the names of the units, the tests, and the
individual participants.
Once we get those names, we have some difficulty because we
get the names along with the military ID numbers. We have to
get SSN's, so we have to go through a whole process. Then, when
we try to notify them, we have to go through OSHA in order to
have the IRS release their addresses. So the notification
process is a rather onerous one that we are trying to work
through and do properly.
The participants are being identified by name but,
unfortunately, quite slowly. Once we determine the Social
Security numbers, we submit those numbers, get them to the IRS,
get the addresses back, and then finally get notifications sent
out.
Despite the difficult problems, as both a veteran and a VA
official, I must state that we could have and should have done
better. The problems cited, and particularly the certification
firewall, caused a very difficult situation which has hampered,
in my opinion, well-intentioned people within the organization
who are trying to do the job properly.
By mid-May of this year, we had identified by name just
over 2,700 participants in 3 of the 12 tests. We have been able
to locate and send letters to 622 of those that we could
identify sufficiently. In this last week, we have submitted 800
more names to the IRS through the circuitous OSHA path in order
to try to get the addresses and notify those people.
Every step taken has been difficult. We received the first
set of names in April to July of last year, but we didn't
receive information on the tests until September. In January
through May of this year, we received the names of other
participants. Again, we have had to cull through the whole list
to find out exactly where they were stationed and when.
Finally, on 22 May, we sent a letter to the people that we
could properly identify. When I signed that letter, I was
assured it had been well coordinated and that the veterans
service organizations had had input. I learned later that they
did have a problem with one of the sentences in our letter, and
we will change that with the next letter that we send out to
ensure that everybody is satisfied that we are doing it
properly.
We presently have a hotline to receive calls. We have
carefully trained the people on that hotline. But occasionally
we have some problems with the information they put out. We
have given them strict guidelines as to what to tell the
veterans, primarily to go to a medical center and get an
examination, and we give them the name of an individual there.
We are continuing to test that hotline to ensure that we are
being properly responsive.
Since the 622 letters were sent, we have received
approximately 100 calls from potential participants in response
to those letters. I might add that in my statement for the
record I have an incorrect number on page 6. I would like to
have that corrected, please, for the record.
Senator Specter. Without objection, it will be placed in
the record.
Mr. Cooper. As I stated, we in VA must and will remain
focused and work more closely. Secretary Principi has taken
steps to ensure better coordination within VA. Similarly, VA
and DoD must work more closely both on information availability
and information transfer between the two of us.
We must continue to improve the system as effectively as we
can while adhering to the laws of the land. We strongly welcome
any assistance possible from any source, particularly veterans
services organizations.
Finally, I would say I have two personnel with me today who
are much more expert than I: Dr. Susan Mather, who is the Chief
of VHA's Office of Public Health and Environmental Hazards; and
Mr. Robert Epley, the Associate Deputy Under Secretary for
Policy and Program Management in VBA. I am ready to answer any
questions you may have, sir.
[The prepared statement of Mr. Cooper follows:]
Prepared Statement of Daniel L. Cooper, Under Secretary for Benefits,
Department of Veterans Affairs
Mr. Chairman and Members of the Committee, thank you for the
opportunity to testify today on the efforts of the Departments of
Defense (DoD) and Veterans Affairs (VA) to provide health care
information and support to veterans who were exposed to environmental
hazards during military service. Accompanying me today is Dr. Susan
Mather, Chief Officer, VA Office of Public Health and Environmental
Hazards, and Mr. Robert Epley, Associate Deputy Under Secretary for
Policy and Program Management.
War and training for war have always exposed America's men and
women in uniform to a wide variety of health hazards. Each war in the
last century has produced unique hazardous exposures. In World War I,
chemical warfare agents, including chlorine and mustard gas, were used.
World War II saw the first deployment of nuclear weapons. Korea exposed
many American POWs to psychological brainwashing techniques and to
extremely cold weather conditions. The widespread use of herbicides
during the Vietnam War is now associated with several adverse health
effects. Military personnel encounter a broad array of environmental
hazards, infectious disease, and psychological health risks any time
they deploy outside the United States.
During peacetime, America's Armed Forces prepare for health hazards
through research and by developing better preventive measures and
conducting appropriate training. Many of these efforts have been well
publicized, while others have been conducted in secret. For example,
the testing of nuclear weapons during the Cold War exposed many
American veterans to increased levels of radiation. Similarly, VA
became aware in 1991 of approximately 4,000 American servicemen who had
been exposed to high concentrations of mustard gas in both study
chambers and field tests as a part of a larger chemical defense
research program begun in World War II. In response, the National
Academy of Sciences assessed the medical literature on health effects
from those exposures, leading to new VA compensation regulations.
Following the Gulf War in 1991, Congress identified thirty-three
separate hazardous substances to which Gulf War veterans may have been
exposed. Public Laws 105-277 (signed Oct. 21, 1998) and 105-368 (signed
Nov. 11, 1998) required VA to establish an agreement with the National
Academy of Science to review and evaluate the medical literature on
possible health outcomes from these exposures. The first phase of this
study was published in 2000 and additional studies are underway. In
addition, extensive analysis has been conducted to determine the
potential health effects of exposure to sarin and cyclosarin at
Khamisiyah following the Gulf War.
Most recently, VA became aware of the exposure of an undetermined
number of U.S. service members to a variety of biological and chemical
agents in secret tests called Project SHAD (Shipboard Hazard and
Defense) conducted during the 1960s.
Because of this long history of hazardous exposures of U.S.
military populations, we must carefully examine our methods for
identifying exposed veterans, studying the potential effects of the
contaminants, and for providing our veterans with appropriate health
care and deserved disability compensation.
In the past, VA has established special programs for specific
groups of veterans potentially exposed to environmental health hazards.
For instance, VA responded to Gulf War health issues through a
comprehensive program of health care, research, outreach, and special
compensation for ``undiagnosed illnesses.'' About 12 percent (84,000)
Gulf War veterans have participated in a clinical registry program. The
principal finding from this clinical evaluation program is that these
veterans are suffering from a wide variety of recognized illnesses that
respond to conventional treatments. Subsequent research studies have
supported these findings, as have similar results from studies
conducted in the United Kingdom and Canada among their Gulf War veteran
populations.
Although special programs are useful, VA has learned many lessons
since the Gulf War and is now taking a more pro-active approach in
establishing policy and programs that will address environmental health
concerns as early as possible.
lessons learned
Clinical Practice Guidelines
Special clinical programs, such as the Gulf War Registry reach only
a limited number of eligible veterans. Therefore, the VA, in
cooperation with DoD, has taken concrete steps to better understand and
to routinely manage post-deployment health problems. A further goal is
to improve veterans' satisfaction with their health care. VA is using
an evidence-based approach to develop clinical practice guidelines for
the evaluation of military veterans following hazardous deployments.
Just completed in collaboration with DoD are a ``Post-Deployment Health
Evaluation and Management Guideline'' and a second clinical practice
guideline for unexplained fatigue and muscle pain, which was recently
released. These guidelines will provide VA physicians with the best
medical practices for dealing with veterans following deployment. A
clinical guideline for PTSD, now in the planning stage, will be the
next step in the development of a sound strategy for the screening,
assessment, and care of all veterans returning from military
deployments.
The regular use of standardized clinical practice guidelines that
outline the best medical practices will decrease the need for ad hoc
registries. Troops will be specifically screened early in the primary
health care setting for illnesses that may be related to a military
deployment. The Gulf War registry programs only reached a minority of
veterans and the clinical findings from examinations of self-selected
populations were difficult to interpret. In contrast, the post-
deployment clinical practice guidelines will ensure that the health
problems of all veterans returning from hazardous deployments are
addressed whenever they seek care in the DoD or VA health systems.
These new Guidelines will give VA primary care providers the tools they
need to diagnose and treat veterans who had participated in hazardous
deployments.
War-Related Illness and Injury Study Centers (WRIISC)
For veterans with severe symptoms that remain unexplained after
examination, the local VA physician can refer them to one of VA's two
War-Related Illness and Injury Study Centers (WRIISC) (formerly known
as Centers for the Study of War Related Illnesses). Many of these
veterans are concerned that their illnesses are related to
environmental hazards they encountered during deployment. The two
Centers are located at the VA medical centers in Washington, DC, and
East Orange, NJ. They are charged with identifying current effective
treatments, developing new treatments, providing environmental hazard
health risk communication to veterans and their families, and promoting
education for VA health care personnel on the ``difficult-to-diagnose''
illnesses found among veterans from all military deployments.
Veterans Health Initiative/Independent Study Guides
Recognizing the need to educate health care providers about the
unique medical care needs and concerns of veterans--including the
effects of environmental hazards--VA began an ongoing training program
known as the Veterans Health Initiative (VHI). Two key products are our
independent study guides ``A Guide to Gulf War Veterans' Health,'' and
``Vietnam Veterans and Agent Orange Exposure.'' In addition, VA has
developed other new independent study guides on a broad range of unique
veteran health issues, including Cold Injury, Hearing Impairment, Post
Traumatic Stress Disorder (PTSD), Prisoner of War (POW), Radiation,
Spinal Cord Injury, Visual Impairment, and Traumatic Amputation and
Prosthetics.
Enhanced Outreach
The Gulf War emphasized to us the value to veterans and their
families of timely access to reliable information about the
environmental health risks during military deployment. Acting on these
lessons, VA developed a new brochure that addresses common health
concerns for military service in Afghanistan and South Asia. It answers
questions about health care and eligibility for VA benefits that
veterans, their families, and their health care providers will have
following this military deployment in the war on terrorism. The
brochure also describes relevant medical care programs that VA has
developed in anticipation of the health needs of veterans returning
from combat and peacekeeping missions abroad. This outreach material
has been distributed to all VAMCs and Regional Offices.
project shad
The recent revelations concerning a series of Cold War tests known
as Project SHAD reinforces the potential environmental hazards that our
military forces face. This project was part of a DoD chemical and
biological warfare test program conducted between 1963 and 1970 to
evaluate the vulnerabilities of U.S. warships to attacks with chemical
or biological warfare agents. Project SHAD exposed veterans to
potentially harmful biological and chemical agents.
VA first learned of SHAD when a veteran filed a claim for service
connection for disabilities he felt were related to his participation
in Project SHAD. In two meetings held with DoD in late 1997, VA was
advised that all material was classified and access to material was not
assured and could only be given on a case-by-case basis. VA was able to
grant that particular veteran's claim without reliance on classified
information.
In May 2000, the Under Secretary for Benefits responded to a
Congressional inquiry requesting assistance for veterans involved in
Project SHAD. A VA/DoD workgroup was subsequently established and met
the first time in October 2000. Since that time, DoD and VA have worked
together collaboratively to develop the facts surrounding Project SHAD.
DoD began the formal process of declassification, compiling rosters
of participants, and providing VA with names and service numbers of
test participants. Initially, information was provided for 1,149
veterans involved in the tests Autumn Gold, Copper Head, and Shady
Grove. Over a period of several months, VBA engaged in the labor
intensive task of identifying the participants of those three tests
identified initially. The social security numbers of 703 veterans were
found. Using social security numbers, VA worked through the National
Institute for Occupational Safety and Health to obtain from IRS the
current addresses for 622 of these individuals. On May 21, 2002,
outreach letters were mailed to the 622 identified participants
involved in the three initial tests.
VA has initiated a significant outreach program to contact Project
SHAD veterans once they are located. For SHAD veterans we have so far
been unable to identify, VA has established a SHAD Hotline (at 1-800-
749-8387), Internet web-site (at www.VA.GOV/SHAD), and e-mail address
(at [email protected]). The VA Internet website provides veterans
with information currently available and a link to DoD's web page. To
date, approximately 125 SHAD hotline inquiries and 43 e-mail messages
have been received. Approximately 14 SHAD related claims for service
connection are currently pending.
Since the beginning of calendar year 2002, DoD has provided VA with
information on nine additional tests. Information on three tests was
provided in January:
Eager Bell I
Eager Bell II
Scarlet Sage
VA received information on six additional tests in May of this
year:
Fearless Johnny
Flower Drum Phase I
Flower Drum Phase II
Purple Sage
DTC Test 68-50
DTC Test 69-32
DoD has identified one hundred and three potential SHAD tests.
However, the number of tests actually conducted is unknown.
Furthermore, the total number of service members involved in these
tests is not known at this time. Unfortunately, the number of veterans
who participated in multiple tests, the names of those tests, and the
potentially harmful agents to which they may have been exposed cannot
be determined until all relevant documentation has been collected,
reviewed, and declassified.
DoD continues to review documentation and declassify additional
SHAD tests. As names and service numbers or social security numbers are
provided, VA will conduct the efforts required to identify the
individuals who participated in these tests and then to locate their
current address. We will engage in an aggressive outreach program to
provide appropriate information to SHAD veterans.
Project SHAD information has been provided to VA medical staff
through annual publication of Information Letters from VA's Under
Secretary for Health. The Information Letters provide VA health care
personnel with background information on Project SHAD, along with
information about the potential short- and long-term health effects of
the specific chemical and biological agents that DoD tells us were used
in these tests. This information has been made available on our SHAD
web site at www.va.gov/SHAD, including the information letter and other
relevant information. As more information becomes available, satellite
video-conferences are planned to broadcast relevant information to all
VA health care facilities.
In addition, VA will begin to work with the National Personnel
Records Center in St. Louis to review personnel and medical files for
individuals listed as participants in tests for whom we have been
unsuccessful in finding social security numbers. This represents
approximately half of all the known participants provided to date. We
are not particularly optimistic that this search will be fruitful but
we believe that it represents a possible source of at least a few
numbers otherwise unknown.
Importantly, a contract with the Medical Follow-up Agency of the
National Academy of Sciences is being developed to include a formal
epidemiological study of mortality and morbidity among SHAD
participants. In contrast to a clinical registry, which cannot provide
scientific data, this independent study will give us the clearest
picture of the health status of SHAD veterans and tell us whether their
health was harmed by prior chemical and biological exposures.
In the meantime, it should be stressed that there are no markers or
laboratory tests for the exposures currently known to have occurred in
Project SHAD. However, the provision of appropriate medical care for
any of the conditions that have developed in the ensuing 40 years since
the SHAD tests were begun is not dependent on specific information
about prior exposures. High quality medical care can be provided right
now for each SHAD veteran who seeks a clinical evaluation in the VA.
service-connected compensation
In order for VA to make accurate rating decisions on claims for
service connection for disabilities associated with SHAD, complete
evidence is necessary when the issue is first decided. Because of the
piecemeal and fragmented approach of declassifying and providing
information, VA may be required to readjudicate claims as additional
evidence becomes available for those service members involved in
multiple tests. Likewise, as evidence is declassified and made
available, VA may find that the new evidence regarding SHAD tests
supports grants of service connection previously denied.
VA will continue to send outreach letters to participants as
additional tests are declassified and participant names and Social
Security numbers are made available. Because it now appears that many
of the service members participated in more than one test, our initial
outreach efforts run the risk of being incomplete until DoD's
declassification efforts are finished. It should be noted that in those
cases where inquiries have come from veterans regarding tests not yet
declassified, VA has been able to provide names to DoD and they have
responded by providing relevant information on a timely basis.
VA also realizes that we cannot understand all the potentially
hazardous exposures experienced by members of the Armed Forces without
consultation and cooperation with other government agencies,
particularly DoD, but also HHS, EPA, and DOE. This coordination is
being addressed at the highest levels in VHA through the VA/DoD
Executive Council.
In conclusion, the Department of Veterans Affairs shares this
Committee's concern about the adverse effects of hazardous exposures
during military service and will continue to aggressively address them.
VA sponsors research to assess the effects of these exposures; is
actively contacting veterans of Project SHAD to notify them of
potential exposures; and has developed numerous studies with the
Institute of Medicine to determine the health effects of hazardous
exposures.
This concludes my testimony. My colleagues and I will be happy to
answer any questions that the Committee may have.
Senator Specter. Thank you very much, Mr. Secretary.
We turn now to Dr. William Winkenwerder, Assistant
Secretary of Defense for Health Affairs. Dr. Winkenwerder, we
are very much concerned about--and focused on--what happened
and why nothing was done up to this point. But at this point,
we will invite your opening statement.
STATEMENT OF WILLIAM WINKENWERDER, M.D., ASSISTANT SECRETARY
FOR HEALTH AFFAIRS, U.S. DEPARTMENT OF DEFENSE; ACCOMPANIED BY
ELLEN EMBREY, DEPUTY ASSISTANT SECRETARY FOR DEFENSE FOR FORCE
HEALTH PROTECTION AND READINESS, AND MICHAEL E. KILPATRICK,
M.D., DIRECTOR, DEPLOYMENT SUPPORT, FORCE HEALTH PROTECTION AND
READINESS
Dr. Winkenwerder. Thank you. Senator Specter, Mr. Chairman,
and members of the committee, thank you for the opportunity to
appear today and to provide this testimony. I have a written
testimony that I will provide for the record. I just want to
start by making a couple of comments.
First, in response to your comment, Senator Rockefeller,
the first is that I do care. I care greatly about these men and
women, not only today but those of the past, the veterans. They
are an important and critical part of the whole DoD
responsibility. When it comes to veterans, over half, for
example, of all the people we care for in the defense health
program are veterans. We care for veterans, and I consider it a
high responsibility, an important responsibility. That is why I
am here today. I could have ignored this hearing. I chose not
to because it is an important issue.
I came upon this information not too long ago, certainly
after I started, which was just after September 11th. I left my
job in the private sector to come work here----
Senator Specter. Dr. Winkenwerder, how could you have
avoided this hearing?
Dr. Winkenwerder. Pardon?
Senator Specter. You say you could have avoided this
hearing but chose not to.
Chairman Rockefeller. Nobody has ever said that to us
before.
Dr. Winkenwerder. Well, I am just saying, you know how you
can certainly say someone else go testify. I wanted to testify.
Senator Specter. Well, whom would you have sent? Secretary
Rumsfeld?
Dr. Winkenwerder. No. There are others that could represent
the Department on this issue.
Chairman Rockefeller. So we should be pretty grateful then
that you are here, shouldn't we?
Dr. Winkenwerder. No. I am telling you I wanted to be here.
I wanted to be here.
Chairman Rockefeller. You had a duty to be here.
Dr. Winkenwerder. Absolutely, and I want to be here,
period.
Chairman Rockefeller. Well, then, why did you point out to
us that you didn't have to come? I am going to give you a hard
time, OK?
Dr. Winkenwerder. OK. Fine.
Chairman Rockefeller. But I will accept your point. You are
here. And I can't argue that.
Dr. Winkenwerder. I care about this issue. I came upon this
information, and I can assure you that I am fully engaged and
that the other people that are with me are fully engaged.
Senator Specter. Dr. Winkenwerder, we will accept that.
Proceed with your statement.
Dr. Winkenwerder. OK. Well, that is in essence--that is the
main message. I want to assure you that the Defense Department
is committed to working with VA and sharing medically relevant
information from Project 112 and SHAD so that veterans who were
involved can be notified and receive appropriate care.
When we started our investigation into Project SHAD, which
was, as I understand it, a couple of years ago, we encountered
several challenges, as it has been explained to me. But I think
today it is fair to say the investigation has established a
format for sharing that information with the VA, has created a
system to declassify this information in a relatively expedited
way, and has determined the locations of the necessary
documents. These documents, again, as it is explained to me,
are spread out in many places. They have not been well
catalogued. This is a problem. This is an issue. I fully accept
that. And we are working with the respective services to look
at literally boxes of information that are in warehouses and
various places around the country to get the information
catalogued and to get it back and to declassify it rapidly so
that we can provide this information.
We provide test information as fact sheets to the VA as
soon as it is declassified. However, in order to expedite the
VA's notification process, we are forwarding to the VA the
names of service members involved in each test we identify
before the declassification process ensues.
To date, we have produced fact sheets on 12 SHAD tests,
which involved about 2,700 or 2,800 service members, and so far
our investigation indicates that most of these tests were done
using simulants and not live agents or real agents that were
thought and believed at that time to be harmless, not something
that would cause any medical harm.
Those service members involved in using live test agents
appear from the information that we have been provided to have
been appropriately protected from those agents. Since the Gulf
War, the services each have made efforts to fulfill today's
requirements, which are much greater and appropriately need to
be, of medical recordkeeping and to include documenting
potentially harmful exposures. And we plan to consolidate all
of these efforts into something we are calling--a software and
a data collection system we are calling Theater Medical
Information Program. TMIP will provide an electronic record of
care in theater that can be entered into the individual's
permanent medical record and it can be then provided to the VA.
Our commitment is to get this information literally from
the start of a service member's experience in the service so
that we have it and then subsequently the VA would have it as
well.
Senior leaders from DoD and VA are working closely together
on these efforts, and let me just close by saying that I am
very interested in getting to the bottom of this as quickly as
possible and getting the information out.
Thank you, and I would be glad to answer your questions.
[The prepared statement of Dr. Winkenwerder follows:]
Prepared Statement of William Winkenwerder, M.D., Assistant Secretary
for Health Affairs, U.S. Department of Defense
Mr. Chairman and members of this distinguished committee,
thank you for the opportunity to be here today and thank you
for your continuing support of the men and women who have
served in our Armed Forces.
As Assistant Secretary of Defense for Health Affairs, I
want to stress that the Department of Defense is committed to
ensuring that we deploy fit and healthy military personnel,
that we monitor their health and environmental exposures while
they are deployed, and that we assess their health status and
address their health concerns when they return. My Deployment
Health Support Directorate is conducting the investigation into
Project SHAD. Today, I would like to explain some of the
challenges we face in the investigation into Project SHAD, and
why I think problems associated with that situation,
particularly in regard to medical record keeping, are not
likely to occur for post-Gulf War operations.
As you know, Project SHAD (Shipboard Hazard and Defense)
was a chemical and biological weapons vulnerability testing
program conducted in the 1960s by the Deseret Test Center in
Utah. In August of 2000, the Secretary of Veterans Affairs
requested that the Secretary of Defense provide information
concerning three classified Project SHAD tests: Autumn Gold,
Copper Head and Shady Grove. In September 2000 DoD assigned
responsibility for fulfilling that request to the Deployment
Health Support Directorate. Within a month, VA and DoD
personnel began meeting regularly to define what medically
relevant information the VA needed to address veterans'
concerns. This collaborative effort established a
communications process, coordination for the exchange of
information between the agencies, and a format for fact sheets
to inform the VA, veterans and the public about the nature of
these exposures and the agents used.
SHAD was part of a larger program called Project 112, which
was itself one of many projects run by the Deseret Test Center.
Project 112 consisted of 103 chemical and biological warfare
agent tests. SHAD involved thirty-four planned tests, many of
which were never performed. These were not clinical trials, but
rather were done for operational preparedness purposes. Leaders
at the time thought they were appropriate tests given the
information they then had available. So far, our investigation
indicates that most of the tests were done using simulants that
were thought to be harmless. Moreover, service members involved
in tests using live agents were appropriately protected.
Nonetheless, the Deployment Health Support Directorate quickly
recognized the necessity to investigate all Project 112 and
SHAD tests, and expanded the scope of the original effort.
The first year of this investigation we discovered the
difficulties in obtaining the needed medically relevant
information and put systems in place to overcome them. First,
we had to find the needed documents. In the 1960's, joint
operations were not so common. The Army planned the SHAD tests,
but for the most part the Navy and Marine Corps conducted the
tests, with assistance from the Air Force. The primary planning
was done at the Deseret Test Center, a facility that closed in
the early 1970's. Records that were kept were stored at
different facilities in different geographic areas, ranging
from Dugway Proving Grounds, Utah, to Aberdeen Proving Ground,
Maryland. Remember, these test plans and reports are not
computer files but paper records stored in boxes or folders in
file cabinets, so finding what you need is a painstaking manual
process.
Learning who may have been involved in a particular test
involves finding personnel records in the Navy archives. Navy
deck logs aren't found in the military system at all, but are
maintained by the National Archives and Records Administration.
At this point our investigators believe they have established
the locations of most of the relevant records. Of course, the
ongoing search could lead to new locations and we will pursue
those leads until we have all relevant data.
