Union Calendar No. 228

GULF WAR VETERANS' ILLNESSES: VA, DOD CONTINUE TO RESIST STRONG EVIDENCE LINKING TOXIC CAUSES TO CHRONIC HEALTH EFFECTS

November 7, 1997. --Committed to the Committee of the Whole House on the State of the Union and ordered to be printed.

Mr. BURTON of Indiana, from the Committee on Government Reform and Oversight, submitted the following

SECOND REPORT

On October 31, 1997, the Committee on Government Reform and Oversight approved and adopted a report entitled "Gulf War Veterans' Illnesses: VA, DOD Continue to Resist Strong Evidence Linking Toxic Causes to Chronic Health Effects." The chairman was directed to transmit a copy to the Speaker of the House.

I. SUMMARY

Responding to requests by veterans, the subcommittee in March 1996 initiated a far-reaching oversight investigation into the status of efforts to understand the clusters of symptoms and debilitating maladies known collectively as "Gulf War Syndrome." We sought to ensure sick Gulf War veterans were being diagnosed accurately, treated effectively and compensated fairly for service-connected disabilities, despite official denials and scientific uncertainty regarding the exact causes of their ailments. We also sought to determine whether the Gulf War research agenda was properly focused on the most likely, not just the most convenient, hypotheses to explain Gulf War veterans' illnesses.
After 19 months of investigation and hearings, the subcommittee finds the status of efforts on Gulf War issues by the Department of Veterans Affairs [VA], the Department of Defense [DOD], the Central Intelligence Agency [CIA], and the Food and Drug Administration [FDA] to be irreparably flawed. We find those efforts hobbled by institutional inertia that mistakes motion for progress. We find those efforts plagued by arrogant incuriosity and a pervasive myopia that sees a lack of evidence as proof. As a result, we find current approaches to research, diagnosis and treatment unlikely to yield answers to veterans' life-or-death questions in the foreseeable, or even far distant, future.
We do not come to these conclusions lightly. Nor do we discount all that has been done to care for, cure and compensate Gulf War veterans. But lives have been lost, and many more lives are at stake.
Six years and hundreds of millions of dollars have been spent in the effort to determine the causes of the illnesses besetting Gulf War veterans. Yet, when asked what progress has been made healing sick Gulf War veterans, VA and DOD can't say where they've been and concede they may never get where they're supposed to be going. The CIA continues to resist broader declassification of Gulf War records. The FDA meekly chastises the Defense Department for the failure to observe agreed-upon rules for the humane use of experimental drugs.
Sadly, when it comes to diagnoses, treatment, and research for Gulf War veterans, we find the Federal Government too often has a tin ear, a cold heart and a closed mind.
Our hearings convinced us the journey from cause to cure for Gulf War veterans runs through the pools, clouds and plumes of toxins in which they lived and fought. It is a journey VA and DOD might never have taken but for persistent pressure from this subcommittee, and other House and Senate panels, that forced the Pentagon to acknowledge a "watershed event" -- the probable exposure of United States troops to chemical weapons fallout at Khamisiyah, Iraq.
With that first admission, the three pillars of Government denial -- no credible detections, no exposures, no health effects -- began to crumble. As the number of U.S. troops presumed exposed grew from 400 to almost 100,000, as the credibility of other chemical detections was sustained, and as private research probed the parallels between Gulf War illnesses and the known symptoms of chemical poisoning, some significant role for toxins in causing, triggering or amplifying neurological damage and chronic symptoms could no longer be denied.
Before Khamisiyah, voluminous and compelling, albeit circumstantial, evidence regarding neurotoxic exposures had been ignored, denied or discredited, while far less abundant evidence and far less plausible psychological theories of causation were pursued with vigor. As a result, diagnostic protocols were insensitive to exposure effects, treatments were limited and vital research was delayed.
Only recently were VA and DOD health registry questionnaires modified to consistently capture the best and only remaining evidence of toxic exposures: veterans' recollections. Only recently was research funded to measure the health effects of sustained, low-does exposure to the combinations of chemicals, pharmaceuticals and environmental toxins to which Gulf war veterans were exposed.
Those denials and delays are symptomatic of a system content to presume the Gulf War produced no delayed casualties, and determined the shift the burden of proof onto sick veterans to overcome that presumption. That task has been made difficult, if not impossible, because most of the medical records needed to prove toxic causation are missing or destroyed. Nevertheless, VA and DOD insist upon reaping the benefit of any doubts created by the absence of those missing records.
The subcommittee believes the current presumptions about neurotoxic causes and effects should be reversed and the benefit of any doubt should inure to the sick veteran.
Finally, we reluctantly conclude that responsibility for Gulf War illnesses, especially the research agenda, must be placed in a more responsive agency, independent of the DOD and the VA.
Fortunately for Gulf war veterans, excellent research into Gulf War illnesses has taken place outside Government sponsorship. This research has advanced a case definition for some illnesses, an important step toward improved diagnosis and treatment. Some experimental treatments have brought relief to afflicted veterans and their families. The subcommittee believes this work must be included within the scope of that agency made responsible for Federal efforts to solve the puzzle of Gulf war illnesses.
We note with approval efforts at the National Institute of Environmental Health Sciences [NIEHS] and other public health agencies to study exposure effects and genetic susceptibility to environmental toxins. Funding for this research would be an important first step in the effort to have an independent agency, with significant expertise in environmental hazards, involved in the solution to Gulf War veterans' health problems.
There is no "silver bullet" to explain or cure so-called Gulf War Syndrome, which is not a discrete syndrome at all, but a variable cluster of symptoms and disease states with different triggers and susceptibilities. The battle to cure Gulf War illnesses must be fought at the cellular, molecular and genetic levels if we hope to heal the delayed wounds of that war and protect future warriors. Absent precise exposures data which can never be recaptured, the best evidence linking toxic causes to chronic effects lies within the bodies and minds of Gulf War veterans. That evidence has been too long ignored.

A. FINDINGS IN BRIEF