Union Calendar No. 228

105th Congress

Report

HOUSE OF REPRESENTATIVES

1st Session

105-388

GULF WAR VETERANS' ILLNESSES: VA, DOD CONTINUE TO RESIST STRONG EVIDENCE LINKING TOXIC CAUSES TO CHRONIC HEALTH EFFECTS

November 7, 1997.-Committed to the Committee of the Whole House on the State of the Union and ordered to be printed

Mr. Burton, from the Committee on Government Reform and Oversight, submitted the following

SECOND REPORT

On October 31, 1997, the Committee on Government Reform and Oversight approved and adopted a report entitled ``Gulf War Veterans' Illnesses: VA, DOD Continue to Resist Strong Evidence Linking Toxic Causes to Chronic Health Effects.'' The chairman was directed to transmit a copy to the Speaker of the House.

I. SUMMARY

Responding to requests by veterans, the subcommittee in March 1996 initiated a far-reaching oversight investigation into the status of efforts to understand the clusters of symptoms and debilitating maladies known collectively as ``Gulf War Syndrome.'' We sought to ensure sick Gulf War veterans were being diagnosed accurately, treated effectively and compensated fairly for service-connected disabilities, despite official denials and scientific uncertainty regarding the exact causes of their ailments. We also sought to determine whether the Gulf War research agenda was properly focused on the most likely, not just the most convenient, hypotheses to explain Gulf War veterans' illnesses.

After 19 months of investigation and hearings, the subcommittee finds the status of efforts on Gulf War issues by the Department of Veterans Affairs [VA], the Department of Defense [DOD], the Central Intelligence Agency [CIA] and the Food and Drug Administration [FDA] to be irreparably flawed. We find those efforts hobbled by institutional inertia that mistakes motion for progress. We find those efforts plagued by arrogant incuriosity and a pervasive myopia that sees a lack of evidence as proof. As a result, we find current approaches to research, diagnosis and treatment unlikely to yield answers to veterans' life-or-death questions in the foreseeable, or even far distant, future.

We do not come to these conclusions lightly. Nor do we discount all that has been done to care for, cure and compensate Gulf War veterans. But lives have been lost, and many more lives are at stake.

Six years and hundreds of millions of dollars have been spent in the effort to determine the causes of the illnesses besetting Gulf War veterans. Yet, when asked what progress has been made healing sick Gulf War veterans, VA and DOD can't say where they've been and concede they may never get where they're supposed to be going. The CIA continues to resist broader declassification of Gulf War records. The FDA meekly chastises the Defense Department for the failure to observe agreed-upon rules for the humane use of experimental drugs.

Sadly, when it comes to diagnosis, treatment and research for Gulf War veterans, we find the Federal Government too often has a tin ear, a cold heart and a closed mind.

Our hearings convinced us the journey from cause to cure for Gulf War veterans runs through the pools, clouds and plumes of toxins in which they lived and fought. It is a journey VA and DOD might never have taken but for persistent pressure from this subcommittee, and other House and Senate panels, that forced the Pentagon to acknowledge a ``watershed event'' - the probable exposure of United States troops to chemical weapons fallout at Khamisiyah, Iraq.

With that first admission, the three pillars of Government denial - no credible detections, no exposures, no health effects - began to crumble. As the number of U.S. troops presumed exposed grew from 400 to almost 100,000, as the credibility of other chemical detections was sustained, and as private research probed the parallels between Gulf War illnesses and the known symptoms of chemical poisoning, some significant role for toxins in causing, triggering or amplifying neurological damage and chronic symptoms could no longer be denied.

Before Khamisiyah, voluminous and compelling, albeit circumstantial, evidence regarding neurotoxic exposures had been ignored, denied or discredited, while far less abundant evidence and far less plausible psychological theories of causation were pursued with vigor. As a result, diagnostic protocols were insensitive to exposure effects, treatments were limited and vital research was delayed.

Only recently were VA and DOD health registry questionnaires modified to consistently capture the best and only remaining evidence of toxic exposures: veterans' recollections. Only recently was research funded to measure the health effects of sustained, low-dose exposure to the combinations of chemicals, pharmaceuticals and environmental toxins to which Gulf War veterans were exposed.

Those denials and delays are symptomatic of a system content to presume the Gulf War produced no delayed casualties, and determined to shift the burden of proof onto sick veterans to overcome that presumption. That task has been made difficult, if not impossible, because most of the medical records needed to prove toxic causation are missing or destroyed. Nevertheless, VA and DOD insist upon reaping the benefit of any doubts created by the absence of those records.

The subcommittee believes the current presumptions about neurotoxic causes and effects should be reversed and the benefit of any doubt should inure to the sick veteran.

Finally, we reluctantly conclude that responsibility for Gulf War illnesses, especially the research agenda, must be placed in a more responsive agency, independent of the DOD and the VA.

Fortunately for Gulf War veterans, excellent research into Gulf War illnesses has taken place outside Government sponsorship. This research has advanced a case definition for some illnesses, an important step toward improved diagnosis and treatment. Some experimental treatments have brought relief to afflicted veterans and their families. The subcommittee believes this work must be included within the scope of that agency made responsible for Federal efforts to solve the puzzle of Gulf War illnesses.

We note with approval efforts at the National Institute of Environmental Health Sciences [NIEHS] and other public health agencies to study exposure effects and genetic susceptibility to environmental toxins. Funding for this research would be an important first step in the effort to have an independent agency, with significant expertise in environmental hazards, involved in the solution to Gulf War veterans' health problems.

There is no ``silver bullet'' to explain or cure so-called Gulf War Syndrome, which is not a discrete syndrome at all, but a variable cluster of symptoms and disease states with different triggers and susceptibilities. The battle to cure Gulf War illnesses must be fought at the cellular, molecular and genetic levels if we hope to heal the delayed wounds of that war and protect future warriors. Absent precise exposure data which can never be recaptured, the best evidence linking toxic causes to chronic effects lies within the bodies and minds of Gulf War veterans. That evidence has been too long ignored.

A. FINDINGS IN BRIEF

Diagnosis

1. VA and DOD did not listen to sick Gulf War veterans as to possible causes of their illnesses.

2. The presence of a variety of toxic agents in the Gulf War theater strongly suggests exposures have a role in causing, triggering or amplifying subsequent service-connected illnesses.

3. Gulf War troops were not trained to protect themselves from the effects of exposure to depleted uranium dust and particles.

4. Pyridostigmine bromide [PB] can have serious side effects and interactions when taken in combination with other drugs, vaccines, chemical exposures, heat and/or physical exercise.

5. VA and DOD health registry diagnostic protocols relied on the unfounded conclusion there were no chemical, biological or other toxic exposures to U.S. troops in the Gulf War theater.

6. VA and DOD health registry diagnosis protocols continue to be based on the unwarranted conclusion that, unless there is an immediate and acute reaction, exposures to chemical weapons and other toxins do not cause delayed or chronic symptoms.

7. Prematurely ruling out toxic exposures as causative, VA and DOD doctors relied on diagnoses of somatoform disorder and Post Traumatic Stress Disorder [PTSD] to explain Gulf War veterans' illnesses.

8. There is no credible evidence that stress or PTSD causes the illnesses reported by many Gulf War veterans.

9. Accurate diagnosis of veterans' illnesses remains difficult due to inadequate or missing personal medical records, missing toxic detection logs, and unreleased classified documents.

10. Accurate diagnosis of veterans illnesses was also hampered by the VA's lack of medical expertise in toxicology and environmental medicine.

11. Exposures to low levels of chemical warfare agents and other toxins can cause delayed, chronic health effects.

Treatment

12. Neither the VA nor the DOD has systematically attempted to determine whether sick Gulf War veterans are any better or worse today than when they first reported symptoms.

13. Treatment of sick Gulf War veterans by VA and DOD to date has largely focused on stress and PTSD.

Compensation

14. Compensation ratings for sick veterans are minimized due to inadequate personal medical records, missing toxic detection logs, and unreleased classified documents which could help veterans establish service-connection of post-war disabilities.

15. Compensation ratings are also minimized by over-reliance on somatoform disorder and PTSD as the basis of disability claims.

Research

16. Federal research strategy has been blind to promising hy-potheses due to reliance on unfounded DOD conclusions regarding chemical exposures.

17. Institutional and methodological constraints make it unlikely the current research structure will find the causes and effective treatments for Gulf War veterans' illnesses in the short term.

18. The FDA was passive in granting and failing to enforce the conditions of a waiver to permit use of PB by DOD.

B. RECOMMENDATIONS IN BRIEF

Diagnosis

1. Congress should enact a Gulf War toxic exposure act establishing the presumption, as a matter of law, that veterans were exposed to hazardous materials known to have been present in the war theater.

2. The VA should contract with an independent scientific body composed of non-Government scientific experts representing, at a minimum, the disciplines of toxicology, immunology, microbiology, molecular biology, genetics, biochemistry, chemistry, epidemiology, medicine and public health for the purpose of identifying those diseases and illnesses associated in peer-reviewed literature with singular, sustained, or combined exposures to the hazardous materials to which Gulf War veterans are presumed to have been exposed.

3. The VA Gulf War Registry and the DOD Comprehensive Clinical Evaluation Program should be re-evaluated by an independent scientific body which shall make specific recommendations to change both programs from crude research tools into effective clinical diagnosis and outcomes monitoring efforts.

4. The VA should refer all Phase II Registry examinations to Gulf War Referral Centers.

5. The VA should add toxicological and environmental medicine expertise to the staff resources dedicated to Gulf War illnesses.

6. DOD and VA should make every effort to find, and where necessary re-create through veterans' testimony, individual Gulf War medical records to reflect vaccines administered, PB use, and exposure to DU, pesticides and other hazardous materials.

7. The President should order an intensified effort to declassify Gulf War documents in any way related to Gulf War veterans' illnesses and should personally certify to the appropriate committees of Congress when he deems declassification of such documents to be against the national interest.

8. DOD failure to adhere to recordkeeping requirements or clinical protocols under an informed consent waiver should result in the presumption of service-connection for any subsequent illness(es) suffered by service personnel to whom the drug or protocol was administered.

Treatment

9. VA and DOD should systematically and effectively monitor the clinical progress of Gulf War veterans to determine the most effective treatments.

10. VA and DOD clinicians should be encouraged to pursue, and be trained in, new treatment approaches to suspected neurotoxic exposure effects.

11. The diagnoses for somatoform disorders and Post Traumatic Stress Disorder [PTSD] should be refined to insure that physiological causes are not overlooked.

Compensation

12. Denials of Gulf War veterans' compensation claims attributable in any way to missing medical records should be reviewed and veterans given the benefit of any doubt regarding the presumptive role of toxic exposures in causing post-war illnesses and disability.

13. For purposes of compensation determinations, disabilities associated with presumed exposures should be deemed service-connected without any limitation as to time.

Research

14. Congress should create or designate an agency independent from the Departments of Defense and Veterans Affairs as the lead Federal agency responsible for coordination of all research into Gulf War veterans' illnesses and allocation of all research funds.

15. The lead Federal agency on Gulf War veterans' illnesses should focus research on the evaluation and treatment of the common spectrum of neuroimmunological disorders known as Gulf War Syndrome, multiple chemical sensitivity, chronic fatigue syndrome and fibromyalgia.

16. DOD and VA medical systems should augment research and clinical capabilities with regard to women's health issues and the health effects of combat service on women's health.

17. VA, in collaboration with NIH, CDC, FDA and other public health agencies should establish an interdisciplinary research and clinical program on the identification, prevention and treatment of environmentally induced neuropathies.

18. FDA should grant a waiver of informed consent requirements for the use of experimental or investigational drugs by DOD only upon receipt of a Presidential finding of efficacy and need.

