to the need culturally to have an open mind, be open to learning things that you didn't know before.

And so if there is one thing that I would continue to hope to convey to our people it is a continued vigilance about different sources and causes of illness and ways to improve. It is sort of a culture of learning and getting better.

Mr. JANKLOW. Assuming we have the baseline data that we need for the current war that we are in, recognizing that our troops could be exposed to biological or chemical warfare, do we have the systems in place?

I mean, that is the key thing. Do we have the systems in place to be able to get the information about the individuals and about the chemical or the agents or the toxins that are being-that they have been exposed to, so that we will have the data base of information to address it without all the types of-new types of frustration that we will have to go through in order to find out whether or not there are or aren't legitimate reasons for illnesses or problems that people have after the war?

Am I making sense to you?

Dr. WINKENWERDER. Yes.

Mr. JANKLOW. Do we have a system in place, is what it comes down to. I realize we had no history before the Gulf war. We now have a history.

Dr. WINKENWERDER. I believe we do have the system in place.
Mr. JANKLOW. Is there anything we can do to make it better?
Dr. WINKENWERDER. Yes.

Mr. JANKLOW. What?

Dr. WINKENWERDER. One of the things that we can do to make it better is to ensure that there is 100 percent compliance with all the policies and all the procedures, the training we have talked about.

Mr. JANKLOW. Have those orders gone out to the military?
Dr. WINKENWERDER. Absolutely.

Mr. JANKLOW. Is there any reason that the military would have for not following orders from above that are lawful?

Dr. WINKENWERDER. No. I have no reason to believe that people have not taken this issue extremely seriously.

Mr. JANKLOW. Do they understand that if they violate direct, lawful orders from a superior, that it sometimes is far more serious in the military than it is in civilian life?

Dr. WINKENWERDER. Yes. I think there is a good understanding of that.

Mr. JANKLOW. Those are all the questions I have, sir.

Mr. SHAYS. Thank you.

Mr. Tierney.

Mr. TIERNEY. Thank you. I have only a followup question.

We know that this 2004 VA budget, Dr. Roswell, has several provisions that are going to restrict the ability of certain classifications of veterans, priority 7 and priority 8, to get treated and to get the cost of care covered-I can't get this thing to stop moving up and down.

Isn't that one of the lessons we've learned, though? If we have incidents that are not really showing signs of symptoms or illnesses for several years after people get out of the service, being covered

for the first 2 years may not be sufficient. And haven't we learned through some of the Gulf war syndrome incidents that it can be any number of years before people start coming down with these symptoms?

So having learned that lesson, we put out a budget that still doesn't seem to address these people's concerns.

What are your concerns about that, and what can we do about the fact that some of these people may not exhibit symptoms in the first couple of years? And how is the VA going to deal with those people without excluding them from coverage?

Dr. ROSWELL. Well, certainly one way to do that is to authorize special access for care for people who have illnesses that occur following a conflict.

We actually had that authority that just expired in 2002 for veterans of the Gulf war. It would be obviously, depending upon the outcome of the current conflict, appropriate for this Congress to consider special authorization for priority care for veterans who have served in this conflict.

The 2 years is a minimum. It would certainly continue beyond that if an identified need were discovered during that period or if an illness, injury, or disability associated with military service were identified that led to a service connection.

Mr. TIERNEY. I think your first recommendation is probably one that we ought to look into, and that is making sure that we provide some sort of flexibility or ability to cover those for people that may be coming out of this conflict, and I appreciate that.

Mr. Chairman, I have no other questions at this time. I want to thank our witnesses for their thoughtful answers and for their assistance here today. Thank you.

Mr. SHAYS. Thank the gentleman. Let me just do a few little minor points for the record.

Dr. Roswell, we are looking at VA data and reports on mortality in the Gulf war. And its recent reports, based on VA data, have been late. There was one report that showed kind of a real spike in deaths, and it was called back and we are curious about that.

So we are going to invite the VA back to have a dialog about this, but I just kind of feel your comment about not showing much difference is something that this committee has a big question with.

