<DOC>
[109th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:26238.wais]
OCCUPATIONAL AND ENVIRONMENTAL HEALTH SURVEILLANCE OF DEPLOYED FORCES:
TRACKING TOXIC CASUALTIES
=======================================================================
HEARING
before the
SUBCOMMITTEE ON NATIONAL SECURITY,
EMERGING THREATS, AND INTERNATIONAL
RELATIONS
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
__________
JULY 19, 2005
__________
Serial No. 109-120
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
http://www.house.gov/reform
______
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COMMITTEE ON GOVERNMENT REFORM
TOM DAVIS, Virginia, Chairman
CHRISTOPHER SHAYS, Connecticut HENRY A. WAXMAN, California
DAN BURTON, Indiana TOM LANTOS, California
ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York
JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York
JOHN L. MICA, Florida PAUL E. KANJORSKI, Pennsylvania
GIL GUTKNECHT, Minnesota CAROLYN B. MALONEY, New York
MARK E. SOUDER, Indiana ELIJAH E. CUMMINGS, Maryland
STEVEN C. LaTOURETTE, Ohio DENNIS J. KUCINICH, Ohio
TODD RUSSELL PLATTS, Pennsylvania DANNY K. DAVIS, Illinois
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
JOHN J. DUNCAN, Jr., Tennessee DIANE E. WATSON, California
CANDICE S. MILLER, Michigan STEPHEN F. LYNCH, Massachusetts
MICHAEL R. TURNER, Ohio CHRIS VAN HOLLEN, Maryland
DARRELL E. ISSA, California LINDA T. SANCHEZ, California
GINNY BROWN-WAITE, Florida C.A. DUTCH RUPPERSBERGER, Maryland
JON C. PORTER, Nevada BRIAN HIGGINS, New York
KENNY MARCHANT, Texas ELEANOR HOLMES NORTON, District of
LYNN A. WESTMORELAND, Georgia Columbia
PATRICK T. McHENRY, North Carolina ------
CHARLES W. DENT, Pennsylvania BERNARD SANDERS, Vermont
VIRGINIA FOXX, North Carolina (Independent)
------ ------
Melissa Wojciak, Staff Director
David Marin, Deputy Staff Director/Communications Director
Rob Borden, Parliamentarian
Teresa Austin, Chief Clerk
Phil Barnett, Minority Chief of Staff/Chief Counsel
Subcommittee on National Security, Emerging Threats, and International
Relations
CHRISTOPHER SHAYS, Connecticut, Chairman
KENNY MARCHANT, Texas DENNIS J. KUCINICH, Ohio
DAN BURTON, Indiana TOM LANTOS, California
ILEANA ROS-LEHTINEN, Florida BERNARD SANDERS, Vermont
JOHN M. McHUGH, New York CAROLYN B. MALONEY, New York
STEVEN C. LaTOURETTE, Ohio CHRIS VAN HOLLEN, Maryland
TODD RUSSELL PLATTS, Pennsylvania LINDA T. SANCHEZ, California
JOHN J. DUNCAN, Jr., Tennessee C.A. DUTCH RUPPERSBERGER, Maryland
MICHAEL R. TURNER, Ohio STEPHEN F. LYNCH, Massachusetts
JON C. PORTER, Nevada BRIAN HIGGINS, New York
CHARLES W. DENT, Pennsylvania
Ex Officio
TOM DAVIS, Virginia HENRY A. WAXMAN, California
Lawrence J. Halloran, Staff Director and Counsel
Kristine Fiorentino, Professional Staff Member
Robert A. Briggs, Clerk
Andrew Su, Minority Professional Staff Member
C O N T E N T S
----------
Page
Hearing held on July 19, 2005.................................... 1
Statement of:
Kilpatrick, Dr. Michael, Deputy Director of the Deployment
Health Support Directorate, Department of Defense,
accompanied by Colonel John Ciesla, Chief of Staff, U.S.
Army Center for Health Promotion and Preventive Medicine
[CHPPM]; and Dr. Susan Mather, Chief Officer, Public Health
and Environmental Hazards, Veterans Health Administration,
Department of Veterans Affairs, accompanied by Dr. Mark
Brown, Director, Environmental Agents Service, Department
of Veterans Affairs........................................ 140
Kilpatrick, Dr. Michael.................................. 140
Mather, Dr. Susan........................................ 161
La Morte, Brian Scott, Company Sergeant Major, B Company,
Third Battalion, 20th Special Forces Group (Airborne),
North Carolina Army National Guard; Raymond Ramos, retired
Staff Sergeant, 442nd Military Police Company, New York
National Guard; David Chasteen, Operation Iraqi Freedom
veteran, associate director of Operation Truth; and Marcia
Crosse, Ph.D., Director, Health Care, Government
Accountability Office...................................... 41
Chasteen, David.......................................... 85
Crosse, Marcia........................................... 89
La Morte, Brian Scott.................................... 41
Ramos, Raymond........................................... 55
Letters, statements, etc., submitted for the record by:
Chasteen, David, Operation Iraqi Freedom veteran, associate
director of Operation Truth, prepared statement of......... 87
Crosse, Marcia, Ph.D., Director, Health Care, Government
Accountability Office:
Information concerning programs.......................... 136
Prepared statement of.................................... 91
Kilpatrick, Dr. Michael, Deputy Director of the Deployment
Health Support Directorate, Department of Defense, prepared
statement of............................................... 143
Kucinich, Hon. Dennis J., a Representative in Congress from
the State of Ohio, prepared statement of................... 121
La Morte, Brian Scott, Company Sergeant Major, B Company,
Third Battalion, 20th Special Forces Group (Airborne),
North Carolina Army National Guard, prepared statement of.. 45
Mather, Dr. Susan, Chief Officer, Public Health and
Environmental Hazards, Veterans Health Administration,
Department of Veterans Affairs:
Information pieces....................................... 163
Prepared statement of.................................... 183
Ramos, Raymond, retired Staff Sergeant, 442nd Military Police
Company, New York National Guard, prepared statement of.... 58
Shays, Hon. Christopher, a Representative in Congress from
the State of Connecticut:
Articles and materials submitted by Susan Zimet, Ulster
County New York legislator, and the Desert Storm Battle
Registry............................................... 7
Prepared statement of.................................... 3
OCCUPATIONAL AND ENVIRONMENTAL HEALTH SURVEILLANCE OF DEPLOYED FORCES:
TRACKING TOXIC CASUALTIES
----------
TUESDAY, JULY 19, 2005
House of Representatives,
Subcommittee on National Security, Emerging
Threats, and International Relations,
Committee on Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 11 a.m., in
room 2154, Rayburn House Office Building, Hon. Christopher
Shays (chairman of the subcommittee) presiding.
Present: Representatives Shays, Duncan, Turner, Dent, and
Kucinich.
Staff present: Lawrence Halloran, staff director and
counsel; R. Nicholas Palarino, Ph.D., senior policy advisor;
Robert A. Briggs, clerk; Kristine Fiorentino, professional
staff member; Erick Lynch and Sam Raymond, interns; Andrew Su,
minority professional staff member; and Earley Green, minority
chief clerk.
Mr. Shays. A quorum being present, the Subcommittee on
National Security, Emerging Threats, and International
Relations hearing entitled, ``Occupational and Environmental
Health Surveillance of Deployed Forces, Tracking Toxic
Casualties,'' is called to order.
Air Force Major Michael W. Donnelly died on June 30th. His
testimony before this subcommittee 8 years ago helped persuade
a skeptical Pentagon and Department of Veterans Affairs [VA],
that wartime exposures caused or amplified subsequent
illnesses. His decade-long struggle against the ravaging
effects of Amyotrophic Lateral Sclerosis [ALS], gave heroic
witness to the reality of toxic casualties. Our work on
deployment health will continue to be guided by his indomitable
spirit.
After the 1991 war in the Persian Gulf, veterans suffering
a variety of unfamiliar syndromes faced daunting official
resistance to evidence linking multiple low-level toxic
exposures to subsequent chronic ill health. Limited
environmental sampling, poor troop location data and glaring
incomplete medical recordkeeping all blocked efforts to reach
epidemiological or clinical conclusions about wartime
exposures.
Since then, the Department of Defense [DOD], has become
much more attuned to the environmental and occupational risks
of the deployment workplace. Lessons learned in the first Gulf
war are being applied to minimize preventable exposures and
illness. Air, soil and water testing is more prevalent.
Baseline routine and incidental driven surveillance reports are
being directed to a central repository. Some information on
possible environmental exposures is finding its way into
individual medical records. But as we will hear this morning,
these promising efforts do not yet comprise the robust,
consistent and sustained deployment health program our forces
need and deserve.
Gathering more data on environmental and occupational risk
is only the first and perhaps the easiest step. It will be of
limited value to past, current and future service members
unless DOD and VA can standardize, analyze and use exposure
data to better inform research agendas and compensation
decisions.
At the subcommittee's request, the Government
Accountability Office [GAO], examined implementation of DOD's
policies on environmental health surveillance. In a new study
released today, GAO reports finding inconsistencies between the
military services and data collection methods. They found
variable levels of training and expertise among those
responsible for environmental monitoring.
While some reports are flowing to a central collection
point, the data integrator, the Army's Center for Health
Promotion and Preventative Medicine, does not know how many
reports to expect or how many might be late or missing at any
given time. Troop location data needed to link individuals to
individual risks is still unreliable or unavailable.
Information on specific sites is often classified, putting
critical data behind the reach of most clinicians and
researchers.
These findings frame our discussion of current deployment
health surveillance activities, and we appreciate the work of
the GAO team on these important issues. We also value the time,
expertise and dedication of our witnesses from Department of
Defense and Veterans Affairs. But we believe, and they agree,
the first voices we need to hear today belong to veterans,
those who lived, worked and faced the risk of toxic harm in
Afghanistan and Iraq.
In this room, in 1997, Major Donnelly described the pain
and frustration caused by official inability or unwillingness
to connect his rare illness with his military service. A once
robust fighter pilot sat before us in a wheelchair. His body
racked by the effects of the disease. His wife and father sat
next to him to help interpret. But when asked if he would go to
war against knowing what would befall him, Michael Donnelly did
not hesitate 1 second before saying, in a whisper, yes.
[The prepared statement of Hon. Christopher Shays follows:]
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Mr. Shays. The Chair would now recognize Mr. Duncan.
Mr. Duncan. Mr. Dent was here before me, if he wants to
make a statement.
Mr. Shays. No, with the gavel, I take the senior member. We
will all get our chances.
Mr. Duncan. Thank you very much, Mr. Chairman. Once again,
you have called a hearing on a very, very important topic.
Unfortunately, due to previously scheduled meetings, I
won't be able to stay for much of it. However, my staff did
tell my VA representative yesterday of something that I have
been wondering about for several years now, and perhaps some of
the witnesses could help answer some of these questions when
they testify, and of course, we all know that for several years
people at the top levels of the Defense Department thought that
some or many of the illnesses that some of the Gulf war, first
Gulf war, veterans were complaining of were psychosomatic or
psychological and not related to their military service. And we
all know about the difficult time that many of these soldiers
had in trying to tie their illnesses into their service.
What raised my curiosity was the fact that we heard almost
no complaints or similarities of symptoms from military
personnel from other countries who had served at the same time
and in the same theaters. And it raised a question in the mind
of many, were these illnesses being claimed primarily because
of our VA system and because there could be a possible
compensation, or--and because, in the other countries where
there was no similar VA compensation program set up, soldiers
were not claiming these same types of illness? Or could it have
been because we were giving our soldiers some type of
vaccinations that had something in them that was causing
problems that weren't being caused in soldiers from other
countries?
