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Gulf War Syndrome II: Following Orders


April 30, 2003
Steven Rosenfeld - TomPaine.com

http://www.tompaine.com/feature.cfm/ID/7661/view/print

Veterans, members of Congress and doctors who have advised the military on providing medical care to deployed US troops are wondering: Has the Pentagon forgotten Gulf War Syndrome?

These critics charge the Pentagon has not followed a 1997 law that specifically requires pre- and post-deployment medical exams with physicals and blood tests to establish baseline medical records for troops sent overseas. In doing so, critics say, the Pentagon risks repeating past mistakes that left tens of thousands of sick Gulf War veterans without the government-provided health care to which they were entitled.

Top Pentagon officials acknowledged in a Congressional hearing on March 25 that they did not screen troops sent to Iraq as specified in the 1997 law, PL 105-85. But they said the military had learned lessons from the first Gulf War, and that its method of examining troops a questionnaire filled out by soldiers and reviewed by medical staff was sufficient.

"We believe that we are following the law and that we are doing it in a way that makes sense," Dr. William Winkenwerder, the Assistant Secretary of Defense for Health Affairs, told the hearing, which was convened by Rep. Chris Shays (R-Conn.). Troops receive a "continuum of care" that includes ongoing check-ups and medical reviews, Dr. Winkenwerder said.

But Rep. Shays strongly disagreed. "From my standpoint, you're not meeting the letter of the law, clearly, and I don't think you're meeting the spirit of the law," he said.

The General Accounting Office is investigating Pentagon compliance with the law, at the request of several members of Congress. Its report is due this summer. The GAO has just released a related report saying the Army could do more to assess the health status of reserve soldiers deployed early in the war.

Meanwhile, as the first troops return from Iraq, veterans groups and others are pressing the Pentagon to expand post-deployment health screening of troops and related medical record-keeping. The National Gulf War Resource Center is lobbying Congress to pass a resolution ordering the Pentagon to conduct physicals and blood tests on returning troops.

"The pre-deployment info is now lost. So we're looking at more post-deployment info," said Betsy Hawkins, chief of staff and spokeswoman for Rep. Shays.

Pentagon compliance with the 1997 law has been a simmering issue since January, when several members of Congress requested the GAO investigation. In early March, The Kansas City Star reported that troops bound for Iraq were not getting the exams. Then Rep. Shays, who chairs the House Committee on Government Reform's Subcommittee on National Security, Emerging Threats and International Relations, convened the March 25 hearing.

Lessons Learned

For veterans, the bottom-line is clear: They don't want a repeat of the "Gulf War Syndrome" experience. After the Gulf War ended in 1991, tens of thousands of soldiers became ill with a range of mysterious maladies. Because the military had incomplete records to assess how or whether their service contributed to these problems, many veterans were left without the government-provided health care they earned as soldiers.

Only after the mysterious illnesses were grouped together and recognized as "Gulf War Syndrome" by the government did the veterans get the health care they felt they needed. The 1991 war now has the highest casualty rate of any American conflict in the last century, with 20 percent more than 220,000 soldiers on medical disability, as of May 2002, and another 50,000 seeking that status.

This experience has made the pre- and post-deployment screening of troops a top priority for veterans of the first Gulf War.

"Laws designed to protect soldiers on the battlefield are being ignored, thereby setting the stage for mystery illnesses to again present themselves after a war with Iraq," Steven Robinson, executive director of the National Gulf War Veterans Resource Center, testified at Shays' hearing. "Service members are being set up to face another round of delay, denial and obfuscation regarding possible service-connected medical conditions or disabilities related to their participation in a Middle East conflict." Others at the March 25 hearing also questioned whether the Pentagon had incorporated lessons of the 1991 war. Two civilian doctors who served on separate federal panels on Gulf War health issues and protecting deployed soldiers told the subcommittee that the Pentagon's overall approach and current protocols were insufficient.

"It is my overall impression that although some initial steps have been taken to carry out this important mandate, implementation has been fragmented and little worthwhile data will be forthcoming from the forms currently used for pre- and post-deployment health assessment," said Dr. Manning Feinleib, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health and member of a federal Institute of Medicine panel on Gulf War and Health. Dr. John Moxley, III, is the managing director of Korn/Ferry International's North American Health Care Division. He chaired the Institute of Medicine's Committee on Strategies to Protect the Health of Deployed US Forces. He testified on March 25 that the Pentagon's practices had not incorporated suggestions by his and other advisory panels.

"Many of the [IOM panel's] recommendations are restatements of recommendations that have been made before, recommendations that had not been implemented," Moxley said. "The committee... believed that failure to move briskly on these fronts would further erode the traditional trust between the service member and the leadership."

The Pentagon's top health officers maintain they have learned the lessons of the Persian Gulf War and Gulf War Syndrome. They say the 1997 law, though well-intentioned, is asking for redundant medical tests because troops are regularly examined. They say having soldiers fill out pre- and post-deployment questionnaires and using HIV blood tests not only satisfies the law, but ensures the military will have adequate records to track veterans' future health.

"We want to do the right thing for troops, when they are deployed and when they come back," said Dr. Michael E. Kilpatrick, Deputy Director, Deployment Health Support Directorate, Office of the Assistant Secretary of Defense for Health Affairs.

But the Pentagon's explanations aren't likely to quiet critics, and the story is getting more coverage. The Associated Press, Army Times, and The Washington Times have all run stories since the March 25 hearing. And several members of Congress and Veterans Administration Secretary Anthony Principi have asked the Pentagon to reassess plans for post-deployment medical screening of soldiers returning from Iraq.

Dr. Kilpatrick told TomPaine.com that the Pentagon will soon expand its post-deployment questionnaire. But he said it was unrealistic to expect returning troops to delay their arrival home to be examined by physicians. He reiterated that conducting physicals wasn't the best way to screen for potential combat-related problems.

Such statements aren't likely to suffice.

"These men and women put their lives on the line for their country," says Betsy Hawkins of Rep. Shays' office. "All they ask is their country take care of them when they return."

Steven Rosenfeld is a commentary editor and audio producer for TomPaine.com

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