II. BACKGROUND

Since the Gulf War ended in 1991, there has been a growing number of reports of chronic illnesses among the nearly 700,000 United States troops who served in Saudi Arabia, Kuwait, and Iraq. Although the illnesses are most common among reservists and National Guardsmen who served in the Gulf, full-time active-duty soldiers have also complained about various maladies.¹
Health complaints by Gulf veterans from Canada, Great Britain, Kuwait, Australia, Czech Republic, Hungary, New Zealand and Norway have also begun to surface. There has also been an increased incidence of similar illnesses in the civilian populations of Kuwait, Iraq, and Saudi Arabia, according to a report to the Human Resources Subcommittee by chemical/biological weapons expert Dr. Jonathan Tucker, director of the chemical and biological nonproliferation project, Monterey (CA) Institute for International Studies.²
Listed in the Persian Gulf health registries of the Departments of Defense [DOD] and Veterans Affairs [VA] are about 113,000 Gulf War veterans [DOD's Comprehensive Clinical Evaluation Program with 44,900 names as of August 1997, and VA's Gulf Health Registry with 67,989 names as of May 1997].³ Most participants in the registries have been diagnosed, approximately 20 percent remained undiagnosed, and roughly 10 percent of those listed had no detectable symptoms.⁴ Many veterans have reported flu-like symptoms, chronic fatigue, rashes, joint and muscular pain, headaches, memory loss, reproductive problems, depression, loss of concentration, gastroin-testinal problems, and other maladies.⁵
According to American Legion: "One of the key questions that arises from evaluating [VA Health] Registry data is: What is happening to those veterans that complain of the most common symptoms? What is the outcome of their visit to the VA? Are they getting better, or are they slipping through the cracks? Our hypothesis is that these veterans who complain of the symptoms are not receiving the proper follow-up and treatment they deserve."⁶
Many Gulf War veterans are concerned that their medical problems are chronic and disabling, and are the result of exposures to one or more chemical, biological, or nuclear agents present in the theater of operations. Health problems of Gulf veterans may stem not only from chemical and biological warfare agents by from other sources such as: pesticides and insect repellants; leaded diesel fuel; depleted uranium; oil well fires; infectious agents; and the anti-nerve agent drug, pyridostigmine bromide.⁷
In 11 hearings⁸ since March 1996, the Human Resources Subcommittee has examined issues dealing with veterans' symptoms and complaints about the handling of their health problems by the VA, especially about inappropriate medical treatment or denial of treatment, missing or inadequate personal medical records, compensation issues, and lack of valid and timely Government research conclusions about the causes of their illnesses. The subcommittee also sough to ensure that any research programs conducted by the Departments of Defense [DOD], Health and Human Services [HHS], and the Environmental Protection Agency [EPA] were well-focused and coordinated.
The subcommittee has examined studies of effects of low level chemical exposures on human and animals, and probable exposures of large numbers of troops to chemical warfare agents and other toxins during and after the war. Typical complaints of Gulf veterans are similar to known effects on humans who have been exposed to organophosphates, such as pesticides and other chemical agents.⁹ Organophosphates are chemically related to Sarin and other warfare agents present in the Gulf War theater.
Not listening to veterans' health complaints, many military and VA doctors -- often unable or unwilling to diagnose veteran's illnesses as the after-effects of possible neurotoxic exposures -- have insisted veterans suffered instead from stress, or post-traumatic-stress-disorder [PTSD].¹⁰ Many private physicians and researchers believe DOD and VA doctors have relied too heavily on psychological theories of causation while discounting the possibility of neurotoxic exposures.¹¹
The Human Resources Subcommittee has listened carefully to hundreds of Gulf War veterans who have written and called the subcommittee since hearings began in March 1996. The subcommittee has also listened to the testimony of 23 Gulf veterans who testified in the 11 hearings held.

A. LISTENING TO GULF WAR VETERANS

[NOTES]

1. Status of Efforts to Identify Persian Gulf War Syndrome, 104th Cong., 2d sess., p. 48 (1996) ("Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4") (statement of Major Thomas Cross, Gulf War veteran and member of the Presidential Advisory Committee on Gulf War Veterans' Illnesses).
2. A report submitted to the subcommittee by Jonathan Tucker, "Chemical/Biological Weapons Exposure and Gulf War Illness," January 29, 1996, p. 1.
3. Memorandum to the subcommittee from the Department of Defense dated September 10, 1997 (in subcommittee files).
4. Congressional Research Service Report, "Gulf War Veterans' Illnesses," 95-450 SPR, April 11, 1997, p. 2.
5. Statement of Lennox E. Gilmer, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 95.
6. Statement of Matt Puglisi, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 81.
7. Status of Efforts to Identify Persian Gulf War Syndrome: Recent GAO Findings, 105th Cong., 1st sess., pp. 42-43 (1997) ("Human Resources Subcommittee hearings, No. 3") (statement of Donna Heivilin, GAO).
8. Human Resources Subcommittee hearings on Gulf War illnesses in the 104th & 105th Congresses: March 11 and 28, June 25, September 19, December 10 and 11, 1996; January 21, April 24, June 24 and 26, 1997. A hearing on informed consent issues, including DOD's use of PB tabs under an informed consent waiver, was held on May 8, 1997.
9. Persian Gulf Veterans' Illnesses, 104th Cong., 2d sess., p. 280 (1996) ("Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 5-6") (statement of Charles Jackson).
10. Statement of Kimo Hollingsworth, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 29; statement of Brian Martin, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 324; statement of Julia Dyckman, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 5-6, p. 195; statement of Michael Donnelly, Human Resources Subcommittee hearing, No. 2, p. 40. Also correspondence from Gulf veterans (in subcommittee files).
11. Statement of William Baumzweiger, Human Resources and Intergovernmental Relations Subcommittee hearings, Nos. 1-4, p. 500; statements attributed to Eula Bingham and Claudia Miller, NY Times, November, 21, 1996, p. B11. See also, Streich, et al., "Symptomatology of Gulf War Era Service," Military Medicine, Walter Reed Army Institute of Research, Bethesda, MD, March 1995.