So I think those are some things that we need to look into
and see whether these illnesses, there still is apparently a
serious question as to whether some of these illnesses are
related to the military or whether there is some other cause,
psychological or a vaccination or what the cause might be.
But I thank you for calling this hearing.
Mr. Shays. I thank the gentleman.
Mr. Dent.
Mr. Dent. Thank you.
Thank you, Mr. Chairman, for conducting this hearing.
I look forward to receiving your testimony. And having seen
a family member die of ALS, I know that issue is not
psychological. And I just look forward to hearing your
testimony about the effects that our service personnel have
experienced while deployed.
So thank you for holding this hearing, Mr. Chairman.
Mr. Shays. I thank the gentleman.
And as the former vice chair of the committee, Mr. Turner.
Mr. Turner. Mr. Chairman, I want to thank you for
continuing your effort to delve into the issue of the health
and safety of our men and women in uniform. Your efforts have
produced real results that we want to make certain that,
through accountability, are implemented. The benchmarking or
needing to know where our men and women in uniform begin and
then the environmental aspects that they are exposed to and the
effects upon their health is incredibly important not only for
us to just determine what happened but also to plan so that we
can effectively protect people in the future. And so your work
here is very important, and I appreciate it.
Mr. Shays. I thank the gentleman.
Before I recognize our witnesses, I ask unanimous consent
that all members of the subcommittee be permitted to place an
opening statement in the record and that the record remain open
for 3 days for that purpose. Without objection, so ordered.
I ask further unanimous consent that all witnesses be able
to submit their written statements in the record. Without
objection, so ordered.
I even ask for unanimous consent to insert into the record
articles and other materials submitted by Susan Zimet, Ulster
County New York legislator, and the Desert Storm Battle
Registry submitted as well. Without objection, so ordered.
[The information referred to follows:]
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Mr. Shays. We have two panels today. Let me thank our
Government officials very much for appreciating the need to
hear from our first panel.
We are reversing the order, in other words. Government is
going second. In this case, we are listening to our second
panel first and that is: Mr. Brian Scott La Morte, a company
sergeant major, B Company, Third Battalion, 20th Special Forces
Group, North Carolina Army National Guard; Mr. Raymond Ramos,
retired staff sergeant, 442nd Military Police Company, New York
National Guard; Mr. David Chasteen, Operation Iraqi Freedom
veteran, associate director of Operation Truth; and Dr. Marcia
Crosse, director, Health Care, Government Accountability
Office.
Our second panel will follow. At this time, gentlemen, will
you rise so I can swear you in? And lady.
Raise your right hands.
[Witnesses sworn.]
Mr. Shays. For the record, our witnesses have responded in
the affirmative, and now when the other two guests speak, we
will make sure our recorder has their names, and we can
identify. Thank you.
Sergeant Major La Morte, you're on. What we do is we do 5
minutes. We roll it over a little bit. But we like you to be as
close to the 5 minutes as you can be.
STATEMENTS OF BRIAN SCOTT LA MORTE, COMPANY SERGEANT MAJOR, B
COMPANY, THIRD BATTALION, 20TH SPECIAL FORCES GROUP (AIRBORNE),
NORTH CAROLINA ARMY NATIONAL GUARD; RAYMOND RAMOS, RETIRED
STAFF SERGEANT, 442ND MILITARY POLICE COMPANY, NEW YORK
NATIONAL GUARD; DAVID CHASTEEN, OPERATION IRAQI FREEDOM
VETERAN, ASSOCIATE DIRECTOR OF OPERATION TRUTH; AND MARCIA
CROSSE, Ph.D., DIRECTOR, HEALTH CARE, GOVERNMENT ACCOUNTABILITY
OFFICE
STATEMENT OF BRIAN SCOTT LA MORTE
Sergeant Major La Morte. I would like to thank the
Honorable Christopher Shays and the fellow members of the
subcommittee.
It is an honor for me to testify on behalf of myself and
the fellow service members and the soldiers that I lead. I am
Sergeant Major Brian Scott La Morte, and I am the Company
Sergeant Major in the National Guard Special Forces Unit. I was
deployed to Kandahar Airfield in Afghanistan in April 2002 with
the Advance Party of the Second Battalion, Third Special Forces
Group. The first mission tasked to me was to secure, clean up
and improve the living conditions at the Combined Joint Special
Operations Task Force Afghanistan, CJSOTFA, I was working at
the Advanced Operation Base North located in Bagram
Afghanistan.
During my initial pre-mission planning trip, I was able to
observe living conditions of team safe houses located on the
Pakistani border as well as OAB North.
After that mission, I was living at Kandahar Airfield for
most of my duration in the theater. I witnessed the airfield
from April 2002 through October 2002. While there was great
improvement made during that time in the country, the base
still had a long way to go.
While I was not included in the first contact of the
Afghanistan Campaign, I know the nature of war, and death and
destruction are norms for the daily contact. The amount of
vehicles that were destroyed along with the human carnage was
unheard of by so few of our ground forces. Today's military is
capable of enormous amounts of destruction with our advanced
firepower that is on call from the Navy and Air Force, from
2,000-pound laser-guided bombs, 30-millimeter depleted uranium
tank-busting rounds to conventional explosives used to destroy
tons of recovered Taliban and Al Qaeda material munitions on a
daily basis. The destruction of cached material and explosives
led to many fires that burned for countless days unattended. As
the Taliban moved out of their bases as fast as they could,
they left many tons of captured Soviet and Afghani equipment
hidden or scattered about.
One such example is enclosed in the picture of my report of
some of over 436 1,100-pound aerial drop-off bombs of different
types that the Taliban had tried to bury in the desert to hide
from the advancing Coalition Forces moving into the Kandahar
region.
Here is a prime example of the mistakes that we have made
in the past two conflicts, Desert Storm and Operation Enduring
Freedom. The next two pictures are from the same cache that
showed buried munitions that were never identified properly.
Like the explosion in Desert Storm, the ammunition depot that
contained chemical weapons which were never identified until
after the improper destruction, we face a similar chance to do
the same again. I reminded the EOD officer in charge of the
necessity of identifying all the weapons before destroying the
cache. He felt it more important to destroy the cache in place
as is rather than exposing his troops to possible booby traps.
Remember that EOD personnel had been killed 6 months
beforehand. I, again, protested to him that there might be
chemical or nuclear weapons, and they should be ID'd first.
In the pictures, I have arrows identifying where the mounds
were buried, where the weapons were buried underneath. And the
picture on the right had no explosives placed on the cache, on
that strip of munitions.
If the mound had contained a chemical weapon, EOD felt it
would burn up in the fire ball following the blast. If it were
nuclear, it would be ruined beyond use. My point to the colonel
is, it is a weapon of information for our side. It was a Soviet
doctrine to carry nuclear and chemical weapons to the
battlefield front.
I found possible chemical weapons in the barren waste land,
and no one wanted to admit the possibility that chemical
weapons were in Afghanistan. It seemed to me, if they had been
found, the rounds would have caused more complications, and it
was better to be ignorant of the fact than to deal with them.
The conditions of the Kandahar Airfield in April 2002 was
showing signs of becoming organized. The Special Forces
compound which housed Forward Operating Base 32 under
Lieutenant Colonel Sherwood was located in the middle of the
base. Directly behind their motor pool was a trash dump that
was pushed out of the way to make room for more troops. The
trash dump contained everything from human bones to armored
vehicles to airplanes and helicopters out of use.
The entire time I was in the area, the dump was on fire.
Smoke from burning rubber, oil and wood drifted across the
base. The smell was incredible, putrid. I could not think of a
better way to describe it. I was conscious of the smoke and
wore a rag over my face when it was really bad. Was there
anything that could be done? Perhaps fighting the fire would
have been a start, but it was not raging out of control, just a
smoldering smudge pot that was more of a nuisance than anything
else.
By the time I had left, the 733rd Facility Engineer Team
was establishing a good working solution to the HAZMAT
environment at Kandahar. I have an attached article there from
the Engineer magazine.
My time at the Advanced Operation Base in Bagram,
Afghanistan, May to July 2002, was spent cleaning up after the
Taliban, Fifth Special Forces Group and Third Battalion SFG.
The building we had occupied had been damaged at some point in
the war. Possible mortar attacks had left large holes in the
roof and no windows in the building. Luckily, it never seemed
to rain while I was there. The dust had free reign and was in
everything in the building. The dust was so fine that if you
opened plastic wrapping on a CD container, there was dirt
inside the CD container already.
The roof was made of tile shingles, and they were made of
material containing asbestos. Tile from the roof was
everywhere. We had moved most of the tiles that were loosened
to the ground before finding out we had asbestos in them. The
facility improvement officer came to our compound 1 day to
announce that the roof would be replaced by a local contractor.
We had to supply the security detail while they worked. The
roof was dismantled and trucked away to dump outside the front
gate. Daily, the contractor dropped tiles down into the living
area and kitchen area of the AOB. We tried our best to keep
them from doing so, but they found ways to avoid walking to the
side of the roof where the truck was parked if they didn't have
to.
Safe houses in the area ran far and wide, from neat and
efficient----
Mr. Shays. Sergeant Major La Morte, I am going to ask you
to kind of summarize.
Sergeant Major La Morte. Well, you have my written
statement.
In summary, sir, I would like to say that we never, as one
of the first Guard units in theater, when we returned we were
never properly tested for heavy metals or asbestos or nerve
agents, which we identified as being in the area thereof.
Taranac Farms came up hot for nerve agents and blood agents.
But that report was classified secret, so I cannot put that in
my medical records. Nor do I have access to that report any
longer.
There are 67 people deployed to that theater in my company
that were never tested for any of those. The DMOB station
glanced over records. I was injured. I broke my back and my
leg, continued to fight for 7 months. And when I came home, the
doctor there just glanced through my report and never mentioned
that. I had to bring it to his attention that I had been
injured and exposed to dust and the asbestos and nerve agents.
I had a persistent cough when I came back. He said it was
normal for the people in our area, not to worry about it. That
is easy for him to say. I still have a persistent cough. And it
needs to be identified.
I lost a soldier when we returned to self-inflicted wounds.
We are not sure if it is the drugs that we were on. I was in
that group of SF guys that came home to some violent
homecomings.
I haven't had too many more problems after that. I had a
couple people who are depressed. And I do believe it is due to
the drug mefloquine that we were taking.
[The prepared statement of Sergeant Major La Morte
follows:]
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Mr. Shays. Thank you very much.
And by the way, your statement was very well organized and
very helpful to the subcommittee. So we have that as well.
Sergeant Major La Morte. Thank you.
Mr. Shays. Thank you.
Staff Sergeant Ramos.
Staff Sergeant Ramos. Good morning.
Mr. Shays. Good morning, sir.
STATEMENT OF RAYMOND RAMOS
Staff Sergeant Ramos. I would like to thank the members of
the Committee on Government Reform and Subcommittee on National
Security for the opportunity to speak on my health issues while
deployed in Iraq. I come as a voice of many soldiers who will
not have the opportunity to have their statements heard and are
still seeking answers, soldiers like Spc. Gerad Mathew, Spc.
Anthony Phillip, Sergeant Herbert Reed, Sergeant Agustin Matos,
Sergeant Jerry Ojeda, Sergeant Anthony Yonnone, Sergeant Hector
Vega. There are many more who have made the ultimate sacrifice
for this country and need answers to the questions of poor
health after having served in the war on global terrorism.
I served in Iraq from April 3, 2003, to September 6, 2003,
with the 442nd Military Police Company under the direct command
headquarters of the 716th Military Police Battalion. We arrived
in Kuwait and were immediately set out to link up with our
battalion. After a few days of getting acclimated to the
weather conditions, our unit was set to cross the border into
Iraq. First of the soldiers to go forth were myself, an
operation sergeant, an admin sergeant and a gunner who were
picked up by two escort vehicles and off we went.
