DSVA Health Information

• Current Status of Army's Position on Evidence of Exposure to Chemical Agents in the Gulf War
• Comprehensive Clinical Evaluation Program (CCEP)
• VA Medical Benefits Registration

CURRENT STATUS OF ARMY'S POSITION
ON EVIDENCE OF EXPOSURE
TO CHEMICAL AGENTS IN THE GULF WAR

SUBJECT: Evidence of Exposure to Chemical Agents in the Gulf War (M-1-99) November 1997

Taking Care of Our Soldiers. Army is providing needed medical care and leaving no stone unturned in searching for possible causes of illnesses. Gulf War veterans have reported a wide variety of symptoms some of which have known causes, some of which do not.

• Army established the Gulf War Health Center at Walter Reed Medical Center to provide an expedited, accessible, and multidisciplinary continuum of care. The Gulf War Health Center conducts the Comprehensive Clinical Evaluation Program (CCEP), and delivers an intensive outpatient treatment program known as the Specialized Care Program.
• Army has conducted diagnostic evaluations to over 24,110 service members who have registered in the DoD Comprehensive Clinical Evaluation Program (CCEP).
• The Specialized Care Program treats those with persistent, disabling symptoms, and coordinates health services research exploring causes and treatment of Gulf War health concerns. It is available to members of all armed services and components, as well as to family members affected by persistent symptoms. It features three weeks of multidisciplinary treatment of patients in small groups of three to eight individuals.
• Army Center for Health Promotion and Preventive Medicine (CHPPM) deployed technical teams to the Persian Gulf in May 1991 to measure the levels of environmental contaminants created by burning oil well fires. In 1993, CHPPM developed a geographic information system (GIS) which integrated the unit location registry database to track and map troop locations in relation to oil fire smoke. Since 1995, CHPPM has expanded this system to track troop exposures to other potential environmental hazards from specific operational events including the demolition at Khamisiyah. Future plans call for mapping exposures to such potential operational hazards such as depleted uranium, SCUD impacts, and other demolition activities.
• Through the GIS database, CHPPM can link troop locations to exposures. This data is provided to qualified researchers for epidemiological analyses. Over the next five years, CHPPM will continue to assess the effect of troop exposure to oil fire emissions and to update the GIS database with any discovered environmental threats using the U.S. Armed Services Center for Research of Unit Records (USASCRUR) unit location registry.

Army is expanding and refining the Gulf War unit location registry database.

• Since 1992, USASCRUR has reviewed over 6 million documents in developing a Gulf War unit location database for all services. Initially, USASCRUR's effort was aimed at assisting CHPPM's analysis of troop exposure to oil well fires' smoke. USASCRUR has a similar database for Vietnam; that database is used in determining veterans' claims of exposure to Agent Orange.
• USASCRUR maintains two distinct databases. The first database is a personnel registry with the names of over 750,000 service members. The second database is the unit location database. These databases combined allow DoD SAGWI to track individual service members who may have been exposed to chemical or environmental threats. Given the magnitude of the potential chemical exposure threat such as the one in Khamisiyah, knowing the daily location of all units is of great importance to ensure all affected service members are notified and informed of the services available to them such as the CCEP.
• The database was mainly of battalion sized units. Since April 1997, Army has brought together the former operations officers (G3/S3 recall project) from division and brigade size units to USASCRUR to validate the unit location registry and provide additional company location information from deployment to redeployment. In July, we completed the daily tracking of XVIII Airborne Corps units. Currently, we are doing the same for former VII Corps units. Army expanded this project to account for all units under Army Central Command (ARCENT) and its support command. We will complete this project in February 1998.
• USASCRUR reviewed and forwarded all records to the Gulf War Declassification Project (GWDP) for declassification and conversion to a searchable data base. Similarly, all new records located by the GWDP are shared with the USASCRUR to update the unit location database. Since October 1997, both activities are under the operational control of Commander PERSCOM, specifically under The Adjutant General Directorate.

Search and Declassification of over 2.3 Million Pages of Operational Records.

• Army made available millions of documents for various investigations on GWI.
• Since March 1995, Army has been DoD's Executive Agent for declassifying Gulf War operational records. Army established the GWDP to accomplish this task. The declassification of intelligence and medical records was assigned to the Director, Defense Intelligence Agency and the Assistant Secretary of Defense (Health Affairs), respectively.
• In 1997, Army sent teams worldwide to retrieve all available documents. After their visits, GWDP received 564 thousand pages of documentation, 292 thousand were duplicates of documents on hand, gaining 272 thousand documents with new information.
• In September 1997, Army completed its declassification mission. The GWDP reviewed and scanned 2.3 million pages of Army operational records. Over 816 thousand pages had possible health-related information and were provided to SAGWI's Investigation and Analysis Directorate. Of those, 22 thousand pages were declassified and posted on the World Wide Web.

