[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
KARSHI-KHANABAD:
HONORING THE HEROES
OF CAMP STRONGHOLD FREEDOM
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON NATIONAL SECURITY
OF THE
COMMITTEE ON OVERSIGHT AND REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
NOVEMBER 18, 2020
__________
Serial No. 116-126
__________
Printed for the use of the Committee on Oversight and Reform
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available on: govinfo.gov,
oversight.house.gov or
docs.house.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
42-593 PDF WASHINGTON : 2021
COMMITTEE ON OVERSIGHT AND REFORM
CAROLYN B. MALONEY, New York, Chairwoman
Eleanor Holmes Norton, District of James Comer, Kentucky, Ranking
Columbia Minority Member
Wm. Lacy Clay, Missouri Jim Jordan, Ohio
Stephen F. Lynch, Massachusetts Paul A. Gosar, Arizona
Jim Cooper, Tennessee Virginia Foxx, North Carolina
Gerald E. Connolly, Virginia Thomas Massie, Kentucky
Raja Krishnamoorthi, Illinois Jody B. Hice, Georgia
Jamie Raskin, Maryland Glenn Grothman, Wisconsin
Harley Rouda, California Gary Palmer, Alabama
Ro Khanna, California Michael Cloud, Texas
Kweisi Mfume, Maryland Bob Gibbs, Ohio
Debbie Wasserman Schultz, Florida Clay Higgins, Louisiana
John P. Sarbanes, Maryland Ralph Norman, South Carolina
Peter Welch, Vermont Chip Roy, Texas
Jackie Speier, California Carol D. Miller, West Virginia
Robin L. Kelly, Illinois Mark E. Green, Tennessee
Mark DeSaulnier, California Kelly Armstrong, North Dakota
Brenda L. Lawrence, Michigan W. Gregory Steube, Florida
Stacey E. Plaskett, Virgin Islands Fred Keller, Pennsylvania
Jimmy Gomez, California
Alexandria Ocasio-Cortez, New York
Ayanna Pressley, Massachusetts
Rashida Tlaib, Michigan
Katie Porter, California
David Rapallo, Staff Director
Daniel Rebnord, Chief Counsel
Amy Stratton, Clerk
Contact Number: 202-225-5051
Christopher Hixon, Minority Staff Director
------
Subcommittee on National Security
Stephen F. Lynch, Massachusetts, Chairman
Jim Cooper, Tennesse Glenn Grothman, Wisconsin, Ranking
Peter Welch, Vermont Minority Member
Harley Rouda, California Paul A. Gosar, Arizona
Debbie Wasserman Schultz, Florida Virginia Foxx, North Carolina
Robin L. Kelly, Illinois Michael Cloud, Texas
Mark DeSaulnier, California Clay Higgins, Louisiana
Stacey E. Plaskett, Virgin Islands Mark E. Green, Tennessee
Brenda L. Lawrence, Michigan Bob Gibbs, Ohio
C O N T E N T S
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Page
Hearing held on November 18, 2020................................ 1
Witnesses
Dr. Patricia R. Hastings, Chief Consultant, Post Deployment
Health Services, Department of Veterans Affairs
Oral Statement................................................... 5
Dr. David J. Smith, Deputy Assistant Secretary of Defense for
Health Readiness, Policy and Oversight,Department of Defense
Oral Statement................................................... 4
Written opening statements and statements for the witnesses are
available on the U.S. House of Representatives Document
Repository at: docs.house.gov.
Index of Documents
----------
Documents entered into the record during this hearing and
Questions for the Record (QFR's) are listed below/available at:
docs.house.gov.
* Letter to Secretary Wilkie from Chairman Lynch, Chairwoman
Maloney, Ranking Member Comer, and Ranking Member Grothman;
submitted by Chairman Lynch.
* Testimony by Paul Widener from the National Security
Subcommittee Hearing on February 27, 2020; submitted by Rep.
Grothman.
* Environmental Protection Web Page entitled Health and
Environmental Effects of Particulate Matter; submitted by Rep.
Kelly.
* Fact Sheet from the Agency for Toxic Substances and Disease
Registry; submitted by Rep. Kelly.
* Letter to Secretary Wilkie from Rep. Luria and the response
from Secretary Wilkie; submitted by Rep. Luria.
* Letter to former Secretary Esper from Rep. Luria and the
response from former Secretary Esper; submitted by Rep. Luria.
KARSHI-KHANABAD:
HONORING THE HEROES
OF CAMP STRONGHOLD FREEDOM
----------
Wednesday, November 18, 2020
House of Representatives
Subcommittee on National Security
Committee on Oversight and Reform
Washington, D.C.
The subcommittee met, pursuant to notice, at 10:03 a.m., in
room 2154, Rayburn House Office Building, Hon. Stephen F. Lynch
(chairman of the subcommittee) presiding.
Present: Representatives Lynch, Welch, Kelly, DeSaulnier,
Grothman, Gosar, Foxx, Cloud, Higgins, and Green.
Also present: Representatives Speier and Luria.
Mr. Lynch. The committee will now come to order. Without
objection, the chair is authorized to declare a recess of the
committee at any time.
I will now recognize myself for an opening statement.
Good morning, everyone, again. Last week, we celebrated
Veterans Day to honor the brave men and women who have sworn to
protect the United States throughout our Nation's history. Our
country owes them all a solemn debt of gratitude. Too often,
however, when our sons and daughters in uniform have returned
home with the scars of war, our government has failed them.
From Agent Orange in Vietnam to toxic exposures from burn
pits in Iraq and Afghanistan, our Nation's veterans have
repeatedly sought acknowledgement of their injuries and
assistance from Washington, only to be met with resistance,
skepticism, and doubt.
This story is regrettably playing out once again for the
soldiers, airmen, marines, and National Guardsmen who deployed
to Karshi-Khanabad, better known as K2, which is a former
Soviet airbase in Uzbekistan on the Afghan border; that U.S.
Forces used to support military operations in Afghanistan
following the September 11 terrorist attacks.
Between 2001 and 2005, more than 15,000 men and women
deployed to K2 to support Operation Enduring Freedom.
Declassified assessments conducted by the military in the early
2000---well, in 2000's and released by our committee in July
show that servicemembers who were deployed to K2 were exposed
to multiple harmful toxins and environmental hazards left over
from their former Soviet occupants, including jet fuels,
volatile organic compounds, depleted uranium, burn pits,
particulate matter, and other cancer-causing chemicals.
Today, nearly 20 years later, the veterans and
servicemembers who deployed to K2 have self-reported nearly
2,000 adverse health conditions, including 491 cancers, that
they believe are connected to their prior service and exposure
at K2. Yet despite this clear evidence that servicemembers were
exposed to dangerous hazards at K2, the VA inexplicably
continues to deny that the life-altering illnesses reported by
these veterans are service-connected, even after a 2015 Army
public health study found that K2 servicemembers were five
times--five times--more likely to develop certain forms of
cancer, compared with others who deployed to South Korea and
other deployments.
The VA's continued denial has left hundreds, if not
thousands, of K2 veterans ineligible for certain preventative
health programs and unable to receive a disability benefit in
connection with their service at K2. This is an injustice that
must be rectified, and Secretary Wilkie has the authority to
fix it by granting presumptive status to K2 veterans today.
If we as a Nation are willing to send our sons and
daughters in uniform to war, then we must be prepared to care
for them upon their return home. Instead, DOD and the VA's
response to the concerns of K2 veterans and their families, and
this subcommittee, have been inadequate.
If not for our oversight, DOD likely would not have
declassified hundreds of pages detailing the toxic hazards U.S.
Forces were exposed to at K2, and the VA would likely have not
committed to launching a new epidemiological study. I knew I
was going to stumble on that. Even then, DOD withheld these
declassified documents from our committee for months, and the
VA study is expected to take at least a year, all while K2
veterans are left waiting for answers.
While I do appreciate the participation of our witnesses,
Dr. Hastings and Dr. Smith, as well as their service to the
country, I'm disappointed that the VA declined to provide an
assistant secretary-level policymaker, as we requested, on a
bipartisan basis, to testify alongside Dr. Hastings at today's
hearing.
Our K2 veterans and the families have sacrificed enough on
behalf of our Nation, and many are still suffering. They
deserve the highest level of attention from both Departments,
and sending an additional VA representative to testify
alongside Dr. Hastings at today's hearing would have more fully
demonstrated that commitment.
Before I yield the floor to Ranking Member Grothman, I'd
like to personally thank him and Ranking Member Comer for the
bipartisanship that they and their staff, very capable staff,
have demonstrated throughout this investigation. We have worked
as partners, as we should.
I'd also like to thank Chairwoman Maloney for her
unwavering support of our post-9/11 warriors, as well as the
gentleman from Tennessee, Congressman Green, for his
partnership and leadership on this issue and for cosponsoring
H.R. 5957, the K2 Veterans Toxic Exposure Accountability Act of
2020. We did that earlier this year.
With that, I'll yield to the ranking member from the great
state of Wisconsin, Mr. Grothman.
Mr. Grothman. Thank you very much.
First of all, I thank you personally for holding this
important hearing. As you mentioned, it's a bipartisan
priority, and I'm glad we're able to work together on this.
Helping all veterans, and particularly those serving in K2, is
very important.
And I'd like to thank Dr. Green, a member of the
subcommittee, who's one of the veterans that served at K2. I
want to offer my gratitude to him for his service to the
country and continued fight to bring justice to the veterans
that served along with him. I met some of these people
personally, and you can't help but be impressed.
This is a unique opportunity as a whole to come together
and get something done. I sincerely thank the chairman for your
work and want to echo your statements with regard to the
witnesses today. We did request a senior-level policymaker, in
particular, dealing with the health of people who put their
lives on the line in the country. I think that's a minimum that
should be expected.
We have the utmost respect for you and your work, Dr.
