sis, both pre and postdeployment. Congress passed Public Law 105-85 in 1998 as part of the defense authorization bill at a time when veterans were experiencing various illnesses. The reason Congress passed this law was so that physicians could monitor changes over time, particularly during and after the deployment. This law also called for the drawing of blood samples, significant medical recordkeeping, and an examination of the soldiers's mental health before and after the conflict.

Instead of following the letter of the law in a meaningful way that will produce scientifically valuable evidence, the Department of Defense and the people responsible for force health protection are interpreting the law so that it creates a deceptive compliance. This half-hearted evidence will produce similar results that have prevented the Institute of Medicine from reaching conclusions from the last Gulf war. The Director of the Deployment Health Support Directorate is charged by this law to implement the lessons learned, and DOD is not following the law.

I will now describe what we understand is the current status of affairs for force health protection. In the predeployment phase, the Department is not conducting hands-on physicals to determine the health status of the force before deployment, as required by law. Instead, they give out a questionnaire. A DOD quote from a recent congressional inquiry described its own questionnaire as follows: These forms contain a limited amount of information. They do provide a means to document health status before and after deployment and afford the deployed service member the opportunity to have deployment-related health concerns addressed.

More significantly in the predeployment phase, the Department is not drawing blood samples from the entire force prior to the deployment, as required by law. Instead, the Department relies on serum collection for HIV testing. This serum could be anywhere from 1 to 3 years old and will not be a snapshot of the soldier's current predeployment health condition. Every scientist from the IOM agrees that predeployment and postdeployment surveillance is the key to understanding illnesses on the battlefield after wars.

More data is preferred over less data. The current activities of DOD and health monitoring in the postdeployment phase are that the Department is not conducting mental and physical evaluations after deployment, as required by law. Instead, the DOD hands the soldiers a questionnaire. The survey, as demonstrated by the testimony of the gentleman to my right, is inadequate and does nothing to satisfy the requirements of the law or provide meaningful information.

Additionally, the lack of mental screening has been demonstrated as problematic. Soldiers recently who served in Afghanistan were sent directly home without any medical assessments. Some of these soldiers committed horrible crimes that may have been related to combat stresses. Had the public law been followed, perhaps a terrible tragedy might have been averted.

In the postdeployment phase, the Department is not drawing blood samples from the force after the deployment as required by law. Instead, they rely on the serum collection for HIV. This serum collection can be old and will not be a snapshot of what has recently occurred on the battlefield. Because the Department is again

failing to collect the baseline data, veterans will not be able to meet the burden of proof required by the Department of Veterans Affairs for treatment. This mistake is precisely what created the controversy surrounding Gulf war illnesses. Service members are being set up to face another round of delays, denials and obstructions.

This prospect is unacceptable and must be corrected. The current medical practices of DOD are all half-hearted, and they are a public disaster waiting to happen. Since forces are actively engaged in combat, we have missed the opportunity to conduct baseline predeployment screening. Mr. Chairman, I humbly request that we implore, demand and make make the Department collect the postdeployment data so that we will not face another round of unanswered questions.

In the military that I served in, there were consequences for failure to obey orders, and anything less than 100 percent effort was unacceptable. We were not allowed to interpret the intent of orders but rather to obey them implicitly. These core values do not seem to work both ways. Veterans will be the ones who will suffer the consequences of the poor implementation of this law, and veterans will be the ones who face another fight because of the lack of data. I hope that those responsible for the implementation of this law will understand that their failures are going to impact the lives and well-being of soldiers returning from this conflict.

Mr. Chairman, I would like to know who we may hold accountable, and I humbly request that we find out immediately. Thank you.

[The prepared statement of Mr. Robinson follows:]

National Gulf War Resource Center

Protecting the Health of Deployed Forces

Lessons Learned from the Persian Gulf War

Before the Subcommittee on National Security, Emerging Threats, and

International Relations

March 25, 2003

National Gulf War Resource Center

Mr. Chairman and members of the committee, the National Gulf War Resource Center (NGWRC) is honored to have the opportunity to submit written testimony for today's hearing on Force Health Protection.