II. BACKGROUND

Since the Gulf War ended in 1991, there has been a growing number of reports of chronic illnesses among the nearly 700,000 United States troops who served in Saudi Arabia, Kuwait, and Iraq. Although the illnesses are most common among reservists and National Guardsmen who served in the Gulf, full-time active-duty soldiers have also complained about various maladies.⁽¹⁾

Health complaints by Gulf veterans from Canada, Great Britain, Kuwait, Australia, Czech Republic, Hungary, New Zealand and Norway have also begun to surface. There has also been an increased incidence of similar illnesses in the civilian populations of Kuwait, Iraq, and Saudi Arabia, according to a report to the Human Resources Subcommittee by chemical/biological weapons expert Dr. Jonathan Tucker, director of the chemical and biological nonproliferation project, Monterey (CA) Institute for International Studies.⁽²⁾

Listed in the Persian Gulf health registries of the Departments of Defense [DOD] and Veterans Affairs [VA] are about 113,000 Gulf War veterans [DOD's Comprehensive Clinical Evaluation Program with 44,900 names as of August 1997, and VA's Gulf Health Registry with 67,989 names as of May 1997].⁽³⁾ Most participants in the registries have been diagnosed, approximately 20 percent remained undiagnosed, and roughly 10 percent of those listed had no detectable symptoms.⁽⁴⁾ Many veterans have reported flu-like symptoms, chronic fatigue, rashes, joint and muscular pain, headaches, memory loss, reproductive problems, depression, loss of concentration, gastroin-testinal problems, and other maladies.⁽⁵⁾

According to American Legion: ``One of the key questions that arises from evaluating [VA Health] Registry data is: What is happening to those veterans that complain of the most common symptoms? What is the outcome of their visit to the VA? Are they getting better, or are they slipping through the cracks? Our hypothesis is that these veterans who complain of the symptoms are not receiving the proper follow-up and treatment they deserve.''⁽⁶⁾

Many Gulf War veterans are concerned that their medical problems are chronic and disabling, and are the result of exposures to one or more chemical, biological or nuclear agents present in the theater of operations. Health problems of Gulf veterans may stem not only from chemical and biological warfare agents but from other sources such as: pesticides and insect repellants; leaded diesel fuel; depleted uranium; oil well fires; infectious agents; and the anti-nerve agent drug, pyridostigmine bromide.⁽⁷⁾

In 11 hearings⁽⁸⁾ since March 1996, the Human Resources Subcommittee has examined issues dealing with veterans' symptoms and complaints about the handling of their health problems by the VA, especially about inappropriate medical treatment or denial of treatment, missing or inadequate personal medical records, compensation issues, and lack of valid and timely Government research conclusions about the causes of their illnesses. The subcommittee also sought to ensure that any research programs conducted by the Departments of Defense [DOD], Health and Human Services [HHS], and the Environmental Protection Agency [EPA] were well-focused and coordinated.

The subcommittee has examined studies of effects of low level chemical exposures on humans and animals, and probable exposures of large numbers of troops to chemical warfare agents and other toxins during and after the war. Typical complaints of Gulf veterans are similar to known effects on humans who have been exposed to organophosphates, such as pesticides and other chemical agents.⁽⁹⁾ Organophosphates are chemically related to Sarin and other warfare agents present in the Gulf War theater.

Not listening to veterans' health complaints, many military and VA doctors - often unable or unwilling to diagnose veterans' illnesses as the after-effects of possible neurotoxic exposures - have insisted veterans suffered instead from stress, or post-traumatic-stress-disorder [PTSD].⁽¹⁰⁾ Many private physicians and researchers believe DOD and VA doctors have relied too heavily on psychological theories of causation while discounting the possibility of neurotoxic exposures.⁽¹¹⁾

The Human Resources Subcommittee has listened carefully to hundreds of Gulf War veterans who have written and called the subcommittee since hearings began in March 1996. The subcommittee has also listened to the testimony of 23 Gulf veterans who testified in the 11 hearings held.

A. LISTENING TO GULF WAR VETERANS

Among Gulf veterans testifying before the subcommittee were Steven Wood, Barry Kapplan, Chris Kornkven, Julia Dyckman, and Brian Martin, all of whom reported health complaints typical of the range of maladies often called the ``Gulf War Syndrome.''

Army S/Sgt. Steven Wood testified that during the first week of March 1991, he drove through ammunition storage sites destroyed by U.S. forces. Near a bombed out bunker, he inspected artillery rounds on the ground which he identified in an Army manual as chemical weapons. ``Later that day,'' Sgt. Wood stated, ``I started to get very sick with symptoms I suffer still today. I sought medical assistance that day ... [and] ... never once received any comprehensive, much less compassionate, treatment from the Army. I was told it was `all in my head.'''

Transferred back to Germany following the war, his symptoms continued. In 1994, Sgt. Wood, unable to get treatment from Army doctors and unable to perform his duties, contacted a German physician. ``This German doctor did more tests in 2 hours than the Army did in 5 years. When my wife and I left the [German] doctor's office, we were told that I `had been poisoned.' These findings were immediately dismissed [by Army doctors] as being worthless since they did not come from a military doctor. Then it was stated to me by this military doctor that they did not like Gulf War veterans [complaining] with health problems.''⁽¹²⁾

Major Barry Kapplan, a career Army pilot who had passed 15 flight physicals in the 11 years prior to deployment to the Gulf War, ``began to feel increasingly ill'' in April 1991 but dismissed the symptoms as related to the harsh desert environment. On May 8, he reported ``violent nausea, vomiting, diarrhea attack.'' On May 28, now back in Germany, he was admitted to a military hospital with ``cardiac arrhythmias ... severely bleeding gums, cough with sputum production, shortness of breath, severe fatigue, diarrhea, hair loss, skin rashes/lesions, and abdominal discomfort.'' Military doctors diagnosed Major Kapplan with ``just post traumatic stress.'' With severe brain, nerve, heart and gastrointestinal problems but still being diagnosed with ``somatoform disorder,'' he was given a discharge by the Army ``due to unemployability'' in October 1995.⁽¹³⁾

Major Kapplan's wife Nancy, a registered nurse, testified about ``the medical issues facing our family'' since her husband's return from the Gulf. Her four children have suffered from continual chronic infections and one child has ``... esophagitis, gastritis and gastroesophageal reflux disease ... with little relief of her symptoms.'' Mrs. Kapplan reported that she has similar chronic symptoms since her husband came home from the war.⁽¹⁴⁾

S/Sgt. Chris Kornkven, an Army Reservist, reported, ``While still in the Gulf I began experiencing symptoms that continue to this day. I had difficulty remembering significant events that happened days earlier ... my knees and shoulders [were] especially painful ... and fatigue stayed with me constantly.'' After the war, his symptoms worsened and included intestinal problems and headaches. He sought treatment in 1992 from VA doctors who - without any physical exam, testing or treatment - referred him to the mental health clinic where he was diagnosed ``PTSD.''⁽¹⁵⁾

``I reported blinding headaches with only offers of aspirin. I reported memory loss ... dismissed as stress. I reported skin problems ..`it's not cancer yet ... come back as needed.' I reported breathing problems ... no diagnosis. I reported intestinal problems ... and rectal bleeding ... dismissed [and] no follow-up. I reported joint pain ... diagnosed as fibromyalgia ... no treatment other than Motrin. I reported chest pains ... and racing heart beats ... [and] was told it was due to an abnormal heart valve ... [which] was hereditary,'' a point which S/Sgt. Kornkven says ``nicely avoids VA's rating guidelines.''⁽¹⁶⁾

During the war, thousands of troops, including S/Sgt. Kornkven, climbed on Iraqi vehicles destroyed by depleted uranium [DU] rounds which leave a residue of dangerous radioactive dust particles when inhaled or ingested. He was tested by the VA and told he ``had a higher DU count than those [troops] carrying around [DU] fragments in their bodies ... [but] it was nothing for me to worry about.''⁽¹⁷⁾

``My wife had a miscarriage in which the fetus had to be surgically removed. She has as much trouble with fatigue as I do. She was diagnosed by a private physician as having fibromyalgia. My son, who is 2 years old, has not slept a complete night since being born. He appears to have intestinal problems, his stools are very acidic, he is VERY light sensitive, and has the exact same rashes on his legs as I do.''⁽¹⁸⁾

As far as the VA's emphasis on stress as a cause of Gulf veterans' illnesses is concerned, S/Sgt. Kornkven stated that while stress may play some part in his malady, he believes that ``... veterans are subjected to much more stress by trying to navigate the bureaucracy of the VA, and with worrying how to cope with medical conditions that are ignored. All the while being unable to work, and wondering how to feed or house a family.''⁽¹⁹⁾

Gulf War and Vietnam War veteran Reserve Navy Captain Julia Dyckman is a registered nurse who was in charge of the emergency room and the out-patient clinic of Combat Zone Fleet Hospital 15 near Al Jubayl, Saudi Arabia, an area often under SCUD missile attacks. Her unit took care of 8,211 out-patients, 697 in-patients, and 90 combat admissions. In her hearing statement, she identified the following medical conditions reported by troops in-theater and treated by her hospital personnel: respiratory problems; unexplained fevers; vomiting; diarrhea; various rashes; numerous reactions to immunizations; unexplained stomach and abdominal pains; and cardiac problems.⁽²⁰⁾

On returning to the United States, Captain Dyckman was assigned to interview returning Gulf veterans. She stated: ``Many personnel voiced concerns over long term health effects, current health conditions, and numerous pay and family situations. The Readiness Commander did not like the results of my interviews ... interfered with my medical care ... [and] ... records of interviews I conducted were discarded. For most Gulf reservists, the only avenue available for medical care was civilian or possibly the VA. Some veterans were too ill to hold down a job and therefore had no medical insurance to cover civilian care.''⁽²¹⁾

``During this time my health continued to deteriorate. I was released from active duty even though my medical problems were not resolved. I sought care at the VA [for the following]: hearing loss; bronchitis; chronic cough; hypertension; rashes; foot and joint pain; stomach ulcer; diarrhea; headaches; abdominal pain. I was diagnosed with gout (although the gout test was negative); offered Tylenol; and told, `Nothing is wrong with you, get it through your head!'''⁽²²⁾

``For over 2-1/2 years I was shuffled from one VA clinic to another, each investigating a different body system. No coordinated treatment or diagnostic effort was ever experienced. It has been a problem with records [needed] for disability claims ... [which were] ... lost in the VA system. Disability and claims procedures are complicated and time consuming. In order to obtain VA treatment for Gulf illness, you have to first have a service connected illness or injury which is difficult to prove even when you were treated in-theater. Also, the VA only considers military and VA medical records for service connection, excluding expert civilian records. Additionally, they only use selected parts of records that agree with the VA and disregard any positive findings.''⁽²³⁾

``You might ask what it is like to be a Persian Gulf war veteran after 6 years. Each day starts with uncertainty. When you eat you are constantly sick and have intermittent diarrhea. Mobility is difficult due to swollen joints and muscle aches. Severe headaches are intermittent. Sometimes you forget what you are doing and what you were going to do. Pain and fatigue are constant companions. You are forced to deal with constant denials from the Pentagon that `nothing happened' during the war. These statements confuse medical providers who then doubt your credibility. What is needed is recognition, though not coded by the CDC, that Gulf war illness is a combination of unique symptoms and outcomes. This is why specific protocols need to be run before the VA says that this illness `doesn't exist' or is `all in your head.'''⁽²⁴⁾

Sgt. Brian Martin was a former member of the 37th Airborne Engineer Battalion, a unit which detonated and destroyed the Iraqi ammunition depot at Khamisiyah containing 100 bunkers and 43 warehouses. He videotaped the event and made it available to the subcommittee and television networks in the summer of 1996. Sgt. Martin testified: ``On March 4th, 1991, we entered the depot area, placing explosives in and around 33 bunkers. We set time charges for detonation, then moved south 3 miles to what we considered a `safe zone.' At no time whatsoever did we fear ... chemical exposure. We were told ... there were no chemicals in the area. Our commanders knew nothing about chemicals in the bunkers. Seven minutes later the destruction of Khamisiyah began.''

``Witnessing these awesome explosions was a remarkable sight. The explosions blew straight into the air, then would spread at the top ... [it was] ... the closest thing to a nuclear mushroom we would ever see. Our excitement quickly turned to fear when `cook offs' or fallout from the explosions began showering down on us. Several missiles landed underneath our trucks, spinning and taking off until blowing up. Men were running everywhere for cover. Giant clouds ... were covering us. The 82d Airborne [12 miles away] asked us to stop the detonation because of `cook-offs' penetrating their area. Our battalion moved into convoy formation and proceeded to vacate the area. Twenty miles later we found an area with no signs of `cook-offs.'''

``For the next 3 days it rained harder than any of us had seen in the 6 months we were there. Our commanders joked about us `putting something into the air to change the weather.' For the next 5 days it was unsafe for us to return to Khamisiyah to finish destroying the remaining 67 bunkers. The skies were dark, gray and cloudy for those 5 days.''

``Since Khamisiyah, I suffer from ... blood in vomit and stools, blurred vision, shaking and trembling ... muscles weakening ... chest pounding like my heart was going to explode. My symptoms were simply written off [by Army doctors] as a `stomach viral infection of an unknown origin.' My medical conditions were ignored. In December 1991, I put in for an `early out' from the military. I did not receive an exit exam nor did I know I was supposed to.''