We linked up with our battalion in Diwanyah. The camp was
located within an Iraqi University that had been occupied by
the 1/3 Marine Division who ran the camp. The area in which we
were given to live was in a science and computer section of the
University. It was littered with debris, blown out windows,
human waste, books as well as piles of dust, dirt and sand.
We had our work cut out for us because this building had to
be cleaned up before the rest of the unit arrived in a few
days. Opposite this building was a lab which had been wired off
because we were told it was used to work on animal and human
cadavers. On the roof of our building, you could see the bones
of a camel that had been left outside. Our unit spent
approximately the next 3 weeks there running enemy prisoner of
war processing and transport, security checkpoint, front gate
duty, Iraqi civilian escort, supply missions and operations
tracking.
The living areas were shared with ourselves and 716th.
There was no running water, just a water buffalo and one-man
shower that could only be used by the 716th.
Eventually, we built our own showers, got some water cans
and imagined being home. Latrines were as such, tent poles put
into the ground to urinate, two wooden stalls with large cans
underneath to move your bowels. And every day, a detail was
assigned to burn the waste which was located outside the living
area.
The unit was then given the task of establishing training
curriculum for the new Iraqi police officers academy. Our unit
consisted of many law enforcement officers and this was a task
that the battalion wanted us to handle. Approximately 3 weeks
passed, and our unit was given an assignment. We were to be
tasked out to the Marines to run in pre-operations, military
police operations. So we set out to link with the 1/7 Marine
Division in An Najaf and began an assignment given us. The
living conditions here were a little better than our last
location. But we had to deal with the same set of sanitary
conditions, which was fine with us because our unit was very
honored and proud to be serving our country. Well, we spent
about a month there and were given movement orders to As
Samawah.
So we set out to join the 2/5 Marine Division. This had to
be one of the hottest days since we had been in country. During
the convoy drive, I became dehydrated, which caused me to
become a heat casualty. The medics had given me three IVs and
were in fear that I was having a heat stroke. A fourth was
about to be administered, but then my temperature started to
improve, and I was given an area to lie down. From that point
on, my health just began to deteriorate. I became very weak.
Headaches began. I was constantly fatigued, no real appetite,
and I just did not feel very well.
Then it seemed as though the whole unit began to get ill.
My operations sergeant went down and other soldiers started
coming down with high fevers, kidney stone problems, diarrhea,
blood in the urine, and this continued for weeks.
This train repair facility was horrible. It was inhabited
by pigeons, rodents, dust, dirt, flies, fleas, oil, trains and
daily sand storms.
I just dealt with my condition trying to exercise, work and
be a productive soldier. These problems didn't stop. They
persisted and got worse.
Time had passed, and we had been given orders to move. And
this is when the Dutch marines arrived. They had come to
replace us and the 2/5 who were finally going home. I
remembered being so impressed with the Dutch because it seemed
as though they brought all of home with them. They immediately
began to not only get their troops settled in, but began to
check the environment and living conditions. And I didn't find
out until I returned to the United States that the Dutch found
there were too high radiation and asbestos levels which made
living for their troops unsuitable healthwise. So they moved
their camp outside the training facility, which brings me to
this pressing issue.
Why does it seem as though other countries are concerned
with their troops' health? The time I spent in Iraq, it seems
as though there were more pressing issues. I completed and
viewed risk assessments and didn't see anything about chemical
or biological threats. I read reports on how all U.S. military
forces need to be on one page, have the reports forwarded in a
timely manner, receive better training and even the proper way
in which the report is to be completed. But don't you think
that after the first Gulf war and issues of health from that
war, we should have gotten it right for this one? Or did we
already know and choose to ignore it?
Why did it have to take myself and other soldiers getting
ill to find out about the depleted uranium? Why does a soldier
have to find out by getting his wife pregnant and having his
daughter deformed for us to put hearings such as this together?
Why did I have to experience being looked at in a negative way
by my immediate chain of command and soldiers in my unit as
well as doctors and staff at Walter Reed when all I did was be
concerned for soldiers?
Why, when the injured, when we inquired about DU in Fort
Dix, did they inform us that there was no known testing for DU?
Why did I have to seek outside help to be tested? And why did
it take myself to find out from the deputy director of
Deployment Health Support that soldiers' illnesses are tracked,
and if there are too many of the same illnesses, an alarm is
set off and commanders are contacted to address the issues?
Why are commanders living as though they are God deciding
who goes for treatment? Why was I told that, when I reported my
findings to the staff at Walter Reed, I was questioned for
hours and told, out of all the troops from Iraq, what made me
think I was exposed, that they were the experts and that they
know I was not contaminated?
Why are methods of testing not sophisticated enough to
detect the levels of DU?
Why was Senator Hillary Clinton told at a Joint Arms
Committee Meeting that all troops returning from war would be
tested and today still having to bring proof that they may have
been contaminated?
I am here because, as a soldier, this has to be corrected
by the soldier. It is the soldier, not the reporter, who has
given us freedom of the press. It is the soldier, not the poet,
who has given us freedom of speech. It is the soldier, not the
lawyer, who gives us the right to a fair trial. It is the
soldier who serves, defends, who salutes and whose coffin is
draped by the flag.
I and the others didn't go to Iraq ill. And I need to know
why it happened. And with all the resources that this country
has, we need to take responsibility for this and make it right
with the soldier.
[The prepared statement of Staff Sergeant Ramos follows:]
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Mr. Shays. Thank you. Let me stop you there, and then I
will ask you questions of what you had later so you will be
able to cover the rest of your testimony.
Mr. Chasteen.
STATEMENT OF DAVID CHASTEEN
Mr. Chasteen. First, I would like to thank Congressman
Shays and all the members of this subcommittee for organizing
this hearing.
I am here today on behalf of Operation Truth, the Nation's
first and largest Iraq war veterans organization. We represent
a number of veterans in all 50 States, Puerto Rico and Guam.
Our mission is to amplify the voice of the troops. Along with
my fellow veterans, I would like to provide a soldier's
perspective on the issues addressed in the GAO report.
As a chemical and biological officer stationed in Bagdad
with the Third Infantry Division, I was the guy who had to
answer questions like, is this anthrax vaccine going to make me
sick? It was up to me to tell the troops that the things we
were doing to them were keeping them safe and that we were
shielding them from as much risk as possible. But war is a
messy, imperfect business and nothing should be taken for
granted.
Were the vaccines and other prophylaxis appropriate?
Absolutely. Did they make some people sick? Yes. Will we know
the long-term health effects of the various exposures if we
don't step up efforts now to monitor the situation? No.
That is the crux of this issue. An ounce of prevention now
will far outweigh the pound of cure needed if in the future we
are left to guess at the conditions our troops faced.
The bottom line is that, when soldiers come back from war,
they are often sick. Very rarely do we have the opportunity to
collect good data on why that's the case. Now is the time to
rigorously enforce the collection reporting of data on
occupational and environmental hazards for our troops in Iraq.
This is an opportunity to do the right thing. It will save
money in the long run, provide better information to our
doctors and researchers, and, most importantly, go a long way
toward providing better health care for our soldiers.
Today, many of our troops are not convinced that their
health and well being is a priority for the government, and who
can blame them? There is currently no plan in place for
evaluating the long-term health care needs for veterans of the
wars in Iraq and Afghanistan, even though organizations like
Operation Truth have been calling on Congress and Department of
Defense to come up with a strategy for over a year now.
And what's more, the continuing controversy of the funding
shortfalls in the Department of Veterans Affairs demonstrates
an inexcusable level of disregard for the pending health needs
of the more than 1 million uniformed men and women who have
served tours of duty in Iraq and Afghanistan.
There are plenty of great folks working hard at the VA,
including my mother who helps run a VA community-based outreach
center back home in Indiana. These people need to be given the
resources required to do their job, and our troops need to know
that, when they come back from war, they will return to the
best health care we can offer them.
In today's edition of the Washington Post, Operation Truth
has placed an ad calling on President Bush and Congress in no
uncertain terms to clean up the VA funding mess immediately and
to provide the leadership needed to ensure that our troops and
veterans don't get short changed.
The problems revealed in the GAO report should be addressed
with the same level of urgency. We have had troops on the
ground in Iraq for over 2 years now. And we cannot wait any
longer to make their health needs a top priority. The
guidelines for health hazard surveillance exists, as noted in
the report, the results of previous congressional hearings
similar to this one today.
Our Congress must demand that the Department of Defense
correct the problems that our commanders in the field face when
they try to follow these guidelines and the hurdles our
doctors, nurses and researchers run up against when they try to
put that field research to good use. Reporting must be
standardized between the branches of service, and
classification policies must be re-evaluated to ensure that
they don't needlessly jeopardize the health of our troops. The
Department of Defense must work more closely with the VA to
better anticipate the health needs of our returning troops.
On behalf of your constituents, you should not tolerate
continued foot dragging when it comes to the well being of our
men and women in uniform. They must know that the full
resources of Congress are being brought to bear on their
behalf, that they won't have to fight a second war for adequate
health care when they return home.
Our troops should know that not just our country but also
their government is committed to their well-being. Thank you.
[The prepared statement of Mr. Chasteen follows:]
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Mr. Shays. Thank you very much.
Dr. Crosse.
STATEMENT OF MARCIA CROSSE, Ph.D.
Dr. Crosse. Mr. Chairman, members of the subcommittee, I am
pleased to be here today as you consider DOD's efforts to
collect and report health surveillance data to address health
issues of deployed service members.
These issues have been of particular interest since the end
of 1991 Persian Gulf war when many service members subsequently
reported suffering from unexplained illnesses.
Research and investigations into these illnesses were
hampered by a lack of health and deployment data including
inadequate occupational and environmental exposure data. In
response, DOD developed military-wide occupational and
environmental health surveillance policies for use during
deployments. These policies call for the submission of health
surveillance reports to a centralized archive within specified
timeframes. The military services are responsible for
implementing these policies.
My remarks will summarize our findings on how the deployed
military services have implemented these policies for Operation
Iraqi Freedom [OIF], and the efforts underway to use health
surveillance reports to address both the immediate and long-
term health issues of the deployed service members.
In reviewing the implementation of these policies, we found
that, although health surveillance data generally have been
collected and reported for OIF, the deployed military services
have used varying data collection standards to conduct their
health surveillance. As a result, they have not been collecting
comparable information.
In addition, the deployed military services have not
submitted all health surveillance reports for OIF as required
by DOD policy for archiving the information. However, officials
don't know if reports are not being completed or if they are
just not being submitted to the archive because they do not
have information about how many health surveillance reports
have been completed during OIF.
DOD has made progress using health surveillance reports to
address immediate in-theater health risks during OIF. OIF is
the first major deployment in which health surveillance reports
have been used routinely as part of operational risk-management
activities. These activities have included health risk
assessments of the potential hazards at a site, including soil
and water samples; risk mitigation activities to reduce
potential exposure, such as relocating trash burning pits
downwind of housing; and risk communication efforts to make
service members aware of the possible health risks, such as
reminders to use insect repellent to reduce the likelihood of
insect-borne diseases. While these efforts may help to reduce
immediate health risks, DOD has not evaluated their
effectiveness in OIF.
DOD's ability to address potential long-term health effects
is limited by several factors related to the use of its
centralized archive of health surveillance reports for OIF.
These include limited access to most reports because of
security classification, incomplete data on service members'
deployment locations and the lack of a comprehensive Federal
research plan incorporating the use of archived health
surveillance reports. Overall, although DOD has made progress
with health surveillance data collection and reporting, the
usefulness of such reports is hampered by DOD's limited ability
to link reported information to individual service members.
