Soldiers' Medical Testing Faulted

Future Health Claims At Stake, Critics Say

U.S. forces were sent to Iraq without the necessary medical testing to support future service-related health claims, veterans' advocates say.

Having investigated the history of similar claims brought by tens of thousands of 1991 Gulf War veterans, advocates fear history may be repeating itself, resulting in claims being rejected, or not settled quickly.

By failing to secure blood samples immediately before and after deployment, by refusing to use modern medical technology to re-evaluate samples from 1991 and by ignoring requests for more comprehensive medical evaluations, the Pentagon has made it difficult to establish direct links between exposures to biological and chemical agents and subsequent illnesses, critics say.

The inability to establish direct links resulted in the federal government's rejection, or delayed processing of tens of thousands of health claims filed by veterans of the 1991 Gulf War.

Recently, veterans advocates have questioned whether medical investigators will be able to solve the mystery of a pneumonia strain that has sickened more than 100 service members in Iraq, killing at least two. Army medical officers say some of the cases may be linked to cigarette smoking.

But the advocates dispute such a claim - family members deny the two dead soldiers were smokers - and point to the hazardous wartime exposures troops have encountered. They include controversial vaccines, chemicalized dust, sandstorms, oil well fires and smoke from bombing explosions. According to recent U.S. Army figures, 5,381 soldiers have become ill during service in Iraq; another 1,076 illnesses have been reported in Afghanistan. The Pentagon did not supply similar totals for the other services, despite repeated requests.

"Some Defense Department health initiatives have been implemented. But all of these blood sampling and hazardous exposure issues demonstrate that the Department of Defense did not learn the lessons from the first Gulf War, nor did they implement policies to protect soldiers from the exposures in this war," said Steve Robinson, a veterans' advocate.

"There is an overall theme here," said Robinson, executive director of the National Gulf War Resource Center and formerly a participant in the Defense Department's multimillion dollar investigation into so-called "mysterious" Gulf War illnesses. "Defense Department officials have not done their jobs," he said, "and their lack of crucial data collection has continued to prevent veterans' access to the government's health care system."

Department of Defense officials have defended their planning, known as Deployment Force Health Protection, saying it adequately covers the health of troops before, during and after deployment.

It "promotes and sustains the health of service members prior to deployment; prevents injury and illness and protects the force from health hazards during deployment; and provides quality, compassionate treatment for deployment-related health conditions, " William Winkenwerder, assistant secretary of defense for health affairs, told members of the House Committee on Veterans' Affairs in July.

Timely Testing

Despite findings by congressional committees and watchdog agencies that medical symptoms associated with Gulf War illness were the result of various toxic exposures, the Pentagon has consistently denied a proven link exists.

According to the U.S. Department of Veterans Affairs, 36 percent of the 581,000 retired veterans serving at the height of the 1991 Gulf War have filed health claims. Of that number, 22 percent of the claims remain pending, or have been denied. More than 11,000 Gulf War veterans, whose average age was 36 when the war began, have since died, many from illnesses their families believed were war-related.

In response to the Gulf War illness controversy, Congress passed legislation in 1997 that requires the military to gather critical health evidence in advance of future wars and overseas assignments. The law requires that the armed services conduct medical exams of service members, including drawing blood samples, before any overseas deployment and after their return.

One of the law's authors was Rep. Steve Buyer, R-Ind., a Gulf War veteran who suffered from persistent illnesses for years afterward. The intent of the legislation was to require that blood samples and medical exams be conducted within "a reasonable amount of time" before deployment overseas, and after return, according to Buyer's spokeswoman Laura Zuckerman. Timely testing would ensure accuracy of the data and make it difficult for the military or others to claim subsequently that an intervening illness was unrelated to overseas duty, Zuckerman said.

By their interpretation of the law, Pentagon planners saw no sense of urgency to collect medical data before and after deployment.

In March, on the eve of the Iraq conflict, Winkenwerder told members of a congressional committee that blood samples, collected for HIV checks six months to a year before overseas duty, were sufficient to meet the requirements of the law.

Winkenwerder also stated that more than a half-dozen health questions submitted to soldiers by non-doctors sufficed and that medical examinations of "healthy, young" service members were neither required, nor necessary.

Another official, Michael E. Kilpatrick, the Defense Department's deputy director of deployment health support, confirmed that the military services had planned to collect blood samples after overseas duty during regular armed-service HIV blood collection at one- to five-year intervals.