``I suffer from excruciatingly painful headaches, memory loss, and severe diarrhea ... mood swings ... I violently vomit if I smell perfumes, vapors or chemicals. I get lost and forget where I am sometimes. I am an ex-paratrooper who needs a cane and wheelchair to get around. My joints ... swell, burn and hurt.''

``Today ... I have some clearly defined diagnoses from the VA of multiple chemical sensitivity, inflammatory bowel disease with scarring of the colon and stomach due to chemical exposure, temporal lobe brain damage also with scarring due to chemical exposure, Reiter's Syndrome, chronic fatigue syndrome, and tinnitus. I have abnormally high platelets around my blood cells, and recently I began testing for Lupus and Alzheimer's Disease. I am worn out all the time, yet I am an insomniac. For all of this, except [for] the chemical injuries ... the VA rated me in 1994 at 100 percent compensation ... then in 1996 added Permanent and Total [disability, following DOD's announcement about Khamisiyah].''⁽²⁵⁾

Other Gulf veterans testified before the subcommittee about life-threatening illnesses such as cancers, heart and lung problems, and Amyotrophic Lateral Sclerosis [ALS].

Colonel Gilbert Roman, U.S. Army Reserve, volunteered for active duty in the Gulf War and was named Deputy Commander of the 311th Evacuation Hospital, Army Medical Service Corps. He stated [in spite of profuse nasal bleeding from pre-cancerous polyps during testimony]: ``I arrived in Theater on January 6, 1991 ... [and] ... during official visits to strategic military cities there were frequent SCUD attacks during which I heard chemical alarms sound. When I asked if these alarms meant chemicals had been detected, I was told that the chemical alarms had malfunctioned. I [soon] became ill and was treated for nausea, headaches, vomiting, diarrhea and high temperature. Rashes I had over my body I thought were normal and expected since I spent most days in the sand, wind and sun with all the attendant fleas, flies and desert parasites. Headaches I attributed to fatigue and lack of sleep.''⁽²⁶⁾

``The symptoms ... continued after I returned home and got progressively worse. In 1993, I registered at [a] veterans' hospital after receiving an invitation from the VA to come in for an examination if I was a Gulf veteran. They recorded all of the ailments I indicated ... [but] ... no treatment was offered. The VA hospital billed me for my supposed `free examination' and they ended up attaching my next year's meager tax return.''⁽²⁷⁾

``To date, although I have now had three official examinations since 1993, I still continue to receive requests for more and more information from the VA claims office. Materials sent are never acknowledged as received, phone numbers given are not to any VA recognized exchange, and the name given for contact is not a true VA employee. Frustration ... [I've been] in the VA `system' 4 years with no real contact from a person; just requests for more information.''⁽²⁸⁾

``In 1996, I was hospitalized three times and treated by my private physician for a respiratory ailment. I could not walk more than 25 steps without having to stop, out of breath and fatigued. This ailment, which was life threatening, would not allow me to lie on my back to sleep as I would begin to drown ... as my lungs filled with fluid. I was forced to sit up for sleep and was constantly fatigued due to lack of sleep and no energy.''⁽²⁹⁾

``My [private] cardiologist, Dr. Peter Steele, diagnosed me as having `cardiomyopathy with congestive heart failure.' Dr. Steele stated [in a letter]: `What is clear is that he served in the Middle East and that he has a cardiomyopathy. I would submit that this may well be part of the Gulf War Syndrome.'''⁽³⁰⁾

Major Michael Donnelly, USAF retired, who flew 44 combat missions during the Gulf War, often flying through plumes from bombed Iraqi munitions manufacturing and storage facilities, stated: ``Upon return from the Gulf, I was reassigned to Florida ... [where] ... I first started to experience strange health problems. I didn't feel as strong as I once had or as coordinated ... [and] ... always fighting a cold or the flu. By the summer of 1995 ... [and] ... stationed in Texas ... I was exposed to malathion fogging, an organophosphate pesticide used for mosquito control, while jogging in the evenings. I started to have serious health problems.''

``Schetoma, or blind spots, in front of my eyes and my heart would beat irratically. Palpitations, night sweats, sleeplessness, trouble concentrating and remembering, and trouble taking a deep breath. Extremely tired much of the time. By December, I had trouble walking and experienced weakness in my right leg. In January 1996, I explained my symptoms, and mentioned I had been in the Gulf War, to a flight surgeon who immediately talked about the effects of stress. I was referred to a neurologist.''

``During the first visit with the neurologist, I heard the line that I would hear throughout the whole Air Force medical system: `There's no conclusive evidence that there's any link between service in the Gulf and any illness.'''⁽³¹⁾

Major Donnelly, in his 20's during the war, was diagnosed in January 1996 with ALS or ``Lou Gehrig's Disease.'' ALS, a rare fatal disease which generally affects people between the ages of 40 to 70, is ``a progressive wasting of muscles that have lost their nerve supply.''⁽³²⁾

DOD's Special Assistant for Gulf War Illnesses Dr. Bernard Rostker, an economist, has admitted that nine cases of ALS among Gulf veterans have been confirmed, and stated under oath that ``for the population that served in the Gulf, we would expect to see roughly between 7 and 11 cases of ALS. And we're looking at nine cases of ALS.''⁽³³⁾

However, [in response to Dr. Rostker's claim] the director of the Cecil B. Day Laboratory for Neuromuscular Research at Massachusetts General Hospital and an ALS expert, Robert H. Brown, Jr., M.D. and Ph.D., stated in a letter to the Human Resources Subcommittee:

``The incidence of new cases of ALS is about 1/100,000 individuals in our [overall] population. Thus, it is true to say that a group of 700,000 individuals might, in the aggregate, be expected to show 7 or so new cases of ALS over a year's time. However, these statements about aggregate populations must be interpreted carefully. In particular, they assume an age-spread that reflects an entire population [emphasis added]. If one looks at the age of onset of ALS, the mean onset age is 55 years. The number of cases showing onset below the age of 40 [emphasis added] is probably no more than 20-25 percent or so of the total. Thus, one might expect 0.20-0.25 cases/100,000 individuals [or an estimated 1.4-1.7 cases of ALS in the 18-40 age range]. As I understand it, there are now 9 or 11 cases of ALS in the Gulf War veterans population. This seems excessive to me [emphasis added].''⁽³⁴⁾

According to a study by Dr. Will Longstreth, professor of neurology at the University of Washington School of Medicine, people exposed to organophosphate compounds, such as pesticides and other chemicals, may be at twice the risk of developing ALS.⁽³⁵⁾

Another Gulf veteran with ALS is Marine Major Randy Hebert, also a subcommittee witness, who testified that he may have been contaminated from a reported exploding chemical mine near his vehicle when the Kuwait invasion began February 24, 1991. Major Hebert stated: ``I recall my right hand feeling cool and tingling''<sup>(36)</sup> as he struggled into his protective clothing and gear. After removing his mask when told it was a false alarm, he received another radio message: ``Your lane is dirty, chemical mine has gone off, go to MOPP 4 [full protective equipment].'' Major Hebert testified, ``I now feel that [removing his mask] was a mistake.'' Shortly after, Major Hebert said, ``he felt funny'' and had trouble breathing.⁽³⁷⁾

Returning home in May 1991, Major Hebert reported symptoms of memory loss, mood swings, vomiting, diarrhea, depression, and severe daily headaches. By the fall of 1994, he experienced uncontrollable coughing, throat muscle constriction, and atrophy in the right arm and hand. In October 1995, after more than 4 years of undiagnosed symptoms, he was finally diagnosed with ALS. ``I believe the medical problems I have discussed are due to low level chemical exposure over an extended period,''⁽³⁸⁾ Major Hebert concluded.

Nick Roberts, a subcommittee witness, was a Seabee with Naval Mobile Construction Battalion 24 stationed near the Port of Al Jubayl, Saudi Arabia -an area reportedly hit by SCUDs. He stated: ``On January 20, 1991, I was awakened by a loud explosion. Running to the bunker, I heard a second explosion and noticed a large fireball. I put my gas mask on. We sat there for approximately 20 minutes and then the all-clear was given. We went outside. I estimate that half of the unit returned to their tents and the other half remained outside talking.''

``I was one of the men outside talking. Within just a few minutes, my arms, neck and face were stinging, my lips felt numb and I had a strange taste in my mouth, like a copper penny ... a metallic taste. Some say a mist came over the camp ... [it seemed] more of a fog. Chemical alarms began sounding. Alarms going off everywhere. Marines camped nearby began to yell, `Go back to your bunkers. We have been gassed.' We were ordered to MOPP level 4. Radio transmissions were coming in, `Confirmed gas attack. Repeat, confirmed gas attack.'''

``We were given the all-clear once again. Afterwards, many of us went to the water tank and washed ourselves down to stop the stinging. My first symptoms were redness of the skin and welts on my chest that afternoon.''

Petty Officer Roberts reported that ``in the days and weeks that followed my symptoms began to grow in number: rashes and small blisters, fever, night sweats, and flu-like symptoms, just to mention a few. After a month, my lymph glands were swollen and my joints hurt. Once home ... we were turned over to the VA ... the Navy said they were not set up to take care of our medical needs. I never got any medication from the VA, nor was I ever diagnosed by the VA.''

Petty Officer Roberts reported that after 1-1/2 years of no help from the Navy or VA, ``I sought private medical help. Within 6 weeks of testing and a biopsy of my lymph gland, I was diagnosed with non-Hodgkin's lymphoma, a cancer, in stage three. I started on chemotherapy 2 days later.''

``The cause of my symptoms is very obvious. I stand by my charge - as I have from the very beginning - of chemical [warfare] exposure, not to mention the overall exposure from fallout due to intensive [United States] bombing of [Iraqi] chemical and biological plants, radiation fallout from thousands of depleted uranium rounds used by the United States, exposure to vaccines and nerve gas pills, and months of breathing smoke from more than 300 oil well fires. I don't see how you can call it anything else. Gulf veterans are suffering [from] chemical poisoning.''⁽³⁹⁾

Petty Officer Roberts concluded: ``By the end of 1993, [there were] 399 men out of 758 [in Battalion 24] who had been put out of the service because they were medically unfit.''⁽⁴⁰⁾

B. CHEMICAL DETECTIONS AND EXPOSURES

According to Gulf veterans who testified before the Human Resources Subcommittee, thousands of chemical alarms sounded and numerous chemical detections by trained U.S. chemical specialists with state-of-the-art equipment were made only to be ignored by American commanders. Czech chemical warfare experts recorded numerous detections, including detections along the Saudi border where hundreds of thousands of United States troops were massed for the invasion.

DOD has admitted that ``the Czech detections were valid.''⁽⁴¹⁾

In May 1994, DOD Secretary William Perry and Joint Chiefs Chairman John Shalikashvili signed a memorandum to Gulf veterans declaring: ``There have been reports in the press of the possibility that some of you were exposed to chemical or biological weapons agents. There is no information, classified or unclassified, that indicates that chemical or biological weapons were used in the Persian Gulf.''⁽⁴²⁾

In October 1994, however, the Senate Banking Committee released a staff report which compiled official documents and eyewitness testimony suggesting that U.S. troops had been exposed to chemical warfare agents during the Gulf War.⁽⁴³⁾

In March 1995, another event cast some doubt on DOD's insistence that there were no chemical or biological warfare agent exposures. In a television interview, John Deutch, then Deputy Secretary of DOD repeatedly qualified his statements regarding chemical weapons exposures in the Gulf War:

Mr. Deutch. Our most thorough and careful efforts to determine whether chemical agents were used in the Gulf lead us to conclude that there was no widespread use of chemicals against U.S. troops.

Bradley. Was there any use? Forget widespread.

Mr. Deutch. I - I do not believe ...

Bradley. ... was there any use?

Mr. Deutch. I do not believe there was any offensive use of chemical agents by Iraqi military troops. There was not ...

Bradley. Was there any - any accidental use. Were our troops exposed in any way?

Mr. Deutch. I do not believe that our troops were exposed in any widespread way to chemical ...

Bradley. In any narrow way? In any way?