And I would also just say, Dr. Winkenwerder, that I have some specific questions about the status status of the Armed Forces Radiobiology Research Institute and their work on a drug to counteract the effects of radiation exposure.

And we're going to send these questions in writing to your office and ask that you respond. I don't think we need to take time to do that now, we think.

Dr. WINKENWERDER. We'd be glad to do that.

Mr. SHAYS. Dr. Hyams, you have the biggest challenge here, and I have a theory and it never fails me that the person who says the least has the greatest contribution at the end to make. So I'm going to just ask-no, I'm not going to do it quite that way. But I'm going to say to you that I would like you to put on the record anything that you think needs to be put on the record or any observation that you would like to put on the record, and then we'll get to the last panel.

And Dr. Hyams, I would also invite you as well. I'm not being facetious. I know all four of you have expertise here, and we didn't ask Dr. Roswell as many questions so you didn't need to jump in, but I'm happy to have all four of you make any final comment. I'll start with you, Dr. Kilpatrick.

Dr. KILPATRICK. Well, I think that the Department of Defense is very focused from the lessons learned in the Gulf on how do we better take care of our men and women in harm's way today. I think the Force Health Protection Program is that cascade effect of programs that will protect health. It does depend on good leadership and cohesive units. We believe we have that. We see that in action today, and it is our duty to make sure from a medical standpoint that those men and women have their health concerns addressed, and our medical department stands by waiting to make sure that their health concerns, whether they are related to the deployment or any other concern, get addressed with facts about exposures we know occurred.

Mr. SHAYS. Thank you.

Dr. WINKENWERDER. Mr. Chairman, I'd just say we appreciate the opportunity to be here today. I think this has been a productive exchange of information. I hope you've found it that way and useful.

My first comment is just to say that I deeply appreciate the sacrifice that our men and women in uniform are making, and I also deeply appreciate the outstanding job that our medical people are doing. I think we've seen from the TV reports and all just the incredible job they're doing. They've made us all very proud.

We are absolutely committed to trying to protect our people who are taking on a very challenging situation, a brutal regime that has terrible weapons. We've done everything that we know we can do to protect them. We will continue throughout this conflict and after the conflict is over to ensure that we look after people's health care needs and that we do right by them for the good service that they've done. So I'm committed to that.

Mr. SHAYS. Thank you.

Dr. ROSWELL. Mr. Chairman, let me begin by thanking you for your leadership over the last decade in moving our government closer to a more full and complete understanding of causes of illnesses following military service in combat. I think your leadership has been instrumental in improving our understanding and readiness and preparedness.

Like so many Americans, my thoughts and prayers today are with the men and women in uniform in Iraq and in the theatre of operations supporting that conflict, and I hope that some way they understand and can know that when they return they will face a vastly improved VA health care system that is responsive to their needs, and they will understand that the very best possible care we can provide will be available to them, and we'll do everything we can to provide that for as long as it's needed.

Mr. SHAYS. Thank you. Dr. Hyams.

Dr. HYAMS. I come to this with my own perspective. I deployed to the Persian Gulf in 1990 to help establish a laboratory in the theatre of operation to survey for biological agents. So I've been dealing with these problems for a long time, and I think one of the

points that is often missed is that we have an obligation also to healthy war veterans. I came back healthy. A lot of other veterans did, too. Nevertheless, we had a lot of questions about what happened to us when we were in the Gulf. I think as a Nation we owe it to even healthy veterans to be able to answer those questions. Mr. SHAYS. Thank you very much. Gentlemen, we appreciate your contribution to the work of this committee, and thank you for your service to your country.

Our second panel is Dr. John H. Moxley III, managing director, North American Health Care Division, Korn/Ferry International; Dr. Manning Feinleib, professor of epidemiology, Bloomberg School of Public Health, John Hopkins University; and Mr. Steven_Robinson, executive director, National Gulf War Resource Center, Inc.

You might want to remain standing, and I'll swear you in.

Moxley, Feinleib and Robinson. Thank you, gentlemen. Raise your right hands, please. First off, is there anyone accompanying you or responding? No. OK.