Hastings. It's vitally important to hear what administrative
policy and remedies may exist for these veterans. I hope we can
still find an appropriate time to hear from a senior VA
policymaker even at this late date. Without significant support
from both your Departments, any congressional effort to make
these veterans whole will be futile.
After the terrorist attacks on September 11, we deployed
units to K2 in Uzbekistan in preparation for invasion to
Afghanistan. An old Soviet base, unfortunately, posed serious
toxic risks, and we knew about those toxic risks, as I
understand it, before we deployed the troops there. We've heard
stories of a pond that flowed green, black sludge coming up
from the ground and contaminated soil throughout the base.
Since that base was closed, there have been enumerate cancers,
illness, and deaths reported from those who served, and we're
going to ask some questions regarding that today.
This is a saddening and largely forgotten tragedy. I
understand and am encouraged by efforts undertaken by both of
you to understand more about the dangers associated with K2.
Development of a K2 roster will make much needed transparency
and help the VA make determinations and help Congress make
determinations, quite frankly. Conducting a comprehensive study
to assess the connections between toxic exposure on K2 and
subsequent illnesses is encouraging. That's a good start, and
we must continue to push forward.
Further, since our last hearing in February, numerous
environmental site studies and operational health risk
assessments have been declassified. They show that multitudes
of toxins--they show the multitude of toxins that these
servicemembers could be exposed to, including jet fuel, PM10,
and radiation.
Shockingly, these documents in previous testimony showed
the military leaders did not communicate the risk of K2 with
those stationed there, despite being instructed to do so, which
is just callousness almost beyond belief. I fully understand
that neither of you were in charge, but I hope you feel as we
do, that, you know, we owe a little bit more attention to the
people who put their lives on the line for this country.
We need to be encouraging screenings for those who served
at K2, and we need to be encouraging K2 veterans to speak up
and come to the VA to seek treatment.
The subcommittee will continue to fight for all
servicemembers that were stationed at K2 and their families. We
cannot afford to sit idly by as those who put their lives on
the line for this country continue to get sick. I hope this
hearing can inform everyone, including the press, how it's best
to move forward.
Again, thank you to the witnesses for being here. I thank
you one more time for showing this--for having this hearing. I
yield back.
Mr. Lynch. I thank the ranking member.
Before we continue, I have a few quick housekeeping
matters. Without objection, Ms. Speier, the gentlewoman from
California; Mrs. Luria, the gentlewoman from Virginia, shall be
permitted to join the subcommittee and be recognized for
questioning the witnesses. They have each done extensive work
on this issue and on caring for our veterans in general, and we
appreciate their participation. They are each subcommittee
chairs on Armed Services, so they deal directly with this
subject matter as well.
I'd like to introduce our witnesses. First, today, we have
Dr. David J. Smith, who is the Deputy Assistant Secretary of
Defense for Health Readiness Policy and Oversight at the
Department of Defense. Welcome.
And we'll also hear from Dr. Patricia R. Hastings, who is
the chief consultant for the post-deployment health services at
the Department of Veterans Affairs.
In accordance with the committee rules, would you both
please rise and raise your right hands?
Do you swear or affirm that the testimony you're about to
give is the truth, the whole truth, and nothing but the truth,
so help you God?
OK. Let the record--you may be seated. Let the record show
that the witnesses have answered in the affirmative.
Without objection, your written statements will be made
part of the record. And with that, Dr. Smith, you are now
recognized to offer a verbal presentation and summary of your
testimony.
STATEMENT OF DR. DAVID J. SMITH, DEPUTY ASSISTANT SECRETARY OF
DEFENSE FOR HEALTH READINESS POLICY AND OVERSIGHT, DEPARTMENT
OF DEFENSE
Dr. Smith. Well, good morning, Chairman Lynch, Ranking
Member Grothman, and the other distinguished members of the
committee. It's my pleasure to appear here today representing
the Department of Defense to address any concerns or questions
members may have regarding the environmental conditions at the
Karshi-Khanabad Airbase, or K2 as we call it, and the
Department's efforts to protect the health of current and
former servicemembers who deployed to that location.
Now, first, I would like to acknowledge that in the 15
years since its closure, several K2 veterans have passed away,
and many K2 veterans have reported significant health
challenges. The untimely death or unexpected development of
illness in current or former servicemembers is of great concern
to the Department, and I personally want to express my
heartfelt sympathies and condolences to any servicemembers and
their family members so affected.
Now, the Department is fully committed to transparency with
respect to the possible environmental exposures at K2. The
documents already provided to the committee demonstrate the
Department has followed its policies regarding environmental
evaluation at forward operating bases.
There has been extensive sampling of soil, water, and air,
and we documented the results of these evaluations and
implemented appropriate mitigation steps. We conducted followup
environmental evaluations in 2002, in 2004, and made the
summary of our findings and conclusions publicly available.
In response to concerns voiced by servicemembers, the
Department has conducted two separate studies of individuals
who deployed to K2. The results of those studies were reviewed
by the joint DOD/VA Deployment Health Working Group at the time
of completion. The overall conclusions of these studies did not
support worsened health outcomes among deployers at K2 when
compared to those contemporaneously deployed to Korea. But
nonetheless, there were some specific diseases, specifically
lymphatic and hemopoietic cancers that appeared among the K2
group at a rate higher than expected.
In response to the concerns raised by your committee about
the health of K2 veterans, the Department immediately renewed
our discussions with the Department of Veterans Affairs, and
the Department has worked closely with our VA colleagues in
designing and implementing a much larger study of K2. So, any
association between deployment to K2 and adverse health effects
can be determined in a manner that is scientifically rigorous
and comprehensive in its analysis.
As you know, I've submitted written testimony in addition
to the oral statement, and at this point, I will look forward,
after Dr. Hastings' testimony and opening Statements, to
answering your questions.
The health and well-being of our servicemembers is my top
priority and remains a top priority for the Department. Thank
you very much.
Mr. Lynch. Thank you.
Dr. Hastings, you're now recognized for a verbal
representation of your testimony.
STATEMENT OF DR. PATRICIA R. HASTINGS, CHIEF CONSULTANT, POST
DEPLOYMENT HEALTH SERVICES, DEPARTMENT OF VETERANS AFFAIRS
Dr. Hastings. Thank you.
Chairman Lynch, Ranking Member Grothman----
Mr. Lynch. I'm not sure if your mic is on.
Dr. Hastings. Chairman Lynch, Ranking Member Grothman, and
members of the subcommittee, thank you for the opportunity to
discuss the ongoing activities and research the VA is
undertaking to address the health concerns that may be
associated with exposure to environmental hazards among
veterans who were deployed between 2001 and 2004 to Karshi-
Khanabad, a former Soviet airbase in Uzbekistan, also known as
K2.
The VA is very aware that we owe those who served at K2 an
understanding of possible health outcomes. The VA is committed
to finding the answers and has embarked on a specific K2 study.
The study will be long-term and not a one-time effort looking
at this cohort.
The Department of Defense did the initial and subsequent
site assessments, and you have been afforded those copies. They
have also shared them with the VA, and we began working on
this, as Dr. Smith said, very early on with the Deployment
Health Working Group.
The 2015 Army Public Health Center evaluated cancer
outcomes and compared the K2 servicemembers to a group deployed
to South Korea but never deployed to southwest Asia. Leukemias
and lymphomas did have an increased risk, and the relative risk
was 5.6. But to put this in a context, this is seven cases at
K2 and five cases in Korea. The small number of cases could be
a coincidence, but it could also be an early signal. Even a
small number of cancers in servicemembers that are relatively
young is a cause for concern. The VA is taking these results
very seriously, specifically for cancers, but also looking at
other health outcomes.
The VA will expand upon the 2015 Army Public Health Center
study. We have identified, with the help of DOD, the 15,777 in
the total cohort. 15,743 of those are currently veterans, with
34 who are still on Active Duty.
My office has put together a comprehensive prospective
epidemiologic study to assess the possible associations between
health conditions and exposure to the environmental hazards
during their K2 deployment. This will take 12 to 18 months to
complete with our current assets. The study will also include
assessments of morbidity, and this will be looking not only at
cancers but also at circulatory, respiratory, neurologic, and
other conditions.
It includes a very good set of comparison groups. It will
be a group of Operation Enduring Freedom, cohorts that served
at the same time but never at K2, and a group that are the OEF
era but did not deploy to K2 or to southwest Asia. And we plan
for this to go on for approximately 20 years because of the
latency of some of the issues that may come up with the cancer
concerns.
In conclusion, the VA is committed to looking at the health
and well-being of all veterans, but specifically here, the K2
veterans, and we're dedicated to looking at the long-term
health consequences. This is expected to translate into better
care for the veterans. It's also expected to help the DOD in
looking at future protective measures they may want to take
during deployments. And we do appreciate your support.
We are now available for your questions.
Mr. Lynch. Thank you very much.
Thank you for your testimony, Dr. Smith and Dr. Hastings.
Just to begin, I am blessed, my district, we have three VA
hospitals within my district in Brockton, Massachusetts, in
Jamaica Plain, and West Roxbury, Massachusetts as well, and we
are extremely thankful for the wonderful work that is done by
our docs and staff, therapists, and the wonderful, wonderful
service that they render to our veterans all across New
England, mostly, the area that we service. So, we're very
thankful for the job that the VA has done in large part within
the system.
However, during our investigation, we've heard from dozens
of veterans whose lives have been irreversibly altered by toxic
exposures at Karshi-Khanabad, K2. Their stories are absolutely
heartbreaking, but I'd like to take a moment to share just a
few.
Sergeant Doug Wilson joined the Air Force in 1998 and
deployed to K2 in December 2001. He returned in 2013, but--
excuse me--he retired in 2013, but just three years later, he
was diagnosed with primary central nervous system lymphoma. To
this day, Mr. Wilson rides a mile and a half in a mechanical
wheelchair twice a week to attend his physical therapy
appointments.