When the desired test reports are located, there is still
the task of declassification. Most of the operation plans and
results of these tests remain classified. These documents
contain operational information about ship vulnerability to and
defenses against chemical and biological weapons. These agents
remain a threat to our forces today so, as you can understand,
these records can not be casually declassified. DHSD developed
a solution. Investigators with appropriate clearances comb
through the documents to identify the medically relevant data.
Early on, VA staff members who also held appropriate clearances
joined our investigators to verify that the information being
sought was what they needed to help settle benefits questions.
Following the identification of these specific topic areas, our
investigators requested that specific information be
declassified. The Army has greatly expedited this
declassification process.
When we first provided data to the VA we learned that DoD
and VA computer systems were not compatible. Both agencies have
made the necessary adjustments to allow the smooth transfer of
this information. We now have the data the VA needs formatted
in such a way that they can use it immediately and easily. In
fact, I believe that one positive outcome of this investigation
has been a new level of cooperation between the VA and DoD that
is focused on providing the information our veterans need and
deserve.
To date we have produced fact sheets on 12 SHAD tests,
which involved between 2700 and 2800 servicemembers. The VA has
a process in place for notifying the servicemembers, however,
we understand the VA has a significant challenge in identifying
them because at the time they served, they were identified by
service numbers, not their social security numbers. The process
to translate service numbers to social security numbers is also
labor intensive. So, to give the VA time to make positive
identifications, we are implementing a process to provide the
VA with the list of names and service numbers as soon as we
have them, before the investigation of a particular test is
completed. And as soon as complete information becomes
available, we will continue to share it with the VA and the
public.
At the time of the project SHAD tests, there was little
awareness of the possible long-term effects of low level toxic
exposures. Our recognition of the importance of individual
assignments, unit locations and documenting medically relevant
exposures following the Gulf War have dramatically changed our
processes. Today, DoD monitors the servicemember's environment
closely. The U.S. Army Center for Health Promotion and
Preventive Medicine and the Naval Environmental Health Center
maintain environmental surveillance wherever our military
forces go. For example, you may have seen news reports of
possible chemical warfare agent exposures at Karshi Khanabad
Air Base in Uzbekistan. Routine environmental monitoring
discovered what appeared to be traces of possible chemical
agents on the base. The base commander immediately cleared the
areas where the contamination was suspected and notified troops
of the situation. Closer investigation proved that the
substances that caused the alert were not chemical warfare
agents. However, that example does demonstrate that we have
procedures to protect our people from environmental dangers,
and that we keep them aware of possible risks.
We are also dedicated to improvements in medical record
keeping. In this area, DoD has stepped boldly into the 21st
century. The services have made individual efforts to fulfill
today's requirements. We plan to consolidate those efforts into
a joint program under the Theater Medical Information Program,
or TMIP. TMIP, which is being tested right now, is a tri-
Service system designed to provide information to deployed
medical forces to support all medical functional areas,
including medical logistics, blood management, patient
regulation and evacuation, medical intelligence, health care
delivery and more. TMIP will integrate several existing and
developmental systems into a single system that can be easily
used by theater commanders and medical personnel in combat
environments. It will also provide an electronic record of care
provided in theater that can be entered into the individual's
permanent medical record and provided to the VA
DoD is in the process of setting up a system that will
monitor the health of all military members for the duration of
their service. It will begin with the Recruit Assessment
Program, which will collect comprehensive baseline health data
from all U.S. military personnel. That program is in pilot
testing right now.
After deployments, servicemembers now receive care based on
a set of clinical practice guidelines for post-deployment
evaluation and treatment developed jointly by DoD and VA
medical personnel. The guidelines are designed to assist health
care providers in screening and evaluating service members and
veterans with health concerns following deployment.
At the other end of the system is a joint DoD/VA exit
physical for service members who are returning to civilian
life.
We already have a number of initiatives working through our
VA/DoD Executive Council, co-chaired by myself and my colleague
Dr. Roswell, the VA Under Secretary for Health. This council
provides the forum for senior health care leaders, including
our Surgeons General, to proactively address potential areas
for further collaboration, and resolve obstacles to sharing.
We are building on the success of our health care council
through the newly established VA/DoD Benefits Council, which is
examining ways to expand and improve information sharing,
refining the process of records retrieval and identifying
procedures to improve the benefits claims process. The VA/DoD
Joint Executive Council, co-chaired by the Under Secretary of
Defense for Personnel and Readiness and the Deputy Secretary of
the VA, brings the leadership of the Health and Benefits
councils together quarterly to demonstrate their commitment to
improving inter-departmental cooperation at all levels. As
Under Secretary of Defense David Chu said of the first meeting,
``Our concern for the well-being of servicemembers extends
beyond just their time on active duty.'' The two panels will
work together to improve coordination between the departments
in such areas as health care services, benefits delivery,
information sharing and capital asset coordination. The future
will hold increased cooperation between our departments,
because our focus is the health of our servicemembers
throughout their military careers and throughout the rest of
their lives.
Mr. Chairman, this concludes my statement. I thank you and
the members of this committee for your outstanding and
continuing support for the men and women of the Department of
Defense. Now, what are your questions?
Senator Specter. Doctor, is it a fact that Navy personnel
were exposed to VX and sarin, both lethal agents?
Dr. Winkenwerder. It appears in one of the tests that that
is the case. They were, in my review of this information. I may
turn to Dr. Kilpatrick, who has been directly involved in this
effort--that people----
Senator Specter. Was that exposure----
Dr. Winkenwerder [continuing]. Were wearing all the
protective--appropriate and necessary protective equipment, and
it was in part to test the ability of that equipment to
protect. Not something we would do today, obviously, but I
think it reflects in my judgment, looking back on this,
certainly not the level of informed consent that we would
expect today, but it is----
Senator Specter. Well, let's just establish a few basic
facts.
Dr. Winkenwerder. OK.
Senator Specter. They were exposed to VX and sarin, lethal
agents, correct?
Dr. Winkenwerder. That is correct.
Senator Specter. All right. Now, they were wearing----
Dr. Winkenwerder. Let me turn to Dr. Kilpatrick.
Senator Specter. And you say that they were----
Dr. Winkenwerder. It was on a barge, not populated with
people.
Senator Specter. And you say that they were wearing
protective clothing?
Dr. Winkenwerder. Protective gear, yes.
Senator Specter. Protective gear.
Dr. Winkenwerder. Everything that would----
Senator Specter. Was it determined that they so-called
protective gear was adequate to protect them?
Dr. Winkenwerder. I don't know what the people at that
time--my understanding, again, these were 40 years ago. The
records are not great in terms of all the details here. But
that would have been my inference that they believed that the
masks, equipment and so forth were protective. I can't
imagine----
Senator Specter. Well, Dr. Winkenwerder, you can't testify
as to what they believe. We have to make a factual
determination what the protective gear was. Have you made a
search to determine if any of the naval personnel involved in
these tests are still alive? A lot of people are alive from the
1960's.
Dr. Winkenwerder. Yes, I believe many of these people are
alive, and we have had contact with some of them.
Senator Specter. Well, have you questioned them----
Dr. Winkenwerder. Yes.
Senator Specter [continuing]. As to the exposure and the
adequacy of the protective gear?
Dr. Winkenwerder. Yes. Let me turn to Dr. Kilpatrick, who
is here with me, and who has actually had some of those
conversations with those service members.
Senator Specter. Let me stick with you, Dr. Winkenwerder,
for just a few minutes to outline the scope of what this
committee is looking for. We want to find out what the facts
are. We have already said Navy personnel were exposed to lethal
agents. We want to find out the specifics as to what they were
exposed to. And we want to find out the specifics as to what
the protective gear was, whether the protective gear was
adequate.
The issue of consent is a very important one. We understand
that there are no documents around which would verify that
there was written consent. Is that correct?
Dr. Winkenwerder. I cannot answer that question for you
today. We will try to provide an answer for you.
Senator Specter. Well, would you please find out?
Dr. Winkenwerder. Yes.
Senator Specter. There are a great many questions to be
answered, and we would not be surprised if you don't have all
the answers today. But let us give you an outline as to what we
expect from you and what we want to have determined. We want to
get into the question of informed consent. Then a central issue
is what happened from 1963 to the present as to informing these
people about the risks that they were exposed to.
Senator Rockefeller sees red about the subject, and,
frankly, so do I. We went through great pains. I chaired the
committee back when we had the hearings in 1995 and 1996 and
what happened with Gulf War Syndrome and how the Department of
Defense did not tell the truth.
It seems to be endemic and epidemic, happens all the time.
And our oversight function--you can leave my red light on.
Don't turn the lights off. It reminds me to conclude.
We want to know what happened in the interim. Every time
this committee turns around, it is Agent Orange or some other
substance, and it is always the same thing about the records
being inadequate. But there are people who were around. Senator
Rockefeller and I were around in 1963. I was conducting,
helping conduct, an investigation about what the Government did
in 1963. And we want to know what efforts are being made now--
Secretary Cooper will respond to this in part--by the Veterans
Administration but also by the Department of Defense. You have
12 tests, 2,700 to 2,800 people involved. They ought to be
notified, they ought to be found, they ought to be located so
they can be apprised as to what they were exposed to. They may
have some lingering symptoms. They may have some lingering
illnesses. We all wonder why we respond in certain ways, but if
that is part of a medical history, they are entitled to know
about it.
But, most fundamentally, we want to probe the question of
why the Department of Defense did nothing from 1963 until a
couple of years ago. We want the precise date when the
investigation started. And we want to know why the probe was
expanded and an announcement made just yesterday. Does it
really take congressional oversight and a congressional jar to
get the Department of Defense to do a little something? We want
to know that because we expect affirmative and positive
responses.
Dr. Winkenwerder. We will provide all of that information.
We would be glad to do so.
Senator Specter. We would like to know also if you hadn't
come, who would have come. We are not too fondly disposed to
having witnesses tell us that they could have avoided the
hearing.
Dr. Winkenwerder. I apologize for suggesting that.
Senator Specter. Because we are not only going to want to
hear from you, Dr. Winkenwerder, but we are going to want to
hear from your superiors. And when your superiors come in,
Senator Rockefeller is really going to get tough.
Mr. Chairman?
Chairman Rockefeller. Thank you.
You indicated that you came, and we are very grateful that
you made that choice. Dr. David Chu, however, decided not to,
and I would like a little explanation from you. He is Under
Secretary for Personnel and Readiness, and we had requested
that he come testify. Now, this committee has oversight over
veterans' care, and I am going to ask you what you think
oversight means and how you react to the word ``oversight.''
What do you think the relationship between congressional
oversight and the Department of Defense, as well as any other
agency, might be?
DoD has not been at all enthusiastic about this hearing,
and I understand that. But only late last week we were told
that Dr. Chu could not attend.
Now, that is not to dishonor any of you because I think all
of you are experts on this subject, and we are very pleased
that you are here. But, you know, you said you decided to come.
Dr. Chu decided not to come. Could you give me a reason for
that? Is he busy?
Dr. Winkenwerder. Mr. Chairman, I don't know if it was a
schedule issue----
Chairman Rockefeller. Could you find out for me?
Dr. Winkenwerder. I can.
Chairman Rockefeller. Because I don't think he wanted to
come. I don't think he wanted to face the music. That is my
interpretation. I would love to have you prove me wrong. But I
would love to have you ask him why it was that he declined late
last week to show up at this hearing on the second day of
Congress being back in session.
Dr. Winkenwerder. We will do it.
Chairman Rockefeller. I am going to give you a hard time,
because I care about veterans. I am not doing this because of
you. You look like a fine person. But you talked about caring
for veterans and that you take care of them. Well, you take
care of them because the Congress told you to by law back in
1982. Yes, you do take care of them, but don't make this into a
big humanitarian gesture. We told you to. And so you have
sharing of some facilities. So that is straight, right? Did you
know that?
Dr. Winkenwerder. I am sorry, but I did not hear you.
Chairman Rockefeller. That we passed a law saying that you
had to share resources with VA?
Dr. Winkenwerder. I could only have assumed that the
Congress did pass a law.
Chairman Rockefeller. You didn't know, but you know now.
Dr. Winkenwerder. I certainly know now, yes.
Chairman Rockefeller. In a sense, like Senator Specter
said, this Project SHAD to me is just a perfect example--that
is why it is so upsetting--of how DoD has historically
responded to service-related exposures. You have got a war to
fight, and you get people to do things, don't take records,
there is no time, people get fired, people don't talk. But it
is OK because you are not veterans. You are the warfighters.
The veterans are the people that come home, if they come home.
Now, as has been said, the Department of Veterans Affairs
first contacted DoD about SHAD in 1997, and I note from your
written testimony that only after Acting Secretary Gober
formally requested information in August of 2000 did DoD begin
to work on compiling this information. So that is 2 years, and
DoD can only guess that it has established the locations of
most of the relevant records.
You indicate that DoD has contacted the SHAD planners, but
the retired technical director of those tests told this
committee personally that he had never received a phone call
from DoD. So, again, there is something askew here. It is so
easy to sort of mislead, so easy to say you are going to do
something, you did do something, but then you start digging in
and you find someone who knows the situation and life isn't
quite so easy.
You know, this task could have been hurried up. DoD could
have chosen to contact retired staff, sort of a creative thing
to do--but you have to think about it--such as the former
Technical Director of Planning and Evaluation for Project 112,
who might have helped sort the wheat from the chaff.
You do have many competing demands, but can you please tell
me why, when DoD first investigated VA's request for
information on SHAD back in 1997, it did not lead to any
broader, more aggressive effort? Why must DoD wait until there
is a congressional inquiry before it does, or starts to do,
more aggressive investigations?
Dr. Winkenwerder. Mr. Chairman, I cannot give you an
explanation for why in 1997 or between 1997 and 2000 there
wasn't more prompt, expedient response on the part of the
Department. What I can tell you is that I am very committed to
getting this information out, that upon learning about this
effort and its importance and what it means, that I have
directed, am directing that every effort be made to get this
information out quickly, accurately, appropriately, and that I
believe that, yes, there is information that needs to be
classified, but the public and our veterans need to know about
what went on.
And so I am very committed to that, and that is my
assurance to you. We will keep you regularly informed or
provide, you know, whatever information you think would be
useful to know more about this as this investigation goes
along.
Chairman Rockefeller. Obviously, some materials have to be
classified in order to protect national security. That becomes
a huge issue in all kinds of fields. People don't want to risk
national security. You get that with the FBI and the CIA. The
FBI is doing this; they need some information, an intercept
from the CIA. The CIA doesn't want to give it to them because
it would compromise sources, et cetera. So there are all kinds
of built-in conflicts, and we understand that.
However, many of the details of deployment of tests,
including unit location, are classified when prepared, but need
not remain so after completion. I am assuming that is true.
The importance of this information to VA in determining
eligibility for benefits and appropriate health care and
research obviously cannot be overestimated. So what can DoD do
to expedite the declassification process that you talk about?
Dr. Winkenwerder. I have requested the assistance of each
of the Secretaries of the services--the Army, Navy, Air Force--
with respect to their part in this. They maintain and actually
have responsibility for the storage of the records, and so
finding the locations of them and then actually getting the
people who can go in and physically get boxes out and have them
catalogued, as I described earlier, I have requested their
assistance on this. I expect them to respond and to give us the
help that we need to get the job done.
I have asked Ms. Embrey, my Deputy for Force Health
Protection, who has responsibility for this and has oversight
responsibility for Dr. Kilpatrick in the deployment health
support area that is responsible for the direct work here, that
this is a priority to get this done, and to get it done
properly. And I have asked to be informed on a regular basis,
and by that I mean, you know, every couple of weeks, on our
progress on this.
I think we have got a job to do, and we need to get it
done. We wanted to give some evidence of our recent efforts
that we have not been standing--or sitting on our hands here
the last few months with this effort. We hope for release of 27
tests within a month or so. We are very hopeful that we will
have that additional information, and then we want to speed
along to get the rest of it.
Chairman Rockefeller. I have been handed a note here which
I would like your response to. It says that what you have been
saying is not a SHAD-specific problem. Declassification will be
an ongoing issue, particularly for special forces. Would you
agree with that?
Dr. Winkenwerder. Could you restate--I am not sure what the
question is there.
Chairman Rockefeller. I am asking if you agree with the
statement----
Dr. Winkenwerder. The statement----
Chairman Rockefeller [continuing]. That this is not--what
you have just said is not a SHAD-specific problem, that is,
limited only to.
Dr. Winkenwerder. Correct.
Chairman Rockefeller. Declassification will be an ongoing
issue, particularly for special forces.
Dr. Winkenwerder. I am going to turn--yes.
Chairman Rockefeller. Would you agree with this statement:
With regard to SHAD, DoD declassified documents for VA on a
limited case-by-case basis upon VA request, but this did not
trigger a larger examination of related issues--in other words,
the de minimis: you ask me a question, I will give you an
answer, but no kind of larger approach. Since the military quit
keeping morning reports, unit locations are frequently the only
data available to determine where a veteran may have been--and
this brings back many memories of the Gulf War Syndrome fiasco.
Forget the fiasco part. Would you agree with the rest of the
statement?
Dr. Winkenwerder. I am not sure I would agree with the
statement that we are only responding to what is very
specifically and, in a very exquisite, targeted way is asked
for. We have an understanding that there is a whole set of
tests, these 103 tests under Project 112 and SHAD. I understand
there are two different names, two different sets of tests,
SHAD being a subset of the Project 112. Our job is to get all
of this information that is available.
Our understanding is that some of these tests, even though
there were 103 that were planned, may have, in fact, never been
performed. We don't know how many there may be of that number--
what the final number may be that were never performed. Again,
it is a matter of getting the information out, reviewing and
finding out if the test was ever done. But we have clear
information on the roughly 52, I think, of the 103--I am sorry,
55 that we know that were either done or we know that they were
not done. But we are trying to get this additional information
on the other 48. We believe a fair amount of that information
may be at the Dugway Proving Ground record storage site. We
have requested to get to that site, to get to that information.
We believe we will be there next month and into those records,
and we will know more at that time.
But that is the best answer I can give you right now.
Chairman Rockefeller. Part of what is coming through is
what has come through so many times before. You have only been
here a short time, and I understand that. That has nothing to
do with you or who you are, what your makeup is. But you just
don't have any sense of how many times we have been through
this exact same conversation. I would have given anything if
you could have seen that atomic veteran describe dying while
his Government didn't care because he couldn't prove--
penniless--that the cancer 50 years later had been caused by
what happened 50 years before. And just on and on and on and
on, and it always comes back to the same questions. You know,
sometimes the VA is slow. The VA are good guys, as far as I am
concerned right now, but sometimes they are slow. But they are
underfunded, too. They don't have the ear of the President like
Donald Rumsfeld does. You know, if you at DoD need more money,
you can go get more money.
Now, I understand you think it doesn't work that way, but
VA can't do that. They can't do that. Tony Principi can't walk
into the Oval Office--he might not get into the Oval Office--to
fight for more money for health care, for researchers that do
things. DoD has got a whole different posture in the culture of
this Nation. And so when you don't take efforts to find out
what it is that happened to people who are no longer yours but
theirs, please understand the anger of the people who represent
those people, who see those people. You don't see those people.
You don't go to their homes. You may see them in hospitals if
they ever get there, but most of them never get there.
You didn't go through the aftermath of the Persian Gulf War
when VA discovered that returning troops were reporting all
kinds of unexplained symptoms. That was kind of a surprise to
people. Now, VA has to take care of those folks. DoD didn't
seem to know anything about it, and we couldn't get any
information for them. So this frustration is not personal. It
is professional and it has built over a long period of time. I
have been on this committee for 18 years, and I have never seen
a change in DoD attitude. I have never seen a change in DoD
attitude. And I don't like that, and there is no reason why I
should. Because, you know, we get you your money, and you can
think of us what you want. You probably don't like politicians,
and you think we just are here for show.
I am not here for show. I am here because I represent one
of the poorest States in the Nation which has the highest
participation of veterans anywhere. So I fight for them like I
fight for our steel industry. So I have got to fight for my
people. The question is: Are you fighting for our people, too?
There is no ancient history here. Many of the participants
and planners are still alive and active. They are still out
there. One of the planners informed my staff that he had filmed
every test and knew the names and codes assigned to each, but
that no one from DoD had contacted him to help with finding or
sorting any records. Other veterans and scientists involved in
these tests have no problems openly discussing the agents used
or what the tests looked like and express the belief that only
the technical aspects and vulnerability assessments are
classified. Why is this so difficult? Why is this so difficult?
What do you need to do to more efficiently separate sensitive
intelligence information from personal exposure histories?
Dr. Winkenwerder. Mr. Chairman, if I could ask if you have
that and are willing to share the name of that individual, I
will ensure that we make the contact with that person. I would
welcome the chance.
Chairman Rockefeller. The Veterans' Affairs Committee will
do anything they can to help you.
Dr. Winkenwerder. And if I might, sir, I would just say I
sense your level of frustration and that of the committee and
others, and I don't have that experience. But what I can tell
you is I am committed to trying to put into place at this point
in time--and other things have been done in the past--the sort
of systems of collecting this information, good records systems
so that, you know, 15 years from now or 10 years from now we
are not here asking these same kinds of questions with the
inability to know really what happened. I am a big believer in
records systems. I think we have made improvements. We have
some other things that we can do. But I think this is really
important. I think it cuts to the very core of what can help us
avoid the problem in the future. That and a sensitivity to the
fact that we do put people in harm's way and we do put people
at or near exposures--I am talking about in the war battle
situation. We need to do everything we can to protect people
from those kinds of risks and injuries, and when they happen,
we need to be as forthcoming as we can given the constraints of
where it occurs, the security constraints, to get the
information out. I think we are all better served if we do
that. That is going to be my tack during my tenure in my job.
Chairman Rockefeller. Clifton Spendlove is the person you
want to talk to.
Under Secretary Cooper, one of the problems here is that we
have put the cart before the horse to some degree. Because of
the delay in releasing this information, the VA is under time
constraints to notify aging veterans long before the potential
clinical effects of the SHAD test can be looked at by
scientists.
Now that VA is notifying veterans that they may have been
SHAD participants, what will you do with claims for benefits
from these veterans whose chronic illnesses may or may not be
due to chemical or biological exposures?
Mr. Cooper. The answer to that, Senator, is that we will
look at their claims and find out whether we can adjudicate the
claims even beyond the SHAD. If we don't have all the
information, at least we can see if there is some compensation
we can provide, based on their medical history, to at least get
the process started. Beyond that, as, we are going through a
process with the National Academy of Sciences, which will take
time.
I think the important thing is to try to look at the claim
as submitted. There have been a couple of cases of people who
came in who had been, in fact, involved in SHAD. We were able
to get their claim processed based on other events that took
place. These veterans were able to receive compensation without
being dependent upon SHAD information. So we will do everything
we can to adjudicate the claim properly and fairly. Other than
that, I think we really have to wait as far as SHAD-specific
things until we get the necessary information.
Chairman Rockefeller. How long do you expect that will be?
Mr. Cooper. I am sorry, sir. I cannot answer that. I will
try to answer for the record, but it is through this laborious
process of getting the technical information back from the
medical community, from the National Academy of Sciences, and
whoever else is doing that type of a test. It is a medical
research type of problem as far as getting a justification. And
of course, we have to do it as the law requires as far as
justifying the claim. But we will do everything we can with the
ones that are coming in, even though they are SHAD-related, to
get them justified and adjudicated based on the medical
information we have. I think that is the best information I can
provide right now, sir.
Chairman Rockefeller. Ellen Embrey, do you know how many
veterans die every day?
Ms. Embrey. No.
Chairman Rockefeller. A thousand. Just think about it.
Senator Specter has indicated it might be good to go on to
the next panel, and I agree. Thank you all very much.
Senator Specter. Before you depart, Dr. Winkenwerder, we
outlined the scope of the issues which we have in mind, and
what we would like you to do is to report back to the committee
in 30 days as to what you have found on your record searches as
to those issues. I don't want to have to repeat them now. And
we want to see what you have found with a view to followup.