The demolition of sarin filled rockets at Khamisiyah.

• Khamisiyah was a huge ammunition storage site, covering 50 square kilometers and containing about 100 ammunition bunkers and several other types of storage facilities. Army engineers found approximately 1,250 rockets in about 10 stacks of crates in an open area now named as the "pit." The number of rockets is an estimate based on Iraqi declarations and United Nations Special Commission (UNSCOM) findings.
• There were no markings to identify the crates or rockets as chemically filled munitions.
• On 4 March 1991, the engineers destroyed 37 bunkers. In May 1996, UNSCOM conclusively identified chemical munitions debris in bunker number 73, one of the destroyed bunkers. On 10 March 1991, the engineers detonated crates containing about 1,250 rockets in the "pit" and 60 remaining bunkers. Six months later, UNSCOM found about 750 of the 1,250 rockets had not been destroyed by the demolition that meant 500 rockets were destroyed. Their investigation showed that the intact rockets contained chemical agents sarin and cyclosarin.
• There were no reports of any one, soldier or civilian, experiencing symptoms consistent with exposure to a chemical agent during the demolition operations, and throughout the entire period of Army occupation at Khamisiyah. Army units departed Khamisiyah in late April 1991.
• Considering UNSCOM findings and further review of intelligence by 1996, CIA recognized Khamisiyah as a possible chemical weapons release site, informed DoD and requested information about troop activity in the area. Since then, the potential troop exposure based on unit locations has been a real concern of everyone.
• In July 1997, SAGWI made public the entire case narrative of this incident.
• In October 1997, Army Inspector General (IG) found no empirical evidence of chemical munitions were present during the demolition. After interviewing over 700 soldiers including about 250 involved in the demolition operation, IG found no conclusive evidence that Army units knew or suspected they were destroying chemical munitions. However, DA IG concluded that given UNSCOM's findings and current available intelligence it was likely that chemical munitions may have been destroyed.

PFC Fisher's Mustard Agent blisters.

• On 1 March 1991, PFC David Allen Fisher, a cavalry scout assigned to the Scout Platoon, Headquarters Troop, 4th Squadron 8th Cavalry, 2d Brigade, 3d Armored Division, while searching a destroyed Iraqi bunker for intelligence materiel and personnel in southeastern Iraq near the Iraq-Kuwait border came in contact with liquid mustard agent. Blisters in his upper arm and urine sample analysis with positive results for a mustard breakdown product confirmed his exposure.
• In August 1997, DoD SAGWI confirmed that PFC Fisher's blister injuries were likely the result of coming in contact with mustard chemical agents. No other reports of similar blisters were made by PFC Fisher's unit or other units in the area. Fox reconnaissance vehicle readings of PFC Fisher's clothing and the bunker he searched alarmed for mustard agents.
• Although analysis of physical evidence conducted a month after the incident did not confirm the exposure, medical experts concluded that PFC Fisher's skin injuries were most likely caused by exposure to mustard agent. PFC Fisher received a Purple Heart for his injuries.

Congressional Interest

• The House Government Reform and Oversight Committee on Human Resources and Intergovernmental Affairs, chaired by Representative Shays (R-CT), during the past year held various hearings related to: GW Veterans' personal experiences and possible encounters with chemical agents and perceived DoD "delay" in releasing information prevented early research focus. On 29 October 1997, the committee issued an oversight report titled "Gulf War Veteran's Illnesses: VA, DoD Continue to Resist Strong Evidence Linking Toxic Causes to Chronic Health Effects."
• The Senate Veterans' Affairs Committee, chaired by Senator Specter (R-PA), has a Special Investigation Unit interested on GWI, chemical defense equipment and doctrine, and how much the chain of command knew and when they knew about it.

Comprehensive Clinical Evaluation Program (CCEP)

The Gulf War Health Center (GWHC), Ward 64, Bldg. 2, Walter Reed Army Medical Center (WRAMC) exists to care for those military men, women and their families who served in the Persian Gulf as part of Operation Desert Storm and Operation Desert Shield. The Comprehensive Clinical Evaluation Program (CCEP) was created by the Department of Defense in response to the health concerns of Gulf War veterans.

