possible exposure to low levels of nerve agent and notified approximately 32,000 Service members that the most recent modeling and analysis indicated that they had not been exposed.

Although we were (and are) confident about the units possibly exposed, we know that some individual may not have been with their units, and some parts of units may have been located in places not with the main unit. Consequently, we continue to uncover and receive information about units and Service members who were probably in the hazard areas. As we collect this new information, we update the numbers that we believe may have been exposed (and notify Service members accordingly). At the present time, the Department believes that 101,754 were potentially exposed to low levels of nerve agent.

Mrs. MALONEY. She further states that 148 Americans died in the war, but that roughly 160,000 have fallen ill; and that 11,000 have died since the Gulf war-much higher than other men and women in the military-and that they have collected a series of 57 symptoms for which there is no known cause, which is the Gulf war syndrome.

I would want to ask what we are doing to protect the health of the men and women that were exposed and the possibility, God forbid, that they may be exposed yet again. And I am the cochair of the Parkinson's Disease Task Force, along with Fred Upton; it is a bipartisan effort. And my father suffered from Parkinson's.

But it has been reported that some of the Gulf war veterans have suffered symptoms similar to Parkinson's. And each year we have been working with the Defense Department, and we have received funding for Parkinson's research on neurotoxin exposure, seeing if that is a reason for the brain damage that causes Parkinson's. But I would argue that, likewise, it may be a study for what we can do to help the men and women that may have been exposed to chemicals.

So my question right now is more of a proactive one of, what are we doing in research?

As I understand it, we have no cure for Gulf war syndrome. And what are we doing to find-are we spending some of our research dollars in trying to find a cure for neurotoxin disease that may be caused by the sarin gas or other things? What are we doing? I am very thankful to the Department of Defense for funding the Parkinson's research.

My question is, is this likewise connected to the Gulf war syndrome?

Dr. WINKENWERDER. To your general question of what are we doing? We are continuing to fund with millions of dollars ongoing research into many of these questions that you have raised. As I alluded to earlier, it's difficult to determine with the levels of certainty that one would like in this case, if one is talking about evaluating these individuals that served, when the baseline of information and what was collected and what people may or may not have been exposed to is not good.

The information is not good, so by definition, to do good research, you need good information. That shouldn't prevent us from funding additional research, as we have done, to look at some of these questions of what would low levels of exposures do to laboratory animals. Certainly we would never do this to any individual on an experimental basis. But studying what happens with animals and looking at some of these things is very important.

Mrs. MALONEY. Specifically, is the Parkinson's research that you are funding-and I thank you for that research. Is that connected to the Gulf war syndrome?

Dr. WINKENWERDER. I am going to turn to Dr. Kilpatrick.

Dr. KILPATRICK. Let me just address it. It is being pursued in two directions.

One is a clinical basis, looking at people; and then that is very tightly tied to a program looking at chemical nerve agents in particular and the effects that they have on brain function. There are projects funded at $5 million a year over the next 3 years; 1.5 mil

lion is looking at repeated low-level exposures of animals to sarin nerve agent, to look at long-term health consequences. That is very applicable to what Gulf war veterans' concerns are.

The other part of the money each year is spent toward what we call the high end of low-level exposure, below symptomatic response to nerve agents, one exposure, and then seeing what are the physiological responses.

And those data from those research sets are really very closely shared with people looking at Parkinson's disease, because they are really looking at the same pathway potentially as far as disease

cause.

Dr. ROSWELL. If I may respond to that from a combined perspective.

Since the Gulf war, over $200 million in federally funded research has been focused on possible causes for Gulf war syndrome. I would like to set the record straight.

One of those studies has looked at death rates in veterans in the Gulf war, and in fact, the overall death rate for veterans who served in the Gulf war is not increased compared to their military counterparts who were deployed outside the theater of operations. If you look at specific-cause mortality in veterans who served in the Gulf war, there is a very slight increase in death due to trauma, such as automobile accidents. But other than that, the mortality rate is not increased in any subcategory, and the overall mortality is not increased.

And I certainly wouldn't want to create a fear for the men and women currently serving in Iraq.

Let me point out that Parkinson's disease is one of several neurodegenerative diseases that DOD and VA are currently studying. VA recently funded the creation of a neuroimaging Center of Excellence for neurodegenerative diseases to look not only at Parkinson's but also other diseases, even when unpublished data suggested that there might be an increase in a degenerative disease known as amyotrophic lateral sclerosis, or Lou Gehrig's disease.

Secretary Principi moved quickly to presumptively service-connect veterans who suffered from that illness and served in the Gulf war, so that they received disability compensation.

I would also point out that 160,000 veterans of the Gulf war have received approved disability claims. But most of those claims are for diseases that we would expect to see in a military age population, and it is a relatively small number for undiagnosed illnesses or the Gulf war syndrome you spoke of.

Mrs. MALONEY. When you mentioned the clinical trials, are you doing them on our veterans? Are we tracking our veterans and seeing if-particularly those that we know were exposed to sarin gas? That would be helpful to see, because some of them apparentlyI am talking to doctors that treat Parkinson's. They have told me that they are developing Parkinson's-like symptoms.