And, Mr. Secretary, with respect to your pursuit of the
medical records, we would like to be apprised also within 30
days as to what you have found on ailments from people who were
identified, and you talk about the laborious process of
establishing a causal connection between what this exposure
was, and we would like to know what you find. We don't want to
see this eventuate into something like Agent Orange when it
took more than a decade before there was legislation on a
presumptive service-connection, because we may have to move on
that route, too. These people have been waiting for almost 40
years. And if they are going to be subjected to the kinds of
scientific analyses which customarily turn out to be
inconclusive--because of the nature of the investigation, you
just can't establish a causal connection--leading to the burden
of proof being put on the veteran, nothing is going to happen.
That is why this committee has taken the lead on presumptive
service-connections, on presumptive causation.
So report back to us, if you would, in 30 days so we can
take a look at what we ought to do further.
Mr. Cooper. Yes, sir.
[The information referred to follows:]
VA Health Care and Compensation for Project SHAD Veterans
Report to the Senate Veterans' Affairs Committee (August 5, 2002)
executive summary
Project SHAD (Shipboard Hazard and Defense) was part of the joint
service chemical and biological warfare test program conducted by the
Department of Defense (DoD) during the 1960s. During a hearing before
the Senate Veterans' Affairs Committee on July 10, 2002, the Honorable
Arlen Specter asked the Department of Veterans Affairs (VA) to send the
committee a report on what we currently know about the ailments
afflicting veterans who participated in Project SHAD.
The benefits portion of this report is based on analysis of data
extracted electronically from VA's Beneficiary Identification and
Records Locator Subsystem (BIRLS) and the Compensation & Pension (C&P)
Master Record file for those veterans identified, to date, who have
filed claims. For health care, the report reflects preliminary data
from VA's computerized health databases. DoD continues to search and
declassify documents associated with Project SHAD. As additional test
information and participant names are made available to VA, we will
continue to analyze data and update our findings.
Thus far, VA has identified 1,739 Project SHAD veterans having VA
claim numbers. Social security numbers were associated with 1,419 of
the 1,739 names and that information was provided to the Veterans
Health Administration (VHA).
On May 21, 2002, VA mailed letters to 622 veterans who participated
in the initial three Project SHAD tests declassified by DoD (i.e.,
Autumn Gold, Copper Head, and Shady Grove) for whom social security
numbers and addresses had been obtained. The letter informed the
veterans of potentially hazardous exposures during military service and
encouraged them to seek an evaluation at a local VA medical center, if
they had any concerns.
Review of health care data shows that of the 622 SHAD veterans, 226
have received health care from VA for a very wide array of common
diagnoses. Preliminary data shows that the most frequent infectious
disease diagnosis was dermatophytosis, a fungal infection of the skin
like athletes foot. The most frequent neurological diagnoses were
disorders of refraction (needing eye glasses) and deafness.
Using BIRLS and C&P Master Record file data, VA identified 299
veterans who were SHAD participants having at least one service-
connected disability. There were many similarities between the
disabilities of the 299 SHAD participant veterans and the total
service-connected veteran beneficiary population. For both SHAD
participants and the total service-connected veteran beneficiary
population, the majority of the disabilities were associated with the
following four body systems: musculoskeletal system, skin, impairments
of auditory acuity, and the digestive system. The most common
disabilities were defective hearing, scars, and generalized skeletal
conditions.
In order to determine whether SHAD veterans are experiencing
particular health problems due to prior exposures during military
service, a formal epidemiological study will have to be conducted. To
answer this question, the Secretary requested the Institute of Medicine
(IOM), Medical Follow-Up Agency, to develop a formal proposal which is
expected by the end of August 2002.
VA treatment data in this report is preliminary and based on the
initial 622 veterans identified with social security numbers. VA will
submit a more extensive assessment of treatment and diagnoses based
upon existing computer records.
background
On July 10, 2002, Senator Specter, Ranking Member, Senate Veterans'
Affairs Committee, requested a report back to the Committee within 30
days about what VA has found out regarding the ailments of Project SHAD
veterans. The information requested was for the ailments of Project
SHAD veterans who have been treated in VA health care facilities and
the medical conditions of Project SHAD veterans who have submitted
compensation claims.
Project SHAD was part of the joint service chemical and biological
warfare test program conducted by DoD during the 1960s. Project SHAD
encompassed tests designed to identify US warships' vulnerabilities to
attacks with chemical or biological warfare agents and to develop
procedures to respond to such attacks while maintaining a war-fighting
capability. Although classified, DoD is in the process of declassifying
relevant medical information.
At this time, the exact number of Project SHAD tests actually
conducted is unknown. As of July 5, 2002, DoD has provided VA with
declassified information relating to twelve tests. In addition, DoD has
provided VA with test names and participant information for two tests
not yet declassified. Approximately 4,684 participants were involved in
the fourteen tests known as:
Autumn Gold
Big Tom
Copper Head
DTC Test 68-50
DTC Test 69-32
Eager Belle I
Eager Belle II
Fearless Johnny
Flower Drum I
Flower Drum II
Half Note
Purple Sage
Scarlet Sage
Shady Grove
Some veterans participated in more than one test. Based on current
information, approximately 2,938 unique service members participated in
these fourteen tests.
identification of veterans who received health care treatment and filed
compensation claims
VA used the names and service numbers of SHAD participants provided
by DoD to identify veterans who have been treated in VA health care
facilities and/or filed compensation claims. That data was matched
against information available in VA's Beneficiary Identification and
Records Locator Subsystem (BIRLS). The Veterans Benefits Administration
(VBA) matched 1,739 records identified with VA claim numbers against
the June 2002 Compensation & Pension Master Record and May 2002 BIRLS
inactive compensation/pension data and extracted information about SHAD
veterans who have filed compensation claims. Of the 1,739 records, we
were able to associate social security numbers with 1,419 names and
provide that information to VHA to match against their databases for
health care utilization.
report findings
The benefits portion of this report is based on analysis of data
extracted electronically from BIRLS and the C&P Master Record file for
those veterans identified, to date, who have filed claims. For health
care, the report reflects preliminary data. DoD continues to search and
declassify documents associated with Project SHAD. As additional test
information and participant names are made available to VA, we will
continue to analyze both VBA and VHA data and update our findings.
I. Project SHAD Veterans Who Have Been Treated in VA Health Care
Facilities
va health databases
VA is engaged in a complex process to augment its medical record
system and to connect computerized health databases into a coherent
network. Because of progress in integrating VA's computerized health
databases, VHA can now track health care utilization by special groups
of veterans such as the veterans who participated in Project SHAD.
In this regard, VA is developing the Health Data Repository (HDR)
to provide the support for a full electronic patient medical record.
VHA will use a combination of the existing VistA system and a
commercial clinical repository product to record all patient data,
thereby creating a ``longitudinal'' record covering all care received
from VA. In addition, the HDR will provide the means to electronically
receive data from other health care entities, such as DoD, private
health care, and any reference facility (such as specialty
laboratories).
For evaluating the health of Project SHAD veterans who come to VA
for health care, the use of these standard health care databases
provide several important advantages over clinical ``registries,''
which have been used in the past to evaluate particular cohorts of
veterans, such as Vietnam and Gulf War veterans. The use of VA's health
databases allows VA to evaluate the health of veterans every time they
obtain care in the VA, not just on the one occasion that they elect to
have a registry examination. This will provide a much broader and
longer-term assessment of the health status of these veterans because
many veterans return frequently for VA health care, and because
veterans are often seen in different clinics or even different parts of
the country for specialized health care.
status of shad veterans seen by va
On May 21, 2002, VA mailed letters to 622 veterans who participated
in the initial three tests declassified by DoD (i.e., Autumn Gold,
Copper Head, and Shady Grove) for whom social security numbers and
addresses had been obtained. The letter informed the veterans of
potentially hazardous exposures during military service and encouraged
them to seek an evaluation at a local VA medical center, if they had
any concerns.
VA's health databases were used to assess SHAD veterans who
received VA health care, including how many had newly enrolled in the
VA health care system, what percentage had previously obtained care
within the VA, and the general types of diagnoses that SHAD veterans
received at VA medical centers, with the following results:
Between May 1 and July 24, 2002, eleven or 1.8 percent of
the 622 veterans who had been mailed letters, enrolled for VA health
care for the first time.
The letter VA sent to SHAD veterans may have had an impact
on the number of veterans seeking VA health care. On average, 15 of
these 622 veterans were seen at a VA health care facility each month
from October 2001 to May 2002. A larger number (48) of these SHAD
veterans were seen at VA health care facilities in June 2002, the month
after the notification letters were mailed.
Of the 622 SHAD veterans, 226 have received health care
from VA at some time in the past and with a very wide array of common
diagnoses. This is to be expected in a cohort of veterans who are 50
years of age and older. The most frequent infectious disease diagnosis
was dermatophytosis, which is a fungal infection of the skin like
athletes foot. The most frequent neurological diagnoses were disorders
of refraction (needing eye glasses) and deafness, which also are common
diagnoses among aging veteran populations.
It is not possible to determine whether any particular
diagnoses is occurring at higher rates than normal because this is a
highly select group of veterans who have sought health care in the VA
system.
The number of SHAD veterans being evaluated by the VA is
too small to assess individual diseases.
va health care utilization among shad participant veterans
In fiscal year 2002, 102 of the 622 SHAD veterans who had been
mailed letters were obtaining health care in the VA system. This is a
16 percent rate of health care utilization, which is comparable to the
15 percent rate of VA health care utilization by the entire U.S.
military veteran population in FY 2002.
The social security numbers of 797 additional veterans who
participated in subsequent declassified tests have been obtained. None
of these 797 veterans were included in the original group of 622 SHAD
veterans contacted by mail in May 2002. The addresses of veterans
associated with this new group have been obtained and, in the near
future, VA will notify them of potential exposures.
Within the constraints of this report, the only health information
that VA has been able to assess for the more recently identified 797
veterans is their VA health care utilization. Among these veterans, 124
(16 percent) received health care from the VA during the current fiscal
year. This is similar to other groups of U.S. veterans.
initial conclusions regarding utilization of va health care
To date, the 622 Project SHAD veterans have not demonstrated higher
utilization of VA health care services compared to other veterans.
However, Project SHAD veterans directly notified by mail of potentially
hazardous exposures appear to have been prompted to seek health care
from the VA. Eleven new veterans who sought health care from the VA for
the first time may have done so because of the notification letters.
epidemiological study to evaluate shad veteran health status
In order to determine whether SHAD veterans are experiencing
particular health problems due to prior exposures during military
service, a formal epidemiological study will have to be conducted.
Neither VA health care databases nor a clinical registry can assess
rates of disease or possible causes because veterans receiving care in
the VA do not constitute a representative sample for research purposes.
As an example, evaluation of over 100,000 Gulf War veterans in VA and
DoD clinical registries has not answered scientific questions about the
health of this population. Both veterans receiving care from the VA and
veterans receiving health care from other providers have to be sampled
in order to conduct a valid scientific study and determine the nature
and causes of their health problems.
The Institute of Medicine (IOM), Medical Follow-Up Agency, has
developed a proposal to conduct this independent, epidemiological
study, and this proposal is currently undergoing internal review by the
IOM. The VA expects to receive the formal proposal in August 2002.
further use of existing vha databases
While this will not be a substitute for the well designed
epidemiological study described above, further information on medical
conditions of SHAD veterans is available with some limitations. Medical
conditions are not stable over time. Some improve while others get
worse. Some are cured while others become chronic. This complicates any
analysis of health status over time. Databases are maintained by fiscal
year and not all patients are seen every year. The two automated
databases containing diagnostic information are the patient treatment
file (PTF), which covers inpatient hospitalization from FY 1970, and
the outpatient file (OPC), which contains diagnostic data beginning in
FY 1997. These data files are extremely large but an analysis of the
medical diagnoses of the SHAD veterans identified with social security
numbers as of July 2002 has begun and will be made available as soon as
possible. VA will submit a more extensive assessment of treatment and
diagnoses based upon existing computer records.
II. Project Shad Veterans Who Have Submitted Compensation Claims
veterans with at least one service-connected disability
As of June 2002, of the 1,739 veterans for whom VA claim numbers
were matched, VA identified 299 veterans who were SHAD participants
having at least one service-connected disability. This group included:
Those veterans receiving compensation (159),
Those evaluated at less than 10 percent for service-
connected disabilities (74),
Those who had at least one service-connected disability
evaluated at 10 percent or more, but with inactive records \1\ (61),
and
---------------------------------------------------------------------------
\1\ In 55 (90%) of these cases, the veteran is deceased.
---------------------------------------------------------------------------
Those with service-connected disabilities, but receiving
disability pension (5).\2\
---------------------------------------------------------------------------
\2\ Two veterans receiving pension had service-connected
disabilities evaluated at 0% and three had service-connected
disabilities evaluated at 10%.
---------------------------------------------------------------------------
veterans who filed for benefits who did not have a service-connected
disability
Of the 1,739 veterans for whom VA claim numbers were matched, 78
veterans did not have a service connected disability.
Sixty-six veterans had all non service-connected
disabilities.
Twelve veterans were receiving disability pension and had
no service-connected disabilities.
combined service-connected evaluation
The following chart shows the distribution based on the combined
service-connected evaluation for the 299 service-connected veterans.
The largest number (76 or 25.4 percent) of the veterans had a combined
service-connected evaluation of 0 percent followed closely by 23.4
percent with a 10 percent evaluation.
Number of Veterans With Combined Service-Connected Evaluation
------------------------------------------------------------------------
Number of Percent of
Combined Evaluation Veterans Total
------------------------------------------------------------------------
0%............................................ 76 25.4%
10%........................................... 70 23.4%
20%........................................... 33 11.0%
30%........................................... 25 8.4%
40%........................................... 21 7.0%
50%........................................... 13 4.3%
60%........................................... 18 6.0%
70%........................................... 8 2.7%
80%........................................... 5 1.7%
90%........................................... 3 1.0%
100%.......................................... 27 9.0%
-------------------------
Total..................................... 299 100.0%
------------------------------------------------------------------------
service-connected disabilities
The 299 veterans had 724 individual service-connected disabilities.
The following chart shows the number of disabilities for each veteran.
For example, 84 veterans had two service-connected disabilities; 11
veterans had five service-connected disabilities. On average, each had
2.4 service-connected disabilities.
Number of Service-Connected Disabilities
[Per Veteran]
------------------------------------------------------------------------
Number of Number of
Number of Service-Connected Disabilities Veterans Disabilities
------------------------------------------------------------------------
1............................................ 108 108
2............................................ 84 168
3............................................ 43 129
4............................................ 27 108
5............................................ 11 55
6............................................ 26 156
--------------------------
Total.................................... 299 724
------------------------------------------------------------------------
service-connected disabilities by body system
The 724 service-connected disabilities were associated with 14 of
the 15 rating schedule body systems. The following chart shows the
number of service-connected disabilities associated with each and the
percentage of total. None of the disabilities were gynecological.
Number of Service-Connected Disabilities Associated With Each Body
Systems
------------------------------------------------------------------------
Number of Percent of
Body System Disabilities Total
------------------------------------------------------------------------
Grand Total--All SC Conditions (Codes 5000- 724 100.0%
9999).......................................
Musculoskeletal System (Codes 5000-5399)..... 225 31.1%
Digestive System (Codes 7200-7399)........... 102 14.1%
Impairment of Auditory Acuity (Codes 6100- 97 13.4%
6299).......................................
Skin (Codes 7800-7899)....................... 76 10.5%
Cardiovascular System (Codes 7000-7199)...... 61 8.4%
Respiratory System (Codes 6501-6899)......... 44 6.1%
Neurological Conditions (Codes 8000-8999).... 26 3.6%
Genitourinary System (Codes 7500-7599)....... 25 3.5%
Mental Disorders (Codes 9200-9599)........... 25 3.5%
Endocrine System (Codes 7900-7999)........... 17 2.3%
Eye (Codes 6000-6099)........................ 14 1.9%
Infectious Diseases, Immune Disorders, 5 0.7%
Nutritional Disorder (Codes 6300-6399)......
Dental and Oral Conditions (Codes 9900-9999). 5 0.7%
Hemic & Lymphatic Systems (Codes 7700-7799).. 2 0.3%
Gynecological Conditions (Codes 7601-7699)... 0 0.0%
------------------------------------------------------------------------
non service-connected disabilities by body system
This group of 299 veterans also had 257 disabilities determined to
be non service-connected. The non service-connected disabilities were
associated with 13 of the 15 rating schedule body systems. The
following chart shows the number of non service-connected disabilities
associated with each body system and the percentage of total. None of
the disabilities were gynecological or dental/oral conditions.
Number of Non Service-Connected Disabilities Associated With Each Body
system
------------------------------------------------------------------------
Number of Percent of
Body System Disabilities Total
------------------------------------------------------------------------
Grand Total--All NSC Conditions (Codes 5000- 257 100.0%
9999).......................................
Musculoskeletal System (Codes 5000-5399)..... 62 24.1%
Impairment of Auditory Acuity (Codes 6100- 28 10.9%
6299).......................................
Cardiovascular System (Codes 7000-7199)...... 26 10.1%
Mental Disorders (Codes 9200-9599)........... 25 9.7%
Digestive System (Codes 7200-7399)........... 23 8.9%
Skin (Codes 7800-7899)....................... 21 8.2%
Respiratory System (Codes 6501-6899)......... 19 7.4%
Neurological Conditions (Codes 8000-8999).... 15 5.8%
Endocrine System (Codes 7900-7999)........... 14 5.4%
Eye (Codes 6000-6099)........................ 12 4.7%
Genitourinary System (Codes 7500-7599)....... 9 3.5%
Hemic & Lymphatic Systems (Codes 7700-7799).. 2 0.8%
Infectious Diseases, Immune Disorders, 1 0.4%
Nutritional Disorder (Codes 6300-6399)......
Gynecological Conditions (Codes 7601-7699)... 0 0.0%
Dental and Oral Conditions (Codes 9900-9999). 0 0.0%
------------------------------------------------------------------------
most common service-connected disabilities
The following chart shows the 15 most common service-connected
disabilities, their associated diagnostic codes, frequency, and the
percent of total. For example, 64 or 8.8 percent of the 724 service-
connected disabilities were for defective hearing/hearing loss.
Most Common Service-Connected Disabilities
----------------------------------------------------------------------------------------------------------------
Diagnostic Percent of
Service Connected Disabilities Codes Frequency Total
----------------------------------------------------------------------------------------------------------------
Total Disabilities.............................................. 5000-9999 724 100.0%
Defective hearing/Hearing Loss.................................. 6100-6101-6102 64 8.8%
-6282-6288-628
9-6292-6293-62
96-6297
Scars........................................................... 7800-7801-7802 47 6.5%
-7604-7805
Generalized, Skeletal condition................................. 5299 41 5.7%
Hemorrhoids, external or internal............................... 7336 28 3.9%
Intervertebral disc syndrome.................................... 5293 26 3.6%
Tinnitus........................................................ 6260 26 3.6%
Hypertensive vascular disease (essential arterial hypertension). 7101 23 3.2%
Hernia, inguinal................................................ 7338 20 2.8%
Lumbo-sacral strain............................................. 5295 17 2.3%
Arteriosclerotic Heart Disease.................................. 7005 16 2.2%
Duodenal ulcer.................................................. 7305 16 2.2%
Arthritis, Degenerative, Hypertrophic or Osteoarthritis......... 5003 14 1.9%
Diabetes Mellitus............................................... 7913 14 1.9%
Arthritis, Due to Trauma, substantiated by x-ray findings....... 5010 13 1.8%
Other impairment of knee........................................ 5257 11 1.5%
Fifteen disabilities accounted for 51.9% of total disabilities.. .............. 376 51.9%
----------------------------------------------------------------------------------------------------------------
most common disabilities (service-connected and non service-connected)
This group of 299 veterans had a total of 981 disabilities (both
service-connected and non service-connected). The following chart shows
the 15 most common disabilities, their associated diagnostic codes,
frequency, and the percent of total. For example, 83 or 8.5 percent of
the 981disabilities were for defective hearing/hearing loss.
Most Common Disabilities
----------------------------------------------------------------------------------------------------------------
Diagnostic Percent of
Most Common Disabilities Codes Frequency Total
----------------------------------------------------------------------------------------------------------------
Total Disabilities.............................................. 5000-9999 981 100.0%
Defective hearing/Hearing Loss.................................. 6100-6101-6102 83 8.5%
-6282-6288-628
9-6292-6293-62
96-6297
Scars........................................................... 7800-7801-7802 51 5.2%
-7804-7805
Generalized, Skeletal condition................................. 5299 50 5.1%
Hypertensive vascular disease (essential arterial hypertension). 7101 34 3.5%
Tinnitus........................................................ 6260 33 3.3%
Intervertebral disc syndrome.................................... 5293 32 3.3%
Hemorrhoids, external or internal............................... 7336 30 3.1%
Diabetes Mellitus............................................... 7913 27 2.8%
Arthritis, Degenerative, Hypertrophic or Osteoarthritis......... 5003 26 2.7%
Lumbo-sacral strain............................................. 5295 26 2.7%
Arteriosclerotic Heart Disease.................................. 7005 23 2.3%
Hernia, inguinal................................................ 7338 23 2.3%
Generalized, The Skin........................................... 7899 21 2.1%
Arthritis, Due to Trauma, substantiated by x-ray findings....... 5010 17 1.7%
Duodenal ulcer.................................................. 7305 17 1.7%
Fifteen disabilities accounted for 50.2% of total disabilities.. .............. 493 50.3%
----------------------------------------------------------------------------------------------------------------
Appendix A lists in descending order of frequency the 981
disabilities associated with the 299 veterans.
disability evaluations within body system
The following chart shows the distribution of 724 service-connected
disabilities based on assigned evaluation and percentage of total for
each of the eleven levels (i.e., 0 percent-100 percent). For example,
93 musculoskeletal disabilities are evaluated at 0 percent and 17
disabilities associated with skin are evaluated at 10 percent. Forty-
eight percent of the total disabilities are evaluated at 0 percent and
25.1 percent of the disabilities are evaluated at 10 percent.
Number of Disabilities Based on Individual Evaluation
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number of
Body System Disabilities 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
--------------------------------------------------------------------------------------------------------------------------------------------------------
Musculoskeletal System 225 93 68 30 9 12 1 9 ........ ........ ........ 3
(Codes 5000-5399)..........
Eye (Codes 6000-6099)....... 14 8 2 ........ 2 ........ ........ ........ ........ ........ ........ 2
Impairment of Auditory 97 55 35 5 ........ 1 1 ........ ........ ........ ........ ........
Acuity (Codes 6100-6299)...
Infectious Diseases, Immune 5 3 ........ ........ 1 ........ ........ 1 ........ ........ ........ ........
Disorders, Nutritional
Disorder (Codes 6300-6399).
Respiratory System (Codes 44 21 8 ........ 6 ........ 1 4 ........ ........ ........ 4
6501-6899).................
Cardiovascular System (Codes 61 8 17 6 8 1 1 11 ........ 1 ........ 8
7000-7199).................
Digestive System (Codes 7200- 102 80 12 4 5 ........ ........ ........ ........ 1 ........ ........
7399)......................
Genitourinary System (Codes 25 14 3 1 1 ........ ........ 2 ........ 1 ........ 3
7500-7599).................
Gynecological Conditions 0 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........
(Codes 7601-7699)..........
Hemic & Lymphatic Systems 2 ........ ........ ........ 2 ........ ........ ........ ........ ........ ........ ........
(Codes 7700-7799)..........
Skin (Codes 7800-7899)...... 76 55 17 ........ 3 ........ 1 ........ ........ ........ ........ ........
Endocrine System (Codes 7900- 17 3 1 11 ........ 1 ........ 1 ........ ........ ........ ........
7999)......................
Neurological Conditions 26 3 11 3 1 2 ........ 1 ........ ........ ........ 5
(Codes 8000-8999)..........