Chief Warrant Officer Scott Welsh was diagnosed with
thyroid cancer in 2013. In testimony before our subcommittee in
February, he wrote: At one time I was worried that since I was
younger than my wife, I would outlive her in old age. However,
now every day all I can think about is how will she go on after
I'm gone, do we have all of my final arrangements in order, and
how will my two sons be taken care of?
Sadly, one of my constituents from Norwood, Massachusetts--
and Norwood has a long and strong history of military service
and patriotism to our country throughout its history. One of my
constituents from Norwood, Kim Brooks, lost her husband,
Lieutenant Colonel Tim Brooks when he was only 36 years old. He
left behind four young children, one of whom followed in his
father's footsteps and graduated from West Point and is now
serving in Active Duty.
To date, K2 veterans have self-reported nearly 500
instances of cancer and nearly 2,000 adverse health conditions.
These veterans and their families, quite frankly, have
sacrificed enough. There's more than enough evidence produced
by this subcommittee, produced by the Army, and produced by K2
veterans themselves, to indicate that these conditions are
service connected.
But when K2 veterans turn to the VA for help, they hear the
same thing over and over: There's no presumption associated
with K2 service and there's no indication of increased cancers.
What is the danger in providing this presumption even if a
handful of these veterans have diseases not caused by their
service? They all put on the uniform to serve this country;
they all deserve to be taken care of.
Dr. Hastings, is that such a bad thing? Is that what we're
guarding against here?
Let's think about the upside of this. A presumption would
provide any of these veterans coming forward with cancer--they
come in and they've reported cancers, that's not in dispute.
It's a 15,000-personnel universe of people, probably much less
right now, and they come forward with accurately diagnosed
types of cancers.
What the VA is saying is, we acknowledge that you've got
cancer, we acknowledge that you served at K2, we acknowledge
that the Army has reported that there were radioactive
isotopes, depleted uranium, there was jet fuel, there were
toxic substances where you served, and it permeated the ground.
It's been evacuated. We've done soil samples, and we know those
hazardous substances, in some cases radioactive, and we have
signs where--the military put signs up, radioactive area,
please keep out. And we built an earthen berm, which does
nothing--the radiation goes right through the earthen berm--and
we kept the soldiers there.
So, knowing all of that, and then these soldiers come
forward and they've demonstrated and have been diagnosed by the
VA and others that they've got cancer, and we deny them
coverage or benefits because we say, we think you may not have
gotten it here. So, it's a veteran with cancer and we're
denying them benefits.
The downside is that maybe one of these poor veterans got
cancer from a source other than K2, and they might be covered.
In my opinion, that is not a--I would absorb that risk. If
there are a few poor souls that might get treatment and
benefits because they've got cancer after putting on that
uniform and serving their country, if that's the downside for
the government here, I embrace it. Cover them all. Cover them
all. Give them the benefits and the care that they deserve, but
don't deny them all for the, you know, for the misplaced
concern that a couple of veterans with cancer might get
treatment and benefits that they might not have connected to
their service at K2.
So, I see the duty and honor that we owe to these veterans
as being primary, and I see a great disservice being done to
these families and these veterans for a bureaucratic mis-
ordering of priorities. Maybe you can explain it to me. Why,
why, why would we deny this presumption with the evidence in
hand when we owe these veterans so much? And the consequences
of not providing the benefits and care are devastating to these
families, and in my opinion, disrespectful of their service as
well. I don't know. Can you help me with that?
Dr. Hastings. Certainly, sir. I am a veteran of 33 years
and----
Mr. Lynch. Thank you for your service. Appreciate that.
Dr. Hastings. Well, thank you for giving me a job I've
loved my entire life.
We are committed to veterans. I am at the VA specifically
because I want to take care of veterans. And Dr. Stone, just as
an aside, was also at K2, so he understands the imperatives
here.
It would be a disservice to the veterans to simply say--and
this is all veterans--to simply say, we don't know how you got
it, we're just going to cover it. My office looks at the
science. I want to find out what the exposures were.
I'd like to tell you a little bit about depleted uranium,
if I could. You, Congress, has supported the Depleted Uranium
Center in Baltimore for over 30 years, and we have an
incredible amount of experience with depleted uranium ever
since the Manhattan Project. We have 84 veterans that we bring
back every two years to look at them, who were involved in
friendly fire incidents, and they do not have an excess
mortality, excess morbidity. They are looked at every two
years. And they do have the demonstrable isotopic signature of
DU.
We have done 6,500 other urines for people concerned about
exposure to DU, and only five have been positive, and all five
had embedded shrapnel that had not been identified by them
before. We have had 37 urines turned in from the K2 cohort. We
have had 25 that were completed. All are negative for the
isotopic signature of depleted uranium. We are----
Mr. Lynch. What about jet fuel?
Dr. Hastings. To finish, DU--for just a moment, we are
absolutely willing to do a urine on every single K2 veteran for
peace of mind.
With regards to the underground leaking tanks, the DOD did
look at the volatile organic compounds and did not find them to
be at a hazardous level.
You go back to the depleted uranium. There was a weapon
that was detonated, blew up, outside the berm. It was--DU can
only penetrate to about two cell levels of the skin, so the
berm would have been protective. And, absolutely, people should
not have gone anywhere near the areas that were cordoned off,
covered with dirt. But the DU--there were hotspots, but the
hotspots were close to the ground in those areas, not that you
would be measured at high levels away from those hotspots. And
they were known, they were mitigated.
The other hazards that were there, the dust--it was a very
dusty environment. My office is continuing to look at the
airborne hazards issues. We worried about lead. There was one
building that had lead paint. So, we're looking at all those
things. But if I simply say right now, you have cancer, we're
covering it, we don't--I want to find the reason so this
doesn't happen again.
Mr. Lynch. Many of these veterans who have cancer, some
have already passed away. The longer the VA and the DOD extend
the time out for this, you know, they'll--it sort of, it's moot
and meaningless to a lot of these families. So----
Dr. Hastings. I absolutely agree. Time is of the essence,
and that's why my office is--good science takes time, and I
have to say, we have what has been described as an elegant--
epidemiologists like to use that term--protocol, and it will
give us many of the answers that you seek. It will take some
time. And we are working with DOD hand-in-hand to make sure we
have the entire cohort, to make sure we have all the data and
to have the comparison groups. But you are right, this is the
imperative.
I would like to also----
Mr. Lynch. It's been--I need to reclaim my time----
Dr. Hastings. Sorry.
Mr. Lynch [continuing]. And we have to move on. But, you
know, the recommended mitigation measure was, don't dig, don't
disturb the soil. That was the mitigation that was recommended
onsite.
The other thing is, I understand you say it's going to take
time, but it's been 20 years. It's been 20 years since some of
these veterans served at K2 and acquired these diseases. So,
that's not comforting for a lot of these families. You know, 20
years, that's a long time. We own that, we all own that. But
you understand that we can't allow this situation to continue.
That's why we asked to have someone from the VA, a senior
policymaker from the VA, to testify today in your place.
In fact, I'll now like to enter into the record a November
10 letter from myself, Chairwoman Maloney, Ranking Member
Comer, and Ranking Member Grothman, the gentleman from
Wisconsin, to Secretary Wilkie, making that request, so that we
might have someone who could actually change the policy or
recommend that the policy be changed on behalf of these
veterans and their families.
Mr. Lynch. It should not be this hard for the men and
women, who dutifully raised their right hand in service to our
Nation, to get the healthcare and the disability benefits that
they have earned by their courageous service. And the VA needs
to fix this. It needs to fix this now.
I will now yield to my friend, the ranking member, the
gentleman from Wisconsin, for five minutes, for his questions.
Mr. Grothman.
Mr. Grothman. Thank you.
I guess I'll start with Dr. Smith. You said there were two
type of cancers in which the amount of cancers found exceeded
the population as a whole or exceeded what we found in the
Korean group. Is that right?
Mr. Lynch. Dr. Smith, you might have to click your
microphone on.
Dr. Smith. Yes, sir, that's correct. In the 2015 study,
there were--and this is a study that we did--epidemiologists
would call a hypothesis-generating study, that is, they looked
at many different outcomes, and they found that in
lymphopoietic and hemopoietic cancers, that there was an
increased incidence.
Initially, they also found melanoma, but then when they did
the normalization and the various work done by epidemiologists,
that was no longer considered statistically significant.
Mr. Grothman. What were the numbers on that?
Dr. Smith. I think it was eight.
Mr. Grothman. Eight? I mean, what was the difference
between the Korean group----
Dr. Smith. Oh, I see.
Mr. Grothman [continuing]. And the K2 group?
Dr. Smith. Yes, sir. The relative risk, as I think Chairman
Lynch had said at the beginning, was 5.64. But the confidence
interval is very wide. It ranged from 1.7 to 18 point----
Mr. Grothman. And what does 5.64 mean?
Dr. Smith. That there is a five times increased risk,
potentially.
But the study, as you may have seen, has caveated that
extensively because of the size of it and the numbers, that we
don't know--and that's the reason why it's very important to be
doing the study that we're doing now, because of the size of
the numbers.
Mr. Grothman. Can you nail the numbers for us, like, how
many does that mean, just numbers, like how many people had the
cancer in K2, and how many had it in the control group and----
Dr. Smith. Yes, sir. It was eight in both.
Mr. Grothman. Pardon?
Dr. Smith. It was eight.
Mr. Grothman. Eight people had it in the K2 group?
Dr. Smith. Yes, sir.
Mr. Grothman. And how many people had it in the Korea
group?
Dr. Smith. I believe it was also eight.
Mr. Grothman. Well, was the Korean group a lot smaller or--
--
Dr. Smith. No. It was actually--it was larger.
Mr. Grothman. A lot larger?
Dr. Smith. Yes, sir. Yes, sir.
Mr. Grothman. So--OK. Kind of significant amounts there.
The Stronghold Freedom Foundation, which you're familiar
with, right? I assume.
Dr. Smith. Yes, sir.
