Mr. SHAYS. Dr. Roswell. I'm going to ask you to bring the mic a little closer. I know it's got a bulky platform to it. Dr. ROSWELL. Mr. Chairman, I'm pleased to be here to testify before the subcommittee today. With me, as you indicated, is Dr. Craig Hyams, who is the VA Chief Consultant for Occupational and Environmental Health. The VA today is better prepared to provide high-quality health care and disability assistance than at any other time in history. And let me begin by dispelling two concerns raised in his opening remarks by Mr. Kucinich. First of all, let me point out that Public Law 105-368 authorizes 2 full years of medical care for any veteran serving in a combat zone for any possible condition related to the military service. So despite the constraints of our current budget, despite an unprecedented demand for VA health care, I want to assure this committee that no veteran serving in the current conflict with Iraq will go untreated by the VA upon their return, should they need such care. Let me also point out that disability compensation was authorized following the Desert Storm/Desert Shield war for even undiagnosed illnesses when those became problematic for many of the men and women who served in the Persian Gulf war. Special legislation authorized VA to provide disability compensation for undiagnosed claims, and because the Persian Gulf war has never officially ended, that same authorization exists today and will exist and be available for anyone currently serving in the conflict in Iraq. Since the operation of Desert Shield and Desert Storm in 1991, a number of improvements have been put in place to better allow us to meet the health care needs of our veterans. VA has implemented an innovative new approach to health care known as the Veterans Health Initiative. This is a comprehensive program designed to increase recognition of the connection between military service and certain health effects, better document veterans' military and exposure histories, improve patient care and establish a data base for further study. In 2002, VA established two war-related illness and injury centers to provide specialized health care for veterans for all combat and peacekeeping missions who suffer difficult to diagnose, but disabling illnesses. These centers provide research into better treatment and diagnoses and develop education programs for health care providers. The Gulf war made clear the value of timely and reliable information about wartime health risks. VA has already developed a brochure that addresses the main health concern for military service in Afghanistan and is currently preparing another brochure for the current conflict in the Gulf. VA has recently developed new clinical practice guidelines based on the best scientifically supported practice that will give health care providers the needed structure, clinical tools and educational resources that will allow them to diagnosis and manage patients with deployment-related health concerns. It's our goal that all veterans who come to VA will find their doctors to be well informed about specific deployment and related health hazards. We're also working very closely with the Department of Defense to improve care and interagency coordination of health information. As you know, governmental coordination plays a critical role in addressing health problems of veterans. In fiscal year 2002, a special deployment health working group of the VA, DOD Health Executive Council, was established to ensure interagency coordination for all veteran and military deployment health issues. This group continues the efforts begun by the Persian Gulf Veterans Coordinating Board and the Military and Veterans Health Coordinating Board. DOD with VA support is developing the Recruit Assessment Program to collect comprehensive baseline health data from all U.S. military recruits. As the first module of a lifelong military veteran and health record, this program will help DOD and VA evaluate health problems among service members and veterans and address post-deployment health questions and document changes in health status. VA and DOD are collaborating on several important health applications that will permit the departments to offer a seamless electronic medical record system, a lifelong medical record system. Key initiatives are the Federal Health Information Exchange and the Healthy People Federal Project. Mr. Chairman, a veteran separating from military service and seeking health care today will have the benefit of VA's decade-long experience with Gulf war health issues, but the real key to addressing long-term needs of veterans is improved medical recordkeeping and environmental surveillance. For VA to provide optimal health care and disability assistance after the current conflict with Iraq, we will need a complete roster of veterans who served in designated combat zones; and second, we will need any data from predeployment, deployment and postdeployment health evaluation and screening. Furthermore, in the event Iraq uses any weapon of mass destruction, it's vital that VA have as much health and environmental information as possible on potential exposure and their health ef fects. This information will allow us to provide appropriate health care and disability compensation for veterans of this conflict. Mr. Chairman, this concludes my statement. Dr. Hyams and myself would be happy to answer any questions you may have. Mr. SHAYS. Thank you very much. [The prepared statement of Dr. Roswell follows:] Statement of The Honorable Robert H. Roswell, M.D. Under Secretary for Health Department of Veterans Affairs Before the Committee on Government Reform, Subcommittee on