Mr. Deutch. The Defense Science Board did an independent study of this matter and found, in their judgment, that there was not confirmation of chemical weapon widespread use in the Gulf.⁽⁴⁴⁾ (emphasis added)

The Pentagon, after 5 years of denial that United States troops were exposed to chemical weapons, finally admitted in June 1996 that 300 to 400 soldiers were ``presumed exposed'' to chemical warfare agents from fallout following detonation of Iraqi munitions bunkers at Khamisiyah. The number of ``presumed exposed'' continued to rise rapidly and by July 1997 the Pentagon had raised the number of exposed to 98,900.⁽⁴⁵⁾

In a January 1996 report to the Human Resources Subcommittee, Dr. Jonathan Tucker stated, ``Considerable data [exists] suggestive of such exposures during the Gulf War. During 1993-94, the staff of the U.S. Senate Banking Committee issued three reports compiling extensive circumstantial evidence for both direct and indirect exposures to U.S. troops to CBW [Chemical/Biological Warfare] agents during the war. In addition, a workshop sponsored by the National Institutes of Health [NIH] in April 1994 found that despite the lack of hard evidence, the possibility of CBW exposures should not be ruled out prematurely. The NIH report concluded, `Until it can be unequivocally established that chemical and/or biological weapons were not used and that troops were not exposed to plumes of destroyed stockpiles, the possibility remains that some symptoms are chronic manifestations of such exposure.'''⁽⁴⁶⁾

Dr. Tucker pointed out that in the last few years considerable information in the public domain - including press accounts, interviews, declassified Government documents under the Freedom of Information Act or posted on GulfLink⁽⁴⁷⁾ - presents a variety of evidence indicating Coalition troops were exposed to low levels of chemical warfare agents. He stated that while these exposures had no influence on the war's outcome, ``they appear to have resulted in delayed health problems in many of the exposed troops.'' In addition to ``affected United States troops, Gulf War illness has been reported among Australian, British, Canadian, Czech, Hungarian, Kuwaiti, New Zealander, and Norwegian veterans.''

Chemical detections during the war were also reported by French and Czech forces, Dr. Tucker stated. Among detections by the French were nerve and mustard vapors near King Khalid Military City during the air bombing campaign. Among the Czech detections were some along the Saudi border where hundreds of thousands of United States ground troops were massed for the invasion of Iraq.

According to a General Accounting Office [GAO] report, ``It is important to note that detections of the nerve agent Sarin occurred on January 19, 1991, and of mustard gas on January 24, 1991, by Coalition partners from Czechoslovakia in areas near Hafir al Batin. DOD has verified the reliability of the Czech equipment but has never identified the source [emphasis added] of these detections, although both DOD and CIA have deemed the detections credible. One cannot rule out the possibility that these detections were the result of fallout from Coalition bombing.''⁽⁴⁸⁾

A recent NY Times report, following an interview in Prague with Defense officials and Gulf War veterans, stated: ``Czech detection teams patrolling the northern Saudi Arabian desert in January 1991 were convinced that nerve gas detected in the early days of the war had been released from Iraqi chemical plants bombed by the United States.''

``Yet despite the reputation of Czech soldiers and their chemical equipment for reliability, combat logs compiled by officers working for Gen. Norman Schwarzkopf show that American commanders ignored Czech warnings that low levels of nerve and mustard gas had been detected in the vicinity of American troops,'' The Times reported. ``Czech soldiers recalled that even as they hurriedly pulled on their gas masks and rubberized chemical warfare suits after detecting chemical agents in the northern Saudi desert, the Americans who were stationed only several hundred feet away remained unprotected.''⁽⁴⁹⁾

According to the Tucker Report, ``Although DOD officials insist that all chemical agent detections by United States forces in the Gulf were false, they have reluctantly admitted that detections by Czech chemical defense detachments operating under contract to the Saudi government appear to have been authentic.''⁽⁵⁰⁾

``In addition to chemical alarms not associated with any obvious military activity, which were presumably triggered by chemical fallout from the bombing campaign,'' Dr. Tucker stated, ``many sick Gulf War veterans describe incidents in which they believe they were directly exposed to a chemical attack. Although most of these accounts are based exclusively on eyewitness testimony, in some cases the veterans' accounts have been corroborated by the available documentary record. A number of direct chemical exposures reported by veterans were associated with attacks by Iraqi SCUD or Frog ballistic missiles.''⁽⁵¹⁾

One such exposure cited by Dr. Tucker included the statement: ``Testifying in March 1994 before a subcommittee of the House Armed Services Committee, Sgt. George Vaughn ... described a SCUD attack ... in which he claimed he was exposed to some toxic chemical. During an alert, Vaughn experienced a problem with sealing his gas mask and the lens fogged up ... but in the heat of the moment ... [he] took the mask off his head. He immediately experienced a bitter almond taste and began choking. Within a day or two, Vaughn and three other members of his unit began to experience nausea, diarrhea, and severe fatigue. The gastrointestinal symptoms persisted after the four men returned from the Gulf. All four also developed fatty skin tumors called angiolipomas, which were surgically removed but have grown back repeatedly. Vaughn testified that the tumors have caused numbness in his arms and limited his motor skills.''⁽⁵²⁾

Among numerous detection devices and equipment used in the war by U.S. forces were M8A1 detector/alarms and the FOX detection vehicles. The Tucker report states that each of the nearly 14,000 M8A1 alarms deployed in the war went off an average of two or three times a day.⁽⁵³⁾

``The alarms went off so frequently, day and night, that some commanders ordered their troops to disregard or even disable them because no obvious symptoms of nerve-agent poisoning had been observed. DOD officials contend that every one of the tens of thousands of chemical agent alerts during the Gulf War was a false alarm,''⁽⁵⁴⁾ Dr. Tucker reported.

The most sophisticated CW agent detection system deployed in the Gulf was the German-made FOX Nuclear/Biological/Chemical [NBC] Reconnaissance Vehicle, an air-tight detector vehicle designed to detect chemical contamination on the ground so that advancing troops can avoid those areas. It carries a crew of four.

Two detection experts in the Gulf War, Army Major Michael Johnson and Marine Gy/Sgt. George Grass, appeared before the Human Resources and Intergovernmental Relations Subcommittee on December 10, 1996. Though still on active duty, they agreed to testify despite concerns about their military careers.

Major Johnson was commander of a FOX troop of detection vehicles. In testimony before the Human Resources Subcommittee, he stated: ``On 7 August 1991, the 54th Chemical Troop received the task of confirming the presence of a suspect liquid chemical agent at the Sabahiyah High School for Girls [Kuwait]. I led the mission ... [with] two FOX vehicles. The mass spectrometer showed the presence of H-Agent (Mustard, a highly volatile blister agent) in the soil. Simultaneously, a dismounted collection team, in full chemical over garments, moved to the container (estimated to be 800-1,000 liter capacity) with chemical agent monitors [CAM] and chemical detection equipment. The dismounted collection team employed detection paper and the CAM ... the detection paper [registered] H-Agent detection; the CAM registered H-Agent.''⁽⁵⁵⁾

Major Johnson indicated that additional tests by both FOX vehicles registered the same results - H-Mustard agent. He also reported that while withdrawing liquid from the container, a British soldier and member of team, had liquid drops make contact with his wrist. He was in extreme pain immediately and going into shock. He was decontaminated and taken to the hospital. The tapes and samples were turned over to personnel wearing camouflage with no rank or patches. It is unknown what happened to the tapes and samples [or the British soldier], according to Major Johnson.⁽⁵⁶⁾

``I would like to emphasize that these are the facts and not speculation of what actions we took,'' stated Major Johnson. ``I know that my unit ... did in fact detect and confirm the presence of toxic chemical warfare agents in Kuwait.''⁽⁵⁷⁾

Gy/Sgt. Grass, a FOX vehicle commander, also reported confirmed detections to the Human Resources Subcommittee. One detection reported was near an ammunition storage area outside Kuwait City. He testified: ``The alarm sounded on the mass spectrometer with a full and distinct spectrum across the monitor and a lethal vapor concentration of S-Mustard. We drove the FOX closer to the dug-in ammo bunkers and fully visible were the skull and crossbones on yellow tape with red lettering, and scull and crossbones on boxes [of ammo] and on signs. As we continued driving through the same ammo storage area the alarm sounded again ... HT-Mustard in lethal dose came across the monitor ... again with skull and cross bones. Another alarm sounded showing positive readings of Benzine Bromide.''⁽⁵⁸⁾

Gy/Sgt. Grass stated: ``I gave my superior officers all the mass spectrometer tickets from the Al Jaber Airfield [detections in the oil fields] and the ammo storage area ... I never saw the tickets I had given them again. When the EOD [ordnance disposal team] arrived, I escorted them to where the chemical weapons were detected [in the ammo storage area] ... they donned full protective equipment ... [and later] ... verbally acknowledged the presence of chemicals weapons in the storage area.''⁽⁵⁹⁾

``Since returning from the Gulf War, I have spoken to almost every FOX vehicle commander from both the 1st and 2d Marine Divisions,'' Gy/Sgt. Grass concluded, ``and every one of them has verbally acknowledged the positive identification of chemical agents in their area of operations.''⁽⁶⁰⁾

A DOD report on the Gy/Sgt. Grass' detection stated: ``Based on the information available thus far in this investigation, the presence of a chemical warfare agent in this area ... is judged to be `Unlikely.' Although two members of the FOX crew believe that their mass spectrometer detected something, the MM-1 did not sound an alarm. Senior NBC officers said that there was no report of chemical warfare agents at this time. Finally, there is no physical evidence - no spectrum, no sample, et cetera.''⁽⁶¹⁾

When a subcommittee Member asked Major Johnson and Gy/Sgt. Grass if they were suffering any physical effects from their Gulf War service, both men answered yes. Major Johnson said he began to have problems after he returned home ... ``changes in my blood pressure, headaches, burning eyes, joint pain, a mysterious growth in my left knee, chest pains, and gastrointestinal bleeding.''⁽⁶²⁾

Gy/Sgt. Grass said, ``I have rashes on my ankle and other parts of my body. My wife has been diagnosed with multiple sclerosis, and there are just numerous cases of illnesses that people have from something that went on over there, whether that was the exposure of chemical weapons or the biological weapons or both.''⁽⁶³⁾

Dr. Tucker, in testimony before the Human Resources Subcommittee, stated: ``Low level exposures to chemical weapons appear to have resulted from three sources: Chemical fallout from the aerial bombardment of Iraqi field munitions depots containing chemical weapons; explosive demolition of munitions bunkers by United States combat engineers; and sporadic and uncoordinated Iraqi use of chemical weapons in the ground campaign. The Pentagon would have us believe that the Khamisiyah incident is the whole story, I will argue that it is just the tip of the iceberg.''⁽⁶⁴⁾

Dr. Tucker, in his statement, identified over 55 specific chemical weapons detection or exposure incidents, and their locations, from January 13 to March 26, 1991.⁽⁶⁵⁾ In addition, he cites a U.S. Marine Corps survey of 1,600 chemical-defense specialists from Marine units who served in the Gulf War. A declassified Marine report stated that 221 respondents (about 13 percent) reported some contact with or detection of Iraqi chemical weapons during the ground war.⁽⁶⁶⁾

In addition, the possibility is raised by Dr. Tucker that the Iraqi saboteurs who ignited the Kuwaiti oil well fires may have deliberately contaminated some of them with chemical warfare agents. He cites a captured top-secret Iraqi military record which gives detailed instructions for sabotaging 31 oil wells with explosives. The record includes an attached letter from the commander of the 29th Infantry Battalion which states in part: ``Please send an assigned person from your personnel to the Chemical Rank Command of Battalion 14 to receive the chemical preparations (Tucker emphasis) distributed to your units according to the directions of the command above.'' Part of the document also makes reference to the use of individual chemical protective gear and decontamination stations for equipment and vehicles.⁽⁶⁷⁾

``This document raises the possibility that Iraqi troops deliberately contaminated the oil well fires with chemical warfare agents, generating clouds of poison-laced smoke with the intent of debilitating Coalition forces downwind,''⁽⁶⁸⁾ Dr. Tucker stated.