DOD officials have said they are revising an existing
policy to add more specific health surveillance requirements,
but unless the military services take measures to implement
this policy, efforts to collect and report health surveillance
data may not improve.
Consequently, we recommended that the Secretary of Defense
ensure that cross-service guidance is created to implement
DOD's policy once it has been revised in order to improve both
the collection and reporting of health surveillance data during
deployments and the linking of this information to service
members.
While DOD's risk management efforts during OIF represent a
positive step, the lack of systematic monitoring prevents full
knowledge of their effectiveness. Therefore, we recommend that
the military services jointly establish and implement
procedures to evaluate the effectiveness of risk-management
efforts.
Furthermore, although health surveillance reports alone are
not sufficient to identify the causes of potential long-term
health effects, they are an important part of research on the
long-term health of deployed service members. To better address
potential health effects of deployment in support of OIF, we
recommend that DOD and VA work together to develop a Federal
research plan that would include the use of archived health
surveillance reports.
Mr. Chairman, this completes my prepared statement. I would
be happy to respond to any questions you or other members of
the subcommittee may have at this time. Thank you.
[Note.--The GAO report entitled, ``Defense Health Care,
Improvements Needed in Occupational and Environmental Health
Surveillance During Deployments to Address Immediate and Long-
term Health Issues, GAO-05-632,'' may be found in subcommittee
files.]
[The prepared statement of Dr. Crosse follows:]
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Mr. Shays. Thank you. At this time, the chair would
recognize Mr. Kucinich. I know he is putting his statement in
the record. But I welcome him to make a statement, and he could
start out with questions if likes.
Mr. Kucinich. I thank the chairman.
And I would like, with the Chair's indulgence, to have my
statement be included in the record and, also with the Chair's
indulgence, to be able to ask a few questions at this time.
[The prepared statement of Hon. Dennis J. Kucinich
follows:]
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Mr. Shays. Yes. You have the floor.
Mr. Kucinich. I want to thank the chair. I want to start
with all the witnesses and say thank you for attending and for
your concern about protecting the health of those who serve
this country.
I would like to begin by asking Staff Sergeant Ramos,
uranium toxicity is not an every day occurrence. And we do not
know of all the effects or how to test for this highly
dangerous illness. Could you tell us a little bit more about
your unit's experience with depleted uranium radiation?
Staff Sergeant Ramos. I didn't know anything about DU.
I started getting these symptoms, and as I mentioned in my
statement, when I inquired, our medic had to come back, and he
had mentioned to us that the Dutch had found some radiation
levels. I inquired about it at Fort Dix, about depleted
uranium. We met with a lieutenant there. We sat down, and he
told us that we had nothing to worry about. And we said, well,
how can we get tested to make sure? And we were told that there
was no known testing for depleted uranium. I had gone outside
of the military to inquire as to how I could be tested.
Mr. Kucinich. And when you went outside the military, what
information were you able to get on your own that you weren't
given by----
Staff Sergeant Ramos. I was put in contact with a Dr.
Durakovic, Asaf Durakovic. And he took the urine samples of
myself and some other soldiers. And the samples were sent out
to three different countries, Germany, Japan and Spain. And
then I received a report from him, which I have a copy of it
here on March 24, 2003.
And which it explained the ratio of 238 and 235 is 146.9.
Mr. Kucinich. Mr. Chairman, is that already in the record?
Mr. Shays. No. So without objection, we will put it in the
record.
Mr. Kucinich. So when you received that report, what went
on in your mind about this experience.
Staff Sergeant Ramos. When I received the report, I was
confused. I didn't know what was going on. And I said, I need
to get answers to this. I had already started my medical board
process at Walter Reed. So when I informed them that I had this
document, I was told to get a copy of it and submit it for
review.
When I had it faxed to me--I turned this in at the medical
board. And then I was directed to meet with a Colonel Hack and
Lieutenant Colonel Mercer at Walter Reed.
Mr. Kucinich. In looking over your testimony, I just would
like to go back over something. How did you come into contact
with depleted uranium?
Staff Sergeant Ramos. Sir, I don't know how I came into
contact with it. I don't know in whatever part of the country
in Iraq I was in; I was not aware of what was in my
surroundings. When I was at the train station is where I became
the most ill.
Mr. Kucinich. Let me ask you this if I may.
Were you firing any munitions yourself.
Staff Sergeant Ramos. No. I did not fire any munitions.
Mr. Kucinich. But you were in places, say, after the fact?
Staff Sergeant Ramos. Correct.
Mr. Kucinich. You were in places where it is your belief
that you were exposed?
Staff Sergeant Ramos. Yes.
Mr. Kucinich. To depleted uranium?
Staff Sergeant Ramos. Yes.
Mr. Kucinich. Were you exposed on skin, or did you breathe
it in? Do you know? Could that really be ascertained?
Staff Sergeant Ramos. Sir, the only thing that I can think
of is inhaling. There was a lot of dust blown around the area.
And that is the only way I think I could have gotten it.
Mr. Kucinich. How are you feeling now?
Staff Sergeant Ramos. I have daily headaches. I have
numbness. My hands go numb. I have joint pains and fatigue.
Mr. Kucinich. How old are you?
Staff Sergeant Ramos. I just turned 43.
Mr. Kucinich. And other than this encounter with depleted
uranium, were you in pretty good health?
Staff Sergeant Ramos. Prior to me going to Iraq, yes.
Mr. Kucinich. Have you been in touch with others in your
unit who went there?
Staff Sergeant Ramos. Yes.
Mr. Kucinich. And they have experienced some of the same
concerns, physical problems?
Staff Sergeant Ramos. The soldiers that I know of that were
tested, yes. Other soldiers in my unit, they haven't expressed
anything--any ill effects to me. Just the soldiers that were in
my unit.
Mr. Kucinich. In your testimony, you alluded to one of your
associates whose wife gave birth and the baby was deformed.
Staff Sergeant Ramos. Yes.
Mr. Kucinich. Are you in touch with that family still?
Staff Sergeant Ramos. Yes.
Mr. Kucinich. Have they had any tests done that would link
the birth deformity to the exposure of your associate?
Staff Sergeant Ramos. He has not had a test that has linked
the exposure to his child. He has tested himself and has tested
positive.
Mr. Kucinich. Positive for what?
Staff Sergeant Ramos. Depleted uranium.
Mr. Kucinich. I would like to ask just one question, if I
may, of Mr. Chasteen. What conclusions have you made about the
medical health system currently in place for soldiers relating
to this issue about depleted uranium?
Mr. Chasteen. Actually, it is interesting that you bring
that up. A Gulf war resource center had a conference in Florida
a couple months ago which was a really good opportunity to get
soldiers and VSOs together along with the VHA people who are
working on these issues. I had a long conversation, made a
friend with Dr. Drew Helmer, who is a neurologist working at
the War-Related Illness and Injury Study Center at the
Department of Veterans' Affairs in New Jersey. The VA actually
has specific resources set up, kind of cutting edge stuff where
they have researchers and practitioners both working for
people, such as Sergeant Ramos, who have illnesses that
probably are linked to their service but have been unable to
conclusively make a connection to the satisfaction of the VA.
The problem that I have found is that the VA centers in
general are unaware of the resources that are available
elsewhere in the VA for these kinds of research and finding
these kinds of things out. So on the one hand, VA is doing real
good, cutting-edge work in trying to connect people with an
answer. But the VA system at large isn't aware sometimes of
even the resources available internally, and also, these are
very small centers that have very little funding. I don't know
if that answers your question.
Mr. Kucinich. OK, Mr. Chairman, I just want to put this on
the record. You know, my staff had contacted the Department of
Defense, maybe it was a couple of years ago when the first
discussions came up about depleted uranium munitions. And maybe
there is some confusion about it. But some of the information
we were getting out of the Feds was that there were some people
who were actually denying that such munitions were even being
used.
I just wanted to mention that to you because I don't know
that we have had any subsequent hearings where it has truly
been established that depleted uranium munitions were used and
the level at which they were used and the attendant health
risks to our soldiers or to the civilian population.
Mr. Shays. In response to the gentleman's question, we
haven't had any hearings specifically about depleted uranium,
and frankly, the case is really still out whether this
represents a problem or not.
The tests that is on you is a question of reliability, and
everybody has some radiation in their bodies. So the issue is,
is this just abnormal because you were there or would we find
that same issue in people in the United States? So it probably
is an area that some time we should focus on. We just, you
know, pick our hearings and have many to chose from.
Mr. Kucinich. I want to thank the Chair for having this
hearing. And as always, you are very concerned in general what
is happening with the people who serve this country. So I thank
you.
Mr. Shays. I thank the gentleman.
I love my staff. We get in a dispute whether it is Ramos or
Ramos. You need to tell me how to say your name.
Staff Sergeant Ramos. Ramos.
Mr. Shays. We will chalk one up to the understaff and not
to the counsel here.
Staff Sergeant Ramos, I would like you to, because I cut
you short here, would you just tell me the illnesses you had?
You said, here is a list of what I came back with.
Staff Sergeant Ramos. Sleep apnea with fatigue,
Fibromyalgia.
Mr. Shays. What does the percent mean? I don't understand
the percent. It says zero percent.
Staff Sergeant Ramos. These are, prior to me being
deactivated from military service, these are percentages I
received from Department of Defense. It is not what I have
received from the VA. This is from the Department of Defense.
Mr. Shays. So it is a disability rating? It is not the
percent of sleep fatigue?
Staff Sergeant Ramos. It is a disability rating.
Mr. Shays. It is not the percentage of sleep----
Staff Sergeant Ramos. No. Fibromyalgia was zero percent.
The PSTD, headaches with Punctuate White Matter, Ischemic
Changes in Parietal Lobes, 30 percent. Cervical myalgia, zero
percent. History of single Leishmaniasis lesion on Left
Anterior Chest, now with pigmented scar, zero percent.
Bilateral Ulnar Nerve Compression Neuropathy, zero percent.
Depleted uranium exposure medically acceptable, zero percent.
Skin rashes, zero percent.
Mr. Shays. I am going to, at this time, have our counsel
ask some questions to the witnesses.
Mr. Halloran. Let me start with Dr. Crosse. Could you
describe for us the impact or the differences you saw in this
military service branch's approach to these issues and the
impact those differences had on the effectiveness of the
surveillance program?
Dr. Crosse. Yes. Let me see if this microphone will work
this time. The services have teams of preventive medicine units
that go out to do this range of activities that they engage in.
The teams are composed of different types of individuals with
different sorts of expertise. Each service has comprised their
teams of different kinds of specialists. And so, to begin with,
you have people with different sorts of training, levels of
expertise going out and doing this.
It's not necessary that an Army unit would necessarily have
an Army preventive medicine team coming in there. So you can't
just assume that the data that are collected for Army bases are
comparable. Because some of the data for an Army installation
might be collected by an Army unit, some of it might be
collected by a Navy unit coming in. They have different types
of expertise.
They also collect somewhat different information. For
example, the water sampling is done the same across all the
services, but the soil sampling is different. The Army teams
collect samples for 20 types of hazards, the Navy teams collect
samples for 15 types of hazards, so it's highly dependent upon
who has done the data collection at a particular installation
at a particular time as to what kind of information would have
been gathered to even be available for archiving.
Mr. Halloran. What explains the consistency of water
testing? Is that a happy accident or did----
Dr. Crosse. Well, each service has been allowed to develop
their own guidance to implement these broader policies. DOD is
now in the process of trying to modify some of this--the
policies to try to get more comparable kinds of requirements
across the services, but that's not yet in place.
Mr. Halloran. So they all just have to do about same water
standard, is that----
Dr. Crosse. Perhaps. There is a joint working group that is
trying to come together to develop standards. And it may be
that water sampling is more straightforward. I'm not a
technical expert to say why that may be the case. But they've
implemented them in different ways with different types of
individuals, different levels of training.