In May, after pressure from congressmen and others, the testing was ordered to be done 30 days after return from overseas duty. Some, but not very many troops who had returned already did not have their samples taken within 30 days, Kilpatrick said.

According to Dr. William Rea, founder and director of the Dallas Environmental Health Center, blood samples need to be taken promptly upon deployment and return, to get an accurate picture of possible exposures to hazards such as solvents, some pesticides and heavy metals. Rea is a surgeon with 40 years of experience in environmental medicine.

Controversial Samples

Veterans' advocates believe defense officials had ample opportunity to confirm the importance of timely blood testing, and had been put on notice by officials from one New England state to do so.

In 1990 and 1991, the U.S. Navy collected blood samples from 900 U.S. Marines within days of their deployment to the Gulf War and days after they left to help track potential wartime illnesses.

Those samples were tested for infectious diseases by a team of doctors that included Kenneth Craig Hyams.

Three years ago, in October 2000, Hyams testified before a presidential oversight board scrutinizing the Pentagon's investigation of Gulf War illnesses. Hyams, who now is a Gulf War researcher for Veterans Affairs, told board members that his research indicated those 900 Marines showed symptoms similar to other Gulf War veterans: 60 percent had reported at least one acute episode of diarrhea; a quarter had constant coughs or sore throats; 34 percent complained of regular nose mucus problems; and 12 percent complained of fevers.

Hyams told board members he wanted to use new scientific techniques to study those samples further for evidence of exposure to low-level chemical warfare gases.

His proposal was received warmly. Doctors on the board believed the new research might help put to rest the debate over the link between Gulf War illness and wartime exposures, said Roger Kaplan, former deputy executive director of the presidential oversight board.

On March 8, 2001, five months after Hyams' testimony, the Pentagon's investigative team announced it had obtained $705,000 for further study of the Marine blood samples.

But Hyams never did the work, and the Army withdrew the funding in March 2003.

Kilpatrick said the tests were never completed because Hyams and others could not satisfactorily show that the results would be reliable. Through intermediaries, Hyams refused repeated requests for an interview.

David Haines, a researcher working for Rhode Island state and military officials, said that for years he has lobbied Navy officials about completing the Marine tests, and offered to assist Hyams in the validation work, so the samples could be examined for chemical warfare agents.

"Although the traces of mustard and nerve agents are degraded in the blood over weeks to months," he said, "the antibodies that may be used for indirect detection of nerve agents last for the lifetime of the individual exposed. I could not say whether mustard agent could be similarly detected, but based on current scientific literature it might be."

Believing that accurate blood tests are essential in detecting the cause of service-related illnesses, Haines helped lead an effort to try to convince Pentagon officials to carefully scrutinize the health of Rhode Island reservists, before and after deployment. During a three-month period before the war began, Haines, Rhode Island Gov. Donald L. Carcieri, Sen. Jack Reed, D-R.I. and Richard Valente, a retired Army general, all urged that blood samples from the reservists be secured just before and after they went overseas. They also requested that follow-up samples be taken annually for three years after their return, and asked that additional samples be taken after administration of the controversial anthrax and smallpox inoculations.

Winkenwerder denied their request about four weeks after the war began.

A Family's Questions

In July, the same month that Winkenwerder was publicly defending his department's deployment health program, Missouri National Guard Spec. Josh Neusche died. He had written his mother, Cindy, that he was being assigned in June for a secret "excavation" mission in Iraq. A few days later, he complained of a sore throat and shortness of breath. He fell into a coma, was put on a respirator at a Baghdad medical facility, transferred to a hospital in Kuwait and then moved to a U.S. Army hospital in Landsthul, Germany.

His family suspects he may have been exposed to a toxin and wants to know exactly what killed him. Neusche's grandfather, Ted Cone, said the family was frustrated by the limited amount of information the military had provided. Cone, a 63-year-old Air Force veteran from Camdenton, Mo., said the family still does not know: what blood samples were taken; what results, if any, blood tests may have shown; and whether a request for an independent autopsy at a German civilian hospital will be honored.

The family wants assurances those questions can be answered. Recently, following press accounts of Neusche's death, Cone said the military's cooperation with the family has improved, but he still wants blood testing data.

"If you can monitor two [blood samples], one before he gets sick and one after, it doesn't take a rocket scientist to ... see there is something [unhealthy] in his blood," he said.

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