Dr. ROSWELL. We have extensively reviewed literature for symptomatic exposures to the organophosphate, which is the class of compounds that sarin nerve gas falls into. The study suggests that there is cognitive impairment in people who suffer symptomatic exposures, but I am not aware of evidence that conclusively links any

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kind of organophosphate or nerve agent exposure to Parkinson's disease specifically.

Some investigators have reported a possible neurodegenerative disorder that involves part of the vasoganglia, which are structures that are affected in Parkinson's, but in a way different than in Parkinson's disease, which is why we've funded the neuroimaging cen

ter.

Mrs. MALONEY. Where is the neuroimaging center?

Dr. ROSWELL. Actually, there are several within the VA. There is one in San Francisco; there is a final selection for the designated center has not yet been made, however.

Mrs. MALONEY. Well, thank you for investing in research for coming up with some cures. And thank you for your testimony. My time is up.

Mr. SHAYS. We have just two more members who will ask some questions, and then we are going to get to the next panel.

Mr. Janklow.

Mr. JANKLOW. Thank you very much, Mr. Chairman.

Help me, if you could. With the testimony-the hearing is about lessons learned from the Gulf. My question is, both of you in your capacities, you, Dr. Roswell, and you, Dr. Winkenwerder, have you looked into the history of why was this so secret so long? With everybody clamoring for information, why did it take so long to get the information out? Why did it have to be dragged out of people? What was the reason for the mystery?

I guess-have you ever been able to find out, or have you ever looked as to the reason for the mystery? It couldn't have been national defense secrets.

Dr. WINKENWERDER. I can't give you a good answer. I will give you the best answer I know, and that is that in many cases it took months and even years for symptoms to develop with people. And that, combined with the poor record base, made it very difficult to do research or to even develop good, plausible mechanisms, causalrelated mechanisms.

Mr. JANKLOW. Have those problems been solved?

Dr. WINKENWERDER. In my judgment, we have a far superior baseline of information. We have a far improved recordkeeping system. We have a far improved ability to surveil and actually keep records in the theater. We have these pre and postdeployment assessments. So our information base, by all accounts, should be far, far better in our current situation.

Mr. JANKLOW. Doctor, I believe you said you have been in your position about 18 months.

Dr. WINKENWERDER. Yes, sir.

Mr. JANKLOW. And for you, is there anything, at least at this point in time in your tenure in this position, where we have a lesson we haven't learned?

Dr. WINKENWERDER. Well, I hope we don't have one that I am not attending to.

Mr. JANKLOW. Are there any-do you know of any that concern you or that we ought to be concerned about?

Or you Dr. Roswell?

Either one of you, are there any lessons we haven't learned?

Dr. ROSWELL. If I could, I think the Gulf war was an unprecedented conflict. The breadth and nature of military occupational exposures had never been experienced by our men and women in any prior conflict. So part of the delay, if you will, the confusion-I think, in retrospect, it is fair to say there was some confusion about exposures and possible health consequences-was because we didn't recognize that a vast number of unprecedented exposures could be factors: the anthrax vaccine, the pyridostigmine bromide that was used, the dense oil fire smoke, the fine particulate sand in the desert, the use of petroleum products to cut down on the blowing sand, the use of permethrin and DEET to protect people from insects-there were so many exposures-the use of depleted uranium as both an armour-piercing munition and a firearm plate, even chemical agent-resistant coating paint, which was applied to vehicles to make them resistant to chemical agents-were just some of the possible exposures that were investigated methodically, consistently over time to try to ferret out possible causes for the illnesses we saw in Gulf war veterans.

And I think that, to me, if there is a lesson learned, it is that we have learned that all of these exposures, singly or in combination, as has been pointed out in this hearing, could be factors in the development of illness. Certainly, every major conflict that U.S. men and women have served in has yielded unexplained illnesses. But that doesn't obviate our need to methodically and thoroughly investigate each and every exposure. And that is why we are committed to do that, and I think that is the partnership that VA and DOD, through the Deployment Health Working Group, are vested in right now.

Mr. JANKLOw. Dr. Kilpatrick, are there any unlearned lessons that you know of lingering from the Gulf war?

Dr. KILPATRICK. I think one of the hardest ones is communication. It doesn't matter how good a job you do, you can always do it better.

And I think one of the issues that we are working at very hard now is to make sure that leaders in the field are communicating to their troops that they are concerned about these various exposures and their health. They are concerned about documenting where they are. They are concerned about making sure they have that access to health care when they come home I think DOD and VA share the same concern for those who are getting off Active Duty; they will be looking perhaps to the VA for health care that they understand that, in fact, there is the ability for them to have 2 years of health care coming out of a combat zone now. That was not present after the Gulf war in 1991. And I think that is—getting that communicated to people, so they know they have that access to health care, is so important.

So I think that is one of the areas where, as good a job as I think we are doing, we always need to look to say, how can we do it better. And I think doing that, through even this hearing, is very helpful to those men and women who are serving today.

Dr. WINKENWERDER. And if I might add to that to say, you know, you never know when you haven't learned a lesson until there are many times you don't until you've learned it, which to me speaks