Mr. Halloran. DOD points to a low rate of non-battle
disease injuries in this theater in particular, in Iraq, as
admittedly indirect evidence of the effectiveness of these
preventative medicine programs. Can you evaluate that claim for
us?
Dr. Crosse. I think it does give some reassurance for the
kind of immediate health effects that you would see in theater.
They have, as we said, made progress I think in going out and
trying to examine the risks on a base, to try to locate trash
burning away from housing, to try to do other kinds of things
that would reduce some of the immediate risk the troops might
face. I think it's way too soon to know what it has done for
longer-term health effects.
Mr. Halloran. Sergeant Major La Morte, let me segue to you
on that subject. In your testimony you describe various moves
your unit made to different locations. At each of those
locations, could you describe for the subcommittee the kinds of
environmental information you were given before, during, after
your stay there in terms of what hazards might be there, what
to avoid, what mitigation steps you might take?
Sergeant Major La Morte. The only report we had when I was
at the Forward Operating Base 32 was that the Taranac Farms
trading area that we used as a range came up hot for blood
agent and nerve gas agents; and we assumed, having not taken it
with us, that it was left from the Soviets since they travelled
with those chemical weapons as part of their SOP.
Mr. Halloran. And that area is just marked off as hot and
you didn't go there, or what was done about it?
Sergeant Major La Morte. The last report I had, that area
has been bulldozed over and is no longer used.
Mr. Halloran. And did you make note of that incident in
your other----
Sergeant Major La Morte. I made notes--when I came home, I
put it in my medical records that I had been in the area of
contamination, but I have nothing--because that report was
secret--that I can put in my medical records.
Mr. Halloran. Staff Sergeant Ramos, could you address the
same question in terms of the locations? If so, what kind of
environmental occupational hazards were you told were there?
What information were you told about what to do about them?
Staff Sergeant Ramos. Right. The information that I was
given afterwards is that there were tanks, vehicles that had
been struck by rounds that were outside the encampment. I
worked in an operations cell, so I was pretty much enclosed in
the building 24 hours a day. I wasn't aware of what was outside
the encampment. It wasn't until, as I said in my statement,
when I got back that I was told that when the Dutch came in
they were taking samples, and they found it unsuitable for
their soldiers to stay in the training facility, so they built
a holding encampment outside of the training facility in
Samawah.
Mr. Halloran. Mr. Chasteen, does your organization have any
kind of information or visibility on the pre- and post-
deployment health assessments and their use and effectiveness?
Mr. Chasteen. We do actually have some reports on that. I
don't have it handy. I can have my staff get it to you.
I will say, though, that I agree. I think it's been a
marked improvement from the first Gulf war in terms of actually
having those assessments and doing those assessments. I know
that me and my soldiers got the pre- and post-deployment
assessments. I know that was a little more regular for Active
Duty soldiers than it was for National Guard and Reserve
soldiers, which is I think not surprising just in terms of kind
of central locations for both where the soldiers lived and
where they were going to return to after they deployed and came
back.
Again, with any of these things, you've got conflicting
motivations. The soldiers, they want to go home. They're not
real interested in a post-deployment examination. They want to
get back to their families. And if those families are off base,
it can be harder for National Guard and Reserve soldiers to
have to stick around an additional week to get those done, as
opposed to Active Duty soldiers who can go home tonight, come
back in a couple of work days and get that done.
So those are some of the issues that are at play there.
Mr. Halloran. Staff Sergeant Ramos, I think you said you
have sought VA care since you separated from the service; is
that right?
Staff Sergeant Ramos. Yes. When I separated from the
service, I went to the VA to file my paperwork for my health
issues, and since then I've received 80 percent from the VA for
my health issues.
Mr. Halloran. So you found both the VA disability, the
process and the health care process had access to information
they needed from your military medical records?
Staff Sergeant Ramos. Well, I had made copies of my
military medical records. I had to make copies. We had a lot of
issues in Fort Dix where things were taken out of your medical
records, so I made copies of everything.
So when I came back I had everything chronologically filed,
and I submitted for each one of my issues documentation,
medications that I was taking, so it made it very easy. Because
the VA's computer system is not on the same with DOD's, so they
don't have access to doctors' notes or addendums.
Mr. Halloran. So you did that yourself.
Staff Sergeant Ramos. I did that myself.
Mr. Halloran. And, Dr. Crosse, what kind of information did
GAO find getting into individual medical records?
Dr. Crosse. Well, there is not a lot of getting individual
medical records generally. For the air bases, the Air Force has
created a summary that can be placed into each service member's
medical record that explains the sorts of hazards that exist at
that air base. It will talk about exposure to fumes from the
fuels and other kinds of things that would exist in that area,
the sorts of insects and diseases that are known, the dust or
other kinds of problems that may exist in that location; and
that's placed into every service member's record who is at the
air base. That is not done regularly for service members in
other locations, however.
For Port Shuaiba, the Army and the Navy have created a
similar kind of exposure summary document, but it's up to
individual service members to place that into their own medical
record if they want it to be placed there. It's not routinely
done for them.
The other kind of exposure documents that would be placed
into a service member's record is if there is an incident that
is actually investigated. If, for example, a tank blows up and
a lot of people become ill from the fumes and they go in and
try to determine what kind of chemical was there and who was
exposed, then there could be a report made for all of the
service members who were exposed in that specific incident.
But, otherwise, there are not routine reports being placed into
service members' records for each location where they're housed
as they're moved around in Iraq.
Mr. Halloran. Sergeant Major La Morte and Staff Sergeant
Ramos and even Mr. Chasteen, were you told--let me try to
address Congressman Kucinich's question. Were you told there
were DU rounds in the vicinity at any time? Were you told about
the hazards of DU before, during or after your deployment?
Sergeant Major La Morte. Yes, sir. I'm aware of DU hazards.
It's in our training for MDC training. There were no reports
that I'm aware of in the military that have indications where
those rounds were used. If there was an overlay for that area,
it would be helpful. Any time that the Air Force is working
with an Asian aircraft, it has depleted uranium rounds. I would
assume that you're in a depleted uranium area.
Mr. Halloran. And, Staff Sergeant Ramos, I think you said
there were some bombed vehicles, or just----
Staff Sergeant Ramos. Yes, there were vehicles. Especially
there was one outside of the operations area. There was a
vehicle that was left there. But----
Mr. Halloran. Was it said or known that it was a DU round,
or just suspected?
Staff Sergeant Ramos. No. I just saw a vehicle that was
blown or shot up that was left there in front of the building
that we ran our operations out of.
But, as far as training, we didn't get anything on DU. Most
of our training was on MP operations, patrols, and how to
properly mark unexploded ordinances.
Mr. Halloran. And has DOD communicated with you since
you've returned, saying you were part of a cohort or a group
that might have been exposed to certain hazards at the training
location?
Staff Sergeant Ramos. No, I have not.
Mr. Halloran. VA neither?
Staff Sergeant Ramos. No.
Mr. Chasteen. I was actually the radiation safety officer
for my DIVARTY, and so depleted uranium was my purview as part
of my responsibilities. We did do depleted uranium training for
soldiers who were going to be coming into contact with those
kinds of rounds.
Obviously, the most common use of depleted uranium in the
Army is for cab guys, guys who are operating the M-1A and M-1A-
2 battle tank. Those units do depleted uranium training on a
regular basis because there is an immediate hazard to soldiers
who handle DU rounds and then would eat afterwards without
having washed their hands. Because, obviously, the main risk of
DU is through ingestion, and that can be a serious problem
because it is toxic.
The soldiers who were going to be working with--we have
some artillery soldiers who are Reservists who were attached to
the cab who did actually get depleted uranium training to make
sure that they understood that if they were handling those
rounds or near those rounds, whatever, that they needed to take
part in precautions, which mostly involved washing their hands
before they ate.
Mr. Kucinich. If I may, Mr. Chairman, to Mr. Chasteen, how
many soldiers received depleted uranium training, to your
knowledge?
Mr. Chasteen. I would have to say, as part of--there are
annual NBC requirements and there are annual radiation safety
requirements. So my specialists, my 54 Bravas, NBC NCOs who
were attached to each company or battery and DIVARTY, those
guys would get it as part of their annualized training.
Mr. Kucinich. Can you extrapolate as to how many that might
be?
Mr. Chasteen. Well, I would say it would be approximately
32, but those would be the specialists who were assigned to
each battery. So the specialists who were responsible for
knowing those things got the training on a regular basis, but
in terms of then disseminating that information out to the rest
of the soldiers, I can't say.
Mr. Shays. Let me tell you, Dr. Crosse, I have one question
that I want you to think of the answer, so I will just have a
conversation with the others for a second. You might want to
consult with your colleagues.
I want you to rank the four branches as to which is further
along in this effort. The bottom line to your report is we're
making progress on optional safety issues in the environment in
the workplace, but which is doing the best at keeping proper
records and trying to keep track of our soldiers in this case
and which is doing the worst? And then I want you to explain to
me why.
Staff Sergeant Ramos, your testimony, I thought--what I was
struck most by--and obviously all of your testimony is very
helpful--but you said, when you're talking about the Dutch,
they immediately began to not only get their troops settled in
but began to check the environment and living conditions; and I
didn't find out until I returned to the United States that the
Dutch found there were too high radiation asbestos levels,
which made living for their troops unsuitable healthwise, so
they moved their camp outside the training facility.
I think that speaks volumes. Our folks lived there, and the
troops that replaced them decided to live somewhere else
because they bothered to check.
And I would say to you, Sergeant Major La Morte, I found
this interesting. I and my fellow soldiers were willing to face
combat and the dangers that it brings, but what I find
disturbing is the looking the other way when it's time to treat
or even test the members who are so willing to face bodily
harm. The right things need to be done. Step up the monitoring
and the treatment and documentation of the exposure.
What I take from your testimony is you all know that
sometimes you're going to be in bad workplaces. Now sometimes
you don't have to live in one place, you can move, but when
you're fighting, you're going to have--OSHA inspectors aren't
going to be able to tell everybody exactly how to conduct
themselves. Sometimes they simply can't. So you're going to be
exposed to bad things.
I think your point is, when we are, we need to make sure
that we're aware of it, are tracking it, and following that
throughout the rest of that individual's life. That is the
obligation that I think exists.
Dr. Crosse, I'm trying to filibuster here. Do you have
enough----
Dr. Crosse. I have an answer.
First, I would say that the archives aren't tracking which
services are submitting reports. As I mentioned before,
sometimes the Navy unit is submitting a report for an Army
base. However, we believe in general that the Army and the Air
Force are doing a better job than the Navy and the Marines. The
Army has the lead responsibility and the longest history
because of CHPPM, their Center for Health Protection--I'm
forgetting what it stands for there--Health Promotion, and they
have had the lead in general on these issues.
The Air Force has an advantage of having fewer fixed
facilities, and they have taken the lead on creating these
exposure summaries that they place into the records of every
service member.
The Navy and the Marines have lagged both in terms of doing
the pre- and post-deployment health assessments. GAO put out a
report a few months ago on the pre- and post-deployment health
assessments, and the Air Force and the Army were doing a much
better job than the Navy and Marines--particularly than the
Marines in doing those kinds of health assessments and getting
them into the individual service member's records.
Also, the Marines are supported by the Navy, but the
Marines are moving around to many different locations in Iraq,
and their location identification has been a particular
problem, we believe.
So, in general, that's the order in which we would place
the services. But, again, we don't have across-the-board data
to measure different components for each service.
Mr. Shays. What type of cooperation did you think you were
receiving from the branches when you were doing your study?