National Security, Emerging Threats, and International Relations on "Protecting the Health of Deployed Forces: Lessons Learned from the Persian Gulf War" March 25, 2003 Mr. Chairman, I am pleased to be here to testify before the Subcommittee on "Protecting the Health of Deployed Forces: Lessons Learned from the Persian Gulf War." With me today is Dr. Craig Hyams, VA's Chief Consultant for Occupational and Environmental Health. Since nearly 250,000 U.S. troops are engaged in renewed conflict in the Gulf region, I am grateful for the opportunity to emphasize that VA today is better prepared to provide high quality health care and disability assistance than at any other time in our history. Since Operations Desert Shield/Desert Storm in 1991, VA has developed and implemented the following policies and programs in response to the lessons learned from that conflict. Health Care, Surveillance, Education, and Outreach Health Care following Combat It is critical to provide informed, knowledge-based health care after every war. Congress has shown an appreciation for the importance of providing health care for combat veterans. Under 38 U.S.C. § 1710(e)(1)(D), added by Public Law 105-368, VA is authorized to provide health care for a two-year period to veterans who serve on active duty in a theater of combat operations during a period of war after the Gulf War, or in combat against a hostile force during a period of hostilities after November 1, 1998. Under this provision, all veterans of conflicts now have a two-year period of access to VA health care for any illness, regardless of whether there is sufficient medical evidence to conclude that the illness is attributable to that service. An exception to this general rule occurs when VA has found that a particular condition is not due to the period of service in question. Veterans of the current conflict with Iraq will be eligible for health care under this provision of law. Although they may be deemed to be serving in the Southwest Asia Theater of Operations during the Gulf War era, our special authority to provide treatment to such veterans expired December 31, 2002 (38 U.S.C. 1710(e)(1)(C)). In addition to providing needed health care, VA has the capability to collect and analyze information on the health status and health care utilization patterns of veterans. The capability to collect this basic health information helps us evaluate specific health questions, such as determining the causes of difficultto-explain symptoms experienced by some veterans returning from certain combat theaters or areas of hostilities. VA's medical record system now permits patient health information to be tracked for special groups of veterans. Moreover, standard health care databases allow VA to evaluate the health care utilization of veterans every time they obtain care from VA, not just on the one occasion that they elect to have a registry examination, as was the practice in the past. This will provide a much broader and longer-term assessment of the health status of these veterans because many veterans return frequently for VA health care and are often seen in different clinics or even different parts of the country for specialized health care. Ensuring High Quality Post-Deployment Health Care Specialized health care during the post-deployment period can help prevent long-term health problems. Therefore, VA has developed evidencebased clinical approaches for treating veterans following deployment. Newly developed Clinical Practice Guidelines (CPG's), which are based on the best scientifically supported practices, give health care providers the needed structure, clinical tools, and educational resources that allow them to diagnose and manage patients with deployment-related health concerns. Two postdeployment CPG's have been developed in collaboration with DoD, a general purpose Post-Deployment CPG and a CPG for unexplained fatigue and pain. Our goal is that all veterans who come to VA will find their doctors to be well informed about specific deployments and related health hazards. Information on Clinical Practice Guidelines are available online at www.va.gov/environagents. This web site also contains information about unique deployment health risks and new treatments. Assessment of Difficult-to-Diagnose Illnesses We have learned that sustained clinical care and research is needed to understand post-deployment health problems. Congress also understood this need and in legislation enacted as Public Law 105-368 required establishment of a plan to develop national centers for the study of war-related illness and postdeployment health issues. Subsequently, in 2002, VA established two such centers, known as "War-Related Illness and Injury Study Centers" (WRIISC's), in East Orange, NJ, and Washington, DC, to provide specialized health care for veterans from all combat and peace-keeping missions who suffer difficult-todiagnose but disabling illnesses. These centers are available through referral to veterans from all eras, including veterans of a future war with Iraq. These centers also provide research into better treatments and diagnoses, develop education programs for health care providers, and develop specialized health care programs to meet veterans' unique needs, such as the National Center for PTSD. The majority of veterans returning from combat and peacekeeping missions are able to make the transition to civilian life with few problems. Most who come to VA for health care receive conventional diagnoses and treatments, and leave satisfied with their health care. Nevertheless, VA has learned that some veterans have greater problems on their return to civilian life, and a small |