Mental Disorders (Codes 9200- 25 2 7 ........ 5 ........ 4 ........ ........ ........ ........ 7
9599)......................
Dental and Oral Conditions 5 4 1 ........ ........ ........ ........ ........ ........ ........ ........ ........
(Codes 9900-9999)..........
Grand Total (Codes 5000- 724 349 182 60 43 17 9 29 0 3 0 32
9999)......................
Percent of Total............ 100.0% 48.2% 25.1% 8.3% 5.9% 2.3% 1.2% 4.0% 0.0% 0.4% 0.0% 4.4%
--------------------------------------------------------------------------------------------------------------------------------------------------------
shad compensation claims pending
As of August 1, 2002, there were compensation claims pending
decisions for 28 veterans alleging disabilities due to exposure to
agents and substances while participating in Project SHAD. Sixteen of
these claims were received subsequent to the May 21, 2002, letter VA
mailed to veterans informing them of potentially hazardous exposures
during military service. Only seven of the 16 claims are from veterans
who actually received the letter. The claims are for service connection
for a wide array of disabilities.
conclusions regarding compensation claims
The data obtained from this review was based on a relatively small
sample 299--cases where veterans had filed compensation claims. Nothing
unique came to light regarding the disabilities of these SHAD
participants. There were many similarities between the awards/
disabilities of the 299 veterans identified as participants of Project
SHAD and the total service-connected veteran beneficiary population.
Average Number of Disabilities On average, the 299 SHAD
participants had 2.4 service-connected disabilities compared to 2.57
disabilities \3\ for the total service-connected beneficiary
population.
---------------------------------------------------------------------------
\3\ VBA Annual Benefits Report, Fiscal Year 2001, dated May 2002,
Table 6 Chap. 3.
---------------------------------------------------------------------------
Majority of Service-Connected Disabilities were Associated
with Four Body Systems For both SHAD participants and the total
service-connected veteran beneficiary population, the majority of the
disabilities were associated with the musculoskeletal system, skin,
impairments of auditory acuity, and the digestive system. Sixty-nine
percent of the disabilities for SHAD participants were associated with
these four body systems compared to 68.9 percent \4\ for the total
service-connected beneficiary population.
---------------------------------------------------------------------------
\4\ VBA Annual Benefits Report, Fiscal Year 2001, dated May 2002,
Table 7 Chap. 3.
------------------------------------------------------------------------
Percent of
Disabilities
Percent of Total
Body System Disabilities Service-
SHAD Connected
Participants Beneficiary
Population *
------------------------------------------------------------------------
Musculoskeletal............................. 31.1% 40.4%
Digestive................................... 14.1% 7.3%
Impairment of Auditory Acuity............... 13.4% 8.9%
Skin........................................ 10.5% 12.3%
------------------------------------------------------------------------
* VBA Annual Benefits Report, Fiscal Year 2001, dated May 2002, Table 7
Chap. 3.
Majority of Individual Service-Connected Disabilities
Evaluated at 0 percent and 10 percent For both SHAD participants and
the total service-connected veteran beneficiary population, the
majority of the disabilities were evaluated at 0 percent and 10
percent. That is, 73.3 percent of the disabilities for SHAD
participants compared to 72.9 percent \5\ for the total service-
connected beneficiary population.
---------------------------------------------------------------------------
\5\ VBA Annual Benefits Report, Fiscal Year 2001, dated May 2002,
Table 8 Chap. 3.
------------------------------------------------------------------------
Percent for
Total
Percent for Service-
Evaluation Assigned Individual Disabilities SHAD Connected
Participants Beneficiary
Population
------------------------------------------------------------------------
0% Evaluation................................ 48.2% 35.0%
10% Evaluation............................... 25.1% 37.9%
------------------------------------------------------------------------
Common Disabilities For both SHAD participants and the
total service-connected veteran beneficiary population,\6\ the
following disabilities were among the most common:
---------------------------------------------------------------------------
\6\ VBA Annual Benefits Report, Fiscal Year 2001, dated May 2002,
Table 10 Chap. 3.
---------------------------------------------------------------------------
Arthritis due to trauma
Defective hearing/Hearing loss
Degenerative Arthritis
Diabetes Mellitus
Duodenal ulcer
Hemorrhoids
Hypertensive vascular disease
Intervertebral disc syndrome
Knee impairments
Lumbo-sacral strain
Scars
Skeletal conditions
Tinnitus
Appendix A.--Frequency of Disabilities Associated with 299 Compensation
Claims
------------------------------------------------------------------------
Description of
Frequency Diagnostic Codes Disability
------------------------------------------------------------------------
83.............................. 6100-6101-6102-628 Defective hearing/
2-6288-6289-6292- Hearing Loss
6293-6296-6297.
51.............................. 7800-7801-7802-780 Scars
4-7805.
50.............................. 5299.............. Generalized,
Skeletal
condition
34.............................. 7101.............. Hypertensive
vascular disease
(essential
arterial
hypertension)
33.............................. 6260.............. Tinnitus
32.............................. 5293.............. Intervertebral
disc syndrome
30.............................. 7336.............. Hemorrhoids,
external or
internal
27.............................. 7913.............. Diabetes Mellitus
26.............................. 5003.............. Arthritis,
Degenerative,
Hypertrophic or
Osteoarthritis
26.............................. 5295.............. Lumbo-sacral
strain
23.............................. 7005.............. Arteriosclerotic
Heart Disease
23.............................. 7338.............. Hernia, inguinal
21.............................. 7899.............. Generalized, The
Skin
17.............................. 5010.............. Arthritis, Due to
Trauma,
substantiated by
x-ray findings
17.............................. 7305.............. Duodenal ulcer
14.............................. 5257.............. Other impairment
of knee
11.............................. 9411.............. Post-Traumatic
Stress Disorder
10.............................. 6600.............. Bronchitis,
chronic
10.............................. 7399.............. Generalized,
Digestive System
9............................... 5002.............. Arthritis,
Rheumatoid
(Atrophic), as an
active process
9............................... 7527.............. Prostate gland
injuries,
infections,
hypertrophy, post-
operative
residuals
9............................... 7819.............. New growths,
benign, skin
8............................... 7346.............. Hernia, hiatal
8............................... 7599.............. Generalized,
Genitourinary
System
7............................... 5099.............. Generalized,
Acute, Subacute,
or Chronic
Diseases of the
Musculoskeletal
System
7............................... 5290.............. Limitation of
motion of
cervical spine
7............................... 6899.............. Generalized,
Nontuberculous
Diseases
6............................... 5203.............. Impairment of
clavicle or
scapula
6............................... 5271.............. Limited motion of
the ankle
6............................... 6099.............. Generalized,
Disease of the
Eye, Impairment
of Central Visual
Acuity,
Impairment of
Field of Vision,
Impairment of
Muscle Function
(eyes)
6............................... 6599.............. Generalized,
Disease of the
Nose and Throat
6............................... 7017.............. Coronary Artery
Bypass Surgery
6............................... 9405.............. Dysthymic
disorder;
Adjustment
disorder with
depressed mood,
Major depression
without
melancholia
5............................... 6034.............. Pterygium
5............................... 6603.............. Emphysema,
pulmonary
5............................... 7099.............. Generalized,
Diseases of the
Heart
5............................... 7806.............. Eczema
5............................... 7813.............. Dermatophytosis
5............................... 7816.............. Psoriasis
5............................... 8018.............. Multiple sclerosis
5............................... 8099.............. Generalized,
Organic Diseases
of the Central
Nervous System
5............................... 9400.............. Generalized
anxiety disorder
4............................... 5015.............. Bones, New Growths
of, Benign
4............................... 5017.............. Gout
4............................... 5020.............. Synovitis
4............................... 5227.............. Ankylosis of any
other finger
4............................... 5285.............. Vertebra, fracture
of, residuals
4............................... 6079.............. Defective visual
acuity
4............................... 6510.............. Sinusitis,
parnsinusitis,
chronic
4............................... 6602.............. Asthma, bronchial
4............................... 6819.............. New growths,
malignant, any
specified part of
the respiratory
system exclusive
of skin growths
4............................... 7007.............. Hypertensive heart
disease
4............................... 7116.............. Claudication,
intermittent
4............................... 7120.............. Varicose Veins
4............................... 7318.............. Gall bladder,
removal of
4............................... 7341.............. Stomach wound
4............................... 7528.............. Malignant
neoplasms of the
genitourinary
system
4............................... 8008.............. Brain, vessels,
thrombosis of
4............................... 8045.............. Brain disease due
to trauma
4............................... 8515.............. Paralysis of the
median nerve
4............................... 8599.............. Generalized,
Diseases of the
Peripheral Nerves
(Paralysis)
4............................... 9203.............. Schizophrenia,
Paranoid type
4............................... 9499.............. Generalized,
Anxiety
Disorders,
Dissociative
Disorders,
Somatoform
Disorders, Mood
Disorders
4............................... 9999.............. Generalized,
Dental and Oral
Conditions
3............................... 5165.............. Amputation of Leg
at a lower level
permitting
prosthesis
3............................... 5201.............. Limitation of
motion of arm
3............................... 5211.............. Impairment of Ulna
3............................... 5215.............. Limitation of
motion of the
wrist
3............................... 5262.............. Tibia and fibula,
impairment of
3............................... 5276.............. Flatfoot, acquired
3............................... 5292.............. Limitation of
motion of lumbar
spine
3............................... 5309.............. Group IX Intrinsic
muscles of hand
3............................... 6018.............. Conjunctivitis,
other, chronic
3............................... 6200.............. Otitis media,
suppurative,
chronic
3............................... 6731.............. Tuberculosis,
pulmonary,
chronic, inactive
3............................... 6799.............. Generalized,
Diseases of the
Lungs and Pleura--
Tuberculosis
3............................... 7299.............. Generalized,
Digestive System
3............................... 7307.............. Gastritis,
hypertrophic
3............................... 7308.............. Postgastrectomy
syndromes
3............................... 7339.............. Hernia, ventral,
postoperative
3............................... 7344.............. New growths,
benign, any part
of digestive
system, exclusive
of skin growths
3............................... 9399.............. Generalized,
Delirium,
Dementia, and
Amnestic and
Other Cognitive
Disorders
2............................... 5019.............. Bursitis
2............................... 5209.............. Elbow, other
impairment of
Flail joint
2............................... 5212.............. Impairment of
radius
2............................... 5224.............. Ankylosis of thumb
2............................... 5225.............. Ankylosis of Index
Finger
2............................... 5253.............. Thigh, Impairment
of
2............................... 5279.............. Metatarsalgia,
anterior
(Morton's
disease)
2............................... 5294.............. Sacro-iliac injury
and weakness
2............................... 5296.............. Skull, loss of
part of, both
inner and outer
tables
2............................... 5314.............. Group XIV--
Anterior thigh
group
2............................... 5319.............. Group XIX--Muscles
of abdominal wall
2............................... 5399.............. Generalized,
Shoulder and
Girdle Muscles,
the Forearm and
Hand, the Foot
and Leg, the
Pelvic Girdle and
Thigh, the Torso
and Neck
2............................... 6029.............. Aphakia
2............................... 6210.............. Auditory canal,
disease of
2............................... 6211.............. Tympanic membrane,
perforation of
2............................... 6299.............. Generalized,
Diseases of the
Ear
2............................... 6310.............. Syphilis,
unspecified
2............................... 6399.............. Generalized,
Infectious
Diseases, Immune
Disorder and
Nutritional
Deficiencies
2............................... 6513.............. Sinusitis,
maxillary,
chronic
2............................... 6699.............. Generalized,
Diseases of the
Trachea and
Bronchi
2............................... 6723.............. Tuberculosis,
pulmonary,
chronic, minimal,
inactive
2............................... 6833.............. Asbestosis
2............................... 7199.............. Generalized,
Diseases of the
Arteries and
Veins
2............................... 7312.............. Liver, cirrhosis
2............................... 7323.............. Ulcerative colitis
2............................... 7345.............. Hepatitis,
infectious
2............................... 7504.............. Pyelonephritis,
chronic
2............................... 7508.............. Nephrolithiasis
2............................... 7512.............. Cystitis, chronic,
includes
interstitial and
all etiologies,
infectious and
non-infectious
2............................... 7706.............. Splenectomy
2............................... 7799.............. Generalized, Hemic
and Lymphatic
Systems
2............................... 7999.............. Generalized, The
Endocrine System
2............................... 8100.............. Migraine
2............................... 8512.............. Paralysis of lower
radicular group
2............................... 8520.............. Paralysis of
sciatic nerve
2............................... 8621.............. Neuritis of
external
popliteal nerve
(common peroneal)
2............................... 9304.............. Dementia
associated with
brain trauma
2............................... 9410.............. Other and
unspecified
neurosis
2............................... 9413.............. Anxiety disorder,
not otherwise
specified
1............................... 5012.............. Bones, New Growths
of, Malignant
1............................... 5013.............. Osteoporosis, with
Joint
Manifestations
1............................... 5021.............. Myositis
1............................... 5022.............. Periostitis
1............................... 5024.............. Tenosynovitis
1............................... 5055.............. Knee Replacement
(Prosthesis)
1............................... 5110.............. Loss of use of
both feet
1............................... 5111.............. Loss of use of one
hand and one foot
1............................... 5154.............. Amputation of
middle finger
1............................... 5155.............. Amputation of ring
finger
1............................... 5199.............. Generalized,
Combinations of
Disabilities and
Amputations of
the
Musculoskeletal
System
1............................... 5202.............. Other Impairment
of Humerus
1............................... 5219.............. Two digits of one
hand, unfavorable
ankylosis of
1............................... 5222.............. Three digits of
one hand,
favorable
ankylosis of
1............................... 5223.............. Two digits of one
hand, favorable
ankylosis of
1............................... 5255.............. Femur, Impairment
of
1............................... 5270.............. Ankle, ankylosis
of
1............................... 5278.............. Claw foot (pes
cavus), acquired
1............................... 5284.............. Other foot
injuries
1............................... 6007.............. Hemorrhage, intra-
ocular, recent
1............................... 6013.............. Glaucoma, simple,
primary, non-
congestive
1............................... 6019.............. Ptosis, unilateral
or bilateral
1............................... 6026.............. Neuritis, optic
1............................... 6062.............. Blindness both
eyes having only
light perception
1............................... 6080.............. Impairment of
Field vision
1............................... 6304.............. Malaria
1............................... 6311.............. Tuberculosis,
military
1............................... 6501.............. Rhinitis,
atrophic, chronic
1............................... 6502.............. Septum, nasal,
deflection of
1............................... 6519.............. Aphonia, organic
1............................... 6604.............. Chronic
obstructive
pulmonary disease
1............................... 6802.............. Pneumoconiosis,
unspecified
1............................... 6820.............. New growths of,
benign, any
specified part of
respiratory
system
1............................... 6821.............. Coccidioidomycosis
1............................... 6825.............. Diffuse
interstitial
fibrosis
(interstitial
pheumonitis,
fibrosing
alveolitis)
1............................... 6847.............. Sleep Apnea
Syndromes
(Obstructive,
Central, Mixed)
1............................... 7003.............. Adhesions,
Pericardial
1............................... 7006.............. Myocardium,
infarction of,
due to thrombosis
or embolism
1............................... 7015.............. Auriculoventricula
r Block
1............................... 7100.............. Arteriosclerosis,
general
1............................... 7118.............. Angioneurotic
edema
1............................... 7304.............. Gastric ulcer
1............................... 7315.............. Cholelithiasis,
chronic
1............................... 7325.............. Enteritis, chronic
1............................... 7326.............. Enterocolitis,
chronic
1............................... 7327.............. Diverticulitis
1............................... 7332.............. Rectum and anus,
impairment of
sphincter control
1............................... 7335.............. Ano, Fistula in
1............................... 7343.............. New growths,
malignant,
exclusive of skin
growths
1............................... 7502.............. Nephritis, chronic
1............................... 7507.............. Nephrosclerosis,
arteriolar
1............................... 7509.............. Hydronephrosis
1............................... 7518.............. Urethra, stricture
of
1............................... 7522.............. Penis, deformity,
with loss of
erectile power
1............................... 7523.............. Testis, atrophy
complete
1............................... 7524.............. Testis, removal
1............................... 7815.............. Pemphigus
1............................... 7903.............. Hypothyroidism
1............................... 7914.............. New growths,
malignant,
endocrine system
1............................... 8004.............. Paralysis Agitans
1............................... 8108.............. Narcolepsy
1............................... 8199.............. Generalized,
Miscellaneous
Diseases of the
Central Nervouse
System
1............................... 8207.............. Seventh (Facial)
cranial nerve,
paralysis of
1............................... 8516.............. Paralysis of the
ulnar nerve
1............................... 8910.............. Epilepsy, grand
mal
1............................... 8999.............. Generalized, The
Epilepsies
1............................... 9204.............. Schizophrenia,
Undifferentiated
type
1............................... 9205.............. Schizophrenia,
Residual type;
Schizoaffective
disorder, other
and unspecified
types
1............................... 9206.............. Bipolar disorder,
manic, depressed
or mixed
1............................... 9303.............. Dementia
associated with
alcoholism
1............................... 9310.............. Dementia due to
unknown cause
1............................... 9326.............. Dementia due to
other neurologic
or general
medical
conditions
(endocrine
disorders,
metabolic
disorders, Pick's
disease, brain
tumors, etc.) or
that are
substance-induced
(drugs, alcohol,
poisons)
1............................... 9403.............. Phobic disorder
1............................... 9404.............. Obsessive
compulsive
disorder
1............................... 9432.............. Bipolar disorder
1............................... 9434.............. Major depressive
disorder
1............................... 9502.............. Psychological
factors affecting
gastrointestinal
condition
1............................... 9904.............. Mandible, malunion
of
981............................. 5000-9999......... Total Service-
Connected & Non
Service-Connected
Disabilities
------------------------------------------------------------------------
Senator Specter. And now we will move to panel two. Thank
you.
Chairman Rockefeller. Let me just introduce them. Our
second panel of witnesses are Steven Smithson of the American
Legion; and then Rick Weidman of the VVA, who is accompanied by
Dr. Linda Schwartz of the VVA Healthcare Committee. The VVA has
worked very diligently to bring attention about Project SHAD to
us in Congress. And, finally, we will hear from Dr. Leonard
Cole, an expert in informed consent and military, biological,
and chemical weapons testing, who testified before the
committee on these subjects in 1994. So, Dr. Cole, welcome
back.
I guess we will stick with the 5-minute rule. All of your
testimony is included, and we are very glad that you are here.
STATEMENT OF RICHARD F. WEIDMAN, DIRECTOR OF GOVERNMENT
RELATIONS, VIETNAM VETERANS OF AMERICA; ACCOMPANIED BY LINDA
SPOONSTER SCHWARTZ, PH.D., CHAIR, VIETNAM VETERANS OF AMERICA
HEALTHCARE COMMITTEE
Mr. Weidman. Good morning, Mr. Chairman.
Chairman Rockefeller. Good morning.
Mr. Weidman. First, Vietnam Veterans of America, we salute
your leadership and that of Senator Specter in holding this
hearing today to begin to unravel a very complicated story. I
ask that our statement be submitted for the record, as
submitted, and I will try and cover a couple of points that
highlight things.
It turns out to be a rather complicated story, and it
really was almost like an investigation on our part. I must
tell you that I was sardonically amused last night when I first
saw that press release about DoD expanding the investigation,
and I just started to laugh and said, Is John Dean the head of
this investigation? I mean, what investigation? The only
investigating that has really been done into these exposures
was done by you, Senator, and folks on the Hill and one small
veterans service organization--actually, two.
I want to salute Senator Nelson for introducing the
veteran's right to know law, and that will take us some
direction toward a solution.
A little bit of chronology. Last fall, it came to our
attention the whole deal about SHAD existing and that there
being many more questions, and we thought when we first started
looking into it that we had a small throw rug, and the more we
pulled on the strand, the larger and larger the picture became.
Project 112, we kept saying to ourselves as we toiled on
this, in addition to other duties, often until 9 or 10 in the
office, that it had to be larger than just this one Navy
project. And that is how we found out about Project 112. The
most important thing about that press release that was issued
last evening by DoD is for the first time they are
acknowledging that Project 112 took place. Heretofore, they had
not acknowledged that Project 112 took place.
A number of things were talked this morning about
classification, and I just want to go into that, if I may, just
to correct the record a little bit.
The muster rolls and the deck logs that contain all of the
names of all of the people on all of the ships involved in all
of the SHAD tests were, in fact, in the public domain, in the
Archives. So was the accident reports of the ships involved
also, in a different part of the National Archives. All of that
was true until we started going over to the National Archives
seeking this information, and suddenly 1 day they had it, and
the next day it was sealed. In other words, this wasn't
classified information. It was public information, had been so
for 40 years, and only when we started to unravel that there
may have been deliberate damage--or deliberate exposures,
excuse me, done to American military personnel was it suddenly
classified.
We would point out, sir, that all of the ships in the fleet
involved in the SHAD test and, indeed, all of the classes of
ships involved in the test are out of the fleet. They no longer
exist. The only ones that exist, because there were some
aircraft carriers involved, have either been mothballed or
completely rebuilt keel up in the 1980's and the 1990's.
Therefore, there can be from our point of view no national
security consideration here, and that title has been used or
that label has been used of national security to really engage
in bureaucratic protectionism of the worst order. In other
words, don't admit we ever made a mistake. We couldn't possibly
have exposed our troops, inadvertently or in this case, many
cases, we believe, deliberately, to all of these toxins.
I want to commend the cooperation that we have had
throughout and the attitude of Secretary Principi and Admiral
Cooper and Nora Egan, who is chief of staff to the Secretary,
for their willingness to get at the bottom. While we would
agree with you about VA, many people in VA being very dedicated
to veterans, I will tell you, sir, that the institutional
response at 810 Vermont Avenue and within the higher levels of
Veterans Benefits Administration was not what it should be, by
any stretch of the imagination.
Beginning in October, in the fall of 2000, the request went
over verbally, and then finally in January of 2001, a formal
letter went from the Acting Secretary of Veterans Affairs to
DoD's Secretary at that particular time. A response was made,
although no letter was ever sent back to the Secretary of
Veterans Affairs. But folks out of DoD did, in fact, call Dr.
Mather. Dr. Mather said she didn't want the names, that that
was really Veterans Benefits Administration work and,
therefore, referred them over there. They were delivered, in
fact, February 2001, to the Veterans Benefits Administration,
the first 1,200 names. They didn't do anything with them. They
put them in a drawer, and it wasn't until October when we
started pressing that the Secretary's office found out that the
names actually had already been furnished, the first batch, by
DoD and nothing had been done with them. It took from October
of 2001 until May of 2002 to reach out to these first 622
veterans.
We have since that time worked with Admiral Cooper, and
they understand now how to use common search engines available
on the Internet in order to locate most of these veterans very
quickly and not wait for IRS, where you can shorten those
months into just a couple of days before you can put those
letters into the mail. Once again, we believe that the top
political leadership at VA has, in fact, acted with alacrity
and with a determination to say we don't know what is wrong but
we are going to find out what is wrong and we are going to try
and fix it. But that has not been true of the corporate
cultures of VBA and VHA, the Veterans Health Administration and
Veterans Benefits Administration, which needs to change in a
dramatic way toward being proactive. Instead of deny,
dissemble, and wait for an army to die or, in this case, wait
for the Navy to die, it needs to be on a proactive basis of we
don't know what is wrong but, by gosh, we are going to find out
everything we can and move to provide Americans who serve their
country in the U.S. military with the health care and with the
benefits that they earned by virtue of that service, if, in
fact, they were harmed by that service.
That is the attitude that we believe that we can expect
from people who are GS-14's, 15's, and SES's, Senior Executive
Service folks. But that is not what we got in this case. At
every step of the way, we had to go to the chief of staff of
the entire VA and with the weight of the Secretary's office to
get key individuals in Environmental Hazards and Public Health
to respond and move forward and for the senior people in VBA--
and I am not including Admiral Cooper in that because he
actually during much of this was not on board yet.