Dr. Crosse. I believe we had good cooperation from them. I
think that the problem is that some of the kinds of information
we wanted to obtain just weren't available.
Mr. Shays. Because they were classified or they just
weren't available?
Dr. Crosse. Well, some of both. But we have security
clearances so that we would be able to access the information,
so it was really more of an issue of some of the kinds of
information just aren't available.
Mr. Shays. Before the troops were sent--we had the military
here. They said they would be checked out before they went, and
they would be checked out when they got back.
What I'm troubled with is, first, I'm not quite sure what
``checked out'' means now. Second, though, when a soldier is
requesting--and others can speak to this as well--requesting
that they verify for certain exposures and it's not being done,
I particularly find that unsettling. In other words, if a
soldier says I think I was exposed.
But, tell me, what is your sense of how many troops, if you
have a sense, where their health was verified at the beginning
and how many when you came back do you think they went through
a decent health check?
Dr. Crosse. In terms of the pre- and post-deployment health
assessments, which is a fairly short assessment that's done,
the Army and the Air Force were in excess of 90 percent, the
Marines were somewhere around 70 percent, and the Navy was a
little above that, maybe 80 percent. I don't have the programs,
I could provide them to your staff.
[The information referred to follows:]
[GRAPHIC] [TIFF OMITTED] T6238.110
Mr. Shays. When you asked officials there why, frankly, not
100 percent but certainly why just 70 percent, what kind of
response would you have received?
Dr. Crosse. Well, that wasn't part of this review. We do
have an entirely separate report on that.
But some of the issues were, just as Mr. Chasteen
mentioned, some of the service members wanted to quickly be
demobilized and get back to their families. It was not
necessarily being done within the first day or two of their
arrival back stateside, and so that became a problem, getting
people back in or being sure that all of the steps that were
necessary were completed. So it was apparently more routine and
given a higher priority by the Army and the Air Force.
We also noted in that report that we had previously looked
at the Army and the Air Force for their compliance rates, and
they had improved considerably. We had not previously looked at
the Navy and Marine compliance with those requirements, and
they were still quite low.
Mr. Shays. Some of this is like a bad memory for me because
we've had so many hearings on this, and there has been a lot of
resistance, not now, on the part of DOD and the VA. But what we
learned from VA was they hardly had anyone, any doctor, who had
any background in occupational hazards. It was as if they could
name only two people out of thousands; and so, you know, the
expertise they had just wasn't in this area.
But literally sitting at that table or one like it, on
either side of Mr. Donnelly was his wife and his father. When
we asked him would he still have gone in the military and
served if he knew that he would get ALS, I thought he would
say, what are you, crazy? But his word was said so softly
because he couldn't speak very loudly, but he said it quickly,
it wasn't a hesitation.
So I just think it's important to just put on the record
that when we have military people who come down and complain
about their bad health, I think they have, one, a right to be
unhappy if they were exposed needlessly, but I think they also
know that they're sometimes going to be exposed. But I think
they have a real right to be angry if they believe that they
have been exposed and aren't getting the kind of care they
need. And that care means that we need to have the records, we
need to know how they went in, we need to know how they left.
Then there are, frankly, some folks who may not feel well
today but have no sense that it may be connected to their
military service because there may have been a bit of delay. It
is unsettling to think that someone gives birth to a child--
and, I mean, there are children who are born deformed from
parents who were not serving in the military, so you're not
always sure, but the fact that someone could wonder. If I were
in the service and I knew that my child was deformed and I
thought it might be because of something I did or received, it
would be something I would be living with the rest of my life,
even though I couldn't be blamed for it. But it's just--so
there are just lots of different levels of the need to continue
to make further progress.
What do you think would be the most helpful thing we could
be suggesting to our next panel from the VA and DOD?
Dr. Crosse. Well, we believe that----
Mr. Shays. And I open that to all the panelists as my last
question.
Dr. Crosse. We believe that they need to be sure that the
policies they're putting in place are implemented consistently,
which would include the collection of this kind of information
and the archiving of that information, including the location
data that their policies already call for but that are not
consistently being complied with.
We also believe that they need to put in place some more
specific plans for evaluating and researching what is going on
and the effects on the service members.
Mr. Chasteen. I would say that, as with many things in the
military, it's extremely important that you make sure that the
responsibility for making sure the policies get implemented
falls with the person who has the power to make sure that those
orders are actually enforced.
What's going to be important is, if we're going to make
this a priority, it has to be something that the command is
aware of and the command is going to be evaluated on. If the
commanders have on their OER, you know, did or did not complete
with guidance on pre and post, this, that and the other, the
problem is you have a commander deciding whether or not the
soldiers can go home early who doesn't necessarily have to have
the responsibility for whether or not the surveys get done and
get sent up to highers. Does that make sense?
Mr. Shays. Yes.
Mr. Chasteen. So you have to make sure that the commanders
are going to be evaluated on whether or not they comply with
this, and that's the only way it's going to get done.
Mr. Shays. Now, speaking to our two sergeants here, did you
feel that it was the responsibility--why don't you answer the
question I just asked, and then I'll ask this last question.
Staff Sergeant Ramos. Well, I agree with Mr. Chasteen that
the responsibility has to fall on the commanders. The
commanders are given a great deal of responsibility, and one of
the responsibilities, most important, is the welfare of their
soldiers.
I also believe that when soldiers DMOB, that DMOB stations
do not offer soldiers a speedy exit: If you sign this waiver
you can get home right away. But then the soldier doesn't
understand that, once they sign that waiver, if something
should happen to them later on, they can't come back to the
mobilization station and say, you know, my thumb was hurting
me. Uh, uh, uh, you signed this waiver, so medically you're
cleared.
I think that's where a lot of problems are happening,
especially with my unit. They returned, and they were
immediately given bottles to submit samples for DU. They stood
on long lines; and they were told, oh, it's going to take a
long time. A lot of them just did not test.
Mr. Shays. OK.
Sergeant Major La Morte. One of the problems we have is
everything is documented as secret, especially in the special
operations community.
Mr. Shays. Not everything is documented as secret. Let's
not get carried away. What do you mean by everything?
Sergeant Major La Morte. Where I've been, what I've done in
country is classified secret. There is no correlation when I
have gone on patrol, where I've gone, whether I've been exposed
to agents or not. If we have to hastily take over a house,
nothing has been checked.
Mr. Shays. Right. But that's going to happen, you're going
to take over a house, and it's not going to be checked, right?
Sergeant Major La Morte. I understand that, sir, but if
where I have been is kept secret and later on it is identified
as a hot spot, how am I going to be correlated into that area?
Mr. Shays. Good point.
Sergeant Major La Morte. A lot of the historical
documentation has been wiped off computers in order to bring it
back in the country or left in country. It is as easy to keep
the documents there than it is to transport them. There is a
lot of electronic media than we don't have access to bring
home.
Mr. Chasteen. The Sergeant Major and I were discussing this
before this hearing conferred. A lot of times the VA is asking
for information regarding where soldiers were located when they
were serving to try to make correlations between agent
exposures and things like that, and something that you actually
run into is there is a real disincentive to actually even bring
that information back from the deployment.
You know, every battle captain like myself keeps logs of
what takes place during combat operations. Those logs are
classified. At the end mobilization there is this big return
home, and almost everything that you have worked with during
deployment, all this staff work and all these other things,
they're classified because it happened during war. Then when
it's time to go home you have a safe about this big to take
everything home in, and naturally the intelligence officer is
going to say, OK, obviously we're not going to take back every
scrap of paper. So what happens is a lot of these records that
would show where people were and what happened, etc., they are,
a lot of times, on electronic media, on hard drives and things
like that, and a lot of times it's easier to just wipe the hard
drive and say that way I can pack it in my suitcase and take my
unclassified stuff with me and not have to put it in the safe,
rather than take back all that classified data.
Soldiers and officers, the lieutenant guy, is going to take
the path of least resistance. If it is easier to wipe a hard
drive rather than take back data that he is not going to be
accountable for maintaining over the long run, he's going to do
it.
Sergeant Major La Morte. I think certain reports need to be
made and kept unclassified, and those reports being----
Mr. Shays. They may need to be declassified?
Sergeant Major La Morte. Yes. And the other thing----
Mr. Shays. When you come right down to it, the only people
hurting by having it classified are people who served.
Sergeant Major La Morte. Correct.
The other thing we need to look at, especially in
Afghanistan, is we are fighting in a warfront that has been
fought as a chemical war and nothing historically was
researched before going in there. We don't know where the hot
spots the Soviets had that we're tripping over. It hasn't
rained in 17 years in some of those locations, so that
environment is still there, and we're kicking it up every time
we drive through it. Everybody would get sick after they do a
vehicle patrol. So it's there.
Mr. Shays. You all have been very good here, very helpful
to us. Is there any last point you want to put on the record?
Anybody?
Dr. Crosse, you all set? I appreciate the work of you and
your colleagues. As always, it is very helpful.
Anyone else?
Thank you. Your testimony was quite helpful to us, and we
thank you for participating.
We go to our second panel: Dr. Michael Kilpatrick, Deputy
Director of the Deployment Health Support Directorate,
Department of Defense, accompanied by Colonel John Ciesla,
Chief of Staff, U.S. Army Center for Health Promotion and
Preventive Medicine. And from the VA, Dr. Susan Mather,
Veterans Health Administration Department of the VA,
accompanied by Dr. Mark Brown, Director of Environmental Agents
Service, Department of Veteran Affairs.
If you would all stand, please. Thank you.
[Witnesses sworn.]
Mr. Shays. Note for our record that the witnesses have
responded in the affirmative.
Again, I thank you for being here to listen to the first
panel. You certainly have a privilege to go first, and thank
you for waiving that privilege. It will make our testimony all
the more helpful to us, so I thank you for that.
I think we will hear from two, correct, Dr. Kilpatrick and
Dr. Mather. I'm sorry. We have the name tags. Colonel, I was
giving you a doctor; and, Doctor, I was giving you a colonel
here.
Thank you, Dr. Kilpatrick.
STATEMENTS OF DR. MICHAEL KILPATRICK, DEPUTY DIRECTOR OF THE
DEPLOYMENT HEALTH SUPPORT DIRECTORATE, DEPARTMENT OF DEFENSE,
ACCOMPANIED BY COLONEL JOHN CIESLA, CHIEF OF STAFF, U.S. ARMY
CENTER FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE (CHPPM);
AND DR. SUSAN MATHER, CHIEF OFFICER, PUBLIC HEALTH AND
ENVIRONMENTAL HAZARDS, VETERANS HEALTH ADMINISTRATION,
DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY DR. MARK BROWN,
DIRECTOR, ENVIRONMENTAL AGENTS SERVICE, DEPARTMENT OF VETERANS
AFFAIRS
STATEMENT OF DR. MICHAEL KILPATRICK
Dr. Kilpatrick. Mr. Chairman, members of the subcommittee,
thank you for the opportunity to appear before you today to
discuss the Department of Defense's deployment occupational and
environmental hazard health surveillance program, a key
component of our force health protection.
My written testimony you have accepted for the record, and
I thank you for that.
I certainly appreciate the opportunity to hear the
testimony of the first panel, particularly the members who have
served and been in combat. As a former Department of Defense
medical officer and currently working for the Department of
Defense in medicine, we have not done our job well if people
still have concerns and questions about their health. We should
be able to answer those questions, we should be able to give
them the right information, and I have learned some things
today I need to go back and work on how we can fix.
We are, in the Department of Defense, firmly committed to
safeguarding the health of our Active and Reserve component
service members before, during and after deployment.
Occupational and environmental health surveillance is a key in
both Operation Iraqi Freedom and Enduring Freedom. We recognize
the importance of sharing these data with the Department of
Veteran Affairs, and we're working to make that information
more available to them.