Mr. Grothman. Yes. They claim that in 45 veterans, they
found 500 instances of adverse effects of toxic exposure. Are
you familiar with their study or----
Dr. Smith. I have not seen their study, no, sir. But I've
heard the testimonies, et cetera.
Mr. Grothman. OK. Have you looked into where they got those
numbers?
Dr. Smith. That is the purpose of the study, is, we're
looking into, we have characterized those that have been in K2
and are now doing the medical work to try to track those down.
Mr. Grothman. OK. So, do you--I mean, that's a lot of
people. That's like over 10 percent, right, if the numbers are
accurate?
Dr. Smith. We have so far found 15,777 that were deployed
to K2, yes, sir.
Mr. Grothman. OK.
Dr. Smith. And if I could correct myself. I just looked it
up. There were seven lympho---lymphatic neoplasms in the K2
group, and there were six in the comparison group.
Mr. Grothman. OK. But the comparison group had a lot more
people?
Dr. Smith. Yes, sir. Four times as many.
Mr. Grothman. Four times. So, it really comes across then
like about per, whatever, per thousand people or whatever, it
comes across like five times as many in the K2 group, right?
Dr. Smith. That's what the relative risk is, yes, sir.
Mr. Grothman. Right. Isn't that kind of huge? And I realize
it's small numbers, but kind of significant?
Dr. Smith. It--whenever we do these--whenever we do these
studies, it does raise a question, yes, sir.
Mr. Grothman. Is there other type of cancers that went the
other way that can----
Dr. Smith. Yes, sir.
Mr. Grothman. OK. Can you give me an example?
Dr. Smith. I don't have the study in front of me, but in
general, overall, there were not other statistically
significant ones, but there was a--there was a greater number
of cancers in general when you looked across all of them in
this cohort. They're healthier in all the other measures.
Mr. Grothman. So, you're telling me the K2 group was
healthier than the Korea group?
Dr. Smith. As far as other parameters that they looked at.
Mr. Grothman. OK. OK. Now, you were aware, or the military
was apparently aware before these people were deployed there--
well, I'll give you a followup, because you're making a point
that I think you want to make there. Do you have any specific
examples that you can elaborate on showing us where the Korean
group was not?
That's OK.
Dr. Smith. I can take that one----
Mr. Grothman. You can show it to me later.
Dr. Smith. It's in the study, but----
Mr. Grothman. Yes, yes.
Can I give him one more followup question?
Mr. Lynch. Sure.
Mr. Grothman. You apparently knew about the potential
hazards before the troops were deployed there, and I suppose,
you know, action can be taken as where the troops move on the
base or that sort of thing. It appears as though that something
should have been said to the troops about some potential
hazards, and they weren't told about it. Is that accurate?
Dr. Smith. No, sir. As far--I can't speak to the actual
individual, but clearly in the various reports that we have
provided to you, there were documented evidence of townhalls,
of various information brochures that were prepared. It was
made quite clear, as is part of our policy, to make sure that
you communicate the results each time. There were multiple
different assessments done at K2, and each time there would be
an in-brief and an out-brief, questions. All the people that
were interested, and some of them, as you'll see as you read
through the reports, actually were mandatory for all people
that were at K2. There were also information made for both the
deployers and also for the providers.
We also, as you know, do post-deployment health assessments
to be able to make sure that if there are any concerns, that
they're recognized, and that we have those discussions with and
do the evaluations that are required. So, I do not think it's
accurate to say that there wasn't any communication with the
individuals that deployed over.
Mr. Grothman. OK. Thank you.
Mr. Lynch. The gentleman yields back.
The chair now recognizes the full committee chairperson,
the gentlelady from New York, Mrs. Maloney, for five minutes.
Mrs. Maloney. Thank you for holding this important hearing.
I have supported this investigation since day one because it
has so many parallels to the experience of the 9/11 first
responders, where we had to work for years to get them the help
that they needed.
In both cases, brave men and women answered the call to
serve this country, but when they asked for help, they were too
often ignored and not met with any kind of help but only delay
after delay. That's why the initial responses from both
Department of Defense and the Department of Veteran Affairs to
the concerns of K2 veterans and our committee have been so
disappointing.
Last December when the McClatchy news outlet first reported
that K2 veterans were being diagnosed with cancers at alarming
rates, the VA's first response was telling McClatchy, quote,
the premise of your inquiry is false. At the time we knew that
at least 61 K2 veterans had been diagnosed with cancer.
Then in response to the first letter that Chairman Lynch
and I sent to the VA in January, VA Secretary Wilkie responded
by saying, quote, there is no presumption associated with K2,
and currently there is no indication of increased cancers, end
quote.
It wasn't until April, after continued pressure from this
committee, that the VA stated it would conduct a new health
study of K2 veterans. Yet the VA told us once again, quote,
currently there is no indication of increased cancers, end
quote. They said this even while acknowledging reports that
there were up to 360 instances of cancer among K2 veterans.
Today, K2 veterans have self-reported almost 500 instances of
cancer within their community.
So, my question is, Dr. Hastings, why did it take the
involvement of our committee for the VA to begin studying K2 in
earnest?
Dr. Hastings. Ma'am, I am very glad to have the support of
this committee. It's exceedingly important. But I would not
characterize VA as not caring. There was not an indication of
an increased cancer rate when Dr. Wilkie wrote that letter. My
office is exploring this in its totality.
I would like to note that 59 percent of the K2 veterans
have submitted a claim for their service, and in most cases,
the claims are related to those normal things that we see with
people who have worked hard in the military, and that is
musculoskeletal issues. Twenty people have turned in a claim
that is related specifically to K2.
I am right now looking at the statistics with VBA to find
other answers, what are the things that are being put in as
claims. I am very concerned about any environmental exposure
for any veteran, and my office explores these. This study that
is being done will give us----
Mrs. Maloney. Thank you. My time is limited. I apologize,
my time is limited. I have future questions.
But I would say 62 reported, 500 self-reported by veterans,
and no action until this committee got involved demanding
answers. You may have been very concerned, but my question was,
why were you so slow in responding to our requests? Why did you
not act on it before we made our request? And I will put more
questions in writing to you on this instance. I congratulate
the chairman for his constant attention on it.
But also, I want to ask, DOD was also slow to respond to
the committee's concerns. Chairman Lynch and I first asked the
Department to provide all environmental and health assessments
related to K2 on January 13, 2020. By the time we received
declassified versions of these documents in June, markings
showed they had been declassified months before, between
February 14 and February 24. These documents were declassified
before the subcommittee held a hearing with K2 veterans on
February 27. Yet DOD provided classified versions of the
documents to the subcommittee on March 18.
Dr. Smith, if these assessments were declassified in
February and you cared so much about helping the veterans, why
didn't the Department make them public or at least produce them
to the committee right away? So, why did DOD----
Dr. Smith. Ma'am, I can't--I can't answer for the timeline
of getting the products over to you, but I do know that we have
provided the information that we have.
Mrs. Maloney. Well, I am concerned----
Dr. Smith. I apologize for any delays on behalf of the
Department, but I'm glad that you have what you have.
Mrs. Maloney. OK. So, go back and take a look at it. Right
now, just go back and look at it and get back to us why DOD
delayed provided classified assessments to the committee if
they were already declassified in February.
I would say that your actions resulted in months of wasted
time, time that these six veterans cannot get back. The fact
that it took pressure from Congress and dire reports in the
press to get the VA and DOD to even acknowledge, this is deeply
unfortunate and does a disservice to our veterans.
I thank the chairman for his leadership, and I yield back.
Mr. Lynch. Thank you. The gentlelady yields back.
The chairman now recognizes the gentleman from Texas, Mr.
Cloud, for five minutes. You're now recognized.
Mr. Cloud. Could you pass on me for the moment and come
back to me?
Mr. Lynch. I'm sorry. Repeat. You want to pass?
Mr. Cloud. Yes. I believe there's a couple members before
me.
Mr. Lynch. OK. The chairman recognizes the gentleman from
Louisiana, Mr. Higgins, for five minutes.
Mr. Higgins. I thank the chairman. I appreciate this
hearing. I 100 percent agree with your very heartfelt line of
questioning, Mr. Chairman. This is a--this is a very
frustrating sort of category of topic between the veterans and
the VA.
Dr. Hastings, thank you for your own service, ma'am. We
have veteran brothers and sisters across the country that are
watching this very carefully because it's a familiar story. You
know, Agent Orange, burn pits, K2 now we're discussing today.
The three elements for granting presumptive condition is a
current diagnosis of a disease or a condition, an in-service
event, and a link between the in-service event and that
diagnosis.
Dr. Hastings, what would happen, what would be the pushback
if the VA granted presumptive condition diagnosis for K2
veterans that present with conditions that may be associated
with their in-service time at K2? What would be the pushback?
Who would get in trouble for that? Would you please answer that
briefly?
Dr. Hastings. No one would get in trouble as such. When
we----
Mr. Higgins. Thank you.
Dr. Hastings [continuing]. Put a presumption together, we--
--
Mr. Higgins. Thank you. So, in the interest of time, with
all due respect, we're trying to establish veterans' rights to
services here. So, let me just--you just acknowledged that
nobody would get in trouble. If the VA ran out of money, you
come back to Congress. It happens all the time. So----
Dr. Hastings. What I would like to note is----
Mr. Higgins [continuing]. If it was in your power--if it
was in your power, Dr. Hastings, to grant presumptive condition
to K2 veterans, would you do it?
Dr. Hastings. Not at this time, no.
Mr. Higgins. Why not?
Dr. Hastings. I want to have an absolute answer for the
veterans. I want them to know if their service was associated--
--
Mr. Higgins. In the long term--again, in the interest of
time, we understand--listen, by all means, study, seek deeper
scientific understanding, but you're talking about--I have
quotes from your statement, you're committed to find answers,
we're looking at long-term studies, large group studies, the
current findings could be an early signal.