We should expect better from people whom we pay, in some
cases, because of ways of getting around the cap, earn more
than U.S. Senators.
Senator Specter. Mr. Weidman, we agree with you about that.
We have your point.
Mr. Weidman. OK. Thank you, sir.
The point is that much of this declassification
investigation can proceed much more quickly, literally in a
matter of weeks, if they made the determination to do it,
because the muster rolls and the deck logs, they know where
they are. They pulled them out of the Archives. All they need
to know is the names of the ships, and we believe that the
names of the ships are much more readily available than they
say. So it is only a matter of putting the manpower on it in a
systematic way and turning the information over to VA. At the
rate they proceeded so far--for the first 622, it took 19
months to do that. At this rate most people will be dead before
we get to them.
In terms of the things that we would propose to do, we
would be glad to work with the committee on those particular
questions, and we have made some proposals directly, seven
proposals to Secretary Principi's office, which they are
considering now, including establishing a real registry. A real
registry is one that is directly connected to the patient
treatment records.
So I thank you very much, Mr. Chairman, and I know that I
went over my 5 minutes and I apologize. It just does become a
very complicated story. Many of the things said today were
inadvertently, we believe, untrue by Mr. Winkenwerder, but he
didn't know that.
[The prepared joint statement of Mr. Weidman follows:]
Prepared Joint Statement of Richard F. Weidman, Director of Government
Relations and Linda Spoonster Schwartz, Chair, VVA Healthcare
Committee, Vietnam Veterans of America
Mr. Chairman, Ranking Member Specter, distinguished members of the
committee, Vietnam Veterans of America (VVA) is very pleased to have
the opportunity to share our views with you today on a topic that has
been at the very core of VVA's mission from day one: investigating
toxic exposures among America's veterans. On behalf of Tom Corey, VVA
National President, and all of us in VVA, we thank and congratulate you
and your colleagues for demonstrating strong leadership on these vital
veterans issues.
First, let us briefly summarize the 60-year history of the
Pentagon's use of American military personnel as human guinea pigs:
Mustard gas testing on servicemembers during WW II
Atomic testing on servicemembers during the early Cold War
period
LSD experiments on servicemembers during the 1960's
Herbicide use and concomitant exposures among troops in
Vietnam, Panama, and stateside
Chemical exposures during and immediately after the Gulf
War
The use of investigation chemical/biological warfare drugs
and biologics during the Gulf War
The ongoing use of the controversial (and likely unsafe)
anthrax vaccine
The most recent revelations about Project 112--the Pentagon's
master chemical/biological warfare agent testing program from the
1960's--have only added to our sense of legitimate moral outrage over
the permanent bureaucracy in the executive branch's cavalier approach
to troop health and safety.
Two days after the attacks on the World Trade Center and the
Pentagon, Department of Defense (DoD) officials invited representatives
of the veterans service organization's (VSOs) to a briefing on what has
since become known as Project Shipboard Hazard and Defense (SHAD).
Rather than provide the VSO's with declassified documents, officials
from what was once known as the Office of the Special Assistant for
Gulf War Illnesses (OSAGWI) provided sanitized, derivative documents
labeled ``Fact Sheets'' regarding three test series: AUTUMN GOLD,
COPPERHEAD, and SHADY GROVE.
As VVA began doing our own research into this issue, we uncovered a
number of important facts:
SHAD was only part of a much larger testing initiative,
known as Project 112. According to the U.S. Army's unclassified history
of its biological warfare program, Project 112 was initiated by then-
Secretary of Defense McNamara in September 1961 at a funding level of
$4 billion. When Pentagon officials originally briefed us on Project
SHAD, we were told that as many as 113 tests may have been conducted.
We have recently learned that Pentagon officials are now backing off of
that figure, claiming that 113 total Project 112 tests were planned but
that SHAD only accounted for 34 of the tests.
Testing activities were coordinated through a headquarters
established at the Desert Test Center at Ft. Douglas Utah in 1962. The
overall program was governed by National Security Action Memoranda 235,
signed by President Kennedy on April 17, 1963. Testing allegedly began
in 1962 and continued through at least early 1969.
Our research indicates that Project 112 tests took place
off the east and west coasts of the United States, in Alaska, and in
Panama. VVA believes that additional test sites were used but because
of the Pentagon's refusal thus far to declassify the records neither we
nor the affected veterans have a full understanding of the true number
and scope of the tests nor the potential health risks that may have
resulted from their participation in Project 112 testing activities.
Without the original documentation before us, we are being asked to
trust the Pentagon's good word about the scope, duration, and potential
hazards associated with the tests. Based on the 60+ year history of the
Pentagon's role in other such tests, we have good reason and ample
precedent to believe that the ``Fact Sheets'' were and are an exercise
in risk-minimization and public relations, and the odds are that said
``Fact'' sheets may not be a legitimate effort to come clean on the
potential consequences of the tests. We have recently obtained a
document that fully validates our concerns as to the lack of a
corporate culture that promotes and rewards organizational integrity
and veracity of OSAGWI and its activities.
``PRSA Bronze Anvil Entry,'' a partial copy of which is attached
for your review, was (and probably remains) OSAGWI's media battle plan
for minimizing the damaging impact of Gulf War illness-related exposure
issues, and, now, Project 112. Let me quote a passage from the page of
this document that I think showcases DoD's approach to military toxic
exposure-related episodes:
Following the war, many veterans began to complain of health
problems they associated with their service in the Gulf. They
clamored for health care and answers, and the news media and
some legislators picked up the battle cry. The President
ordered a thorough review and finally, DoD conceded that
America's finest might have been exposed to low levels of
chemical warfare agent.
For five years, the DoD had denied the possibility of
chemical warfare exposure during the Gulf War. With this new
information in the news, the DoD faced charges of a cover-up
and conspiracy. Finally, in late 1996, a special office was
created and charged to ``turn over every stone'' and find out
what was making Gulf War veterans sick.
The Gulf War lasted only 100 hours. The public relations
battle is still on-going.
``Bronze Anvil Entry'' is rife with such language, Mr. Chairman:
talk about ``tactics'' and ``strategy'' for dealing with the media, the
veterans, the Congress. By their own admission, the [Bronze Anvil
Entry] ``communications plan is the basis, guide, and baseline for
almost everything the organization does, from investigating what
happened in the Gulf War, to media relations and responding to veterans
concerns.''
In other words, everything OSAGWI has done has been guided not by a
quest for the facts and the truth but by a media-driven PR-strategy
designed to absolve the department of any and all responsibility for
the illnesses reported by the veterans. Some might well maintain that
this is a self-serving bureaucratic protectionism strategy that has
absolutely nothing to do with either true national security concerns
nor with the health and welfare of the many decent Americans serving in
the Armed services at the time who may well have been affected.
What has this exercise apparently driven by public relations
concern cost the American taxpayer? Over $150 million since FY1996. For
this amount of money, not one single peer reviewed scientific article
has been produced, making all of the ``materials'' and so-called ``case
studies not worth the paper they are written on. The American tax
payers have decidedly NOT gotten their money's worth from this exercise
in appearing to do something.
What has it cost the veteran? Continued pain and suffering,
compounded by a relentless less than forthcoming, forthright, and
honest Pentagon spin-machine that has effectively obstructed genuine
scientific inquiry and debate over Gulf War illnesses.
How effective was the OSAGWI ``spin machine''? The document boasts
that ``Media relations have matured with national press calling to ask
if controversial issues are `news' before determining level of
coverage.''
Earlier this year, Secretary Rumsfeld said that the proposed Office
of Strategic Influence had been abolished. In fact, it has been
operating since 1996 and continues operating to this day. Once known as
the Office of the Special Assistant for Gulf War Illness, it now
masquerades under the title of ``Deployment Health Support
Directorate.''
VVA believes that the permanent bureaucrats and seemingly permanent
agents of contractors that staff this ``Deployment Health Support
Directorate'' continue to deliberately mislead the Secretary and his
office as to the truth about this operation, as it is in their
immediate pecuniary interest to do so, and they appear to be unfettered
by sense of duty and loyalty to the good American men and women who
honorably served our Nation in military service who may have be harmed
by this course of action/inaction.
In the near term, Congress can best serve ill veterans by striking
the Deployment Health Support Directorate's funding from the TRICARE
Management Activity (where it is currently funded) and prohibiting the
Pentagon from any further expenditures on this office, pending GAO's
examination of this office and its activities over the past several
years. VVA believes that any such GAO investigation should be
spearheaded by GAO's Strategic Issues or Applied Research Methodologies
divisions, which have very good track records in investigating DoD
activities.
To restore the trust and confidence of the American people, and
particularly American veterans in the federal government's response to
these kinds of exposure-related controversies, more sweeping changes
will be required.
There are four common themes that run through nearly all of the
historical examples I've enumerated thus far:
1. In nearly every case, servicemembers who were test subjects
rarely if ever were informed of the potential health consequences of
the exposures;
2. The tests were almost invariably deemed ``secret'' or a
``national security issue'' by the Pentagon bureaucracy, which
routinely classified the tests and prohibited affected personnel from
discussing the tests or seeking medical treatment for symptoms
associated with exposures;
3. Medical record keeping and follow up of the affected personnel
was nonexistent;
4. When evidence of a nexus between potential service-connected
toxic exposures and subsequent illnesses veterans emerges, the Pentagon
(and Department of Veterans Affairs) immediately seeks to denigrate or
minimize any such connection.
At VVA, we have a phrase to describe this phenomenon: the
disposable soldier syndrome.
In our view, the Pentagon has always viewed us--the soldiers,
sailors, airman, Marines, Coast Guardsmen--as nothing more than
disposable cogs in the giant military machine. In reality, we are the
most critical component of the machine: the literal flesh-and-blood
that gives this machine its ability to defend America, her citizens,
and her interests. We will not be treated as one more consumable,
disposable, National Stock Number item. We never did, and would hope
the distinguished Senators on this Committee will disavow this latter
day version of Robert McNamara's ``spare parts'' theory of American
military personnel.
Mr. Chairman, you and other distinguished colleagues in the
Congress have begun to recognize the need for fundamental reform in
this area. We applaud Representative Thompson and Senator Nelson for
offering the ``Veterans Right to Know Act of 2002,'' which addresses
the Project 112/Project SHAD controversy by charging GAO to thoroughly
investigate and oversee the declassification and dissemination of the
test records. The Congress must do much more, however, if we are to
ensure that no such episodes occur in the future.
Because DoD and VA bureaucrats have politicized the medical
research arena and monopolized control over research funding decisions,
it is completely impossible for most non-federal researchers with
unconventional or controversial theories about the origins of Gulf War
illnesses to receive federal funding. Moreover, both DoD and VA have an
inherent conflict of interest when it comes to investigating these
kinds of issues.
Consider the following analogy. When the Bridgestone/Firestone
``exploding tire'' scandal erupted, the Congress did not tell the
manufacturer, ``We trust you: go investigate yourself, make
recommendations for change, then implement those changes--you have our
blessing!'' Congress held hearings and monitored the National Highway
Transportation Safety Administration's investigation of Bridgestone/
Firestone. The same model applies to airline crashes. Congress does not
rely on the aircraft manufacturers crash report; it listens to the
National Transportation Safety Board's investigators, who are
independent of both the manufacturer and the aviation industry as a
whole. Congress set up this system to ensure that no conflict of
interest would compromise safety investigations, a wise and sensible
approach to transportation safety policy.
Yet for the last decade, the Congress has allowed the agency that
most likely created the Gulf War illness problem (DoD), and the agency
charged with paying for the problem (i.e., the VA, through health care
and disability payments to sick veterans), to both investigate Gulf War
illnesses and their own role in responding to sick Desert Storm
veterans. This is an obvious conflict of interest, one that has
prolonged the suffering of the veterans, destroyed their trust in the
federal government, and resulted in the waste of at least $150 million
over the past five years through OSAGWI, as the Defense Department has
``investigated'' its own response to Gulf War illnesses. It is also how
the Pentagon and the Air Force have managed to spend over $180 million
on Agent Orange-related Ranch Hand research that has produced less than
half-a-dozen peer-reviewed scientific papers over the last 15 years.
Even those few peer reviewed articles were produced just recently under
extreme pressure by the Congress to produce tangible scientifically
valid results.
To end this conflict of interest and restore integrity to the
process of investigating and treating veteran's medical conditions,
last year VVA called for the creation of a National Institute of
Veterans Health (NIVH) within NIH. This notional NIVH would not only
eliminate the conflict of interest problem outlined above, it would
provide a vehicle for establishing a medical research corporate culture
focused on veteran health care, in contrast to the current VA medical
corporate culture of ``health care that happens to be for veterans.''
VVA recognizes that the VA has established a reputation for
providing advanced care for blinded veterans or those with severe
ambulatory impairments. However, the VA has never truly developed a
corporate culture focused on the diagnosis and treatment of the full
range of environmental and occupational hazards that are unique to
military service. This is especially true of the VA's Research and
Development Office, where the overwhelming majority of VA-funded
research programs are geared towards medical problems found in the
general population, not those specific to the veteran patient
population or those with military service. Even though it is possible
at virtually no additional cost to collect veteran specific variable
information on all the studies funded though this section, the current
leadership of VA Research & Development refuses to do so.
By establishing a new NIVH with veteran advocates serving on the
peer-review panels that make research funding decisions, the Congress
would be creating a research institute that would be truly focused on
the unique medical needs of veterans. Locating the NIVH within NIH
would ensure that the full medical resources of the federal government
and private sector could be marshaled in a rational, veteran-friendly
environment, free of the politicizing and conflict-ridden influences
that have for more than 20 years precluded effective research into the
unique environmental and occupational hazards that have impacted the
health of American veterans.
One of the first lines of inquiry that should be pursued by this
proposed entity is what we term ``the in-country effect,'' the idea
that the totality of the military experience in a theater of operation
has a cumulative effect on the health of the veteran. We believe that
more than enough epidemiological research exists to show that both
Vietnam and Gulf War veterans display higher rates of illness than
their nondeployed counterparts. Researching the mechanisms that produce
these higher morbidity rates among those who serve in theater should be
a top research priority for the notional NIVH.
Additionally, this proposed NIVH must be supplemented by the
creation of a Congressionally directed mandatory declassification
review panel, whose purpose would be to screen (on both a historical
and an ongoing basis) and declassify any operational or intelligence
records for evidence of data that would have an impact on the health
and welfare of American veterans. The need for such an entity--
completely independent from the Pentagon and the U.S. intelligence
community--is obvious.
Even today, thousands of pages of Gulf War-related records remain
classified. In January 1998, the CIA admitted that its own internal
review had identified over 1 million classified documents with
potential relevance to Gulf War illnesses. Virtually no documents
associated with the 1960's era SHAD program have been declassified, and
DoD has thus far rebuffed VVA's FOIA requests that the documents be
made public. Through the experience of the Kennedy Assassination Review
Commission and the Nazi War Crimes Declassification Review panel, we
have learned that such specialized declassification panels work well.
If we are to be certain that all data that may effect the health of
American veterans is to be available for the veterans and their
physicians, the Congress must create such a standing declassification
review panel immediately. Such a move would also help to restore trust
and confidence among veterans in the federal government and its
response to veteran's health issues.
VVA believes that the VA should remain in the veteran health care
business, but only if there is a dramatic change in the corporate
culture of the Veterans Health Administration (VHA).
During his tenure as Undersecretary for Health, Dr. Thomas
Garthwaite put forward a proposal known as the Veterans Health
Initiative (VHI). The purpose of the VHI was to put veteran patient
care at the core the VHA's corporate culture. As Dr. Garthwaite
testified before Congress in April 2001,
The Veterans Health Initiative was established in September
1999 to recognize the connection between certain health effects
and military service, prepare health care providers to better
serve veteran patients, and to provide a data base for further
study.
The components of the initiative will be a provider education
program leading to certification in veterans' health; a
comprehensive military history that will be coded in a registry
and be available for education, outcomes analysis, and
research; a database for any veteran to register his military
history and to automatically receive updated and relevant
information on issues of concern to him/her (only as
requested); and a Web site where any veteran or health care
provider can access the latest scientific evidence on the
health effects of military service.
VVA's experience is that while some progress has been made in
development of curricula by the Office of Public Health and
Environmental Hazards, virtually no one at the service delivery level,
or at the researcher level know that these exist. After three years,
there is still not visible effort to train or enlighten staff at the
hospital level or actually doing research of the importance of taking a
complete military history and testing for various natural and man-made
risk factors that a veteran may have been exposed to based on when,
where. branch of service, and what the veteran actually did in the
military. VVA maintains that this is what Veterans Health Care (and
hence VA) should be all about, not just general health care that
happens to be for veterans.
We note that to date, comprehensive clinical practice guidelines
and continuing medical education courses in dealing with Gulf War
illnesses have yet to be distributed throughout the VA medical system.
The visualized cash awards for clinicians passing competency exams in
veteran specific health issues has not materialized. We know from
internal VA emails obtained via FOIA that senior officials in Public
Health and Environmental Hazards resisted creating a registry for
Vietnam era SHAD veterans. As many members of this committee may
recall, there was tremendous resistance by VHA to the idea of creating
a Gulf War registry in the early 1990's; it took an act of Congress to
get that effort off the ground. Given this institutional resistance to
identifying environmental hazards and their impact on the health of
veterans from multiple eras, how can we trust these same office with no
apparent change in corporate culture to implement Dr. Garthwaite's
well-conceived vision for veterans' health care?
We have communicated these concerns to Secretary Principi, urging
him to recognize that changing the existing VHA corporate culture
immediately is imperative, and we look forward to working with him
towards that end. VVA believes that this committee can play a key role
in this process by offering comprehensive legislation to create NIVH
and an affiliated declassification body. The VA's Gulf War Research
Advisory Committee has already sent such a recommendation to Secretary
Principi. VVA hopes the committee will use the Research Advisory
Committee's recommendations as a blueprint for changing the way
veterans exposure-related health issues are addressed.
Mr. Chairman, this concludes my written statement. On behalf of our
national president, Tom Corey, please accept my thanks for allowing VVA
the opportunity to share our views on this very important topic.
Appendix I: Extract from OSAGWI's ``Bronze Anvil'' Communications Plan
Summary
research
At the time, the Gulf War appeared to be an overwhelming public
relations success. The American public gave whole-hearted support to
their military sons and daughters, sending them off to fight the
world's largest army. The media provided minute-by-minute coverage from
the good-by kisses through the daily military victories to the tearful
reunions. Cheering crowds across the nation lined graffiti-filled
streets to honor the returning victor.
Following the war, many veterans began to complain of health
problems they associated with their service in the Gulf. They clamored
for health care and answers, and the news media and some legislators
picked up the battle cry. The President ordered a thorough review and
finally, DoD conceded that America's finest might have been exposed to
low levels of chemical warfare agent.
For five years, the DoD had denied the possibility of chemical
warfare exposure during the Gulf War. With this new information in the
news, the DoD faced charges of cover-up and conspiracy. Finally, in
late 1996, a special office was created and charged to ``turn over
every stone'' and find out what was making Gulf War veterans sick.
The Gulf War lasted only 100 hours. The public relations battle is
still on-going.
One of the first actions of the Office of the Special Assistant for
Gulf War Illnesses (OSAGWI) was to review the backlog of incoming
correspondence and identify the concerns and interests of veterans.
Meetings with representatives of 60 national veterans groups (VSOs)
were conducted, and congressional interest identified. Goals,
objectives, strategies, tactics and messages were formulated. Letters,
emails, and telephone contact were all targeted to specific audiences
including veterans, veterans' groups, Congress, and other government
agencies. Monthly updates for VSOs allowed them to pass information to
their millions of members while town hall meetings across the nation
provided one-on-one interchange with veterans. An interactive Internet
site was created (GulfLINK, TAB X) receiving up to 60,000 ``hits'' a
week. Audience analysis indicated that many might not have access to
the Internet, so a newsletter (GulfNEWS, TAB X) was developed. By March
1997, most of the national press and veterans' groups appeared
satisfied that the DoD was on the right track and many thought the
issue was dead. However, the public relations professionals were not so
sanguine.
Based on the textbook model of ``lifecycle states of issues.'' (Tab
X), the team projected that there was potential for a second wave of
high concern and high interest. Additionally, there was also a strong
possibility that the DoD was actually facing two lifecycles--one in the
Washington D.C. area, and a second, later one, in ``Middle America.''
(TAB X) The team also analyzed current goals and objectives; strategies
and tactics; media coverage; veterans' correspondence; and message
delivery and acceptance. Media analysis indicated decreasing interest
by national and military press; however, a few influential media
continued their negative coverage, which was repeated in regional and
local press on a regular basis (Tab X). A few vocal legislators
continued to challenge the DoD's commitment to Gulf War veterans.
Incoming emails, letters, and telephone calls from veterans, analyzed
for content and tone, indicated a shift toward an increase in level of
trust and a greater desire for information. Interviews with veterans'
service groups indicated similar shifts in interest, focusing more on
applying lessons learned from the Gulf War to future operations.
Informal surveys indicated that service members still in uniform have a
vested interest in the DoD's efforts and the eventual outcome.
Conversely, activist groups had formed and were becoming very active.
Research confirmed that the crisis had not been resolved. While
some veterans still accused the DoD of cover-up and conspiracy, many
simply didn't know what to think--they provided fertile ground for
activists.
planning
Following this analysis, the communication plan was updated with
two new objectives while strategies and tactics were greatly expanded
and energized for a proactive and synergistic effort (TAB X).
New objectives featured DoD's commitment to the health and welfare
of Gulf War veterans as well as current and future service members and
veterans (TAB X). Target audiences were expanded to include all active
duty, Guard, and Reserve and their family members; health care
providers in the DoD; plus veterans and community members living and
working near military installations. The overall strategy was to create
``message redundancy'' through personal and second party contact.
Military members would become ``ambassadors in uniform,'' influencing
other audiences such as neighbors, peers, and extended family members.
The outreach was expanded to target military installations and more
conferences, conventions, and seminars. Town halls at each installation
would still target veterans and their families, while briefings would
reach the new audiences. Briefers were selected and trained for
specific venues and audiences. Manned displays were developed for high
traffic locations and local media heavily marketed to provide radio,
TV, and newspaper coverage. Presentations, brochures, displays, and
visual aids were targeted to widely varied audiences, incorporating of
risk communication techniques. The brochure was sized to fit in uniform
pockets and a pocket added to the tri-fold.
With no dedicated public affairs budget, all research, graphic
design, product production and planning was done with the existing
staff. The budget for printing had to be greatly increased as well as
travel since a large team now goes on each trip.
execution
The communication plan is the basis, guide and baseline for almost
everything the organization does, from investigating what happened in
the Gulf War, to media relations and responding to veterans concerns.
Investigations. All investigations of the Gulf War are based on
veterans' expressed concerns. Veterans are personally interviewed and
their comments incorporated into comprehensive reports, which are then
posted on the interactive Internet site, GulfLINK with a request for
comment from any reader (TAB X). Many Veterans are personally notified,
provided copies, and asked for feedback (TAB X). Fact sheets, news
stories, press releases (TAB X) and often a press conference accompany
every new report when it is published. Veterans' service organizations
(VSOs) are hosted each month for a roundtable discussion on releases,
updates, or to discuss other issues and concerns. To date, more than 25
narratives, reports, and information papers have been released (TAB X).
Media. From the beginning, OSAGWI has had a proactive media
approach. More than 150 news releases have gone to hundreds of national
and local media via the DoD and OSAGWI Internet sites, list servers,
and multi-fax/email (TAB X). Press conferences are held regularly.
Thousands of media queries receive timely and comprehensive response
(TAB X) by public affairs professionals while CBS, MSNBC, ABC, CNN, 60
Minutes, BBC, NPR, Washington Post, etc. interview experts on
controversial issues. Extensive media training precedes al interviews
and Q&As are prepared for every release and emerging issue. Media
relations have matured with national press calling to ask if
controversial issues are ``news'' before determining level of coverage.
Currently, approximately 300 local media around the nation are
individually marketed resulting in extensive coverage of OSAGWI's
outreach efforts. Trade and specialty media are also heavily marketed
(TAB X).