The Services, the Joint Staff and the Combatant Commands
have made substantial progress in addressing deployment health-
related issues with occupational and environmental exposures;
and then we heard from the panel before, commanders bear this
responsibility and commanders do what leaders check.
Medical intelligence provided by the Armed Forces Medical
Intelligence Center and other sources is used to anticipate
environmental health hazards; and we have well-trained Army,
Navy and Air Force medical personnel conducting ongoing in
theater environmental surveillance, closely monitoring air,
water, soil, food and disease vectors for health threats. They
collect baseline data on air, water, soil when base camps are
established, routine data, following up with air, soil and
water in those base camps to detect any changes. Then they look
at incident-related data when we anticipate or expect that
perhaps there has happened a chemical spill, industrial
accidents or any illness outbreaks or chemical/biological agent
exposures. That data is certainly systematically identified,
documented and archived.
As you've heard before, the U.S. Army's Center for Health
Promotion and Preventive Medicine is our main archive center;
and they have just recently completed a summary report of OIF/
OEF environmental surveillance monitoring data from January
2003, to April 25. They analyzed nearly 3,900 air, water, soil
samples taken in 274 locations in Iraq, 28 locations in
Afghanistan, and several locations in Kuwait and neighboring
countries. We also have over 1,000 environmental reports that
were collected in theater and have been sent to the CHPPM for
that archiving. Again, these environmental health assessments
give us a very good understanding of what our troops are being
exposed to while they are deployed.
Incident-related data, as you heard from the GAO, is
collected when we believe there is potential contamination with
a hazardous substance; and when we do that, we identify the
individuals at risk, testing is accomplished if indicated,
information is entered into their medical record, and medical
debriefings are provided.
One example of this activity is a possible radiation
exposure threat when the Al-Tuwaitha Nuclear Research Center in
Iraq was looted during the early days of OIF. DOD performed
extensive environmental assessments and checked personnel
radiation levels. We joined with the International Atomic
Agency, Iraq's Ministry of Health and Iraq's Atomic Energy
Commission to perform health evaluations of some 4,000 people
living in five villages surrounding Al-Tuwaitha. The
assessments found no abnormalities related to radiation.
We also developed fact sheets for the United States and
coalition personnel and briefed our service members in town
hall type meetings. Personnel radiation measurements
demonstrated that radiation doses to our personnel were within
acceptable limits, and so we would expect no short- or long-
term health effects.
During OIF/OEF, we have done extensive environmental and
medical surveillance for possible depleted uranium exposure.
The DOD biomonitoring policy, which was redrafted in 2004,
specifies procedures for identifying personnel possibly exposed
to DU, assessing their degree of exposure, and following up
with urine bioassays to document exposure level. We also
include in that testing of individuals we express a concern
about exposure or possible exposure to depleted uranium.
As of last month, we have completed 1,970 samples from
personnel, 24-hour urine samples. Only six of those have been
found to be positive for depleted uranium, and all individuals
were involved in fragment exposure to depleted uranium.
The staff has also looked at some 450,000 post-deployment
health assessment forms where our service members are reporting
their concerns about environmental exposures. The most commonly
reported concerns were sand or dust, vehicle exhaust and loud
noise. The least commonly reported concerns were depleted
uranium and the exposure to radiation. DOD is using these
results, along with our health risk communication capability,
to make sure that there is sufficient information available to
service members, their families, military leaders and health
care providers to alleviate concerns and anxieties that may be
produced because of these exposures.
The Government Accountability Office has identified a
concern that access to archived environmental surveillance
reports is limited by their security classification. Please be
assured that the classification of this data does not hinder
the Department's ability to ensure the appropriate care of our
services members for health issues resulting from deployed
occupational and environmental exposures. We remain committed
to improving the continuum of care through our force health
protection program and to educating our military members about
environmental factors that could affect their health and about
our preventive measures to safeguard their health.
Mr. Chairman, I thank you for inviting me here today. I am
pleased to accept your questions.
Mr. Shays. Thank you.
[The prepared statement of Dr. Kilpatrick follows:]
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Mr. Shays. Dr. Mather, let me just throw out a question I'd
like both of you to think about. I want to get a little bit
more about the depleted uranium. I want to know if it's more
dangerous to breathe or if it's particles are on your skin. I'd
like to know how much information we have about depleted
uranium. But for the site you're talking about, I think it was
actually a friendly fire attack; is that accurate?
Dr. Kilpatrick. The individuals who have fragments were in
friendly fire, yes. They were in close--and it was actually
more calling in air support and being very close to where that
air support fired.
Mr. Shays. Closer than they should have been, or the fire
was a little closer? But, anyway, I will get into it in a bit,
but if you will just know that is an interest there.
And, Dr. Kilpatrick, you're finished, right?
Dr. Kilpatrick. I'm finished.
STATEMENT OF DR. SUSAN MATHER
Dr. Mather. Mr. Chairman, thank you for your invitation.
Thank you for the opportunity to come and talk about VA's
initiatives in response to the healthcare needs of OIF/OEF
veterans.
I am accompanied by Dr. Mark Brown, as you point out, who
is a VA toxicologist.
VA's goal is to ensure that every serviceman or woman
returning from combat has access to world-class services and
uncomplicated, seamless passage from soldier to citizen. This
is dependent, in part, upon the seamless transition of a wide
range of basic data about these new veterans from DOD to VA.
I am pleased to say that VA and DOD together are finding
better ways to move this data more efficiently between our two
Departments. One example is VA's successful development, with
DOD's assistance, of a roster of men and women who have
returned from serving in OIF/OEF and then separated from
military service. Our most recently updated roster of May 17,
2005, contains 360,674 OIF and OEF veterans who have left
Active duty, many of whom have sought VA care. We anticipate
serving 103,000 of these veterans in 2005.
Besides use in tracking veterans, this roster is also
invaluable for providing outreach about the benefits they have
earned.
I would be remiss, too, if I did not mention that VA's 207
vet centers also play an important role in outreach. To date,
VA vet centers have served 18,000 of these new OIF/OEF veterans
in helping their readjustment in civilian life.
VA has also been working closely with DOD to identify those
OIF and OEF veterans who suffer from serious deployment-related
illnesses or injuries, even before their separation. VA and DOD
has signed an MOA that will help give VA access to the DOD
Physical Evaluation Board data base of seriously injured
service members. This effort is being championed by VA's new
seamless transition office established last January, which is
charged with identifying OIF and OEF veterans and insuring
their priority to VA health care.
In your invitation to testify today, you asked about how
occupational and environmental health surveillance collected by
DOD will be used to address health issues of returning service
members. We know from previous experience how important it is
to have credible answers to the questions about possible health
problems from exposure to environmental and occupational
hazards during military deployments, so we are pleased to hear
from DOD about their activities in this area and their
willingness to share this data with VA in the future.
DOD described the active environmental surveillance program
you've heard about today in two briefings to the DOD/VA
Deployment Health Working Group. VA will use this data to help
evaluate disability claims and conduct research on long-term
health effects from military hazardous exposures. It will be
useful but less important for diagnosing and treating health
problems.
For example, an OIF veteran suffering from asthma diagnosis
and treatment would not depend on whether he was exposed, for
example, to sulfur dioxide in the sulfur fire at Al Mishraq,
which Dr. Kilpatrick talked about in his testimony, but the
treatment would be the same regardless of the cause. On the
other hand, if that veteran wanted to file a disability claim
based on a hazardous exposure, then data about his or her
exposure could be essential to support the claim.
Similarly, research into whether asthma rates were higher
among all service members exposed to sulfur dioxide in Al
Mishraq, Iraq, would need these environmental data.
I would emphasize that access to what must be an enormous
amount of raw, uncorrelated environmental surveillance data
without being able to track it by individual location or other
means would not be very useful to VA or to the veterans.
Compiling all this separate data into a useable electronic
format is essential to making this information useful to the
VA.
VA recognizes that making world-class services for veterans
is only the first step. We must also get the word out to
veterans and their families about the services they have
earned. As VA adds names provided by DOD of newly separated OIF
and OEF veterans to our roster, the Secretary of Veterans
Affairs mails each a letter welcoming them home, thanking them
for their service to the country and briefly explaining VA
programs available. We have significantly expanded our
collaboration with DOD to enhance outreach to Reservists and
National Guard, with over 2,000 briefings reaching 135,000
Reserve and Guard members in 2003 and 2004. This year alone we
have provided nearly 1,000 briefings.
Working with DOD, we have developed and distributed over a
million copies of a new brochure summarizing VA benefits for
this group of veterans. The VA has also produced a brochure
addressing major environmental health issues of service members
in Iraq and a similar brochure for veterans in Afghanistan and
also for women, and I ask that these information pieces be
inserted in the record.
Mr. Shays. Without objection, that will be done.
[The information referred to follows:]
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Dr. Mather. The VA has developed a range of training
materials and other tools for frontline staff through the
Veterans Health Initiation, as well as evidence-based clinical
practice guidelines for improving treatment for veterans
following deployment. We are also developing a clinical
reminder to providers with specific health screening
requirements to assure that veterans are appropriately
evaluated.
VA and DOD are making progress in systems that will be the
basis for the transfer of occupational and environmental health
surveillance information and enable the transfer of pre- and
post-deployment health assessment data to VA physicians and
claims examiners.
I have briefly described how DOD's data on new OIF and OEF
veterans helps VA provide better services to veterans in many
different ways. The roster of separated OIF and OEF veterans is
useful for patient tracking, outreach and future research. We
clearly look forward to receiving a complete roster of all
deployed personnel, both separated and those remaining on
active duty, and the environmental and occupational
surveillance data that DOD is collecting today in Iraq and
Afghanistan as soon as it is available in a usable electronic
format.
I want to emphasize that service members separating from
military service and seeking health care from VA today will
have the benefit of VA's decade-long experience with Gulf war
health issues, as well as the President's commitment to
improving collaboration between VA and DOD.
This concludes my statement. My colleague and I will be
happy to respond to any questions that you have.
[The prepared statement of Dr. Mather follows:]
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Mr. Shays. Thank you all very much.
Dr. Kilpatrick, I would like you to read your testimony on
page 10 about Al-Samawah and then just then kind of translate
it for me. It seems we're going to deal with the issue of
depleted uranium.
Let me just say that--both Colonel and Dr. Brown, feel free
to be equal participants in the question and answer--if we ask
one, feel free to jump in. I know Dr. Kilpatrick and Dr. Mather
will enjoy your interaction.
So if you would read this, just the whole education
session.
Dr. Kilpatrick. Certainly, sir.
Al-Samawah, Iraq. Concern about alleged contamination with
depleted uranium and exposure to toxic chemicals among some
members of the 442nd Military Police Unit. Extensive
environmental sampling was accomplished. A classified Navy
environmental assessment report was written and a follow-on
Army environmental assessment is being finalized for this rail
yard, where no combat occurred. No toxic chemicals, with the
exception of some chemicals contained in a railroad tank car,
nor depleted uranium were identified. Nevertheless, 167 were
offered laboratory testing for any depleted uranium exposures;
66 of those personnel participated in the urine DU bioassay
testing, and all of them tested in the normal range for total
uranium levels with no detections of depleted uranium in their
urine.
Army medical DU experts met with the 442nd soldiers in
medical hold at Fort Dix, NJ, in April 2004, and conducted a
similar meeting with the 442nd Family Support Group in
Orangeburg, NY, about 2 weeks later. Another group of subject-
matter experts simultaneously met with the main body of the
442nd in Kuwait and provided information about DU and testing
and then briefed them again at Fort Dix. Fact sheets on DU and
DU testing were provided.