You have veterans that don't have time. They don't have
time for long-term study. I don't understand why the VA would
not just grant presumptive condition to K2 veterans that
present with conditions and diseases that very well may have
been caused by their service exposure to conditions at K2.
None of us argue against--none of us on this committee are
saying don't study. By all means, conduct your long-term
studies, but in the meantime, grant these veterans the
presumptive coverage that they need to address the diseases
that they very likely contracted while in service to our
country at K2.
Please just explain to the committee what--you've already
said there'd be no pushback, nobody would get in trouble. But
these veterans and their families are most certainly in trouble
with the health conditions. So, what--I'll give you my
remaining time. Please respond, because we don't understand, on
this committee, why the VA would not just go ahead, while
you're conducting your long-term studies--knock yourself out
with your long-term studies, we want that, we understand it. In
the meantime, grant these veterans the presumptive coverage
that they need.
And you've stated there'd be no pushback, but that if it
was in your power, you would not do it. We don't understand.
I'll give you my remaining 45 seconds to explain, ma'am. And
again, thank you for your service. We get it that you're
dedicated. We do not understand this lack of providing service
to our veterans, though. I give you the floor, good lady.
Dr. Hastings. Most veterans receive direct service
connection, and as I said, 59 percent of the K2 veterans have
turned in a claim. Twenty of them specifically believe that
they're related to K2 and have put it in that way. So, veterans
are able, and we encourage every veteran to turn in a claim if
they believe military service has negatively impacted them. But
at this point in time, the Secretary, in order to put forward a
presumption, would need to have scientific support, and that is
not there at this time.
We are going to get him an answer. I will get him an
answer. I care very deeply about the K2 situation, but it would
be a disservice to say, put in the presumption, because then
the urgency is just not there to find the answers for these
veterans. So, direct service connection, absolutely put in a
claim. We will look at those. I'm looking at them with VBA
right now, but a presumption is premature.
Mr. Higgins. Thank you, good lady, for participating in
today's hearing.
Mr. Chairman, I yield.
Mr. Lynch. I thank the gentleman. The gentleman yields
back.
The chair now recognizes the gentleman, the ranking member,
the gentleman from Wisconsin, for the purpose of introducing a
unanimous consent request.
Mr. Grothman. Yes. I'd like to--unanimous consent to place
testimony from the February hearing into the record. It's just
a one-sentence thing, so do you mind if I read it?
It's from a master sergeant, Paul Widener, and his
testimony was just contradictory to what you guys gave us. K2
members were told repeatedly that no significant risk from
hazards existed, there were no briefings on toxic exposures, no
protective equipment recommended, issued, or employed.
Thank you.
Mr. Lynch. Without objection, the unanimous consent request
is granted, and the document is entered into evidence.
Mr. Lynch. The chair now recognizes the gentlelady from
Illinois, Ms. Kelly, for five minutes.
Ms. Kelly. Thank you, Mr. Chair.
Due to the work of this subcommittee, we now have new
evidence about the conditions that U.S. servicemembers lived
and worked in when they deployed to Camp Stronghold Freedom
between 2001 and 2005.
In July, our committee released hundreds of pages of
previously classified K2 health and environmental assessments.
These reports, which the U.S. military produced in 2001, 2002,
and 2004, detail multiple toxic hazards that servicemembers
were exposed to at K2. For example, according to one assessment
during subsurface soil testing in 2001--and I quote--elevated
levels of volatile organic compounds and total petroleum
hydrocarbons were detected at numerous locations throughout
Stronghold Freedom.
A June 2002 operational health risk assessment estimated--
and I quote--between 50 percent and 75 percent of personnel at
Stronghold Freedom will be exposed to elevated levels of
compounds in the air.
And a September 2004 health assessment described the
probability of exposure to particulate matter as, quote,
frequent.
Mr. Chairman, I request unanimous consent to enter into the
record an Environmental Protection Agency web page titled,
Health and Environmental Effects of Particulate Matter, which
reads: Small particles less than 10 micrometers in diameter
pose the greatest health problems, because they can get deep
into your lungs, and some may even get into your bloodstream.
Mr. Chairman, I request unanimous consent to enter into the
record a fact sheet from the Agency for Toxic Substances and
Disease Registry website which reads: Studies in humans suggest
that exposure might lead to a higher risk of getting bladder
cancer, multiple myeloma, or non-Hodgkin's lymphoma.
Dr. Hastings, in your opening statement, you testified that
the VA is conducting an epidemiological study to better
understand the health outcomes for K2 veterans. What conclusion
or conclusions would need to be derived from this study that
would lead the VA to make a presumptive service connection for
K2 veterans?
Dr. Hastings. The study will look at cancer specifically,
but it will also look at other conditions. It will look at
circulatory, neurologic. It will look at the mortality rates.
So, it is a comprehensive look.
And I absolutely agree with you and with the ATSDR, who we
work with in my office very closely, that particulate matter is
problematic, as are the other exposures that are there, and we
are looking at all of those.
Ms. Kelly. And what can Congress do to better help these
veterans and prevent this from ever happening again?
Dr. Hastings. I think DOD is very cognizant of the
protections that they need to employ to take care of people
before they ever get to VA. That's No. 1. When I deployed, I
came back, I had to do the post-deployment health assessments
just like every soldier, even though I'm a physician.
At the VA, we are getting answers. I know that people use
Agent Orange as the issue that was delayed. We learned a lot of
things from that. We learned from Agent Orange. We began
embarking on looking at this when it was brought out in
McClatchy. We started working immediately with the Deployment
Health Working Group and our colleagues at DOD to get the
adjudicated list of the veterans to make sure that we had all
of the assessments. And we are working hand-in-hand with this.
The support that you can give us is exactly like this, to
bring this to the attention of the veterans. I will note that
whenever we have an airborne hazards discussion with Congress,
our numbers in the airborne hazards registry go up. And only
about 17 percent of the people at Karshi-Khanabad have entered
the registry. I know that there are some, because Uzbekistan is
not listed as one of the registry countries, but 80 percent of
the people at Karshi-Khanabad are eligible for the registry.
And that is another way that we can look at their deployments
and their health history.
Ms. Kelly. Thank you.
Dr. Hastings. So, the support you give us is important. You
support us also with the deployment with the Depleted Uranium
Center in Baltimore, and that has been extremely helpful with
looking at K2.
Ms. Kelly. OK. The hazards at K2 created an environment
that put the heroes of Camp Stronghold Freedom at significant
risk, including for cancer and other respiratory and
neurological conditions. Based on what we already know about
the hazards found at K2, I'm not sure what additional evidence
that the VA could possibly need to conclude that the illnesses
reported by K2 veterans are service connected.
And I yield back.
Mr. Lynch. The gentlelady yields back.
I do want to rule that the gentlelady from Illinois'
request, unanimous consent request, is granted without
objection, and the committee will receive those documents as
evidence. Thank you.
Mr. Lynch. I now like to recognize my friend from
Tennessee, the gentleman, Mr. Green is also a K2 veteran, and
he is now recognized for five minutes.
Mr. Green. Thank you, Chairman Lynch and Ranking Member
Grothman, for holding this hearing. And I want to thank our
witnesses for testifying today.
Chairman Lynch, I especially am grateful for you and for
all the time and effort that you've put in to getting to the
bottom of this. With 16,000 K2 veterans out there, we
appreciate your effort and are closer today to some answers
because of you.
I think everybody on the committee knows that I flew
through K2 as a night stalker. It is deeply unsettling that two
decades later, others who were there are now battling cancer
with no answer about a service connection. The DOD and the VA
really should know by now.
As a doctor who had to do substantial research while
earning my medical degree, I'm fully aware of the need for
these studies to be thorough and scientific, but if we can
create two ground breaking messenger RNA coronavirus vaccines
in less than a year, we can certainly study health effects on
K2 troops from thoroughly researched toxins that we know the
effects of and have known the effects of for many, many years.
I don't want to point the finger at our witnesses here
today. I know this was a problem long before they got to the
jobs, but these veterans need help and they need it now. The VA
motto is to care for him who shall have borne the battle. We're
grateful for all the steps you're taking and are counting on
you guys to ensure these men and women are treated fairly. We
cannot leave them, my brothers and sisters, our brothers and
sisters, as Dr. Hastings has said she served as well, behind.
My first question revolves around some recently published
information. CBS did a special, Catherine Herridge interviewed
senior intelligence community member Mike Lechlitner. He was
there at the time and conducted the assessments of K2.
In your written testimonies, you mentioned that radiation
was possibly not all that high, but Mr. Lechlitner claims quite
differently saying that he saw readings of seven to nine times
higher than normal. He even determined that there was
yellowcake present, which neither written testimonies mention.
He was even handed a bag of it, he said in his comments to CBS.
He also notes that there was arsenic and cyanide, which, again,
neither testimony mentions.
I'd just like a, you know, yes or no from either of you,
was there yellowcake at K2?
Dr. Smith. This is Dr. Dave Smith. The answer is, we did
not find any evidence of yellowcake. Initially, on the first
survey that was done, it was indicated that it was uranium
material. On further analysis--as you know, some of those
things can't be determined in the field, but on further
analysis, it was determined that it was oxidizing depleted
uranium. So, no, there was not yellowcake. It is certainly
possible that he was in the first tranche of surveyors and then
did not hear about the subsequent results. Over.
Mr. Green. Dr. Hastings?
Mr. Lynch. Just a clarification. When we're talking about
yellowcake, we're talking about unprocessed uranium or lower
level process uranium, is that what we're talking about?
Dr. Smith. We're talking about depleted uranium. Yellowcake
is actually enriched or--it's an old term that was basically
would be part of where you're trying to enhance the
characteristics of uranium. Over.
Mr. Green. It's a--yes. It's a precursor to a weapon,
right?
Dr. Smith. That's right.
Mr. Green. Dr. Hastings, your awareness of any yellowcake
at the site?