CCEP has several purposes. First, it1 was developed to diagnose conditions that are known illnesses that have some symptoms similar to those experienced by Gulf War veterans. Many of these diagnosable conditions are treatable. Second, clinical and laboratory data are collected in a standardized and structured way at all sites involved in the program. This ensures that patients get a complete workup at all site across the nation. Third, the clinical information is collected in a centralized manner which will allow assessment of the possibility of different exposures as a cause of this illness.

CCEP contains two phases. In Phase I, a routine history and physical are performed, and blood and urine specimens are collected. A computerized questionnaire is completed. This questionnaire addresses issues such as location of your unit, exposure, combat experiences, use of nerve agent antidote pills (pyridostigmine biomide) and symptoms of illness. You are also asked to sign several forms. This allows for collection of your clinical data along with other patients' data so that the issue of exposure and their relationship to your symptoms can be addressed. At the conclusion of Phase I, your doctor will review your medical condition and possibly request additional tests via Phase 2.

In Phase 2, numerous laboratory tests and several consultations with specialists are done. These tests are looking for possible causes of your illness. At the end of Phase 2, a referral to the Specialized Care Program (SCP) is a possibility.

The Gulf War Health Center is dedicated to your care, and Ms. Nancy Bitsko, the CCEP Patient Representative, will coordinate all of your activities and ensure your experience at Walter Reed is a favorable one. She may be contacted at (202) 782-6563, DSN 662-6565.  

VA Medical Benefits Registration

The rumors are true! You DO need to go and register at a VA Hospital to ensure that you remain eligible to receive your VA medical benefits.

Under the VA health care eligibility reform act signed into law in October 1996, Veterans are required to "enroll" at their local VA hospital to ensure that they remain eligible for health care and medical benefits. The bill requires the VA to quantify how many veterans need care. We will be divided into seven eligibility categories and VA funds allocated to service those with the most pressing needs. The VA is currently in a test period to determine the scope of the need. The test period ends 1 October 1998. YOU need to register prior to October 1 this year.

The wording of the VA rules for Health Care enrollment state that "after October 1, 1998, some veterans may still be treated without being enrolled."

Unless you are severely disabled as a result of a service related injury, you can bet that it will be easier to enroll now than to convince somebody under budget constraints that you are one of the "some" that need to be an exception to policy.

I have not yet managed to get registered at the Atlanta VA hospital. There are certain hours (which change with the day) for registration. All staff members contacted by phones advised me to bring a copy of my DD214. You don't need a certified copy, just certain data elements from the form. The Atlanta VA center told me that I have to fill out a VA Form 10-10F financial worksheet which requires information on your spouse and children, their individual yearly incomes, and you and your spouses assets including value of home, IRA, stocks, bonds, and other real properties and your debts. They also sent me a copy of VA Form 10-10 (RS), a four page form that includes most of the same things listed on the financial disclosure form.

A VA Consumer Affairs representative sent me an e-mail that explained that the form required was the VA Form 10-10 which can be downloaded from their web site, http://www.va.gov. You will also find copies of the VA public affairs announcements at this web site. The information on the web site leads me to believe that re-registration will be required every year. This makes sense since people's incomes/assets are subject to change.

Hopefully the process will get easier. Don't get too frustrated if the guidance and forms change. It's evident that they are still busy trying to write the administrative rules to implement the law.

The VA Center in Birmingham served me well before I moved to Atlanta. They had good people with a caring attitude and improvements will appear as the VA works the bugs out. But we certainly need to pass the word to all our fellow veterans to register. The VA will never be adequately funded unless they can clearly document the needs of their customers. JAYHAWK!

UPDATE: As a follow-up to the above information, I managed to go to the Atlanta VA hospital on Friday, 17 April. The Atlanta VA wanted none of the forms sent to me earlier by either the VA Consumer Affairs representative or the Atlanta VA hospital. But they did have all of my service data loaded into their computer files. I asked (again) what was needed to register so I could tell my co-workers. I was told that all the veteran had to do was come in, OR, that I could confirm their registration if I knew their Social Security number.

Well, I know my wife's social security number. The lady punched it in, asked me if I knew my wife's birthday and retirement date and then told me that her data was on file. She then asked me if I wanted to register her. I replied "sure." The VA rep made four keystrokes and said it was done.

The Atlanta VA hospital representative said that registration was important to ensure that each individual hospital gets its share of the annual budget. I still recommend that you take the time to go register.

Lee Brame MAJ (Ret)