LETTER OF TRANSMITTAL

HOUSE OF REPRESENTATIVES,

Washington, DC, November 7, 1997.

Hon. NEWT GINGRICH,
Speaker of the House of Representatives,
Washington, DC.

DEAR MR. SPEAKER: By direction of the Committee on Government Reform and Oversight, I submit herewith the committee's second report to the 105th Congress. The committee's report is based on a study conducted by its Subcommittee on Human Resources.

DAN BURTON,
Chairman.

CONTENTS

1. Summary
   1. Findings in brief
      • Diagnosis
      • Treatment
      • Compensation
      • Research
   2. Recommendations in brief
      • Diagnosis
      • Treatment
      • Compensation
      • Research
2. Background
   1. Listening to Gulf War veterans
   2. Chemical detections and exposures
   3. Toxic exposures in the Gulf War theater
      • Chemical weapons
      • Biological weapons
      • Infecctious deseases
      • Deleted [sic] uranium
      • Oil well fires and petroleum contamination
      • Experimental drugs and vaccines
      • Pesticides and multiple chemical sensitivity
   4. Acute v. chronic effects of low level exposures
   5. Exposures and VA diagnostic protocols
      • Correspondence between Representative Christopher Shays, Chairman, Subcommittee on Human Resources and Intergovernmental Relations, and Jesse Brown, Secretary, Department of Veterans Affairs
   6. Impact of missing records
   7. Stress related diagnoses
   8. Treatment and research
   9. Other executive agency actions on Gulf veteran's illness
3. Findings
   • Diagnosis
     • Finding 1 VA and DOD did not listen to sick Gulf War veterans as to possible causes of their illnesses
     • Finding 2 The presence of a variety of toxic agents in the Gulf War theater strongly suggests exposures have a role in causing, triggering or amplifying subsequent service-connected illnesses
     • Finding 3 Gulf War troops were not trained to protect themselves from the effects of exposure to depleted uranium dust and particles.
     • Finding 4 Pyridostigmine bromide [PB] can have serious side effects and interactions when taken in combination with other drugs, vaccines, chemical exposures, heat and/or physical exercise.
     • Finding 5 VA and DOD health registry diagnosis protocols rely on the unfounded conclusion there were no chemical, biological or other toxic exposures to U.S. troops in the Gulf War theater.
     • Finding 6 VA and DOD health registry diagnosis protocols rely on the unwarranted conclusion that, unless there is an immediate and acute reaction, exposures to chemical weapons and other toxins do not cause delayed or chronic symptoms.
     • Finding 7 Prematurely ruling out toxic exposures as causative, VA and DOD doctors relied on diagnoses of somatoform disorder and Post Traumatic Stress Disorder [PTSD] to explain Gulf War veterans' illnesses
     • Finding 8 There is no credible evidence that stress or PTSD causes the illnesses reported by many Gulf War veterans.
     • Finding 9 Accurate diagnosis of veterans' illnesses remains difficult due to inadequate or missing personal medical records, missing toxic detection logs, and unreleased classified documents.
     • Finding 10 Accurate diagnosis of veterans illnesses was also hampered by the VA's lack of medical expertise in toxicology and environmental medicine.
     • Finding 11 Exposures to low levels of chemical warfare agents and other toxins can cause delayed, chronic health effects.
   • Treatment
     • Finding 12 Neither the VA nor the DOD has systematically attempted to determine whether sick Gulf War veterans are any better or worse today than when they first reported symptoms.
     • Finding 13 Treatment of sick Gulf War veterans by VA and DOD to date has largely focused on stress and PTSD.
   • Compensation
     • Finding 14: Compensation ratings for sick veterans are minimized due to inadequate personal medical records, missing toxic detection logs, and unreleased classified documents which could help veterans establish service-connection of post-war disabilities.
     • Finding 15: Compensation ratings are also minimized by over- reliance on somatoform disorder and PTSD as the basis of disability claims.
   • Research
     • Finding 16: Federal research strategy has been blind to promising hypotheses due to reliance on unfounded DOD conclusions regarding chemical exposures.
     • Finding 17: Institutional and methodological constraints make it unlikely the current research structure will find the causes and effective treatments for Gulf War veterans' illnesses in the short term.
     • Finding 18: The FDA was passive in granting and failing to enforce the conditions of a waiver to permit use of PB by DOD.
4. Recommendations