Dr. Hastings. Again, in looking at the information that was
there, there was uranium. The supposition was it was
yellowcake, but it was not. It was rusting or oxidizing
depleted uranium. So, yellowcake was not there.
Mr. Green. Thank you for sharing that.
Dr. Hastings, in your written statement, you encourage
veterans to receive the DU urine testing. And I'm not
suggesting that this is your fault, but I have a document from
the VA from one of my constituents who actually went to the VA.
And in reading over the document from the VA on explaining what
happened at K2 and the potential risks that those veterans were
exposed to, it seems to me--and I can get you a copy of it--it
seems to me to sort of downplay the need for these veterans to
get the DU urine test.
I'd like to know from you that there's a commitment that
every veteran who asks for that test gets that test.
Dr. Hastings. Yes. When a veteran asks for that test, we
have a Depleted Uranium Center that the test is done by the
Joint Pathology Center or done by the CDC. Veterans can come in
and get that test. As I said, the 6,500 that we have done for
people that were exposed in Gulf war and the 37, of which 25
have been completed, all have been negative except for five
from the first Gulf war and that was related to shrapnel. And
they were negative, so I believe that most of them----
Mr. Green. I understand your sample--I understand that your
sample size is such that it is, but in the document that I saw,
it seemed to discourage--it seemed to tell the VA staff how to
discourage veterans from requesting the test. I just want to
make sure
[inaudible].
Dr. Hastings. I would like to see that because I would not
discourage it. I would like to see it. I would not discourage
it. In fact, we encourage it because peace of mind is
important.
Mr. Green. Thank you.
Thank you, Mr. Chairman. I yield.
Mr. Lynch. The gentleman yields back, and I thank him for
his questioning and for his service.
The chair now recognizes the gentlelady from Virginia, who
is also the chair of the VA subcommittee on disability
assistance, and she as well is a United States Navy veteran.
Mrs. Luria, you're now recognized for five minutes.
Mrs. Luria. Thank you, Chairman Lynch. And thank you to the
Oversight Committee and the subcommittee for allowing me to
participate today.
As the chair of the Disability Assistance and Memorial
Affairs Subcommittee on Veterans' Affairs and also a member on
Armed Services of the Military Personnel Subcommittee, I'm very
interested in this issue. I'm glad that we have the opportunity
to speak to our witnesses today.
I would like to request unanimous consent to enter in the
record two letters, one that I have recently written and
received a response from Secretary Wilkie at the VA, and
another to former Secretary Esper at Armed Services, with their
enclosures as well, providing responses on this issue.
Mr. Lynch. Without objection, so ordered.
Mrs. Luria. And I'd like to start with addressing an issue
of trust. I think that in even just the responses to these
letters and coupling that with the testimony we've received
today, there is an enormous amount of conflicting information.
And being familiar with the other issues of toxic exposure that
we're dealing with in the Veterans' Affairs Committee, having
recently provided healthcare to additional veterans, Blue Water
Navy veterans for their exposure to Agent Orange, extensively
investigating the issues surrounding burn pits, as well as this
K2 issue, it seems that there is information provided to
veterans that does not instill their trust in the system, both
within DOD healthcare and within the VA. And I'd like to cite
several things here, and these were provided to me by Secretary
Esper's response.
One of those is specifically concerning advice provided to
healthcare providers addressing the concerns of K2 veterans.
And although this is an undated document, it's assessed in the
remarks here that it was approximately dating from around 2001
or 2002. What can I do to build trust and rapport? So, this is
the provider to the patient who's concerned about exposure at
K2.
And in this Army document it says: Summary of key messages.
The most important messages to communicate are, one, there were
no K2 exposures of health consequence; the protective risk
control measures were effective; and show care and commitment
during clinical care; ongoing monitoring ensures continued
protection.
So basically, they told the veterans, don't be worried
about it.
And then I found this other document as one of the
enclosures from the Army Public Health Center and it says: You
do not need to get a medical examination or have any additional
medical screenings just because you were at K2.
So, for our veterans who are watching today who have
concern about this, this information that they provided is
directly in conflict to what you've been discussing today.
And then, Dr. Hastings, specifically, you said that there
was no evidence when Secretary Wilkie responded to the letter
of inquiry from the Oversight Committee; however, I have here
in what I was provided by Secretary Esper, a July 2015 Army
Medical Department Journal, which specifically states that this
is an important topic which is worthy of public health efforts
and resources. It gives the same statistical data that has been
given about the two types of cancer with increased incidence
and the same statistical data in a chart here that we've
discussed today, and that dates to 2015. So, I don't understand
your response there.
And I would like to shift further to the fact that, Dr.
Hastings, in your testimony today, your written testimony
doesn't discuss water. There's been environmental samplings for
airborne particulates, for soil quality, but you don't address
water in here at all. And then when I revert back to a document
that I was also provided by the Department of Defense, the
Periodic Occupational Environmental Monitoring System, from
2001 to 2005 at K2, it does address water. But in that it
specifically says both the short-term and long-term health
risks, they talk about the sampling that was done. It actually
contradicts itself because it says no samples were taken from
water that was purified by reverse osmosis units and the
concern and contaminants in that were not evaluated. However,
in the next paragraph, it says that they did receive samples
from that.
Long story short--and you can review this. It'll be entered
in the record.--it says the confidence in these risk estimates
about water, both short and long-term health risks are low.
So, in my remaining time, can you address why you did not
address anything related to water? Because we're talking about
fuel contamination in the soil, depleted uranium in the soil.
And I'm not an environmental scientist or a doctor, but my
understanding is that if we're using a source of groundwater,
that these things leech into groundwater, and they should be
very closely scrutinized as far as the water that people were
both using for non-potable water sources, i.e., bathing,
cooking, cleaning, as well as water that was being purified by
reverse osmosis units because that process is, you know, less
effective at removing contaminants than, say, a distilling unit
process, and what water samples were taken and what further
analysis is needed on the water that people were consuming
while they were stationed at K2?
Dr. Hastings. Chair Luria, I'd like to take that for the
record and get you a complete answer. The water that was--is
used in deployment, as you know from being military, is very
important, and in many cases, it is bottled water, but I need
to investigate that to get you a complete answer.
Mrs. Luria. OK. Well, this--just to say that this
references reverse osmosis units that were being used for the
potable water, so I would be interested in seeing your followup
testimony on that.
Dr. Hastings. Absolutely. I'll take that for record. Thank
you.
Mrs. Luria. OK.
Dr. Smith. If I can add, there were multiple reports of the
water testing and the various technical reports that actually
did test both the potable water and some of the bottled water.
And all of them said that it was--there were no concerns
related to potable water, but we'll provide you additional
information on that.
Mrs. Luria. Well, thank you. I would be interested in that.
Because, again, I'll quote what the study says, is the
confident in the risk estimates about potable water are low,
and this is a final study reviewed by CENTCOM and then approved
in May 2011 conducted by the U.S. Army. So, I would appreciate
any followup additional studies that have been conducted.
And thank you, again, to the chair for allowing me to
participate. And I yield back.
Mr. Lynch. The gentlelady yields back.
As well, I'd point out in the Stronghold Freedom Foundation
report that was provided to the committee, there were 345
claims of urological disorders, as well as 397 cases of
neurological disorders among K2 veterans. So, that might also
support the questions and emphasis that the gentlelady from
Virginia has put on some of these reports.
And, you know, I do want to amplify that some of these on-
the-ground reports and assessments were given a low level of
confidence in terms of the threat that was present on the
ground.
So, with that, I would like to recognize the gentlelady
from North Carolina, Ms. Foxx, for five minutes.
Ms. Foxx. Thank you, Mr. Chairman.
My first question's for Dr. Hastings. Has the VA determined
whether long-term health problems in K2 veterans arise after
having served on the K2 base?
Dr. Hastings. That is one of the things that this study
will address. At this point in time, the veterans, if they
believe that the military service has negatively impacted their
health, that they proceed with a claim for direct service
connection. At this time, without the study, we cannot say that
there is an association.
As you know, many of these veterans deployed to many other
locations also and thus the reason we have the other two
cohorts, one that was deployed to OEF but not to K2, and the
other that is an OEF error but not deployed to either K2 or
OEF. That's what will give us the answers.
Ms. Foxx. Dr. Hastings, I'm over to your left. I'm right up
on the dais.
Dr. Hastings. Oh, I'm sorry.
Ms. Foxx. Over here.
Dr. Hastings. There you are.
Ms. Foxx. OK. Is there scientific evidence that
demonstrates that K2 veterans are not suffering these health
effects as a result of their service on the K2 base?
Dr. Hastings. No. And that's the reason we need the study.
Ms. Foxx. Are there any other viable explanations for the
large number of toxic exposure in servicemembers who spent time
at K2?
Dr. Hastings. Yes. Veterans are exposed to many things
during their service. And as I've noted a couple times before,
59 percent of the K2 veterans have turned in a claim. The
majority of those claims are for musculoskeletal issues. I am
specifically looking at those issues that are of concern to
this committee, and the study will give us many of those
answers.
Ms. Foxx. Dr. Smith, is it true that a 2001 health
assessment found that ambient air in K2 was the main concern
for environmental contaminants and found elevated levels of
volatile organic compounds in petroleum hydrocarbons throughout
the base?
Dr. Smith. No, ma'am. The 2001 survey did find elevated
volatile organic compounds in subsurface in wind in the
digging, and there clearly early on was an incident with Uzbeki
contractors where they were digging to create the berm where
they ran into one of the underground plumes. And certainly
folks had acute health effects at that time that were the
contractors.
That prompted a fair amount of additional survey. There
clearly are volatile organic compounds that were found. None of
them exceeded the exposure levels, that I'm aware of, in the
surveys that were done in 2001, 2002, and 2004. So----
Ms. Foxx. Well, to followup on that, is it true that a 2002
health assessment found that between 50 and 75 percent of
personnel at the K2 base would be exposed to elevated levels of
toxic contaminants?