In that connection, FOX vehicle operator Gy/Sgt. Grass also testified about detections at Kuwait's Al Jaber Airfield during the oil well fires: ``As the mass spectrometer was monitoring for chemical agent vapor contamination with the usual readings from the oil fires, the alarm went off and the monitor showed a lethal vapor concentration of the chemical agent S-Mustard.'' Gy/Sgt. Grass noted that when he reported the detection to the Division NBC officer, he was told the reading was false and had been produced by oil well vapors. ``We explained to him [NBC officer] that we already know what the oil fire vapors looked like on the monitor and the readings were clearly distinct with the words S-Mustard printed across the screen and on the tape printed out as evidence of the contamination the Marines were exposed to. Division still insisted we had false readings and abruptly signed off the radio.''⁽⁶⁹⁾

Dr. Tucker's hypothesis about Iraqi disbursement of toxic agents in the updraft and high downwinds of the oil well fires is supported by the experience of ex-CIA agent Dr. David Morehouse. While in the Gulf theater, Dr. Morehouse and other CIA agents found multiple empty canisters or metal cylinders about 20 inches long and 4 inches in diameter placed upright in the sand [and] ``leaned like the Tower of Pisa,'' downwind of numerous well-head fires. In his book ``Psychic Warrior,'' he writes: ``It's obvious that the Iraqis placed the canisters next to the fires to mask the plume from the canisters. So I think they released a slow-acting toxin to poison the Coalition forces, and they covered it up with oil well fires. Every soldier downwind of those fires must've inhaled the bug of whatever it was. The heroes had been poisoned.''⁽⁷⁰⁾

Dr. Tucker's subcommittee statement concluded: ``Evidence in the public domain from a variety of sources indicates a far larger number of credible chemical weapons detection and exposure incidents than DOD or CIA have thus acknowledged. Eyewitness accounts, declassified intelligence records, and operational logs all suggest that Iraq deployed chemical weapons into the Kuwait Theater of Operations [KTO] prior to the Gulf War and may have employed them in a sporadic and uncoordinated manner against the Coalition forces during the ground war. U.S. troops also appear to have been exposed to low level chemical warfare agents from the air bombardment and ground detonations of chemical facilities.''⁽⁷¹⁾

Dr. Tucker, a former senior policy analyst to the Presidential Advisory Committee on Gulf War Veterans' Illnesses [hereinafter ``PAC''], was dismissed summarily from the PAC in December 1995, allegedly for his research on chemical exposures to U.S. troops and gathering the views of people inside and outside the Government who also believed that Gulf veterans were suffering from toxic exposures. His dismissal with only 1 hour's notice was in spite of high performance review ratings.⁽⁷²⁾

C. TOXIC EXPOSURES IN GULF WAR THEATER

U.S. troops who served in the Gulf War were exposed to multiple toxins, any one of which - alone or a combination of toxins producing a synergistic interaction - may well be responsible for the illnesses reported by thousands of veterans.

According to a GAO report, ``U.S. troops might have been exposed to a variety of potentially hazardous substances. These substances include compounds used to decontaminate equipment and protect it against chemical agents, fuel used as a sand suppressant in and around encampments, fuel oil used to burn human waste, fuel in shower water, leaded vehicle exhaust used to dry sleeping bags, depleted uranium, parasites, pesticides, drugs to protect against chemical warfare agents (such as pyridostigmine bromide), and smoke from oil-well fires. DOD acknowledged in June 1996 that some veterans may have been exposed to the nerve agent Sarin following post-war demolition of Iraqi ammunition facilities.''⁽⁷³⁾

Chemical Weapons

After 5 years of denial that United States troops were exposed to any chemical weapons, DOD disclosed on June 21, 1996 that some 400 soldiers were ``presumed exposed'' to Iraqi nerve agents. This event occurred when the 37th Army Combat Engineers detonated enemy munitions bunkers at Khamisiyah, Iraq in March 1991, sending plumes of nerve gas wafting into the atmosphere and dispersing over unprotected soldiers.⁽⁷⁴⁾

The number of exposed troops began to rise in following months as the DOD and CIA reconsidered modeling results pertaining to wind direction and other factors. In September 1996, DOD raised the number to 5,000 exposed; in October, to nearly 21,000 exposed.⁽⁷⁵⁾

On July 24, 1997, results of a new computer modeling study were revealed by the DOD and CIA suggesting that 98,900 United States troops must be ``presumed exposed'' to chemical weapons from the Khamisiyah bunker detonations. Original CIA computer modeling estimates released in June 1996 stated the plumes carried northerly for perhaps 25 miles. New modeling estimates stated the plumes carried southerly for perhaps 300 miles from the blast site, producing fallout over some 100,000 troops positioned in southern Iraq, Kuwait, and northern Saudi Arabia.⁽⁷⁶⁾

In April 1997, the CIA released 41 declassified documents, 1 of which stated the CIA had warnings starting in 1984 that thousands of chemical weapons were stored in Khamisiyah bunkers.⁽⁷⁷⁾ According to news accounts, the CIA claims they notified the Pentagon before the war of the presence of these weapons at Khamisiyah. The DOD had denied it until February 25, 1997, when the Pentagon disclosed that the CIA had in fact warned the Army but it never reached commanders of the 37th Army Engineers Battalion that detonated the Khamisiyah depot.⁽⁷⁸⁾

The United Nations Special Commission on Iraq [UNSCOM] testified on July 29, 1997 at the Presidential Advisory Committee [PAC] meeting in Buffalo, NY that the aerial bombardment during the war of the Ukhaydir, Iraq chemical weapons storage depot, and possibly the Mymona depot, sent toxins into the air that may have produced fallout over United States troops stationed in Saudi Arabia.⁽⁷⁹⁾ The CIA, also in testimony at the PAC meeting, stated: ``CIA and DOD now assess that there may have been a release of chemical agent from the Ukhaydir Ammunition Depot as a result of aerial bombing ...'' The CIA is continuing exposure modeling of this event.⁽⁸⁰⁾

[hereinafter ``UNSCOM''], ``Investigation of Deployment of Chemical Weapons,'' July 1997.

In August 1997, it was reported that a 1990 study by the Lawrence Livermore National Laboratory informed the U.S. Air Force - 3 months before the Gulf War began - that bombing of Iraqi chemical weapons manufacturing facilities would release deadly nerve agents over U.S. troops who were massing several hundred miles to the south. This report predicted a dispersion of chemical warfare agents over an area 10 times greater than subsequent DOD and CIA studies would show.⁽⁸¹⁾

According to testimony before the Human Resources Subcommittee by Gulf War expert James Tuite, director of the Gulf War Research Foundation, the Livermore Laboratory study proved to be prophetic. He stated: ``Up to now, the missing element ... has been the mystery of how the [chemical] agents were transported from the research, production and storage sites in Iraq to [Coalition] troops.'' This has been an especially difficult issue given that it has been the long-held assertion of DOD, DIA, and the CIA that the winds were blowing in the wrong direction [northerly] during the detection events.

``The report I submit today [I believe] solves the mystery of the [chemical] detections that occurred after the initial wave of Coalition bombings of these chemical warfare agent storage facilities during the first 2 days of the air war. Using available visible and infrared meteorological satellite imagery from NOAA [National Oceanic and Atmospheric Administration], which was available to military planners [but not used] during the war - a war before which they expressed deep concern over the fallout effects from these bombings - I have been able to determine that a thermal plume rose into the atmosphere over the largest Iraqi chemical warfare agent research, production, and storage facility at Muthanna after Coalition aircraft and missile bombardment.''

``Seventeen metric tons of Sarin were reportedly destroyed during these attacks, which began on January 17, 1991. These thermal and visual plumes extended [southerly] directly toward the areas where those same chemical warfare agents were detected and confirmed by Czechoslovak chemical specialists. Hundreds of thousands of U.S. servicemen and women were in the area where these detections occurred, assembling for the upcoming ground invasion of Iraq and the liberation of Kuwait.''⁽⁸²⁾

Biological Weapons

According to Dr. Jonathan Tucker's 1996 report to the subcommittee, Iraq had initially denied possession of biological weapons following the war. Over the next 5 years, however, persistent detective work by UNSCOM personnel gradually forced Iraqi authorities to admit the existence of an offensive biological warfare program, an extensive and sophisticated effort led by Ph.D. scientists trained in the West.

Dr. Tucker stated: ``As the centerpiece of this effort, Iraq mass-produced and weaponized three [biological] agents on a large scale: the bacterial agent that causes the disease anthrax, which is nearly always fatal within 4 days; botulinum toxin, an exceedingly potent bacterial toxin; and aflatoxin, a fungal toxin that is a liver carcinogen but can also serve as an incapacitating agent. In addition ... Iraq experimented with a range of other lethal and incapacitating agents.''⁽⁸³⁾

Dr. Tucker reported that Iraq conducted field trials of biological agents in bombs, rockets and aerosol generators from 1988 until Iraq invaded Kuwait in August 1990. At this point, their research and development [R&D] program shifted to a ``crash'' effort on large-scale production and weaponization.

``Even if Iraq was deterred from a large-scale or overt use of chemical and biological weapons [as a result of United States warnings of massive retaliation], it may still have engaged in covert or insidious (i.e., low-level) operations. Certainly, Iraq would have nothing to gain by admitting that it had employed chemical or biological weapons during the Gulf War, and much to lose politically and economically, since such as admission would make it even less likely that the UN sanctions would be lifted. Thus, Iraq's denials [of chemical and biological weapons use] should not be taken at face-value, especially in view of the evidence for Iraqi chemical weapons use.''

Dr. Tucker cites Iraqi military manuals on the use of chemical and biological weapons. An Iraqi Air Force Academy manual on nerve agents notes that these poisons ``have a cumulative effect; if small doses are used repeatedly on a target, the damage can be very severe.''<sup>(84)</sup> An Iraqi Chemical Corps manual states: ``It is possible to select anti-personnel biological agents in order to cause lethal or incapacitating casualties in the battle area or in the enemy's rear areas ... [and] incapacitating agents are used to inflict casualties which require a large amount of medical supplies and treating facilities, and many people to treat them. Thus it is possible to hinder the opposing military operations.''⁽⁸⁵⁾

A report by the U.S. Navy's Biological Defense Research Program, which performed BW detection and analysis for U.S. forces during the Gulf War, concluded: ``No agents (including anthrax and botulinum toxin) detected during Desert Shield/Storm despite fielding of state-of- the-art detection methods.''⁽⁸⁶⁾

A recent GAO report stated: ``DOD has consistently denied that Gulf War veterans were intentionally or unintentionally exposed to biological warfare agents, and prior to June 1996, it denied any exposure to chemical warfare agents. If servicemembers were exposed, exposure would have occurred in one of three ways: 1) through intentional Iraqi use of chemical or biological warfare agents; 2) through theaterwide contamination resulting from air war bombings of Iraq, or 3) through site-specific events. DOD has taken the position that chemical and biological agent exposures can be confirmed only through evidence of mass [and immediate] incidents of morbidity and mortality. Since there were no such instances, DOD asserted that Gulf War veterans were not exposed.''⁽⁸⁷⁾

The GAO report observed: ``According to the CIA ... the Iraqis had weaponized several biological agents at the time of the Gulf War, including anthrax, botulism, and aflatoxin (a potent liver carcinogen). ... [Aflatoxin's] effects may not be observed until decades after low-level exposure ...''⁽⁸⁸⁾

Infectious Diseases

According to the PAC December 1996 report, ``Infectious diseases endemic to the Gulf region include shigellosis, malaria, sandfly fever, and cutaneous leishmaniasis. Along with these infectious diseases, DOD medical personnel also monitored troops for dengue, Sindbis, West Nile fever, Rift Valley fever, and Congo-Crimean hemorrhagic fever. The documented low rates of infection among U.S. troops suggest exposures were minimal and/or preventive measures were ineffective.''<sup>(89)</sup> [hereinafter ``PAC Report''], pp. 98-99.

Microbiologist and immunologist Dr. Howard Urnovitz, chairman of the Calptye Biomedical Corp., testified before the Human Resources Subcommittee on the Gulf War Syndrome. He stated: ``One of my research efforts is focused on how chemical and infectious agents interact to initiate and maintain a chronic disorder. The symptoms [of Gulf War Syndrome] are similar to those of over a dozen unexplained epidemics over the last 60 years ... including headache, muscle pain, slight paralysis, damage to the brain, spinal cord or peripheral nerves, mental disorders ...''

``Recent studies have found that prolonged and aggressive antibiotic therapy appears to abate many of the symptoms associated with Gulf War Syndrome. Usually the therapy takes longer than ordinary treatments (i.e., 6 to 9 weeks instead of less than 3 weeks) and in many cases the symptoms return when the therapy is discontinued. It is not clear whether this response is directly due to the control of some antibiotic-sensitive microorganisms or a direct action on an inflammatory or neurologic process or some placebo effect.''

