Protecting the Health of Deployed Forces

Feinleib, Dr. Manning, professor of epidemiology, Bloomberg School of
Public Health, Johns Hopkins University, prepared statement of
Kucinich, Hon. Dennis J., a Representative in Congress from the State
of Ohio:

Letters dated November 27, 2002 and February 27, 2003
Letter dated February 27, 2003

Maloney, Hon. Carolyn B., a Representative in Congress from the State

of New York:

Page

130

Pages from "Saddam's Bombmaker,"

Prepared statement of

Moxley, Dr. John H., III, managing director, North American Health

Care Division, Korn/Ferry International, prepared statement of

Robinson, Steven, executive director, National Gulf War Resource Center,

Inc., prepared statement of

Roswell, Robert H., M.D., Under Secretary for Health, Department of
Veterans Affairs, prepared statement of

Shays, Hon. Christopher, a Representative in Congress from the State
of Connecticut:

Prepared statement of

Winkenwerder, William, Jr., M.D., M.B.A., Assistant Secretary of Defense

for Health Affairs, Department of Defense:

Followup questions and responses.

Prepared statement of

50, 60, 62, 67

PROTECTING THE HEALTH OF

FORCES: LESSONS LEARNED
LEARNED

DEPLOYED

FROM THE

PERSIAN GULF WAR

TUESDAY, MARCH 25, 2003

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 2 p.m., in room 2247, Rayburn House Office Building, Hon. Christopher Shays (chairman of the subcommittee) presiding.

Present: Representatives Shays, Turner, Lewis, Murphy, Janklow, Kucinich, Maloney, Bell and Tierney.

Staff present: Lawrence Halloran, staff director and counsel; Thomas Costa and Kristine McElroy, professional staff members; Robert A. Briggs, clerk, Joe McGowen, detailee; David Rapallo, minority counsel; and Jean Gosa, minority assistant clerk.

Mr. SHAYS. I would like to call this hearing to order, this hearing entitled, "Protecting the Health of Deployed Forces: Lessons Learned from the Persian Gulf War."

When the war in Iraq is over, we will mourn our dead, and a grateful Nation will welcome home legions of battle-tested men and women who fought for freedom in a far-off place. Some will be well. Some will be wounded. We may not always be able to tell the difference.

Not all the casualties of modern warfare are apparent. Injuries and illnesses linked to exposures to chemicals, pathogens, and toxins may not manifest symptoms until months or years after the victory parades. But those wounded are as much our responsibility to prevent or treat as those caused by bullets and bombs on the battlefield. Today we ask if the health of deployed forces is being effectively monitored and adequately protected against the insidious but often avoidable perils of their very hazardous workplace.

Gulf war operations in 1991 could have taught us much about the dose-response relationship between wartime exposures and delayed health effects, but essential health data was never recorded. The Department of Defense [DOD], took years to acknowledge obvious deficiencies in Gulf war-era health protections for deployed forces. Since 1997, the Pentagon has issued impressive volumes of directives and joint staff policies on improved medical recordkeeping, battlefield environmental monitoring, troop location data, and health surveillance before, during and after deployments. Ex

ternal panels of experts have echoed those recommendations to standardize and integrate service-specific protocols and systems. The 1998 Defense Authorization Act directed the Department to implement many of the recommended improvements to medical tracking and disease prevention.

Witnesses today will describe substantial progress in applying the lessons learned during Operation Desert Storm about force health protection, but questions remain whether the ambitious plans and proposals of peacetime will be able to pierce the fog of war and yield the detailed real-time information needed to assess health effects after the battle. Do the pre and postdeployment questionnaires now being administered meet the statutory mandate for medical examinations? Will the brief, hastily administered surveys capture the data required by DOD and the Department of Veterans Affairs [VA], to reach valid epidemiological conclusions about service-connected health effects?

VA Secretary Anthony Principi recently concluded, much of the controversy over the health problems of veterans who fought in the 1991 war could have been avoided had more extensive surveillance data been collected. We agree. There should be no mysterious Iraq war syndrome after this victory. Veterans of this era should not go empty-handed into battle to prove deployment exposures caused or contributed to their postwar illnesses.

In modern warfare, smart weapons dominate the battlefield and minimize collateral casualties. By far the smartest, most complex, most elegant system we send into battle is the human body. Accurate timely information is the life-cycle maintenance log of our most precious military asset, freedom's sons and daughters, brothers and sisters, fathers and mothers. We look to those entrusted with their care to protect them.

We welcome our witnesses this afternoon, and we look forward to their testimony.

[The prepared statement of Hon. Christopher Shays follows:]

TOM DAVIS, VIZONA.
CHAIRMAN

DAK BURTON, INDIANA

CHRISTOPHER SHAYS. CONNECTICUT
ILEANA ROS-LEHTINEN, PLOFIDA
JOHN M. MCHUSH, NEW YORK

JOHN & MICA, FLORIDA

MARK E. SOUDER, INOLANA

STEVEN C. LATOURETTE OHIO

DOUS OSE, CALIFORNIA

RON LEWIS, KENTUCKY

JO ANN DAVIS, VIRGINIA

TOOD RUSSELL PLATTS, PENNSYLVANIA
CHRIS CANNON, UTAH

ADAN H. PUTNAM, FLOREDA

EDWARD L. SCHOOK, VIRGINIA
JOHN J. DUNCAN, JR, TENNESSEE
JOHN SULLIVAN, OKLAHOMA
NATHAN DEAL, GEORGIA
CANOICE MILLER, MICHIGAN
TIM NUIFPHY, FENNSYLVANIA
MICHAEL R. TURNER OHIO
JOHN A. CARTER, TEXAS

WILLIAM J. JANGLOW, SOUTH DAKOTA
MARSHA BLACKBURN, TENNESSEE

Statement of Rep. Christopher Shays

March 25, 2003

When the war in Iraq is over, we will mourn our dead and a grateful nation will welcome home legions of battle-tested men and women who fought for freedom in a far off place. Some will be well. Some will be wounded. We may not always be able to tell the difference.

Not all the casualties of modern warfare are apparent. Injuries and illnesses linked to exposures to chemicals, pathogens and toxins may not manifest symptoms until months or years after the victory parades.

But those wounds are as much our responsibility to prevent, or treat, as those caused by bullets and bombs on the battlefield. Today we ask if the health of deployed forces is being effectively monitored and adequately protected against the insidious, but often avoidable, perils of their very hazardous workplace.

Gulf War operations in 1991 could have taught us much about the dose/response relationship between wartime exposures and delayed health effects, but essential health data was never recorded. The Department of Defense (DOD) took years to acknowledge obvious deficiencies in Gulf War-era health protections for deployed forces.

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Protecting the Health of Deployed Forces: Lessons Learned ..., Volumes 74-77