Public Communication. OSAGWI is a unique government organization--
providing one-on-one interaction via an 800 number 16 hours a day, and
more than 200,000 personal responses via emails and letters (TAB X).
Q&As for every issue and concern ensure all interactions with veterans
provide consistent and correct information.
We work closely with the VA, and other government agencies to
provide answers to all veterans' concerns.
GulfNEWS/GulfLINK. All products are posted on GulfLINK and veterans
notified about new postings. Nearly 25,000 veterans subscribe to
GulfNEWS, a bi-monthly newsletter containing highlights of GulfLINK.
Outreach. Most members of the organization participate in the
national outreach--whether going to military installations for weeklong
visits, or participating in conferences, conventions, or seminars. All
receive training on communicating with veterans, family members, or the
news media. All are prepared to discuss individual issues while many
are trained as briefer for specific audiences. Media are also heavily
marketed any time we participate in an event--medical media at medical
conventions, local media at base visits, and others whenever possible.
Local VA representatives and VSOs actively participate in base visits
designed specifically for each unique audience.
Products and Distribution. Brochures (TAB X) provide answers to
frequently asked questions while the tri-fold is more generic, but
contains a pocket to hold a postcard, newsletter, and GulfLINK
information (TAB X). Five display panels can be grouped for maximum
effect or stand-alone for greater distribution (TAB X). Briefings are
tailored for individual audiences and briefer selected for credibility
with audience (TAB X). An annual report targets Congress (TAB X).
Approximately 5,000 brochures, tri-folds, maps, fact sheets, etc. are
individually distributed at each base visit. Additionally, these same
products are regularly distributed around the nation to base libraries,
clinics, and family support centers; VA clinics and hospitals;
veterans' support groups such as VFW chapters; regional veterans'
service centers; and even state libraries.
evaluation
The Department of Defense and its subordinate units are not funded
to conduct formal research in the form of scientific surveys. However,
regular analysis of media coverage, correspondence, activist groups'
issues, and individual veterans' feedback, can provide insightful
information to evaluate the success of public affairs programs.
Evaluation of programs is almost a weekly process. Analysis of
correspondence tone and content, media coverage, activist issues, VSO
concerns, and informal surveys result in minor modifications of tactics
on a constant basis. Focus groups held at four installations helped
reshape the products while risk communication professionals also
provided their expertise on both products and processes. After each
outreach, team members participate in an extensive evaluation of
presentations; product and display design and distribution; and
audience response. Although the erosion of DoD credibility cannot be
rebuilt quickly, analysis indicates that we're on the right track.
Chairman Rockefeller. Dr. Cole, one of the problems with
Project SHAD and with the use of many investigational new drugs
during the Gulf War has been the niceties of distinguishing
ethically between test subjects who have given consent to
participate in an experiment and between participants for whom
notification is implied rather than secured. Based on your
studies of other tests, would you presume that the participants
in Project SHAD received sufficient notifications of the
hazards of the tests in which they participated? Is the
military doing a better job with that now, 10 years after the
Gulf War?
Mr. Cole. That is a good question, and the answer is
difficult to give. It can't be black and white based on the
information we have about SHAD.
What I do see, having looked at the SHAD reports, the fact
sheets that were issued by the Department of Defense, is a
differentiation they make between what they describe as test
subjects as opposed to test conductors.
There is a certain, I think, lack of fairness and realism
when you try to differentiate what rights a person should have
in terms of informed consent if he or she is designated a
tester rather than a subject. So just by changing the category,
you are still not changing the fact that the tester is a
participant. And if he is in the area of a potentially toxic or
lethal material, as part of an experiment, I would think that
he deserves the same kind of respect concerning informed
consent as a human subject.
Senator Specter. Mr. Chairman, might I ask one question
here? Because I am going to have to excuse myself in a few
minutes.
On this issue the line between a test subject and a test
conductor is so vague, if there is exposure, that ought to be
the determinant. Does the Department of Defense now have
ironclad regulations which require written informed consent if
there is exposure?
Mr. Cole. I do not know; when you use the word
``ironclad,'' I do not know. I know that it has been official
military policy since 1953 by way of a memorandum which I cite
in my written testimony that the Department of Defense is
obligated, as is the rest of this country, to respect the
Nuremberg code. That code was the outcome of the 1947 trial of
Nazi doctors who did horrible experiments on humans during
World War II. The Nuremberg code is a 10-item statement. Its
sum and substance is that nobody should be participating or
permitted to be participating as a human subject in research
without being informed of what he or she is getting into. He
should have the opportunity to disqualify himself or excuse
himself from being a research subject. This is simply summed up
in the two words ``informed consent.''
Senator Specter. Well, Mr. Chairman, my suggestion is that
we make that inquiry at the staff level, and I don't think we
ought to rely on the Nuremberg code as an enforcement mechanism
with the Department of Defense. That is less satisfactory than
the International Criminal Court. So this is something which is
just baseline fundamental, and in a civil court, without the
immunity and protection of the Federal Tort Claims Act, if
there isn't informed consent, it is just a major error and
imposition on people who are subjected to these sorts of tests.
So we will pursue that.
Mr. Cole. May I quickly say something about this? I am
aware of tests that did take place in which volunteers were
given information and then consented to be experimental
subjects under the military experimental program. So this has
certainly taken place in some instances.
Ms. Schwartz. Mr. Chairman, if I might, in my research of
looking at the Ranch Hand data that the Air Force had, it was--
they do have actually an informed consent. The difficulty is it
is so broad it would never pass the inspection of any internal
review board that we have today. And so if you do embark on
this investigation, I suggest that you look at the criteria
that is required for any tests or experiments of research
funded by the U.S. Government and compare it with some of the
informed consents that military members are given.
Senator Specter. Thank you very much.
Thank you, Mr. Chairman.
Chairman Rockefeller. Thank you, Senator Specter.
We have not called upon Steve Smithson yet, and you are
giving testimony, and I apologize to you.
STATEMENT OF STEVEN R. SMITHSON, ASSISTANT DIRECTOR, NATIONAL
VETERANS AFFAIRS AND REHABILITATION COMMISSION, THE AMERICAN
LEGION
Mr. Smithson. Good morning, Mr. Chairman and members of the
committee. The American Legion appreciates the opportunity to
provide testimony this morning regarding the strategies being
pursued by the Departments of Defense and Veterans Affairs to
provide appropriate care and support to veterans who may have
been exposed to environmental hazards during their military
service. As U.S. troops are currently deployed overseas
fighting the war on terrorism, this topic becomes even more
relevant.
While military service is inherently dangerous and certain
risks are to be expected, the Government is obligated to
provide proper health care and compensation to those who
sustain chronic disabilities as a result of such service. While
VA is charged with caring for military members once they leave
active duty, its mission is tied directly to information and
support received from Department of Defense. Herein lies a
fundamental problem. DoD's primary mission is to fight wars and
maintain national security. Caring for troops wounded or
otherwise injured in the advancement of this mission has often
been seen as secondary to its ultimate mission. However,
without adequate communication, cooperation, and open sharing
of information between these two entities, VA's ability to
successfully serve our Nation's veterans is severely
compromised.
Prior to the Gulf War deployment, troops were not
systematically given comprehensive pre-deployment health
screenings, nor were they properly briefed on the potential
hazards, such as fallout from depleted uranium munitions, that
they might encounter on the battlefield or in the theater.
Additionally, the recordkeeping was very poor. Numerous
examples of lost or destroyed medical records of active duty
and reserve personnel have been identified. Vaccines were not
administered in a consistent manner, and vaccination records
were often unclear or incomplete. Moreover, personnel were not
provided information concerning vaccines or prescribed
medications. Some medications were distributed with little or
no documentation or dosage instructions, to include possible
side effects or instructions to immediately report unexpected
side effects to medical personnel. Physical evaluations, both
pre- and post-deployment, were not comprehensive, and
information regarding troop movements and locations and
possible environmental hazard exposures was severely lacking.
This lack of such baseline data and other information is
commonly recognized as a major limitation in the evaluation and
understanding of potential causes of the multi-symptom
illnesses reported by many Gulf War veterans following the war.
Unless the failures in the system just cited are corrected, we
are doomed to repeat this pattern in the current war on
terrorism as well as other future deployments.
To avoid the problems just mentioned, the lessons learned
from the Gulf War have precipitated the passage of laws and
policies designed to create a concept of force health
protection. For example, Section 765 of Public Law 105-85
directed DoD to take specific actions to provide medical
tracking for personnel deployed overseas in contingency or
combat operations, outlining a policy for pre- and post-
deployment health assessments and blood samples. The conduct of
thorough pre- and post-deployment examinations, including the
drawing of blood samples, was specifically identified in the
law. Such action is crucial for the accurate recording of a
service member's health prior to the deployment and in
documenting any changes in their health during deployment.
Moreover, this is exactly the information that is needed by VA
to adequately care for and compensate service members for
service-related disabilities once they leave active duty.
On the surface the concept of force health protection and
related policies appear to have addressed the major problems of
the past. However, in reality, as it was learned from recent
Institute of Medicine and General Accounting Office reports on
the subject as well as in testimony earlier this year before
the House Veterans' Affairs Subcommittee on Health, the
aforementioned force health protection policies are not being
fully implemented, a major breakdown being at the field level.
The organizational mechanisms tasked with ensuring
implementation of these policies from the command level down to
the operational unit are obviously not working. Again, this
lack of urgency and compliance with the law appears to be
related to DoD's corporate philosophy and culture and directly
impacts its ranking of priorities. Unfortunately, the service
member and veteran ultimately pay the price for this inaction.
Title 38 of the United States Code places the burden of
proof in establishing a service-connected disability on the
veteran and establishing service connection directly impacts
the veteran's ability to access VA health care. Without
adequate DoD health surveillance and documentation of troop
locations, environmental hazards, and other exposures, and
timely sharing of this information with VA, this burden is
virtually impossible for the veteran to meet. If relevant
health and environmental exposure information is incomplete or
does not even exist due to previously discussed breakdowns in
the system, discussions on how VA and DoD can better share this
information is moot. The American Legion believes a total
commitment from all levels of the Department of Defense,
especially the Secretary's office, as well as strong
congressional oversight, are needed to ensure that such
policies are actually implemented in a timely and consistent
manner.
One other major obstacle that prevents sharing of relevant
exposure information has to do with classification issues. In
the case of Project SHAD, the mere existence of a potentially
hazardous activity, not to mention possible exposure and
personnel participation information, was not known for many
years afterwards because of national security and
classification issues. National security is a legitimate
concern, but veterans should not have to suffer undue hardship
when national security is used unnecessarily as a justification
to withhold information that is necessary for all veterans to
pursue health care and compensation from VA. An oversight
working group on biological and chemical testing as set forth
in the proposed Veterans Right-to-Know Act of 2002 could prove
to be an invaluable tool in overseeing the identification and
declassification of such tests.
The American Legion also believes that a sincere desire in
information sharing and mutual cooperation at the highest level
of DoD and VA is needed. A June 2002 letter from the Secretary
of Veterans Affairs to the Secretary of Defense, expressing the
importance of VA-DoD cooperation in quickly declassifying and
releasing additional information regarding SHAD is a good
example of such a desire. Such action at this level needs to
continue if we are to satisfactorily resolve the hurdles
associated with the dissemination of SHAD-related information
as well as to avoid such problems in the future.
Mr. Chairman, that completes my testimony. I will be happy
to answer any questions you or members of the committee may
have.
[The prepared statement of Mr. Smithson follows:]
Prepared Statement of Steven R. Smithson, Assistant Director, National
Veterans Affairs and Rehabilitation Commission, The American Legion
Mr. Chairman and Members of the Committee:
The American Legion appreciates the opportunity to provide
testimony regarding the strategies being pursued by the
Departments of Defense (DoD) and Veterans Affairs (VA) to
provide appropriate care and support to veterans who may have
been exposed to environmental hazards during their military
service. As U.S. troops are currently deployed overseas
fighting the war on terrorism, this topic becomes even more
relevant.
While military service is inherently dangerous and certain
risks are to be expected, the government is obligated to
provide proper health care and compensation to those who
sustain chronic disabilities as a result of such service. While
VA is charged with caring for military members once they leave
active duty, its mission is tied directly to information and
support received from DoD. Herein lies a fundamental problem.
DoD's primary mission is to fight wars and maintain national
security. Caring for troops wounded or otherwise injured in the
advancement of this mission has often been seen as secondary to
its ultimate mission. However, without adequate cooperation,
communication and open sharing of information between these two
entities, VA's ability to successfully serve our nation's
veterans is severely compromised.
History is ripe with examples of DoD's failure to be
forthcoming with timely and accurate information pertaining to
toxic exposures such as Agent Orange in Vietnam, radiation
exposure from Cold War nuclear detonation testing as well as
biological and chemical warfare defense testing, known as
Operation Shipboard Hazard and Defense (SHAD), in the 1960s.
These are just a few examples of where crucial exposure
information was unnecessarily withheld or classified, resulting
in additional hardship and suffering for those exposed.
Unfortunately, the Gulf War was no different. It took over five
years for the Pentagon to publicly admit that U.S. troops were
exposed to low levels of nerve agent following the destruction
of an Iraqi munitions storage facility--Khamisiyah--in Southern
Iraq in March 1991. Recent disclosures by DoD officials
regarding Khamisiyah exposure modeling efforts raises serious
doubts as to the accuracy of such modeling, bringing into
question the actual number of U.S. troops exposed and the level
of exposure.
Hints of a possible repeat of this pattern recently
surfaced in the war on terrorism with reports that U.S. troops
stationed at a former Soviet air base in Uzbekistan may have
been exposed to chemical agents that had seeped from old
weapons caches stored by the /former Soviet Union. Such news,
initially reported in early June, was later rebuffed by
military officials as a false alarm.
Exposure information pertaining to Project SHAD, a series
of experiments designed to test the vulnerability of American
war ships to chemical and biological warfare attacks, is slowly
being declassified. To date twelve out of a possible 113 tests
have been declassified and participants' names provided to VA,
resulting in the initial notification this past May of only 622
veterans. In order to ensure that all information relevant to
the health and well being of those involved in the SHAD tests
is provided to VA in an expeditious manner and all identified
participants are notified of the possible health consequences,
H.R. 5060 and S. 2704, the Veterans Right-To-Know Act of 2002,
was recently introduced. The American Legion fully supports
this legislation that specifically addresses the tests
associated with Project SHAD and calls for the identification
of all DoD tests involving chemical or biological weapons in
which military personnel may have been exposed to actual or
simulated agents with or without their knowledge or consent. We
also note that S. 2514, the Defense Appropriations Bill for
Fiscal Year 2003 was recently amended to include a provision
addressing the SHAD issue.
In other instances procedural breakdowns, such as improper
record keeping, has been the culprit. A perfect example is the
poor documentation of possible exposures during the 1991 Gulf
War. Prior to the Gulf War deployment, troops were not
systematically given comprehensive pre-deployment health
screenings, nor were they properly briefed on the potential
hazards, such as fall out from depleted uranium munitions, that
they might encounter on the battlefield or in the theater.
Additionally, as referenced above, record keeping was very
poor. Numerous examples of lost or destroyed medical records of
active duty and reserve personnel have been identified.
Vaccines were not administered in a consistent manner and
vaccination records were often unclear or incomplete. Moreover,
personnel were not provided information concerning vaccines or
prescribed medications. Some medications were distributed with
little or no documentation or dosage instructions, to include
possible side effects or instructions to immediately report
unsuspected side effects to medical personnel. Physical
evaluations--pre and post deployment--were not comprehensive
and information regarding troop movements/locations and
possible environmental hazard exposures was severely lacking.
The lack of such baseline data and other information is
commonly recognized as a major limitation in the evaluation and
understanding of potential causes of the multi-symptom
illnesses reported by many Gulf War veterans following the war.
Unless the failures in the system cited above are corrected, we
are doomed to repeat this pattern in the current war on
terrorism as well as other future deployments.
As briefly outlined above, there are numerous obstacles
that impede DoD's sharing of relevant information on
potentially hazardous exposures with veterans and VA. One major
obstruction is that DoD's primary mission, as previously
discussed, is inherently at odds with VA's role of providing
health care and compensation to veterans. It is not so much
that DoD intentionally puts up roadblocks to prevent veterans
from being properly served by VA, but rather the fact that this
is not a DoD priority. To avoid the procedural problems
encountered both during and after the Gulf War, as discussed
above, ``lessons learned'' from the Gulf War, have precipitated
the passage of laws and policies designed to create a concept
of Force Health Protection. For example, Section 765 of PL 105-
85 directed DoD to take specific actions to improve medical
tracking for personnel deployed overseas in contingency or
combat operations, outlining a policy for pre and post
deployment health assessments and blood samples. The conduct of
a thorough examination (pre and post deployment), including the
drawing of blood samples was specifically identified in the
law. Such action is crucial for the accurate recording of a
service member's health prior to deployment and in documenting
any changes in their health during deployment. Moreover, this
is exactly the information that is needed by VA to adequately
care for and compensate service members for service-related
disabilities once they leave active duty.
On the surface the concept of Force Health Protection and
related policies appear to have addressed the major problems of
the past. However, in reality, as was learned from recent
Institute of Medicine (IOM) and General Accounting Office (GAO)
Reports on the subject as well as in testimony earlier this
year before the House Veterans Affairs Subcommittee on Health,
the aforementioned Force Health Protection policies are not
being consistently implemented. The organizational mechanisms
tasked with ensuring implementation of these policies from the
command level down to the operational unit are obviously not
working. Again, this lack of urgency and compliance with the
law appears to be related to DoD's corporate philosophy/culture
and directly impacts its ranking of priorities. Unfortunately,
the service member and veteran ultimately pay the price for
this inaction.
Title 38 United States Code places the burden of proof in
establishing a service-connected disability on the veteran and
establishing service connection directly impacts the veteran's
ability to access VA health care. Without adequate DoD health
surveillance and documentation of environmental hazards and
other exposures, and timely sharing of this information with
VA, this burden is virtually impossible for the veteran to
meet. If relevant health and environmental exposure information
is incomplete or does not even exist due to previously
discussed breakdowns in the system, discussions on how VA and
DoD can better share this information is moot. The American
Legion believes a total commitment from all levels of DoD, as
well as strong congressional oversight, are needed to ensure
that such policies are actually implemented in a timely and
consistent manner.
One other major obstacle is the delay in relevant exposure
information due to classification issues. In the case of
Project SHAD, the mere existence of a potentially hazardous
activity, not to mention possible exposure and personnel
participation information, was not known for many years
afterward because of national security and classification
issues. National security is a legitimate concern, but veterans
should not have to suffer undue hardship when national security
is used unnecessarily as a justification to withhold
information that is necessary for a veteran to pursue health
care and compensation from VA. An oversight working group on
biological and chemical testing as set forth in the proposed
``Veterans Right-To-Know Act of 2002'' could prove to be an
invaluable tool in overseeing the identification and
declassification of such tests.
The American Legion also believes that a sincere desire in
information sharing and mutual cooperation at the highest level
of DoD and VA is needed. A June 2002 letter from the Secretary
of Veterans Affairs to the Secretary of Defense, expressing the
importance of ``VA-DoD cooperation'' in quickly declassifying
and releasing additional information regarding SHAD, is a good
example of such a desire. Such action at this level needs to
continue if we are to satisfactorily resolve the hurdles
associated with dissemination of SHAD-related information as
well as avoid such problems in the future.
Mr. Chairman, that completes my testimony. I will be happy
to answer any questions you or members of the committee may
have at this time.
Chairman Rockefeller. Thank you, and your testimony was
already previously included in the record.
Mr. Smithson. Yes, sir.
Chairman Rockefeller. Dr. Cole, you have testimony, and I
don't want to keep you from your testimony. And I am really
grateful that you are here. We have looked at the Persian Gulf
War legacy together, and the business of informed consent for
unapproved drugs, and the discipline within the military to
make sure that it is written at best, verbal if less than best.
What are the rules? Two questions. One is: The law actually, I
think, says you have got to sign your name, the soldier has to
sign his name. I don't think verbal is enough. I think the
soldier has to sign his name. But I am not sure of that because
I am not a lawyer.
Second, if you had to--and I am projecting this forward to
the Gulf War from SHAD--if you had to estimate the number of
military who were subject to taking PB, who were told about it,
who had to give their informed consent on a daily basis, so to
speak, what would that number be? Would it be above 20 percent?
STATEMENT OF LEONARD COLE, PH.D., DEPARTMENT OF POLITICAL
SCIENCE, RUTGERS UNIVERSITY, NEWARK, NJ
Mr. Cole. Well, something like 250,000, as far as we know,
but that is just an approximation, because as far as I am
concerned personally, a lot of what happened can be excused
because of, I think, the fear, the worry, the legitimate
anxiety that our troops might have been exposed to sarin or, in
the case of the anthrax vaccine which was administered, because
we were worried about anthrax during the 1991 Gulf War. What I
think is unforgivable is that we don't have the records to
indicate who got the doses, when, how many of them received it,
so now we can't go back and follow their medical history.
Chairman Rockefeller. Isn't that because they didn't
actually go collect them? That is what I am trying to get at.
Mr. Cole. Well, I don't know what the reasons were. There
was disorganization. There was an unwillingness to do the kind
of follow-through that would have----
Chairman Rockefeller. But the military has different
sections. They have people who supply the warfighting weapons.
They have people who would deploy. They have people who look at
radar. They have people who worry about health care. So that
the confusion argument has always been sort of a dodge to me. I
mean, you have people in the military and DoD, whose only
responsibility is health care. They don't make decisions about
whether you launch an aircraft to go do something. The only
decisions they make are on the health care aspects of what the
DoD is doing, are they being carried out properly?
And so unless they are vastly understaffed or if they are
ignored when they try to do the right thing, which is always
possible, I don't understand it. Am I right, though, that the
verbal consent isn't enough, it has got to be written?
Mr. Cole. OK. We have to----
Chairman Rockefeller. Or is that a bureaucratic distinction
even if it is legally correct?
Mr. Cole. Well, I think beyond bureaucracy, beyond--it
enters into the realm of legality and ethics. Any human subject
research where a person is going to be experimented on is the
issue. If an experimental drug is not necessarily for his own
benefit, as would not be the case with piridostigmine bromide
or the anthrax vaccines, but, rather, just simply to see what
the effects of a potential agent would be, a person not only
must give consent, but must do it in writing after being
appropriately informed. Such experimentation on human subjects
goes on now in the military.
On the other hand, when you are in a battlefield situation
and the troops are imminently threatened, I don't know that
there is a requirement for anybody to sign his name and say,
``I will take this kind of medication or drug.'' I just don't
know the answer to that.
Chairman Rockefeller. Well, then, what are the implications
for the future? I mean, it is one thing to look back at SHAD
and to decry the walking away from all of that. But now we are
talking about a whole different kind of warfighting where
people are not in large clusters, where they are, you know, in
the jungles of the Philippines or Indonesia or they are either
tree-covered or they are not tree-covered, or they are 14,000
feet in the air and there are 5 or 6 of them or 8 or 10 of them
or 2 or 3 of them, and there certainly isn't going to be a
medical officer going around getting informed consent should
such a kind of thing be required.
So, I mean, if you take the new type of war into account--
you know, al Qaeda is in 70 countries plus all the other
terrorist groups, including the ones we have in our own
country--what do you see all of this leading to? Because
biological and chemical weapons are now on the table. You don't
have a discussion about anything without talking about them. It
was kind of the surprise back--well, it wasn't a surprise, but
it was new back in the Gulf War. Now it is expected.
Mr. Cole. Well, the kind of conversation that you want to
have now and that you started having in the 1990's is already a
national conversation when you talk about vaccines--smallpox
vaccine, anthrax vaccine. Never mind just the military. We are
talking about whether every citizen in the United States should
receive a smallpox vaccination. That is still under debate. Now
there has been a decision that something like 500,000 people
ought to get it, those people who would most likely be the
first responders in case there is an attack.