   • Diagnosis
     • Recommendation 1: Congress should enact a Gulf War toxic exposure act establishing the presumption, as a matter of law, that veterans were exposed to hazardous materials known to have been present in the war theater.
     • Recommendation 2: The VA should contract with an independent scientific body composed of non-Government scientific experts representing, at a minimum, the disciplines of toxicology, immunology, microbiology, molecular biology, genetics, biochemistry, chemistry, epidemiology, medicine and public health for the purpose of identifying those diseases and illnesses associated in peer-reviewed literature with singular, sustained, or combined exposures to the hazardous materials to which Gulf War veterans are presumed to have been exposed.
     • Recommendation 3: The VA Gulf War Registry and the DOD Comprehensive Clinical Evaluation Program should be re-evaluated by an independent scientific body which shall make specific recommendations to change both programs from crude research tools into effective clinical diagnosis and outcomes monitoring efforts.
     • Recommendation 4: The VA should refer all Phase II Registry examinations to Gulf War Referral Centers.
     • Recommendation 5: The VA should add toxicological and environmental medicine expertise to the staff resources dedicated to Gulf War illnesses.
     • Recommendation 6: DOD and VA should make every effort to find, and where necessary re-create through veterans' testimony, individual Gulf War medical records to reflect vaccines administered, PB use, and exposure to DU, pesticides and other hazardous materials.
     • Recommendation 7: The President should order an intensified effort to declassify Gulf War documents in any way related to Gulf War veterans' illnesses and should personally certify to the appropriate committees of Congress when he deems declassification of such documents to be against the national interest.
     • Recommendation 8: DOD failure to adhere to recordkeeping requirements or clinical protocols under an informed consent waiver should result in the presumption of service-connection for any subsequent illness(es) suffered by service personnel to whom the drug or protocol was administered.
   • Treatment
     • Recommendation 9: VA and DOD should systematically and effectively monitor the clinical progress of Gulf War veterans to determine the most effective treatments.
     • Recommendation 10: VA and DOD clinicians should be encouraged to pursue, and should be trained in, new treatment approaches to suspected neurotoxic exposure effects.
     • Recommendation 11: The diagnoses for somatoform disorders and Post Traumatic Stress Disorder [PTSD] should be refined to insure that physiological causes are not overlooked.
   • Compensation
     • Recommendation 12: Denials of Gulf War veterans' compensation claims attributable in any way to missing medical records should be reviewed and veterans' given the benefit of any doubt regarding the presumptive role of toxic exposures in causing post-war illnesses and disability.
     • Recommendation 13:For purposes of compensation determinations, disabilities associated with presumed exposures should be deemed service-connected without any limitation as to time.
   • Research
     • Recommendation 14:Congress should create or designate an agency independent from the Departments of Defense and Veterans Affairs as the lead Federal agency responsible for coordination of all research into Gulf War veterans' illnesses and allocation of all research funds.
     • Recommendation 15: Recommendation 15: The lead Federal agency on Gulf War veterans' illnesses should focus research on the evaluation and treatment of the common spectrum of neuroimmunological disorders known as Gulf War Syndrome, multiple chemical sensitivity, chronic fatigue syndrome and fibromyalgia.
     • Recommendation 16: DOD and VA medical systems should augment research and clinical capabilities with regard to women's health issues and the health effects of combat service on women's health.
     • Recommendation 17: VA, in collaboration with NIH, CDC, FDA and other public health agencies should establish an interdisciplinary research and clinical program on the identification, prevention and treatment of environmentally induced neuropathies.
     • Recommendation 18: FDA should grant a waiver of informed connsent requirements for the use of experimental or investigational drugs by DOD only upon receipt of a Presidential finding of efficacy and need.
5. Appendix

VIEWS

Additional views of Hon. Henry A. Waxman, Hon. Edolphus

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

Additional views of Hon. Bernard Sanders