Dr. Smith. I believe the 50 to 75 percent was related to
the fact that there was an issue, which we find throughout
southwest Asia, of particulate matter in the air, so dust. And
certainly that is a risk in that part of the world, and it
clearly does exceed what we consider to be exposure limits that
we would set in the United States, but it's a reality of those
deployments. Yes, ma'am.
Ms. Foxx. So, what does Congress need to do to ensure that
all eligible servicemembers and veterans receive the health
benefits they're entitled to?
Dr. Smith. Well, clearly that's not in the DOD's lane as
far as ultimately determining that unless they happen to be a
retiree. I will say, relative to the particulate matter, this
has been a concern for a while and we have a number of studies
that have been looking at that. To date, it's primarily
respiratory related and for individuals who had a
predisposition because of their makeup. But the STAMPEDE
Studies and others have looked at this quite carefully and we
continue to study that issue.
Ms. Foxx. Thank you, Mr. Chairman. I yield back.
Mr. Lynch. The gentlelady yields back.
The chair now recognizes the gentleman from Arizona, Mr.
Gosar. You're recognized for five minutes.
The chair now recognizes the gentleman from Texas, Mr.
Cloud, for five minutes.
I know we have--there he is. OK.
Mr. Cloud. Hello, hello, hello. Can you hear me?
Mr. Lynch. We certainly can. Yes, please proceed. Thank
you.
Mr. Cloud. Well, thank you, Chairman, for hosting this
hearing on this extremely important topic. Thank you,
witnesses, for being here, for your service as well.
This, of course, is an extremely important topic to all of
us because we care about the men and women who served to
protect our country. Of course, the grave concern is, you know,
while we want these decisions to be science based and all is
the concern of, if the science takes so long to develop to get
the case, that it's a moot point of not being able to help
those. We've seen that happen, tragically, in the past.
So, Dr. Hastings, could you speak to the process of how you
come to these conclusions? When do you get to the tipping
point, so to speak, of when you--when you're able to balance
the, OK, we have the information we need to make a decision
here as opposed to continuing to get the science so exact that
it can't help anybody because it takes so long? I mean, we're
talking a couple decades now. And how long does it take for
these symptoms to present? Can you speak to that, please?
Dr. Hastings. First, I'll answer how long does it take for
the symptoms to present. In some cases with toxic exposures, it
can be in minutes, but with some of the cancers and the things
we're looking at, there can be a latency period, as you know.
With regards to studies, the model that is used by the
National Academy of Science, Engineering, and Medicine looks at
five levels. There is a level from causation all the way down
to no evidence of an association. In most cases, causation is
pretty hard to get to, and we don't look for causation. That's
a very high bar. And, in fact, the National Academy of Science,
Engineering, and Medicine has only used causation for exposure
once and that was in Gulf War and Health, Volume 2, looking at
fuels with regards to benzene and leukemias.
In most cases, for example, the Agent Orange presumptions,
most of those are evidence of an association or possibility of
an association. So, we really are looking at associations, and
I don't think with this we would get to causation. If we did,
that would be surprising. So, we are looking at associations.
Mr. Cloud. OK. I know in my district, one of the issues
that has come up repeatedly that isn't exactly the same but
related is the issue of burn pits and the families that have
been affected by exposure. And in this case, we have a registry
that, while the research has been ongoing, there's been a
registry where people can register.
Could you talk to what you all have done in the way of
making sure that veterans have a way to--I know a number of
them have state claims already, but what are you doing
proactively to connect with veterans to inform veterans of
their potential exposure?
Dr. Hastings. Well, we do a lot of outreach. We have the
website that we use. We send letters, and many times with
regards to airborne hazards and open burn pits, specifically,
we work with DOD. DOD sends out electronic as well as hard copy
letter notices to anyone that may be eligible for the burn pit
registry to encourage them while they're on Active Duty if they
have been in the area that is eligible for the burn pit
registry to make sure that they do apply.
We do the same thing in the VA. We send out letters. We
encourage people to apply. One of the things that you did here
in Congress for us last year was you gave us some funding to do
more outreach. And at this point in time, we are working with
the funding that you gave us to put together a comprehensive
plan to do more outreach to veterans, and this would be through
podcast radio spots as well as some changes to the website.
Mr. Cloud. OK. You mentioned that 59 percent of the claims
at the site were musculoskeletal. Do you have a breakdown of
the----
Dr. Hastings. No. I'm sorry. Fifty-nine percent of K2
veterans have submitted a claim and the majority of those are
musculoskeletal, but I would need to take for the record any
further breakdown.
Mr. Cloud. OK. Yes, if we could get that information, that
would be nice. Thank you.
Thank you, Chairman.
Dr. Hastings. Certainly.
Mr. Lynch. The gentleman yields back. We thank the
gentleman.
The chair now recognizes the gentlelady from California,
Ms. Speier, who is the chair of the House Armed Services
Committee's Subcommittee on Military Personnel, and someone who
has done a lot of work and is keenly interested in the health
and care and protection of our veterans as well as our active
military.
So, Ms. Speier, you're now recognized for five minutes.
I'm not sure if you are muted.
OK. We see you.
Ms. Speier, you're now recognized.
We might have a technical issue here.
Apparently, Ms. Speier's audio is not working.
OK. While we're waiting to solve that technical issue, I
would like to do a followup question.
As I recall, the VA announced that it would conduct a new
epidemiological study to assess the health outcomes of
veterans. And, Dr. Hastings, you in your opening statement
testified that this new study will take between 12 and 18
months to complete. But I do want to note that it's already
been almost seven months since the VA first told the
subcommittee it planned to conduct the study.
So, does it still need 12 to 18 months or are you baking in
the six months that we've already--or seven months that we've
already engaged?
Dr. Hastings. I'm baking in the seven months; however, I
will tell you that we are doing it with a very small staff at
this point in time. We are working with DOD. So, at this point
in time, I would say that by next--let's see. By next December
is when I'm hoping that we would be able to give you at least a
preliminary report on our findings, if not completion.
Mr. Lynch. OK. Has the actual study started yet?
Dr. Hastings. Yes.
Mr. Lynch. So, beyond design?
Dr. Hastings. It's beyond design. We have made the cohort
selections.
Mr. Lynch. OK. I do recognize--I welcome the additional
research that, you know, if we can lead to faster diagnoses or
improvement of treatment options for our veterans, but I'm just
very concerned that we might reach a point where we have a
study that gives us inconclusive results again, while we still
have these veterans suffering and without their rightful
benefits.
You did refer a number of times to the VA study as being
prospective, a prospective epidemiological study. What do we
mean by that?
Dr. Hastings. This is not going to be a one and done. This
is going to be a study that has started now looking at the
complete group, but it will go into the future. That is very
important with some of the diseases that we see that are of
concern.
Mr. Lynch. OK. Dr. Smith, you noted that DOD has provided
the VA with a--and this is a quote--a complete list of
individuals who deployed to K2, as well as other background
material and environmental assessments.
With the exception of the roster, because I understand
you've already provided high level numbers of, you know,
privacy considerations, do the background materials and
environmental assessments that you mentioned include additional
documents or information beyond what DOD has already provided
to the subcommittee?
Of course, the universe we're talking about here.
Dr. Smith. Yes, sir. I'm not aware of additional documents
that you haven't received, but I'll look back to my subject
matter expert and ask. So, that's what they've received along
with--and we're working hand and glove with them to try to make
sure--because they will also have all of the health records and
the information that we have, post-appointment health surveys,
et cetera, to help, you know, fill out the study to make sure
all the information that's available is available to them.
Mr. Lynch. That's helpful. We appreciate that, Doctor.
I'm not sure if we have Ms. Speier back online, again. I
would like to welcome her, again. Ms. Speier is the chair of
the House Armed Service Committee, Subcommittee on Military
Personnel, and a great partner of ours on this subcommittee and
someone who is, as I say, keenly interested in the health,
welfare, and protection of our troops, our active military, and
our veterans.
So, with that, I'd like to yield five minutes to Ms.
Speier.
Ms. Speier. Thank you, Mr. Chairman. I truly value our
working relationship and appreciated all that you did on our
recent codel to Fort Hood.
I apologize to our witnesses because, as you know, we're
having a caucus election contemporaneously. So, if this
question has been asked, forgive me.
But to you, Dr. Smith, you stated in your testimony that
remediation measures such as, and I quote, covering
contaminated areas with clean soil and declaring them, quote,
off limits were taken to reduce the risk of these hazards.
But in testimony before this subcommittee and in press
accounts, veterans deployed to K2 stated that contaminated soil
was used to build a berm around K2, used to fill sandbags, and
that constant floods dispersed this soil around the base.
One veteran who first deployed to K2 in 2001 testified
that, quote, the DOD did not mitigate any risks within the work
and living areas of K2, closed quote. So, given the health
conditions reported by K2 veterans, would you agree that it's
possible the Army's mitigation measures were not as effective
at preventing toxic exposures?
Dr. Smith. Thank you for the question. I have to rely on
the evidence that we have, and I do not have any evidence to
say that they did not do it. Now, within the first couple of
weeks of deployment, this is when a number of these things were
uncovered. So, clearly, the remediation did not get completed
until a number of weeks to--and I can't give you a timeline,
but certainly the follow-on technical reports, et cetera, have
validated that the recommendations that they made had been
implemented.
Each time you do one of these surveys, you may find
additional or--additional items that need further remediation,
but I do not have any evidence to suggest that they were not
done. Over.
Ms. Speier. So, if you were given additional evidence,
would you then review it and incorporate it in your study?
Dr. Smith. Yes, ma'am. Absolutely.
Ms. Speier. So, the study is going to be--forgive me. I did
come late. The study is going to be completed within 180 days
or not?
Dr. Smith. I'll defer to Dr. Hastings, but--no, ma'am, I do
not believe it'll be done in 180 days, because we want it to be
thorough and scientifically rigorous, and I do not think that
that is realistic. Over.
Ms. Speier. So, have you given the committee an idea as to
how long it will take?