``It is known that the Gulf War was one of the most toxic battlefields in the history of modern warfare. Syndromes associated with organophosphate-induced delayed neuropathy [OPIDN] could explain many of the observed and unexplained illnesses. However, it may not be mutually exclusive to have tissue damage resulting from toxic exposures, which leads to inflammatory responses in critical tissues with ensuing opportunistic bacteriological, viral, and fungal infections. The continued presence of these pathogens may greatly impair a possible healing process. All of these risk factors need to be considered in trying to understand the underlying pathology of Gulf War Syndrome.''⁽⁹⁰⁾

Dr. Garth Nicolson, chief scientific officer and research professor at the Institute for Molecular Medicine, states that some illnesses can be explained by exposure of veterans to various biological agents, called chronic pathogenic infections, in combination with chemicals and then transported home to family members. Dr. Nicolson, who has studied 650 Gulf veterans and their immediate family members, discounts stress as a major factor in causing Gulf veterans' illnesses.

In testimony before the Human Resources Subcommittee, Dr. Nicolson stated: ``Gulf War illness [GWI] is not caused by stress, it is caused by multiple exposures to chemical, environmental, radiological and/or biological agents that cause chronic multisystem signs and symptoms that for the most part can be diagnosed as existing diseases. We have been particularly interested in veterans with GWI whose family members are now also sick with similar signs and symptoms, suggesting that many GWI patients suffer from biological, not chemical or radiological, origins for their illnesses. Illnesses caused by chemical or radiological exposures should not be transmitted to family members. GWI in immediate family members is officially denied by DOD and VA.''⁽⁹¹⁾

``After examining GWI patients'' blood for the presence of chronic biological agents, the most common infection found was an unusual microorganism, Mycoplasma fermentans (incognitus strain), a slow-growing mycoplasma located deep inside blood leukocytes (white blood cells) of slightly under one-half of GWI patients studied. When they are in the blood, similar to other bacteria, they can cause a dangerous system-wide or systemic infection. In addition, cell-penetrating mycoplasmas, such as Mycoplasma fermentans, may produce unusual autoimmune-like signs and symptoms ...''⁽⁹²⁾

``In GWI patients that tested positive for mycoplasmal infections in their blood, we have found that this type of infection can be successfully treated with multiple courses of specific antibiotics, such as doxycycline. Multiple treatment cycles are required, and patients relapse often after the first few cycles, but subsequent relapses are milder and patients eventually recover.''⁽⁹³⁾

``Chemical exposures can cause toxicological effects and produce many but not all of the signs and symptoms of GWI. In addition, chemical exposures can result in immunosuppression and leave an individual susceptible to infections.''⁽⁹⁴⁾

Leishmaniasis is also an infectious disease and is caused by a microscopic parasite that invades certain types of white blood cells. The disease is transmitted by sandflies, and a number of different leishmania species are known to infect humans. Disease that involve low levels of parasite infection can be particularly difficult to diagnose. It is rarely seen in the United States; however, more than 30 cases have been diagnosed among Gulf veterans. Accurate diagnosis of leishmaniasis, which can have a long latency period, is important because effective treatment involves the use of potentially toxic drugs in clinical trials but not yet approved by the Food and Drug Administration [FDA].⁽⁹⁵⁾

Depleted Uranium

Depleted uranium [DU] is a highly, toxic, radioactive by-product of the uranium enrichment process.⁽⁹⁶⁾ DU is used in munitions as armor-piercing rounds fired at enemy tanks, and as protective armor on U.S. tanks. When a DU penetrator impacts a hard target, most of the round burns up, scattering uranium dust and shrapnel in and around the target. In the Gulf War, DU is credited with destroying over 1,400 Iraqi tanks, as well as other equipment and weapons storage facilities.⁽⁹⁷⁾

``Exposure to DU armor and/or penetrators is dangerous, but DU poses the greatest risk to those who: breathe smoke or dust from a burning vehicle hit by DU rounds; climb on or enter a vehicle hit by DU rounds; or were in a friendly fire incident involving DU rounds.''⁽⁹⁸⁾

One of the more severe DU exposure events occurred in July 1991 in Doha, Kuwait when a major U.S. Army ammunition depot and motor pool exploded and burned for 2 days. DU armor on vehicles and 9,000 pounds of DU rounds were oxidized to powder exposing 3,500 soldiers in the vicinity to radiation and DU aerosol particles that were widely distributed by high winds. Soldiers involved in the cleanup several days after the fire were not warned of DU contamination and, therefore, wore no protective gear.⁽⁹⁹⁾

[Abstract 5, ``How U.S. Troops Were Exposed to DU'']

According to the booklet ``DU: The Stone Unturned,'' published by Swords to Plowshares: ``Even after the [Doha] fire, soldiers were never told about the presence of DU contamination. Soldiers swept the compound with brooms, picked up debris with their bare hands, and were never issued respiratory masks or other protective clothing.''⁽¹⁰⁰⁾

``Like most soldiers,'' the DU publication continues, ``S/Sgt. Chris Kornkven was unaware of the use of DU munitions during the war. Due to his exposure to DU dust on destroyed Iraqi vehicles, he has since tested positive for internalized depleted uranium.'' [S/Sgt. Kornkven testified before the Human Resources Subcommittee on January 21, 1997.]⁽¹⁰¹⁾

Radiation exposure expert Dr. Asaf Durakovic, a medical unit commander in the Gulf War and most recently the chief of nuclear medicine at the VA Medical Center in Wilmington, DE was a witness at the Human Resources Subcommittee hearing on June 26, 1997. Dr. Durakovic reported that his expertise was never used because he and his staff were never informed of the intended use of DU before the war or during the war.⁽¹⁰²⁾

In late 1991, following the war, 24 ill soldiers from the 144th Transportation & Supply Company in New Jersey were referred to Dr. Durakovic at the VA Medical Center in Wilmington for diagnosis and treatment. These soldiers had worked on battle damaged tanks and vehicles in the Gulf from January to March 1991 without protective equipment or clothing. In March, a Battle Damage Assessment Team arrived in full radioprotective clothing, inspected the vehicles, declared them ``hot'' and off-limits.⁽¹⁰³⁾

Preliminary testing showed 14 of 24 veterans ``contained decay products of radioactive uranium.'' According the Dr. Durakovic, urine samples sent to the Army Radiochemistry Lab in Aberdeen, MD, disappeared. Dr. Durakovic recommended additional, more comprehensive testing - including tests to determine if the 24 veterans had also inhaled DU particles - but further tests and treatments were denied by the VA. Of the 14 veterans, 2 have since died, and the remaining members of the 144th Company have scattered around the country making medical follow-up unlikely.⁽¹⁰⁴⁾

``None of my recommendations was ever followed. Every conceivable road block was put in my line of management of those patients. I was ridiculed. There were obstacles throughout my attempt to properly analyze the problems of those patients. My plan failed because of total lack of interest on the part of the VA to do anything for those unfortunate patients. I [even] received phone calls from DOD suggesting that this work is not going to yield meaningful information and should be discontinued.''⁽¹⁰⁵⁾

Dr. Durakovic was later terminated by the Wilmington VA hospital, he alleges for his outspoken views of the VA concerning the diagnosis and treatment of sick Gulf War veterans.

Physicist and DU expert Leonard Dietz, who testified before the Human Resources Subcommittee, writes and speaks frequently on the dangers of depleted uranium. In a recent abstract he stated, ``A large number of unprotected Gulf War veterans could easily have acquired dangerous quantities of DU in their bodies. We refer to scientific measurements that have been made of the atmospheric wind-borne transport of uranium aerosols up to 25 miles from their sources. Micrometer particles of DU can spread over a large region and poison many people both radiologically and chemically.''⁽¹⁰⁶⁾

[Abstract 20, ``DU Spread & Contamination of GW Veterans.'']

``A comprehensive epidemiological study should be made of all Gulf War veterans and their families,'' Dietz said, ``searching for evidence of residual DU in their bodies and for causes of genetic defects in their children. The health issues associated with DU munitions should be investigated and evaluated by independent medical and scientific experts separated completely from the DOD, VA, National Laboratories, U.S. military services and their contractors.''⁽¹⁰⁷⁾

Dr. Michio Kaku, nuclear physics professor at City University of New York, stated, ``Ultimately, the Gulf War Syndrome will be traced to a variety of factors, simply because the Pentagon released so much firepower on the Iraqis during that war that large quantities of materials were sent into the atmosphere, including DU and chemicals stored in warehouses. Ultimately, when the final chapter is written, DU will have a large portion of the blame.''⁽¹⁰⁸⁾

[Abstract 17, ``DU: Huge Quantities of Dangerous Waste.'']

``The Pentagon should release all its classified information concerning the Gulf War Syndrome and depleted uranium,'' Dr. Kaku said. ``It is a national embarrassment that the Pentagon, even at this late date, is still withholding vital information about precisely what happened during the Gulf War.''⁽¹⁰⁹⁾

A 1993 report by the GAO concluded, ``Although the Army's stated policy is to minimize personnel's exposure to radiation, it has not effectively educated its personnel in the hazards of DU contamination and in proper safety measures appropriate to the degrees of hazard. What little information is available is not widely disseminated and training on DU is basically limited ...''⁽¹¹⁰⁾

The DOD did not properly train Gulf troops to the dangers of DU before and during the war, according to Dr. Bernard Rostker, DOD's Special Assistant for Gulf War Illness. He made this statement in a July 1997 meeting on depleted uranium with Human Resources Subcommittee staff. Dr. Rostker advised the Human Resources staff that steps were being taken to educate troops, who may fight future wars, on the toxic effects of DU exposure.

Oil Well Fires and Petroleum Contamination

Iraqi troops, in a deliberate act of sabotage and revenge, ignited hundreds of Kuwaiti oil wells during the Gulf War. According to a Defense Science Board Report, ``On February 23, 1991, Iraqi forces began to destroy and set fire more than 700 oil wells throughout Kuwait.''<sup>(111)</sup> The date is challenged by the University of Arizona's Environmental Research Laboratory, concluding that, ``Solar radiation data indicate that the first oil well fires were most likely set on or around January 17, 1991''⁽¹¹²⁾ [an important date because it suggests an additional month of troop contamination]. The last of the 749 oil well fires, including storage tanks and refineries, were extinguished 10 months later, in November 1991.⁽¹¹³⁾

Oil well fires and petroleum related exposures are another possible cause of the Gulf War Syndrome. In testimony submitted to the Presidential Advisory Committee [PAC], chemical engineer and expert on health effects of petroleum exposure, Craig Stead stated: ``Petroleum was a major Gulf War environmental exposure. American troops were exposed to petroleum from oil well fires, oil contaminated drinking and shower water, oil soaked clothing, and use of petroleum for dust suppression, pesticide application, and fuel. Petroleum inhalation, ingestion and skin absorption causes illness. The symptoms of petroleum illness are consistent with symptoms reported by Gulf War veterans.''

``Clinical techniques exist to diagnose petroleum illness,'' Mr. Stead said. ``These techniques include broncho alveolar lavage [BAL], computed tomography, and magnetic resonance imaging. Known treatments for petroleum include the use of anti-inflammatory steroids, expectoration of oil in the lungs, and diet. Left untreated, petroleum illness is a progressive disease which can lead to emphysema and cancer as endpoints.''⁽¹¹⁴⁾

Sick Gulf War veterans testified about their experiences before the Presidential Advisory Committee and a National Institutes of Health Gulf War workshop. Testimony included:

``When they blew the oil well fires, it was unlike anything I ever seen in my life. It was like being in a locked closet in the dark. We are in the middle of 500 oil well fires. And the only thing that they [U.S. military] gave us was a white T-shirt and [said] `Put it over your face.' When they brought in the civilian contractors to put out these oil well fires, they had self-contained breathing apparatus. They had chemical suits. They had everything. Members of my team did [get ill].''⁽¹¹⁵⁾

``[I] was in the center of the oil fires in Kuwait City with no capability of distinguishing the sun from the moon for the first 6 weeks after the liberation of Kuwait. [My] body was so oil and soot covered that a black watch band was camouflaged on [my] wrist. The scarf [I] wore around [my] face did not filter out the air borne debris. [My] spit looked like oil and when [I] sneezed [my] mucus looked like axle grease.''⁽¹¹⁶⁾

``We were by the oil well fires for 2 weeks and we camped right next to them.''⁽¹¹⁷⁾

``I developed severe nasal problems from the oil smoke. I got breathing problems.''⁽¹¹⁸⁾

``I lived six city blocks from the fires for almost 2 weeks. I flew in the stuff every day.''⁽¹¹⁹⁾

``For 7 months, my husband's ship chartered through burning oil derricks in the water. They were on the oil spill. They ingested oil-infested water. They cooked with it. They showered in it. He has chemical sensitivity. He has asthma. He got it in the service.''⁽¹²⁰⁾

``We suffered chemical ingestion when our drinking, cooking, washing, and bathing water became heavily contaminated with some sort of chemical that burned our mouth, throat, esophagus, and stomach. When we took our showers, we smelled of petrochemicals as well as the freshly washed clothes we put on. The food tasted of kerosene. We were in a 100 percent contaminated environment. I became very sick with digestive problems that same day that the contamination came aboard ship in our drinking water. The Navy ships' distilling plants ... cannot filter out chemicals.''⁽¹²¹⁾

Gulf War veteran Debbie Judd, an Air Force nurse, testified before the PAC on a survey completed in 1995 by the Operation Desert Storm Association on 10,051 sick Gulf veterans. She reported the following results: ``Specific to the oil in the environment there, those breathing or enveloped in oil fire smoke was 96 percent; within clear visual area of the oil fires was 90 percent; worked in, lived in, or made travel through the burning oil fields was 72 percent; washed in water with an oily sheen was 68 percent. Those having oily taste to their food was 66 percent, and those with oily taste to the drinking water was 65 percent.''⁽¹²²⁾

A study, ``Kuwait Oil Fire Health Risk Assessment,'' by the U.S. Army's Environmental Health Agency concluded: ``Results of this [report] indicate the potential for significant long-term adverse health effects for the exposed troop or civilian employee populations is minimal ...''⁽¹²³⁾ [Executive Summary].