We are dealing with really a tough issue. I don't mean to
move the locus of discussion from just the Veterans' Affairs
Committee concerns to the Nation at large, but the reality is
the questions that you are raising have national implications
for all citizens, not just for veterans or not just people
facing military situations next week or next month. I don't
know that there is a good answer, but I do believe that there
are good people working on, let's say, the least of the bad
answers.
In summary, I think you can take the smallpox vaccination
as a model, or piridostigmine bromide, or anthrax, for a whole
range of questions. How many people are we likely to save as a
consequence of this policy as opposed to how many we are likely
to injure or even kill as a consequence of the policy? We don't
have the numbers clearly down yet, but it is risk versus
benefit.
Chairman Rockefeller. In a sense, what you are saying--and
I think I will close with this, with the exception if any of
you have anything more that you want to say, which I would
welcome. It is a little bit like all of the American people are
potentially veterans, so to speak. And we are not just talking
about Iraq, we are not talking about other parts of the world.
We are talking about this country. So then the whole question
of what are we doing to beef up our public health system, the
number of vaccines, informed consent for Americans who, you
know, aren't at war, who are bringing up children, working, or
whatever it is. They have their agendas, and they are also
facing a form of danger which is very much up on them. So it
suddenly is a different kind of question, isn't it? It is not
the warfighters overseas but the American people at home, and
all of the ethical and legal questions begin to sort of
overlap, don't they?
Mr. Cole. Yes, I have a personal answer, if I may, for what
I would say would be appropriate. I don't know that it is
necessarily the correct national policy, but I believe that
everybody should have the opportunity to take or refuse a
smallpox vaccination or an anthrax vaccination, after being
given the full panoply of the potential risks and benefits,
unless the person is, obviously, not mentally competent or a
juvenile. That is what we are about. We are a democracy.
Informed consent is more than just about experiments. It is
about how we should be living in a democracy.
[The prepared statement of Mr. Cole follows:]
Prepared Statement of Leonard A. Cole, Ph.D., Adjunct Professor,
Department of Political Science, Rutgers University, Newark, NJ
Thank you for inviting me to comment on the ethics of conducting
open air testing with biological and chemical warfare agents. Ever
since 1976, when the public first learned that the U.S. Army had
conducted germ warfare tests over populated areas, new information
about such testing has continued to surface. Most recently, in May
2002, the Department of Defense released information about a series of
tests undertaken in the 1960s under ``Project Shipboard Hazard and
Defense,'' or SHAD. These tests were part of a joint service program to
assess the vulnerability of U.S. warships to a chemical or biological
warfare attack. Unlike other outdoor biological and chemical warfare
tests, these experiments may have deliberately exposed people to actual
biological and chemical weapons without their informed consent.
For a 20-year period, from 1949 to 1969, the Army conducted
hundreds of mock germ warfare attacks by releasing bacteria and
chemicals over populated areas--from San Francisco to New York, from
Minneapolis to Corpus Christie, Texas. The test agents, which the army
calls simulants, were intended to mimic more lethal bacteria and
chemicals that would be used as weapons. The purpose was to see how the
bacteria and chemicals spread while people went about their normal
activities.
The Army contends that none of the exposed population was at risk
because the agents were harmless. Furthermore, it did not consider
those people to be human subjects with the right of informed consent,
but rather people who just happened to be in the area. Belatedly, the
Army recognized that some of the bacteria and chemicals, including
Serratia marcescens and zinc cadmium sulfide, posed health risks. In
consequence, by the late 1960s, those agents were no longer being used
as simulants. [Leonard A. Cole, Clouds of Secrecy: The Army's Germ
Warfare Tests Over Populated Areas (Lanham, MD: Rowman and Littlefield,
1990).]
In other tests, the Army targeted individuals with actual warfare
agents, such as the microorganism Coxiella burnetti, the cause of Q
fever. In these instances, the targeted people were volunteers who were
treated as human subjects. They were given information in advance about
the tests, and were assured of quick medical treatment if they became
ill. [Leonard A. Cole, The Eleventh Plague: The Politics of Biological
and Chemical Warfare (New York: W.H. Freeman, 1998).]
Recent reports about SHAD suggest that, unlike in these other
tests, people were deliberately exposed not only to simulants, but to
bio/chem weapons, and that the exposed people were not treated as human
subjects. This is evident, for example, in material released by the DoD
about a SHAD test called ``Shady Grove.''
The report indicates that Coxiella burnetti, as well as simulants,
were sprayed at ships in open Pacific waters. The report also says:
The crews who participated in Shady Grove were not test
subjects, but test conductors. Participants should have been
fully informed of the details of each test. . . . Under actual
test conditions, test conductors should have worn appropriate
nuclear, biological, and chemical (NBC) protective equipment
and should have taken extensive safety precautions to prevent
any adverse health effects from the testing. [Fact Sheet,
Office of the Special Assistant to the Undersecretary of
Defense (Personnel and Readiness) for Gulf War illnesses,
Medical Readiness and Military Deployments. Provided at the
request of the Department of Veterans' Affairs. N.d., circa May
2002.]
No reference is made to the participants' right of informed
consent, apparently because the crews were not considered to be ``test
subjects,'' but ``test conductors.'' Moreover, the statement is not
clear that crew members received appropriate information about risks
and protection, only that they ``should'' have received such
information.
In SHAD tests titled ``Flower Drum, Phase II'' and ``Fearless
Johnny,'' VX nerve agent was sprayed at ships to assess the resulting
contamination and the effectiveness of decontamination efforts. The
DoD's fact sheet indicates that VX is ``one of the most toxic
substances ever synthesized,'' and that it is able to kill ``within 10-
15 minutes after absorption of a fatal dose.'' But the fact sheet does
not say whether crews were properly protected from the agent. Nor is it
clear that anyone involved with the decontamination was informed about
the nature of VX. [Fact Sheets, Office of the Special Assistant to the
Undersecretary of Defense (Personnel and Readiness) for Gulf War
illnesses, Medical Readiness and Military Deployments. Provided at the
request of the Department of Veterans' Affairs. N.d., circa May 2002.]
How much danger the crews faced during these tests remains
uncertain. In fairness, it is important to recognize that today's
standards and values are not necessarily the same as those of earlier
periods. In the 1950s and 1960s, the culture appeared less sensitive
than it is today to the rights of patients and of humans research
subjects. Still, even with that understanding, and with due recognition
of the Soviet threat that prompted the tests, ethical questions remain.
During World War II, the Germans used thousands of Jews and other
concentration camp inmates as involuntary experimental subjects. The
experiments commonly caused pain, disfigurement, and death. In 1947,
doctors who performed the experiments were tried in Nuremberg, and the
verdict included a code of conduct for research with human subjects.
The Nuremberg code enshrines the requirement that people be fully
informed and give consent before becoming test subjects. The code
became a standard in all civilized societies. In 1953, a DoD memorandum
to the Army, Navy, and Air Force affirmed the code as policy and began
with the admonition that ``the voluntary consent of the human subject
is absolutely essential.'' [U.S. Secretary of Defense, Memorandum for
the Secretary of the Army, Secretary of the Navy, Secretary of the Air
Force, subject: Use of Human Volunteers in Experimental Research,
Washington, DC, February 26, 1953.]
Thus, any supposition that rules for human research subjects were
different in the 1950s or 1960s than today would be untrue. Researchers
may have been less sensitive to the requirement of informed consent.
Patients and subjects may have been less informed generally about their
rights. But the requirement of informed consent was official military
policy.
In the context of the SHAD tests, several conclusions seem
appropriate.
Deliberately exposing people to biological or chemical
weapons without some level of informed consent, would have been
contrary to official policy. Ignoring the right of informed consent
would also have been inconsistent with the military's treatment of
human subjects in other tests in which actual weapons (as opposed to
simulants) were used.
The requirement of informed consent should apply to
everyone put at risk in such tests, whether the participants are
designated as testers or subjects.
The United States government has a particular
responsibility to people who were placed at risk by its experiments.
The responsibility should include providing medical care and financial
compensation to any participant made ill by the tests.
Chairman Rockefeller. Any other comments? Yes, please?
Ms. Schwartz. Just to let you know, I am retired from the
U.S. Air Force, and I am on the faculty of the Yale School of
Nursing, and I am in epidemiology. And basically one of the
things about--you asked the question about did they go around
and get informed consent before they give medications. Not
necessarily, if it is something that has been, you know, a
protocol that has already been established by the DoD, by the
Air Force or so forth, but you do keep records of who gets
what. Nurses do have to chart, and people who are giving those
injections do have to chart.
And Dr. Cole brought out a very important part. You wish
that you could give the military member the option to have this
injection or not, but that is not what happens because there is
a certain commitment to mission readiness, and along with that
the person has the right to know, the military person has the
right to know what it is they are going to be doing.
But the reality of what has happened here, both with SHAD
and what you have been talking about this morning, is one
thing. When everything is all said and done, whatever happened
to those people on those ships, whatever happened to the people
in the desert, this country owes them. We owe them. The
Veterans Administration is the workmen's comp for people who go
to war, for the men and women that have been exposed. And it
is--and I know you have been a leader, and I thank you so much
for it, Senator Rockefeller. But the truth of the matter is
that every day veterans around this country have to beg for
help. They have to beg for the care and consideration that they
deserve for putting their life on the line every single day.
We owe them the honor and respect of not making them beg
for this help. We also have to look at the world today. This
country has been jolted every day by something new--the
Catholic Church, Arthur Andersen, Wall Street. It is
unbelievable to me that we trust these men and women to defend
our country and we will not--we will question their honesty, we
will question what they say happened to them. And it is left to
them, left to them and their families and their children, to
make sense out of the sacrifice.
We recently did--we looked at the deaths of over 5,000
Vietnam veterans who served in Vietnam. The average age at the
time of death was 51 years old. And as poignant and as striking
as that might be, the saddest part of all is many of them died
without knowing that they died for their country.
Chairman Rockefeller. The hearing stands in recess. Thank
you.
[Whereupon, at 11:24 a.m., the committee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Ben Nighthorse Campbell, U.S. Senator From
Colorado
Thank you, Mr. Chairman. I appreciate your convening this hearing
and welcome everyone here today as we continue our efforts to
investigate toxic exposures among our nation's veterans.
Recently, we have received new information concerning the use of
and exposure to chemical and biological agents as part of a warfare
testing program in the 1960's. We continue to hear of Gulf War veterans
who are suffering from a host of unexplainable symptoms. And now, we
have American soldiers involved in another war--the war against
terrorism.
As our knowledge of scientific methods and research improves, we
learn of the glaring errors we made in the past. There should be no
question that our government should provide the necessary care and
restitution for injuries caused by these errors.
One might think that after the debacles of the Vietnam and Gulf
Wars, accountability for illnesses incurred from exposure to chemical
agents during war time would be a pretty clear issue. Unfortunately,
however, the Department of Defense has not made the task of obtaining
all of the data an easy one.
Treating those who protect our nation's security as human guinea
pigs for research purposes is inexcusable. Not only must we discontinue
such practices, we must also make every effort to see that such
exposures do not take place accidentally.
Our primary concern should be to take the steps necessary for
caring for the health of our veterans. I am hopeful that through
careful analysis of the available data, we can understand precisely the
causes of and the treatments for illnesses due to exposures. Then, we
must implement policies to make sure that such exposures do not take
place either intentionally or unintentionally.
I believe it is imperative that we restore the trust and confidence
of America's veterans in the federal government's response to these
kinds of exposures.
Again, I thank the chair, and look forward to today's testimony.
______
Prepared Statement of Joy J. Ilem, Assistant National Legislative
Director, Disabled American Veterans
Mr. Chairman and Members of the Committee:
I am pleased to present the views of the Disabled American Veterans
(DAV) concerning strategies of the Departments of Defense (DoD) and
Veterans Affairs (VA) to provide the most appropriate care and support
to veterans who might have been exposed to environmental hazards during
their military service.
The health and well-being of the men and women who put themselves
in harm's way in defense of our Nation continues to be one of our
foremost concerns and is of great importance to the DAV's more than 1.2
million members and their families. We appreciate the Committee's
efforts to identify obstacles that prevent DoD from sharing relevant
information on potentially hazardous exposures with veterans and VA. We
strongly agree with the Committee that veterans deserve assurance that
DoD can work productively with VA to identify, treat and, when
possible, prevent potential long-term health consequences of their
military service.
The hazards of military service are well documented and include
possible exposure to radiation, chemical and biological agents,
herbicides, a variety of environmental hazards, infectious diseases,
and a host of other toxins. Each new battlefield presents a unique set
of health hazards. Many soldiers suffer life-long disabilities as a
result of their military experience, due to blindness, spinal cord
injury, cold injury, traumatic amputation, hearing impairment, and post
traumatic stress disorder.
Following the terrorist attacks on the World Trade Center and the
Pentagon, the United States began to deploy troops to Afghanistan,
Pakistan, and neighboring former Soviet Republics. To date over 30,000
active duty personnel have been deployed and over 50,000 Reserve
personnel have been called to active duty in support of operations in
South Asia. According to DoD, these troops may experience high-altitude
health hazards, and exposure to a variety of infectious diseases and
environmental hazards to include agricultural and industrial
contamination of food and water supplies, air pollution, and severe
sand and dust storms.
During Operations Desert Shield and Desert Storm, the United States
deployed 697,000 military personnel to the Persian Gulf. Serious health
concerns related to service in the Persian Gulf were reported as Gulf
War veterans began to return home in 1991 with complaints of vexing
symptomatology and the development of unexplained illnesses. More than
100,000 troops who served in the Gulf War report they continue to
suffer from a range of maladies including chronic muscle and joint
pain, fatigue, headaches, memory loss, balance problems, and sleep
disturbances. The complexity and controversy surrounding Gulf War
illnesses immediately became apparent as the VA attempted to medically
treat and compensate veterans who had become ill following their
military service in the Gulf War. Controversy over this issue still
exists today, more than ten years later, as scientists and medical
researchers continue to search for answers and contemplate the various
health risk factors associated with service in the Gulf War and
reported illnesses affecting many veterans who served there.
Following the Gulf War, 33 separate hazardous substances were
identified to which Gulf War veterans may have been exposed. DoD was
heavily criticized for failing to provide explanations about Gulf War
veterans' health concerns or respond in a prudent manner. Faith in the
government's commitment to ensuring the safety of servicemembers' and
veterans' health and providing appropriate care was seriously eroded.
After intense pressure, DoD admitted its shortcomings and failure to
properly communicate with troops during the Gulf War about health
concerns relating to smoke from oil well fires, required vaccinations
and medications, exposure to depleted uranium, and other chemical
hazards.
Most recently, veterans service organizations (VSO) were notified
that veterans who participated in a series of Cold War tests known as
Project SHAD (Shipboard Hazard and Defense), a program encompassing
several tests initiated in the 1960s to determine the vulnerabilities
of United States warships to an attack with chemical or biological
warfare agents, may have been exposed to potentially harmful biological
and chemical agents. Only after intense pressure from veterans and
Congress did DoD finally begin to release information about the tests
conducted. VA and DoD, in a joint meeting, informed VSOs that both
agencies would work collaboratively to develop the facts surrounding
Project SHAD and accomplish declassification of materials, compile
rosters of participants and inform them of potential exposures and
possible short and long-term health effects. To date DoD has identified
103 potential SHAD tests. However, the total number of servicemembers
involved in the tests is still unknown. In May 2002, VA initially
notified 622 of about 4,300 veterans already identified as participants
in project SHAD about potential exposures. The Veterans Right To Know
Act of 2002 (H.R. 5060 and S.2704), was recently introduced in part to
expedite the process of gathering all essential information related to
SHAD and test participants. DAV fully supports this legislation, which
calls for full disclosure of each DoD test involving chemical or
biological weapons in which members of the Armed Forces or civilians
were or may have been exposed to actual or simulated hazardous agents,
whether with or without their knowledge or consent.
In November 1998, President Clinton directed the establishment of
the Military and Veterans Health Coordinating Board (MVHCB), an
interagency body including the Secretaries of Defense, Health and Human
Services, and Veterans Affairs, to ensure coordination among the
respective agencies with respect to clinical, research, and health risk
communication issues related to the health of military members,
veterans, and their families during and after future deployments. The
MVHCB is responsible for making recommendations to minimize adverse
health consequences of deployment and to coordinate an interagency
information management (IM), and information technology (IT) task
force, to ensure that all IM/IT requirements including record keeping
are addressed by the agencies. A Deployment Health Working Group (DHWG)
was also designed to determine interagency priorities for the
assessment and prevention of deployment and post-deployment health
issues. The work group is focusing on pre- and post-deployment health
assessments, medical surveillance during deployments, combat stress
control, and individual environmental exposure assessments. The group
is responsible for providing recommendations to the various agencies
concerning research, clinical findings, prevention, diagnosis, and
clinical care. Another component of the group is to help ensure lessons
learned from previous military combat operations are translated into
effective preparation for future missions.
Last year, a new Office of the Special Assistant to the Secretary
of Defense for Gulf War Illnesses, Medical Readiness and Military
Deployments (OSAGWI-MRMD) was formed to continue the support for
appropriate health care for sick Gulf War veterans while promoting
changes in existing military doctrine, policy and procedures that will
minimize any future hazardous exposures during deployments. DoD
recognized it must properly train military personnel in the use of
chemical detection equipment, effectively communicate safety
precautions for depleted uranium, the use of pesticides, and other
chemical hazards future troops may encounter on the modern battlefield.
Military officials claim they have a new mind set concerning the
long-term health of their troops and have indicated that they are
taking measures to improve medical monitoring of personnel sent
overseas to fight the war on terrorism, in an attempt to avoid
lingering health problems like those experienced by Gulf War veterans.
Officials claim they are keeping careful records for troops and
requiring servicemembers to complete a simple medical screening before
and after they are deployed. One report indicated that the Armed Forces
are beginning to convert medical records for each servicemember to an
electronic database. The report also noted that the Pentagon has
started environmental monitoring for areas where its sends its troops.
Certainly, we hope these measures are being carried out. However, only
time will tell if the appropriate agencies have fully addressed the
lessons learned in the Gulf War and if efforts have been effectively
coordinated to protect the health of our troops.
The DAV believes military personnel should have complete medical
examinations prior to deployment and after completion of an assignment
to include collection of blood samples. This would allow clinicians and
researchers to ascertain changes in health status in individuals and
groups of servicemembers if health concerns become apparent following a
particular deployment. It is also important that accurate record
keeping during deployment is accomplished and accessible, especially if
a servicemember becomes ill during the deployment. Many sick Gulf War
veterans were unable to access field health treatment records once they
returned home. DoD reported that many veterans could not obtain records
because they were filed by the name of the hospital that retired the
records and veterans could not furnish the name of the field hospital
to which they were admitted. This documentation can be crucial to a
veteran's medical treatment and application for VA disability
compensation benefits.
It is essential that all appropriate agencies work together to
integrate deployment health-related lessons learned with regard to
future doctrine and policy. This will help to assure that
servicemembers and their families understand the possible health risks
they face and how they can best protect themselves and their families'
health and get the assistance and care they need as they transition
into veteran status. The appropriate federal agencies must share
responsibility for force health protection before, during, and after
deployments. Without coordination, future veterans will likely
experience problems similar to those that Gulf War veterans faced. DoD
is obligated to provide accurate information about the health risks
servicemembers face. The Department needs to be proactive rather than
reactive concerning risks servicemembers may encounter during future
deployments from the modern battlefield and environmental conditions.
Likewise, the Veterans Health Administration must focus its scientific
research, medical treatment, and outreach on veterans who become ill as
a result of their military service. Disabled veterans must have access
to appropriate treatment regimes so they can try to regain their health
and well-being following military service.
It is the government's obligation to provide veterans who suffer
from service-related disabilities with health care and compensation.
However, for VA to make accurate rating decisions on claims for service
connection for disabilities associated with toxic exposures, it must
have access to all relevant documentation. The current system in place
makes it nearly impossible in some cases for veterans to obtain
relevant exposure information in support of their claim for service
connection, i.e., barriers reported by DoD in getting relevant Project
SHAD information declassified expeditiously. It is essential that DoD
practice good record keeping, especially for high-risk military
exercises, and shares that information with the VA, servicemembers and
veterans in a timely manner. Excessive delays for information are
unacceptable. A veteran's health and well-being should not be put at
further risk due to institutional barriers in information sharing
between VA and DoD. This process must be streamlined and veterans must
be immediately made aware of exposure to hazardous toxins and possible
health effects.
DoD's past failures in providing servicemembers and veterans with
important information about potential toxic exposures and possible
health effects is well documented. Project SHAD is just one more
example. In the mean time, these veterans may have been denied
treatment form the VA for health problems or compensation for
disabilities that may only now be linked to their military service. DoD
says it is concerned about the health and well-being of its troops;
however, veterans believe actions speak louder than words. DoD reports
it is now trying to streamline its medical record keeping process
through the collection of pre- and post-deployment physicals, medical
intelligence, health care delivery and other important documentation.
This action is long overdue. Veterans who have sacrificed their good
health in defense of our Nation deserve more than just promises. It is
essential that DoD overcome institutional barriers and aggressively
pursue initiatives that will ensure veterans who have suffered severe
health consequences as a result of their military service have access
to critical information related to hazardous exposures so they can be
properly compensated for service-related disabilities and afforded
timely and appropriate medical treatments. Without a true collaboration
between the involved agencies we are doomed to repeat the past.
Unfortunately, it is veterans who will needlessly suffer and continue
to pay the price for inaction.
We urge the Committee to closely monitor the federal agencies
responsible for coordinating force health protection. We sincerely
appreciate the opportunity to present our views on this important issue
and its relationship to the health status of the veteran population.
______
Joint Prepared Statement of the Desert Storm Justice Foundation, Paul
Lyons, President; Desert Storm Battle Registry, Kirt P. Love,
President; and American Veteran Justice Foundation, Dannie Wolf,
President
Dear Committee Members
At the time in late 2000, OSAGWI had the opportunity to respond to
a question posed to them concerning Project SHAD. Kirt Love and Venus
Hammack were present at this Pentagon NSO meeting to hear CPT. Mike
Kilpatrick and UNSECDEF Dr. Bernard Rostker say they would reply to the
question of project SHAD. It would be nearly 2 years before anything
else was said by this agency.
This stall tactic is on going with other investigations, as it does
with Gulf War issues. It started with Warren Rudmans' statements on
behalf of PSOB (investigating OSAGWI) that OSAGWI should change from
investigation to medical deployment. Then it produced heavily biased
data that was unsupportive of veteran ``benefit of the doubt'' asto
incidents and medical issues.
The moment that Dr. Bernard Rostker left office in 2001 they
changed that policy, they summarily cut all ties with any Gulf War
grass roots groups and dealt strictly with the National Service
Organizations. They stopped returning phone calls and emails, and
dodged veterans at public events throughout 2001. The issue fell silent
until the Anthrax incident of October 2001.
OSAGWI has 6,000,000 records related to the Gulf War of which
1,200,000 are of medical relevance. From that they post 57,000 they
claim have relevance, and never produce evidence that the other
6,000,000 are even real. 12 years later these materials (mainly CIA and
CENTCOM) are 99% classified SECRET or higher--and not releasable.
It is our firm belief that having viewed some records outside DOD
intelligence main frame that many of the records are of HIGH
relevance--like DIA's unwillingness to discuss its highly classified
records on the 9 Nuclear Reactors in the 1991 Gulf War supplied by the
Russians. That the Russians recommended we NOT bombed them, and we did.
If Deployment Health Support Directorate is given the opportunity
to run the SHAD investigation like it did the Gulf War investigation,
it will deliberately stall and with hold vital data to keep damage to a
minimum. Without Non-Military oversight, DOD is NOT capable of
regulating or investigating itself internally.
Our organization has had interaction with OSAGWI since 1997, and we
are very familiar with their team having interacted with them on every
level to include Public Town Hall Meetings. Every where they went
around the United States, the veteran groups treated them same--``You
have NO credibility with us''. From observation we also supported that
conclusion, they do NOT provide answers to FOIA's of medical relevance
or even basic request.