Mr. Shays. Thank you very much. That, from my laymen's
point of view, seems to me that you all took this very
seriously----
Dr. Kilpatrick. Sir, again, to reflect the total accuracy,
the individuals coming back from theater to Fort Dix, several
of those individuals expressed concern about depleted uranium,
and their urine samples were taken for testing. It was some 3
months before those results were given back to those soldiers;
and, obviously, in the meanwhile they began to wonder what was
going on. When it really came to light that there was greater
concern than just three soldiers, I think the Army stepped up
in doing the right thing in addressing the concerns of
individuals and trying to get information to the individuals at
the time that they were concerned.
Did that reach every individual? I can't answer that for
sure because, again, it was who was present when they went to
give those briefings.
Mr. Shays. Of the 67 that you tested, the range was normal?
Dr. Kilpatrick. Of the 66 who were tested, they were tested
both at the laboratory at the Army Center for Health Promotion
and Preventive Medicine at the Armed Forces Institute of
Pathology and at the Centers for Disease Control and Prevention
[CDC]; and all of those were within what we considered to be
the normal range of uranium.
As you earlier said, we all have some uranium in our
bodies. CDC's national studies says that 95 percent of the
population has 50 nanograms or less of natural uranium in their
urine per liter, and that's what we used as our cutoff to refer
people to the DOD/VA medical followup for completed depleted
uranium exposure if it's higher than that.
Mr. Shays. Dr. Mather, my sense is that the VA is a lot
more capable now of knowing who is going to come in the door.
After we had hearings on the Gulf war, you really didn't have
lists of people and so on, but that has changed, hasn't it?
Dr. Mather. That has changed. Two things that are different
in this war is that when someone comes in who is an OIF or an
OEF veteran we know that and we can track them through the
system; and, also, we have primary care doctors for every
patient that registers with us so there is someone who is in
charge of that individual's care through the system. So I think
we're much better prepared now than we were 10 years ago.
One of the things that has happened as a result of the
first Gulf war is setting up the VA/DOD center in Baltimore. I
think we already have some numbers that show that DOD has
referred 278 OIF/OEF veterans to the Baltimore DU program, and
VA providers have referred 118 OIF/OEF veterans to that
program.
We've tested a total of 396 veterans and service members.
Nine had urine uranium levels above background. We can now do
more specific testing that shows which of this is naturally
occurring uranium, the uranium that is dug out of the soil, or
depleted uranium, which is less radioactive than naturally
occurring uranium; and one of those nine actually had depleted
uranium in their urine.
Baltimore's DU program has identified four OIF/OEF veterans
who have retained DU fragments, and these are the friendly fire
victims that Dr. Kilpatrick talked about.
Mr. Shays. Maybe as doctors you can describe to me, what is
the different impact of inhaling something, swallowing
something or having it, you know, pretty much embedded in your
body?
Dr. Mather. Well, there is no doubt that being embedded is
the most dangerous, because you're constantly getting fall-off
from the depleted uranium. We don't know a lot about ingestion
and inhalation. Of course, you wouldn't recommend that somebody
have a regular diet containing depleted uranium or be in an air
space contaminated with that, but very few people are in that
situation. I don't know of any even in wartime in a tank. It's
a limited time that you're exposed to that.
So from the perspective of the specialists in Baltimore,
the single biggest hazard from the heavy metal is in retrained
shrapnel. Dr. Kilpatrick might want to expand on that.
Dr. Kilpatrick. To try to add some more science to it,
again, the Army Center for Health Promotion and Preventive
Medicine did the depleted uranium capstones study where in an
enclosed facility they fired depleted uranium rounds through a
depleted uranium armored tank. They measured the particles of
depleted uranium that were released, both inside and outside
the tank. They looked at the size of those particles, the
concentration, and they were then able to use models to predict
inhalation and exposure, both radiological and chemical
exposure to people. They found that people could be inside a
tank that had been penetrated for up to 5 minutes without
having enough of a dose inhaled into their lungs to have any
medical concern for their future; and I think that's a good
news story dated from the Gulf war, is that people were out of
those tanks very quickly when they were hit.
But, you're right, the inhalation is probably secondary to
the fragment ingestion. There was a very small amount of
natural or depleted uranium that would be absorbed. Most of it
would pass out through the intestine.
Mr. Shays. But would your body absorb it more through
digestion, or if it's in your skin does it just permeate
through your body?
Dr. Kilpatrick. If it's in your skin, it is essentially
with your body fluids. It then becomes soluble slowly, and it
develops levels. This is what we have seen in the Gulf war
veterans' medical followup study, is if they continue to
excrete high levels of depleted uranium in their urine and
their kidneys are functioning perfectly normal, they have
adapted to that depleted uranium level in their bodies so that
it gets into the body fluid and is excreted through the kidney.
And inhalation, a very small amount or an ingestion of a small
amount, if it does get into the body fluids is excreted very
quickly through the kidney and is essentially gone.
Mr. Shays. Colonel, would you like to add anything here?
Colonel Ciesla. Mr. Chairman, I probably couldn't add much
to what Dr. Kilpatrick said, other than that it depends upon
whether you're talking about the chemical toxicity of DU, since
it's a metal, and the radiological exposure, in which case
having embedded fragments is the bigger hazard because you keep
the radiologic source with you and so it's able to continually
bombard the surrounding tissue.
But, once again, as Dr. Kilpatrick indicated, people with
fragments will theoretically present the most severe exposure
potential, and we have not seen actual health effects that
resulted from that exposure.
Mr. Shays. You see, in the reports and studies that the
military DOD has done on depleted uranium--candidly, we haven't
spent a lot of time on this--but you have some folks who think
it's extraordinarily dangerous, I guess, because of the word
uranium. My sense is that in a vehicle like a tank this heavy
metal is basically encapsulated--in other words, it's in the--
there is metal on either side of it?
Colonel Ciesla. Yes, Mr. Chairman. Actually, when you're
talking about the DU penetrator, if I had one here in front of
us, it would look like a big artillery shell.
Mr. Shays. No, I'm talking about the armament.
Colonel Ciesla. Oh, the external armor, sir?
Mr. Shays. Yes. So it's low-level radiation, but if it's
hit and penetrated, then there is the dust, correct?
Colonel Ciesla. That is correct, sir.
Mr. Shays. Is there anything between the depleted uranium--
is it encapsulated? Is it covered or coated with something?
Colonel Ciesla. Yes, sir. It's encoated with an epoxy
resin, some of which is the actual paint they use to cover the
exterior of the tank. The actual turret of a Bradley or an M-1,
the exterior surfaces that are armored, have depleted uranium
literally incorporated into the metal that comprise the turret.
Inside and outside--there is what we call chemical agent
resistant coating on the outside, which is the colors you see
outside of the tank at Bradley, and then inside there is an
epoxy resin paint, usually a light green or very light color to
give it some illumination. So that's between it, sir.
Mr. Shays. If I was in the military I would want the best
protection I could get. But I would--going back to our old
hearings, I mean, we had people who would go into these tanks
days later and describe the dust around. They weren't told it
wasn't a great idea, but I'm sure they were told this time.
Let me say that we have votes, but I am not going to hold
you up afterwards. Let me have the professional staff ask a few
questions that we need to get on the record.
Ms. Fiorentino. Dr. Kilpatrick, I wanted to followup with
some more questions about the follow-on Army environmental
assessment that's being finalized. What are the findings of
that environmental assessment and why is that not finalized
yet?
Dr. Kilpatrick. That assessment is in the final draft. In
fact, I have the report as going through the Army chop chain,
so that I think that all the data are there.
What it does show that was not in any of the testimony that
I had here, because I got a copy of it this morning to take a
look at, is that there was, in fact, an armored vehicle that
appeared to have been penetrated by depleted uranium on a
flatbed on a train track some 150 meters away from the housing
area where individuals were. There was indication of depleted
uranium at the penetration hole on the vehicle itself.
There were some wipes taken at that area that gave an
indication of depleted uranium. But other wipes on the vehicle
or on the car, air samples taken around the car were all
negative for any indication for depleted uranium, as were all
other sampling in that entire area.
As you heard described, there were a lot of oils and paints
and grease, the pigeon droppings, a lot of other issues were
present in that environment, but as far as a radiological
hazard, it was only on that armed vehicle on that flatbed.
Ms. Fiorentino. Does DOD routinely test for DU at all
military bases or forward-operating bases?
Dr. Kilpatrick. If you're asking do we routinely ask people
coming back from deployment, that is one of the questions on
the post-deployment health assessment that we ask: Do you have
a concern about exposure to depleted uranium?
If an individual answers yes to that question, they should
have a conversation with an expert to say what was your
exposure, what is your concern. If it was, I was loading
ammunition and I washed my hands after loading it, then we say
you really don't need to worry. If it was, I was nearby where
friendly fire came in, then we would say, yes, you do need; and
then we refer them on to have a 24-hour urine sample collected.
That can be collected anywhere but can only be tested at the
CHPPM Center, at the Armed Forces Institute of Pathology or at
CDC, are the three laboratories that we use that are certified
to do tests on human samples.
Ms. Fiorentino. When will the OHS data be compiled into a
usable data base for VA researchers to use, and who is going to
be responsible for compiling that data?
Dr. Kilpatrick. That is probably a question that I would
have to give you a subjective swag on. The data, as you know,
are being archived at CHPPM. We are working to develop a system
or process to analyze that data. Obviously, its location of
where it is collected at present, as you heard from Dr. Mather,
just getting a large dump of data is not going to help the VA.
They're going to have to be able have it location-specific and
then ideally located to where people are.
And if you want to add something to that before I go on--
let me just add part of the answer to your question depends on
who is asking, because I would say it is available now.
With all of the data that we are accumulating, if they ask
us for a unit and location, people and location, there is a
classification that the subcommittee is well aware of; and that
is an issue, to be sure. But if you said to me, can you tell
what this individual was exposed to because they were in this
general location and you just establish the link there, that is
an answer we can provide right now.
In fact, a lot of OEHS surveillance information is
available right now in that form. It is just a matter of asking
for it.
Mr. Shays. We have a choice of going on afterwards, and I
don't think we are going to do that. So we are going to cut
this hearing off. There are probably some things that we should
have put on the record that we may need to do by written
request.
Dr. Brown, is there any comment that you want to make
before we adjourn this hearing?
Dr. Brown. One of the things that I think was just hinted
at a little bit here but I think was very important at this
hearing that came out was the aspect of risk communication
about some of these hazards. Dr. Mather described very well our
DU program that we run at Baltimore that we opened up for the
1991 Gulf war to monitor depleted uranium in--for example, do
urine samples of veterans who were concerned about how depleted
uranium may have affected their health. One of the critical
things that they found that they had to do there was they had
to develop risk communication to be able to talk to the
individuals who asked for the tests.
So when you explain when somebody gets a number--we heard
earlier a veteran describe a number he got in the mail from one
of these tests--and the group found that is not adequate. This
is unusual. It is a type of exposure. It is frightening because
you're talking about radioactivity, you're talking about heavy
metal toxicity, and doing the background work that you need to
do to explain that to a patient is absolutely critical. This is
something that the VA program has done an outstanding job in
developing the means to explain what that number means to
somebody's health.
Mr. Shays. Thank you.
Let me say I have 5 minutes until the machine closes.
Given that we have been wrestling with these issues for
more than 12 years, I have seen noticeable improvement in the
attitude of both DOD and the Department of Veterans' Affairs. I
like the fact that there is an Office of Deployment Health
Support Directorate. That is a good thing.
So I compliment both DOD and the VA on working to just make
improvements. I know you know we have a ways to go. But thank
you for your good work and thank you for the progress that we
have made. Thank you.
With this, the hearing is adjourned.
[Whereupon, at 1:05 p.m., the subcommittee was adjourned.]
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