Public laws (specifically PL 105-85) designed to protect soldiers on the battlefield are being ignored, thereby setting the stage for mystery illnesses to again present themselves after a war with Iraq.

FHP was supposed to be a catalyst for a fundamental reorientation of military medicine. The intent was to broaden the focus from acute-care services and post-casualty intervention to include proactive, preventive services that maintain healthy and fit forces. Additionally, FHP was designed to correct the mistakes of 1991 by collecting baseline data on the health of our forces before, during, and after war. These efforts were to provide the platform for future research should any chemical or biological event occur.

Unfortunately, FHP results have been utterly disappointing. These shortfalls demonstrate a lack of willingness to follow the public law and a lack of understanding of the lessons from medical mistakes made more than 12 years ago. Ignoring those lessons will create a whole new round of delays and denials should hostilities include the release of CBW on the battlefield.

Recently the Institute of Medicine completed its review of Pesticides and Solvents use in the first Gulf War. One of the conclusions of the committee was that lack of data prevented the committee from linking exposures of the war to illnesses that veterans suffer from. As the IOM begins its next round of investigations into oil well fires and chemical compounds they are keenly aware that there is also a lack of data on these types of exposures. The NGWRC can safely predict that the IOM will reach the same conclusions because baseline data was never considered and post exposure data was never collected.

It is important to note that reports from the IOM are used by the Department of Veterans Affairs to rule in or rule out service-connection for veteran's illnesses. This is why the public law is so important and why ignoring it will harm another generation of veterans.

Looking at the public law it is clear that some initiatives to decrease risks in military operations have been implemented, many others have not:

Implemented - Standardizing methods identifying medical threats and appropriate countermeasures prior to deployment - these features have been incorporated in early military deployment planning efforts. Also, the use of surveillance teams to monitor the environment and CBW are now an integral part of the war plan and should be conducted throughout the operation.

National Gulf War Resource Center

• Not implemented - Medical screening and analysis, both pre- and postdeployment. Congress passed PL 105-85 in 1998 as part of the defense authorization bill at a time when Gulf War veterans were experiencing various ailments known collectively as Gulf War Syndrome: joint pain, headaches, memory loss, rashes, balance problems, and loss of motor skills. The screenings were meant to provide epidemiologists and doctors a baseline snapshot of every soldier's health. Then, physicians could monitor changes over time, particularly during and after deployment. The law also called for drawing blood samples, significant medical record keeping, and an examination of the soldier's mental health.

The Pentagon has been quoted saying "it cannot verify that soldiers in the antiterrorism campaign or the war with Iraq are undergoing medical exams before and after deployment as required by law." The NGWRC knows that statement is true based on information from deploying National Guard soldiers.

Instead of following the letter of the law in a meaningful way that will produce scientifically valuable evidence Dr. Michael Kilpatrick and his superiors are interpreting the law in a way, which creates❞Deceptive Compliance". This halfhearted effort will produce similar results that have prevented the IOM from reaching conclusions from the last Gulf War.

The director of the Deployment Health Support Directorate is charged by this law to implement lessons learned. DoD is not following the law.

The current activities of DoD and health monitoring in the Pre-Deployment phase are described below.

In the Pre-Deployment phase the Department is not conducting hands-on physicals to determine the health status of the force before deployment as required by law. Instead, DoD is handing out a questionnaire.

A DoD quote from a recent Congressional inquiry describes its own questionnaire as follows " Although these forms contain a limited amount of information, they do provide a means to document health status before and after deployment, and afford the deployed Service member the opportunity to have deployment-related health concerns documented and addressed."

More significantly the Department is not drawing blood samples from the entire force prior to deployment as required by law. Instead, DoD is relying on the serum collection for HIV testing. This serum may be anywhere from one to three years old and will not be a snapshot of the soldier's current pre-deployment health condition. Even a retired Army Ranger knows the best time to collect data is immediately after the event, not months to years later. Every scientist from the IOM also agrees with this assessment. More data is preferred over poor data.