Acknowledging medical conditions is one thing, but VA's ``Burden of
proof'' policy is punitive in nature, and if DHSD is allowed to
continue as is--it will make sure that SHAD veterans have as much
trouble proving their claims as Gulf War veterans have theirs. Exposure
dictates treatment, and so far the Deployment Health Clinical Center
supported by DHSD is largely psychiatric research. They run on the
basis that Somatization is the answer, which does not support lab
baseline data.
As a veteran of the Gulf War, we have first hand knowledge of
OSAGWI interaction. On that basis we recommend Oversight investigation
into their operation at this time for the protection of other soldiers
currently deploying that are NOT protected from lessons learned by this
agency.
military exposures
Many Veterans have been failed by the DESP: deployment
environmental surveillance program
[1] Info related to service members health and deployments status--
was incomplete or inaccurate, according to GAO Report 02-478T.
[2] DoDs' numerous databases, including those that capture health
info, currently are not linked.
This transfer of data to a common electronic system, that
will document, archive and
Access medical surveillance data is poor at best
[3] The Secretary of the Army is responsible for medical
surveillance for all of the DoD's deployments; this should be
consistent with DoDs' medical surveillance policy.
[4] Without this info, troops may not recognize potential side
effects of exposures or take prompt precautionary actions, including
seeking medical care.
Current Policies and Lessons Learned Programs have NOT
been full Implemented today.
The (CHCS II) Composite HEALTHCARE system needs to be
audited, according to GAO Report -02-173T
the continuing challenges of care
[1] We have also reported that not all medic encounters in theater
were being recorded on individual records.
So why are veteran's today, still having to prove to
adjudicators their exposures?
Benefit of the doubt is almost never granted, impart
because of DOD's stalling of actual exposures and events that surface
nearly 30 years later.
[2] VBA considers the VCAA's implementation a significant factor in
the recent growth of its inventory of Compensation and Pension claims
awaiting decisions--from the law's enactments.
Please read PL 106-475, Nov 9 2000.
[3] Despite VBA's efforts, recent results from its quality
assurance reviews indicate a significant decrease in rating accuracy,
due in large part, to improper regional office implementation of VCAA
requirements.
[4] This law obligated the VA to assist a claimant in obtaining
evidence that is necessary to establish eligibility for service
connected benefit's being sought.
Question--what is being done when claimants are informed
relevant records are unable to be obtained?
[5] This lack of data by design, negatively impacts the STAR
system, Systematic Technical Accuracy Review for the Regional Office.
Today many claimants have not received notification request for
evidence from V.A. federal service officers, and were not obtained by
the VBA for evidence. Yet many vets have been failed by lax Industrial
hygiene and sanitation in the Gulf War Theater; and very sadly, few
have been evaluated in this manner.
We, the above mentioned Gulf War Veteran's groups, insist the
proper review of statistics and the number of claimant information, as
seen by doctor's licensed by The American Board of Industrial Hygiene
or Industrial Health Foundation. Those who are specialized in
Environmental Medicine and/or Environmental Health could also treat us.
Environmental Medicine is the medical discipline which studies and
assesses the effect of environmental factors upon individuals with
particular emphasis on the effect of foods, chemicals, water, indoor
and outdoor air quality at home, work or school. It considers each
patient as a unique individual exposed to a unique set of circumstances
and needing an individualized therapy.
Veterans seek this type of this evaluation for their claim.
Once the cause of the health problem is uncovered, treatment is as
direct as possible with minimal use of pharmaceutical drugs, which can
often have adverse side effects and also often only mask other
symptoms.
Treatment consists of environmental controls, diet, nutritional
supplements, correction of hormonal or metabolic deficiencies or
imbalances, education and immunotherapy; (injectable and/or sublingual)
where indicated. The amount of physicians in this area working at
VAMC's is insufficient to support the number of post Vietnam deployed
patient population.
compensation
DVA will find it difficult to assist in conducing research should
troops be exposed to environmental or occupational hazards, and
identify legitimate service connected disabilities to adjudicate
veterans disability claims.
Service Connected disabilities adjudication have been hampered by a
lock of 1.1 completed baseline health data of GWV
2.2 assessments of their potential exposure to environmental health
hazards and 3.3 specific health data on care provided before, during
and after deployments.
VSO officials we spoke with at the regional offices we visited
expressed concern about the clarity and necessity of VCAA pre-decision
notification letters.
Some VSO's are having trouble understanding these letters.
There is not a way for a claimant to be sure the training and skill of
the VSO who represents them.
Paul Lyons, President, Desert Storm Justice Foundation
Kirt P. Love, President, Desert Storm Battle Registry
Dannie Wolf, President, American Veteran Justice Foundation
______
Prepared Statement of the National Gulf War Resource Center
Mr. Chairman and other distinguished members of the committee; the
National Gulf War Resource Center (NGWRC) is pleased to discuss this
issue from the Gulf War veteran perspective. Understanding how members
of the U.S. military have been exposed to chemical, biological,
radiological or hazardous material, no matter how the exposer happened,
is critical to developing a strategy for treatment. We thank you in
advance for holding this important hearing.
In your invitation for testimony you wrote ``Veterans deserve
assurances that DoD can work productively with the VA to identify,
treat and if possible-prevent potential long-term health consequences
from their military service''
We agree with this statement. It is a simple request. However, with
regard to Gulf War veterans, assurances and productivity have been
lacking. We characterize DoD's efforts as unacceptable, bordering on
deception.
In keeping with the goals of this committee we have divided our
testimony into three sections. Each section covers what we believe is
the historical barrier that prevents the flow of information. The
barriers we have identified are DoD Culture, Information Dominance, and
Burden of Proof.
dod culture
DoD has a demonstrated 50-year history of mitigating its failures
with delay, denial and obstruction. Especially when it comes to
exposures and what I call ``bad policy, resulting in self-inflicted
wounds.'' It is this bad policy, and culture that produced a thirty,
forty and fifty year waiting period for admissions of guilt and
corrective action from DoD.
The DoD culture is a mindset demonstrated over time and developed
into a pattern of expected results based on whatever the external
pressure is. Corporate cultures can be a good thing when they are
developed to be mutually beneficial to the organization, the worker and
consumer. Examples of organizational cultures that are bad are in the
news today, in these organizations; losses and mistakes are hidden with
strategic spin to delay the inevitable outcome. The company that is
built on perception rather than truth will always find it-self in a
credibility argument.
Veterans have always understood what they were up against when
taking on DoD.
How can this committee change the DoD Culture? How can we help DoD
develop its credibility with veterans?
We start by holding the spin experts accountable. There should be
hearings that investigate and prosecute those who would lie to delay
the inevitable truth. Why is it acceptable, why do these spin experts
continuing to receive taxpayer dollars?
Veterans are the consumers; we demand that the practice of
deception be stopped. We deserve truth and an honest broker. Our health
is at risk because of Public Relations tactics. Truth would go a long
way toward fixing this problem. Not truth in 30 years but truth now.
Veterans have a right to know when they have been exposed to anything
harmful.
If DoD knows then why shouldn't the veteran. SHAD is a classic
example of DoD Culture gone amuck. DoD knew of the exposures in the
SHAD test for many years, certainly during the time that veterans like
Jack Alderson were making inquiries into his health status.
What was the response he was given when he asked for information?
He was told that no such test ever occurred. He was blatantly lied to.
Even as this lie began to fall apart DoD's Office of the Secretary of
Defense for Gulf War Illnesses (OSAGWI) continued to lie to media and
veteran service advocates. When asked if a list of names containing
those potentially exposed were available, Mrs. Barbara Goodno and her
public relations experts at the OSAGWI denied the existence of any such
list on more than one occasion.
I do not speculate on this subject. I worked in this organization
and saw the list of names before I retired. The question is: What is it
about the DoD Culture that allowed this person to continually lie to
the media and to veterans when she knew full well that a list was
available and it contained the names of veterans who had been exposed?
I believe that she did it because of the DoD culture of striving
for Information Dominance. It is the nature of DoD to mitigate and
control the damage of a story even if being less than honest harms the
public.
I often tell my young nephew that lying is wrong, and dumb. Telling
the truth is always better. Lying becomes even worse when you do it and
you know you're wrong, because eventually, in 30 or 40 years the
institution will be caught. I tell my nephew that a person who lies
when they are obviously caught is twice the fool.
Risk communication, the buzzword of DoD public relations should not
mean, let me deceive you, let me delay the outcome for the benefit of
protecting my organization. It should mean that you understand your
audience, you understand your message and you deliver it with truth and
honesty demonstrating your commitment to solving the issue and
addressing the public concerns.
Our suggestion to this committee is to change the DoD Culture. If
DoD won't change on its own then we need to establish oversight with
teeth. Terminate, prosecute and ban from governmental contact anyone
who would purposely deceive America. We expect high standards from our
soldiers, why not the same from the civilian leadership of DoD.
Veterans can't be held hostage to public relations anymore. A bill
recently introduced, S. 2704 and HR. 5060 is an attempt to establish an
oversight mechanism that will protect veterans and allow information to
flow both ways.
information dominance
It should be of no surprise to anyone on this committee that when
dealing with DoD you are subjecting yourself to a multitude of tactics
and techniques that are battle tested and designed for one purpose,
domination of the battlefield. It does not matter if the enemy is a
country or a ``perception,'' the strategy is the same. DoD Information
Dominance is an obstacle that prevents veterans from gaining the truth
about their battlefield exposures.
Information dominance may be defined as superiority in the
generation, manipulation, and use of information sufficient to afford
its possessors dominance over the full spectrum of an issue or
conflict.
For DoD, information dominance has three sources. DoD Public
Affairs representatives use these sources to ``Control the Message.''
This control becomes the barrier that veterans face when trying to
obtain information. The three sources of Information dominance are:
Command and Control that permits everyone to know where
they are in the battlespace, and enables them to execute operations
when and where they choose. They understand that no matter what you may
want they can wait you out. They are the sole source provider.
Intelligence that ranges from knowing the enemy's
dispositions to knowing the location of enemy assets in real-time. It
also means knowing the expected outcome of a course of action. DoD
weighs the cost of admitting the truth now or later based on the
desired outcome. If DoD has done something wonderful you cant make them
stop talking about it. If they have done something wrong they will
``get back to you later,'' even if they know the answer already.
Information Warfare that confounds enemy information
systems at various points (sensors, communications, processing, and
command), while protecting one's own. Here is the meat of the problem.
When you confront DoD in any form you are the enemy. Confounding the
issues with disinformation or one-sided information is a primary tactic
of DoD. Using SHAD as an example we have seen the DoD message develop
over time. First they said the test never happened. Then they said it
happened but no list were available. Then they said the list is
available but only simulants were used. Now they admit live agent was
used in some test but they say people wore protective clothing. This is
a pattern of information dominance that allows DoD to eek out
information and mitigates the story. They have known all along what the
exposures are.
Interestingly, the organization conducting the SHAD investigation
is also responsible for producing the Gulf War Investigation. The
reports produced from OSAGWI for the Gulf War are about mitigating the
exposure.
Recently a full 11 years after the Gulf War Dr. Michael Kilpatrick
of OSAGWI admitted during a public hearing, that its chemical warfare
agent reports from the Gulf War on Khamisiyah were--in his exact
words--``A wild ass guess.''
The VA used this report and others to deny treatment, benefits and
compensation to veterans. Why did it take 11 years to admit what
veterans knew immediately after the war? Why has it taken SHAD
veteran's 40 years to hear the truth?
DoD proudly sees itself as second to none in the use of
information. Controlling the message is information dominance. This
power is the barrier, which prevents soldiers and veterans from
learning the true nature of exposures. The idea of acceptable losses,
and no remorse, coupled with strategic spin has become the norm from
DoD. Veterans demand a ``no excuses'' policy from DoD when they hold
the information key to understanding exposures and health consequences.
I implore this committee to establish some method to ensure information
cannot be used as a weapon against our own veterans, so this type of
``bad policy'' never happens again.
burden of proof
More than decade ago, U.S. Forces were deployed to fight in a war
that would be won in a matter of hours rather than years. The speed of
battle and the technology that was employed ensured our success as we
achieved our objectives. Today we are beginning to hear the familiar
rhetoric in preparation for a new war with Iraq. We are seeing stories
of how important our soldiers are and how well trained and magnificent
they are in the conduct of their duty to protect America.
This sentiment is true and deserved but for some the feeling that
``soldiers matter'' only comes out in time of war much like people who
turn to prayer only when they find themselves in dire straights.
Serving veterans of the Gulf War has taught me how much soldiers fade
from the conciseness of America when the war is over. 300,000 out of
700,000 in theater Gulf War veterans have sought treatment from the VA
for what they believe to be service-connected disabilities. Now in this
time of great need and demand on our military I would like this
committee to consider the burden of proof and how the DoD's culture and
spin control of information has denied veterans health care.
Under the current policies of the Veterans Administration (VA)
soldiers who are called to war and then return home are required to
present evidence of exposure or injury to the VA--- before they become
eligible for care and compensation from the VA. This policy places the
burden of proof on the service member to insure that DoD does its job.
Some examples of the DoD failures in obtaining this burden of proof
during the Gulf War include: Poor record keeping both in and out of
theater, poor unit location management, lack of environmental
monitoring, lack of useful chemical and biological agent monitoring,
lack of predictive analysis and consideration of downwind hazards
resulting from pre ground-war bombing, lack of knowledge on the effect
and use of investigational new drugs and vaccines, poor enforcement of
and adherence to pesticides use, lack of standards and methods when
using or working around depleted uranium, the list goes on and on.
The soldier would have needed to be a journalist, lawyer,
environmentalist, scientist, chemical and biological weapons expert,
meteorologist and doctor to obtain the proof required by the VA for
service-connected disability.
Interestingly enough, the military has all these occupational
specialties in its ranks but the DoD and the VA still requires the
individual to be responsible for obtaining and maintaining the required
information. This is the crux of the problem: In obtaining access to
the entitlement of medical treatment and services from the VA the
burden of proof is improperly placed on the veteran when it should be
placed on DoD.
Lessons learned from the Gulf War were supposed to address this
problem and as a result of ``Lessons Learned'' from studying the events
of the Gulf War. The DoD and the JCS developed a plan that would
prevent an event like ``Gulf War Syndrome'' from ever occurring again.
This proactive policy was called Force Health Protection or (FHP). FHP
is a protocol and the congress wisely established it in a public law
designed to conduct a series of physical test on soldiers, before,
during and after deployment. It also requires DoD to maintain medical
data, exposure and event reports, and movement and location data.
During my last assignment in the military I briefed this policy to
numerous active duty soldiers around the United States. The Office of
the Special Assistant for Gulf War Illnesses (OSAGWI) now called the
Special Assistant for Gulf War Illnesses, Medical Readiness and
Military Deployments (SAGWI/MR/MD) was then and is still today the lead
agency on the investigation into Gulf War exposures and has also
transitioned into Deployment Health Policy. The DoD is still ignoring
this law, with no implemented policy. I would welcome your questions
for the record to enable me to justify this statement.
The problem of how to improve sharing of information between DoD
the VA and the veterans is two fold:
1. DoD is not enforcing the policy enacted into law as a
result of lessons learned from the Gulf War (PL.105-85, Section
762-765).
2. The burden of proof for service-connected disabilities is
obviously misplaced and should fall on DoD and not the
individual.
There have been many initiatives that have been suggested in order
to speed the effectiveness and delivery of health care to veterans,
however none have taken the shape of actual implementation. Despite
pressure from two presidents, both the VA and DoD have made little
headway in combining their health-care programs or sharing critical
information. If they took those two simple actions, it would relieve
the burden of proof from the individual. ``Most of the sharing
initiatives are more illusory than real,'' said Stephen Joseph,
assistant secretary of Defense for Health Affairs during the Clinton
administration.
``VA and DoD created several joint facilities in recent years, but
most of the management and operational functions at the facilities
continue to be run separately,'' Joseph said.
Joseph further stated, ``The biggest hindrance to greater
cooperation and coordination between the two departments is their
diverging missions. Delivering quality health care to veterans is the
VA's primary mission. DoD's health programs are focused on keeping the
military healthy and ready for the next engagement.''
However there is a flaw in the belief that these missions are
different or competing. They should be complimentary. DoD gets the
soldier at the reception station, builds the medical record and in some
cases sends the soldier to war. The VA is the recipient of the veteran
when they return from war or leave the service. In order to take care
of the soldier DoD must take responsibility for the burden of proof
from day-1 through the soldiers end of service. The reason that VA
health care has been limited for Gulf War veterans is the lack of
commitment from the DoD to do its job while the soldier is engaged in
the conduct of his or her duty.
Let me give an example of how this flaw has impacted Gulf War
Veterans. Upon their return from the Gulf War, veterans began
complaining of various illnesses and diseases that they believed were
attributed to their service in the Gulf region. Veterans themselves
began to organize and ask for assistance from DoD, the VA and others.
No matter which direction veterans pointed to try and understand their
illness the DoD and its selected scientists refuted veterans claims by
making bold unfounded statements that were not backed up by scientific
research.
Even today DoD requires veterans and the public to simply believe
them because they say so. Poor policies, weak protective measures, lack
of records and other failures forced DoD to go back into time and write
reports about the events of the Gulf War to try and explain the
multitude of exposures. These reports are ``no more than guesses'' at
what actually happened. Their conclusions can be easily refuted. The
final reports were then used by the VA as evidence to substantiate lack
of service connection to the exposures Gulf War veterans faced. Instead
of actually fact finding for the purpose of helping veterans the
reports have been used as weapons to prevent access to care and
compensation. Today, science has caught up with the DoD, and we are
discovering that these illnesses are absolutely service connected
exposures and injuries. Allowing DoD to go back in time and guess about
exposures and then give this information to the VA to deny benefits
places the veteran in a double jeopardy. It makes as much sense as
letting Enron investigate itself or asking the fox to guard the hen
house.
What are the obstacles and how do we improve benefits and services
for Department of Veterans Affairs beneficiaries?
We must first eliminate the DoD culture of delay, denial, and
obstruction. Then Congress must demand that the DoD obey the Force
Health Protection law's already on the books. This law also extends to
the reserve component of the military. The DoD can accomplish this
today, with its existing force structure. The civilian leadership
simply needs to issue the order, and follow-up to insure that it's
accomplished. The Secretary of Defense, on a monthly basis, should
brief the Congress until there is compliance. The VA should be involved
in the process proactively not retroactively.
It's often said, ``the first casualty of war is truth.'' Our
veterans are not demanding a big bag of money; they are demanding that
which could be granted today. Truth. The whole truth, and nothing but
the truth
______
Prepared Statement of Paul A. Hayden, Deputy Director, National
Legislative Service, Veterans of Foreign Wars of the United States
Mr. Chairman and members of the committee:
On behalf of the 2.7 million members of the Veterans of Foreign
Wars of the United States (VFW) and our Ladies Auxiliary, I would like
to thank you for the opportunity to comment on the strategies being
pursued by the Departments of Defense (DOD) and Veterans Affairs (VA)
to provide the most appropriate care and support to veterans who might
have been exposed to environmental hazards during their military
service.
Throughout the past century, in peace and war, our military men and
women have been exposed to a wide variety of environmental and manmade
hazards. Aside from normal deployment exposures such as diseases
endemic to certain geographical locations, troops in WWI were exposed
to mustard gas among others agents; in WWII they exposed to radiation
from atomic explosions; in Vietnam they exposed to herbicides designed
to defoliate the jungle, and; in the Gulf War, they were exposed to low
levels of toxic nerve gas.
In fact, this Committee found in its 1998 Report of the Special
Investigation Unit on Gulf War Illness, that the ``Gulf War experience
can be seen as a microcosm for continued concerns regarding our
nation's military preparedness and ability to respond effectively to
health problems that may arise . . . as ``both [DOD] and [VA] gave
insufficient priority to matters of health protection, prevention, and
monitoring of troops when they [were] on the battlefield and thereafter
when they [became] veterans.''
Now, as a result of DODs recent disclosure regarding a group of
Cold War chemical and biological tests commonly referred to as Project
Shipboard Hazard And Defense (SHAD) that exposed veterans to dangerous
and harmful agents, our Nation's attention is once again focused on how
DOD and VA can ``collect information adequately about, keep good health
records on, and produce reliable and valid data to monitor the health
care and compensation status of veterans.''
Seeking to apply lessons learned from the past, DODs current
efforts in this arena revolve around the concept of Force Health
Protection. One of the ways they accomplish this is by having the
servicemember, not a physician, assess their state of health before and
after deployments, by filling out forms DD Form 2795, Pre-Deployment
Health Assessment, and DD Form 2796, Post-Deployment Health Assessment.
In addition, DD Form 2796 asks the troops for their deployment
location, country, and name of operation.
In the Spring 2002, Vol. 1, Issue 4, Deployment Quarterly magazine,
a DOD health official in response to a question regarding whether a
soldier ``should get a complete physical examination after [they]
return from a deployment'' replied, ``complete physical examinations
are not necessary for most people who are returning from a
deployment.'' This answer clearly contradicts and undermines the intent
of Congress, not to mention the safety of the servicemember, when they
authored Section 765 of PL 105-85. Under this law, DOD is required to
perform pre-deployment medical examinations and post-deployment medical
examinations to include the drawing of blood. All of these exams are to
be retained in a centralized location to improve future access.
Aside from DOD's failure to implement current law, the Institute of
Medicine (IOM) in its report, Protecting Those Who Serve, (the
recommendations of which the VFW concurs) stated that DOD has made
``few concrete changes at the field level'' the most important
recommendations remain unimplemented, despite the compelling rationale
for urgent action.'' Additionally, a January 8, 2002, New York Times
article seems to further illustrate this point. A Pentagon official in
deployment health described the new mind-set in military health care as
``trying to train people to ask questions, which is a change in
military culture . . . Senior leaders need to understand that there is
a major shift.''
We believe the chair of the IOM Committee on Strategies to Protect
the Health of Deployed U.S. Forces articulated the position that senior
leaders are failing to grasp when he stated, ``while the accomplishment
of the mission always will be the paramount objective, soldiers must
know that their health and well-being are taken seriously. Failure to
move briskly to incorporate these procedures (improved medical
surveillance, accurate troop location, exposure monitoring, etc. . . .)
will erode the traditional trust between the servicemember and the
military leadership, and could jeopardize the mission.'' While DOD has
received input from numerous expert panels, and has sought to implement
changes based on lessons learned, it is our opinion that they have
failed to carry out DOD-wide changes in an effective and efficient
manner. They are not entirely to blame though, as institutional
barriers are oftentimes hard to overcome.
Up to this point, our testimony has focused primarily on DOD, and
rightly so, because in order for VA to properly care for and compensate
a veteran, it depends on accurate and timely information from the
veteran's military health record. We believe that every veteran is
entitled to a comprehensive life-long medical record of illnesses and
injuries they suffer, the care and inoculations they receive, and their
exposure to different hazards. Further, the transfer of this record
from DOD to VA should be seamless. Communication between the two
agencies needs to be streamlined so that data can be given to front-
line health care and benefit providers. Because that is not always the
case, the problem experienced by veterans in the past has been their
inability to convince VA that their disability is service connected.
According to Title 38, USC, the burden of proof is placed upon the
veteran. This is an inherit inequity of the system that demands
correction.
In cases such as these, Congress has a long history of creating
presumptions for specific cases such as Vietnam veterans and exposure
to the herbicide Agent Orange and presumption for service connection
due to undiagnosed illnesses for Persian Gulf veterans. If DOD provided
proper data to VA then there would be no need for corrective
Congressional action and veterans who have a right to know if their
illnesses were caused by exposure while in service would not have to
wait decades to properly address their valid concerns.
The VFW believes that only a total commitment to Force Health
Protection from the highest levels of DOD can ensure accurate health
data collection and dissemination. Further, the VA must remain vigilant
in its role as the chief advocate for our nation's veterans; and once
again, Congress must use its powers of oversight and legislation to
ensure that future generations of veterans receive the care they were
promised by a grateful nation.
This concludes my testimony.
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