[Witnesses sworn.]

Mr. SHAYS. Note for the record that all three of our witnesses have responded in the affirmative. Thank you, gentlemen, for your patience. You have the opportunity to read a statement or submit a statement and make some comments. You have obviously heard the panel before you. So you might want to respond in what you've heard, which would be helpful.

So we're going to start, just as you are there, and we'll start with you, Dr. Moxley.

STATEMENTS OF DR. JOHN H. MOXLEY III, MANAGING DIRECTOR, NORTH AMERICAN HEALTH CARE DIVISION, KORN/ FERRY INTERNATIONAL; DR. MANNING FEINLEIB, PROFESSOR OF EPIDEMIOLOGY, BLOOMBERG SCHOOL OF PUBLIC HEALTH, JOHNS HOPKINS UNIVERSITY; AND STEVEN ROBINSON, EXECUTIVE DIRECTOR, NATIONAL GULF WAR RESOURCE CENTER, INC.

Dr. MOXLEY. Yes, sir. Thank you. Mr. Chairman, members of the committee, as has been noted, I'm managing director of the North American Health Care Division of Korn/Ferry International. I'm here because I served as chair of the Committee on Strategies to Protect the Health of Deployed U.S. Forces of the Institute of Medicine. The Institute of Medicine is part, as you well know, of the National Academies chartered in 1863 to advise the government on matters of science and technology.

We have submitted a written statement for your review and for the record. I shall not repeat that statement. What I intend to do in the next few minutes is to summarize the history of the need for a report, highlight a few of our findings and proposals and then close by attempting to convey to the committee the intensity that our committee felt about the need for progress in the protection of deployed forces.

The immediate history of the committee stems from the concern of then Deputy Secretary of Defense John White that there was a need to learn from lessons of the Gulf war and develop a strategy to better protect the health of U.S. troops in future deployments.

In consultations with the IOM, it was agreed that they would undertake the study. The first step was the development of four technical reports addressing, first, health risks during deployments; second, detection and tracking of exposures; third, physical protection and decontamination; and, fourth, health consequences and treatment and the importance of medical recordkeeping.

All four of those reports were detailed, were released at the time of completion, and were excellent reports.

The committee that I chaired was charged with attempting to synthesize the technical findings of the aforementioned reports and other information to form a final overarching policy report. Our report was completed over 2 years ago.

One of the first and most surprising findings was that we were not alone. Between 1994 and 2000, the Department of Defense sought assistance from seven expert panels who generated 10 reports examining these issues. Although DOD had agreed with the large majority of the findings, we found that very few had been implemented at the field level. Many recommendations remained totally unimplemented. Our committee concluded that despite all the advice and apparent agreement with it, progress had been unacceptable.

We also concluded that it was very difficult to improve upon the recommendations made multiple times since 1994. Hence, many of our recommendations are restatements of recommendations that had been made before but remained unimplemented. We continue to stand behind all of them.

I'd now like to briefly summarize three areas of particular concern to the committee. First, it is vital that the location of units and individuals, together with activity information, be documented during deployments. The information is important for real-time command decisionmaking and essential for reconstructing deployments for epidemiological studies and the provision of post-deployment health care.

Despite many previous painful lessons, adequate systems for recording and archiving the locations of deployed individuals are not in place. The technology exists. Troops can be tracked in real-time, and it is time to do it.

Second, the Department of Defense must be candid and trusted by service members, their families and the American people. To achieve that end, they must be more proficient at understanding and using contemporary principles of risk assessment, risk management and risk communication.

The following vignette from the Somalia deployment vividly makes the point. Problems arose when family members learned of fire fights from news media instead of from official sources of information in the chain of command.

Distraught family members in the United States were calling deployed service members on cell phones, upsetting the service members and causing decreases in force effectiveness. Rather than trying to quash the situation with top-down orders, the commanders worked with the troops and family members and developed a system of phone trees to notify family members in near real-time of the status of their deployed loved ones after a conflict.