Craig Stead provided a statement to the Human Resources Subcommittee in which he said the Army study was flawed: ``In 1994, the Army issued the final Kuwait Oil Fire Health Risk Assessment. The Assessment used Gulf air pollution data gathered in May through November 1991. Air pollution from the oil field fires during this time was much less than during the Gulf War for the following reasons: The months of May through November [when the study was done] have the Shamal winds blowing from the northwest causing the smoke plume from the oil field fires to disperse widely and ascend to great heights. During the Gulf War (February and March) low wind speeds and air inversions were common. Under these conditions the smoke plume was on the ground, creating high localized levels of air pollution to which the troops were exposed.''⁽¹²⁴⁾

An Institute of Medicine [IOM] document confirms Mr. Stead's statement: ``The Army Health Risk Assessment could not launch a successful air-sampling effort until the beginning of May, after the more stagnant air conditions of the winter months had passed. Those who undertook the sampling efforts did so with this knowledge.''<sup>(125)</sup> Principal author of the Army report, Dr. Jack Heller, also confirmed the Stead statement: ``What we measured at the time we were there starting in May when the Shamal winds were strongly blowing and there was a lot of thermal lofting of the pollution. We didn't have those ground level impacts [present during the war]. In fact the whole time I was there I had [only] one ground level impact.''⁽¹²⁶⁾

Mr. Stead stated: ``Dr. Heller did not factor into the Assessment study the high levels of wartime air pollution to which the troops were actually exposed. The Assessment is seriously flawed ... [and] ... is a primary document relied upon by DOD, PAC, VA and IOM in concluding the oil field fires presented no health hazard to the troops.''⁽¹²⁷⁾ Mr. Stead also said the study was additionally flawed because it neglected to include troop exposures to contaminated rain during the fires, oil contamination in water for drinking, cooking and showering.⁽¹²⁸⁾

Also, a January 1991 study by the U.S. Army Intelligence Agency, issued on the eve of the invasion, forewarns of the threat of the oil well fires and tends to refute the U.S. Army Environmental Health Agency's Risk Assessment. The Army Intelligence report stated: ``Owing to Iraq's defensive `scorched earth' plan for Kuwait, the overall Kuwaiti oil infrastructure presents a serious hazard to advancing ally ground forces. There is overwhelming evidence that once ordered, the Iraqi forces will initiate demolition of oil wells, oil-gathering centers, oil-storage depots, pumping stations, large tank farms, refineries, and oil/product loading terminals. Demolition of these facilities and complexes will result in massive fires - `Burning Kuwait.'''

``The danger of oil fires, toxic gas, and smoke in the Kuwaiti Theater of Operations [KTO] is very serious [emphasis added]. These dangers ... are as follows: 1) Associated toxic and highly flammable gas from spilled raw sour crude oil from nonburning oil wells; 2) Intense heat of oil-well fires, possible natural-gas wells, and fire trenches; 3) Dense smoke and superheated gases from these fires. By far the greatest danger is from dissociated hydrogen sulfide gas and highly volatile light ends [gases] released from wellhead blowouts. In the KTO, the prevailing winds generally blow from the north-northwest southward toward Saudi Arabia [emphasis added]. Smoke and gases from Kuwaiti fires and blowouts most likely will be blown in the face of northerly advancing [United States] forces along the southern front of the KTO.''⁽¹²⁹⁾

Experimental Drugs and Vaccines

In December 1990, a month before the war, the Food and Drug Administration [FDA] agreed to issue a waiver to the DOD allowing the military to issue experimental drugs and vaccines to U.S. personnel in the Gulf without first obtaining informed consent. A factor possibly contributing to the illnesses of Gulf veterans was the ingestion of anti-nerve gas pills, pyridostigmine bromide tablets [PB tabs]. Troops were required to take the experimental drug to counter the effects of potential exposure to chemical warfare agents.

PB expert Dr. Thomas Tiedt, a neuroscientist and former pharmaceutical industry researcher, testified before the Human Resources Subcommittee that ``evidence shows that Gulf War Syndrome was easily predicted. The symptoms largely match those of cholinergic syndrome, which results from inhibition of the life-critical and development-critical enzyme acetylcholinesterase [AchE]. Pyridostigmine bromide, Sarin, and organophosphate pesticides are examples of AchE inhibitors ... [which] cause stunning nerve and muscle degeneration moments after a single dose, which worsens with multiple doses.''⁽¹³⁰⁾

``My team's research at the University of Maryland during the mid-1970's about physiological and microscopic AchE toxicity was comprehensive,'' Dr. Tiedt stated. ``Our work was followed by an explosion of research by DOD during the 1980's, the most relevant of which was produced by my co-authors and colleagues at Maryland and the [Army's] chemical-warfare R&D center in Aberdeen [MD]. DOD [research] established by the early 1980's that: 1) PB would be harmful in healthy individuals; 2) PB was worthless, even counterproductive, as a protectant against chemical warfare; and 3) PB was more toxic than sub-lethal doses of chemical warfare agents. I understand PB was taken by about 500,000 soldiers ... [and] it has been reported that 50-60 percent of soldiers taking PB have acute side effects.''⁽¹³¹⁾

Dr. Tiedt concluded: ``More attention is needed on the long record by the military to conduct involuntary, meritless, and hazardous experiments on soldiers. The Nuremberg Code [signed following World War II] states, `No experiments should be conducted where there is an a priori reason to believe that death or disabling injury will occur.' The use of PB was an experiment. It was the first time we used PB for such a purpose. There were no data supporting its use or the way it was used. Sadly, no records remain or were kept.''⁽¹³²⁾

Researcher and pharmacologist Mohamed Abou-Donia of Duke University has conducted research on animals using pyridostigmine bromide and other chemicals. Dr. Abou-Donia fed groups of hens with the anti-nerve agent PB, the insecticide permethrin, and the insect repellant DEET - all routinely used by the military in the Gulf War theater. Each chemical was administered alone and in various combinations.

According to Dr. Abou-Donia: ``This study shows that relatively high doses of PB, DEET, and permethrin appear to cause minimal health risk when used individually. It demonstrates, however, the increased neurotoxicity associated with coexposure to the same doses of test compounds. Although this study was not intended to simulate actual exposure conditions that may have existed during the Persian Gulf War, nor was it designed as a dose-response study, from it one can hypothesize why co-exposure to test compounds may have contributed to Gulf War veterans' illnesses. The variety of symptoms reported by veterans make it unlikely that a single etiologic cause is responsible for producing the Gulf War illnesses.''⁽¹³³⁾

Dr. Satu Somani, PB expert and professor of pharmacology and toxicology at Southern Illinois University's School of Medicine, also testified before the Human Resources Subcommittee on the health effects of pyridostigmine bromide. Dr. Somani stated:

``Years after Desert Storm, many veterans continue to suffer from medical problems such as fatigue, headache, joint pain, gastrointestinal disorders, and other ailments. This testimony is based on the premise that Gulf veterans were taking pyridostigmine as a precautionary measure against potential exposure to nerve agents (e.g., Sarin) and they were exposed to insecticides and other harmful chemicals. They were also under physical stress that modified the effects of such exposure. The toxic, harmful or poisonous nature of nerve agents is exacerbated by the fact, even if an individual were provided pre- or post-treatment, there is still a strong potential for such effects to continue because of delayed neurotoxicity [Somani emphasis]. Further, while acute toxicity can be treated with atropine, oxime and diazepam, no treatment is available for delayed neurotoxicity.''⁽¹³⁴⁾

``Delayed neurotoxicity, first reported in the 1950's, can occur 5 or 10 years after exposure to nerve agents. Studies have shown that organophosphate-induced delayed neurotoxicity [OPIDN] is due to inhibition of neurotoxic esterase enzyme in the nervous system, and histopathological axonal degeneration. This also produces muscular weakness and ataxia (difficulty in movement).''⁽¹³⁵⁾

Dr. Somani concluded: ``Based on recent experimental evidence and the similarities of symptoms of delayed neurotoxicity reported by workers in the organophosphate industry and also by Desert Storm veterans, the author concludes that GWS may be due to low-level exposure to Sarin [a chemical warfare agent] exposure, intake of pyridostigmine [bromide], and exposure to pesticides and other chemicals. The adverse effects of such exposures were amplified by physical stress conditions.''⁽¹³⁶⁾

Vaccines were also given to Gulf War troops. Anthrax was tested and approved by the FDA for limited use, and was administered to about 150,000 troops in the Gulf region. Botulinum toxoid vaccine was approved by the FDA for use with a waiver of informed consent, and about 8,000 troops were given this vaccine. It is also not known if side effects could occur with these vaccines when combined with PB or other chemicals.⁽¹³⁷⁾

The PAC report was critical of the FDA and DOD handling of experimental drugs and vaccines. It stated: ``The Committee also found that DOD and FDA deliberated carefully before enabling, through rulemaking, DOD to require troops to take pyridostigmine bromide [PB] and botulinum toxoid [BT] vaccine as pretreatments for possible CBW agents without FDA approval of the products for that purpose. We were concerned that FDA had failed, in the 5 years since the Gulf War, to devise better long-term methods governing military use of drugs and vaccines for CBW defense. We also found DOD's inability to produce records of who received PB or BT indicative of much need for wholesale improvement in the government's performance on medical recordkeeping during military engagements.''⁽¹³⁸⁾

Pesticides and Multiple Chemical Sensitivity [MCS]

Multiple chemical sensitivity is a disease that is being debated throughout the medical field. While a number of leading medical organizations have published papers that question the existence of multiple chemical sensitivity its diagnosis and its possible treatments,⁽¹³⁹⁾ a growing number of physicians and scientists have accepted the basic premise that exposure to a wide range of chemicals existing in the modern world can produce synergistic effects and cause a variety of health problems.

MCS expert Dr. Claudia Miller of the University of Texas Southwest Medical Center at San Antonio has focused her research, and co-authored several books over the past 9 years on patients who report developing chronic illnesses and chemical intolerances. These illnesses follow low level exposure to various chemicals, including pesticides, solvents, and combustion products. In subcommittee testimony, she stated: ``In 1995, we published a study of 37 patients who had been exposed to pesticides ... who subsequently reported developing multi-system symptoms and new-onset chemical, food and drug intolerances. Eighty percent of these individuals ... were no longer able to work or could only work part-time because of their health problems.''⁽¹⁴⁰⁾

Dr. Miller testified that common symptoms reported by these patients at the time they were exposed were often flu-like illnesses, fatigue, concentration difficulties, headaches, shortness of breath, musculoskeletal pain, and gastrointestinal symptoms. The patients also reported, according to Dr. Miller, ``new and unusual intolerances for common chemicals such as fragrances, traffic exhaust, gasoline, and household cleaning products. In addition, many found they could no longer tolerate alcoholic beverages, various foods, caffeine, and medications.''⁽¹⁴¹⁾

Beginning in 1992, Dr. Miller was asked by the Houston VA Medical Center to consult on the first group of sick Gulf War veterans. Dr. Miller evaluated 75 veterans and testified that ``These veterans' symptoms and their frequent reports of new-onset intolerances to chemicals, foods, and medications reminded me of the civilians we studied with histories of exposure to organophosphate or carbamate pesticides or to mixtures of solvents at low levels. Comparison of eight symptom scales derived by factor analysis revealed similar ordering of symptoms in the Gulf veterans and the pesticide-exposed civilians.''⁽¹⁴²⁾

Pesticides and insect repellants were heavily used before, during and after the Gulf War, according to Albert Donnay, executive director of the MCS Referral & Resources in Baltimore. Information he received from the DOD indicates that 21 different pesticides were used but no records were kept of amounts used, what they were used for, or who applied them.