Dr. Smith. Yes, ma'am. In my testimony, I was suggesting
that it will be somewhere between 12 to 18 months. I would
expect certainly by 2022. Over.
Ms. Speier. All right. Dr. Hastings and Dr. Smith, what
more can DOD and VA do to expedite the healthcare for these K2
veterans whose conditions might be related to their military
service at K2, especially during the 12 to 18 months that you
anticipate the study will take?
Dr. Hastings. Ma'am, in many cases, veterans have access to
VA-delivered healthcare. They are able to come to the VA, to
register for healthcare. If they have not, if they have a
service-connected illness, they also--if they got out of the
military within five years, are eligible to come to the VA. And
if they have transited through a combat area, they certainly
are eligible under the combat eligibility listing.
And, again, any military service that may have negatively
impacted their health, we encourage them to put in a claim, and
59 percent of the K2 veterans have done that so far.
Ms. Speier. And you've been in communication with the other
K2 veterans about the potential risk that they may have
experienced?
Dr. Hastings. We have been in contact with some K2 veterans
who have contacted my office. We do have a website. We have
that available for them to look at. We do have depleted uranium
website also, and they are able to get tested for depleted
uranium. You may have missed this, but we have had 25 K2 urine
assays done for the isotopic signature of the depleted uranium.
All of those have been negative. We have 12 more that are
waiting to be completed, either at the Joint Pathology Center
or at the CDC.
This is a test that takes an analytical chemist, a Ph.D.,
with very fine instrumentation. We have done 6,500 of those for
people involved in the Gulf war. All but five of those were
negative, and those people had shrapnel injury.
We do have 84 other veterans that had shrapnel injury from
the Gulf war that we bring back every two years to look at and
examine, and they are doing well. They have no excess
morbidity/mortality in that group over what you would expect.
Ms. Speier. Thank you, Dr. Hastings. My time's expired.
Mr. Chairman, I would certainly recommend that if they've
already identified that some 60 percent of the veterans from K2
have been identified and have come forward, it would make sense
that we should communicate with the remaining 40 percent of
veterans who had been assigned to K2 to alert them to potential
risks that they may have been subjected to. And maybe we can do
that through an NDAA or a VA bill, but it's certainly something
that should take place, I think, so that they're all aware.
Going to a website, I think, is expecting a lot when people are
trying to survive today.
Thank you. I yield back.
Mr. Lynch. I thank the gentlelady, and her point is well
received. In questioning from the gentlelady from Virginia,
Mrs. Luria, we did have records of letters from physicians who
indicated that notification to the 40 percent, so to speak, was
not given; that they were not advised that they should be alert
to the possibility of medical conditions arising from their
service at K2.
So, I agree with the chairwoman of the House Armed Services
Committee on Military Personnel that we should make that
notification official and we should try to expedite it in the
next available legislative vehicle. So, I welcome her
participation in that and happy to work with her.
I am told that we have Mr. Gosar back online. So, I'd like
to recognize the gentleman from Arizona for five minutes.
Mr. Gosar. Thank you, Mr. Chairman. And sorry we had a
failure with the audio, but thank you for calling this hearing.
And being so close to Veterans Day, I want to thank all our
veterans for their service. And maybe looking at this in a
little different light. You know, trust is a series of promises
kept. And I think that's what we have to start by looking at
this analogy is making sure that we're actually engaging the
veterans. So----
Now, between the fall of 2001 where troops are first
deployed to Afghanistan and 2005 when Uzbekistan withdrew
permission to the use of the base, it is estimated that
approximately 10,000 individuals served at K2. But there are
now concerns that this number may not be accurate, as it may
not include those troops which served at K2 on a temporary
assignment or may not identify troops who were there on
classified assignment.
Dr. Smith, does the DOD have an accurate accounting of how
many U.S. troops served at the K2 base while it was in
operation during the earlier, the war in Afghanistan?
Dr. Smith. Sir, we continue to comb and look, as I
mentioned in my testimony. Through a DMDC run, we have added to
the number. We're now at 15,777, and it's what we have in our
records to date, but we're doing due diligence and continually
looking for other sources to be able to make sure that we do
have the most complete list for the study. Over.
Mr. Gosar. So, you basically tried to outreach to them, I
mean, to make sure that they know that they have a possible
exposure?
Dr. Smith. Sir, I'm not aware of specific outreach
specifically to K2. We do, as you're probably aware, do post-
deployment assessments for all of our returning servicemembers
and also clearly advertise that we're available to discuss if
they have any concerns associated with their deployments at any
time. Over.
Mr. Gosar. Well, I think that we ought to go even further.
I think the gentlelady from California kind of started bringing
this up, is instead of depending upon the veteran, it would be
very nice for us to engage. You know, we have the records on
our side, so shouldn't we as active DOD and Veterans' Affairs
be reaching out as well?
Dr. Hastings. Hi. This is Pat Hastings. I actually do have
a letter here which we had planned on sending out in July;
however, because of COVID, we have not sent it out. And it was
advising them about where they could go to look for additional
information. It spoke about the possibility of a depleted
uranium test.
So, I have the letter. I'm happy to share it. Because of
COVID it was not felt to be wise to send it out at this time
because the danger of COVID, specifically for a urine test,
would be problematic. But we certainly could send it out and
just ask them to wait until it is a safer environment and give
them the information in regards to the website that they could
get information from.
Mr. Gosar. So, now, is there any way or a system that
exists to identify these individuals like in states and
districts? You know, like, I'm from Arizona, so we have a big
veteran population. Is there a way that we could utilize the
state numbers break down so that we may have an additional way
of contact and maybe get, you know, ahead of the game instead
of always trying to catch our tail?
Dr. Hastings. I do not know if we would be able to get down
to the district level. I can look at that and take that for
record.
Mr. Gosar. Yes. We're an asset. Every member here has a
constituency of the veterans, and I just think that it's a, you
know, building that trust that is so in need.
But, you know, I thank everybody for coming, Mr. Chairman,
very timely on the call for this hearing, and I think we need
to keep our foot on the gas pedal to make sure that we're
honoring our promises to make sure our veterans are healthy,
wealthy, and wise.
Thank you, Mr. Chairman.
Mr. Lynch. I thank the gentleman.
Let me just ask as a followup to Mr. Gosar's inquiry. How
is the VA contacting veterans regarding their study? How is
that facilitated?
Dr. Hastings. We have the complete list and we are able to
look at various data bases. One would be the mortality data
bank that comes from the national data banks for mortality. We
have cancer registries, et cetera. We actually do not need to
contact the veterans specifically. We can look at their medical
records. We can look at the different data bases nationally to
look at their health conditions.
Mr. Lynch. But when we look at the numbers that have self-
reported versus the ones that you've diagnosed; this is a much
larger number that has self-reported.
Dr. Hastings. In studies like this, self-report often is--
we would have to investigate those further, because self-report
may not be accurate.
Mr. Lynch. How would you know? If you miss--if you're not
communicating with these veterans and they're not self-
reporting, then they're not----
Dr. Hastings. Right. This is based----
Mr. Lynch. They don't exist. So, what I'm saying is that if
you got a veteran out there that's having medical problems and
they know that there's a study going on at the VA regarding
people that have served where they have served and that there's
issues there, that would be helpful that they know about this.
Dr. Hastings. We want them to get the medical care that is
required, whether from the VA or their own physician, but we
really are not looking at the care and treatment. We are
looking at the conditions, and so we would not need to have the
veterans sending us medical records and that sort of thing. We
are looking at health outcomes.
Mr. Lynch. I'm just trying to make them aware of the study.
Dr. Hastings. Absolutely. And in this letter, which I'm
happy to share, it does----
Mr. Lynch. The one we haven't sent out yet?
Dr. Hastings. I have not sent it out, but it does----
Mr. Lynch. OK. So, we know because of COVID that all these
appointments are being stretched out because we can't process
them like we would, you know, under normal circumstances and,
you know, that's understandable. However, some things can be
done through telehealth methods. I know they're doing some of
that at the VA where the servicemember's not coming in for
treatment, but there's telehealth appointments being made so
they can get information back and forth.
So, I would encourage you with all dispatch to get that
letter out, and we'll just have to deal with the backlog of
cases in terms of appointments, but it's good to get them on
the books, even if we can't conduct them in the short term, we
at least plan to, and get this ball rolling and get more people
informed of what's going on.
Dr. Hastings. I will make the commitment to get the letter
out and I will--the telehealth doesn't work really well when
you're asking them to bring in a urine specimen. So, I will
change the verbiage for that and ask them to wait on that
portion until after it is a safer environment. But I will make
the commitment to send the letter that lets them know there is
a study that is going on and lets them know where they can get
additional information.
Mr. Lynch. Great. Great. Thank you.
Let's see. Do we have an idea, once the study is completed,
how long between the completion of the study and a decision on
presumption or no presumption?
Dr. Hastings. I would hesitate to speak for the Secretary,
but if the Secretary has strong science, the Secretary is able
to make those determinations.
Mr. Lynch. OK. So, we're not quite clear on that. All
right.
I believe that concludes the number of members who were
desiring to testify and to question.
Let me--in closing, I just want to thank all the members. I
realize there are several hearings going on; there's a caucus
going on. There are a lot of other things going on, but I'm
very pleased with the number of members who took the time to
participate in this hearing. I want to thank the Ranking
Member, Mr. Grothman from Wisconsin, for his leadership as
well.
I want to thank our panelists, Dr. Hastings and Dr. Smith.
Thank you for your service to your country and for your
willingness to come before the committee and help us with our
work. This was a very important conversation and a very
important process.
With that and, without objection, all members will have
five legislative days within which to submit additional written
questions for the witnesses to the chair which will then be
forwarded to the witnesses. And we just ask our witnesses to
please respond as promptly as you are able.
And this hearing is now adjourned.
[Whereupon, at 11:53 p.m., the subcommittee was adjourned.]