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.

The text of the majority report entitled ``Gulf War Veterans' Illnesses: VA, DOD Continue to Resist Strong Evidence Linking Toxic Causes to Chronic Health Effects'' is based on 11 hearings held by the Committee on Government Reform and Oversight's Subcommittee on Human Resources. During those hearings, the committee heard testimony and reviewed voluminous documents provided by private citizens and the Federal Departments.
Throughout those hearings, the minority repeatedly insisted that the Department of Defense was uniquely situated to assist in our investigation of chemical weapons exposure. The majority report proves that basic point. Therefore, the purpose of these additional views is to underscore the role of the DOD and make additional suggestions that we believe would assist in the ultimate goal of helping the veterans receive the care and compensation they deserve.
Iraq invaded Kuwait on August 2, 1990. In support of United Nations Resolution 660, the United States sent troops to the Persian Gulf in Operation Desert Shield. About 5 months later, Operation Desert Storm began with an air war against Iraq. Forty days later, a four day ground war ensued. By the conclusion of hostilities, the United States had committed approximately 697,000 troops in the Gulf.
Troops who served in the Gulf were demographically different from previous contingents of U.S. Forces, with 7 percent female troops and 17 percent of the force gathered from Reserve and National Guard Personnel. (``Unexplained Illnesses Among Desert Storm Veterans'', Archives of Internal Medicine, February 13, 1995, volume 155). For reasons that are unknown, it appears the Gulf War Syndrome is most common among Reservist and National Guardsman, although a small percentage of active duty soldiers have complained of similar illnesses.
The symptoms and ailments associated with Persian Gulf service, span the spectrum of illnesses and diseases. Some veterans described very specific symptoms, while others report more general and non-specific ailments including, chronic fatigue, memory and weight loss, joint pain, sleep disturbance, rashes, chest pain, and shortness of breath, diarrhea and other gastro-intestinal and other unexplained maladies. These illnesses have occurred in varying degrees of seriousness and do not appear to be fatal, but symptoms may be sufficiently debilitating and chronic as to cause long-term suffering and disability.
In response to congressional pressure concerning the symptoms experienced by veterans, the Department of Veterans Affairs began collecting data and compiling a Persian Gulf Registry. The VA published the original Persian Gulf Registry program manual (M-10, Part III) in December 1992. The uniform case assessment protocol was implemented at VA medical centers nationwide in June 1994 and introduced by an Under Secretary's Health Information letter on June 22, 1994. VA published a revised program manual on September 14, 1995.
All veterans who identify themselves through the Persian Gulf Registry, as having served in the Persian Gulf War theater of operations, are given a standard medical examination. Seventy-seven percent of veterans who undergo this exam receive a diagnosis and are treated at local VA medical centers. If a diagnosis is not possible following the preliminary examination, a referral for a follow-up exam is given at one of the four Persian Gulf Referral Centers. These centers have developed expertise in addressing symptoms arising out of undiagnosed illnesses. Additional examinations are possible if a diagnosis is not found following the second exam. Treatment is provided based on the results of the exams.
To date there are no clear indications of what may cause the disparate collection of symptoms appearing in veterans who served in the Persian Gulf. However, it is known that while in the Gulf states, the troops were exposed to a variety of natural and artificial substances which could be hazardous alone or in combination with other non-toxic substances. Those substances include, but may not be limited to multiple pre-deployment vaccinations; medical treatments designed to lessen effects of potential chemical exposure;⁽⁴²⁴⁾ insect and rodent repellents; tropical parasites; environmental hazards (such as oil fires); and shrapnel from armor and ammunition made of depleted uranium.
The VA has embarked upon several studies which consider the possible use of biological or chemical agents. However, the primary responsibility for potential chemical exposures or the possible role of biological contaminants during the pendency of the conflict would have belonged to the Department of Defense. The DOD was uniquely situated to conduct or commission studies to gage the likely interaction of medications or immunizations provided soldiers and reservists in combination with air, soil or water contaminants encountered by the troops. However, the Department of Defense steadfastly maintained that chemical and/or biological weapons were not used in the Gulf. Because of this refusal to acknowledge these exposures, multiple government agencies with research funding dedicated to the resolution of the illnesses experienced by troops, wasted countless dollars and valuable time in focusing on unlikely sources of illnesses given the official account of battlefield activities rendered by the Pentagon. While there may be a need to maintain secrecy for troop protection during times of war, that necessity must quickly vanish in the aftermath of a conflict. The rationale of troop preservation and protection used by the military in times of war to maintain secrecy must produce candor in the aftermath of a conflict. Here, that need to preserve and protect the health and well-being of troops would have mandated a full and complete disclosure of chemical and/or biological weapons used in the Gulf. These disclosures may have reduced or eliminated needless suffering. Unfortunately, that disclosure was not forthcoming. It was not until June 21, 1996 that the Department of Defense acknowledged that American troops were exposed to fall-out from chemical agents. Therefore, we must concur with the findings of the final report of the Presidential Advisory Commission (issued January 7, 1997) which found that the Department of Defense had been ``patronizing and dismissive of veterans'' concerns and failed to act in good faith regarding knowledge of the existence of documents which suggested chemical weapons exposures.
However, we must note that since the publication of that report, the DOD seems to have been chastened by the criticism and has endeavored to engage in disclosure concerning chemical and biological exposure. However, it appears that those efforts may be hampered by internal and bureaucratic turf battles between military and civilian Defense employees about the necessity and level of disclosure. We trust that the actions of this committee communicate a strong message. Those who favor disclosure must be victorious in those internal battles. Their defeat will mean that those who are charged with the responsibility of defending freedom will be engaged in denying and stifling the most precious rights of American citizens - the right to be informed about governmental activities and to demand accountability of public officials. In a democracy, accountability cannot be suspended even during times of war.
The need for candor and openness in the military should be self-evident. As a Nation, we cannot expect young people to answer the call to war if they cannot expect to be treated fairly and with compassion if they are injured in service to their country. We commend the veterans who participated in these hearings. By testifying before this committee and sharing their stories, they have shown their continued belief and faith in the democracy that they risked their lives defending. We trust that the Department of Defense will follow their example. We believe that the candor of the department will assist in the diagnosis and treatment of these injured former and current armed service personnel.
In addition to their health concerns, we believe greater emphasis should be placed on the claims process. Approximately 76,000 veterans claims have been processed by the VA for service-connected disability and compensation as a result of their Persian Gulf experience.<sup>(425)</sup> Of that number, approximately 22,300 have been approved for service-connected disability and compensation. Therefore we were pleased that on January 7, 1996, when President Clinton endorsed a change in disability rules for Persian Gulf War veterans that would allow more to receive disability payments for ``undiagnosed illnesses''. We trust that those veterans whose claims were denied previously will be reassessed quickly.
Finally, we believe that future medical mysteries can and should be avoided. In our investigation, we were shocked to learn that the Pentagon would spend thousands of dollars training and equipping each soldier, but fail to spend any money in developing a system that would track their health status. Therefore, we would recommend the implementation of a baseline health evaluation prior to deployment; the development of a computerized central database for medical records during a military deployment and the use of a standardized system of recordkeeping among the military branches.

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.
Hon. Harold E. Ford, Jr.

Additional views of Hon. Bernard Sanders

[NOTES]

424. Some of these medicines had not been approved by the Federal Food and Drug Administration. They were considered "investigational".
425. The VA cannot provide the total number for claims filed only by Persian Gulf Veterans, because claims currently in the process are not categorized by time or area of service. Unfortunately, they can only provide figures on the number of claims by Persian Gulf veterans after those claims have gone through the review process.