In a memorandum to the Human Resources Subcommittee, Mr. Donnay stated: ``Officials in DOD responsible for pesticide use have told me that they kept no records of pesticide use during the Persian Gulf deployment. We urge DOD to focus on the chronic effects of pesticide exposures, not just the two pesticides currently being studied (DEET and Permethrin), but all 21 pesticides that the DOD admits sending to and using in the Persian Gulf during Operation Desert Shield and Desert Storm.'' Mr. Donnay wrote that ``... data from the EPA, DowElanco and others linking MCS to organophosphate pesticides [showed that] ... of the top 10 pesticides associated with MCS reports from 1984-1990 by the EPA-funded National Pesticide Telecommunications Network, 7 are on the DOD list of those used in the Persian Gulf. Even if the veterans' exposures to nerve agent fallout were not enough to induce illness, the DOD failed to consider how these may have interacted synergistically [emphasis added] with the veterans' extensive exposure to chemically similar pesticides. None of the CCEP [DOD's Gulf health registry] reports published to date discuss MCS data. We are concerned that MCS [data] was abandoned without any analysis ... and data are now being withheld from qualified researchers.''⁽¹⁴³⁾

The PAC report states, ``The Committee concludes it is unlikely that health effects and symptoms reported today by Gulf War veterans are the result of exposure to pesticides during the Gulf War. Lindane is an animal liver carcinogen, but it is too early to see an elevated liver cancer rate in Gulf War veterans.'' The PAC report draws no conclusion about MCS, but comments that ``There is no consensus case definition for MCS, although two recent government-sponsored conferences have attempted to develop one.''⁽¹⁴⁴⁾

D. ACUTE V. CHRONIC EFFECTS OF LOW LEVEL CHEMICAL EXPOSURES

In testimony before the subcommittee, Dr. Stephen Joseph, formerly DOD's Assistant Secretary for Health Affairs, stated, ``Current accepted medical knowledge is that chronic symptoms or physical manifestations do not later develop among persons exposed to low levels of chemical nerve agents who did not first exhibit acute symptoms of toxicity.''⁽¹⁴⁵⁾ This unequivocal statement became the basic medical policy of DOD and VA in terms of diagnosis, treatment, compensation and research of the illnesses affecting thousands of Gulf War veterans.

Dr. Claudia Miller, an expert on low level chemical exposures, stated before the subcommittee that Dr. Joseph's statement was not necessarily true. ``I think it is premature for anyone to say that low levels of organophosphates cannot cause chronic health problems,'' Dr. Miller said. ``There is a lot of literature now suggesting that is quite a possibility and there are ways to approach that question scientifically.''⁽¹⁴⁶⁾

``Sarin was not the only organophosphate-type exposure soldiers may have encountered in the Gulf: pesticides in this chemical class and pyridostigmine bromide, a related carbamate drug, were also widely used,'' Dr. Miller stated. ``There are now several studies, in addition to our own, linking chronic, multi-system symptoms to [low level] organophosphate/carbamate exposure.''⁽¹⁴⁷⁾

Dr. Stephanie Padilla, Environmental Protection Agency [EPA] neurotoxicology expert, agrees. In subcommittee testimony, Dr. Padilla said, ``Exposure to organophosphates may produce residual adverse effects ...'' and cause ``... organophosphate-induced-delayed-neuropathy [OPIDN]. Recent studies ... indicate there may be long-term health effects associated with exposure ...'' and ``... one [study] concluded that `results clearly indicate that there are chronic neurological sequelae to acute organophosphate poisoning ... .'''⁽¹⁴⁸⁾

In response to Dr. Joseph's statement that chronic symptoms from low level chemical exposure do not later develop unless acute symptoms first appeared, Dr. Padilla testified that pyridostigmine bromide, the anti-nerve gas tablets which the troops were required to take, would dampen or ``mask the acute effects'' of chemical exposure.⁽¹⁴⁹⁾

The subcommittee also learned that a 1974 study of low level chemical exposures, conducted by Dr. Karlheinz Lohs, then director of the Institute of Chemical Toxicology of the East German Academy of Sciences, concluded that ``mustard CW agents are capable of producing a wide range of mutagenic, carcinogenic, hepatotoxic [causing liver damage] and neurotoxic effects. It is important to note that even in the case of exposure to very slight amounts which do not necessarily bring on acute symptoms, toxic reactions may set in. How far this may lead to nerve-cell, hematopoietic or parenchymatous lesions depends largely on the state of health of the individual (for example, previous injury to any particular organ), duration of exposure or intervals between exposures and, last but not least, on individual `detoxification capacity' (enzymatic polymorphism, genetic disposition, and so on.)''⁽¹⁵⁰⁾

Dr. Joseph was not familiar with the Lohs study.⁽¹⁵¹⁾

Also in the 1970's, Dr. Frank Duffy, associate professor of neurology at Harvard University Medical School, and his research associates conducted a study for the U.S. Army's Rocky Mountain Arsenal [RMA], a facility where nerve gas containing munitions were stored and decommissioned. The Army post surgeon, Dr. Maurice Gaon, noted an unusual number of civilian employees with a symptom complex including fatigue, sleep difficulties, memory loss, trouble concentrating, irritability, loss of libido, among others. These symptoms were primarily noticed in employees much later following reported exposures to the nerve agent Sarin, an organo-phosphate. The Army called on Dr. Duffy and his associates to plan and implement a study of these exposures.⁽¹⁵²⁾

This situation provided Dr. Duffy with an opportunity to study the effects of accidental low level Sarin exposures on humans after 1 year, comparing their symptoms with symptoms of rhesus monkeys after 1 year by injecting the primates with low doses of Sarin.

The results, according to Dr. Duffy, indicated that ``low levels of exposure to the nerve agent Sarin can produce long-lasting effects. It was perfectly clear that not only were people, after [low level Sarin] exposure showing long-term effects, but it was widely accepted in the pesticide industry that exposure to related compounds like malathion and parrathion or the chlorinated hydrocarbon insecticides led to long-term consequence.''⁽¹⁵³⁾

Dr. Duffy stated: ``It has been suggested that since Army personnel did not appear to suffer acute symptoms which could be clearly recognized as resulting from acute Sarin exposure, that this explanation for Gulf War Syndrome must be irrelevant. This is not necessarily a valid assumption. First, the low level exposure to the monkey group demonstrated no symptoms ... and second, most of the exposed Army personnel at RMA suffered relatively minor symptomatology.''⁽¹⁵⁴⁾

According to the NY Times, Dr. Frank Duffy and his research colleagues Dr. James Burchfiel of the University of Rochester and Dr. Peter Bartels of the University of Arizona, ``said in interviews that the Pentagon seemed intent on ignoring or dismissing their evidence. Their research, which studied the effects of low doses of Sarin on humans and primates, showed the exposure resulted in long-term or chronic, perhaps permanent, changes in brain waves, which could be connected with ... symptoms common among Gulf veterans.''⁽¹⁵⁵⁾

In a 1987 letter to Robert Hall of the Hawaii Institute for Biosocial Research, Dr. Duffy also noted the possible confusion between organophosphate-delayed-neuropathy and stress: ``I applaud your effort in raising the level of consciousness about the serious potential for long-term effects due to exposures to these [organophosphate] compounds. It has been our experience that the side effects of minimal but continual exposures to the compounds mimic the symptoms associated with a stressful life [emphasis added]. Accordingly, most individuals are unable to determine whether their irritability is related to a stressful life or to a recent organophosphate exposure. This is a serious issue.''⁽¹⁵⁶⁾

Results of U.S. Air Force [USAF] studies on the health effects of sublethal, low dose exposure to nerve agents, published in 1992, bear on the question of acute v. chronic symptoms. The study was ordered because some AF personnel (e.g., bomb loaders and medical personnel) worked in potentially contaminated environments. USAF's Armstrong Laboratory conducted the studies of nerve agent behavioral toxicity in laboratory rhesus monkeys, and concluded that: ``Behavioral deficits [in primates] can be reliably detected in the absence of any overt [acute] signs of toxicity. This is especially important when assessing the effects of low-level exposures to extremely toxic compounds such as OP [organophosphate] nerve agents.'' The Air Force studies suggest that ``... repeated low-dose exposure to soman [a nerve agent] caused progressive and lasting inhibition of ChE [cholinesterase enzyme] ...''⁽¹⁵⁷⁾

Also disputing Dr. Joseph's statement was Dr. Seymour Antelman, University of Pittsburgh professor of psychiatry, who in a letter to the editor of the New York Times, stated: ``[Dr. Joseph's] view ... is almost certainly wrong. My research, published in leading scientific journals and the subject of a June 21, 1988, Science Times article, has shown that the effects of chemicals can develop and grow over time, and need not be present at the time of exposure. Such `time dependent sensitization' is more likely after exposure to a low level stimulus.''⁽¹⁵⁸⁾

In May 1996, 7 weeks prior to DOD's first admission of chemical exposures, Major General Ronald Blanck, commander of the Walter Reed Army Medical Center and the Army's chief physician, said, ``Clearly there is some evidence of low level exposure.''⁽¹⁵⁹⁾

Two VA physicians - Dr. Victor Gordan of the Manchester (NH) VA Medical Center and Dr. Charles Jackson of the Tuskegee (AL) VA Medical Center - began to suggest soon after the war that the sick Gulf veterans they had examined were exposed to chemicals. However, their views did not receive much attention from VA headquarters, DOD, or the news media.

In Human Resources Subcommittee testimony, Dr. Gordan, who has treated 544 Gulf veterans since 1991, stated, ``What is strikingly consistent in these veterans' stories are: 1) a drastic change in their health status from very good to perfect, as it was before deployment to the Gulf War, to poor to fair after their return from the war; 2) the large variety and number of symptoms suggesting dysfunction of more than one organ system in their bodies; and 3) the very consistent history of being exposed to chemicals in the Gulf, including the strong belief [by veterans] of being exposed to chemical warfare. These consistent stories point very strongly toward the environmental hazards as the cause or causes of these unexplained illnesses. Unless the science addresses these environmental hazards, we will never be able to adequately explain and hopefully solve these medical problems.''⁽¹⁶⁰⁾

Dr. Gordan concluded, ``Chemicals ... are the greatest masquerader in the modern medicine ... because they penetrate into all sorts of systems and organs, and those organs get dysfunctional, and those dysfunctions bypass symptoms, and symptoms can mimic so-called quantifiable disease, including arthritis, even PTSD.'' [emphasis added]⁽¹⁶¹⁾

In the same hearing, Dr. Jackson, an environmental physician covering Agent Orange and Gulf War illnesses, said, in reference to the chairman's earlier question to the VA, ``Well, one of the questions that you asked to Dr. Mather was whether or not one person in the VA had made the clinical opinion that there was a veteran exposed to chemical and/or biological agents, and, yes, there was. We did this back 3 years ago.''⁽¹⁶²⁾

Attributing the illnesses he was seeing to the product of multiple chemical exposures, Dr. Jackson said, ``Symptoms of the veterans are not inconsistent with those of the farm and veterinary workers with chronic low dose exposure to organophosphorus insecticides.''⁽¹⁶³⁾

Dr. Jackson added, ``Recent DOD and CIA revelations concerning the destruction of tons of mustard and Sarin in Iraq have supported the probability of exposure to the ... agents.''<sup>(164)</sup> ``We have gone on record as saying that we believe this is a significant factor. ... It was not a popular opinion, nor was it the official opinion of the VA.''⁽¹⁶⁵⁾

Dr. Frances Murphy, the VA's Director of Environmental Agents Service, offered the Department's official opinion, which supports Dr. Joseph, in testimony before the Human Resources Subcommittee: ``Studies of low level chemical warfare agent exposure were not given high priority ... because military and intelligence sources had stated that U.S. troops had not been exposed to chemical agents. Current body of research proves that low level exposures cannot cause health effects [emphasis added].''⁽¹⁶⁶⁾

The results of a study conducted by Dr. David Schwartz and his University of Iowa Medical School research colleagues were recently published